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2017 Canadian Conference for Global Health – An Interview with MScN Candidate Rachel Olliver

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Written by Matt Jalink, MSc Candidate in Community Health and Epidemiology
Interview with CCGH Attendee Rachel Ollivier, MScN Candidate

Rachel had the opportunity to attend the three-day Canadian Conference for Global Health (CCGH) in Ottawa at the end of October. The conference brought together leaders in the global health field to present and discuss current challenges and various research projects and initiatives aimed to combat these challenges. I had the chance to sit down with Rachel Ollivier, a Master of Science in Nursing candidate at Dalhousie University, to ask her about her experiences at the conference.

What are you studying here at Dalhousie and how did your past and current studies influence your experience at the Canadian Conference for Global Health?

I’ve just begun my first year of the Master of Science in Nursing program here at Dal, and I’ll be working with Dr. Megan Aston and Dr. Sheri Price as my co-supervisors. My thesis research will aim to explore the experiences of postpartum childbearing persons with perinatal sexual health education using a feminist post-structural methodology. Before coming to Dalhousie, I completed my undergraduate nursing degree at the University of British Columbia’s Okanagan campus. While studying at UBCO, I had the opportunity to work as a research assistant with Dr. Kathy Rush on her work in Western Province, Zambia after completing my final nursing practicum there; an experience that spurred a keen interest in global health research.

What was your overall impression of the conference?

I really enjoyed it! There was a diverse range of topics presented and discussed; the content of the sessions was fairly dense, though very thought-provoking. I especially enjoyed the workshop sessions, some of which were in my area of interest, being maternal and reproductive health. Shawna O’Hearn [Director of the Global Health Office] co-chaired one standout session on allyship in global health partnerships.

What was your favourite session you attended? Who was presenting and what did you take away from the discussion?

It’s tough to choose one favourite, but one workshop that I really enjoyed was “From gender blind to gender transformative global health research”, lead by Rosemary Morgan from the Johns Hopkins Bloomberg School of Public Health and Sarah Ssali from Makerere University in Uganda. We discussed how gender analysis should be incorporated into global health research. The ‘Allyship’ workshop was also a favourite because it explored the importance of acknowledging privilege and how that plays into fostering meaningful, impactful global health partnerships. It’s a topic that some researchers, such as my supervisor Dr. Megan Aston, have been promoting for years but remains ignored by many- it’s the elephant in the room. Allyship is a day-to-day practice and the presenters discussed how and why impact must be emphasized over intent when working with others, whether it be abroad or at home.

Did you meet any interesting people over the three days?

Absolutely, there were so many great global health leaders to meet and connect with. I was able to reconnect with Dr. Fastone Goma, my colleague from the University of Zambia. We got to know each other better and finally meet in person after many emails back and forth throughout the summer! I also had the chance to meet Dr. Vic Neufeld from the University of Victoria through the Canadian Coalition for Global Health Research. Dr. Neufeld is a wonderful, passionate mentor and is great at facilitating relationships and partnerships in the global health field. Dr. Sarah Ssali from the Department of Women and Gender Studies at Makerere University in Uganda was also an amazing person to connect with and shared very valuable insight.

What are your future career plans and how did attending the CCGH influence this plan?

I will be applying to bridge into the PhD in Nursing program here at Dalhousie as the next step in pursuing a career in global health research! I’m incredibly fortunate to have mentors both here in Canada and abroad to help facilitate future work in the field. One of my many reasons for choosing Dalhousie for my graduate studies was the opportunity to become involved with the WHO/PAHO Collaborating Centre for Health Workforce Planning & Research, where I am currently working as a research assistant with Dr. Gail Tomblin Murphy, the Centre’s Director, and Janet Rigby. I am also planning to apply for the Queen Elizabeth II Diamond Jubilee Scholarship, which would allow me the opportunity to travel to either Ifakara or Dar es Salaam in Tanzania, from May-August 2018, to assist with research, likely in the area of maternal and newborn health.

I would like to thank Rachel for sitting down with me to share her fantastic experience at the Canadian Conference for Global Health, and we wish her the best in her future studies and research career!

For more information on this annual conference please visit the CCGH website.

Antimicrobial Resistance

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Written by Matt Jalink – MSc Candidate in Community Health and Epidemiology

“The world is running out of antibiotics” – WHO report

Antimicrobial resistance (AMR) occurs when bacteria, viruses and other microorganisms change in ways that cause existing medications (ex. antibiotics – bacterial infections, antivirals – viral infections) to be ineffective. These resistant microorganisms are commonly termed “superbugs” and are a major public health concern due to their ability to spread in populations and impose large individual and society costs (WHO, 2017). AMR organisms cause more than 2 million infections and approximately 23,000 deaths each year in the United States (Marston, 2016). The economic costs are also substantial, estimated at $20 billion in excess medical spending each year (Marston, 2016).

AMR is causing traditionally curable diseases are becoming increasingly more difficult to treat. Data collected from 77 countries shows that antibiotic resistance in gonorrhea is causing infections to be harder and sometimes impossible to treat, and is on the rise (WHO, 2017).

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(WHO, 2017)

Factors Influencing Antimicrobial Resistance

Microorganisms resistant to modern medicine have existed for thousands of years, and appear to predate the antibiotic era. Frozen samples collected from Yukon contained bacteria with resistant mutations 30,000 years before the discovery of penicillin, the world’s first antibiotic (D’Costa, 2011). But despite naturally occurring antibiotic resistance, the number of cases of resistant microorganisms continues to rise, which can be attributable to human activity.
One example is through the overuse of antibiotics. The overuse of antibiotics is in many cases unwarranted, and regiments are frequently not completed, leading to drug resistance. A number of drug-resistant infections are found in hospitals, such as Methicillin-resistant staphylococcus aureus (MRSA). However, impatient antibiotic usage represents only 38.5% of the total antibiotic market (Marston, 2016). A recent American study found that 12.6% of outpatient visits in the US resulted in the prescription of an antibiotic, and 30% of those prescriptions were deemed inappropriate (Marston, 2016). Canada ranks in the middle of 30 European countries in outpatient antimicrobial use.

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(Canada, 2017)

The overuse of antibiotics largely stems from over-prescribing of medications for conditions that don’t require antibiotics for treatment. The level of antibiotic prescription across Canada varies by province, with the highest levels found Newfoundland and Labrador.

Screen Shot 2017-10-02 at 11.12.08 AM

(Canada, 2017)

Outside of North America and Europe, outpatient antibiotic prescription can account for 20 – 100% of antibiotic use depending on location (Morgan, 2011). In many of these nations, antibiotics are dispensed directly to the consumer, and are more likely to be inappropriately selected and taken at doses below optimum levels (Morgan, 2011).

With increasing levels of drug resistant infections, new medications are needed. However, the pace of new antibiotic development has slowed considerably. There were 16 antibiotics were approved by the FDA between the years 1983 and 1987, but only 2 new antimicrobial drugs were approved between 2008-2012 (Boucher, 2013) and 5 in total since 2012 (Marston, 2016). There are certain characteristics of the antibiotic market that likely hinder pharmaceutical industry investment in new drug development. The limited duration of treatment, relative low prices per dose, and the potential for the rapid emergence of resistance (uncertain market longevity) all diminish revenue prospects for new antimicrobial drugs (Marston, 2016).

The agricultural sector also contributes towards the growing resistance of microorganisms. An association has been found between antibiotic consumption by animals and the existence in humans of microorganisms resistant to the same antibiotic classes (Chantziaras, 2014). In 2014, approximately 82% of antimicrobials important to human medicine were distributed and sold for use in food-producing animals (Health Canada, 2014). The influence of the agricultural use of antibiotics on human health has drawn a range of responses, including policies in Europe banning antibiotic use for animal growth, and regulation from the Food and Drug Administration (FDA) encourage similar practices.

Response, methods to combat antimicrobial resistance

Surveillance of antimicrobial resistance starting from local global health departments is very important for managing and controlling AMR. Surveillance captures information about AMR incidence, prevalence, and trends from particular regions. This information can be pooled together to see national and global trends of AMR. The Global Antimicrobial Surveillance System (GLASS) shares data internationally on antimicrobial resistance to inform decision-making, drive local and regional action, and provide an evidence base for action and advocacy (WHO, 2017). In Canada, AMR is monitored by the Canadian Antimicrobial Resistance Surveillance System (CARSS).

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(WHO, 2017)

Basic public health measures like sanitation, hand washing, and food and water security can decrease the spread of AMR (WHO). Public Education Campaigns have proven effective on reducing inappropriate prescribing of antibiotics in Belgium and France (Gelband, 2015). There has also been a substantial effort to address inappropriate antibiotic use within hospitals; including implementation of antimicrobial stewardship programs, which seek to reduce inappropriate antibiotic and antimicrobial selection and reduce the inappropriate use of broad-spectrum antimicrobials. However, these stewardships have had limited implementation and acceptance in hospitals (Marston, 2016). Vaccines have a role as well. It is estimated that improved vaccine covered for Streptococcus pneumonia could prevent 11.4 antibiotic days per year in children under 5 years of age worldwide (Laxminarayan, 2016).

Citations

Canada, P. (2017). Government of Canada’s response to antimicrobial resistance – Canada.ca. [online] Canada.ca. Available at: https://www.canada.ca/en/public-health/services/antibiotic-antimicrobial-resistance/government-canada-response-antimicrobial-resistance.html [Accessed 13 Oct. 2017].

Chantziaras I, Dewulf J, Boyen F, Callens B, Butaye P. Antimicrobial resistance prevalence of pathogenic and commensal Escherichia coli in food-producing animals in Belgium. Vlaams Diergeneeskundig Tijdschrift. 2014;83(5):225-33.

D’costa VM, King CE, Kalan L, Morar M, Sung WW, Schwarz C, Froese D, Zazula G, Calmels F, Debruyne R, Golding GB. Antibiotic resistance is ancient. Nature. 2011 Sep 22;477(7365):457.

Gelband H, Molly Miller P, Pant S, Gandra S, Levinson J, Barter D, White A, Laxminarayan R. The state of the world’s antibiotics 2015. Wound Healing Southern Africa. 2015 Jan 1;8(2):30-4.

Laxminarayan R, Matsoso P, Pant S, Brower C, Røttingen JA, Klugman K, Davies S. Access to effective antimicrobials: a worldwide challenge. The Lancet. 2016 Jan 15;387(10014):168-75.

Marston HD, Dixon DM, Knisely JM, Palmore TN, Fauci AS. Antimicrobial resistance. Jama. 2016 Sep 20;316(11):1193-204.

Morgan DJ, Okeke IN, Laxminarayan R, Perencevich EN, Weisenberg S. Non-prescription antimicrobial use worldwide: a systematic review. The Lancet infectious diseases. 2011 Sep 30;11(9):692-701.

World Health Organization (WHO). Antimicrobial Resistance. 2017.

Local Harm Reduction Programs: A follow-up on Student Service Learning Program Experiences

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Written by Matt Jalink, MSc Candidate in Community Health and Epidemiology

In November 2016, I spoke with second year medical students (Andy Jin, Chad Purcell, and Sam Armstrong) who were about to begin their Service Learning Program experiences facilitated by the Dalhousie Global Health Office. The Service Learning Program is offered during the first two years of Undergraduate Medical Education at Dalhousie University. The program integrates community engagement concepts into classroom-based learning (Professional Competencies class) in their first year with an optional community-based project experience in their second year. The projects are designed in collaboration with community partners (including staff and people who use their services) and the university (students, staff and Faculty) to address a community-identified priority issue or gap in knowledge.

At the end of their experience, I met with these three students to hear about their Service Learning projects. Chad and Sam worked with Direction 180 and Mainline, two non-profit organizations in Halifax who implement harm reduction programs for people who use drugs. Chad and Sam, created a video to increase awareness of the emerging opioid treatment medication, Naloxone. Andy worked with RECAP , the Centre for Research, Education & Clinical Care of At-Risk Populations in Saint John.

Chad, Sam and Andy found their Service Learning Program experiences to be positive, meaningful and fulfilling. The unique experiences the program offered allowed the students to see how curriculum concepts present in a real world context. All three noted that they felt privileged to have had this opportunity.

The preparation from the Global Health Office helped them feel prepared to work with the community organizations  But they spoke about being overwhelmed with the complexity and wealth of information from the clients. The ability to select their project helped the student’s preparation, and the community partners were excellent at filling in the experiences from the populations that they work with on a daily basis.

 

Chad Purcell

Chad Purcell

 

The students had many positive experiences with their community partners. Sam and Chad enjoyed learning about Direction 180’s operations, and the vulnerable population they serve. Creating a video to highlight the realities of the opioid epidemic in Halifax and the life-saving treatment programs Direction 180 offer was rewarding. The goal of the video was to humanize the experience of addiction and educate the public about the potential health consequences and contributing factors to the use of drugs.

Andy greatly enjoyed forming new relationships with the wonderful staff at RECAP. The experience included the development of a financial mentoring program that aims to assist and support clients with their finances.

The challenging aspects of the students’ Service Learning program experiences were dependent on the nature of their project. Sam and Chad found some of the technical aspects of their video shooting challenging. Chad noted that with the help of the staff, the interviews with the patients went smoothly. Sam found editing their video to a reasonable length the most challenging due to ample footage.

 

Sam Armstrong (middle)

Sam Armstrong (middle)

 

Partaking in the Service Learning program had an influence on the students’ professional development and future career path. Chad and Sam both noted that gaining insight into the lives of the patients that they will one day serve and learning first hand the extent of the opioid crises in Canada to be invaluable experiences towards their career development. Andy also found working directly with patients to be influential in his own career path, and has a greater interest in becoming involved with public health and policy.

I would like to thank Andy, Chad, and Sam for sharing their Service Learning Projects! They were very insightful, conscientious, and impactful for their communities. For more information on available experiences through the Service Learning Program on both Halifax and Saint John campuses, please visit The Service Learning Program’s webpage.

2017 Global Health Photo Contest Winners!

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Blog Post – Global Health Photo Contest
Monday May 1st, 2017
Written by Matt Jalink, MSc Candidate in Community Health and Epidemiology

Each year Dalhousie’s Global Health Office hosts a photo contest to acknowledge outstanding photos that capture beautiful images and inspiring stories. Staff, students, medical residents, and faculty are all eligible to enter the competition, and we would like to highlight some of the winners below.

Our winning photos come from Dr. Ron George, an associate professor and medical director of research from the Department of Anaesthesia, Pain Management, and Perioperative Medicine here at Dalhousie University. Dr. George’s first photo was taken near a rural health clinic in Ifakara, Tanzania.

The elderly man in the photo had travelled from a remote village, leaving his family and friends behind to the clinic receive treatment for his chronic medical condition.

Mohammad

The second photo submitted by Dr. George depicts a student at the Archbishop Amissah Memorial Catholic School near Cape Coast, Ghana.

While working at the local teaching hospital we wanted to become involved with the community. The young man in the photo introduced me to his school’s headmaster who connected us with the community facilitating the opportunity to work with nurses, doctors, and midwives. The photo was taken on our final day together.

motherland

Angali Ghimire, a first year graduate student studying pharmacology here at Dalhousie University, submitted our second place photo captioned: “Earthquake took my home, not my hope.” Ms. Ghimire’s photo was one of many she took showing the scenes from the devastating 7.8 magnitude earthquake that shook Nepal in April 2015.

This photo shows a scene from my husband’s village shortly after the earthquake, with two villagers cooking a meal with what food and supplies they had available.

Earthquake-Nepal

We would like to offer a special thanks to Ms. Anjali Ghimire and Dr. Ron George for their spectacular photo submissions. Their beautiful pictures illustrate global health through different lenses, but share a common message of heath transcending boundaries.

For more information please visit our Photo Contest webpage and to see all the images from the contest please view our facebook album.

Water Advisories in Canada’s First Nations’ Communities

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April 2017
Written by: Matt Jalink, MSc Candidate in Community Health and Epidemiology

Clean, drinkable water is a luxury that we as Canadians take for granted. Our nation has the second largest landmass with an abundance of fresh water, accounting for 20% of the world’s fresh water stores. Turning on the tap is not a cause for concern for most Canadians, but it is a serious issue among our First Nations communities. Only 6 months ago, a CBC investigation found that 2/3 of all First Nation Communities in Canada have been under a minimum of 1 drinking advisory at some time in the last decade.

As of Jan 31st 2017 in 77 First Nations communities south of the 60th parallel, there were 28 short-term drinking water advisories, indicating that there is a temporary water quality issue on a specific water system and 96 long-term DWAs, meaning the advisory has been in place for more than one year. These figures are also underestimated because British Columbia First Nations and communities within the Saskatoon Tribal Council are not included in this count. Some First Nations communities have had drinking water advisories for decades, like Shoal Lake Reserve on the Manitoba-Ontario border, which have been on a boil advisory for over 20 years.

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Another example comes from the Potlotek First Nations community in Cape Breton, where the residents are living with terrible water conditions. Dark, dirty water is flowing from the taps due to high concentrations of iron and manganese. Residents are refusing to drink the water and a no boil drinking water advisory is in effect, despite being declared safe to drink by Health Canada. Only 10km away in the neighboring community St. Peter’s, residents have clean, clear drinking water. The residents of the Potlotek First Nations community held a protest this past fall in response to the ongoing water issues, and the federal government responded by granting the Potlotek community a new multi-million dollar water system. According to the regional director general for Indigenous and Northern Affairs Canada Chris McDonnell, the committee formed to plan the new multi-million dollar water system includes the Potlotek community, community water treatment plant operators, engineers from Indigenous and Northern Affairs Canada, and a private sector company. However, the new system is expected to take several years to complete, and the residents are forced to continue to use bottled water.

Drinking water advisories are based on the results of water quality tests, which may be issued if water is considered to be either potentially unsafe, or confirmed unsafe. The chiefs and councils of the First Nations communities are responsible for issuing the water drinking advisories. Health Canada is partnered with First Nations communities to monitor the quality of drinking water and advise on issues related to water safety. Three types of drinking water advisories can be recommended by Health Canada. They include: boil water advisories, do not consume advisories, and do not use advisories, which increase in severity.

Sustainable Development Goal #6

Sustainable Development Goal #6

The liberal government made fixing drinking water advisories in our First Nations communities a priority in their election campaign. They pledged $1.8 billion dollars over five years to lift all long–term drinking water advisories. A year and a half into term, the Liberals are behind on schedule. Very little has been done in decreasing the number of drinking water advisories, which may be due in part to their complexity. If a drinking water advisory has been lifted, it doesn’t necessarily mean the drinking water is safe across the entire community. Often communities are battling multiple water advisories simultaneously, and one advisory can cover a single building, or an entire community. Adding to the complexity, drinking water advisories flicker on and off regularly, fostering a feeling of mistrust in the safety of the water. For example, Indigenous Affairs Canada claims that a 16-year boil water advisory in Nazko, B.C. was lifted in Nov 20th 2015. But the water is still considered unsafe to drink because of dangerous concentrations of arsenic present in the water. According to a resident, the filter at their water treatment plant responsible for removing the toxic element has stopped working and hasn’t yet been repaired.

There is often confusion over which drinking water advisories are active, which may be attributed to discrepancies between Health Canada and Indigenous Affairs Canada lists. As mentioned above, Health Canada lists 96 long-term drinking water advisories in 77 communities while Indigenous and Northern Affairs Canada lists only 71 long-term drinking water advisories in 48 communities. More needs to be done to help lift drinking water advisories off of our First Nation’s Communities so everyone can have access to clear, clean, safe water.

 

Improving Mental Health in the Workplace

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Written by Matt Jalink, MSc Candidate in Community Health and Epidemiology, Dalhousie University.

Burden of Mental Health in Canada

Often when we discuss illness and health, we focus solely on physical wellbeing, new infectious disease outbreaks like Ebola, the management and treatment of chronic diseases or injury. Considerably less attention is paid to the invisible, hidden illnesses that are the leading cause of disability in Canada1, 2,3, a burden that is 1.5 times higher than all cancers, and 7 times greater than all infectious disease combined in Ontario4. We are talking about mental illnesses.

The burden of mental health in Canada is considerable. Childhood and adolescence is a time of increased risk for developing mental illness as almost 70% of mental health problems begin at this time. By the time Canadians reach 40 years of age, one in every 2 have or have had a mental illness5. Discrepancies between income groups are evident as Canadians in the lowest income bracket are 3 to 4 times more likely than those in the highest income group to report poor to fair mental health status6. The burden of mental illness extends from the individual to a societal level. Approximately 20% of working population is currently suffering from mental health and as a result 500,000 Canadians will miss work any given week due to mental health issues or illness7, 8.

The burden mental illness places on the individual and society has economic consequences. In Canada, mental illness costs a summed estimated $ 51 billion per year in healthcare costs, lost productivity, and reductions in quality of life5, 9. However, up to 25% of disability costs associated with mental health problems could be avoided by taking action.

Social barriers, primarily social stigma, hinder individuals and companies from taking action. Only 1/3 of individuals facing mental health challenges choose to access help because of the fear of being stigmatized10. An example comes from Ontario where 39% of workers would not tell their managers if they were experiencing a mental breakdown11. Stigmatism extends beyond the individual suffering from mental health to colleagues and coworkers who, in a study on Ontario workers, 64% would be concerned about how work would be altered if a colleague had mental illness11. Stigmatism towards mental health has been decreasing12, but effective interventions and programs are needed to alleviate both the stigma and burden imposed by mental health especially in the workplace where 82% of senior executives have stated that their company promotes a mentally healthy work environment, while only 30% of employees believe this to be true.

Not Myself Today –Canadian Intervention for workhouse

 One such program is Not Myself Today, an evidence-informed, practical solution to help employers transform mental health at work. Working in conjunction with Partners for Mental Health, Not Myself Today is focused on helping companies build greater awareness, reduce stigma, and foster safe and supportive work environments.

 An easy 4-step process allows businesses to partake in the Not Myself Today program.

notmyselftodayThe program is based on the insight that everyone has days that we don’t feel like ourselves, and most of us have learned or been told to suppress these feelings and respond to questions like, “How are you doing today?” with “Good” or “Fine” when we could be feeling a wide range of emotions. Not Myself Today leverages these insights to familiarize people to the concept of mental health and build empathy and understanding towards those living with mental illness.

Participating companies and organizations receive a toolkit (physical and digital) containing hands-on activities, tools and resources, as well as ongoing support to engage and educate their workforce about mental health throughout the year.

All funds generated by Not Myself Today directly support the work of Partners for Mental Health (PMH) and the development, execution, evaluation of the initiative. PMH is a national charitable organization accredited by Imagine Canada that is catalyzing a social movement to change the way people think about, act towards, and support mental health and those living with mental illness.

Why Companies Should Join

Registering with Not Myself Today benefits both those battling mental illness and companies as whole. Poor mental health status and mental illness is costly for individuals, employers and the economy. Taking concrete actions to promote and protect employee mental health has benefits. The average positive return on investment is 2.3 for employers investing in a mentally healthy workplace13. To date, more than 320 companies and organizations both small and large from a wide range of sectors have brought Not Myself Today to their workplace with great success.

References

1 Institute for Health Metrics and Evaluation (2015). Global Burden of Diseases, Injuries, and Risk Factors Study, 2013. Data retrieved from http://www.healthdata.org/data-visualization/gbd-compare

2 Mental Health Commission of Canada (2014). Why investing in mental health will contribute to Canada’s economic prosperity and to the sustainability of our health care system. Retrieved from http://www.mentalhealthcommission.ca/English/node/742

3 Lim et al. (2008). A new population-based measure of the burden of mental illness in Canada.Chronic Diseases in Canada, 28: 92-8.

4 Ratnasingham et al. (2012). Opening eyes, opening minds: The Ontario burden of mental illness and addictions. An Institute for Clinical Evaluative Sciences / Public Health Ontario report. Toronto: ICES.

5 Smetanin et al. (2011). The life and economic impact of major mental illnesses in Canada: 2011-2041. Prepared for the Mental Health Commission of Canada. Toronto: RiskAnalytica.

6 Mawani and Gilmour (2010). Validation of self-rated mental health. Statistics Canada Catalogue no. 82-003-X.

7 Dewa, Chau, and Dermer (2010). Examining the comparative incidence and costs of physical and mental health-related disabilities in an employed population. Journal of Occupational and Environmental Medicine, 52: 758-62. Number of disability cases calculated using Statistics Canada employment data, retrieved from http://www40.statcan.ca/l01/cst01/labor21a-eng.htm

8 Institute of Health Economics (2007). Mental health economics statistics in your pocket. Edmonton: IHE. Number of absent workers calculated using Statistics Canada work absence rates, retrieved from http://www.statcan.gc.ca/pub/71-211-x/71-211-x2011000-eng.pdf

9 Lim et al. (2008). A new population-based measure of the burden of mental illness in Canada.Chronic Diseases in Canada, 28: 92-8.

10Statistics Canada (2003). Canadian Community Health Survey: Mental Health + Wellbeing.

11 Dewa (2014). Worker attitudes towards mental health problems and disclosure. International Journal of Occupational and Environmental Medicine, 5: 175-86.

12 Bell Canada (2015). Bell Let’s Talk: The first 5 years (2010-2015). Retrieved from http://letstalk.bell.ca/letstalkprogressreport

13Creating a mentally healthy workplace: Return on investment analysis report, beyondblue and the Australian Mental Health Commission, March 2014.

Tuberculosis Detection: Rats with an MD?

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Written by Matt Jalink, MSc Candidate in Community Health and Epidemiology
January 2017

In October 2016 we published an article about the innovative Apopo HERO rats and their application to tuberculosis (TB) diagnosis and landmine detection. Today we are focusing in on the TB detecting rats, and their uncanny ability to diagnoses TB with their keen sense of smell.

The Apopo TB detection program began modestly in 2007 with 4 government partnership clinics, but has since expanded to 28 collaborating clinics in Dar es Salaam, Tanzania and in Maputo, Mozambique. Tanzania and Mozambique are among the World Health Organization’s 22 high-TB burden countries, which can be partially attributed to inefficient TB diagnostic techniques. The Tanzanian national standard diagnosis via sputum microscopy is only 40-60% accurate, and can be even lower among HIV positive individuals. As a result, many individuals infected with TB aren’t captured by current diagnosis techniques and are sent home where they can infect anyone who comes into close contact with them. Thus, Apopo seeks to improve TB diagnosis, operating as a second-line treatment.

 

apopo-rats-trained-to-sniff-tuberculosis-in-africa6

 

In order to ensure accurate diagnosis, Apopo HERO rats are trained through a comprehensive five-step program outline below:

  1. Socialization
    • The rats open their eyes at 4 weeks of age and are immediately socialized to develop a comfort for being routinely handled.
  2. Click Training and Scent Conditioning
    • The rats learn to associate the clicking noise to a food reward.
  3. Scent Discrimination
    • Trainers offer rats a choice between positive and negative sputum samples. When the rats pause above a positive sample, they are rewarded with a food reward and clicking noise.
  4. Multiple Sample Evaluation
    • The rats progress to evaluating multiple samples in sequence. The samples are orientated in a linear bar containing ten sputum samples. Here the rats are learning how to evaluate large numbers of samples in a short amount of time.
  5. TB Rat Accreditation
    • The final test the rats face is to pass an internal accreditation process before joining the work force. The test is conducted under blind conditions, and to pass the evaluation, the rat must identify every TB positive patient in order to ensure high sensitivity. When rats indicate samples that were previously tested negative, the suspected sample is confirmed again in the lab. The Hero rats have caught almost 3000 wrongly diagnosed TB patients in just the past few years.

 

 

 

Once the accredited rats are ready to work, they fall in as a second line treatment for TB diagnosis, meaning they are used to confirm or discredit previously tested samples. The process begins when patients are tested at a collaborating clinic or hospital for TB using sputum microscopy. Samples are labeled with their test result, stored, and collected by Apopo on a regular basis. Apopo collects both positive and negative samples and the respective correlating patient codes. Although the rats are immune to most tropical diseases, the samples are still denatured in an autoclave to ensure the samples are no longer contagious. The samples are now ready for rat inspection, and are placed in a linear sequence under sniffing holes. The rat MDs pause and scratch at samples they think are positive for TB. A single rat can screen 100 samples in approximately 20 minutes, a process that would take a lab technician more than 2 days to process. The samples identified as positive by the rats are then confirmed via culture in the lab. All results either confirmatory or dissenting are sent back to their respective health centres to advise patient treatment.

So far, Apopo TB detecting rats have positively identified 10,671 cases of TB, screened more than 390,485 samples, and stopped 81,390 potential infections.

Apopo was ranked the top-rated non-profit on GreatNonProfits for 2nd year in a row and were awarded the opportunity to exhibit work at the World Innovation Summit for Health on TB-detecting rats.

For more information on the Apopo rats please visit their website.

Local Harm Reduction Programs: An Interview with Service Learning Program Participants Andy Jin, Sam Armstrong, and Chad Purcell

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Written by Matt Jalink, Community Health & Epidemiology student at Dalhousie University
November 2016

Service Learning is a program that if offered during the first two years of Undergraduate Medical Education at Dalhousie University. The program integrates community engagement concepts into classroom-based learning (Professional Competencies class) in their first year with an optional community-based project experience in their second year. The projects are designed in collaboration with community partners (including staff and people who use their services) and the university (students, staff and Faculty) to address a community-identified issue or gap in knowledge.

Andy Jin, Sam Armstrong and Chad Purcell are second year Dalhousie Medical Students partaking in the service-learning program facilitated by the Dalhousie Global Health Office. Andy is based out of Dalhousie Medical School’s New Brunswick’s campus while Sam and Chad can be found on the Halifax campus. I sat down with Andy, one of the program’s student representatives with the Service Learning Leadership Team, as well as two part-time pharmacists Sam and Chad, to discuss their service learning projects for this upcoming year.

 

Tell us about yourselves and your pathway to Medicine

Andy: Many individuals have been influential in my decision to pursue medicine at Dal, but most important of all was my wife. As a Chinese national, she helped me to understand the poverty and the sufferings of many individuals in the world. Every step of the way, she was there right beside me, encouraging and inspiring me to look beyond our immediate surroundings for a greater good.

Chad: I grew up in Bedford, Nova Scotia and first started considering medicine as a career during junior high. High school helped solidify my interest in medicine, and I decided to attend Dalhousie upon graduation. After completing a BSc in Biology, I applied to both the medicine and pharmacy programs at Dalhousie and was accepted into pharmacy. I was still interested in medicine after finishing pharmacy, so I reapplied and was accepted into the Dalhousie Medicine class of 2019.

Sam: I also grew up in Bedford and after one year of undergraduate science was accepted into the Dalhousie Pharmacy program. Pharmacy gave me the opportunity to interact with patients in health-related setting, and I enjoyed the hands-on clinical care aspects of the program. The idea of acting as the coordinator of care and the wide range of opportunities medicine offers influenced me to pursue medicine here at Dalhousie.

 

Why did you choose to pursue the Service Learning Program?

Andy: The Service Learning program offered a unique opportunity for me to dive into the real world of medicine and learn about the needs of our community in an organized manner. I wanted to see the reality of health and medicine, not just in an artificial school environment. Also, the safety and feedback mechanisms that were incorporated into the SL (Service Learning) program gave me the assurance that this experience will be a valuable asset to not only my medical career, but also to my personal growth.

Sam: I saw it [the service learning program] as a good opportunity to become actively engaged in the community. It offers a structured framework for community service, and in this case, an avenue to advocate for underserved populations.

Chad: I was happy with the opportunity the Service Learning Program provided to become involved with the community. The creative component of the project also appealed to me.

 

What type of work will you be doing with our Service Learning partners? 

Andy: The details of the project are yet to be finalized. I will most likely work on a Needle exchange program, a harm reduction intervention that intends to minimize and mitigate the harmful effects of substance abuse in individuals. Ultimately, I hope this will help to empower those clients to make everlasting changes that will improve their health and well being.

Chad + Sam: We will both be working with Direction 180, a community-based nonprofit organization operating on a harm reduction model. We are tasked with making video focused on increasing awareness of Naloxone, an anti-opioid medication critical in treating opioid overdose in an emergency situation. Heroin, fentanyl, and morphine are some common examples of opioid drugs. Naloxone blocks and counters the effects of opioids including slowed breathing, extreme drowsiness, and loss of consciousness. Our video will target the opioid-dependent population to raise awareness of the lifesaving treatment that is now available without prescription for emergency use.

 

What results are you hoping to achieve from this project? What you hope to gain from this experience yourself?

Andy: In a general sense, I hope to see an improvement of health and well being among the clients.  Specifically, the needle exchange program can decrease transmission of communicable diseases, minimize overdosing, and reach the marginalized population. Realistically, it might not be possible to observe any tangible improvements, but a step towards the right direction is indeed one less step needed for a positive change. Some individuals in current society may not approve of harm reduction strategies, and I understand their concerns. However, the potential benefits of these programs cannot be ignored, and I want to obtain insights on how they can be better implemented to achieve a balance and maximize its strength.

Sam: Our primary goal for this video is to raise awareness of Naloxone’s availability to the opioid dependent population. It is vital that opioid users are aware and have access to this potentially life-saving emergency treatment option.

Chad: Working on this video project will allow us to gain a greater appreciation for the reasons and circumstances that led to the position that these individuals find themselves in. I hope to gain a sense of empathy for what opioid addiction and seeking treatment are like from their perspective.

 

What have you done to prepare yourself for your Service Learning Project?

Andy: In order to better prepare for the project, I am reading journal articles and publications around relevant topics, such as needle exchange program and substance abuse.  For an effective intervention, however, a bottom-up approach is perhaps one of the most important aspects. Listening to the clients and identifying what their needs and wants. As such, my supervisor and I are trying to communicate with various stakeholders who are intimately connected to the clients.  This may provide the opportunity for me to interact with the clients and identify effective strategies for the project.

Chad: Both Sam and I took a preparation course through Direction 180 about Naloxone and how to administer it.

Sam: We supplemented the course with reading some background info about Naloxone and the dosage form now available in the community. Going forward, Chad and I plan on meeting again with the Direction 180 staff to see how the video can best address the objectives of the project.

 

What about this opportunity excites you the most?

Andy: I am very excited about all the life lessons, collaborations, and the meaningful relationships that I can obtain through SL program.  These experiences will help me to grow as a competent, compassionate health care professional that has positive impact on the individuals who are in need.

Sam: I’m looking forward to working with opioid dependent individuals to better understand living with opioid addiction in our community. I’m also curious as to the opioid-user’s perspective on Naloxone and their experience with the treatment.

Chad: I’m excited about being out interacting with the opioid dependent community, seeing what a day in their life entails. I am also interested in what Direction 180’s reaction to our video will be, and the impact it has on the community.

I would like to thank Andy, Sam and Chad for sharing their upcoming service learning projects, and I look forward to hearing more about their progress later in the term! If you are interested in learning more about the Service Learning program, please visit our Service Learning webpage.

Kite Mosquito Patches

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Written by Matt Jalink, Community Health & Epidemiology student at Dalhousie University
23 October 2016

Mosquitos are annoying, plentiful, and at times, dangerous. Whether you’re on a camping trip in a Canadian national park or walking to school in Dar es Salaam Tanzania, mosquitos are an irritating and potentially fatal part of our lives. Malaria, Zika, Dengue Fever, and West Nile are a few examples of mosquito-vector pathogens responsible for high rates of morbidity and mortality. Due to our changing climate, mosquitos are now expanding to new areas and thus new control and prevention efforts are needed. Current mosquito repellent and control measures are either toxic depending on the DEET concentration, ineffective with short duration of protection, or time-consuming and cumbersome to apply.

Luckily, Kite offers two novel mosquito repellant options. They currently have 1 product on store shelves and another in the later stages of development and testing. Kite Shield Repellent is a patent pending, DEET-free aerosol that is made from botanical active ingredients. The repellent provides approximately four hours of protection from the pesky insects. Expected to be released next year, the Kite Patch is developed as a lightweight, wearable sticker that has been shown to provide 48 hours of protection under lab conditions.

Each year the Global Health Office at Dalhousie selects a theme to connect our discussions and events; this year we have chosen the Sustainable Development Goals established by the UN. This innovative product line highlights two of the UN Sustainable Development Goals: #4 Global Health and Wellbeing and #9 Industry, Innovation, Infrastructure. Kite’s goal of decreasing mosquito-born pathogens through essential medical product innovation is a creative next step towards reaching our UN sanctioned goals.

 

 

Kite Mosquito Repellent Patch. Can be attached to clothing, bags, and other surfaces

Kite Mosquito Repellent Patch. Can be attached to clothing, bags, and other surfaces

 

Both products work by targeting the insects’ sense of smell. The powerful, non-toxic, easily applicable mosquito repellent patch targets the insect’s CO2 receptors, inhibiting their ability to locate their human target . Mosquitos can locate a person via exhaled CO2 from up to 100 yards away. The repellent products were developed at the University of California Riverside and financed through an individual donor financing campaign. To date, they have received six figures worth of funding from more than 10’000 backers that include the Bill and Malinda Gates Foundation and the American National Institute of Health.

 

Lab-proven protection from Kite technology

Lab-proven protection from Kite technology

To test the Kite Patch’s effectiveness in the field, a large scale, 6-month pilot trial is currently underway in Uganda. Uganda is an East-African nation endemic to many mosquito-born pathogens including Malaria where in some areas, greater than 60% of children are infected. Kite is working with in-country organization Pilgrim Africa, who is helping distribute the repellent patches, implement the campaign infrastructure, and collect feedback on the technology.

Kite is an exciting, creative new method of preventing mosquito born illnesses aimed at tackling the Global Health and Wellbeing and Industry, Innovation and Infrastructure objectives of the Sustainable Development Goals . With 2 million deaths per year from Malaria alone, new technology and control methods like Kite are needed to help prevent and control mosquito transmitted diseases.

To find out more about the Sustainable Development Goals click here.

To find out more about the Kite Patch click here.

Hero Rats

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Written by Matt Jalink, Community Health & Epidemiology student at Dalhousie University
September 29th 2016

Rats don’t always have to be pests. An innovative NGO called Apopo, has recruited these rodents for humanitarian purposes. Giant African pouched rats (Cricetomys Gambianus), seen below, have been put through vigorous training to detect explosives such as landmines in addition to aiding in tuberculosis (TB) diagnosis using their keen sense of smell.

 

HeroRat sniffing out a landmine

HeroRat sniffing out a landmine

 

Founded in 1998, by Belgian Bart Weetjenss, Apopo operates as a non-profit organization responsible for training detection rats in one of two programs: Mine Action and Tuberculosis Detection. Mine Action focuses on landmine and explosive removal while Tuberculosis Detection offers a second line option for TB diagnosis. Both programs have yielded impressive results thus far.

This particular breed of rat, the Giant African Pouched Rat, was selected for Apopo’s programs because of their immunity to many tropical disease infections and is endemic to sub-Saharan Africa. The rats are bred in captivity, and the first stage of their training involves being handled by trainers at 5-6 weeks of age to become familiar with human interaction. The rat pups are trained through operant conditioning using a combination of click sounds and food rewards. Click training typically starts at 6 weeks of age so the rats associate the clicking sound with a food reward (usually banana or peanut). Once the rats have grasped the association of clicks with food, they are trained onto their target sent, TNT or TB depending which program they are allocated to. Their tasks become increasingly more difficult, finalizing in a blind accreditation test in order to graduate from their academy. Fortunately, very few of the rats fail to complete their training. If the rat is falling behind in their training schedule, it is not economically efficient to allocate additional training time. The unsuccessful rats are granted an early retirement, and are continually cared for on the Apopo sites.

Currently, Apopo has 31 working rats in the TB Headquarters in Morogoro, Tanzania and 9 at the Maputo clinic in Mozambique. Angola has 42 operational landmine detection rats, and Mozambique has 20 respectively. With 47 rats still in various stages of training, we can expect to see the HeroRat workforce increase over the next few years.

 

Apopo TB detection rat sniffing sputum samples for TB

Apopo TB detection rat sniffing sputum samples for TB

Despite being immune to most tropical diseases, the rats receive weekly veterinary checkups and regular preventative treatments for parasites. To date, no rats have been lost due to their detection work in either TB or mine detection, and the majority live to the end of their expected life span of 8 years. When it is noticed that the rats are not their typical enthusiastic selves about going to work anymore, they are awarded with retirement where they continue to receive weekly health checks and exercise.

Apopo’s headquarters can be found in Morogoro Tanzania where the breeding and training facilities and primary TB detection clinic are located. Mine action centres are located in Mozambique Angola and the Southeast Asian nations Vietnam, Thailand, Cambodia and Laos DPR. They hope to expand to other nations, but the issue lies with funding. With the cost of training one rat at €6000.00, it is not an easy endeavor. Further logistics involve having to register as an NGO through the country’s government and once achieved, import necessary equipment, machines, trained rats and recruit local individuals to become staff.

Stay tuned for more posts about the Mine Action and Tuberculosis Detection Programs!

Below is a link of the founder Bart Weetjenss giving a TED talk about Apopo!

https://www.ted.com/talks/bart_weetjens_how_i_taught_rats_to_sniff_out_land_mines?language=en