Bidding adieu

So the date has been finalized, June 11th  will be my last day. I finished my last experiment (ran a real time PCR experiment end of May). I am moving away from benchwork and basic science into hopefully a career in global health.

You see, two things happened over the course of these last few years during my postdoctoral years- on the positive side, my social mindedness was taking over my thoughts and driving me toward a path where I wanted to be directly involved in making people’s lives better, hence the Master of Public Health from Johns Hopkins (yes I did graduate people, this May in fact!). And two, a negative feeling with regards to biological research in general was setting in. I was starting to feel the pressure of “publish or perish” culture. This absolutely did not sit well with me especially since all I wanted to do was have fun doing science and that was getting harder and harder to do.

One positive and one a very negative feeling (I might elaborate a bit more when I am ready to spin it in a less negative tone): I am glad the positive one took over. I have finished my public health program and I have decided to move on into a global health career.

This decision has not been easy but it never will be especially since what I will be giving up is something that I have immensely enjoyed and something that is a part of who I was, who I am and who I will be. Now that I think about it: if there has been a constant in my life- that would be my love for biology.

As human beings, we are naturally curious and this curiosity is exactly what drives people into scientific pursuit; there is no better way to scratch that curiosity itch if you will. While I was always the nerdy curious kid, I never thought I would get to spend almost 15 years of my adult life (20 if you include my undergraduate years!) trying to figure out what goes within us, delving deeper and deeper within each of our cells.

Now for some cliches: All good things must come to an end; Change is the only constant thing (and any other that you can think of)

I do feel guilty about leaving all this behind- guilty because I am leaving behind what I know best; guilty because there are unfinished experiments that I am going to thrust on other people in the lab (of course there is no end to the experiments); guilty because I would not be earning for a little while and have to rely on my spouse for finances. But beyond all this contrition is the excitement, excitement about having to learn things that are out of my comfort zone (keeps my mind sharp a.k.a  terrifying!), excitement about getting to travel and volunteering with some cool organizations, excitement about the challenging opportunities that might come my way- I am ready as ever as I will be.

I am fortunate that I have had excellent scientific/academic mentors. I am also extremely lucky to have spent all these years in different labs with lab members who have become much more than colleagues.

All in all, in the end, I am glad and truly grateful that I was in control of this change, that when the time was right, I was able to make a decision- such things rarely happen in my life. Usually I am just thrown into situations and I hate making decisions!

Indeed, come June 11th, I will be hanging up my lab coat, for now anyway :)

Gandhi said “Be the change that you wish to see in the world" and I hope to achieve exactly that even in some miniscule form. 

Wish me luck y'all... 

What is sustainability in health programs?

Sustainability is the ability of a system or a process to endure. And for a process to endure, we have to build it in such that it remains flexible and adaptable in many contexts. 

The health program that comes to mind when you think about sustainability is the eradication of smallpox. The smallpox eradication effort was continually adapted to fit the changing needs and goals of the disease eradication program. Over time, with decreasing number of smallpox cases, the emphasis shifted from routine vaccination to surveillance. 

Far too often, public health policies and programs are implemented on small scales and with limited funds and risks being discontinued when funding runs out – even if it was successful. There is a mismatch between the expectation of long-lasting effects of large-scale interventions and reality. Trying to scale up health innovations or even continuing a program when the funding runs out or political landscape changes is challenging. 

In the last decade, there has been a big push toward creating programs and interventions that are sustainable. More and more donors are recognizing the importance of the sustainability of evidence-based health interventions and favor programmatic approaches that include long-term maintenance. All of this recognition has culminated in the adoption of Sustainable Development Goals (SDGs) by the United Nations earlier this year. 

The SDGs differ from the Millennium Development Goals (MDGs) by virtue of being much more comprehensive with 12 goals and 17 focus areas. The SDGs set zero-oriented goals: getting to zero cases of hunger, child and maternal deaths and poverty. This lofty goal cannot be achieved by relying solely on the ever-shrinking development assistance from rich donors, as was the case with the MDGs. This is why the SDGs put sustainable, economic development right at the core of the strategy. The goals have been developed through consultation with nearly 100 member states and millions of citizens—probably the largest and most inclusive and participatory process we have ever seen. This allows for adaptable goal setting by countries that would then allow them to assess their own strengths and leverage their assets to meet the targets. To me, some of the most significant changes that we see in the SDGs are the emphasis on accountability, the separation of the issues of poverty from issues of food and nutrition security and the stronger goals with respect to women’s empowerment. 

To strategically include sustainability in health programs and policies requires a “clear understanding of the concepts of sustainability and operational indicators to monitor sustainability” (1). The first step in designing sustainable health programs is to define the program elements that need to be sustained. It is also essential to build and effectively leverage partnerships for a program to be sustainable. This would imply that if you are planning a large scale program or intervention, you need to start early by planning, engaging the partners, using appropriate frameworks that conceptualize sustainability and incorporating outcome/success measures for your sustainability approach. 

To go from theoretical frameworks to successful sustainability, there has to be more research with regards to how sustainable existing programs are, especially the ones that have incorporated “sustainability” into their programmatic approach. We need to know what works and what does not. We need to know what are the stumbling blocks that prevent programs from becoming sustainable. In doing so, in the future, we can design better plans for sustainable health programs, especially  in settings where resources are becoming more and more limited. 

Sustainability has been a huge challenge in programs designed to address micronutrient (vitamins and minerals) deficiencies. Micronutrient deficiencies impact a large number of children under-5 years of age worldwide. Many of these deficiencies co-occur with infections can exacerbate other infections that may be present (4-6). One such micronutrient is Vitamin A; globally, nearly one-third of children under the age of 5 are deficient. We know vitamin A supplementation (VAS) works; a meta-analysis of 43 studies published in 2011 showed that VAS in children at risk for deficiency reduces mortality by about 24% (2). Despite large-scale efforts for VAS in children since the 1990s, as of 2013, the coverage rate is anywhere between 10-90% (3). Nutrition interventions often rely on aid dollars and fortified foods or supplements from wealthy countries or private donors  (for e.g. Vitamin A products for supplementation are obtained from the Micronutrient Initiative which is supported by Canadian International Development Agency). Both lack of support from the local Ministeries of Health (since these programs do not often align with their priorities) and lack of policy initiatives to address micronutrient deficiencies contribute to the problems that dietary interventions encounter. The issues mentioned above point to one major theme— “SUSTAINABILITY”—that we as public health practitioners have to take into account when planning programs both at local and global levels.

References:

1) Shediac-Rizkallah MC, Bone LR. Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy. Health Educ Res. 1998 Mar;13(1):87-108. Review. PubMed PMID: 10178339.

2) Imdad A, Herzer K, Mayo-Wilson E, Yakoob MY, Bhutta ZA. Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age. Cochrane Database of Systematic Reviews 2010, Issue 12. Art. No.: CD008524. DOI: 10.1002/14651858.CD008524.pub2.

3) Vitamin A supplementation coverage rate (% of children ages 6-59 months). Available at http://data.worldbank.org/indicator/SN.ITK.VITA.ZS

4) de Gier B, Campos Ponce M, van de Bor M, Doak CM, Polman K. Helminth infections and micronutrients in school-age children: a systematic review and meta-analysis. Am J Clin Nutr. 2014 Jun;99(6):1499-509. doi: 10.3945/ajcn.113.069955. Epub 2014 Apr 16. Review. PubMed PMID: 24740209

5) Amare B, Moges B, Mulu A, Yifru S, Kassu A. Quadruple burden of HIV/AIDS, tuberculosis, chronic intestinal parasitoses, and multiple micronutrient deficiency in Ethiopia: a summary of available findings. Biomed Res Int. 2015;2015:598605. doi: 10.1155/2015/598605. Epub 2015 Feb 12. Review. PubMed PMID: 25767808; PubMed Central PMCID: PMC4342072.

6) Bhutta ZA. Effect of infections and environmental factors on growth and nutritional status in developing countries. J Pediatr Gastroenterol Nutr. 2006 Dec;43 Suppl 3:S13-21. PubMed PMID: 17204974.

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