Inside Duke Medicine

An international approach

“There are certain rights people have, and one is the right to good health, no matter where you live,” said Michael Merson, M.D., director of the Duke Global Health Institute, when discussing its mission. “But the challenges of global health are complex. Addressing these challenges requires skills and knowledge from many perspectives – from the life sciences to the social sciences.

The Duke Global Health Institute (DGHI) was created in 2006 to address health disparities around the world. Since its inception, the institute has collaborated with programs at Duke and abroad to strengthen efforts in global health research, service and education. DGHI research is focused around six Signature Research Initiatives (SRIs) on emerging global health themes. The SRIs engage faculty from multiple Duke schools and departments and address major current issues in Global Health from a broad interdisciplinary perspective. The six SRIs are: obesity and cardiovascular disease; global aging; gender, poverty and health; emerging infectious diseases; global environmental health; and health systems strengthening.

“These signature research initiatives reflect areas of priority in global health and some of the preexisting strengths of Duke University and Duke University Medical Center,” said John Bartlett, M.D., of the Department of Medicine and the newly appointed DGHI associate director of research. “The intent is that each initiative can evolve over time based on expertise in the university and based on global health needs.”

Duke has been building its international presence in medicine for over a decade, with projects in Asia, Africa, and Europe. The collaboration with Kilimanjaro Christian Medical Center in Moshi, Tanzania on a variety of projects related to emerging infectious diseases, including HIV/AIDS, is one example.

In 2002, John Crump, M.D., was recruited to help expand research programs in Tanzania. “We started in a very modest way, with small studies that were funded by donations from individuals and industry. The goal in those early days was to demonstrate enough of a track record of research collaboratively in Tanzania that we could eventually compete successfully for NIH grants. By 2004, we succeeded in getting our first NIH grant,” said Crump.

The DGHI is also expanding research efforts in India, where Merson and others are involved in studies
looking at behavioral changes to stem the tide of AIDS, as well as research into curbing ever-increasing rates of cardiovascular disease, obesity, and diabetes.

Other Duke faculty research projects include work in Sri Lanka, where there are ongoing infectious disease and behavioral studies in the aftermath of the 2005 Indian Ocean tsunami, and in Leon, Nicaragua, where Duke researchers are studying RNA diagnosis of infectious disease. The Duke-NUS Graduate Medical School in Singapore will also see a boost in its infectious disease programs with the recent arrival of Duane Gubler, M.D., as director of the Signature Research Program in
Emerging Infectious Diseases, which will identify strategies to prevent future SARS-like epidemics in Asia.

Though communicable diseases place a heavy burden on developing nations, noncommunicable diseases, such as obesity and heart disease, will continue to challenge countries around the world.
“Five of our new signature research initiatives are focused on these areas as we anticipate the future of global health,” said Bartlett. He hopes to recruit faculty from throughout Duke to take an interdisciplinary approach to these new global health issues.

Another essential element to global health research is commitment, something demonstrated by Duke’s long-term international efforts. Crump recently coauthored a JAMA paper detailing ethical considerations for short-term experience in global health, including respecting cultural differences, training local staff and achieving mutual and reciprocal benefits. But this takes time.

“When doing research in developing countries, one must learn to be patient and to measure progress on longer time horizons. Progress can be quite slow, whether that’s because of infrastructure, personnel or bureaucratic limitations, so you have to adapt to a more long- term way of thinking about things,” acknowledged Crump.
For more information about the Duke Global Health Institute, visit http://www.globalhealth.duke.edu