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GHTC’s Kim Lufkin is in Kenya this week, documenting global health research projects and the impact on people in the country. This is her first post from the field. On Tuesday, our team went to visit the US Embassy in Nairobi in order to meet with some fantastic Americans working in Kenya for several US agencies, like the CDC, USAID, State Department and DoD. On the way through security, the guard pulled out the small device I constantly carry in my purse to monitor my blood glucose levels—I’ve been a Type I diabetic since age five. I realized how fortunate I am to have a quick, easy-to-use diagnostic tool that I can carry with me wherever I go. In fact, the range of testing and treatment options made available to me has grown leaps and bounds since I was a child, thanks to research and development for new diabetes products. This realization in the security line at the US Embassy stood in stark contrast to the diagnostic and treatment tools available to children in Kenya suffering from a painful and deadly neglected disease called visceral leishmaniasis, or VL. These children are in desperate need of new diagnostic and treatment tools. I remember when I was first diagnosed with diabetes at five years old, there wasn’t a fast and accurate way to monitor my glucose levels. My mom would prick my finger to withdraw blood, and then apply my blood to a small test strip. After waiting a short amount of time, she’d wipe the blood away, and the strip would change colors. She’d then have to compare the color to photos on the back of the bottle, making her best guess about what range my glucose level fell within. And the level wasn’t even current – it represented what my glucose level was several hours before—making preparing my insulin dose even that much more difficult. My mom would then have the constant battle of giving me my insulin with a syringe injection at least three times a day, which I fought tooth and nail every time. Photo: Glenn Austin/PATH This hardly compares with the process children in Kenya have to suffer through in order to determine if they have VL. On Monday, we met with Simon Bolo—an inspiring man who works with the Drugs for Neglected Diseases initiative (DNDi) in Nairobi. He told us how the only 100% accurate ways of diagnosing VL, even for children, involves incredibly painful punctures to their spleen or bone marrow. Both are conducted with giant needles required to pierce the skin and bone marrow. Children suffering from VL deserve the same commitment to research that I’ve benefited from as a diabetic in the US. Over the past 20 years, the methods available to me to test my glucose levels throughout the day have vastly improved—I now have a small machine that requires little blood and gives me accurate results in five seconds. My treatment options have also advanced, from the types of insulin available to me and the fact that I now use an insulin pump, doing away with the need for multiple injections every day. Because of these improvements, my overall health as a diabetic has improved tremendously. A matched commitment to research for neglected diseases such as VL could have the same results for children in Kenya and around the world. These children should not have to go through such painful diagnostic procedures to confirm whether they have VL—imagine if they had access to a simple, effective, and rapid blood test that they could easily access in their community’s clinic. VL affects the “poorest of the poor,” Simon told us on Monday. “Our governments need to wake up and take responsibility” for supporting research that can lead to lifesaving new tools. Children in Kenya deserve the same access to modern and effective diagnostics and treatment that I’ve has as a diabetic in the US. Increased support for neglected disease research can provide them with that.

Katherine E. “Kemy” Monahan, a career foreign service officer steeped in development issues and an economist and lawyer by training, was appointed as deputy executive director of the Global Health Initiative (GHI) in July. She had been the Brussels-based Counselor for International Development and the US Agency for International Development (USAID) Representative to the European Union. She took up her new post in late September and just three weeks into her job traveled to Kenya. On Tuesday, after seeing a Centers for Disease Control and Prevention (CDC) research site in the Kibera slum, she talked to GHTC’s Breakthroughs blog on site about her impressions of the US global health work in Kenya, the importance of research, and the critical need now to make the case to Congress for investing in global health. Katherine E. “Kemy” Monahan, a career foreign service officer Photo: Evelyn Hockstein/PATH Q: What was most memorable about your visit to Kibera? A: There is such a contrast. You see this very poor slum that is far from an ideal environment and then you see very healthy mothers and children inside their homes. That’s a real tribute to the work that CDC and Carolina for Kibera are doing here. When people do get sick, they can go to a clinic here, thanks to these organizations. I met a grandmother who was part of a CDC study. The CDC worker found out that the child had a very high fever, and the grandmother didn’t know about it. They took him to the clinic, gave him medicine, and the grandmother said he was better immediately. She was very happy. Q: What is the benefit of the CDC research in Kibera? A: The grandmother said it well. We asked her what the project was about. She said that the CDC was trying to find more out about the diseases that are most dangerous, that they would tell the Ministry of Health their results, and that would be used to help the neighborhood and the whole country. She was exactly right. CDC really has educated people well about the study. Q: Where does research fit into the priorities of the Global Health Initiative (GHI)? A: GHI is very focused on efficiencies, on all the agencies working well together, and working with other stakeholders such as the host government, other donors, and NGOs. If I think of the one thing that has been most important in cost savings and advancements in global health, it would be research and development (R&D). Research and development can create whole new paradigms. It can cut costs dramatically with one new vaccine, or one new drug, or one new test. R&D is expensive on the front end but very cost effective once you start implementing it. It’s so important that we remember this is a long-term investment. There are examples all over PEPFAR (the President’s Emergency Plan for AIDS Relief), with the pneumococcal vaccine, and the many new innovations now being tested, such as microbicides research. Q: Like many programs in the US federal budget, global health funds are under threat. A House bill would cut $700 million from the administration’s request. How do you make the case for global health in these times? A: There are so many reasons why GHI is good for Americans. It’s not just a moral imperative. It’s not just a reflection of American values—although it is both of those. It’s also about national security, making sure we know how to fight epidemics, helping keep other countries strong. It’s really value for our money. It’s a small percentage of the budget that really is making a difference. Q: If $700 million is cut, what is lost? A: We would not be able to do so many of the things that Americans support. We may not be able to do all the work in preventing malaria, for instance, or we may have to cut back on pre-natal care that is so vital for the health of pregnant women. The choices would be very hard. The United States takes its commitments very seriously. The world respects us for meeting our commitments. America’s word is a bond, something to be proud of. We don’t want to lose that pride when it comes to meeting our commitments in global health, especially when they are so meaningful to people around the world.

John Donnelly, a writer working with the GHTC, will be blogging this week from our trip to visit global health research projects in Kenya. This is his first post from the field. Inside a large room at the US Embassy in Nairobi, Robert F. Breiman, MD, the country director for the Centers for Disease Control and Prevention (CDC) in Kenya, explained a portion of the US-funded research in Nairobi’s largest slum, Kibera. He referenced the recent hit movie, Contagion, in which an infectious disease speeds around the world, spread by air travelers and killing people within days of contact. “It’s not that Contagion couldn’t happen like in the movie,” Breiman said. “But what we are doing in Africa is changing the whole game in detecting infectious diseases.” During the beginning of the Global Health Technologies Coalition’s 10-day trip to Kenya to look at US-funded global health research and development (R&D), Breiman took us to Kibera to illustrate the use of technologies to control the spread of infectious disease and also to act as a warning system for the emergence of possible epidemics. As we walked in CDC-issued gumboots over ground inside the slum that was literally human refuse, garbage, plastic bags and mud, Breiman said the US government started efforts to hold clinical trials and track infectious disease in Kibera in 2004. Before, it had only worked in rural areas in Kenya. He said the shift into Kibera came because of the rapid urbanization of the country and the knowledge that a new disease such as SARS “would spread in a far different way in a rural area than it would in a tinderbox like this.” CDC officials held many meetings with residents about the project. “At first, we didn’t have their trust,” Breiman said. “Some people thought we would just be here for a few studies and then go.” Photo: Evelyn Hockstein/PATH He said that the purpose of CDC’s studies in the area was clear: Collecting data to impact policy. He also told them that CDC was committed to starting a program and staying. The program gave study participants the benefit of free health care, which later led to the building a health clinic in the slum. Of the many projects in two of Kibera’s 12 villages, Soweto and Gatwikera, one was a door-to-door HIV testing campaign, using rapid HIV tests; 80 percent—an astounding number—accepted the tests. A second larger project has been an ongoing disease surveillance of 28,500 residents. CDC community health workers visit each resident’s household every two weeks, using hand-held PDAs to record detailed information on family members’ health. They collect data on fevers, diarrhea, tuberculosis, pneumonia, and jaundice. Any sick member of the family is referred to the health clinic. “In the big cholera outbreak in 2010 in Nairobi, we detected it immediately because of our surveillance,” Breiman said. “Our team immediately jumped on it and started a safe water campaign.” The CDC team also has detected a daunting number of typhoid cases, which was virtually wiped out in the United States in the late 19th century. “By the age of 10, one out of every five children has had typhoid in their blood in Kenya,” he said. “It’s extraordinary, almost unimaginable.” Using population modeling, CDC estimated that 30,000 to 40,000 people contract typhoid every year in Kenya’s slums. It presented the data to the government of Kenya. “This kind of early detection of dangerous pathogens is important before they wreck havoc in these communities and around the world,” he said. Residents who have participated in the studies told us that they had their doubts at first, but now trust the CDC research. Photo: Evelyn Hockstein/PATH “For me, I was distrustful at first,” said Margaret Opondo, 42, a widow with three children. “There are people who try to take advantage of those of us in the slums. They do tests or take photos and they benefit. But I do trust them now. I believe their work is very important.” Last week, she said her son had a major nose bleed, and the clinic referred her to a hospital for treatment. He recovered, and Opondo didn’t pay anything. CDC covered the cost. “I was very happy about that,” she said. Another resident, Agribina Asingwa, 47, said when CDC workers came to her door for HIV testing, everyone agreed to be tested – all 11. “If they hadn’t come and done that, it would have taken us a longer period to get tested. CDC made it easy for us. “And,” she said, “I was really excited afterward. None of us tested positive.” Next: A trip to the western Kenya city of Kisumu.

Alex Dehgan, science and technology advisor to the admistrator of USAID, talks global health R&D with GHTC Dr. Alex Dehgan is the science and technology adviser to the administrator of the US Agency for International Development (USAID), where he helps employ science, technology, and creativity to help solve traditional and persistent development challenges. Previously, he worked in the Department of State on science diplomacy issues with the Muslim world, including Iraq, Afghanistan, and Pakistan. He talked with GHTC’s Breakthroughs blog on a number of issues, including a NASA-USAID innovation for remote areas and the promise of several products in the pipeline that could save many lives. Q: During USAID’s 50th year, there’s a lot of talk about helping women in the developing world. How are you doing this with scientific research? A: Microbicide research is a good example. It would empower women to protect themselves against HIV. In areas where there are economic disparities, where the relationship involves older men and younger and poorer women, and men refuse to use condoms, a microbicide might be the only way for a woman to protect herself. Another example is research and development with mobile phones. It helps women capitalize on the benefits of microfinance. It allows children to have access to educational materials. It allows for easy cash dispersal. And in health care situations in remote locations, NASA and USAID have an incubator program called LAUNCH. One of the innovations is essentially a lab-in-a-box, a handheld device that takes a drop of blood and analyzes it for quick diagnosis of a variety of diseases. This could have exceptional uses, including for regular checkups for women who are pregnant. Q: You’ve just had a large gathering in Washington, DC, of researchers at the Saving Lives at Birth event, part of USAID’s Grand Challenges initiative. Why was this important to you? A: We focused on three constraints: How to improve the capacity of caregiver, how to deliver new tools, and how to ensure demand generation by women. What we need to do now is provide women in remote settings with new tools. For instance, we’ve now have these simulation models that allow health care workers to simulate doing a C-section surgery. That kind of innovation is very important. Q: So what innovation jumped out at you at this gathering? A: One that caught my attention was a nominee from Australia on stopping post-partum bleeding, which is a major cause of death after childbirth. Now, there’s a drug that stops the bleeding, but you need cold chain – refrigeration – which can be difficult in remote areas. What the inventor did was turn the drug into an aerosol, which doesn’t need refrigeration. It’s a great example of how we use innovation to create easier ways to get the products people need out in the communities. Q: What about challenges in research? What happens after you get unexpected results from a trial? A: Microbicides is a good example. It’s one of the challenges that exist and it involves a great deal of trial and error research. It requires incremental knowledge, and it requires building upon the failures of other people, so that we can get to a product that works. We all tend to celebrate breakthroughs, but we don’t often look at how many combinations we had to try in order to get to the point itself. You have to try a variety of combinations. We are frequently expecting results very quickly and come up with answers on timelines, but it doesn’t always work out that way. That said, we need to recognize that failure is actually an opportunity to learn and move forward; we need to not be afraid to take risks.