1 00:00:05,056 --> 00:00:06,491 >> GOOD MORNING, GOOD AFTERNOON, 2 00:00:06,491 --> 00:00:08,459 GOOD EVENING TO EVERYONE WHO 3 00:00:08,459 --> 00:00:11,095 JOINED US FOR THIS GLOBAL 4 00:00:11,095 --> 00:00:11,362 WORKSHOP. 5 00:00:11,362 --> 00:00:12,297 I'M KAREN PLEVOCK-HAASE, I'M A 6 00:00:12,297 --> 00:00:13,832 PROGRAM OFFICER AT THE NATIONAL 7 00:00:13,832 --> 00:00:14,899 HEART, LUNG AND BLOOD INSTITUTE 8 00:00:14,899 --> 00:00:17,235 IN THE CENTER FOR TRANSLATION 9 00:00:17,235 --> 00:00:18,536 RESEARCH AND IMPLEMENTATION 10 00:00:18,536 --> 00:00:18,770 SCIENCE. 11 00:00:18,770 --> 00:00:21,806 ON BEHALF OF THE ORGANIZING 12 00:00:21,806 --> 00:00:23,441 COMMITTEE AND MY CO-CHAIR MISS 13 00:00:23,441 --> 00:00:24,676 VERONICA TONWE I WANT TO EXTEND 14 00:00:24,676 --> 00:00:25,977 A WARM WELCOME AND THANK YOU FOR 15 00:00:25,977 --> 00:00:28,179 JOINING US TODAY AND TOMORROW 16 00:00:28,179 --> 00:00:30,348 FOR ENGAGING DISCUSSIONS AROUND 17 00:00:30,348 --> 00:00:31,783 GLOBAL IMPLEMENTATION SCIENCE 18 00:00:31,783 --> 00:00:32,884 APPROACHES TO IMPROVE MATERNAL 19 00:00:32,884 --> 00:00:34,185 HEART LUNG BLOOD AND SLEEP 20 00:00:34,185 --> 00:00:34,853 HEALTH OUTCOMES. 21 00:00:34,853 --> 00:00:37,255 OVER THE NEXT FEW DAYS WE HAVE A 22 00:00:37,255 --> 00:00:39,691 PACKED AGENDA IN A INCLUDES 23 00:00:39,691 --> 00:00:40,658 KEYNOTE SPEECHES AND PANEL 24 00:00:40,658 --> 00:00:41,092 DISCUSSIONS. 25 00:00:41,092 --> 00:00:42,961 BEFORE WE MOVE INTO OUR 26 00:00:42,961 --> 00:00:45,930 WELCOMING RACKS I WANTED TO GO 27 00:00:45,930 --> 00:00:49,300 OVER THE FORMAT, OBJECTIVES AND 28 00:00:49,300 --> 00:00:49,968 GOALS. 29 00:00:49,968 --> 00:00:52,503 DAY 1 TWO KEYNOTE PRESENTATIONS, 30 00:00:52,503 --> 00:00:54,672 THREE PANEL DISCUSSIONS, FOCUSED 31 00:00:54,672 --> 00:00:58,309 ON IMPLEMENTATION SCIENCE AND 32 00:00:58,309 --> 00:01:00,411 MATERNAL CARDIOVASCULAR HEALTH, 33 00:01:00,411 --> 00:01:03,348 HEMATOLOGY, AND BLOOD 34 00:01:03,348 --> 00:01:04,249 TRANSFUSIONS AS FACTORS IN 35 00:01:04,249 --> 00:01:05,450 MATERNITY MORBIDITY AND 36 00:01:05,450 --> 00:01:07,886 MORTALITY, AND A SPOTLIGHT ON 37 00:01:07,886 --> 00:01:09,120 THE NIH SCIENCE PROGRAMS. 38 00:01:09,120 --> 00:01:11,489 DAY 2 WILL START WITH A KEYNOTE 39 00:01:11,489 --> 00:01:13,558 IMPROVING EVIDENCE BASE FOR 40 00:01:13,558 --> 00:01:14,559 MATERNITY CARE, THREE PANELS 41 00:01:14,559 --> 00:01:17,595 WHICH WILL INCLUDE A FOCUS ON 42 00:01:17,595 --> 00:01:18,463 IMPLEMENTATION SCIENCE AND 43 00:01:18,463 --> 00:01:20,999 MATERNAL LUNG HEALTH, SLEEP 44 00:01:20,999 --> 00:01:22,100 HEALTH, INNOVATIVE CARE 45 00:01:22,100 --> 00:01:22,367 DELIVERY. 46 00:01:22,367 --> 00:01:25,270 SESSIONS ARE DESIGNED TO PARK 47 00:01:25,270 --> 00:01:27,005 NEW IDEAS, HIGHLIGHT STRATEGIES, 48 00:01:27,005 --> 00:01:29,073 AND ENCOURAGE COLLABORATION 49 00:01:29,073 --> 00:01:29,874 ACROSS DISCIPLINES AND BORDERS. 50 00:01:29,874 --> 00:01:32,377 IN TERMS OF THE WORKSHOP 51 00:01:32,377 --> 00:01:34,245 OBJECTIVES, WE HOPE TO EXPLORE 52 00:01:34,245 --> 00:01:35,480 MATERNAL HEALTH CRISIS IN THE 53 00:01:35,480 --> 00:01:44,289 U.S. IN THE CONTEXT HEALTH 54 00:01:44,289 --> 00:01:48,359 DISPARITIES AND, USING GLOBAL 55 00:01:48,359 --> 00:01:51,829 SUCCESSES TO DETERMINE HOW 56 00:01:51,829 --> 00:01:53,164 EVIDENCE-BASED PRACTICES CAN BE 57 00:01:53,164 --> 00:01:54,999 CONTEXTUALLY ADAPTED TO IMPROVE 58 00:01:54,999 --> 00:01:57,201 MATERNAL HEALTH IN VULNERABLE 59 00:01:57,201 --> 00:01:58,069 POPULATIONS WORLDWIDE. 60 00:01:58,069 --> 00:01:59,938 IMPORTANTLY, WE WANT TO EXPLORE 61 00:01:59,938 --> 00:02:02,807 CHALLENGES AND OPPORTUNITIES FOR 62 00:02:02,807 --> 00:02:04,208 ADVANCING IMPLEMENTATION 63 00:02:04,208 --> 00:02:04,976 RESEARCH, TRAINING, CAPACITY 64 00:02:04,976 --> 00:02:06,411 BUILDING FOR MATERNAL HEALTH, 65 00:02:06,411 --> 00:02:08,479 WITH FOCUS ON HEART, LUNG, 66 00:02:08,479 --> 00:02:10,782 BLOOD, AND SLEEP DISORDERS THAT 67 00:02:10,782 --> 00:02:11,316 IMPACT PREGNANT WOMEN AND 68 00:02:11,316 --> 00:02:14,385 MOTHERS IN THE U.S. AND ABROAD 69 00:02:14,385 --> 00:02:15,520 INCLUDING LMICs. 70 00:02:15,520 --> 00:02:17,822 WE WILL DISCUSS THE IMPORTANCE 71 00:02:17,822 --> 00:02:19,557 OF ENGAGING THE COMMUNITY IN 72 00:02:19,557 --> 00:02:20,758 MATERNAL HEALTH RESEARCH, AND 73 00:02:20,758 --> 00:02:23,061 PROGRAMS TO IMPROVE HEALTH OF 74 00:02:23,061 --> 00:02:24,595 MOTHERS IN PERINATAL AND 75 00:02:24,595 --> 00:02:25,496 POSTPARTUM PERIOD. 76 00:02:25,496 --> 00:02:26,597 SOMETHING WE WANT TO HIGHLIGHT 77 00:02:26,597 --> 00:02:29,834 OVER THE NEXT FEW DAYS IS HOW WE 78 00:02:29,834 --> 00:02:30,902 CAN FACILITATE RECIPROCAL 79 00:02:30,902 --> 00:02:32,370 LEARNING AND SHARING OF INSIGHTS 80 00:02:32,370 --> 00:02:34,339 BETWEEN GLOBAL AND DOMESTIC 81 00:02:34,339 --> 00:02:36,507 SETTINGS TO FOSTER INNOVATIVE 82 00:02:36,507 --> 00:02:42,246 SOLUTIONS AND CO-LEARNING 83 00:02:42,246 --> 00:02:44,415 OPPORTUNITIES THAT ENHANCE 84 00:02:44,415 --> 00:02:45,717 OUTCOMES. 85 00:02:45,717 --> 00:02:46,384 OUR GOALS TO EXCHANGE 86 00:02:46,384 --> 00:02:48,686 CUTTING-EDGE RESEARCH FINDINGS 87 00:02:48,686 --> 00:02:49,988 AND BEST PRACTICES, IDENTIFY 88 00:02:49,988 --> 00:02:52,490 KNOWLEDGE GAPS AND CRITICAL 89 00:02:52,490 --> 00:02:54,359 UNMET NEEDS, AND UNCOVER 90 00:02:54,359 --> 00:02:55,326 OPPORTUNITIES FOR IMPROVING 91 00:02:55,326 --> 00:02:59,397 MATERNAL HEART, LUNG, BLOOD, AND 92 00:02:59,397 --> 00:03:01,366 SLEEP HEALTH OUTCOMES USING 93 00:03:01,366 --> 00:03:02,233 IMPLEMENTATION SCIENCE. 94 00:03:02,233 --> 00:03:04,969 WE HOPE WE CAN FOSTER 95 00:03:04,969 --> 00:03:06,204 PARTNERSHIPS AND COLLABORATIONS 96 00:03:06,204 --> 00:03:08,673 THAT CAN DRIVE PROGRESS IN 97 00:03:08,673 --> 00:03:09,040 MATERNAL HEALTH. 98 00:03:09,040 --> 00:03:10,641 AS WE START THE FANTASTIC 99 00:03:10,641 --> 00:03:11,843 SESSIONS I'D LIKE TO ENCOURAGE 100 00:03:11,843 --> 00:03:14,579 YOU TO STAY ENGAGED THROUGH THE 101 00:03:14,579 --> 00:03:15,480 QUESTION-AND-ANSWER BOX FOR 102 00:03:15,480 --> 00:03:17,882 QUESTIONS AND CHAT FEATURE FOR 103 00:03:17,882 --> 00:03:18,182 DISCUSSION. 104 00:03:18,182 --> 00:03:21,586 MODERATORS WILL BE ACTIVELY 105 00:03:21,586 --> 00:03:23,154 MONITORING THE QA BOX AND WILL 106 00:03:23,154 --> 00:03:23,988 BRING COMMENTS AND QUESTIONS 107 00:03:23,988 --> 00:03:26,758 INTO THE LIVE DISCUSSION. 108 00:03:26,758 --> 00:03:28,793 I'M DELIGHTED WE HAVE DR. KARA 109 00:03:28,793 --> 00:03:31,329 LOUIS FROM THE CENTER FOR 110 00:03:31,329 --> 00:03:35,266 TRANSLATION RESEARCH AND 111 00:03:35,266 --> 00:03:36,801 IMPLEMENT SCIENCE TO PROVIDE 112 00:03:36,801 --> 00:03:37,702 BRIEF WELCOMING REMARKS. 113 00:03:37,702 --> 00:03:45,610 I WILL PASS OVER TO DR. LEWIS. 114 00:03:45,610 --> 00:03:46,677 THANK YOU. 115 00:03:46,677 --> 00:03:47,678 >> GOOD MORNING, GOOD AFTERNOON, 116 00:03:47,678 --> 00:03:48,579 GOOD EVENING, EVERYONE. 117 00:03:48,579 --> 00:03:50,415 I'M DELIGHTED TO WELCOME YOU TO 118 00:03:50,415 --> 00:03:52,283 THE WORKSHOP CENTERING GLOBAL 119 00:03:52,283 --> 00:03:53,351 IMPLEMENTATION SCIENCE 120 00:03:53,351 --> 00:03:55,219 APPROACHES TO IMPROVE MATERNAL 121 00:03:55,219 --> 00:03:57,088 HEALTH, MATERNAL HEART, LUNG, 122 00:03:57,088 --> 00:04:00,925 BLOOD, AND SLEEP HEALTH 123 00:04:00,925 --> 00:04:01,192 OUTCOMES. 124 00:04:01,192 --> 00:04:03,027 I'M CARA LEWIS, DEPUTY DIRECTOR 125 00:04:03,027 --> 00:04:10,435 AT NHLBI CENTER FOR TRANSLATION 126 00:04:10,435 --> 00:04:11,502 RESEARCH, CTRIS GOING FORWARD, A 127 00:04:11,502 --> 00:04:12,637 GREAT PRIVILEGE TO EXTEND THE 128 00:04:12,637 --> 00:04:14,705 WARM WELCOME ON BEHALF OF 129 00:04:14,705 --> 00:04:18,443 LEADERSHIP AND STAFF OF NHLBI. 130 00:04:18,443 --> 00:04:19,644 THANKS TO THOSE WHO MADE THIS 131 00:04:19,644 --> 00:04:20,244 EVENT POSSIBLE. 132 00:04:20,244 --> 00:04:21,946 I THANK THE MANY PANELISTS AND 133 00:04:21,946 --> 00:04:23,681 EXPERTS WHO WILL BE SHARING 134 00:04:23,681 --> 00:04:26,317 INSIGHTS ON THE CHALLENGES AND 135 00:04:26,317 --> 00:04:27,852 SUCCESSES OF SUPPORTING 136 00:04:27,852 --> 00:04:28,920 IMPLEMENTATION RESEARCH, WHICH 137 00:04:28,920 --> 00:04:32,123 CAN REVEAL STRATEGIES TO 138 00:04:32,123 --> 00:04:33,424 TRANSLATE BASIC SCIENCE 139 00:04:33,424 --> 00:04:33,958 DISCOVERIES, EPIDEMIOLOGIC 140 00:04:33,958 --> 00:04:36,594 INSIGHTS, INTERVENTION RESEARCH 141 00:04:36,594 --> 00:04:40,465 FINDINGS TO IMPROVE MATERNAL 142 00:04:40,465 --> 00:04:40,731 OUTCOMES. 143 00:04:40,731 --> 00:04:44,702 IT'S AN HONOR TO SEE SUCH AN 144 00:04:44,702 --> 00:04:46,137 ESTEEMED GROUP GATHERED HERE 145 00:04:46,137 --> 00:04:46,337 TODAY. 146 00:04:46,337 --> 00:04:49,073 I WANT TO TAKE THE OPPORTUNITY 147 00:04:49,073 --> 00:04:50,508 TO THANK YOU, OUR ATTENDEES, WE 148 00:04:50,508 --> 00:04:53,811 KNOW ALL OF YOU ARE VERY BUSY 149 00:04:53,811 --> 00:04:54,745 WITH MULTIPLE COMPETING 150 00:04:54,745 --> 00:04:56,214 PRIORITIES, IT MEANS A LOT TO US 151 00:04:56,214 --> 00:04:58,416 AT NHLBI AND CTRIS THAT YOU 152 00:04:58,416 --> 00:05:00,284 AGREED TO JOIN US AT THIS 153 00:05:00,284 --> 00:05:00,885 WORKSHOP. 154 00:05:00,885 --> 00:05:01,486 THANK YOU. 155 00:05:01,486 --> 00:05:03,554 I'M EXCITED TO LEARN WITH AND 156 00:05:03,554 --> 00:05:05,823 FROM YOU ALL TODAY. 157 00:05:05,823 --> 00:05:08,960 NOW A FEW REMINDERS WHY WE'RE 158 00:05:08,960 --> 00:05:11,696 HERE. 159 00:05:11,696 --> 00:05:12,296 DESPITE SIGNIFICANT SCIENTIFIC 160 00:05:12,296 --> 00:05:13,898 ADVANCES, MATERNAL MORBIDITY AND 161 00:05:13,898 --> 00:05:16,200 MORTALITY REMAINS PRESSING 162 00:05:16,200 --> 00:05:16,934 GLOBAL CHALLENGES PARTICULARLY 163 00:05:16,934 --> 00:05:18,469 IN LOW-RESOURCE SETTINGS. 164 00:05:18,469 --> 00:05:19,103 MATERNAL MORTALITY IS RISING IN 165 00:05:19,103 --> 00:05:23,441 THE U.S. AND WE'RE SEEING 166 00:05:23,441 --> 00:05:24,609 DISPARITIES EXACERBATED. 167 00:05:24,609 --> 00:05:25,843 SOBERING FACT IN THE UNITED 168 00:05:25,843 --> 00:05:28,246 STATES UP TO 80% OF THESE 169 00:05:28,246 --> 00:05:29,680 MATERNAL DEATHS ARE PREVENTIBLE. 170 00:05:29,680 --> 00:05:40,358 AND THIS IS WHERE WHERE THE T 171 00:05:44,095 --> 00:05:46,197 SCIENCE COMES IN, TO PROMOTE 172 00:05:46,197 --> 00:05:48,633 WELL-BEING FOR ALL, AT ALL AGES. 173 00:05:48,633 --> 00:05:50,668 WE CAN LOOK TO NHLBI STRATEGIC 174 00:05:50,668 --> 00:05:54,205 VISION GOAL NUMBER 4, ADVANCE 175 00:05:54,205 --> 00:05:56,174 TRANSLATIONAL RESEARCH, TO 176 00:05:56,174 --> 00:05:57,608 FACILITATE INNOVATION AND 177 00:05:57,608 --> 00:06:01,212 ACCELERATE RESEARCH TRANSLATION 178 00:06:01,212 --> 00:06:02,413 ACROSS THE RESEARCH SPECTRUM, 179 00:06:02,413 --> 00:06:04,081 BRIDGING BASIC TO CLINICAL, 180 00:06:04,081 --> 00:06:07,018 CLINICAL TO PRACTICE, POPULATION 181 00:06:07,018 --> 00:06:08,653 TO HEALTH IMPACT, OBJECTIVE 6 TO 182 00:06:08,653 --> 00:06:09,554 OPTIMIZE CLINICAL AND 183 00:06:09,554 --> 00:06:11,322 IMPLEMENTATION RESEARCH TO 184 00:06:11,322 --> 00:06:13,591 IMPROVE HEALTH AND REDUCE 185 00:06:13,591 --> 00:06:14,025 DISEASE. 186 00:06:14,025 --> 00:06:15,226 WHILE NEW INTERVENTIONS TO 187 00:06:15,226 --> 00:06:17,094 IMPROVE MATERNAL HEALTH MAY BE 188 00:06:17,094 --> 00:06:19,163 NECESSARY TO ROUND OUT THAT 189 00:06:19,163 --> 00:06:21,365 WHICH IS AVAILABLE, ONE APPROACH 190 00:06:21,365 --> 00:06:23,668 FORWARD IS TO CAPITALIZE ON THE 191 00:06:23,668 --> 00:06:24,435 SCIENTIFIC RESEARCH INVESTMENTS 192 00:06:24,435 --> 00:06:28,272 OF NIH AND OTHER AGENCIES TO 193 00:06:28,272 --> 00:06:31,442 EXPLORE WAYS TO INCREASE 194 00:06:31,442 --> 00:06:32,977 ACCESSIBILITY, UPTAKE, ADOPTION, 195 00:06:32,977 --> 00:06:34,378 INTEGRATION OF EXISTING 196 00:06:34,378 --> 00:06:35,646 EVIDENCE-BASED INTERVENTIONS, 197 00:06:35,646 --> 00:06:37,248 ESPECIALLY FOR POPULATIONS THAT 198 00:06:37,248 --> 00:06:39,750 ARE DISPROPORTIONATELY IMPACTED 199 00:06:39,750 --> 00:06:42,286 AND FOR THOSE IN MATERNITY CARE 200 00:06:42,286 --> 00:06:43,020 DESERTS. 201 00:06:43,020 --> 00:06:45,690 IMPLEMENTATION RESEARCH IS 202 00:06:45,690 --> 00:06:48,960 DESIGNED TO BRIDGE THIS GAP 203 00:06:48,960 --> 00:06:50,394 USING THEORIES, MODELS, 204 00:06:50,394 --> 00:06:51,295 FRAMEWORKS, MEASURES, METHODS, 205 00:06:51,295 --> 00:06:54,131 TOOLS, THIS TYPE OF RESEARCH CAN 206 00:06:54,131 --> 00:06:56,200 ELUCIDATE WAYS TO CUSTOMIZE OR 207 00:06:56,200 --> 00:06:58,269 STREAMLINE OR OTHERWISE OPTIMIZE 208 00:06:58,269 --> 00:06:59,136 EVIDENCE-BASED INTERVENTIONS FOR 209 00:06:59,136 --> 00:07:00,571 ENHANCING THE REACH WE HOPE TO 210 00:07:00,571 --> 00:07:06,510 SEE, THE IMPACT WE HOPE TO HAVE, 211 00:07:06,510 --> 00:07:07,845 EQUITY FOR INSTANCE BY FOCUSING 212 00:07:07,845 --> 00:07:09,814 ON STRATEGIES TO DELIVER, SCALE, 213 00:07:09,814 --> 00:07:10,581 SPREAD INTERVENTIONS IN 214 00:07:10,581 --> 00:07:14,285 PARTNERSHIP WITH COMMUNITIES TO 215 00:07:14,285 --> 00:07:15,152 EXPLORE CONTEXTUAL ADAPTATIONS 216 00:07:15,152 --> 00:07:17,555 AS NEEDED WE CAN ADDRESS 217 00:07:17,555 --> 00:07:19,257 COMPLEXITIES THAT IMPACT 218 00:07:19,257 --> 00:07:20,024 IMPLEMENTATION SUCCESS. 219 00:07:20,024 --> 00:07:22,827 THIS WORKSHOP IS AN OPPORTUNITY 220 00:07:22,827 --> 00:07:25,663 TO DELVE INTO NUANCES OF 221 00:07:25,663 --> 00:07:26,530 IMPLEMENTATION RESEARCH, SHARE 222 00:07:26,530 --> 00:07:27,965 INSIGHTS THAT CAN INCREASE 223 00:07:27,965 --> 00:07:29,600 IMPACT OF EFFECTIVE MATERNAL 224 00:07:29,600 --> 00:07:31,769 HEALTH INTERVENTIONS THAT 225 00:07:31,769 --> 00:07:32,870 ADDRESS HEART, LUNG, BLOOD, AND 226 00:07:32,870 --> 00:07:33,404 SLEEP DISEASES. 227 00:07:33,404 --> 00:07:36,040 ONE OF THE CORE PRINCIPLES OF 228 00:07:36,040 --> 00:07:38,676 THIS WORKSHOP IS RECIPROCAL 229 00:07:38,676 --> 00:07:39,243 LEARNING. 230 00:07:39,243 --> 00:07:40,044 THERE'S AN IMMENSE KNOWLEDGE 231 00:07:40,044 --> 00:07:42,813 BASE TO BE SHARED AMONG 232 00:07:42,813 --> 00:07:44,382 RESEARCHERS, PRACTITIONERS, 233 00:07:44,382 --> 00:07:46,250 PROFESSIONALS AND THE PUBLIC 234 00:07:46,250 --> 00:07:47,752 ACROSS THE GLOBE AND WE'RE HERE 235 00:07:47,752 --> 00:07:50,187 TO LEARN IN ONE ANOTHER, 236 00:07:50,187 --> 00:07:52,056 BRINGING GREAT MINDS TOGETHER 237 00:07:52,056 --> 00:07:54,792 ENRICHING OUR UNDERSTANDING AND 238 00:07:54,792 --> 00:07:55,860 FOSTERING SOLUTIONS. 239 00:07:55,860 --> 00:07:57,094 COLLABORATION IS KEY TO 240 00:07:57,094 --> 00:07:57,828 OVERCOMING THE COMPLEX 241 00:07:57,828 --> 00:07:59,297 CHALLENGES THAT WE FACE IN 242 00:07:59,297 --> 00:08:01,165 MATERNAL HEALTH AND BY WORKING 243 00:08:01,165 --> 00:08:03,567 TOGETHER WE CAN CREATE SYNERGIES 244 00:08:03,567 --> 00:08:04,635 THAT AMPLIFY OUR IMPACT. 245 00:08:04,635 --> 00:08:09,273 SO, AS WE EMBARK ON THIS 246 00:08:09,273 --> 00:08:11,876 JOURNEY, I ENCOURAGE YOU TO 247 00:08:11,876 --> 00:08:13,311 PARTICIPATE, SHARE EXPERIENCES, 248 00:08:13,311 --> 00:08:14,178 CHALLENGE CONVENTIONAL THINKING, 249 00:08:14,178 --> 00:08:15,846 IDENTIFY GAPS AND OPPORTUNITIES 250 00:08:15,846 --> 00:08:16,814 FOR FUTURE RESEARCH. 251 00:08:16,814 --> 00:08:20,551 LET US USE THIS PLATFORM TO 252 00:08:20,551 --> 00:08:21,852 INSPIRE, BE INSPIRED, INNOVATE 253 00:08:21,852 --> 00:08:24,455 AND TO IMPLEMENT, AND TO MAKE A 254 00:08:24,455 --> 00:08:25,556 TANGIBLE DIFFERENCE IN LIVES OF 255 00:08:25,556 --> 00:08:27,525 MOTHERS AND FAMILIES AROUND THE 256 00:08:27,525 --> 00:08:27,858 WORLD. 257 00:08:27,858 --> 00:08:31,796 WE'RE ASKING YOU TO USE THIS 258 00:08:31,796 --> 00:08:33,130 DIVERSE EXPERTISE GATHERED HERE 259 00:08:33,130 --> 00:08:34,765 TODAY AND TOMORROW TO IDENTIFY 260 00:08:34,765 --> 00:08:35,866 OPPORTUNITIES FOR ENHANCING WHAT 261 00:08:35,866 --> 00:08:38,903 WE CALL LATE STAGE TRANSLATION 262 00:08:38,903 --> 00:08:41,972 RESEARCH THAT LEVERAGES ALL THAT 263 00:08:41,972 --> 00:08:43,808 WE CAN FOR HEART, LUNG, BLOOD, 264 00:08:43,808 --> 00:08:46,577 AND SLEEP CONDITIONS. 265 00:08:46,577 --> 00:08:47,445 THE NATIONAL HEART, LUNG AND 266 00:08:47,445 --> 00:08:48,979 BLOOD INSTITUTE IS COMMITTED TO 267 00:08:48,979 --> 00:08:52,016 ADVANCING THIS TYPE OF RESEARCH 268 00:08:52,016 --> 00:08:52,917 THAT DIRECTLY TURNS DISCOVERIES 269 00:08:52,917 --> 00:08:55,986 INTO REAL WORLD HEALTH IMPACTS. 270 00:08:55,986 --> 00:08:58,622 CTRIS, THE STRATEGIC FOCAL POINT 271 00:08:58,622 --> 00:08:59,857 FOR THE ACTIVITIES, IS EXCITED 272 00:08:59,857 --> 00:09:03,361 TO HOST YOU TODAY. 273 00:09:03,361 --> 00:09:04,729 A COUPLE LAST POINTS, I'M 274 00:09:04,729 --> 00:09:06,864 REQUIRED TO REMIND THAT YOU 275 00:09:06,864 --> 00:09:09,233 UNDER THE FEDERAL ADVISORY 276 00:09:09,233 --> 00:09:12,203 COMMITTEE ACT, FACA, SIGNED INTO 277 00:09:12,203 --> 00:09:14,505 LAW IN 1972, OUR WORKSHOPS ARE 278 00:09:14,505 --> 00:09:17,341 NOT CONSTITUTED FOR YOU TO 279 00:09:17,341 --> 00:09:19,310 ADVISE NHLBI OR MAKE SPECIFIC 280 00:09:19,310 --> 00:09:20,845 RECOMMENDATIONS TO NHLBI OR NIH. 281 00:09:20,845 --> 00:09:23,047 KEEP IN MIND WE ASK THAT YOU 282 00:09:23,047 --> 00:09:24,682 FRAME THE INSIGHTS YOU SHARE 283 00:09:24,682 --> 00:09:26,550 WITH US AS CHALLENGES THAT WE 284 00:09:26,550 --> 00:09:29,286 OUGHT TO OVERCOME AND 285 00:09:29,286 --> 00:09:31,355 OPPORTUNITIES FOR NHLBI TO 286 00:09:31,355 --> 00:09:32,990 EXPLORE, NOT A SPECIFIC 287 00:09:32,990 --> 00:09:33,357 RECOMMENDATION. 288 00:09:33,357 --> 00:09:34,091 THE OPPORTUNITIES YOU IDENTIFY 289 00:09:34,091 --> 00:09:36,827 WILL PLAY AN IMPORTANT ROLE AS 290 00:09:36,827 --> 00:09:38,796 NHLBI AND ITS DIVISIONS DEVELOP 291 00:09:38,796 --> 00:09:40,564 AND EXECUTE ON THEIR STRATEGIC 292 00:09:40,564 --> 00:09:41,766 VISION IMPLEMENTATION PLANS FOR 293 00:09:41,766 --> 00:09:43,100 THE FUTURE. 294 00:09:43,100 --> 00:09:46,137 ONCE AGAIN, WELCOME TO THE 295 00:09:46,137 --> 00:09:47,471 GLOBAL IMPLEMENTATION SCIENCE 296 00:09:47,471 --> 00:09:48,773 APPROACHES TO IMPROVE MATERNAL 297 00:09:48,773 --> 00:09:50,841 HEART, LUNG, BLOOD, AND SLEEP 298 00:09:50,841 --> 00:09:51,675 HEALTH OUTCOMES WORKSHOP. 299 00:09:51,675 --> 00:09:53,711 I LOOK FORWARD TO THE RICH 300 00:09:53,711 --> 00:09:54,678 DISCUSSIONS AND MEANINGFUL 301 00:09:54,678 --> 00:09:55,813 CONNECTIONS THAT WILL EMERGE 302 00:09:55,813 --> 00:09:56,714 FROM OUR TIME TOGETHER. 303 00:09:56,714 --> 00:09:58,416 THANK YOU FOR THE COMMITMENT TO 304 00:09:58,416 --> 00:10:00,284 THIS VITAL CAUSE. 305 00:10:00,284 --> 00:10:04,989 LET'S GET STARTED ON WHAT 306 00:10:04,989 --> 00:10:08,926 PROMISES TO BE AN ENLIGHT AND 307 00:10:08,926 --> 00:10:09,693 WORKSHOP. 308 00:10:09,693 --> 00:10:11,629 OVER TO YOU, DR. WILLIAMS, TO 309 00:10:11,629 --> 00:10:13,197 MODERATE. 310 00:10:13,197 --> 00:10:14,832 >> THANK YOU. 311 00:10:14,832 --> 00:10:15,833 GREETINGS. 312 00:10:15,833 --> 00:10:17,601 I'M DR. MAKEDA WILLIAMS, NHLBI 313 00:10:17,601 --> 00:10:19,336 GLOBAL HEALTH PROGRAM DIRECTOR. 314 00:10:19,336 --> 00:10:21,272 IT'S MY GREAT PLEASURE TO WILL 315 00:10:21,272 --> 00:10:23,607 BE YOU TO THIS KEYNOTE SESSION 316 00:10:23,607 --> 00:10:25,576 ON MATERNAL HEALTH, A CRITICAL 317 00:10:25,576 --> 00:10:27,211 FIELD THAT TOUCHES LIVES ACROSS 318 00:10:27,211 --> 00:10:29,146 EVERY CORNER OF THE GLOBE. 319 00:10:29,146 --> 00:10:31,682 IN THESE KEYNOTES WE'LL EXPLORE 320 00:10:31,682 --> 00:10:34,118 TWO PIVOTAL DIMENSIONS OF 321 00:10:34,118 --> 00:10:35,453 MATERNAL HEALTH, PURSUIT OF 322 00:10:35,453 --> 00:10:37,822 MATERNAL BIRTH EQUITY IN THE 323 00:10:37,822 --> 00:10:39,557 UNITED STATES, AND BROADER 324 00:10:39,557 --> 00:10:43,928 GLOBAL EFFORTS TO ENHANCE 325 00:10:43,928 --> 00:10:44,495 MATERNAL HEALTH THROUGH 326 00:10:44,495 --> 00:10:45,429 IMPLEMENTATION SCIENCE. 327 00:10:45,429 --> 00:10:47,665 FIRST SPEAKER IS A DISTINGUISHED 328 00:10:47,665 --> 00:10:50,935 ADVOCATE FOR MATERNAL BIRTH 329 00:10:50,935 --> 00:10:53,337 EQUITY, AT THE FOREFRONT OF 330 00:10:53,337 --> 00:11:00,578 ADDRESSING DISPARITIES. 331 00:11:00,578 --> 00:11:02,446 DR. JOII CREAR-PERRY WILL LOOK 332 00:11:02,446 --> 00:11:03,747 AT SYSTEMIC BARRIERS THAT 333 00:11:03,747 --> 00:11:04,582 CONTRIBUTE TO INEQUITABLE BIRTH 334 00:11:04,582 --> 00:11:07,251 OUTCOMES IN THE UNITED STATES 335 00:11:07,251 --> 00:11:09,553 AND SHARE INNOVATIVE STRATEGIES 336 00:11:09,553 --> 00:11:13,390 HER ORGANIZATION IS DEPLOYING TO 337 00:11:13,390 --> 00:11:19,964 ENSURE EVERY MOTHER REGARDS RES 338 00:11:19,964 --> 00:11:30,407 OF RACE OR STATUS CYSTS . 339 00:11:30,841 --> 00:11:34,078 DR. ECHE EZEANOLUI, A CLINTON 340 00:11:34,078 --> 00:11:35,145 SCIENTIST WITH USING 341 00:11:35,145 --> 00:11:36,347 IMPLEMENTATION SCIENCE TO 342 00:11:36,347 --> 00:11:39,416 IMPROVE HEALTH SERVICES AND 343 00:11:39,416 --> 00:11:40,951 OUTCOMES, INVOLVED IN SEVERAL 344 00:11:40,951 --> 00:11:41,986 SIGNIFICANT PROJECTS INCLUDING 345 00:11:41,986 --> 00:11:45,556 SERVING AS MULTIPLE P.I. FOR 346 00:11:45,556 --> 00:11:47,091 ACCELERATING CERVICAL CANCER 347 00:11:47,091 --> 00:11:47,725 ELIMINATION THROUGH INTEGRATION 348 00:11:47,725 --> 00:11:50,794 OF SCREEN AND TREAT SERVICES IN 349 00:11:50,794 --> 00:11:51,028 NIGERIA. 350 00:11:51,028 --> 00:11:54,064 WITH VAST EXPERIENCE IN PROGRAM 351 00:11:54,064 --> 00:11:54,965 IMPLEMENTATION AND EVALUATION, 352 00:11:54,965 --> 00:11:57,434 HE HAS BEEN PART OF OVER 25 353 00:11:57,434 --> 00:12:01,639 FUNDED PROJECTS IN THE UNITED 354 00:12:01,639 --> 00:12:03,474 STATES AND NIGERIA, DR. 355 00:12:03,474 --> 00:12:06,510 EZEANOLUI WILL DELVE INTO 356 00:12:06,510 --> 00:12:08,312 IMPLEMENTATION SCIENCE ADVANCING 357 00:12:08,312 --> 00:12:11,582 MATERNAL HEALTH WORLD WIDE, 358 00:12:11,582 --> 00:12:12,349 HIGHLIGHTING INNOVATION, 359 00:12:12,349 --> 00:12:13,117 COMMUNITY ENGAGEMENT, ADAPTION 360 00:12:13,117 --> 00:12:14,184 OF EVIDENCE-BASED PRACTICES TO 361 00:12:14,184 --> 00:12:17,588 MEET THE NEEDS OF VULNERABLE 362 00:12:17,588 --> 00:12:19,123 POPULATIONS. 363 00:12:19,123 --> 00:12:20,090 BOTH DOMESTICALLY AND 364 00:12:20,090 --> 00:12:21,325 INTERNATIONALLY, BY EXAMINING 365 00:12:21,325 --> 00:12:25,162 SUCCESSFUL CASE STUDIES AND 366 00:12:25,162 --> 00:12:25,796 ONGOING PROJECTS, DR. EZEANOLUI 367 00:12:25,796 --> 00:12:27,565 WILL PROVIDE UNDERSTANDING HOW 368 00:12:27,565 --> 00:12:30,167 TO TRANSLATE GLOBAL BEST 369 00:12:30,167 --> 00:12:33,571 PRACTICES INTO LOCAL CONTEXT. 370 00:12:33,571 --> 00:12:34,705 THESE PRESENTATIONS TOGETHER 371 00:12:34,705 --> 00:12:35,773 WILL ILLUMINATE CHALLENGES AND 372 00:12:35,773 --> 00:12:37,608 KICK OFF THE TWO-DAY WORKSHOP 373 00:12:37,608 --> 00:12:39,176 WHERE WE EXPLORE HOW 374 00:12:39,176 --> 00:12:42,680 COLLECTIVELY EFFORTS CAN BE 375 00:12:42,680 --> 00:12:43,347 BOLSTERED TO ENSURE SAFE AND 376 00:12:43,347 --> 00:12:45,416 EQUITABLE CARE FOR ALL MOTHERS. 377 00:12:45,416 --> 00:12:48,185 THANKS FOR JOINING. 378 00:12:48,185 --> 00:12:53,924 RIGHT NOW IT APPEARS DR. 379 00:12:53,924 --> 00:12:57,528 CREAR-PERRY MAY BE HAVING 380 00:12:57,528 --> 00:12:58,596 TECHNICAL DIFFICULTIES SO I'LL 381 00:12:58,596 --> 00:13:00,364 ASK DR. EZEANOLUI TO PROCEED AND 382 00:13:00,364 --> 00:13:03,701 WE'LL COME BACK TO DR. 383 00:13:03,701 --> 00:13:04,001 CREAR-PERRY. 384 00:13:04,001 --> 00:13:09,239 ARE YOU ABLE TO BEGIN FIRST? 385 00:13:09,239 --> 00:13:09,840 >> ABSOLUTELY. 386 00:13:09,840 --> 00:13:10,374 >> THANK YOU SO MUCH. 387 00:13:10,374 --> 00:13:11,408 >> THANK YOU SO MUCH. 388 00:13:11,408 --> 00:13:13,544 CAN YOU HEAR ME WELL? 389 00:13:13,544 --> 00:13:16,046 >> YES, WE CAN HEAR YOU VERY 390 00:13:16,046 --> 00:13:16,246 WELL. 391 00:13:16,246 --> 00:13:17,047 THANK YOU. 392 00:13:17,047 --> 00:13:17,481 >> THANK YOU. 393 00:13:17,481 --> 00:13:20,551 THANK YOU SO MUCH FOR THAT 394 00:13:20,551 --> 00:13:20,985 INTRODUCTION. 395 00:13:20,985 --> 00:13:26,790 ONE OF THE THINGS, NEXT SLIDE 396 00:13:26,790 --> 00:13:29,059 PLEASE. 397 00:13:29,059 --> 00:13:31,595 SO THIS IS MY DISCLOSURES, 398 00:13:31,595 --> 00:13:36,300 NOTHING TO DISCLOSE EXCEPTION 399 00:13:36,300 --> 00:13:37,935 FUNDING FROM NIH AND SOME OTHER 400 00:13:37,935 --> 00:13:38,502 INSTITUTIONS. 401 00:13:38,502 --> 00:13:39,703 NEXT SLIDE PLEASE. 402 00:13:39,703 --> 00:13:42,406 I'M GOING TO TALK ABOUT OUR 403 00:13:42,406 --> 00:13:44,375 EXPERIENCE IN COMMUNITY 404 00:13:44,375 --> 00:13:44,875 ENGAGEMENT IN FOSTERING 405 00:13:44,875 --> 00:13:47,011 INNOVATION AND HOW BEST WE HAVE 406 00:13:47,011 --> 00:13:49,980 TRIED TO ADAPT BEST PRACTICES 407 00:13:49,980 --> 00:13:51,415 AROUND THE GLOBE. 408 00:13:51,415 --> 00:13:52,049 NEXT SLIDE. 409 00:13:52,049 --> 00:13:55,219 SO ONE OF THE THINGS THAT WAS 410 00:13:55,219 --> 00:13:59,690 IMPORTANT FOR ME STARTING MY 411 00:13:59,690 --> 00:14:05,295 CAREER, WORKING IN LAS VEGAS AND 412 00:14:05,295 --> 00:14:06,964 NIGERIA, PEPFAR. 413 00:14:06,964 --> 00:14:08,966 WE RECOGNIZE THE EFFORT THAT THE 414 00:14:08,966 --> 00:14:14,438 UNITED STATES PUTS TO THE UNITED 415 00:14:14,438 --> 00:14:18,142 STATES FUND FOR AIDS RELIEF, ONE 416 00:14:18,142 --> 00:14:20,644 FOR ME ONE OF THE MOST 417 00:14:20,644 --> 00:14:23,714 TRANSFORMING THINGS, A FOCUS 418 00:14:23,714 --> 00:14:25,049 INITIALLY MOVING OF CHILD 419 00:14:25,049 --> 00:14:26,583 BEARING AGE TO IDENTIFY THESE 420 00:14:26,583 --> 00:14:28,886 WOMEN EARLY IN PREGNANCY, TO 421 00:14:28,886 --> 00:14:31,055 SCREEN THEM FOR HIV, TO PUT 422 00:14:31,055 --> 00:14:33,691 INTERVENTION SO THE IDEA WAS TO 423 00:14:33,691 --> 00:14:35,659 STOP THE NEW GENERATION OF 424 00:14:35,659 --> 00:14:36,960 CHILDREN BEING BORN WITH HIV. 425 00:14:36,960 --> 00:14:40,164 WHAT HAPPENED AT THAT TIME WAS 426 00:14:40,164 --> 00:14:42,232 ALL THE FUNDING WAS RESTRICTED 427 00:14:42,232 --> 00:14:44,968 FOR ONLY HIV AND HIV PROGRAM 428 00:14:44,968 --> 00:14:45,169 ALONE. 429 00:14:45,169 --> 00:14:48,372 THERE WAS NO -- IT WAS EXCLUDED 430 00:14:48,372 --> 00:14:49,373 BY CONGRESS THAT THOSE FUNDS 431 00:14:49,373 --> 00:14:51,041 SHOULD NOT BE USED FOR RESEARCH. 432 00:14:51,041 --> 00:14:53,744 IT DIDN'T TAKE LONG FOR THE 433 00:14:53,744 --> 00:14:56,246 COMMUNITY TO RECOGNIZE THAT 434 00:14:56,246 --> 00:14:59,783 THESE WOMEN LIVING WITH HIV HAVE 435 00:14:59,783 --> 00:15:01,785 OTHER PROBLEMS, CARDIOVASCULAR 436 00:15:01,785 --> 00:15:04,088 DISEASE, TYPIER TENSION, 437 00:15:04,088 --> 00:15:05,389 CERVICAL CANCER, OTHER PROBLEMS 438 00:15:05,389 --> 00:15:08,459 NOT HIV, THIS BEGAN TO EXPAND TO 439 00:15:08,459 --> 00:15:10,627 HIV AND RELATED DISEASES IN 440 00:15:10,627 --> 00:15:13,964 RECOGNITION THAT THESE ARE NOT 441 00:15:13,964 --> 00:15:17,000 WOMEN WITH HIV, WOMEN LIVING 442 00:15:17,000 --> 00:15:19,536 WITH HIV AND OTHER PROBLEMS TOO 443 00:15:19,536 --> 00:15:20,637 AND BEGAN TO RECOGNIZE 444 00:15:20,637 --> 00:15:21,739 OPERATIONAL RESEARCH AND 445 00:15:21,739 --> 00:15:23,373 IMPLEMENTATION SCIENCE WAS 446 00:15:23,373 --> 00:15:25,342 NEEDED IN ORDER TO BUILD OUT 447 00:15:25,342 --> 00:15:26,543 UNDERSTANDING HOW BEST TO USE 448 00:15:26,543 --> 00:15:30,147 STRATEGIES THAT WE KNOW HAVE 449 00:15:30,147 --> 00:15:32,349 WORKED SOMEWHERE ELSE, ADAPT, 450 00:15:32,349 --> 00:15:35,953 APPLY THEM IN THIS SETTING IN A 451 00:15:35,953 --> 00:15:37,921 WAY WE CAN ADVANCE 452 00:15:37,921 --> 00:15:39,957 MATERNAL/CHILD HEALTH. 453 00:15:39,957 --> 00:15:43,927 ONE THING THE PROGRAM WAS PUT IN 454 00:15:43,927 --> 00:15:45,896 THIS G11 GRANT, A SMALL GRANT OF 455 00:15:45,896 --> 00:15:49,333 THIRTY THOUSAND, TO TAKE A U.S. 456 00:15:49,333 --> 00:15:51,135 INSTITUTION, PAIR WITH LMIC 457 00:15:51,135 --> 00:15:52,569 INSTITUTION, BE ABLE TO DEVELOP 458 00:15:52,569 --> 00:15:55,739 GRANT MANAGEMENT OFFICES IN 459 00:15:55,739 --> 00:15:56,607 THESE INSTITUTIONS THAT CAN 460 00:15:56,607 --> 00:15:57,374 DRIVE THE RESEARCH. 461 00:15:57,374 --> 00:16:01,245 THIS IS THE SAME FUNCTION 462 00:16:01,245 --> 00:16:02,980 PERFORMED AND ORGANIZED BY 463 00:16:02,980 --> 00:16:03,547 NATIONAL COUNCIL UNIVERSITY 464 00:16:03,547 --> 00:16:04,648 ADMINISTRATION IN THE UNITED 465 00:16:04,648 --> 00:16:04,948 STATES. 466 00:16:04,948 --> 00:16:08,452 SO THROUGH THIS LITTLE FUND, IT 467 00:16:08,452 --> 00:16:10,420 WAS VERY IMPORTANT YOU STARTED 468 00:16:10,420 --> 00:16:12,122 TO SEE THIS THOSE COLLABORATIONS 469 00:16:12,122 --> 00:16:14,491 BUILD BETWEEN THE UNITED STATES 470 00:16:14,491 --> 00:16:16,460 AND THE LMICs, GIVING AN 471 00:16:16,460 --> 00:16:18,996 EXAMPLE OF NIGERIA YOU'LL SEE 472 00:16:18,996 --> 00:16:23,600 PROGRAMS FROM HARVARD UNIVERSITY 473 00:16:23,600 --> 00:16:26,003 WALKING IN NIGERIA, CREATING 18 474 00:16:26,003 --> 00:16:28,939 NIGERIA, INITIALLY A 475 00:16:28,939 --> 00:16:31,141 COLLABORATION BETWEEN HARVARD 476 00:16:31,141 --> 00:16:31,708 UNIVERSITY AND TRANSITIONING 477 00:16:31,708 --> 00:16:32,242 NIGERIAN LEADERSHIP. 478 00:16:32,242 --> 00:16:35,746 YOU SEE THE SAME THING WITH 479 00:16:35,746 --> 00:16:37,848 UNIVERSITY OF MARYLAND WORKING 480 00:16:37,848 --> 00:16:39,783 WITH NIGERIA, OVER TIME 481 00:16:39,783 --> 00:16:41,785 TRANSITIONING TO LEADERSHIP IN 482 00:16:41,785 --> 00:16:42,085 NIGERIA. 483 00:16:42,085 --> 00:16:43,520 SAME WITH COLUMBIA UNIVERSITY 484 00:16:43,520 --> 00:16:48,992 WORKING WITH NIGERIA AND ENDING 485 00:16:48,992 --> 00:16:52,496 UP WITH CIAHP, SOME BUILD UPON 486 00:16:52,496 --> 00:16:54,364 THIS SMALL GRANT, VERY IMPORTANT 487 00:16:54,364 --> 00:16:55,566 GRANT THAT BUILT OUT RESEARCH 488 00:16:55,566 --> 00:16:57,100 INFRASTRUCTURE NECESSARY FOR 489 00:16:57,100 --> 00:16:57,901 THESE INSTITUTIONS TO MANAGE 490 00:16:57,901 --> 00:16:59,503 FUNDS THAT THEY ARE GIVING, BE 491 00:16:59,503 --> 00:17:06,877 ABLE TO FOLLOW THEM AND COMPLY 492 00:17:06,877 --> 00:17:07,945 WITH RULES ACCORDING TO THE 493 00:17:07,945 --> 00:17:10,681 FUNDING AGENCY FROM THE UNITED 494 00:17:10,681 --> 00:17:11,148 STATES. 495 00:17:11,148 --> 00:17:11,915 NEXT SLIDE. 496 00:17:11,915 --> 00:17:13,917 ONE THING WE WERE LUCKY TO GET 497 00:17:13,917 --> 00:17:15,285 AFTER SPENDING 25 YEARS IN THE 498 00:17:15,285 --> 00:17:16,820 UNITED STATES, I DECIDED IT WAS 499 00:17:16,820 --> 00:17:18,689 TIME FOR ME, I WENT TO MEDICAL 500 00:17:18,689 --> 00:17:21,558 SCHOOL AT UNIVERSITY OF NIGERIA, 501 00:17:21,558 --> 00:17:23,594 AND UNIVERSITY PRESIDENT ASKED 502 00:17:23,594 --> 00:17:26,463 IF I COULD HELP DEVELOP 503 00:17:26,463 --> 00:17:28,098 PROGRAMS, RESEARCH PROGRAM AT 504 00:17:28,098 --> 00:17:28,398 UNIVERSITY. 505 00:17:28,398 --> 00:17:30,033 WHEN I WENT BACK TO UNIVERSITY 506 00:17:30,033 --> 00:17:31,602 OF NIGERIA ONE OF THE THINGS 507 00:17:31,602 --> 00:17:37,341 SURPRISING TO ME WAS IN MY OLD 508 00:17:37,341 --> 00:17:40,377 COLLEGE OF MEDICINE DEPARTMENT, 509 00:17:40,377 --> 00:17:41,478 WITH BIOSKETCH, YOU UNDERSTAND 510 00:17:41,478 --> 00:17:42,713 THAT HAVEN'T BEEN DOING A LOT OF 511 00:17:42,713 --> 00:17:44,214 RESEARCH SO ONE OF THE FIRST 512 00:17:44,214 --> 00:17:48,352 IMPORTANT THINGS TO DO WAS TO 513 00:17:48,352 --> 00:17:50,454 APPLY FOR G11 TO BUILD 514 00:17:50,454 --> 00:17:51,655 INFRASTRUCTURE THAT CAN ACTUALLY 515 00:17:51,655 --> 00:17:53,490 HELP THEM MANAGE FUNDING WHEN 516 00:17:53,490 --> 00:17:55,459 THEY DO RECEIVE THEM, THIS WAS 517 00:17:55,459 --> 00:17:56,593 CRITICALLY IMPORTANT. 518 00:17:56,593 --> 00:17:57,828 SO I SOUGHT COLLABORATION OF 519 00:17:57,828 --> 00:18:04,401 VERY GOOD FRIEND OF MINE, GREG 520 00:18:04,401 --> 00:18:07,604 ARONS, AT UC SAN DIEGO, MANAGING 521 00:18:07,604 --> 00:18:08,705 $1.5 BILLION IN GRANT FUNDING, I 522 00:18:08,705 --> 00:18:10,140 BELIEVE THEY UNDERSTAND HOW TO 523 00:18:10,140 --> 00:18:13,310 MANAGE THIS FUNDING AND THEY 524 00:18:13,310 --> 00:18:15,045 HAVE DONE IT, THEY CAN TEACH US 525 00:18:15,045 --> 00:18:15,812 HOW TO DO IT. 526 00:18:15,812 --> 00:18:17,247 THAT'S ONE OF THE FUNDING WE 527 00:18:17,247 --> 00:18:17,447 GOT. 528 00:18:17,447 --> 00:18:18,115 NEXT SLIDE. 529 00:18:18,115 --> 00:18:20,684 WHAT WE DID WAS TO TRY TO 530 00:18:20,684 --> 00:18:22,386 DEVELOP RESEARCH INFRASTRUCTURE 531 00:18:22,386 --> 00:18:25,355 SO THAT THE SCIENTIFIC FOCUS ON 532 00:18:25,355 --> 00:18:27,424 SCIENCE, WHAT HAPPENED FOR US IS 533 00:18:27,424 --> 00:18:29,393 THAT AS WE GOT FUNDING AT 534 00:18:29,393 --> 00:18:31,795 UNIVERSITY OF NIGERIA WE ALSO 535 00:18:31,795 --> 00:18:33,664 UNIVERSITY OF NIGERIA HAPPENED 536 00:18:33,664 --> 00:18:37,100 TO BE ORGANIZING AGENCY FOR 537 00:18:37,100 --> 00:18:38,001 IMPLEMENTATION SCIENCE ALLIANCE, 538 00:18:38,001 --> 00:18:39,903 FROM ALL THE SIX REGIONS OF THE 539 00:18:39,903 --> 00:18:40,237 COUNTRY. 540 00:18:40,237 --> 00:18:41,872 WHAT WE DID WAS INSTEAD OF 541 00:18:41,872 --> 00:18:43,206 LIMITING THAT TRAINING FOR 542 00:18:43,206 --> 00:18:47,244 UNIVERSITY OF NIGERIA, WE 543 00:18:47,244 --> 00:18:48,111 EXPANDED TO 12 CENTERS ACROSS 544 00:18:48,111 --> 00:18:50,981 SIX REGIONS OF THE COUNTRY. 545 00:18:50,981 --> 00:18:52,282 THAT'S ONE OF THE THINGS KNOWING 546 00:18:52,282 --> 00:18:54,952 WHEN YOU HAVE AN OPPORTUNITY TO 547 00:18:54,952 --> 00:18:58,956 DO SOMETHING, DO YOU DO IT JUST 548 00:18:58,956 --> 00:19:00,157 IN LIMITED OR INTEGRATE INTO 549 00:19:00,157 --> 00:19:03,226 EXISTING PROGRAMS SO IN THIS 550 00:19:03,226 --> 00:19:05,295 CASE WE HAVE EXISTING 551 00:19:05,295 --> 00:19:06,163 PRACTICE-BASED RESEARCH NETWORK, 552 00:19:06,163 --> 00:19:07,698 THIS NETWORK HAS MEMBER 553 00:19:07,698 --> 00:19:09,232 ORGANIZATION ACROSS THE COUNTRY, 554 00:19:09,232 --> 00:19:11,635 AND WE SAID, WELL, IF WE'RE 555 00:19:11,635 --> 00:19:13,704 TRAINING UNIVERSITY OF NIGERIA 556 00:19:13,704 --> 00:19:15,472 CAN WE INTEGRATE TO OTHER 557 00:19:15,472 --> 00:19:17,441 INSTITUTIONS TO SET UP GRANT 558 00:19:17,441 --> 00:19:22,145 MANAGEMENT APPLICATIONS TO THEM. 559 00:19:22,145 --> 00:19:23,080 WE'RE CURRENTLY WORKING TO 560 00:19:23,080 --> 00:19:25,115 INCREASE THIS NUMBER TO DOUBLE 561 00:19:25,115 --> 00:19:27,417 THAT, THE PRINCIPLE IF YOU'VE 562 00:19:27,417 --> 00:19:28,719 SEEN ONE, YOU TEACH ONE. 563 00:19:28,719 --> 00:19:30,020 IF YOU DO THAT, YOU'RE ABLE TO 564 00:19:30,020 --> 00:19:30,921 DOUBLE THAT. 565 00:19:30,921 --> 00:19:33,223 THE WHOLE IDEA IS THAT NIH 566 00:19:33,223 --> 00:19:35,926 CANNOT FUND EVERY SINGLE 567 00:19:35,926 --> 00:19:36,927 INSTITUTION IN LMIC TO BUILD 568 00:19:36,927 --> 00:19:38,895 THIS INFRASTRUCTURE BUT WHAT 569 00:19:38,895 --> 00:19:40,630 IT'S DOING IS FUND INSTITUTIONS 570 00:19:40,630 --> 00:19:42,599 WHO BECOME LIKE A HUB, AND 571 00:19:42,599 --> 00:19:43,834 INSTITUTIONS ARE EXPECTED TO 572 00:19:43,834 --> 00:19:44,901 TRAIN OTHER INSTITUTIONS. 573 00:19:44,901 --> 00:19:46,770 THAT IS NOT HAPPENING WELL. 574 00:19:46,770 --> 00:19:50,807 THOSE ARE SOME OPPORTUNITIES WE 575 00:19:50,807 --> 00:19:51,675 SEE. 576 00:19:51,675 --> 00:19:52,242 THEY DEVELOP THAT FUNDING 577 00:19:52,242 --> 00:19:54,544 INSTITUTION, IT STAYS IN THAT 578 00:19:54,544 --> 00:19:55,412 INSTITUTION BUT NOW THE 579 00:19:55,412 --> 00:19:56,513 INSTITUTION HAS SEEN, HAS DONE, 580 00:19:56,513 --> 00:19:58,382 WE THINK IT'S TIME FOR THAT 581 00:19:58,382 --> 00:20:00,417 INSTITUTION TO TEACH AND THERE 582 00:20:00,417 --> 00:20:01,852 BY EXPAND NUMBER OF INSTITUTIONS 583 00:20:01,852 --> 00:20:03,086 TO BE ABLE TO DO THAT. 584 00:20:03,086 --> 00:20:04,388 THAT'S SOME OF THE APPROACH 585 00:20:04,388 --> 00:20:09,826 WE'RE TRYING TO USE IN EXPANDING 586 00:20:09,826 --> 00:20:13,563 THAT TO THE NIGERIAN AALLIANCE, 587 00:20:13,563 --> 00:20:16,333 TO EXPAND IN OTHER INSTITUTIONS. 588 00:20:16,333 --> 00:20:17,968 NEXT SLIDE. 589 00:20:17,968 --> 00:20:26,843 AND ONCE WE HAVE THESE 590 00:20:26,843 --> 00:20:27,811 STRUCTURES TO MANAGE THE 591 00:20:27,811 --> 00:20:30,247 WORKFORCE, YOU SEE MANY 592 00:20:30,247 --> 00:20:32,115 PROGRAMS, D43s FROM NIH 593 00:20:32,115 --> 00:20:34,084 INSTITUTES SUPPORTING TRAINING 594 00:20:34,084 --> 00:20:35,819 OF WORKFORCE IN IMPLEMENTATION 595 00:20:35,819 --> 00:20:38,789 SCIENCE AND CANCER RESEARCH, 596 00:20:38,789 --> 00:20:39,389 HIV, CARDIOVASCULAR DISEASE, 597 00:20:39,389 --> 00:20:42,726 SICKLE CELL DISEASE, YOU CAN SEE 598 00:20:42,726 --> 00:20:43,827 STRUCTURE OF VERY IMPORTANT, 599 00:20:43,827 --> 00:20:46,229 BEGINS TO TRAIN THE WORKFORCE, 600 00:20:46,229 --> 00:20:50,734 IMPORTANT IN YOU'RE GOING TO 601 00:20:50,734 --> 00:20:55,205 HAVE AN EFFECTIVE INNOVATION 602 00:20:55,205 --> 00:20:57,174 THIS HAPPENS WHEN ONE SIDE IS 603 00:20:57,174 --> 00:20:58,842 WELL EQUIPPED WITH KNOWLEDGE, 604 00:20:58,842 --> 00:21:02,779 WITH EXPERTISE, WITH EXPERIENCE 605 00:21:02,779 --> 00:21:07,350 AND THEIR CONTEXT, AND HAVE 606 00:21:07,350 --> 00:21:12,856 EXPERIENCE WITH OWN CONTEXT AND 607 00:21:12,856 --> 00:21:13,824 KNOWLEDGE, EFFECTIVE RECIPROCAL 608 00:21:13,824 --> 00:21:18,962 INVASION, THESE TRAINING GRANTS, 609 00:21:18,962 --> 00:21:20,163 ESPECIALLY K43, CRITICAL, WHEN I 610 00:21:20,163 --> 00:21:21,598 WAS TRAINING THIS PART OF THE 611 00:21:21,598 --> 00:21:26,970 GRANT WAS NOT AVAILABLE. 612 00:21:26,970 --> 00:21:35,378 EQUIVALENT OF K08 K01 FOR U.S. 613 00:21:35,378 --> 00:21:37,147 CITIZENS WHO DO RESEARCH IN 614 00:21:37,147 --> 00:21:38,648 LIMITED SETTINGS. 615 00:21:38,648 --> 00:21:41,384 YOU COULDN'T COMPETE IN THIS 616 00:21:41,384 --> 00:21:42,185 GRANT. 617 00:21:42,185 --> 00:21:43,353 BY LEVELING THE GRANT FIELD, I 618 00:21:43,353 --> 00:21:44,788 USED TO TELL THEM NOW BECAUSE 619 00:21:44,788 --> 00:21:45,989 YOU CAN COMPETE AMONG PEOPLE 620 00:21:45,989 --> 00:21:48,492 WITH THE SAME BARRIERS YOU HAVE, 621 00:21:48,492 --> 00:21:50,594 SAME CHALLENGES, BE ABLE TO 622 00:21:50,594 --> 00:21:51,361 STAND OUT. 623 00:21:51,361 --> 00:21:52,996 COMPETING WITH ME OR SOMEBODY 624 00:21:52,996 --> 00:21:56,733 ELSE FROM HOPKINS OR ANY OTHER 625 00:21:56,733 --> 00:21:59,035 UNIVERSITY, SAME K01 OR OTHER 626 00:21:59,035 --> 00:22:03,006 GRANTS, SO THE K43 WAS SPECIFIC 627 00:22:03,006 --> 00:22:04,141 GRANT NIH ESTABLISHED, BECAME 628 00:22:04,141 --> 00:22:05,842 ONE OF THE FOUNDATIONS WHAT 629 00:22:05,842 --> 00:22:08,011 WE'RE TALKING ABOUT TODAY, 630 00:22:08,011 --> 00:22:11,414 RECIPROCAL INNOVATION, WHICH 631 00:22:11,414 --> 00:22:13,150 WE'LL HAVE STARTED, TALKING 632 00:22:13,150 --> 00:22:16,319 ABOUT TRAINING THE WORKFORCE IN 633 00:22:16,319 --> 00:22:17,754 LMIC. 634 00:22:17,754 --> 00:22:20,590 YOU GET THEM GETTING U54, BEGIN 635 00:22:20,590 --> 00:22:23,226 TO DO RESEARCH THAT REALLY DRIVE 636 00:22:23,226 --> 00:22:24,094 PRACTICE AND POLICY. 637 00:22:24,094 --> 00:22:25,395 AND IT'S THIS PRACTICE AND 638 00:22:25,395 --> 00:22:28,365 POLICY CHANGE THAT GO ON FOR 639 00:22:28,365 --> 00:22:32,202 OVERALL HEALTH OUTCOME FOR 640 00:22:32,202 --> 00:22:32,402 WOMEN. 641 00:22:32,402 --> 00:22:35,906 NEXT SLIDE. 642 00:22:35,906 --> 00:22:38,308 THIS IS SOMETHING PEOPLE FORGET, 643 00:22:38,308 --> 00:22:40,377 TO CONDUCT RESEARCH, ESPECIALLY 644 00:22:40,377 --> 00:22:44,414 IN LMIC, AS IT IS, IN OTHER 645 00:22:44,414 --> 00:22:47,384 PLACE, THERE'S A CRITICAL 646 00:22:47,384 --> 00:22:50,020 PARTNER IN THIS, RESEARCH 647 00:22:50,020 --> 00:22:50,987 COORDINATORS, THE MID-LEVEL 648 00:22:50,987 --> 00:22:53,089 RESEARCH PEOPLE THAT ARE NOT THE 649 00:22:53,089 --> 00:22:54,824 P.I.s, NOT PhDs, NOT 650 00:22:54,824 --> 00:22:56,593 M.D.s, BUT CRITICAL FOR US TO 651 00:22:56,593 --> 00:22:57,827 DO RESEARCH WELL. 652 00:22:57,827 --> 00:22:59,763 FOR A LONG PERIOD OF TIME 653 00:22:59,763 --> 00:23:02,933 PhDs, M.D.s WERE THE FOCUS 654 00:23:02,933 --> 00:23:07,404 AND TRAINED TO THE D43 BUT 655 00:23:07,404 --> 00:23:09,072 THERE'S RECOGNITION THERE'S NEED 656 00:23:09,072 --> 00:23:12,142 FOR TRAINING OF COORDINATORS AND 657 00:23:12,142 --> 00:23:13,443 RESEARCH ENGAGEMENT OFFICERS, 658 00:23:13,443 --> 00:23:18,148 THE IDEA CAME FROM OUR 659 00:23:18,148 --> 00:23:19,783 EXPERIENCE CONDUCTING TRIAL IN 660 00:23:19,783 --> 00:23:22,519 NIGERIA TRYING TO WORK IN THE 661 00:23:22,519 --> 00:23:23,820 COMMUNITIES, IN RECOGNITION OF 662 00:23:23,820 --> 00:23:26,223 IMPLEMENTATION SCIENCE THAT THE 663 00:23:26,223 --> 00:23:28,091 IDEA OF HOSPITAL FACILITY BASED 664 00:23:28,091 --> 00:23:30,293 SCREENING OF WOMEN FOR SEVERAL 665 00:23:30,293 --> 00:23:31,661 DISEASES WAS NOT THE WAY TO GO, 666 00:23:31,661 --> 00:23:33,597 THAT WE NEED TO BE ABLE TO REACH 667 00:23:33,597 --> 00:23:36,833 THE WOMEN, ESPECIALLY IN 668 00:23:36,833 --> 00:23:38,501 NIGERIA, WHERE 40% OF THE WOMEN 669 00:23:38,501 --> 00:23:39,869 DELIVER IN HOSPITALS, 60% OF 670 00:23:39,869 --> 00:23:41,404 THEM DELIVER IN THE COMMUNITY. 671 00:23:41,404 --> 00:23:46,176 SO EVEN IF YOU'RE TO CAPTURE AND 672 00:23:46,176 --> 00:23:49,346 SCREEN EVERY WOMAN, YOU'RE STILL 673 00:23:49,346 --> 00:23:50,547 AT 40% OF WOMEN. 674 00:23:50,547 --> 00:23:52,215 AT THE BEGINNING OF 675 00:23:52,215 --> 00:23:52,916 IMPLEMENTATION SCIENCE IN 676 00:23:52,916 --> 00:23:55,018 NIGERIA, IT WAS ONE OF THE FIRST 677 00:23:55,018 --> 00:23:57,320 IMPLEMENTATION SCIENCE STUDIES 678 00:23:57,320 --> 00:24:00,824 FUNDED IN NIGERIA, TO ACTUALLY 679 00:24:00,824 --> 00:24:04,361 GO TO WHERE THE CONGREGATIONAL 680 00:24:04,361 --> 00:24:04,894 CENTERS, CHUMPS, MOSQUES, 681 00:24:04,894 --> 00:24:05,829 COMMUNITY CENTERS. 682 00:24:05,829 --> 00:24:10,033 AS WE DID THIS WE RECOGNIZED 683 00:24:10,033 --> 00:24:11,801 NIGERIA WITH 250 DIFFERENT 684 00:24:11,801 --> 00:24:13,637 CULTURE AND DIFFERENT LANGUAGES 685 00:24:13,637 --> 00:24:15,272 THAT WE NEEDED PEOPLE IN THE 686 00:24:15,272 --> 00:24:17,374 COMMUNITY WHO ARE TRAINED TO BE 687 00:24:17,374 --> 00:24:19,209 ABLE TO COMMUNICATE THE 688 00:24:19,209 --> 00:24:20,410 COMMUNITIES, RESPECTING THEIR 689 00:24:20,410 --> 00:24:21,845 CULTURE, ALSO ANSWERING THEIR 690 00:24:21,845 --> 00:24:22,712 QUESTIONS AND HELPING THEM 691 00:24:22,712 --> 00:24:23,713 UNDERSTAND THE PROJECT THAT 692 00:24:23,713 --> 00:24:25,248 WE'RE DOING IN THIS COMMUNITY. 693 00:24:25,248 --> 00:24:27,317 THAT'S HOW WE DEVELOP THE 694 00:24:27,317 --> 00:24:28,752 COMMUNITY RESEARCH ENGAGEMENT 695 00:24:28,752 --> 00:24:29,019 OFFICERS. 696 00:24:29,019 --> 00:24:32,155 THEIR ROLE IS TO BE IN THE 697 00:24:32,155 --> 00:24:33,456 COMMUNITY, EDUCATE THE COMMUNITY 698 00:24:33,456 --> 00:24:33,823 ABOUT PROJECTS. 699 00:24:33,823 --> 00:24:37,727 SO THEY WILL BE THE ONES TALKING 700 00:24:37,727 --> 00:24:38,728 ABOUT BREASTFEEDING, IN THE 701 00:24:38,728 --> 00:24:40,130 CHURCHES TALKING ABOUT SCREENING 702 00:24:40,130 --> 00:24:41,231 FOR HYPERTENSION, WHY SHOULD YOU 703 00:24:41,231 --> 00:24:43,199 SCREEN FOR SOMETHING THAT IS NOT 704 00:24:43,199 --> 00:24:46,703 GIVING YOU ANY SYMPTOM? 705 00:24:46,703 --> 00:24:48,772 CERVICAL CANCER, ALL THOSE 706 00:24:48,772 --> 00:24:50,640 THINGS THAT HAPPEN IN THE 707 00:24:50,640 --> 00:24:51,841 FACILITY WHEN THE WOMAN GOES 708 00:24:51,841 --> 00:24:53,376 THERE, AN OPPORTUNITY TO LOOK AT 709 00:24:53,376 --> 00:24:54,844 SOMEONE IN THE COMMUNITY AND ASK 710 00:24:54,844 --> 00:24:56,313 THE QUESTIONS THEY NEED TO ASK. 711 00:24:56,313 --> 00:24:58,315 SO BY THE TIME THEY ACTUALLY 712 00:24:58,315 --> 00:25:00,750 APPEAR AT THE HOSPITALS, AND 713 00:25:00,750 --> 00:25:02,485 THERE'S ENOUGH COURAGE TO 714 00:25:02,485 --> 00:25:03,586 PARTICIPATE IN CLINICAL TRIALS 715 00:25:03,586 --> 00:25:07,190 OR RESEARCH BY THE RESEARCH 716 00:25:07,190 --> 00:25:07,857 COORDINATORS, THEY ALREADY 717 00:25:07,857 --> 00:25:09,426 UNDERSTAND WHY THEY SHOULD BE 718 00:25:09,426 --> 00:25:11,561 INVOLVED IN CLINICAL TRIALS, WHY 719 00:25:11,561 --> 00:25:13,096 THEY SHOULD PARTICIPATE IN THESE 720 00:25:13,096 --> 00:25:15,198 PROGRAMS, WHY THEY SHOULD AND 721 00:25:15,198 --> 00:25:17,334 WHY -- HOW IT DOES AFFECT THEIR 722 00:25:17,334 --> 00:25:17,901 OWN HEALTH OUTCOME. 723 00:25:17,901 --> 00:25:19,502 THIS IS ONE OF OUR TRAINING 724 00:25:19,502 --> 00:25:21,638 WHERE WE BROUGHT IN COMMUNITY 725 00:25:21,638 --> 00:25:23,273 RESEARCH ENGAGEMENT OFFICERS AND 726 00:25:23,273 --> 00:25:25,241 RESEARCH COORDINATORS FROM ALL 727 00:25:25,241 --> 00:25:27,210 THE SIX REGIONS AND OTHER 36 728 00:25:27,210 --> 00:25:30,146 SITES THAT WERE PART OF THE 729 00:25:30,146 --> 00:25:30,914 PRACTICE-BASED RESEARCH NETWORK 730 00:25:30,914 --> 00:25:34,751 IN NIGERIA. 731 00:25:34,751 --> 00:25:35,952 NEXT SLIDE. 732 00:25:35,952 --> 00:25:37,587 SO, ONE OF THE THINGS AS YOU 733 00:25:37,587 --> 00:25:40,223 BEGIN TO GROW THIS NUMBER OF 734 00:25:40,223 --> 00:25:43,059 INDIVIDUALS YOU BEGIN TO HAVE 735 00:25:43,059 --> 00:25:46,029 P.I.s THAT ARE WELL 736 00:25:46,029 --> 00:25:46,996 KNOWLEDGED, NOW DEVELOPED, NOW 737 00:25:46,996 --> 00:25:48,198 CAN APPLY AND MANAGE GRANTS. 738 00:25:48,198 --> 00:25:50,166 WE BEGIN TO THINK HOW YOU TAKE 739 00:25:50,166 --> 00:25:51,568 THINGS THAT HAVE BEEN KNOWN TO 740 00:25:51,568 --> 00:25:55,638 WORK WHICH IS WHAT I SEE 741 00:25:55,638 --> 00:25:59,376 IMPLEMENTATION SCIENCE. 742 00:25:59,376 --> 00:26:01,845 MY FRAY WAS FROM THE INFECTIOUS 743 00:26:01,845 --> 00:26:03,213 DISEASE SPECIALIST, WHO STARTED 744 00:26:03,213 --> 00:26:04,614 ASKING QUESTIONS WHY THINGS ARE 745 00:26:04,614 --> 00:26:06,483 NOT WORKING. 746 00:26:06,483 --> 00:26:10,086 IF WE KNOW PAP SMEARS HELP WOMEN 747 00:26:10,086 --> 00:26:11,521 IDENTIFY CERVICAL CANCER EARLY, 748 00:26:11,521 --> 00:26:13,356 IDENTIFIED EARLY, IT CAN BE 749 00:26:13,356 --> 00:26:13,690 TREATED. 750 00:26:13,690 --> 00:26:16,960 WHY IS ONLY 10% OF WOMEN WITH 751 00:26:16,960 --> 00:26:20,130 HIV -- HAVE A PAP SMEAR DONE? 752 00:26:20,130 --> 00:26:23,433 IF WE KNOW WE CAN HELP WITH 753 00:26:23,433 --> 00:26:25,368 INDIVIDUAL THROUGH SICKLE CELL, 754 00:26:25,368 --> 00:26:29,672 HOW COME ONLY 25% OF PEOPLE WITH 755 00:26:29,672 --> 00:26:32,075 SICKLE CELL, IF YOU KNOW ASPIRIN 756 00:26:32,075 --> 00:26:36,479 CAN HELP, HOW COME ONLY 10% OF 757 00:26:36,479 --> 00:26:37,914 THOSE WITH PREVIOUS HEART 758 00:26:37,914 --> 00:26:38,148 ATTACK. 759 00:26:38,148 --> 00:26:39,215 THESE WERE THE QUESTIONS AT THE 760 00:26:39,215 --> 00:26:42,719 TIME DID I NOT RECOGNIZE WERE 761 00:26:42,719 --> 00:26:44,687 THE BRAIN OF IMPLEMENT SCIENCE. 762 00:26:44,687 --> 00:26:45,989 WE HAVE THE INTERVENTION THAT WE 763 00:26:45,989 --> 00:26:49,692 KNOW THAT WORKS. 764 00:26:49,692 --> 00:26:52,896 HOW DO WE GET THEM IN PLACES, 765 00:26:52,896 --> 00:26:55,064 INTEGRATE THEM IN PLACES WHERE 766 00:26:55,064 --> 00:26:57,567 THEY ARE ACTUALLY LEADING TO 767 00:26:57,567 --> 00:27:01,638 HEALTH OUTCOME, AND NO PLACE IS 768 00:27:01,638 --> 00:27:03,306 THAT AS IMPORTANT AS LMICs, 769 00:27:03,306 --> 00:27:05,909 NOT A LOT OF RESOURCES TO TRY 770 00:27:05,909 --> 00:27:07,444 NEW THINGS, BUT THIS BELIEF I 771 00:27:07,444 --> 00:27:10,180 DON'T HAVE A REFERENCE, IF WE 772 00:27:10,180 --> 00:27:11,915 IMPLEMENT THINGS WE ALREADY KNOW 773 00:27:11,915 --> 00:27:14,317 WE CAN SOLVE 80% OF THE PROBLEM 774 00:27:14,317 --> 00:27:16,286 WHICH MEANS IT'S ONLY ABOUT 20% 775 00:27:16,286 --> 00:27:18,721 THAT REQUIRES NEW INFORMATION. 776 00:27:18,721 --> 00:27:20,023 SO, WHAT ABOUT WE START WITH 777 00:27:20,023 --> 00:27:22,425 FIRST OF ALL THE THINGS WE KNOW 778 00:27:22,425 --> 00:27:23,860 THAT WORK. 779 00:27:23,860 --> 00:27:25,728 ADAPT THEM, IMPLEMENT THEM IN 780 00:27:25,728 --> 00:27:27,997 THESE SETTINGS, BE ABLE TO DRIVE 781 00:27:27,997 --> 00:27:29,632 THE CHANGE IN PRACTICE AND 782 00:27:29,632 --> 00:27:30,867 CHANGE IN POLICY THAT WE HAVE 783 00:27:30,867 --> 00:27:34,671 KNOWN THAT LEADS TO BET OUTCOME 784 00:27:34,671 --> 00:27:36,539 FOR WOMEN. 785 00:27:36,539 --> 00:27:37,407 ADAPTATION AND CO-CREATION 786 00:27:37,407 --> 00:27:39,709 STRATEGY BECAME A FOCUS. 787 00:27:39,709 --> 00:27:42,445 WE WANTED TO ADAPT THE NCC 788 00:27:42,445 --> 00:27:43,980 GUIDELINES FOR CANCER, FOR 789 00:27:43,980 --> 00:27:45,615 INDIVIDUALS LIVING WITH CHRONIC 790 00:27:45,615 --> 00:27:45,849 DISEASE. 791 00:27:45,849 --> 00:27:49,652 WE STARTED TO FOCUS ON TO CREATE 792 00:27:49,652 --> 00:27:52,188 PALLIATIVE CARE PACKAGE FOR 793 00:27:52,188 --> 00:27:53,156 COMMUNITIES WITHOUT PALLIATIVE 794 00:27:53,156 --> 00:27:57,093 CARE EXPERT. 795 00:27:57,093 --> 00:27:57,527 NEXT SLIDE. 796 00:27:57,527 --> 00:28:03,333 SO ONE OF THE THINGS WE DID WAS 797 00:28:03,333 --> 00:28:05,401 CO-CREATE PACKAGE FOR 798 00:28:05,401 --> 00:28:08,905 INDIVIDUALS LIVING WITH SICKLE 799 00:28:08,905 --> 00:28:11,307 CELL DISEASE. 800 00:28:11,307 --> 00:28:14,043 WE ASKED INDIVIDUALS LIVING WITH 801 00:28:14,043 --> 00:28:17,680 SICKLE CELL, STAKEHOLDERS, IT'S 802 00:28:17,680 --> 00:28:18,982 IMPORTANT TO IDENTIFY EVERYONE'S 803 00:28:18,982 --> 00:28:20,416 SICKLE CELL, COMMUNITY 804 00:28:20,416 --> 00:28:20,717 ENGAGEMENT. 805 00:28:20,717 --> 00:28:24,354 WHEN YOU ACTUALLY ASK PEOPLE WHO 806 00:28:24,354 --> 00:28:26,656 IS THIS STAKEHOLDER, PEOPLE WILL 807 00:28:26,656 --> 00:28:28,424 TELL YOU IT'S POLICYMAKERS, THE 808 00:28:28,424 --> 00:28:31,261 PEOPLE WHO ARE IMPLEMENTING, IT 809 00:28:31,261 --> 00:28:32,028 IS THE RESEARCHERS. 810 00:28:32,028 --> 00:28:34,097 IF YOU FIND OUT FOR EACH DISEASE 811 00:28:34,097 --> 00:28:37,700 WHO IS THE LOCAL PARTNER 812 00:28:37,700 --> 00:28:38,034 ACTUALLY 813 00:28:38,034 --> 00:28:39,569 WE ASKED THEM AND FIND 814 00:28:39,569 --> 00:28:41,437 CONSISTENTLY AGAIN AS YOU SEE 815 00:28:41,437 --> 00:28:43,506 THAT THE RELIGIOUS LEADERS WERE 816 00:28:43,506 --> 00:28:46,442 VERY KEY PART OF STAKEHOLDERS IN 817 00:28:46,442 --> 00:28:48,545 THEIR COMMUNITY, THEY WERE THE 818 00:28:48,545 --> 00:28:50,713 IMAMS IN THE COMMUNITIES, WHAT 819 00:28:50,713 --> 00:28:53,650 WE CALL THE TRIBAL HEALERS IN 820 00:28:53,650 --> 00:28:54,984 THEIR COMMUNITIES, WHICH MAY NOT 821 00:28:54,984 --> 00:28:56,953 EXIST IN OTHER PLACES BUT WE'VE 822 00:28:56,953 --> 00:28:57,954 DONE RESEARCH THAT SHOWS BEFORE 823 00:28:57,954 --> 00:29:00,223 WOMEN APPEAR IN THE HOSPITAL, 824 00:29:00,223 --> 00:29:02,859 THAT THEY MAY HAVE GONE TO 825 00:29:02,859 --> 00:29:05,929 TRADITIONAL HEALER WHERES MORE 826 00:29:05,929 --> 00:29:07,330 THAN 60% COME TO HOSPITAL. 827 00:29:07,330 --> 00:29:08,565 WE INVITED DIVERSITY OF PEOPLE 828 00:29:08,565 --> 00:29:10,633 FROM THE SIX REGIONS OF THE 829 00:29:10,633 --> 00:29:12,602 COUNTRY TO SIT DOWN AND SAY WHAT 830 00:29:12,602 --> 00:29:15,672 IS PALLIATIVE CARE? 831 00:29:15,672 --> 00:29:18,308 YOU KNOW, YOU THAT IS LIVING, 832 00:29:18,308 --> 00:29:22,679 INDIVIDUALS LIVING CAN SICKLE 833 00:29:22,679 --> 00:29:23,413 CELL, PEDIATRICS, ADULT, WHAT 834 00:29:23,413 --> 00:29:24,380 DOCTORS TAKE CARE OF THEM, TO 835 00:29:24,380 --> 00:29:25,415 BRING THEM TO THE TABLE. 836 00:29:25,415 --> 00:29:28,585 IN EACH OF THE TABLE YOU HAVE 837 00:29:28,585 --> 00:29:29,786 REPRESENTATIVES OF THESE 838 00:29:29,786 --> 00:29:30,787 STAKEHOLDERS, MULTIPLE TABLES. 839 00:29:30,787 --> 00:29:33,856 WE ASKED THEM TO PUT TOGETHER A 840 00:29:33,856 --> 00:29:34,724 PALLIATIVE CARE PACKAGE FOR 841 00:29:34,724 --> 00:29:35,825 INDIVIDUALS WITH CHRONIC DISEASE 842 00:29:35,825 --> 00:29:38,561 BUT IN THIS CASE FOCUS ON THE 843 00:29:38,561 --> 00:29:39,963 INDIVIDUAL WITH SICKLE CELL 844 00:29:39,963 --> 00:29:40,196 DISEASE. 845 00:29:40,196 --> 00:29:41,931 THIS IS ONE OF THE THINGS WE'VE 846 00:29:41,931 --> 00:29:43,600 SEEN ADAPTATION OF THINGS WE 847 00:29:43,600 --> 00:29:46,336 KNOW THAT WORK IN OTHER COUNTRY 848 00:29:46,336 --> 00:29:48,171 TO LMIC IS CRITICAL BUT ALSO 849 00:29:48,171 --> 00:29:49,505 ADAPTATION FROM DISEASE TO 850 00:29:49,505 --> 00:29:51,674 DISEASE IS ALSO VERY IMPORTANT. 851 00:29:51,674 --> 00:29:53,209 THERE'S A LOT WE CAN LEARN FROM 852 00:29:53,209 --> 00:29:55,078 WHAT HAPPENED WITH HIV PROGRAM 853 00:29:55,078 --> 00:29:59,582 AS WE ADDRESS SICKLE CELL 854 00:29:59,582 --> 00:30:00,883 DISEASE, ADDRESS THE CHRONIC 855 00:30:00,883 --> 00:30:02,085 DISEASES LIKE HYPERTENSION OR 856 00:30:02,085 --> 00:30:03,119 CANCER. 857 00:30:03,119 --> 00:30:04,520 BEING ABLE TO ADAPT AND 858 00:30:04,520 --> 00:30:07,490 UNDERSTAND HOW TO ADAPT PROGRAMS 859 00:30:07,490 --> 00:30:08,558 THAT ALREADY KNOWN TO WORK BUT 860 00:30:08,558 --> 00:30:10,326 UNDERSTAND YOU PUT THEM IN A 861 00:30:10,326 --> 00:30:11,394 DIFFERENT SETTING IS VERY 862 00:30:11,394 --> 00:30:12,528 CRITICAL. 863 00:30:12,528 --> 00:30:16,366 THAT'S ONE OF THE THINGS THE 864 00:30:16,366 --> 00:30:18,635 ALLIANCE FOCUSED ON TRAINING THE 865 00:30:18,635 --> 00:30:20,737 WORKFORCE TO DO IT, CREATING 866 00:30:20,737 --> 00:30:22,038 RESEARCH ENVIRONMENT TO DO THAT, 867 00:30:22,038 --> 00:30:24,641 BUT ALSO SUPPORTING THE PROGRAMS 868 00:30:24,641 --> 00:30:25,541 THAT ACTUALLY FORM THE 869 00:30:25,541 --> 00:30:27,310 FOUNDATION OF THE IMPLEMENTATION 870 00:30:27,310 --> 00:30:30,346 SCIENCE ALLIANCE TO SAY HOW DO 871 00:30:30,346 --> 00:30:32,982 WE MAKE IT BETTER AND HOW DO WE 872 00:30:32,982 --> 00:30:34,283 ACTUALLY DISSEMINATE THAT AND 873 00:30:34,283 --> 00:30:36,252 SCALE IT UP ACROSS THE COUNTRY. 874 00:30:36,252 --> 00:30:39,022 NEXT SLIDE. 875 00:30:39,022 --> 00:30:42,291 SO, THIS AGAIN COMES TO ONE 876 00:30:42,291 --> 00:30:43,426 THING THAT IS DIVERSITY IN 877 00:30:43,426 --> 00:30:44,727 CLINICAL TRIALS. 878 00:30:44,727 --> 00:30:47,263 IT'S SOMETHING THAT FDA HAS 879 00:30:47,263 --> 00:30:48,831 IDENTIFIED, SOMETHING THAT FDA 880 00:30:48,831 --> 00:30:50,933 SET OUT IN FIVE YEAR GOAL TO 881 00:30:50,933 --> 00:30:51,834 INCREASE DIVERSITY IN CLINICAL 882 00:30:51,834 --> 00:30:53,503 TRIALS IN THE UNITED STATES. 883 00:30:53,503 --> 00:30:55,238 IT'S SOMETHING THAT THE FDA 884 00:30:55,238 --> 00:30:57,440 REPORTED THAT IT FAILED IN DOING 885 00:30:57,440 --> 00:30:57,840 THAT. 886 00:30:57,840 --> 00:31:00,710 THAT DESPITE FIVE YEARS OF 887 00:31:00,710 --> 00:31:02,612 INVESTMENT, THERE'S STILL NOT A 888 00:31:02,612 --> 00:31:04,981 GOOD DIVERSITY IN CLINICAL 889 00:31:04,981 --> 00:31:05,214 TRIALS. 890 00:31:05,214 --> 00:31:07,717 SO WHERE PEOPLE END UP TAKING 891 00:31:07,717 --> 00:31:08,518 MEDICATION NEVER TRIED SOMEONE 892 00:31:08,518 --> 00:31:09,619 THAT LOOKS LIKE THEM. 893 00:31:09,619 --> 00:31:12,221 THE FDA HAS BEEN VERY FOCUSED ON 894 00:31:12,221 --> 00:31:13,523 TRY TO INCREASE THAT DIVERSITY 895 00:31:13,523 --> 00:31:14,757 IN CLINICAL TRIALS. 896 00:31:14,757 --> 00:31:17,260 SO YOU CAN IMAGINE WHERE YOU SEE 897 00:31:17,260 --> 00:31:19,095 COUNTRIES LIKE NIGERIA, THE 898 00:31:19,095 --> 00:31:20,329 LARGEST COUNTRY IN AFRICA, 899 00:31:20,329 --> 00:31:22,165 PARTICIPATING IN CLINICAL TRIALS 900 00:31:22,165 --> 00:31:28,638 AT THE RATE OF 1.3%, 3%, 5%, YOU 901 00:31:28,638 --> 00:31:32,041 SEE THE OPPORTUNITY TO EXPAND 902 00:31:32,041 --> 00:31:33,142 RETENTION, RECRUITMENT OF PEOPLE 903 00:31:33,142 --> 00:31:34,544 IN CLINICAL TRIALS. 904 00:31:34,544 --> 00:31:35,645 THAT STARTS WITH THE COMMUNITY 905 00:31:35,645 --> 00:31:36,846 ENGAGEMENT THAT WE TALKED ABOUT. 906 00:31:36,846 --> 00:31:38,147 FOR EXAMPLE, THAT STARTS WITH 907 00:31:38,147 --> 00:31:39,248 SOME OF THE THINGS YOU HAVE TO 908 00:31:39,248 --> 00:31:41,751 DO IN THE COMMUNITY TO MAKE THEM 909 00:31:41,751 --> 00:31:42,318 UNDERSTAND. 910 00:31:42,318 --> 00:31:46,489 SO WHEN WE STARTED TO LOOK AT 911 00:31:46,489 --> 00:31:48,224 OUR PROJECT, RESEARCH PROJECT 912 00:31:48,224 --> 00:31:50,460 FUNDED BY NHLBI, COMMUNITY 913 00:31:50,460 --> 00:31:52,261 SCREENING FOR HYPERTENSION, 914 00:31:52,261 --> 00:31:54,030 WE'RE CHALLENGED FURTHER WITH 915 00:31:54,030 --> 00:31:55,665 SOMETHING IN THE HOSPITALS, 12 916 00:31:55,665 --> 00:31:57,867 HOSPITALS ACROSS THE SIX 917 00:31:57,867 --> 00:31:59,402 REGIONS, STARTED DOING A DRS 918 00:31:59,402 --> 00:32:00,837 TRAINING FOR DOCTORS AND NURSES 919 00:32:00,837 --> 00:32:02,138 IN THOSE HOSPITALS. 920 00:32:02,138 --> 00:32:02,839 YOU WOULD THINK THAT'S STANDARD 921 00:32:02,839 --> 00:32:04,874 IN THE U.S. BUT EVERY DOCTOR AND 922 00:32:04,874 --> 00:32:11,547 EVERY NURSE THAT WORKS IN A 923 00:32:11,547 --> 00:32:12,982 HOSPITAL HAS THEIR BLS, BUT ONE 924 00:32:12,982 --> 00:32:15,151 OF THE THINGS WE'RE TRYING TO DO 925 00:32:15,151 --> 00:32:17,787 TO DEVELOP THIS PROGRAM TO 926 00:32:17,787 --> 00:32:19,422 UNDERSTAND BASIC LIFE SUPPORT. 927 00:32:19,422 --> 00:32:20,556 ALL OF THOSE TRAINING, ACTUALLY 928 00:32:20,556 --> 00:32:22,525 ONE OF THE THINGS I'VE BEEN 929 00:32:22,525 --> 00:32:26,028 SHOWING IF THERE IS A 930 00:32:26,028 --> 00:32:28,631 CARDIOVASCULAR EVENT, WE'VE 931 00:32:28,631 --> 00:32:31,367 NEVER WITNESSED, BEING ABLE TO 932 00:32:31,367 --> 00:32:36,639 DEPLOY THINGS IN BLS HAVE SAVED 933 00:32:36,639 --> 00:32:38,875 MORE LIVING THAN ALL ICUs, WE 934 00:32:38,875 --> 00:32:40,143 STARTED TO FOLLOW THE SAME 935 00:32:40,143 --> 00:32:42,011 PRINCE TELL, SEE ONE, DO ONE, 936 00:32:42,011 --> 00:32:43,079 TEACH ONE. 937 00:32:43,079 --> 00:32:43,646 ACTUALLY WHY NOT? 938 00:32:43,646 --> 00:32:45,748 YOU DON'T NEED TO BE A DOCTOR OR 939 00:32:45,748 --> 00:32:47,383 NURSE TO DO BLS. 940 00:32:47,383 --> 00:32:50,887 THAT'S SOMETHING THAT YOU'RE 941 00:32:50,887 --> 00:32:52,855 GOING TO SPREAD. 942 00:32:52,855 --> 00:32:54,524 IF SOMEONE WERE TO DROP IN THE 943 00:32:54,524 --> 00:32:56,259 AIRPORT IN NIGERIA, PEOPLE WILL 944 00:32:56,259 --> 00:32:57,994 BRING OUT CELL PICTURES TO TAKE 945 00:32:57,994 --> 00:33:00,196 PICTURES TO PUT ON FACEBOOK, 946 00:33:00,196 --> 00:33:04,000 SECOND BEGIN TO SHOUT IN THE 947 00:33:04,000 --> 00:33:05,568 NAME OF GOD, WHAT YOU WOULD NOT 948 00:33:05,568 --> 00:33:09,172 SEE IS SOMEBODY THAT JUMPS OUT 949 00:33:09,172 --> 00:33:10,807 AND STARTS BASIC LIFE SUPPORT, 950 00:33:10,807 --> 00:33:12,542 TERM THAT WE THINK BY TRAINING, 951 00:33:12,542 --> 00:33:14,744 BY INCREASING THAT KNOWLEDGE, 952 00:33:14,744 --> 00:33:15,845 YOU CAN EXPAND SURVIVAL ALONG 953 00:33:15,845 --> 00:33:21,083 THE WAY. 954 00:33:21,083 --> 00:33:21,551 NEXT SLIDE. 955 00:33:21,551 --> 00:33:25,454 SO WHEN YOU DO ALL OF THESE, IN 956 00:33:25,454 --> 00:33:28,224 YOUR SMALL SPACE, EACH ONE OF 957 00:33:28,224 --> 00:33:30,293 COURSE HERE TODAY OCCUPY A VERY 958 00:33:30,293 --> 00:33:34,130 SMALL SPACE, NO MATTER HOW BIG 959 00:33:34,130 --> 00:33:35,531 THE PROGRAMS OR KNOWLEDGE MIGHT 960 00:33:35,531 --> 00:33:36,766 BE WE'RE QUITE A SMALL PLACE. 961 00:33:36,766 --> 00:33:39,068 ONE OF THE THINGS IS TO FIND A 962 00:33:39,068 --> 00:33:42,104 PLAT 963 00:33:42,104 --> 00:33:43,406 PLATFORM TO SHARE LESSONS 964 00:33:43,406 --> 00:33:44,173 LEARNED. 965 00:33:44,173 --> 00:33:46,742 IN NIGERIA FOR EXAMPLE THERE ARE 966 00:33:46,742 --> 00:33:48,344 PROGRAMS FUNDED THAT DO NOT 967 00:33:48,344 --> 00:33:51,948 WORK, WE SEE THAT FUNDED BY NIH, 968 00:33:51,948 --> 00:33:53,482 SET UP DOES NOT WORK. 969 00:33:53,482 --> 00:33:55,151 THE NEXT YEAR FUNDED BY W.H.O. 970 00:33:55,151 --> 00:33:56,786 TO DO THE SAME THING WE KNOW 971 00:33:56,786 --> 00:33:58,221 DOES NOT WORK. 972 00:33:58,221 --> 00:33:59,856 SO THAT'S, AGAIN, BECAUSE THERE 973 00:33:59,856 --> 00:34:03,259 IS THIS LACK OF DISSEMINATION OF 974 00:34:03,259 --> 00:34:04,160 THINGS THAT HAPPEN. 975 00:34:04,160 --> 00:34:06,529 BY THE WAY STUDIES HAVE ALREADY 976 00:34:06,529 --> 00:34:08,197 BEEN PUBLISHED IN "LANCET," 977 00:34:08,197 --> 00:34:09,899 PRESENTED IN VERY GOOD 978 00:34:09,899 --> 00:34:11,767 CONFERENCE IN WASHINGTON, D.C. 979 00:34:11,767 --> 00:34:15,071 BUT YOU COME TO THE CAPITAL OF 980 00:34:15,071 --> 00:34:19,041 NIGERIA, THEY SAY WHAT IS THAT? 981 00:34:19,041 --> 00:34:20,776 THEY NEVER HEARD THE STUDY. 982 00:34:20,776 --> 00:34:22,211 FIRST TIME IN NIGERIA, I 983 00:34:22,211 --> 00:34:24,714 REMEMBER HAVING THE MINISTER OF 984 00:34:24,714 --> 00:34:29,418 HEALTH IN A CONFERENCE IN 985 00:34:29,418 --> 00:34:31,487 NIGERIAN ALLIANCE, HE USED TO 986 00:34:31,487 --> 00:34:32,588 WRITE LETTERS OF SUPPORT FOR 987 00:34:32,588 --> 00:34:33,990 PEOPLE WRITING A GRANT AND NEVER 988 00:34:33,990 --> 00:34:35,892 HAD SOMEBODY COME BACK TO TELL 989 00:34:35,892 --> 00:34:38,494 HIM, OH, WE GOT THE GRANT. 990 00:34:38,494 --> 00:34:39,262 WHICH WAS IMPORTANT. 991 00:34:39,262 --> 00:34:41,464 ONE OF THE THINGS WE'RE TRYING 992 00:34:41,464 --> 00:34:44,634 TO DO IS BECAUSE THAT'S THE 993 00:34:44,634 --> 00:34:46,269 EFFECT OF ENGAGEMENT OF 994 00:34:46,269 --> 00:34:47,270 STAKEHOLDERS, THE GOVERNMENT, 995 00:34:47,270 --> 00:34:48,704 THE GRANT IS SUPPORTED IN 996 00:34:48,704 --> 00:34:51,040 WRITING, NOW YOU HAVE THE 997 00:34:51,040 --> 00:34:52,541 FUNDING, IMPLEMENT IN THE 998 00:34:52,541 --> 00:34:53,843 COUNTRY, YOU WANT POLICYMAKERS 999 00:34:53,843 --> 00:34:55,044 INVOLVED TO LOOK FORWARD TO THE 1000 00:34:55,044 --> 00:34:56,545 RESULT THAT COMES THERE. 1001 00:34:56,545 --> 00:34:58,547 SO THE LIKELIHOOD OF ADOPTING 1002 00:34:58,547 --> 00:35:01,150 THOSE RESULTS WHEN THEY COME IS 1003 00:35:01,150 --> 00:35:03,019 CRITICAL AND IS IMPORTANT. 1004 00:35:03,019 --> 00:35:03,986 SO THAT EARLY ENGAGEMENT IS 1005 00:35:03,986 --> 00:35:04,253 CRITICAL. 1006 00:35:04,253 --> 00:35:08,691 ONE OF THE THINGS WE SET OUT 1007 00:35:08,691 --> 00:35:10,559 FOUR MAIN PLATFORMS. 1008 00:35:10,559 --> 00:35:11,560 ONE IS WEEKLY RESEARCH IN 1009 00:35:11,560 --> 00:35:12,194 PROGRESS. 1010 00:35:12,194 --> 00:35:15,598 THAT IS OPEN TO ANY INVESTIGATOR 1011 00:35:15,598 --> 00:35:18,768 IN NIGERIA WHO IS DOING 1012 00:35:18,768 --> 00:35:19,635 IMPLEMENTATION SCIENCE, 1013 00:35:19,635 --> 00:35:21,270 PRESENTING THE WORK, GET INPUT 1014 00:35:21,270 --> 00:35:22,605 FROM PEOPLE DOING SIMILAR WORK 1015 00:35:22,605 --> 00:35:23,806 IN DIFFERENT DISEASE AREAS, THEY 1016 00:35:23,806 --> 00:35:26,676 CAN HAVE THAT COMMUNITY OF 1017 00:35:26,676 --> 00:35:27,109 SHARED KNOWLEDGE. 1018 00:35:27,109 --> 00:35:29,946 THE OTHER THING IS MONTHLY 1019 00:35:29,946 --> 00:35:31,147 RESEARCH WEBINARS BRINGING IN 1020 00:35:31,147 --> 00:35:33,015 EXPERTS IN NIGERIA AND OUTSIDE, 1021 00:35:33,015 --> 00:35:36,385 BE ABLE TO HAVE THEM TALK ABOUT 1022 00:35:36,385 --> 00:35:36,752 SPECIFIC TOPICS. 1023 00:35:36,752 --> 00:35:38,120 THE QUARTERLY RESEARCH IS ONE OF 1024 00:35:38,120 --> 00:35:39,922 THE MOST POPULAR. 1025 00:35:39,922 --> 00:35:44,260 WE BRING IN EXPERTS, WE BRING IN 1026 00:35:44,260 --> 00:35:45,861 SOMEONE THAT DID THE FRAMEWORK, 1027 00:35:45,861 --> 00:35:49,532 WHO IN NIGERIA HAS USED THE 1028 00:35:49,532 --> 00:35:51,634 FRAMEWORK IN THEIR STUDY, PAY 1029 00:35:51,634 --> 00:35:54,904 THEM TO DELIVER THIS CONFERENCE. 1030 00:35:54,904 --> 00:35:56,439 THAT'S OUR BEGINNING PART OF 1031 00:35:56,439 --> 00:35:59,709 SEEING EQUAL LEADERSHIP, EQUAL 1032 00:35:59,709 --> 00:36:02,578 INVOLVEMENT, AND ANNUAL 1033 00:36:02,578 --> 00:36:04,080 IMPLEMENTATION SCIENCE, THIS 1034 00:36:04,080 --> 00:36:07,550 YEAR IN ABUJA WITH GLOBAL 1035 00:36:07,550 --> 00:36:08,484 INFORMATION SOCIETY. 1036 00:36:08,484 --> 00:36:09,118 NEXT SLIDE. 1037 00:36:09,118 --> 00:36:11,854 THIS IS JUST AN EXAMPLE OF THAT 1038 00:36:11,854 --> 00:36:12,722 IMPLEMENT SCIENCE. 1039 00:36:12,722 --> 00:36:14,590 YOU SEE WHAT WE'RE TALKING ABOUT 1040 00:36:14,590 --> 00:36:14,790 HERE. 1041 00:36:14,790 --> 00:36:16,459 YOU SEE A LOT OF INDIVIDUALS 1042 00:36:16,459 --> 00:36:19,862 FROM THE U.S., FROM AUSTRALIA, 1043 00:36:19,862 --> 00:36:21,497 WITH THEIR OWN EXPERTISE. 1044 00:36:21,497 --> 00:36:23,666 ALSO WHETHER WE'RE LOOKING ABOUT 1045 00:36:23,666 --> 00:36:26,969 WHERE IS THOSE AFRICANS WHO HAVE 1046 00:36:26,969 --> 00:36:28,504 USED THESE FRAMEWORKS, USED 1047 00:36:28,504 --> 00:36:29,839 THESE MODELS AND THEORIES IN 1048 00:36:29,839 --> 00:36:31,574 THEIR WORK. 1049 00:36:31,574 --> 00:36:32,675 HE TALK ABOUT SCIENCE 1050 00:36:32,675 --> 00:36:33,976 COMMUNICATION, TALK ABOUT EQUITY 1051 00:36:33,976 --> 00:36:35,611 IN RESEARCH, TALK ABOUT 1052 00:36:35,611 --> 00:36:38,247 IMPLEMENTATION SCIENCE 1053 00:36:38,247 --> 00:36:39,849 ENVIRONMENT. 1054 00:36:39,849 --> 00:36:41,017 YOU TALK ABOUT PRACTICE-BASED 1055 00:36:41,017 --> 00:36:45,488 RESEARCH NETWORKS, HOW THEY HAVE 1056 00:36:45,488 --> 00:36:45,721 EFFECT. 1057 00:36:45,721 --> 00:36:47,790 WE PAIR WITH PEOPLE IN THE 1058 00:36:47,790 --> 00:36:50,860 COUNTRY WHO HAVE ACTUALLY DONE 1059 00:36:50,860 --> 00:36:52,828 THIS, WHO UNDERSTAND THE CONTEXT 1060 00:36:52,828 --> 00:36:54,030 SPECIFIC TO THAT LMIC AND BE 1061 00:36:54,030 --> 00:36:54,997 ABLE TO DO THAT. 1062 00:36:54,997 --> 00:36:55,664 NEXT SLIDE. 1063 00:36:55,664 --> 00:36:57,500 THIS IS THE CONFERENCE THAT I 1064 00:36:57,500 --> 00:36:57,767 MENTIONED. 1065 00:36:57,767 --> 00:36:59,502 I HOPE MOST OF YOU CAN COME. 1066 00:36:59,502 --> 00:37:02,004 IF YOU WORK IN NIGERIA, IT'S AN 1067 00:37:02,004 --> 00:37:03,005 IMPORTANT PLACE BECAUSE THE 1068 00:37:03,005 --> 00:37:03,773 GOVERNMENT IS THERE. 1069 00:37:03,773 --> 00:37:06,275 THEY HAVE ALWAYS BEEN THERE. 1070 00:37:06,275 --> 00:37:07,910 NIH HAS ALWAYS BEEN THERE, 1071 00:37:07,910 --> 00:37:09,779 STARTED WITH THE FOGARTY 1072 00:37:09,779 --> 00:37:11,213 INSTITUTE IN 2015, AND SINCE 1073 00:37:11,213 --> 00:37:13,382 THEN THEY HAVE BEEN AT THIS 1074 00:37:13,382 --> 00:37:17,553 CONFERENCE EACH YEAR, EVERY YEAR 1075 00:37:17,553 --> 00:37:18,754 SINCE THEN. 1076 00:37:18,754 --> 00:37:20,356 THEY RECOGNIZE HOW MUCH IT HAS 1077 00:37:20,356 --> 00:37:28,264 DONE, FROM THIS ORGANIZATION, 1078 00:37:28,264 --> 00:37:29,565 EXPANDING OUT OF NIGERIA TO 1079 00:37:29,565 --> 00:37:31,400 OTHER COUNTRIES. 1080 00:37:31,400 --> 00:37:32,401 NEXT SLIDE. 1081 00:37:32,401 --> 00:37:34,270 AND THIS IS MY LAST SLIDE, I 1082 00:37:34,270 --> 00:37:35,571 WANT TO TALK ABOUT WHAT DAN SAID 1083 00:37:35,571 --> 00:37:37,540 WHEN HE TALKED ABOUT A CONNECTED 1084 00:37:37,540 --> 00:37:37,773 CULTURE. 1085 00:37:37,773 --> 00:37:40,609 WHAT WE WANT TO TALK ABOUT IS 1086 00:37:40,609 --> 00:37:42,144 INNOVATION, IMPORTANT FOR US TO 1087 00:37:42,144 --> 00:37:43,579 UNDERSTAND WHAT WE REALLY MEAN 1088 00:37:43,579 --> 00:37:45,448 BY A CONNECTED CULTURE. 1089 00:37:45,448 --> 00:37:51,420 A CONNECTED CULTURE STARTS WITH 1090 00:37:51,420 --> 00:37:52,221 RECIPROCAL LEADERSHIP, WHETHER 1091 00:37:52,221 --> 00:37:54,190 THERE'S MEETING OF EQUALS. 1092 00:37:54,190 --> 00:37:57,026 ONE THING NIH HAS DONE THAT GOT 1093 00:37:57,026 --> 00:37:58,761 IT RIGHT, THE IDEA OF MULTIPLE 1094 00:37:58,761 --> 00:37:58,994 P.I.s. 1095 00:37:58,994 --> 00:38:02,064 MULTIPLE P.I.s WAS A WAY TO 1096 00:38:02,064 --> 00:38:04,333 RECOGNIZE IF YOU'RE CONDUCTING 1097 00:38:04,333 --> 00:38:05,468 STUDY IN TANZANIA, YOU HAVE A 1098 00:38:05,468 --> 00:38:09,839 TEAM OF PEOPLE WHO IS GOING TO 1099 00:38:09,839 --> 00:38:11,474 GO INTO HOUSEHOLD AND INTERVIEW 1100 00:38:11,474 --> 00:38:16,846 60 HOUSEHOLD OF MUSLIM WOMEN, 1101 00:38:16,846 --> 00:38:20,649 THAT THOSE PEOPLE KNOW, TELLING 1102 00:38:20,649 --> 00:38:24,687 YOU THE CULTURE, THINGS WILL 1103 00:38:24,687 --> 00:38:26,255 ALLOW THESE PEOPLE, DO MARRIAGE, 1104 00:38:26,255 --> 00:38:28,557 SIT ON THE TABLE, RECOGNIZE THAT 1105 00:38:28,557 --> 00:38:29,992 LEADERSHIP WAS SOMETHING NIH HAS 1106 00:38:29,992 --> 00:38:33,295 DONE THAT I PERSONALLY THINK 1107 00:38:33,295 --> 00:38:36,232 HAVE INCREASED THAT DEVELOPMENT 1108 00:38:36,232 --> 00:38:39,502 OF THE SUPERVISION OF PEOPLE IN 1109 00:38:39,502 --> 00:38:40,803 LMICs WORKING WITH INDIVIDUALS 1110 00:38:40,803 --> 00:38:43,873 COMING IN, NO LONGER SHIFTED 1111 00:38:43,873 --> 00:38:45,407 FROM JUST THE PERSON WORKING ON 1112 00:38:45,407 --> 00:38:47,643 IT, THE PERSON RUNNING AROUND, 1113 00:38:47,643 --> 00:38:48,944 BUT THE RESEARCH TO THE TABLE 1114 00:38:48,944 --> 00:38:50,146 WHERE YOU ACTUALLY HAVE 1115 00:38:50,146 --> 00:38:53,215 SOMETHING TO BRING TO THE TABLE, 1116 00:38:53,215 --> 00:38:55,117 AND MULTIPLE P.I. YOU SHARE IN 1117 00:38:55,117 --> 00:38:56,485 THAT LEADERSHIP, ONE OF THE 1118 00:38:56,485 --> 00:38:58,254 THINGS DONE VERY WELL. 1119 00:38:58,254 --> 00:38:59,021 COLLABORATIVE LEARNING, THOSE 1120 00:38:59,021 --> 00:39:00,189 THINGS WE'RE TALKING ABOUT, 1121 00:39:00,189 --> 00:39:03,492 INSTEAD OF JUST HAVING ONE 1122 00:39:03,492 --> 00:39:05,027 PERSON GIVE LECTURES LET'S HAVE 1123 00:39:05,027 --> 00:39:08,631 TWO PEOPLE, I WANT TO TALK ABOUT 1124 00:39:08,631 --> 00:39:10,933 THE EPIS FRAMEWORK IN AFRICA, 1125 00:39:10,933 --> 00:39:15,538 HAVE THE COLLABORATIVE LEARNING, 1126 00:39:15,538 --> 00:39:16,305 THE EARLY ENGAGEMENT, CONSISTENT 1127 00:39:16,305 --> 00:39:18,040 STRATEGY NECESSARY. 1128 00:39:18,040 --> 00:39:20,242 I KNOW I HAVE 10 TO 15 MINUTES 1129 00:39:20,242 --> 00:39:22,211 TO DO THIS BUT I HOPE THAT I 1130 00:39:22,211 --> 00:39:23,212 HAVE OPENED UP SOME OF THE 1131 00:39:23,212 --> 00:39:24,847 DISCUSSION THAT'S GOING TO 1132 00:39:24,847 --> 00:39:26,382 HAPPEN IN THESE TWO DATES, EACH 1133 00:39:26,382 --> 00:39:28,217 OF THESE AREAS IS EXPANDED MORE. 1134 00:39:28,217 --> 00:39:31,187 I HOPE TO BE ABLE TO CONTRIBUTE 1135 00:39:31,187 --> 00:39:32,488 IN THE DISCUSSIONS OF OUR 1136 00:39:32,488 --> 00:39:33,856 EXPERIENCE COMING IN FROM MY 1137 00:39:33,856 --> 00:39:37,293 WORK HERE IN LAS VEGAS AND MY 1138 00:39:37,293 --> 00:39:37,660 WORK IN NIGERIA. 1139 00:39:37,660 --> 00:39:40,095 THANK YOU SO MUCH FOR HAVING ME 1140 00:39:40,095 --> 00:39:40,296 HERE. 1141 00:39:40,296 --> 00:39:42,131 THANK YOU. 1142 00:39:42,131 --> 00:39:44,300 >> THANK YOU SO MUCH, DR. 1143 00:39:44,300 --> 00:39:47,937 EZEANOLUI, FOR AN AWESOME 1144 00:39:47,937 --> 00:39:48,270 PRESENTATION. 1145 00:39:48,270 --> 00:39:49,104 WE DON'T HAVE DR. CREAR-PERRY 1146 00:39:49,104 --> 00:39:50,573 WITH US AT THIS TIME. 1147 00:39:50,573 --> 00:39:53,309 WE'LL OPEN UP FOR COMMENTS AND 1148 00:39:53,309 --> 00:39:55,144 QUESTIONS FOR DR. EZEANOLUI AND 1149 00:39:55,144 --> 00:39:56,412 WHILE PEOPLE ARE TEEING UP 1150 00:39:56,412 --> 00:39:58,547 QUESTIONS IN THE Q&A SECTION I 1151 00:39:58,547 --> 00:40:02,384 HAD A COUPLE OF QUESTIONS FOR 1152 00:40:02,384 --> 00:40:04,353 YOU, DR. EZEANOLUI, KIND OF 1153 00:40:04,353 --> 00:40:07,623 TYING INTO THE LASTING -- ONE OF 1154 00:40:07,623 --> 00:40:09,491 THE LAST THINGS ABOUT THE 1155 00:40:09,491 --> 00:40:10,960 CONFERENCE COMING UP, THAT THE 1156 00:40:10,960 --> 00:40:12,528 GOVERNMENT, THE DECISION MAKERS 1157 00:40:12,528 --> 00:40:14,396 AND POLICYMAKERS ARE ALWAYS 1158 00:40:14,396 --> 00:40:14,597 THERE. 1159 00:40:14,597 --> 00:40:17,933 SO WHAT IS IT THAT YOU CAN SHARE 1160 00:40:17,933 --> 00:40:20,336 WITH US REGARDING LESSONS 1161 00:40:20,336 --> 00:40:22,338 LEARNED ABOUT HAVING THE 1162 00:40:22,338 --> 00:40:24,440 COMMITMENT AND THE CONSTANT 1163 00:40:24,440 --> 00:40:26,375 INVOLVEMENT OF DECISION MAKERS 1164 00:40:26,375 --> 00:40:27,676 AND POLICYMAKERS WITH THE WORK 1165 00:40:27,676 --> 00:40:30,846 YOU'RE DOING IN COUNTRY? 1166 00:40:30,846 --> 00:40:32,514 >> SO, YES, THAT'S VERY 1167 00:40:32,514 --> 00:40:33,549 IMPORTANT. 1168 00:40:33,549 --> 00:40:34,316 I WAS MENTIONING ACTUALLY START 1169 00:40:34,316 --> 00:40:35,684 AT THE TIME YOU'RE APPLYING FOR 1170 00:40:35,684 --> 00:40:36,452 A PROJECT. 1171 00:40:36,452 --> 00:40:39,622 SO IF I AM APPLYING FOR RESEARCH 1172 00:40:39,622 --> 00:40:41,590 PROJECT, I ALWAYS MAKE SURE 1173 00:40:41,590 --> 00:40:43,592 THERE IS A POLICYMAKER BECAUSE 1174 00:40:43,592 --> 00:40:45,561 WHAT IS THE USE OF MY RESEARCH 1175 00:40:45,561 --> 00:40:46,862 IS THE RESEARCH IS JUST TO BE 1176 00:40:46,862 --> 00:40:48,731 PUBLISHED AND SHARED IN SOME BIG 1177 00:40:48,731 --> 00:40:54,436 JOURNAL THAT NOBODY -- WE ALL 1178 00:40:54,436 --> 00:40:54,970 KNOW ABOUT IMPLEMENTATION 1179 00:40:54,970 --> 00:41:00,042 SCIENCE, 1 1 -- 17 YEARS TO BE 1180 00:41:00,042 --> 00:41:02,111 IMPLEMENTED INTO PRACTICE. 1181 00:41:02,111 --> 00:41:03,946 ONE IS HOW WE FORM ORGANIZATION, 1182 00:41:03,946 --> 00:41:04,847 SECOND IS THE GOVERNMENT. 1183 00:41:04,847 --> 00:41:07,816 WHEN I GET A LETTER FROM THE 1184 00:41:07,816 --> 00:41:09,018 MINISTER OF HEALTH, PUBLIC 1185 00:41:09,018 --> 00:41:10,552 HEALTH DEPARTMENT, I TELL THEM 1186 00:41:10,552 --> 00:41:11,720 ABOUT THIS PROJECT WE'RE 1187 00:41:11,720 --> 00:41:13,922 PLANNING TO DO SO THEY ARE 1188 00:41:13,922 --> 00:41:16,458 NOT -- WE HAVEN'T EVEN GOTTEN 1189 00:41:16,458 --> 00:41:18,093 THE PROJECT, WRITE A LETTER TO 1190 00:41:18,093 --> 00:41:19,528 SAY THEY SUPPORT THE IDEA. 1191 00:41:19,528 --> 00:41:20,929 THEY KNOW WHAT WE'RE TRYING TO 1192 00:41:20,929 --> 00:41:21,196 DO. 1193 00:41:21,196 --> 00:41:23,098 SECOND, WE GOT THE FUNDING, I GO 1194 00:41:23,098 --> 00:41:26,068 BACK AND SAY WE GOT THE FUNDING, 1195 00:41:26,068 --> 00:41:26,935 AND I'M EXCITED. 1196 00:41:26,935 --> 00:41:28,437 I USE THAT OPPORTUNITY TO 1197 00:41:28,437 --> 00:41:29,805 EXTRACT IS IT OKAY IF I COME 1198 00:41:29,805 --> 00:41:33,075 BACK EVERY SIX MONTHS TO TELL 1199 00:41:33,075 --> 00:41:34,610 YOU HOW WE'RE DOING? 1200 00:41:34,610 --> 00:41:36,145 THE MINISTER SAYS OF COURSE. 1201 00:41:36,145 --> 00:41:38,213 THEN I GO BACK TO START THE 1202 00:41:38,213 --> 00:41:38,714 IMPLEMENTATION. 1203 00:41:38,714 --> 00:41:40,316 WHAT IT DOES, HE IS ACTUALLY 1204 00:41:40,316 --> 00:41:41,850 PART OF THAT PROJECT EVERY STEP 1205 00:41:41,850 --> 00:41:42,718 OF THE WAY. 1206 00:41:42,718 --> 00:41:45,020 SIX MONTHS, I COME BACK AND SAY, 1207 00:41:45,020 --> 00:41:46,989 YOU KNOW, WE'RE DOING SO WELL 1208 00:41:46,989 --> 00:41:49,858 RECRUITING 25% OF OUR SAMPLE 1209 00:41:49,858 --> 00:41:52,261 SIZE, THIS IS WHAT WE'RE LOOKING 1210 00:41:52,261 --> 00:41:53,929 AT. 1211 00:41:53,929 --> 00:41:55,864 YOU GET THEM INVOLVED AT EVERY 1212 00:41:55,864 --> 00:41:58,067 STAGE. 1213 00:41:58,067 --> 00:42:03,539 AT THE CONFER INSURES, IN EVERY 1214 00:42:03,539 --> 00:42:04,540 MEANING SINCE 2012 THE MINISTER 1215 00:42:04,540 --> 00:42:06,942 OF HEALTH HAS BEEN THERE. 1216 00:42:06,942 --> 00:42:08,844 HEAD OF AGENCIES HAVE ALL BEEN 1217 00:42:08,844 --> 00:42:10,012 THERE, IMPORTANT, THESE ARE THE 1218 00:42:10,012 --> 00:42:12,114 PEOPLE TO ADOPT IT. 1219 00:42:12,114 --> 00:42:13,749 YOU'RE JUST THE RESEARCHER. 1220 00:42:13,749 --> 00:42:14,817 YES, YOU PUBLISH, YOUR 1221 00:42:14,817 --> 00:42:15,484 COLLEAGUES KNOW WHAT YOU'RE 1222 00:42:15,484 --> 00:42:18,354 DOING BUT WHAT ABOUT THE PEOPLE 1223 00:42:18,354 --> 00:42:19,755 WHO ARE GOING TO MAKE IT PART OF 1224 00:42:19,755 --> 00:42:21,623 THEIR PRACTICE AND PART OF 1225 00:42:21,623 --> 00:42:24,360 POLICY MAKING? 1226 00:42:24,360 --> 00:42:26,995 SO EARLY ENGAGEMENT. 1227 00:42:26,995 --> 00:42:29,064 SUSTAINED ENGAGEMENT A WAY TO 1228 00:42:29,064 --> 00:42:30,566 MAKE SURE POLICYMAKERS, 1229 00:42:30,566 --> 00:42:33,635 IMPLEMENTING PARTNERS ARE 1230 00:42:33,635 --> 00:42:35,471 PARTNERS FROM THE BEGINNING AND 1231 00:42:35,471 --> 00:42:36,739 REMAIN SUSTAINED PARTNERS TO THE 1232 00:42:36,739 --> 00:42:36,905 END. 1233 00:42:36,905 --> 00:42:38,640 YOU NEED THEM WHEN YOU START TO 1234 00:42:38,640 --> 00:42:40,876 IMPLEMENT AND WHEN YOU 1235 00:42:40,876 --> 00:42:41,844 DISSEMINATE, WHEN YOU ADOPT 1236 00:42:41,844 --> 00:42:42,745 THOSE THINGS INTO POLICY. 1237 00:42:42,745 --> 00:42:44,380 THANK YOU SO MUCH. 1238 00:42:44,380 --> 00:42:45,481 >> YOU'RE VERY WELCOME. 1239 00:42:45,481 --> 00:42:47,683 I HAVE A FOLLOW-UP QUESTION TO 1240 00:42:47,683 --> 00:42:49,618 THAT, KNOWING THAT 1241 00:42:49,618 --> 00:42:50,919 IMPLEMENTATION SCIENCE, ALTHOUGH 1242 00:42:50,919 --> 00:42:53,021 NOT A NEW-NEW FIELD FROM SCRATCH 1243 00:42:53,021 --> 00:42:56,091 BUT THOSE OF US AND OTHERS ARE 1244 00:42:56,091 --> 00:42:57,059 STILL LEARNING ABOUT 1245 00:42:57,059 --> 00:42:58,060 IMPLEMENTATION SCIENCE SO WHEN 1246 00:42:58,060 --> 00:43:00,496 YOU ARE ENGAGING WITH THE 1247 00:43:00,496 --> 00:43:01,096 POLICYMAKERS AND DECISION 1248 00:43:01,096 --> 00:43:05,267 MAKERS, HOW ARE YOU MAKING THEM 1249 00:43:05,267 --> 00:43:12,708 QUOTE/UNQUOTE SCIENTIFICALLY -- 1250 00:43:12,708 --> 00:43:13,342 [CROSSTALK] 1251 00:43:13,342 --> 00:43:15,444 >> ONE THING IS WHAT I ALREADY 1252 00:43:15,444 --> 00:43:18,380 EMPHASIZE, THERE'S A DIFFERENCE 1253 00:43:18,380 --> 00:43:18,981 BETWEEN IMPLEMENTATION SCIENCE 1254 00:43:18,981 --> 00:43:20,482 AND CLINICAL TRIALS IN THE WAY 1255 00:43:20,482 --> 00:43:21,550 WE UNDERSTOOD IT BEFORE. 1256 00:43:21,550 --> 00:43:23,552 A CLINICAL TRIAL IS WE'RE TRYING 1257 00:43:23,552 --> 00:43:25,687 TO TRY A NEW VACCINE FOR HIV, 1258 00:43:25,687 --> 00:43:27,389 TRYING TO SEE WHETHER OR NOT IT 1259 00:43:27,389 --> 00:43:27,790 WORKS. 1260 00:43:27,790 --> 00:43:34,296 IN A THE LOT OF IMPLEMENTATION 1261 00:43:34,296 --> 00:43:35,597 SCIENCE, WE KNOW INTERVENTION 1262 00:43:35,597 --> 00:43:37,766 WORKS, THAT'S A DIFFERENCE FOR 1263 00:43:37,766 --> 00:43:39,101 ME, THERE'S AN EVIDENCE FOR WHAT 1264 00:43:39,101 --> 00:43:40,936 WE'RE TRYING TO IMPLEMENT. 1265 00:43:40,936 --> 00:43:43,105 YOU'RE SAYING, YOU KNOW, THIS 1266 00:43:43,105 --> 00:43:45,140 THING HAS WORKED IN KENYA, ANY 1267 00:43:45,140 --> 00:43:46,408 HAS WORKED IN THE U.S. 1268 00:43:46,408 --> 00:43:48,477 THIS HAS WORKED IN SOUTH AFRICA. 1269 00:43:48,477 --> 00:43:50,112 THIS IS HOW WE WANT TO SEE 1270 00:43:50,112 --> 00:43:51,647 WHETHER THIS WILL WORK HERE LOOK 1271 00:43:51,647 --> 00:43:54,216 AT THE CONTEXT OF THE LARGEST 1272 00:43:54,216 --> 00:43:57,920 COUNTRY IN AFRICA, CAN THIS WORK 1273 00:43:57,920 --> 00:43:58,120 HERE? 1274 00:43:58,120 --> 00:43:59,988 SO THIS UNDERSTANDING, THIS IS 1275 00:43:59,988 --> 00:44:00,756 NOT SOMETHING THAT WE DON'T KNOW 1276 00:44:00,756 --> 00:44:01,356 THAT WORKS. 1277 00:44:01,356 --> 00:44:02,825 THIS IS SOMETHING WE KNOW THAT 1278 00:44:02,825 --> 00:44:03,158 WORKS. 1279 00:44:03,158 --> 00:44:05,794 SO HOW CAN WE ACTUALLY DO THAT 1280 00:44:05,794 --> 00:44:07,963 HERE IN A WAY -- YOU'RE SETTING 1281 00:44:07,963 --> 00:44:13,435 THE STAGE IF THIS WORKS, WILL WE 1282 00:44:13,435 --> 00:44:14,436 STARTED PRACTICE-BASED NETWORK 1283 00:44:14,436 --> 00:44:17,840 IN NIGERIA, WE SELECTED TWO 1284 00:44:17,840 --> 00:44:19,675 SITES FROM EACH REGION, CALLED 1285 00:44:19,675 --> 00:44:21,109 THEM MODEL RESEARCH AND 1286 00:44:21,109 --> 00:44:23,412 INNOVATION CENTER, THE IDEA IF 1287 00:44:23,412 --> 00:44:24,813 WE TRY EVERYTHING IN EACH OF 1288 00:44:24,813 --> 00:44:26,482 THOSE REGIONS WE HAVE ONE 1289 00:44:26,482 --> 00:44:33,155 INTERVENTION, ONE CONTROL SIDE, 1290 00:44:33,155 --> 00:44:36,425 DEPENDING ON STUDY SIDE, IF THAT 1291 00:44:36,425 --> 00:44:37,292 INTERVENTION WORKS WELL SCALING 1292 00:44:37,292 --> 00:44:40,696 UP THE GOVERNMENT CAN SEE MODEL 1293 00:44:40,696 --> 00:44:42,231 SITES, MODEL SITES IN THEIR 1294 00:44:42,231 --> 00:44:43,232 COMMUNITY, WE'RE NOT TALKING 1295 00:44:43,232 --> 00:44:46,034 ABOUT THE UNITED STATES BUT 1296 00:44:46,034 --> 00:44:48,904 SOUTH AFRICA, MODEL SITES IN 1297 00:44:48,904 --> 00:44:50,639 NIGERIA THAT HAVE DONE THIS. 1298 00:44:50,639 --> 00:44:51,940 THAT INVOLVEMENT AT THE 1299 00:44:51,940 --> 00:44:55,677 BEGINNING MAY BE THE BEST 1300 00:44:55,677 --> 00:44:55,944 AUDIENCE. 1301 00:44:55,944 --> 00:44:57,746 WHAT I'M NOTICING WHEN YOU TALK 1302 00:44:57,746 --> 00:44:59,615 TO THEM AS YOU APPLY FOR THAT 1303 00:44:59,615 --> 00:45:01,049 APPLICATION, SO NOT JUST THEY 1304 00:45:01,049 --> 00:45:02,885 WROTE YOU A LETTER, I DON'T JUST 1305 00:45:02,885 --> 00:45:04,353 GET A LETTER FROM THEM, NO, I 1306 00:45:04,353 --> 00:45:05,521 DON'T THINK THAT'S THE RIGHT WAY 1307 00:45:05,521 --> 00:45:07,523 TO DO IT. 1308 00:45:07,523 --> 00:45:09,258 I WANT TO EXPLAIN WHAT WE'RE 1309 00:45:09,258 --> 00:45:10,225 THINKING OF DOING. 1310 00:45:10,225 --> 00:45:12,761 GOING BACK TO SAY WE GOT IT, 1311 00:45:12,761 --> 00:45:15,764 THAT MAKES THEM -- THEY ARE NOT 1312 00:45:15,764 --> 00:45:17,599 LISTED, I SAY MISSING 1313 00:45:17,599 --> 00:45:20,969 INVESTIGATOR IN ALL THE GRANTS, 1314 00:45:20,969 --> 00:45:22,104 MINISTER FOR HEALTH DOES KNOW 1315 00:45:22,104 --> 00:45:23,171 WHAT'S GOING ON. 1316 00:45:23,171 --> 00:45:23,572 >> YES. 1317 00:45:23,572 --> 00:45:26,708 THANK YOU. 1318 00:45:26,708 --> 00:45:28,443 WE NOW HAVE DR. CREAR-PERRY. 1319 00:45:28,443 --> 00:45:31,613 I'M GOING TO PRESS PAUSE ON Q&A 1320 00:45:31,613 --> 00:45:34,116 AND GO BACK TO DR. CREAR-PERRY 1321 00:45:34,116 --> 00:45:36,718 TO GIVE HER AN OPPORTUNITY TO 1322 00:45:36,718 --> 00:45:38,387 PRESENT. 1323 00:45:38,387 --> 00:45:40,255 THANK YOU, AND WELCOME SO MUCH. 1324 00:45:40,255 --> 00:45:42,324 WE'RE NOT ABLE TO HEAR YOU. 1325 00:45:42,324 --> 00:45:44,192 YOU MIGHT BE ON MUTE. 1326 00:45:44,192 --> 00:45:45,160 THERE YOU ARE. 1327 00:45:45,160 --> 00:45:47,362 >> THANK YOU, I'M SO SORRY FOR 1328 00:45:47,362 --> 00:45:48,130 THE TARDINESS. 1329 00:45:48,130 --> 00:45:52,434 BLAME MY HEAD AND NOT MY HEART. 1330 00:45:52,434 --> 00:45:53,936 MY LIFE HAS BEEN A LITTLE 1331 00:45:53,936 --> 00:45:55,137 CHAOTIC LATELY. 1332 00:45:55,137 --> 00:45:58,774 WHEN I CAN GET ON A FEW MINUTES 1333 00:45:58,774 --> 00:46:00,409 TO SEE FAMILY MEMBERS, IT'S 1334 00:46:00,409 --> 00:46:03,345 EXCITING TO BE ABLE TO BE PART 1335 00:46:03,345 --> 00:46:04,346 OF THIS. 1336 00:46:04,346 --> 00:46:07,616 WE'RE GOING TO TALK ABOUT BLACK 1337 00:46:07,616 --> 00:46:08,383 MATERNAL HEALTH, 1338 00:46:08,383 --> 00:46:09,351 TRANSNATIONALLY, AND I'M GOING 1339 00:46:09,351 --> 00:46:11,987 TO SAY NEXT SLIDE TO WHOEVER IS 1340 00:46:11,987 --> 00:46:13,755 RUNNING MY SLIDES IF THAT'S 1341 00:46:13,755 --> 00:46:14,856 OKAY. 1342 00:46:14,856 --> 00:46:15,290 GREAT. 1343 00:46:15,290 --> 00:46:17,693 WE'LL GIVE HISTORICAL CONTEXT 1344 00:46:17,693 --> 00:46:18,260 ABOUT BIRTH EQUITY, DISCUSS 1345 00:46:18,260 --> 00:46:19,661 DEVELOPMENTS IN THE UNITED 1346 00:46:19,661 --> 00:46:21,196 STATES, DISCUSS HOW INEQUITIES 1347 00:46:21,196 --> 00:46:23,599 IN INFANT HEALTH ALSO CAUSE 1348 00:46:23,599 --> 00:46:26,234 PROBLEMS, AND IGNORE THE NEW 1349 00:46:26,234 --> 00:46:29,271 JERSEY PART, I COPIED AND PASTED 1350 00:46:29,271 --> 00:46:30,172 AN OLD SLIDE. 1351 00:46:30,172 --> 00:46:31,707 THE MISSION OF THE 1352 00:46:31,707 --> 00:46:34,109 COLLABORATIVE, NOW NINE YEARS 1353 00:46:34,109 --> 00:46:36,244 OLD, TO CREATE TRANSNATIONAL, 1354 00:46:36,244 --> 00:46:38,413 THE REASON I'M SPECIFIC ABOUT 1355 00:46:38,413 --> 00:46:40,482 THAT LANGUAGE, TRANSNATIONAL, 1356 00:46:40,482 --> 00:46:41,984 NOT GLOBAL, AS A BLACK AMERICAN 1357 00:46:41,984 --> 00:46:43,318 THEY USE WORDS LIKE GLOBAL SAY 1358 00:46:43,318 --> 00:46:45,153 THE U.S. IS SPECIAL SOMEHOW FROM 1359 00:46:45,153 --> 00:46:46,922 THE REST OF THE WORLD. 1360 00:46:46,922 --> 00:46:48,557 WE KNOW VERY MUCH SO THAT 1361 00:46:48,557 --> 00:46:50,626 TRANSNATIONALLY WE LEARNED FROM 1362 00:46:50,626 --> 00:46:52,494 THE COLLEAGUES IN KENYA AND 1363 00:46:52,494 --> 00:46:53,395 COLLEAGUES IN BRAZIL AND 1364 00:46:53,395 --> 00:46:54,262 COLLEAGUES AROUND THE WORLD SO 1365 00:46:54,262 --> 00:46:56,331 INSTEAD OF MAKING IT SEEM LIKE 1366 00:46:56,331 --> 00:46:58,200 WE'RE SPECIAL IN THE UNITED 1367 00:46:58,200 --> 00:46:58,967 STATES, ESPECIALLY CONSIDERING 1368 00:46:58,967 --> 00:47:00,936 WE HAVE THE WORST MATERNAL 1369 00:47:00,936 --> 00:47:07,142 HEALTH OUTCOMES IN THE WORLD, E 1370 00:47:07,142 --> 00:47:10,445 WANT TO BE PART OF THE BLACK 1371 00:47:10,445 --> 00:47:10,979 DIASPORA, LEANING INTO 1372 00:47:10,979 --> 00:47:12,848 TRANSNATIONAL INSTEAD OF USING 1373 00:47:12,848 --> 00:47:14,750 THE TERM GLOBAL BECAUSE LANGUAGE 1374 00:47:14,750 --> 00:47:16,351 MATTERS, PEOPLE HAVE BEEN USING 1375 00:47:16,351 --> 00:47:19,087 LANGUAGE TO HARM US, WE'RE GOING 1376 00:47:19,087 --> 00:47:24,693 TO RECLAIM TO SO SHOW 1377 00:47:24,693 --> 00:47:24,993 SOLIDARITY. 1378 00:47:24,993 --> 00:47:27,529 WE WANT TO THRIVE, LIVE OUR BEST 1379 00:47:27,529 --> 00:47:28,163 LIVES. 1380 00:47:28,163 --> 00:47:31,133 OUR SKIN IS POPPING, WE SHOULD 1381 00:47:31,133 --> 00:47:35,303 BE ABLE TO THRIVE, THAT MEANS 1382 00:47:35,303 --> 00:47:35,937 INSTANT HEALTH, SEXUAL HEALTH, 1383 00:47:35,937 --> 00:47:38,907 PEOPLE ARE NOT JUST BORN TO GET 1384 00:47:38,907 --> 00:47:41,109 PREGNANT AND MAKE BABIES. 1385 00:47:41,109 --> 00:47:42,110 REPRODUCTIVE HEALTH SO IF YOU 1386 00:47:42,110 --> 00:47:43,812 WANT TO HAVE A BABY YOU SHOULD 1387 00:47:43,812 --> 00:47:45,614 HAVE WELL-BEING, NOT JUST IN THE 1388 00:47:45,614 --> 00:47:47,249 HOSPITAL BUT DO YOU HAVE FOOD, 1389 00:47:47,249 --> 00:47:48,917 DO YOU FEEL SAFE, DO YOU HAVE 1390 00:47:48,917 --> 00:47:50,018 SPIRITUAL HEALING, ALL THE 1391 00:47:50,018 --> 00:47:51,987 THINGS THAT ALLOWS YOU TO 1392 00:47:51,987 --> 00:47:52,988 OPTIMIZE TRANSNATIONAL BLACK. 1393 00:47:52,988 --> 00:47:55,290 WE'RE BLACK, NOT AFRICAN 1394 00:47:55,290 --> 00:47:57,225 AMERICAN, BECAUSE ALTHOUGH FOR 1395 00:47:57,225 --> 00:47:58,326 TEN GENERATIONS MY FAMILY HAS 1396 00:47:58,326 --> 00:47:59,961 BEEN HERE SINCE STOLEN FROM THE 1397 00:47:59,961 --> 00:48:02,030 CONTINENT OF AFRICA MY BLACKNESS 1398 00:48:02,030 --> 00:48:05,200 IS ETHNICITY, IT'S A CULTURE, A 1399 00:48:05,200 --> 00:48:05,834 FEELING, A SPIRITUALITY, SO WE 1400 00:48:05,834 --> 00:48:07,302 CHOSE TO USE THE TERM BLACK 1401 00:48:07,302 --> 00:48:09,371 INSTEAD OF AFRICAN AMERICAN. 1402 00:48:09,371 --> 00:48:11,540 WE DO THIS THROUGH SHIFTING 1403 00:48:11,540 --> 00:48:13,408 SYSTEMS AND CULTURE BECAUSE IF 1404 00:48:13,408 --> 00:48:14,743 YOU JUST DO POLICY WITHOUT 1405 00:48:14,743 --> 00:48:16,044 SHIFTING HOW YOU FEEL AND THINK 1406 00:48:16,044 --> 00:48:17,679 AND MOVE, HOW THE SPIRIT MOVES 1407 00:48:17,679 --> 00:48:19,314 WITHIN YOU, YOU'RE NOT GOING TO 1408 00:48:19,314 --> 00:48:21,049 HAVE CHANGES IN YOUR HEALTH 1409 00:48:21,049 --> 00:48:21,316 OUTCOMES. 1410 00:48:21,316 --> 00:48:24,586 THAT'S THROUGH TRAININGS, WE DO 1411 00:48:24,586 --> 00:48:26,321 RESEARCH, TECHNICAL ASSISTANCE, 1412 00:48:26,321 --> 00:48:27,089 POLICY, ADVOCACY, COMMUNITY 1413 00:48:27,089 --> 00:48:28,590 CENTER COLLABORATION. 1414 00:48:28,590 --> 00:48:31,693 OUR VISION IS ALL BLACKS AROUND 1415 00:48:31,693 --> 00:48:32,828 THE WORLD, MAMAS, BABIES, AND 1416 00:48:32,828 --> 00:48:34,396 VILLAGES THRIVE. 1417 00:48:34,396 --> 00:48:35,397 NEXT SLIDE PLEASE. 1418 00:48:35,397 --> 00:48:37,532 OUR FOCUS IS MIXTURE OF CLINICAL 1419 00:48:37,532 --> 00:48:43,038 AND SOCIAL, AS ONOB/GYN WE WORK 1420 00:48:43,038 --> 00:48:45,006 TO DISMANTLE ON THE SOCIAL 1421 00:48:45,006 --> 00:48:47,976 DETERMINANTS OF HEALTH. 1422 00:48:47,976 --> 00:48:48,510 NEXT SLIDE PLEASE. 1423 00:48:48,510 --> 00:48:50,278 SO I HAD THE HONOR OF PRESENTING 1424 00:48:50,278 --> 00:48:54,316 AT THE U.N. MANY TIMES, BUT 1425 00:48:54,316 --> 00:48:56,685 FIRST TIME I NEVER HEARD OF THE 1426 00:48:56,685 --> 00:48:58,820 TERM IN THE UNITED STATES HUMAN 1427 00:48:58,820 --> 00:48:59,187 RIGHTS. 1428 00:48:59,187 --> 00:49:00,555 WE TALK ABOUT CIVIL RIGHTS BUT 1429 00:49:00,555 --> 00:49:03,725 IF YOU ASKED THE AVERAGE U.S. 1430 00:49:03,725 --> 00:49:04,593 CITIZEN WHAT HUMAN RIGHTS MEAN, 1431 00:49:04,593 --> 00:49:05,594 THEY COULD NOT TELL YOU. 1432 00:49:05,594 --> 00:49:07,996 JOE BIDEN IS THE FIRST U.S. 1433 00:49:07,996 --> 00:49:09,498 PRESIDENT TO SAY OUT LOUD THAT 1434 00:49:09,498 --> 00:49:10,832 HEALTH IS A HUMAN RIGHT. 1435 00:49:10,832 --> 00:49:13,368 SO IF HEALTH IS A HUMAN RIGHT, 1436 00:49:13,368 --> 00:49:14,669 THAT MEANS WE NEED TO KNOW NOW 1437 00:49:14,669 --> 00:49:15,971 THAT WE HAVE AGREED HEALTH IS A 1438 00:49:15,971 --> 00:49:18,073 HUMAN RIGHT IN THIS COUNTRY, WE 1439 00:49:18,073 --> 00:49:21,109 SHOULD LEARN WHAT HUMAN RIGHTS 1440 00:49:21,109 --> 00:49:21,276 ARE. 1441 00:49:21,276 --> 00:49:22,544 EVERY OTHER HIGH INCOME NATION 1442 00:49:22,544 --> 00:49:25,814 BELIEVES THE MOMENT YOU TAKE A 1443 00:49:25,814 --> 00:49:29,217 BREATH ... YOUR FIRST BREATH, 1444 00:49:29,217 --> 00:49:30,852 RIGHT? 1445 00:49:30,852 --> 00:49:32,721 WHEN YOU'RE BORN, THAT WOULD BE 1446 00:49:32,721 --> 00:49:34,556 MIKE MY SECOND CHILD WHO WEIGHED 1447 00:49:34,556 --> 00:49:38,727 LESS THAN A POUND WHEN BORN, 445 1448 00:49:38,727 --> 00:49:40,562 GRAMS, TOOK A FIRST BREATH ... 1449 00:49:40,562 --> 00:49:41,463 HE WAS FULLY HUMAN. 1450 00:49:41,463 --> 00:49:43,098 HE HAD THE RIGHT TO ALL THE 1451 00:49:43,098 --> 00:49:45,500 THINGS THAT MAKE ONE FULLY 1452 00:49:45,500 --> 00:49:45,834 HUMAN, RIGHT? 1453 00:49:45,834 --> 00:49:53,308 UNLIKE IF YOU WERE PREGNANT IN A 1454 00:49:53,308 --> 00:49:55,544 TUBE YOU'RE NOT HUMAN, YOU'RE 1455 00:49:55,544 --> 00:49:55,744 CELLS. 1456 00:49:55,744 --> 00:50:00,081 BUT THE MOMENT YOU TAKE A FULL 1457 00:50:00,081 --> 00:50:01,616 BREATH, YOU'RE A FULL SPIRIT, 1458 00:50:01,616 --> 00:50:02,918 HAVE YOU THE RIGHT WITHOUT 1459 00:50:02,918 --> 00:50:06,188 DISTINCTION OF RACE, COLOR, SEX, 1460 00:50:06,188 --> 00:50:08,390 LANGUAGE, RELIGION, POLITICAL OR 1461 00:50:08,390 --> 00:50:09,825 OTHER OPINION, NATIONAL OR 1462 00:50:09,825 --> 00:50:13,862 SOCIAL ORIGINAL YOU'RE ENTITLED 1463 00:50:13,862 --> 00:50:15,397 TO RIGHTS AND FREEDOMS SET 1464 00:50:15,397 --> 00:50:17,132 FORTH, RIGHT TO LIFE, LIBERTY, 1465 00:50:17,132 --> 00:50:18,366 SECURITY, OF ALL PERSONS, 1466 00:50:18,366 --> 00:50:19,434 STANDARD OF LIVING ADEQUATE FOR 1467 00:50:19,434 --> 00:50:20,669 HEALTH AND WELL-BEING OF 1468 00:50:20,669 --> 00:50:21,636 YOURSELF AND YOUR FAMILY. 1469 00:50:21,636 --> 00:50:26,141 AND MOTHERHOOD AND CHILDHOOD ARE 1470 00:50:26,141 --> 00:50:26,408 ENTITLED. 1471 00:50:26,408 --> 00:50:28,009 YOU HAVE A STANDARD BECAUSE YOU 1472 00:50:28,009 --> 00:50:30,178 TAKE A BREATH ... WHEN YOU'RE 1473 00:50:30,178 --> 00:50:31,413 BORN BUT MAMAS AND BABIES HAVE 1474 00:50:31,413 --> 00:50:32,214 SPECIAL PROTECTION BECAUSE WE 1475 00:50:32,214 --> 00:50:34,082 KNOW IF YOU AS A COUNTRY, A 1476 00:50:34,082 --> 00:50:35,784 GROUP OF PEOPLE, AS A HUMAN 1477 00:50:35,784 --> 00:50:37,419 BEING, CAN'T CARE FOR MOMS AND 1478 00:50:37,419 --> 00:50:38,753 BABIES AND PROTECT THEM, WHAT 1479 00:50:38,753 --> 00:50:43,124 ARE YOU HERE FOR? 1480 00:50:43,124 --> 00:50:44,659 NEXT SLIDE PLEASE. 1481 00:50:44,659 --> 00:50:45,794 SO REPRODUCTIVE JUSTICE MOVEMENT 1482 00:50:45,794 --> 00:50:48,129 WAS STARTED 30 YEARS AGO, 30th 1483 00:50:48,129 --> 00:50:50,899 ANNIVERSARY, BY 12 BLACK WOMEN, 1484 00:50:50,899 --> 00:50:52,767 FOUNDING MOTHERS, FOUNDING 1485 00:50:52,767 --> 00:50:56,471 MOTHERS OF REPRODUCTIVE JUSTICE. 1486 00:50:56,471 --> 00:50:59,441 IN 1994, THIS IS A PICTURE OF 1487 00:50:59,441 --> 00:51:01,076 MAMA LORETTA, THE TENETS ARE YOU 1488 00:51:01,076 --> 00:51:02,811 CAN DECIDE IF AND WHEN YOU WISH 1489 00:51:02,811 --> 00:51:06,214 TO HAVE A CHILD, SHOULD BE ABLE 1490 00:51:06,214 --> 00:51:07,849 TO PARENT THOSE CHILDREN IN SAFE 1491 00:51:07,849 --> 00:51:08,884 AND SUSTAINABLE COMMUNITIES, NOT 1492 00:51:08,884 --> 00:51:11,253 BEING AFRAID OF POLICE HARASSING 1493 00:51:11,253 --> 00:51:13,688 YOU, STALKING YOU, MAKING SURE 1494 00:51:13,688 --> 00:51:16,324 YOUR CHILD CAN PLAY OUTSIDE 1495 00:51:16,324 --> 00:51:16,825 WITHOUT BEING HARASSED, 1496 00:51:16,825 --> 00:51:17,626 ESPECIALLY IN THE UNITED STATES 1497 00:51:17,626 --> 00:51:19,828 WITH ROLLING BACK OF RIGHTS, 1498 00:51:19,828 --> 00:51:22,764 ABORTION RIGHTS BEING TAKEN 1499 00:51:22,764 --> 00:51:23,565 AWAY, TALKING ABOUT 1500 00:51:23,565 --> 00:51:24,432 CONTRACEPTION BEING TAKEN AWAY, 1501 00:51:24,432 --> 00:51:26,368 NOT BEING ABLE TO MOVE REFUGEES, 1502 00:51:26,368 --> 00:51:33,742 TALKING ABOUT BUILDING A WALL, 1503 00:51:33,742 --> 00:51:34,509 BUILDING A BARRICADE, WITHOUT 1504 00:51:34,509 --> 00:51:37,545 CREATING A SYSTEM FOR NOT HAVING 1505 00:51:37,545 --> 00:51:38,446 SEX TRAFFICKING, TRAFFICKING OF 1506 00:51:38,446 --> 00:51:40,415 CHILDREN, THE RIGHT TO PERSONAL 1507 00:51:40,415 --> 00:51:43,351 BODY AUTONOMY IS A GLOBAL RIGHT 1508 00:51:43,351 --> 00:51:44,486 BOLD BACK FROM AUTHORITARIANS 1509 00:51:44,486 --> 00:51:45,787 FROM PUTIN TO DONALD TRUMP. 1510 00:51:45,787 --> 00:51:47,422 WE HAVE TO FIGHT HARD AS A 1511 00:51:47,422 --> 00:51:49,391 COLLECTIVE MOVEMENT TO ENSURE 1512 00:51:49,391 --> 00:51:52,460 THAT WE'RE SAFE, THAT WE DON'T 1513 00:51:52,460 --> 00:51:53,762 LET FOLKS EITHER AUTHORITARIANS 1514 00:51:53,762 --> 00:51:56,398 ON THE CONTINENT, PLACES LIKE 1515 00:51:56,398 --> 00:51:57,365 KENYA OR PLACES LIKE RURAL 1516 00:51:57,365 --> 00:52:01,836 LOUISIANA WHERE I'M FROM. 1517 00:52:01,836 --> 00:52:02,938 NEXT SLIDE PLEASE. 1518 00:52:02,938 --> 00:52:08,843 THESE ARE A COUPLE BOOKS THAT AS 1519 00:52:08,843 --> 00:52:09,044 WELL. 1520 00:52:09,044 --> 00:52:09,945 REPRODUCTIVE JUSTICE, YOU HEAR 1521 00:52:09,945 --> 00:52:14,883 WHITE WOMAN TALK BIT ABOUT IT S 1522 00:52:14,883 --> 00:52:15,150 ABORTION. 1523 00:52:15,150 --> 00:52:16,551 I'M NOT HERE TO SAY YOU 1524 00:52:16,551 --> 00:52:17,919 SHOULDN'T HAVE THE RIGHT TO FULL 1525 00:52:17,919 --> 00:52:19,587 RANGE OF CARE, ALL THAT IS PART 1526 00:52:19,587 --> 00:52:20,989 OF HEALTH CARE. 1527 00:52:20,989 --> 00:52:22,424 I'M BE A OB/GYN, REPRODUCTIVE 1528 00:52:22,424 --> 00:52:25,493 HEALTH CARE IS WHAT WE PROVIDE. 1529 00:52:25,493 --> 00:52:28,096 THINGS LIKE ABORTION, 1530 00:52:28,096 --> 00:52:29,731 CONTRACEPTION, TUBAL LIGATION, 1531 00:52:29,731 --> 00:52:30,398 IUDs, INFERTILITY, ACCESS TO 1532 00:52:30,398 --> 00:52:33,034 MAKING SURE YOU DON'T BLEED TO 1533 00:52:33,034 --> 00:52:43,411 DEATH, DON'T HAVE INFECTION, 1534 00:52:43,411 --> 00:52:45,380 STDs, CHLAMYDIA, WE'RE SHOWING 1535 00:52:45,380 --> 00:52:47,148 WE'RE ONLY IMPORTANT TO CREATE 1536 00:52:47,148 --> 00:52:49,117 CAPITALISM, BODIES TO BE USED BY 1537 00:52:49,117 --> 00:52:54,356 WHITE MEN TO MAKE THEM MONEY. 1538 00:52:54,356 --> 00:53:00,929 WE'RE BIGGER THAN A UTERUS OR 1539 00:53:00,929 --> 00:53:01,262 VAGINA. 1540 00:53:01,262 --> 00:53:03,465 EDUCATION, INTIMATE PARTNER 1541 00:53:03,465 --> 00:53:05,133 VIOLENCE, PARENTING, BIRTHING 1542 00:53:05,133 --> 00:53:06,267 OUTCOMES, HIV, DISTANCE PORE 1543 00:53:06,267 --> 00:53:07,635 TAIGS, WE DON'T HAVE A RAILWAY 1544 00:53:07,635 --> 00:53:08,803 SYSTEM IN THE UNITED STATES, 1545 00:53:08,803 --> 00:53:10,572 FROM D.C. TO NEW YORK BUT THE 1546 00:53:10,572 --> 00:53:11,840 REST OF THE COUNTRY WE STILL 1547 00:53:11,840 --> 00:53:13,508 TREAT IT AS IF YOU NEED A GREEN 1548 00:53:13,508 --> 00:53:15,243 BOOK IF YOU'RE OF COLOR TO MOVE 1549 00:53:15,243 --> 00:53:18,446 FROM ONE PLACE TO ANOTHER. 1550 00:53:18,446 --> 00:53:19,547 HOUSING INSECURITY, PAY EQUITY, 1551 00:53:19,547 --> 00:53:20,615 CIVIL RIGHTS, ROLLING BACK 1552 00:53:20,615 --> 00:53:21,883 VOTING RIGHTS IN THIS COUNTRY, 1553 00:53:21,883 --> 00:53:24,319 ALL OF THESE. 1554 00:53:24,319 --> 00:53:27,288 WE DON'T WANT REPRODUCTIVE 1555 00:53:27,288 --> 00:53:28,456 CHOICE, A GROUP OF WOMEN TO WHO 1556 00:53:28,456 --> 00:53:30,225 CANNER ON CAPITOL HILL TO CHOOSE 1557 00:53:30,225 --> 00:53:31,326 WHICH OF THESE ISSUES WE HAVE 1558 00:53:31,326 --> 00:53:32,427 LEGISLATION FOR. 1559 00:53:32,427 --> 00:53:35,063 WE ALL HAVE -- IT'S IMPORTANT 1560 00:53:35,063 --> 00:53:37,165 FOR US -- SORRY, I SEE SOMEONE 1561 00:53:37,165 --> 00:53:41,302 HAS SOMETHING IN THE CHAT. 1562 00:53:41,302 --> 00:53:42,504 >> WE'LL DO QUESTIONS WHEN 1563 00:53:42,504 --> 00:53:44,039 YOU'RE COMPLETE WITH THE 1564 00:53:44,039 --> 00:53:44,372 PRESENTATION. 1565 00:53:44,372 --> 00:53:46,207 >> SOUNDS GREAT! 1566 00:53:46,207 --> 00:53:47,308 PERFECT FOR ME. 1567 00:53:47,308 --> 00:53:49,177 SO WE DON'T WANT A GROUP OF 1568 00:53:49,177 --> 00:53:54,215 WOMEN, WHITE WOMEN, BLACK WOMEN, 1569 00:53:54,215 --> 00:53:56,851 WHOEVER, TO BE IN D.C., CAPITOL 1570 00:53:56,851 --> 00:53:57,685 HILL, DECIDING WHICH ISSUES. 1571 00:53:57,685 --> 00:53:59,320 WE WANT ALL OF THEM EVERY YEAR, 1572 00:53:59,320 --> 00:54:03,958 TO FOCUS ON SEX ED, RACISM, 1573 00:54:03,958 --> 00:54:05,060 REPARATIONS, WE INSIST ALL 1574 00:54:05,060 --> 00:54:07,562 PEOPLE ACROSS THE WORLD WHO HAVE 1575 00:54:07,562 --> 00:54:09,297 BEEN OPPRESSED GET FREEDOM. 1576 00:54:09,297 --> 00:54:10,965 THAT'S REPRODUCTIVE JUSTICE. 1577 00:54:10,965 --> 00:54:12,600 NEXT SLIDE PLEASE. 1578 00:54:12,600 --> 00:54:14,569 SO HERE ARE SOME PEOPLE I WORK 1579 00:54:14,569 --> 00:54:15,136 WITH. 1580 00:54:15,136 --> 00:54:17,639 I ALREADY MENTIONED MAMA 1581 00:54:17,639 --> 00:54:18,406 LORETTA, RIGHT HERE. 1582 00:54:18,406 --> 00:54:19,707 THIS IS MONICA. 1583 00:54:19,707 --> 00:54:24,446 MONICA IS OVER SISTER SONG, THE 1584 00:54:24,446 --> 00:54:28,616 ORGANIZATION HOUSED IN ATLANTA, 1585 00:54:28,616 --> 00:54:30,552 THIS COMES FROM BLACK WOMEN'S -- 1586 00:54:30,552 --> 00:54:32,654 THE ORGANIZATION THAT DOES THE 1587 00:54:32,654 --> 00:54:37,025 BLACK WOMEN REPRODUCTIVE JUSTICE 1588 00:54:37,025 --> 00:54:38,226 POLICY AGENDA, REGINA MOSS IS 1589 00:54:38,226 --> 00:54:41,062 THE LEADER HERE IN D.C., 1590 00:54:41,062 --> 00:54:43,565 POLICIES AREN'T BLACK WOMEN'S 1591 00:54:43,565 --> 00:54:43,798 HEALTH. 1592 00:54:43,798 --> 00:54:45,834 AS RESEARCHERS ESPECIALLY AT NIH 1593 00:54:45,834 --> 00:54:54,442 YOU COME WITH A FRAMEWORK, WOULD 1594 00:54:54,442 --> 00:54:55,310 BE WHITE SUPREMACIST, EUGENESIS, 1595 00:54:55,310 --> 00:54:56,945 IF YOU PERCEIVE I'M BROKEN 1596 00:54:56,945 --> 00:54:59,247 BECAUSE I HAVE BLACK SKIN YOU'LL 1597 00:54:59,247 --> 00:55:01,749 SAY THINGS LIKE IF ONLY DR. JOIA 1598 00:55:01,749 --> 00:55:03,284 WOULD HAVE FEWER BABIES HER 1599 00:55:03,284 --> 00:55:04,719 BIRTH OUTCOME WOULD BE BETTER, 1600 00:55:04,719 --> 00:55:06,888 YOU SHOULD HAVE NO MORE THAN TWO 1601 00:55:06,888 --> 00:55:08,590 CHILDREN PER FAMILY, WHEN WE 1602 00:55:08,590 --> 00:55:10,725 KNOW PEOPLE LIKE DONALD TRUMP 1603 00:55:10,725 --> 00:55:11,826 FROM EIGHT CHILDREN, CLEARLY -- 1604 00:55:11,826 --> 00:55:14,129 OR SIX MANY, HOWEVER MANY, THREE 1605 00:55:14,129 --> 00:55:15,330 DIFFERENT WOMAN, CLEARLY HAVING 1606 00:55:15,330 --> 00:55:16,131 PROBLEMS WITH HEALTH OUTCOMES, 1607 00:55:16,131 --> 00:55:18,266 THIS IDEA WE MUST LOOK AT A 1608 00:55:18,266 --> 00:55:20,735 PERSON BASED UPON OUR EUGENESIS 1609 00:55:20,735 --> 00:55:28,443 AND RACIST BELIEF AND PICK 1610 00:55:28,443 --> 00:55:30,879 INDICATORS IS WHAT WE MUST GET 1611 00:55:30,879 --> 00:55:31,980 FREEDOM FROM. 1612 00:55:31,980 --> 00:55:38,620 HOW WE SEE THE WORLD INSTEAD OF 1613 00:55:38,620 --> 00:55:39,387 WRITE SUPREMACY, PATRIARCHAL, 1614 00:55:39,387 --> 00:55:41,823 I'VE BEEN MARRIED TWICE, WE 1615 00:55:41,823 --> 00:55:47,829 WOULDN'T PICK MARITAL STATUS 1616 00:55:47,829 --> 00:55:48,830 INDICATOR SHOULD BE SOCIAL 1617 00:55:48,830 --> 00:55:51,232 SAFETY, SOCIAL SAFETY AND 1618 00:55:51,232 --> 00:55:51,866 CONNECTEDNESS, JUST BEING 1619 00:55:51,866 --> 00:55:53,735 MARRIED IF YOUR HUSBAND IS 1620 00:55:53,735 --> 00:55:54,969 ABUSING YOU DOESN'T MAKE YOU 1621 00:55:54,969 --> 00:55:56,504 SAFE AND DOESN'T PROTECT YOU. 1622 00:55:56,504 --> 00:55:58,473 JUST BEING MARRIED IF YOU'RE 1623 00:55:58,473 --> 00:55:59,974 BOTH UNDERRESOURCED AND LIVED IN 1624 00:55:59,974 --> 00:56:02,310 A COUNTRY THAT DOESN'T PROVIDE 1625 00:56:02,310 --> 00:56:03,711 FOR HOUSING, FOOD, SAFE PLACE TO 1626 00:56:03,711 --> 00:56:06,347 SLEEP AT NIGHT, IS NOT GOING 1627 00:56:06,347 --> 00:56:11,819 TO -- JUST MARRYING SOMEBODY 1628 00:56:11,819 --> 00:56:17,192 WON'T SAVE ARE YOU FROM HARMS OF 1629 00:56:17,192 --> 00:56:17,525 RACISM. 1630 00:56:17,525 --> 00:56:20,361 BIRTH EQUITY, A PHRASE WE USE, A 1631 00:56:20,361 --> 00:56:21,996 TERM I CREATED IN 2015, MANY 1632 00:56:21,996 --> 00:56:23,631 ORGANIZATIONS UTILIZE IT NOW AS 1633 00:56:23,631 --> 00:56:27,936 THE FRAMEWORK HOW THEY SEE THEIR 1634 00:56:27,936 --> 00:56:31,306 WORK INCLUDING AMERICAN NURSING 1635 00:56:31,306 --> 00:56:31,973 ASSOCIATING FOR POSTPARTUM 1636 00:56:31,973 --> 00:56:32,640 NURSES IN AMERICA. 1637 00:56:32,640 --> 00:56:34,943 IT'S NOT THIS IDEA IF I POINT MY 1638 00:56:34,943 --> 00:56:35,843 FINGER YOU'RE GOING TO DO BETTER 1639 00:56:35,843 --> 00:56:37,145 BECAUSE I SAY SO. 1640 00:56:37,145 --> 00:56:39,214 IT'S MY JOB AS A SYSTEM, MY JOB 1641 00:56:39,214 --> 00:56:40,982 AS A HUMAN BEING, TO ASSURE YOU 1642 00:56:40,982 --> 00:56:43,484 HAVE THE CONDITIONS FOR OPTIMAL 1643 00:56:43,484 --> 00:56:46,654 BIRTH, LIKE I SAID, YOU CAN 1644 00:56:46,654 --> 00:56:47,722 STRIFE AND THRIVE, BECAUSE 1645 00:56:47,722 --> 00:56:49,390 WHITENESS IS NOT THE GOAL. 1646 00:56:49,390 --> 00:56:50,058 FOR ALL PEOPLE. 1647 00:56:50,058 --> 00:56:51,593 SO YOU HAVE TO BE WILLING TO 1648 00:56:51,593 --> 00:56:52,894 ADDRESS RACIAL AND SOCIAL 1649 00:56:52,894 --> 00:56:54,996 INEQUITIES IN A SUSTAINED 1650 00:56:54,996 --> 00:56:55,330 EFFORT. 1651 00:56:55,330 --> 00:56:56,731 NEXT SLIDE PLEASE. 1652 00:56:56,731 --> 00:56:58,900 SO WHAT'S THE HISTORICAL 1653 00:56:58,900 --> 00:57:00,235 CONTEXT? 1654 00:57:00,235 --> 00:57:05,039 NEXT SLIDE PLEASE. 1655 00:57:05,039 --> 00:57:07,108 EVERYTHING, EVERYTHING FROM MY 1656 00:57:07,108 --> 00:57:08,109 COLLEAGUE DR. McCLEAN, 1657 00:57:08,109 --> 00:57:12,146 EVERYTHING IS A THING WITH A 1658 00:57:12,146 --> 00:57:12,547 SEVENTY RELATIONS. 1659 00:57:12,547 --> 00:57:14,215 REQUIRES WE KNOW SOMETHING ABOUT 1660 00:57:14,215 --> 00:57:15,650 HOW IT AROSE, AND DEVELOPED, AND 1661 00:57:15,650 --> 00:57:18,286 HOW IT FITS INTO THE LARGER 1662 00:57:18,286 --> 00:57:19,654 CONTEXT OR SYSTEM OF WHICH IT IS 1663 00:57:19,654 --> 00:57:20,121 A PART. 1664 00:57:20,121 --> 00:57:23,424 IT IS IMPORTANT TO NOTE WHEN WE 1665 00:57:23,424 --> 00:57:25,927 SPEAK THE SYSTEMS AND 1666 00:57:25,927 --> 00:57:27,795 INSTITUTIONS LIKE NIH OR LIKE 1667 00:57:27,795 --> 00:57:29,330 YOUR NON-PROFIT OR, I DON'T 1668 00:57:29,330 --> 00:57:31,299 KNOW, THE PENTAGON OR THE 1669 00:57:31,299 --> 00:57:32,834 KREMLIN, THAT IT'S BASED ON 1670 00:57:32,834 --> 00:57:36,337 PARTICULAR SET OF RULES AND 1671 00:57:36,337 --> 00:57:37,972 RELATIONS. 1672 00:57:37,972 --> 00:57:40,174 NEXT SLIDE PLEASE. 1673 00:57:40,174 --> 00:57:41,876 SO REPRODUCTIVE JUSTICE, THIS IS 1674 00:57:41,876 --> 00:57:44,212 A FAMOUS PAINTING, ONE OF OUR 1675 00:57:44,212 --> 00:57:45,313 FOUNDING FATHERS, WE LOVE HIM, 1676 00:57:45,313 --> 00:57:46,014 HE'S GREAT. 1677 00:57:46,014 --> 00:57:49,017 I LOVE HIM AS WELL. 1678 00:57:49,017 --> 00:57:49,917 HOWEVER, BEHIND THE SHAME, 1679 00:57:49,917 --> 00:57:51,653 SOMETHING WE'VE NEVER TALKED 1680 00:57:51,653 --> 00:57:52,654 ABOUT, BLACK WOMEN WHO ENSURED 1681 00:57:52,654 --> 00:57:56,157 HE WAS ABLE TO DO HIS JOB. 1682 00:57:56,157 --> 00:57:58,259 SO FROM 1619 TO 1719, I HOPE 1683 00:57:58,259 --> 00:58:01,796 YOU'VE SEEN THE 1619 PROJECT, WE 1684 00:58:01,796 --> 00:58:04,299 HAD NO BODY AUTONOMY, FOR 100 1685 00:58:04,299 --> 00:58:05,733 YEARS, STILL BEING STOLEN FROM 1686 00:58:05,733 --> 00:58:07,135 AFRICA, COULDN'T DECIDE IF AND 1687 00:58:07,135 --> 00:58:08,903 HOW TO GET PREGNANT. 1688 00:58:08,903 --> 00:58:12,407 ONCE THEY BANNED THE 1689 00:58:12,407 --> 00:58:14,242 TRANSATLANTA SLAVE TRAIT IN 1720 1690 00:58:14,242 --> 00:58:15,009 SLAVERY WAS STILL LEGAL, ANOTHER 1691 00:58:15,009 --> 00:58:16,544 100 YEARS AS THE MAIN ECONOMIC 1692 00:58:16,544 --> 00:58:19,514 ENGINE OF THE UNITED STATES OF 1693 00:58:19,514 --> 00:58:21,049 AMERICA, AS PRODUCING ENSLAVED 1694 00:58:21,049 --> 00:58:25,653 HUMAN BEINGS, OUR JOB AS BLACK 1695 00:58:25,653 --> 00:58:29,991 WOMEN, PEOPLE WHO ARE WHITE IN 1696 00:58:29,991 --> 00:58:32,427 THIS COUNTRY TODAY BECAME RICH, 1697 00:58:32,427 --> 00:58:36,931 OUR BODIES WERE THE FACTORY. 1698 00:58:36,931 --> 00:58:41,202 THERE WAS A FOCUS FROM 1821 TO 1699 00:58:41,202 --> 00:58:43,371 1921, COULD NO LONGER UTILIZE 1700 00:58:43,371 --> 00:58:43,938 LEGALLY, REPRESS OUR ABILITY 1701 00:58:43,938 --> 00:58:45,373 BECAUSE WE WERE NO LONGER 1702 00:58:45,373 --> 00:58:45,807 USEFUL. 1703 00:58:45,807 --> 00:58:48,476 YOU SEE INCREASE IN EUGENICS, 1704 00:58:48,476 --> 00:58:50,278 FAMILY PLANNING, DESIRE TO SAY 1705 00:58:50,278 --> 00:58:51,913 YOU NASTY DIRTY WOMEN, PLEASE 1706 00:58:51,913 --> 00:58:57,385 STOP HAVING BABIES, PLEASE STOP 1707 00:58:57,385 --> 00:59:01,989 HAVING SEX. 1708 00:59:01,989 --> 00:59:03,958 BLAME-EUGENICS TO TODAY. 1709 00:59:03,958 --> 00:59:04,826 >> YOU HAVE TWO MINUTES AND WE 1710 00:59:04,826 --> 00:59:08,763 HAVE TO GO TO Q&A. 1711 00:59:08,763 --> 00:59:09,630 THANK YOU. 1712 00:59:09,630 --> 00:59:09,964 >> PERFECT. 1713 00:59:09,964 --> 00:59:11,466 WHAT ARE THE SOCIAL DETERMINANTS 1714 00:59:11,466 --> 00:59:11,733 OF HEALTH? 1715 00:59:11,733 --> 00:59:14,235 THE CONDITIONS IN WHICH PEOPLE 1716 00:59:14,235 --> 00:59:17,405 ARE BORN, GROW, LIVE, WORK, AGE. 1717 00:59:17,405 --> 00:59:18,806 AND THESE CIRCUMSTANCES ARE 1718 00:59:18,806 --> 00:59:22,977 SHAPED BY DISTRIBUTION OF MONEY, 1719 00:59:22,977 --> 00:59:25,246 POWER, RESOURCES THAT THE 1720 00:59:25,246 --> 00:59:27,482 GLOBAL, NATIONAL, AND LOCAL 1721 00:59:27,482 --> 00:59:27,715 LEVELS. 1722 00:59:27,715 --> 00:59:31,586 SO EXAMPLES, GLOBALLY WE HAVE A 1723 00:59:31,586 --> 00:59:32,153 GLOBAL TRANSNATIONAL TRADE, 1724 00:59:32,153 --> 00:59:32,820 HOUSING, EDUCATION, HEALTH CARE, 1725 00:59:32,820 --> 00:59:33,554 PUBLIC SAFETY. 1726 00:59:33,554 --> 00:59:36,090 WE HAVE TO LOOK AT EVERY LEVEL 1727 00:59:36,090 --> 00:59:37,658 TO ENSURE WE CAN ALL THRIVE. 1728 00:59:37,658 --> 00:59:38,393 THAT'S IT. 1729 00:59:38,393 --> 00:59:40,027 THANK YOU. 1730 00:59:40,027 --> 00:59:41,896 WE CAN GO TO 1731 00:59:41,896 --> 00:59:42,530 QUESTION-AND-ANSWER. 1732 00:59:42,530 --> 00:59:43,331 >> THANK YOU SO MUCH. 1733 00:59:43,331 --> 00:59:45,400 I'M GLAD YOU WERE ABLE TO MAKE 1734 00:59:45,400 --> 00:59:45,900 IT. 1735 00:59:45,900 --> 00:59:49,804 WE'RE GOING TO GO BACK TO THE 1736 00:59:49,804 --> 00:59:50,605 QUESTION-AND-ANSWER SESSION. 1737 00:59:50,605 --> 00:59:53,808 I HAD A QUESTION THAT I WANTED 1738 00:59:53,808 --> 00:59:56,577 TO JUST WRAP UP WITH DR. 1739 00:59:56,577 --> 01:00:00,081 EZEANOLUI AND THEN TAKE 1740 01:00:00,081 --> 01:00:00,348 QUESTIONS. 1741 01:00:00,348 --> 01:00:02,617 >> IF YOU WANT ME TO STAY 1742 01:00:02,617 --> 01:00:04,919 AROUND, WHATEVER FITS YOUR 1743 01:00:04,919 --> 01:00:05,453 SCHEDULE. 1744 01:00:05,453 --> 01:00:06,621 I APOLOGIZE FOR MY LATENESS. 1745 01:00:06,621 --> 01:00:07,789 >> PLEASE STAY, IF YOU'RE ABLE 1746 01:00:07,789 --> 01:00:09,824 TO STAY, THERE MAY BE QUESTIONS 1747 01:00:09,824 --> 01:00:10,725 FOR YOU. 1748 01:00:10,725 --> 01:00:12,160 THANK YOU SO MUCH. 1749 01:00:12,160 --> 01:00:13,461 DR. EZEANOLUI, I WANTED TO ASK 1750 01:00:13,461 --> 01:00:15,029 ONE MORE QUESTION BEFORE I WENT 1751 01:00:15,029 --> 01:00:16,631 TO THE Q&A SECTION. 1752 01:00:16,631 --> 01:00:25,506 IT WAS REGARDING THE G11, HOW 1753 01:00:25,506 --> 01:00:26,307 THE INFRASTRUCTURE HAS IMPACTED 1754 01:00:26,307 --> 01:00:27,642 CLINICAL RESEARCH AS YOU 1755 01:00:27,642 --> 01:00:28,910 MENTIONED DIVERSITY IN CLINICAL 1756 01:00:28,910 --> 01:00:29,444 TRIALS. 1757 01:00:29,444 --> 01:00:30,878 HOW HAVE YOU LEVERAGED THE 1758 01:00:30,878 --> 01:00:33,848 INFRASTRUCTURE THAT YOU BUILT 1759 01:00:33,848 --> 01:00:36,217 WITH THAT G11 AWARD FOR CLINICAL 1760 01:00:36,217 --> 01:00:36,484 TRIALS? 1761 01:00:36,484 --> 01:00:37,819 >> THANK YOU SO MUCH. 1762 01:00:37,819 --> 01:00:39,887 SO, IF YOU REMEMBER, I TALKED 1763 01:00:39,887 --> 01:00:41,823 ABOUT THE PRACTICE BASED 1764 01:00:41,823 --> 01:00:42,723 RESEARCH NETWORK. 1765 01:00:42,723 --> 01:00:44,358 OF THE TWO SITES WE TAKE FROM 1766 01:00:44,358 --> 01:00:46,994 EVERY REGION OF THE COUNTRY, SO 1767 01:00:46,994 --> 01:00:49,263 THOSE 12 MODEL AND INNOVATION 1768 01:00:49,263 --> 01:00:55,870 RESEARCH CENTER WE CALL THEM 1769 01:00:55,870 --> 01:00:57,605 WERE PROGRAMS, HIGH VOLUME 1770 01:00:57,605 --> 01:00:57,872 PROGRAMS. 1771 01:00:57,872 --> 01:00:59,774 TO BE PART OF THE SITE YOU MUST 1772 01:00:59,774 --> 01:01:01,442 HAVE AT LEAST 1,000 WOMEN OF 1773 01:01:01,442 --> 01:01:04,145 CHILD BEARING AGE WITH HIV IN 1774 01:01:04,145 --> 01:01:04,946 YOUR PROGRAM. 1775 01:01:04,946 --> 01:01:07,648 SO THAT TELLS US THAT SERVES A 1776 01:01:07,648 --> 01:01:09,317 LARGE POPULATION, TO HAVE UP TO 1777 01:01:09,317 --> 01:01:10,985 1,000 WOMEN OF CHILD BEARING AGE 1778 01:01:10,985 --> 01:01:11,819 WITH HIV. 1779 01:01:11,819 --> 01:01:14,121 IN THAT PLACE. 1780 01:01:14,121 --> 01:01:17,358 THAT'S HOW THEY WERE SELECTED. 1781 01:01:17,358 --> 01:01:20,595 SOME SITES HAVE 2,000. 1782 01:01:20,595 --> 01:01:23,164 SO WHEN WE GOT THIS G11 ONE 1783 01:01:23,164 --> 01:01:25,399 THING WE TRIED TO DO WAS TAKE 1784 01:01:25,399 --> 01:01:27,902 THE 12 PROGRAMS AND TRAIN THEM 1785 01:01:27,902 --> 01:01:29,437 IN SETTING UP THE INFRASTRUCTURE 1786 01:01:29,437 --> 01:01:31,839 SO THAT EACH OF THOSE SITES 1787 01:01:31,839 --> 01:01:35,810 REPRESENTS A CENTER. 1788 01:01:35,810 --> 01:01:37,378 IT'S NOT LIKE JUST FUNDING. 1789 01:01:37,378 --> 01:01:40,615 WE GOT LIKE I SAID G11 IS VERY 1790 01:01:40,615 --> 01:01:42,283 SMALL FUNDING BUT VERY EFFECTIVE 1791 01:01:42,283 --> 01:01:44,886 FUNDING BECAUSE OF WHAT IT DID 1792 01:01:44,886 --> 01:01:46,187 FOR US, RELYING THAT PARTNERSHIP 1793 01:01:46,187 --> 01:01:47,622 WITH UC-SAN DIEGO, THEY TRAVELED 1794 01:01:47,622 --> 01:01:49,490 TO NIGERIA FOR TWO WEEKS BUT 1795 01:01:49,490 --> 01:01:55,029 INSTEAD OF US TAKING PEOPLE TO 1796 01:01:55,029 --> 01:02:02,036 UC SAN DIEGO, THEY CAME TO 1797 01:02:02,036 --> 01:02:04,672 NIGERIA FOR TWO WEEKS, WE 1798 01:02:04,672 --> 01:02:07,508 BROUGHT ALL THE COORDINATORS 1799 01:02:07,508 --> 01:02:10,044 FROM 12 SITES. 1800 01:02:10,044 --> 01:02:15,816 WE ENDED UP WITH 24 PEOPLE, ENDS 1801 01:02:15,816 --> 01:02:19,120 UP WITH 13 SITES. 1802 01:02:19,120 --> 01:02:21,389 THAT EXPANSION OF BEING ABLE TO 1803 01:02:21,389 --> 01:02:23,090 HANDLE PROJECTS, ONE OF THE 1804 01:02:23,090 --> 01:02:24,759 THINGS THEY DID, AFTER THE 1805 01:02:24,759 --> 01:02:26,494 TRAINING, WAS ACTUAL THROW BEGIN 1806 01:02:26,494 --> 01:02:28,496 TO TALK TO WOMEN ABOUT CLINICAL 1807 01:02:28,496 --> 01:02:30,431 TRIALS AND TO SAY, WILL YOU 1808 01:02:30,431 --> 01:02:31,198 PARTICIPATE IN CLINICAL TRIALS, 1809 01:02:31,198 --> 01:02:33,601 YOU WON'T BELIEVE THIS. 1810 01:02:33,601 --> 01:02:35,703 THEY HAVE 10,000 WOMEN SIGN A 1811 01:02:35,703 --> 01:02:37,338 CONSENT THAT THEY WOULD LIKE TO 1812 01:02:37,338 --> 01:02:40,608 BE APPROACHED WHEN THERE'S A 1813 01:02:40,608 --> 01:02:41,709 CLINICAL TRIAL OPPORTUNITY. 1814 01:02:41,709 --> 01:02:42,810 TEN THOUSAND SIGNED A CONSENT. 1815 01:02:42,810 --> 01:02:44,946 THIS IS NOT A CONSENT FOR ANY 1816 01:02:44,946 --> 01:02:45,746 PARTICULAR STUDY. 1817 01:02:45,746 --> 01:02:47,682 THIS IS A CONSENT THAT IF 1818 01:02:47,682 --> 01:02:49,383 THERE'S A CLINICAL TRIAL, WE 1819 01:02:49,383 --> 01:02:52,653 WANT TO BE -- YOU CAN CONTACT 1820 01:02:52,653 --> 01:02:53,187 US. 1821 01:02:53,187 --> 01:02:56,490 THEY GIVE THEIR CONTACT, THEIR 1822 01:02:56,490 --> 01:02:58,326 CONSENT TO CONSENT WITH CLINICAL 1823 01:02:58,326 --> 01:03:00,428 TRIAL. 1824 01:03:00,428 --> 01:03:00,728 THAT'S HUGE. 1825 01:03:00,728 --> 01:03:02,597 WHAT WE DID EMBARK ON A SECOND 1826 01:03:02,597 --> 01:03:06,334 PART, 10,000 WOMEN WITH HIV, 1827 01:03:06,334 --> 01:03:10,972 WEPT BACK TO HAVE AGE-MATCHED 1828 01:03:10,972 --> 01:03:12,540 10,000 WITHOUT HIV, IN THE END 1829 01:03:12,540 --> 01:03:15,343 WE'LL HAVE A 20,000 COHORT, 1830 01:03:15,343 --> 01:03:22,883 10,000 WITH HIV, 10,000 AGE 1831 01:03:22,883 --> 01:03:24,118 MATCH WITHOUT HIV. 1832 01:03:24,118 --> 01:03:28,155 WITH NO FUNDING. 1833 01:03:28,155 --> 01:03:30,858 YOU CAN WE ALREADY HAVE A GRANT 1834 01:03:30,858 --> 01:03:36,230 THAT IS ONGOING ON THE FUNDING 1835 01:03:36,230 --> 01:03:39,533 FOR NHLBI, FROM NCI, FOR 1836 01:03:39,533 --> 01:03:40,635 CERVICAL CANCER. 1837 01:03:40,635 --> 01:03:41,602 WE UTILIZE PEOPLE WORKING IN THE 1838 01:03:41,602 --> 01:03:42,937 PLACE TO DO THAT. 1839 01:03:42,937 --> 01:03:45,006 I TALK ABOUT BREAKING DOWN 1840 01:03:45,006 --> 01:03:45,239 SILOS. 1841 01:03:45,239 --> 01:03:47,942 JUST BECAUSE FUNDING IS FROM 1842 01:03:47,942 --> 01:03:50,911 NIH, FUNDING IS FROM NCI, 1843 01:03:50,911 --> 01:03:52,613 FUNDING IS FROM NHLBI, IF YOU 1844 01:03:52,613 --> 01:03:54,615 HAVE PEOPLE ON THE SITE WE CAN 1845 01:03:54,615 --> 01:03:56,317 USE THAT TO ENHANCE CARE FOR 1846 01:03:56,317 --> 01:03:56,951 WOMEN. 1847 01:03:56,951 --> 01:04:01,822 IF A WOMAN IS COMING IN FOR 1848 01:04:01,822 --> 01:04:02,623 EXAMPLE WITH CERVICAL CANCER, 1849 01:04:02,623 --> 01:04:05,893 WHY CAN'T SCREEN FOR BREAST 1850 01:04:05,893 --> 01:04:06,894 CANCER, SOMETHING WE'RE BUILDING 1851 01:04:06,894 --> 01:04:08,295 CLINICAL TRIAL, WITH THAT 1852 01:04:08,295 --> 01:04:09,230 STRUCTURE IN THERE TO SAY NOW 1853 01:04:09,230 --> 01:04:11,032 WE'RE DOING SOME OF THIS TO SAY 1854 01:04:11,032 --> 01:04:14,201 IF A WOMAN COMES IN, OUR FUNDING 1855 01:04:14,201 --> 01:04:16,971 IS FOR CERVICAL CANCER BUT WHILE 1856 01:04:16,971 --> 01:04:19,573 THEY ARE WAITING, CAN YOU GET 1857 01:04:19,573 --> 01:04:20,041 BLOOD PRESSURE? 1858 01:04:20,041 --> 01:04:22,777 THAT'S SOMETHING YOU CAN DO. 1859 01:04:22,777 --> 01:04:24,412 CAN YOU TEACH THEM HOW TO DO 1860 01:04:24,412 --> 01:04:25,479 BREAST SELF-EXAMINATION, 1861 01:04:25,479 --> 01:04:27,348 SOMETHING YOU CAN DO. 1862 01:04:27,348 --> 01:04:29,316 INTEGRATING AND BREAKING SILOS 1863 01:04:29,316 --> 01:04:31,652 OF FUNDING IS ONE OF THE WAYS TO 1864 01:04:31,652 --> 01:04:34,588 LOOK AT THESE INSTITUTIONS, LOOK 1865 01:04:34,588 --> 01:04:35,923 AT THEIR INFRASTRUCTURE, 1866 01:04:35,923 --> 01:04:41,128 FLUBBING HUMAN CAPITAL AND IN 1867 01:04:41,128 --> 01:04:42,196 PROGRAM. 1868 01:04:42,196 --> 01:04:44,265 >> I WANTED TO ASK DR. 1869 01:04:44,265 --> 01:04:47,435 CREAR-PERRY IF YOU HAVE ANYTHING 1870 01:04:47,435 --> 01:04:50,838 TO ADD AS RELATES TO BUILDING 1871 01:04:50,838 --> 01:04:51,038 TRUST. 1872 01:04:51,038 --> 01:04:52,573 >> EVERYTHING YOU SAID WAS MIND 1873 01:04:52,573 --> 01:04:53,274 BLOWING, HONESTLY. 1874 01:04:53,274 --> 01:04:55,543 I COULD TALK TO YOU FOR AN HOUR 1875 01:04:55,543 --> 01:04:56,577 ABOUT ALL OF THIS. 1876 01:04:56,577 --> 01:04:57,945 WE CAN'T GET BLACK PEOPLE IN THE 1877 01:04:57,945 --> 01:04:59,346 UNITED STATES TO SIGN UP FOR 1878 01:04:59,346 --> 01:05:00,014 CLINICAL TRIALS. 1879 01:05:00,014 --> 01:05:02,083 LET'S JUST START WITH THAT. 1880 01:05:02,083 --> 01:05:04,185 WE HAVE TO PAY THEM, BRIBE THEM. 1881 01:05:04,185 --> 01:05:05,920 THEY HAVE BEEN HARMED SO MUCH BY 1882 01:05:05,920 --> 01:05:08,355 THE HEALTHCARE SYSTEM THAT 1883 01:05:08,355 --> 01:05:10,658 USUALLY WHITE INSTITUTIONS COUNT 1884 01:05:10,658 --> 01:05:12,727 ON RELATIONSHIPS OF SMALL BLACK 1885 01:05:12,727 --> 01:05:13,360 PROVIDERS, PATIENTS, TO SEE IF 1886 01:05:13,360 --> 01:05:14,462 THEY WILL ASK THEM. 1887 01:05:14,462 --> 01:05:17,631 TO GET 10,000 TO VOLUNTEER, ALSO 1888 01:05:17,631 --> 01:05:19,166 WITH THE SMALL AMOUNT OF MONEY 1889 01:05:19,166 --> 01:05:21,736 YOU HAD, IN ORDER TO DO THIS 1890 01:05:21,736 --> 01:05:25,673 AMAZING WORK I'M IMPRESS AND 1891 01:05:25,673 --> 01:05:27,842 GRATEFUL, REMINDS REMINDS ME OK 1892 01:05:27,842 --> 01:05:31,545 HERE WITH SMALL BUDGETS. 1893 01:05:31,545 --> 01:05:32,980 BIGGEST WE GOT FOR $4 MILLION, 1894 01:05:32,980 --> 01:05:34,281 BIG FOR A NON-PROFIT, BUT 1895 01:05:34,281 --> 01:05:36,917 COMPARED TO -- I'M ON THE BOARD 1896 01:05:36,917 --> 01:05:39,320 OF UCSF SO THEY GIVE OUT 1897 01:05:39,320 --> 01:05:39,987 BILLIONS OF DOLLARS AROUND 1898 01:05:39,987 --> 01:05:41,422 HEALTH CARE AND DON'T GET THE 1899 01:05:41,422 --> 01:05:42,289 OUTCOMES WE GET. 1900 01:05:42,289 --> 01:05:43,624 WHAT THIS SAYS TO ME WHEN YOU 1901 01:05:43,624 --> 01:05:45,793 INVEST IN THE PEOPLE CLOSEST TO 1902 01:05:45,793 --> 01:05:47,228 THE PAIN, YOU ACTUALLY GET 1903 01:05:47,228 --> 01:05:48,062 PROGRESS. 1904 01:05:48,062 --> 01:05:49,296 WHEN YOU KEEP INVESTING IN LARGE 1905 01:05:49,296 --> 01:05:50,598 INSTITUTION WHO IS HAVE TO ASK 1906 01:05:50,598 --> 01:05:52,466 US HOW TO DO THE WORK WE'LL KEEP 1907 01:05:52,466 --> 01:05:53,667 HAVING THE POOR OUTCOMES WE 1908 01:05:53,667 --> 01:05:54,969 CURRENTLY HAVE. 1909 01:05:54,969 --> 01:05:56,604 THAT'S MY COMMENT. 1910 01:05:56,604 --> 01:05:59,240 >> YEAH, I WAS WONDERING IF HAD 1911 01:05:59,240 --> 01:06:01,008 YOU SOME EXAMPLES OF THINGS YOUR 1912 01:06:01,008 --> 01:06:02,209 COLLABORATIVE IS DOING WHERE YOU 1913 01:06:02,209 --> 01:06:04,178 ARE BUILDING THE TRUST AND HOW 1914 01:06:04,178 --> 01:06:07,014 THAT HAS BEEN IMPACTING JUST THE 1915 01:06:07,014 --> 01:06:11,285 HEALTH CARE, THE OUTCOMES, THE 1916 01:06:11,285 --> 01:06:11,552 COMMUNITY. 1917 01:06:11,552 --> 01:06:14,688 >> BUILDING TRUST IS HARD. 1918 01:06:14,688 --> 01:06:16,090 WE'VE BEEN HARMED SO MUCH, THERE 1919 01:06:16,090 --> 01:06:18,058 WAS A TIME I WOULD START WITH 1920 01:06:18,058 --> 01:06:19,493 ALL THE BUTTERFLIES AND RAINBOWS 1921 01:06:19,493 --> 01:06:20,461 ABOUT THE WORK. 1922 01:06:20,461 --> 01:06:21,562 RIGHT NOW I START WITH THE 1923 01:06:21,562 --> 01:06:21,962 TRAUMA. 1924 01:06:21,962 --> 01:06:23,164 I WOULDN'T TO PULL BACK AND 1925 01:06:23,164 --> 01:06:24,198 START SELLING SOME OF THE GOOD 1926 01:06:24,198 --> 01:06:26,500 THINGS WE'VE BEEN ABLE TO DO, 1927 01:06:26,500 --> 01:06:28,335 BUILD TRUST WITH RESPECT FOR 1928 01:06:28,335 --> 01:06:29,770 MATERNAL CARE TOOLKIT, WORKING 1929 01:06:29,770 --> 01:06:31,739 WITH ORGANIZATIONS LIKE KAISER 1930 01:06:31,739 --> 01:06:33,374 HOSPITAL SYSTEM, THE LARGEST 1931 01:06:33,374 --> 01:06:34,475 NON-PROFIT IN THE UNITED STATES, 1932 01:06:34,475 --> 01:06:37,711 TO WORK ON TRUST BUILDING, 1933 01:06:37,711 --> 01:06:40,714 TEACHING THE SAME TALK I JUST 1934 01:06:40,714 --> 01:06:42,116 GAVE, WE DON'T LEARN THAT IN THE 1935 01:06:42,116 --> 01:06:42,783 UNITED STATES. 1936 01:06:42,783 --> 01:06:45,519 YOU'LL KEEP BLAMING AND SHAMING 1937 01:06:45,519 --> 01:06:45,786 PATIENTS. 1938 01:06:45,786 --> 01:06:48,255 TRUST BUILDING STARTS WITH THE 1939 01:06:48,255 --> 01:06:49,657 TRUTH, HISTORY OF REPRODUCTIVE 1940 01:06:49,657 --> 01:06:51,091 OPPRESSION, THE SAME TALK TO 1941 01:06:51,091 --> 01:06:52,760 BUILD TRUST WITH THE ENTIRE 1942 01:06:52,760 --> 01:06:54,962 GATES FOUNDATION, I WAS THE 1943 01:06:54,962 --> 01:06:55,462 ANNUAL KEYNOTE SPEAKER. 1944 01:06:55,462 --> 01:06:57,231 WE'RE NOT GOING TO BE ABLE TO 1945 01:06:57,231 --> 01:06:58,899 BUILD TRUST ON LIES. 1946 01:06:58,899 --> 01:07:00,968 THE BEGINNING, YOU HAVE TO TELL 1947 01:07:00,968 --> 01:07:02,736 TRUTH HOW WE GOT HERE AND THEN 1948 01:07:02,736 --> 01:07:04,038 TALK ABOUT HOW WE CAN BUILD 1949 01:07:04,038 --> 01:07:04,972 TRUST AND GET THROUGH THE 1950 01:07:04,972 --> 01:07:05,206 TRAUMA. 1951 01:07:05,206 --> 01:07:06,440 >> THANK YOU SO MUCH. 1952 01:07:06,440 --> 01:07:08,309 FOR THOSE WHO HAVE QUESTIONS, IF 1953 01:07:08,309 --> 01:07:10,611 YOU COULD ENTER IT IN THE Q&A 1954 01:07:10,611 --> 01:07:11,946 SECTION, THAT WOULD BE HELPFUL. 1955 01:07:11,946 --> 01:07:13,681 I'M TRYING TO GO THROUGH SOME 1956 01:07:13,681 --> 01:07:16,083 QUESTIONS AND COMMENTS IN THE 1957 01:07:16,083 --> 01:07:18,586 CHAT, SO JUST BE PATIENT WITH ME 1958 01:07:18,586 --> 01:07:18,819 ON THAT. 1959 01:07:18,819 --> 01:07:21,222 ONE OF THE QUESTIONS ACTUALLY 1960 01:07:21,222 --> 01:07:22,990 IT'S A COMMENT FROM THE DIRECTOR 1961 01:07:22,990 --> 01:07:27,027 OF THE CENTER FOR TRANSLATION 1962 01:07:27,027 --> 01:07:28,762 RESEARCH AN IMPLEMENTATION 1963 01:07:28,762 --> 01:07:29,797 SCIENCE, OUTSTANDING 1964 01:07:29,797 --> 01:07:30,731 PRESENTATION, THANKS FOR YOUR 1965 01:07:30,731 --> 01:07:32,967 PRACTICE REAL WORLD STRATEGY FOR 1966 01:07:32,967 --> 01:07:34,301 ENGAGING POLICYMAKERS AND 1967 01:07:34,301 --> 01:07:36,270 CLARIFYING DIFFERENCE BETWEEN 1968 01:07:36,270 --> 01:07:37,905 EFFICACY, EFFECTIVENESS 1969 01:07:37,905 --> 01:07:38,672 RESEARCH, IMPLEMENTATION SCIENCE 1970 01:07:38,672 --> 01:07:39,440 RESEARCH, DR. GEORGE MENSAH. 1971 01:07:39,440 --> 01:07:41,275 I'M NOT SURE IF YOU WANT TO COME 1972 01:07:41,275 --> 01:07:43,711 OFF THE MIC AND VIDEO AND SAY A 1973 01:07:43,711 --> 01:07:44,478 FEW WORDS. 1974 01:07:44,478 --> 01:07:47,448 >> OH, I'D LOVE THAT. 1975 01:07:47,448 --> 01:07:51,485 1976 01:07:51,485 --> 01:07:52,920 >> MAYBE HE'S DEPARTED. 1977 01:07:52,920 --> 01:07:54,488 IF HE COMES BACK, I'LL BRING HIM 1978 01:07:54,488 --> 01:07:58,158 BACK TO SAY A COUPLE OF WORDS. 1979 01:07:58,158 --> 01:08:01,562 THERE'S ALSO A COMMENT ABOUT 1980 01:08:01,562 --> 01:08:03,631 TRANSLATING SCIENCE INTO POLICY 1981 01:08:03,631 --> 01:08:06,066 CONSUMABLE KNOWLEDGE PRODUCTS 1982 01:08:06,066 --> 01:08:09,570 SUCH AS POLICIES, BRIEFS, 1983 01:08:09,570 --> 01:08:11,405 POSITION PAGES, BULLETINS AND 1984 01:08:11,405 --> 01:08:17,811 BLOGS IS CRITICAL IN INFORMING 1985 01:08:17,811 --> 01:08:18,145 POLICYMAKERS. 1986 01:08:18,145 --> 01:08:26,954 DR. CREAR-PERRY, HOW IS YOUR 1987 01:08:26,954 --> 01:08:28,389 EXPERIENCE WITH THAT HERE IN THE 1988 01:08:28,389 --> 01:08:29,256 UNITED STATES? 1989 01:08:29,256 --> 01:08:30,591 >> I WOULD SAY FIRST TIME WAS 1990 01:08:30,591 --> 01:08:31,091 BACK IN 2016. 1991 01:08:31,091 --> 01:08:34,728 I DON'T KNOW IF YOU'VE HEARD 1992 01:08:34,728 --> 01:08:36,997 ABOUT THE BLACK MAMAS MATTER 1993 01:08:36,997 --> 01:08:37,765 ALLIANCE, BLACK WOMEN ARE DYING 1994 01:08:37,765 --> 01:08:40,200 IN THE UNITED STATES DESPITE 1995 01:08:40,200 --> 01:08:43,437 INCOME OR EDUCATION, HIGHER THAN 1996 01:08:43,437 --> 01:08:43,871 WHITE COUNTERPARTS. 1997 01:08:43,871 --> 01:08:47,107 WE HAD A HILL BRIEFING. 1998 01:08:47,107 --> 01:08:49,243 I CALLED MY FRIEND IN RICHMOND, 1999 01:08:49,243 --> 01:08:50,077 THE CHAIR OF CONGRESSIONAL BLACK 2000 01:08:50,077 --> 01:08:51,779 CAUCUS AT THE TIME, WE GOT THIS 2001 01:08:51,779 --> 01:08:54,014 DATA BLACK WOMEN ARE DIEING IN 2002 01:08:54,014 --> 01:08:55,049 CHILD BIRTH, WE WANT TO SHARE 2003 01:08:55,049 --> 01:08:58,018 AND NEED A ROOM. 2004 01:08:58,018 --> 01:09:04,358 HE GAVE US HEARING ROOM, BROUGHT 2005 01:09:04,358 --> 01:09:04,992 THE PRESIDENT OF THE AMERICAN 2006 01:09:04,992 --> 01:09:07,294 COLLEGE OF OB/GYN, THE SECOND 2007 01:09:07,294 --> 01:09:10,431 BLACK PERSON TO LEAD THIS AND 2008 01:09:10,431 --> 01:09:11,832 BRING IN ADVOCATES, DR. JACKSON, 2009 01:09:11,832 --> 01:09:13,968 YOU MAY BE FAMILIAR WITH, SHE 2010 01:09:13,968 --> 01:09:15,502 DID RESEARCH THAT SHOWED IF YOU 2011 01:09:15,502 --> 01:09:16,804 HAVE POLICE VIOLENCE IN A 2012 01:09:16,804 --> 01:09:18,138 COMMUNITY YOU'LL HAVE HIGHER 2013 01:09:18,138 --> 01:09:19,340 RATES OF INFANT MORTALITY. 2014 01:09:19,340 --> 01:09:22,409 IT'S NOT THAT THE POLICE ARE 2015 01:09:22,409 --> 01:09:23,944 PHYSICALLY SHOOTING MAMAS, 2016 01:09:23,944 --> 01:09:25,179 ALTHOUGH THEY RECENTLY DID, THE 2017 01:09:25,179 --> 01:09:26,780 STRESS OF HAVING SO MUCH POLICE 2018 01:09:26,780 --> 01:09:28,515 INFLUENCE IN YOUR COMMUNITY 2019 01:09:28,515 --> 01:09:30,384 MAKES YOU GO INTO LABOR EARLIER, 2020 01:09:30,384 --> 01:09:31,919 HORMONES ARE HIGHER. 2021 01:09:31,919 --> 01:09:33,153 WE'RE ABLE TO SHOW POLICYMAKERS 2022 01:09:33,153 --> 01:09:34,788 RACISM IS REAL AND CAUSES 2023 01:09:34,788 --> 01:09:36,357 BIOLOGICAL HARM TO YOUR BODY SO 2024 01:09:36,357 --> 01:09:37,524 ALTHOUGH A LOT OF COLLEAGUES 2025 01:09:37,524 --> 01:09:39,626 SPEND TIME LOOKING AT THE 2026 01:09:39,626 --> 01:09:41,261 BIOLOGICAL IMPACTS OF RACISM, TO 2027 01:09:41,261 --> 01:09:44,198 LOOK FOR A PILL OR SHOT, WE'RE 2028 01:09:44,198 --> 01:09:45,532 LOOKING FOR POLICYMAKERS TO 2029 01:09:45,532 --> 01:09:46,533 CHANGE POLICIES CAUSING RACISM 2030 01:09:46,533 --> 01:09:48,936 TO HARM OUR BODIES IN THE FIRST 2031 01:09:48,936 --> 01:09:49,136 PLACE. 2032 01:09:49,136 --> 01:09:51,972 >> JUST TO FOLLOW UP FROM YOU, 2033 01:09:51,972 --> 01:09:53,741 FROM DR. GEORGE MENSAH, THANK 2034 01:09:53,741 --> 01:09:56,577 YOU FOR THE OUTSTANDING 2035 01:09:56,577 --> 01:09:58,645 PRESENTATION, DR. CREAR-PERRY, 2036 01:09:58,645 --> 01:10:00,180 APPRECIATE YOU DELIVERING THIS 2037 01:10:00,180 --> 01:10:02,049 DESPITE THE CHALLENGES YOU 2038 01:10:02,049 --> 01:10:04,184 MENTIONED. 2039 01:10:04,184 --> 01:10:09,189 HE'S NOW ON VIDEO AND AUDIBLE. 2040 01:10:09,189 --> 01:10:10,924 WOULD YOU LIKE TO MAKE A 2041 01:10:10,924 --> 01:10:11,158 COMMENT? 2042 01:10:11,158 --> 01:10:12,126 >> THANKS A LOT. 2043 01:10:12,126 --> 01:10:14,328 IT'S BEEN A TERRIFIC WAY TO 2044 01:10:14,328 --> 01:10:16,397 BEGIN THE MORNING. 2045 01:10:16,397 --> 01:10:17,931 I WANTED TO MENTION REAL 2046 01:10:17,931 --> 01:10:20,434 APPRECIATION FOR THESE TWO 2047 01:10:20,434 --> 01:10:21,201 EXCELLENT PRESENTATIONS. 2048 01:10:21,201 --> 01:10:23,070 SO THANKS FOR GIVING ME THE 2049 01:10:23,070 --> 01:10:23,370 OPPORTUNITY. 2050 01:10:23,370 --> 01:10:27,341 BUT I WAS IN THE MIDDLE OF 2051 01:10:27,341 --> 01:10:28,075 ACTUALLY TYPING ANOTHER COMMENT, 2052 01:10:28,075 --> 01:10:30,177 SO I HAVE THE FLOOR LET ME GO 2053 01:10:30,177 --> 01:10:36,784 AHEAD AND SAY IT. 2054 01:10:36,784 --> 01:10:38,185 DR. CREAR-PERRY, I WAS MOVED BY 2055 01:10:38,185 --> 01:10:40,120 YOUR COMMENT IN YOU INVEST IN 2056 01:10:40,120 --> 01:10:43,424 THE PEOPLE CLOSEST TO THE PAIN, 2057 01:10:43,424 --> 01:10:45,592 YOU GET THE GREATEST PROGRESS. 2058 01:10:45,592 --> 01:10:47,628 AND I COMPLETELY AGREE WITH YOU. 2059 01:10:47,628 --> 01:10:49,730 SO THE QUESTION TO YOU, GIVEN 2060 01:10:49,730 --> 01:10:51,465 WHAT WE'VE HEARD FROM BOTH OF 2061 01:10:51,465 --> 01:10:54,701 YOU, HOW DO THE TWO OF YOU PUT 2062 01:10:54,701 --> 01:10:57,738 YOUR HEADS TOGETHER TO IDENTIFY 2063 01:10:57,738 --> 01:11:00,140 THE UNIQUE OPPORTUNITY FOR NIH 2064 01:11:00,140 --> 01:11:03,577 AND NHLBI TO BE ABLE TO IDENTIFY 2065 01:11:03,577 --> 01:11:06,780 THE 10,000 WOMEN, NOT JUST BLACK 2066 01:11:06,780 --> 01:11:10,717 WOMEN, BUT BLACK WOMEN, 2067 01:11:10,717 --> 01:11:13,353 INDIGENOUS WOMEN, AND WOMEN WHO 2068 01:11:13,353 --> 01:11:14,388 BEAR A HUGE DISPROPORTIONATE 2069 01:11:14,388 --> 01:11:17,057 BURDEN, HOW DO WE DO THE SAME 2070 01:11:17,057 --> 01:11:18,492 THING HERE, WHAT ARE YOUR 2071 01:11:18,492 --> 01:11:25,933 THOUGHTS BY WAY OF IDENTIFYING 2072 01:11:25,933 --> 01:11:26,733 OPPORTUNITIES? 2073 01:11:26,733 --> 01:11:35,109 >> I AM CURIOUS IF YOU'RE 2074 01:11:35,109 --> 01:11:42,249 RELATED TO ANY DR. MENSAH'S IN 2075 01:11:42,249 --> 01:11:42,816 NEW ORLEANS. 2076 01:11:42,816 --> 01:11:43,417 >> VIRTUAL COUSINS. 2077 01:11:43,417 --> 01:11:44,785 >> I WOULD SAY I WOULD BE SO 2078 01:11:44,785 --> 01:11:45,119 HONORED. 2079 01:11:45,119 --> 01:11:47,754 THIS IS WHAT THE WORK THAT OUR 2080 01:11:47,754 --> 01:11:48,822 TRANSNATIONAL TEAM WAS TRYING TO 2081 01:11:48,822 --> 01:11:50,691 DO TO SHOW EXPERIENCE AND IDEAS 2082 01:11:50,691 --> 01:11:52,459 YOU HAVE ALREADY CREATED IN 2083 01:11:52,459 --> 01:11:53,760 NIGERIA TO GET THESE 10,000 2084 01:11:53,760 --> 01:11:56,196 WOMEN, HOW CAN WE LEARN FROM YOU 2085 01:11:56,196 --> 01:12:00,334 SO WE CAN SHOW UNDERSTANDING WE 2086 01:12:00,334 --> 01:12:02,636 HAVE ABOUT RACISM BEING 2087 01:12:02,636 --> 01:12:03,003 OPERATIONALIZED. 2088 01:12:03,003 --> 01:12:04,238 I WAS TRAINED IN CONFEDERATE 2089 01:12:04,238 --> 01:12:06,273 MEDICINE, WHAT I CALL IT. 2090 01:12:06,273 --> 01:12:07,241 I UNDERSTAND THE SPOTS INSIDE 2091 01:12:07,241 --> 01:12:09,776 THE HEALTH CARE. 2092 01:12:09,776 --> 01:12:12,946 BLACK WOMEN MORE LIKELY TO DIE 2093 01:12:12,946 --> 01:12:16,450 IN HYPERTENSION, WE CAN USE HIV, 2094 01:12:16,450 --> 01:12:17,518 WE'VE KNOWN FOR DECADES BLACK 2095 01:12:17,518 --> 01:12:18,852 WOMEN ARE THE MOST LIKELY TO 2096 01:12:18,852 --> 01:12:19,820 HAVE HIV. 2097 01:12:19,820 --> 01:12:20,621 WE'VE BEEN DECREASING THE NUMBER 2098 01:12:20,621 --> 01:12:21,688 OF BLACK WOMEN IN THE UNITED 2099 01:12:21,688 --> 01:12:22,055 STATES. 2100 01:12:22,055 --> 01:12:24,091 WHEN YOU SAY THOSE NUMBERS HERE 2101 01:12:24,091 --> 01:12:25,526 THEY SEEM LARGE BECAUSE WE'VE 2102 01:12:25,526 --> 01:12:26,827 STARTED TO IMPLEMENT SOME THINGS 2103 01:12:26,827 --> 01:12:28,695 HERE BUT WE DON'T HAVE THE TRUST 2104 01:12:28,695 --> 01:12:30,664 THAT YOU HAVE IN NIGERIA, WHAT 2105 01:12:30,664 --> 01:12:33,066 IF WE COULD USE BOTH THE 2106 01:12:33,066 --> 01:12:37,337 MECHANICAL MEDICAL THINGS WE 2107 01:12:37,337 --> 01:12:39,006 LEARNED HERE PLUS TRUST OF 2108 01:12:39,006 --> 01:12:48,615 NIGERIA TO BUILD A GLOBAL WAY TO 2109 01:12:48,615 --> 01:12:52,452 END HIV GLOBALLY, INSTEAD OF 2110 01:12:52,452 --> 01:12:54,188 GIVING VACCINES AFTER THE FACT. 2111 01:12:54,188 --> 01:13:00,861 >> TAKING THIS MESSAGE TO THE 2112 01:13:00,861 --> 01:13:02,596 POPULATION, YOU TALK -- WE NEVER 2113 01:13:02,596 --> 01:13:04,364 PUBLISH A STUDY UNTIL WE PROVIDE 2114 01:13:04,364 --> 01:13:05,666 DATA TO THE COMMUNITY WHERE WE 2115 01:13:05,666 --> 01:13:07,000 DID THE STUDY. 2116 01:13:07,000 --> 01:13:08,635 SO THIS IS NO LONGER JUST ABOUT 2117 01:13:08,635 --> 01:13:10,704 PUBLICATIONS FOR US. 2118 01:13:10,704 --> 01:13:12,439 SO WHEN WE FINISH, WE GO BACK, 2119 01:13:12,439 --> 01:13:14,875 FOR EXAMPLE WHEN WE DID THE BABY 2120 01:13:14,875 --> 01:13:15,642 SHOWERS WE WENT, SOMETHING 2121 01:13:15,642 --> 01:13:17,177 HAPPENING IN THE U.S., WE WENT 2122 01:13:17,177 --> 01:13:19,379 TO WHERE THE PEOPLE ARE SO IF 2123 01:13:19,379 --> 01:13:23,850 YOU WANTED TO LOOK AT, EVEN IF 2124 01:13:23,850 --> 01:13:25,619 YOU'RE LOOKING AT PEOPLE MOST 2125 01:13:25,619 --> 01:13:26,620 AFFECTED, NEW IMMIGRANTS FOR THE 2126 01:13:26,620 --> 01:13:28,021 UNITED STATES, MOST OF THEM GO 2127 01:13:28,021 --> 01:13:32,960 TO THEIR PLACE OF WORSHIP, A 2128 01:13:32,960 --> 01:13:35,462 CHURCH, A MOSQUE, NOT READING A 2129 01:13:35,462 --> 01:13:36,897 JOURNAL IN "LANCET," RIGHT? 2130 01:13:36,897 --> 01:13:39,499 ONE THINGS WE DO IS GO BACK TO 2131 01:13:39,499 --> 01:13:41,335 THE COMMUNITIES, WE SCREENED IN 2132 01:13:41,335 --> 01:13:43,704 BABY SHOWER SCREENED 10,000 2133 01:13:43,704 --> 01:13:45,439 WOMEN, 7,000 MALE PARTNERS FOR 2134 01:13:45,439 --> 01:13:47,841 HIV AND SICKLE CELL. 2135 01:13:47,841 --> 01:13:48,242 AND HYPERTENSION. 2136 01:13:48,242 --> 01:13:50,010 THIS IS BECAUSE WHAT WE DID IN 2137 01:13:50,010 --> 01:13:51,111 THAT STUDY PEOPLE SAID NIH IS 2138 01:13:51,111 --> 01:13:52,112 NOT GOING TO FUNDS THIS. 2139 01:13:52,112 --> 01:13:54,982 THIS IS ALL ABOUT HIV. 2140 01:13:54,982 --> 01:13:57,384 I SAID THE WOMEN DOESN'T HAVE 2141 01:13:57,384 --> 01:13:57,851 HIV ALONE. 2142 01:13:57,851 --> 01:14:00,120 WHEN YOU DO HIV ONLY SCREENING 2143 01:14:00,120 --> 01:14:01,788 THAT'S STIGMATIZING THE WOMAN. 2144 01:14:01,788 --> 01:14:07,160 YOU KNOW, THAT'S NOT -- SO WEIR 2145 01:14:07,160 --> 01:14:09,096 WE WROTE A PROPOSAL OF BABY 2146 01:14:09,096 --> 01:14:11,164 SHOWER, AN AMERICAN CONCEPT. 2147 01:14:11,164 --> 01:14:12,466 >> IT IS. 2148 01:14:12,466 --> 01:14:13,634 >> WE JOINED BOTH OF THEM TO 2149 01:14:13,634 --> 01:14:15,235 PRESENT THIS INFRASTRUCTURE OF 2150 01:14:15,235 --> 01:14:18,839 THE BABY SHOWER WHERE TWO 2151 01:14:18,839 --> 01:14:19,940 DIFFERENT CULTURES, BUT 2152 01:14:19,940 --> 01:14:20,841 INTEGRATED APPROACH TO TESTING 2153 01:14:20,841 --> 01:14:22,476 SO BECAUSE YOU TAKE A BLOOD FROM 2154 01:14:22,476 --> 01:14:25,445 A WOMAN, I CAN DO HIV ON IT BUT 2155 01:14:25,445 --> 01:14:27,948 WHY CAN'T I DO SICKLE CELL AND 2156 01:14:27,948 --> 01:14:29,049 HEPATITIS B ON IT? 2157 01:14:29,049 --> 01:14:35,289 I HAVE THE SAME SAMPLE OF BLOOD. 2158 01:14:35,289 --> 01:14:38,025 THE WOMAN ABOUT COME BACK FROM 2159 01:14:38,025 --> 01:14:39,793 FOGARTY, ANOTHER INSTITUTION, 2160 01:14:39,793 --> 01:14:44,197 WE'RE GOING TO COLLECT YOUR 2161 01:14:44,197 --> 01:14:45,599 BLOOD, I HAVE THE SAMPLE. 2162 01:14:45,599 --> 01:14:47,234 TO PUT THE WOMAN AT THE CENTER 2163 01:14:47,234 --> 01:14:48,869 OF THE INTERVENTION, NOT THE 2164 01:14:48,869 --> 01:14:51,071 FUNDING, AND THE FUNDING STREAMS 2165 01:14:51,071 --> 01:14:52,172 TO SUPPORT THAT INTERVENTION. 2166 01:14:52,172 --> 01:14:54,174 SO WHEN WE DO THAT WE CAN GO 2167 01:14:54,174 --> 01:14:56,009 BACK TO COMMUNITIES AND TALK TO 2168 01:14:56,009 --> 01:14:57,110 THE COMMUNITIES, WE PICK 2169 01:14:57,110 --> 01:14:59,179 DISEASES SOMETHING WE COULD DO. 2170 01:14:59,179 --> 01:15:00,747 WE TALKED ABOUT NUTRITION DURING 2171 01:15:00,747 --> 01:15:02,916 PREGNANCY, TALKED ABOUT BLOOD 2172 01:15:02,916 --> 01:15:03,517 PRESSURE. 2173 01:15:03,517 --> 01:15:04,651 TALKED ABOUT DIABETES, HEPATITIS 2174 01:15:04,651 --> 01:15:04,985 B. 2175 01:15:04,985 --> 01:15:06,420 EVERYTHING THAT WE TAKE THERE WE 2176 01:15:06,420 --> 01:15:09,256 HAVE SOMETHING THAT CAN BE DONE. 2177 01:15:09,256 --> 01:15:11,058 IT'S NOT, YOU KNOW, CLINICAL 2178 01:15:11,058 --> 01:15:12,359 TRIAL TO IDENTIFY NEW THINGS. 2179 01:15:12,359 --> 01:15:13,760 IT'S WHAT CAN BE DONE THAT WE 2180 01:15:13,760 --> 01:15:15,162 ALREADY KNOW THAT WORKS. 2181 01:15:15,162 --> 01:15:17,397 WE TAKE THEM BACK, IN YOUR 2182 01:15:17,397 --> 01:15:19,132 COMMUNITY THIS IS A NUMBER OF 2183 01:15:19,132 --> 01:15:20,600 WOMEN SCREEN FOR HIV POSITIVE, 2184 01:15:20,600 --> 01:15:23,837 THIS IS THE NUMBER SCREENED FOR 2185 01:15:23,837 --> 01:15:25,672 HEPATITIS B, WE LINKED THEM TO 2186 01:15:25,672 --> 01:15:29,176 CARE SO THESE WOMEN WITH 2187 01:15:29,176 --> 01:15:32,779 HEPATITIS B THEIR CHILDREN WILL 2188 01:15:32,779 --> 01:15:34,548 GET FIRST DOSE IN THE HOSPITAL, 2189 01:15:34,548 --> 01:15:35,982 WHY THEY NEED TO DELIVER IN THE 2190 01:15:35,982 --> 01:15:37,818 HOSPITAL TO CHILDREN CAN GET 2191 01:15:37,818 --> 01:15:42,189 THAT BECAUSE MAJORITY OF 2192 01:15:42,189 --> 01:15:44,157 TRANSMISSION FOR HEPATITIS B IS 2193 01:15:44,157 --> 01:15:44,358 HERE. 2194 01:15:44,358 --> 01:15:46,693 WE TALK ABOUT SICKLE CELL, IF A 2195 01:15:46,693 --> 01:15:49,663 WOMAN IS A-S, WHEN WE SCREEN, 2196 01:15:49,663 --> 01:15:52,499 THERE'S A CHANCE FOR THE WOMEN 2197 01:15:52,499 --> 01:15:53,700 IRRESPECTIVE OF THE MALE PARTNER 2198 01:15:53,700 --> 01:15:56,436 A CHANCE FOR THAT PERSON TO HAVE 2199 01:15:56,436 --> 01:15:58,638 SICKLE CELL, MALE PARTNERS HAVE 2200 01:15:58,638 --> 01:15:58,805 A-S. 2201 01:15:58,805 --> 01:16:03,043 WE ARE TRYING TO PUT THAT POWER 2202 01:16:03,043 --> 01:16:05,679 ON 25% OF THOSE WOMEN THAT 2203 01:16:05,679 --> 01:16:07,714 SCREEN FOR AS, FOR SICKLE CELL. 2204 01:16:07,714 --> 01:16:10,584 TAKING THAT MESSAGE BACK TO THEM 2205 01:16:10,584 --> 01:16:12,018 INSTEAD OF FOCUSING ON 2206 01:16:12,018 --> 01:16:13,453 PUBLISHING THEM, TO TAKE BACK TO 2207 01:16:13,453 --> 01:16:15,756 THE COMMUNITY TO GIVE THEM THAT, 2208 01:16:15,756 --> 01:16:17,257 EVEN WHEN YOU PUBLISH, PART OF 2209 01:16:17,257 --> 01:16:19,893 THE PUBLICATION THEIR NAME IS 2210 01:16:19,893 --> 01:16:21,795 NOT THERE. 2211 01:16:21,795 --> 01:16:23,096 >> ONE STATEMENT ABOUT 2212 01:16:23,096 --> 01:16:25,599 PUBLICATION, IS THAT OKAY? 2213 01:16:25,599 --> 01:16:25,799 YEAH? 2214 01:16:25,799 --> 01:16:26,466 >> YES, GO AHEAD. 2215 01:16:26,466 --> 01:16:27,033 >> GREAT. 2216 01:16:27,033 --> 01:16:29,336 IN THE U.S., WE'RE TRYING TO 2217 01:16:29,336 --> 01:16:30,971 CHANGE THE PUBLICATIONS BECAUSE 2218 01:16:30,971 --> 01:16:31,638 IT'S PEER REVIEWED. 2219 01:16:31,638 --> 01:16:33,039 THERE ARE NO PEERS FOR THE WORK 2220 01:16:33,039 --> 01:16:34,574 YOU AND I DO. 2221 01:16:34,574 --> 01:16:37,544 THINK ABOUT WHAT WE TALKED 2222 01:16:37,544 --> 01:16:39,579 ABOUT. SO TRANSFORMATIONAL. 2223 01:16:39,579 --> 01:16:43,116 WHEN I SEND IN ARTICLES ABOUT 2224 01:16:43,116 --> 01:16:44,618 RACISM WHAT PEER DO I HAVE? 2225 01:16:44,618 --> 01:16:50,090 WE NEED TO THINK ABOUT CREATING 2226 01:16:50,090 --> 01:16:51,858 NEW JOURNALS, WE'RE TRYING TO 2227 01:16:51,858 --> 01:16:53,393 HOLD "THE LANCET," WHICH I'VE 2228 01:16:53,393 --> 01:16:54,828 WRITTEN MANY ARTICLES TO, IT'S 2229 01:16:54,828 --> 01:16:56,663 EASIER TO FINDS PEERS IN 2230 01:16:56,663 --> 01:16:58,532 "LANCET" THAN SOME OTHER ONES 2231 01:16:58,532 --> 01:16:59,866 BUT UNTIL WE CAN CHANGE THE IDEA 2232 01:16:59,866 --> 01:17:01,601 WHAT A PEER IS AND WHO YOU SEE 2233 01:17:01,601 --> 01:17:04,638 AS A PEER BECAUSE WHITE 2234 01:17:04,638 --> 01:17:06,306 SUPREMACY NEVER SEES US AS THEIR 2235 01:17:06,306 --> 01:17:06,606 PEER. 2236 01:17:06,606 --> 01:17:08,708 >> WE HAVE TIME FOR ONE MORE 2237 01:17:08,708 --> 01:17:11,445 QUESTION BEFORE WE GO TO BREAK. 2238 01:17:11,445 --> 01:17:13,213 THIS IS A QUESTION REGARDING 2239 01:17:13,213 --> 01:17:15,382 SELF-ADVOCACY FOR BOTH OF YOU. 2240 01:17:15,382 --> 01:17:17,818 IT'S A MAJOR ASPECT OF THE 2241 01:17:17,818 --> 01:17:21,555 MATERNAL EXPERIENCE. 2242 01:17:21,555 --> 01:17:22,722 WHAT IS YOUR ORGANIZATION DOING 2243 01:17:22,722 --> 01:17:28,528 TO HELP WOMEN, HOW DO YOU HELP 2244 01:17:28,528 --> 01:17:29,062 WOMEN SELF- ADVOCATE. 2245 01:17:29,062 --> 01:17:31,698 I'LL START WITH YOU. 2246 01:17:31,698 --> 01:17:34,634 >> I WAS ALREADY JUMPING IN. 2247 01:17:34,634 --> 01:17:35,735 >> I'M ALREADY SELF-ADVOCATING. 2248 01:17:35,735 --> 01:17:36,069 >> EXACTLY. 2249 01:17:36,069 --> 01:17:39,039 IT'S THE ONLY WAY WE CAN LIVE 2250 01:17:39,039 --> 01:17:39,339 TRUTHFULLY. 2251 01:17:39,339 --> 01:17:40,574 I'VE BEEN -- MY ORGANIZATION 2252 01:17:40,574 --> 01:17:44,177 THAT HAS 2253 01:17:44,177 --> 01:17:45,579 BEEN FOCUSING ON MAKING SURE 2254 01:17:45,579 --> 01:17:47,581 WE'RE NOT DOING IT BY OURSELVES. 2255 01:17:47,581 --> 01:17:52,385 WE'VE BEEN SUPPORTING EACH OTHER 2256 01:17:52,385 --> 01:17:57,724 SINCE HARRIETT TUBMAN, SHE TOLD 2257 01:17:57,724 --> 01:17:59,359 HER HUSBAND HE COULDN'T LIVE IF 2258 01:17:59,359 --> 01:17:59,993 HE WAS ENSLAVED. 2259 01:17:59,993 --> 01:18:01,895 HOW WE MAKE SURE WE HAVE 2260 01:18:01,895 --> 01:18:03,763 SUPPORT, TO ADVOCATE IS GETTING 2261 01:18:03,763 --> 01:18:04,965 INFORMATION, MAKING SURE YOU 2262 01:18:04,965 --> 01:18:06,466 NEVER GO SOMEWHERE BY YOURSELF. 2263 01:18:06,466 --> 01:18:08,768 WHEN I HAD MY SON WHO WEIGHED 2264 01:18:08,768 --> 01:18:12,506 LESS THAN A POUND, I DROVE 2265 01:18:12,506 --> 01:18:16,676 MYSELF TO THE HOSPITAL. 2266 01:18:16,676 --> 01:18:18,845 DIDN'T ASK MY THEN-HUSBAND TO 2267 01:18:18,845 --> 01:18:20,180 DRIVE ME, I DROVE. 2268 01:18:20,180 --> 01:18:22,482 NOT A GOOD IDEA. 2269 01:18:22,482 --> 01:18:23,683 BLACK WOMEN HAVE TO LET OTHERS 2270 01:18:23,683 --> 01:18:25,185 TAKE CARE OF THEM, TO NOT FEEL 2271 01:18:25,185 --> 01:18:26,653 LIKE WE HAVE TO TAKE OVER AND 2272 01:18:26,653 --> 01:18:27,988 THE WORLD NEEDS TO MEET US 2273 01:18:27,988 --> 01:18:28,188 THERE. 2274 01:18:28,188 --> 01:18:33,760 SO THAT'S WHERE I AM TRUTHFULLY. 2275 01:18:33,760 --> 01:18:37,731 >> DR. ECHE? 2276 01:18:37,731 --> 01:18:40,233 >> WHEN I CAME TO THE UNITED 2277 01:18:40,233 --> 01:18:42,502 STATES FROM NIGERIA 30 YEARS AGO 2278 01:18:42,502 --> 01:18:44,938 SOMEBODY TOLD ME NO MATTER HOW 2279 01:18:44,938 --> 01:18:45,906 GOOD THEIR PLAYER IS, A COACH 2280 01:18:45,906 --> 01:18:47,574 HAS TO PUT HIM ON THE PLAYING 2281 01:18:47,574 --> 01:18:47,774 FIELD. 2282 01:18:47,774 --> 01:18:48,775 I SCRATCH MY HEAD. 2283 01:18:48,775 --> 01:18:49,743 I HAD NOBODY. 2284 01:18:49,743 --> 01:18:52,112 I DIDN'T KNOW WHO IS GOING TO 2285 01:18:52,112 --> 01:18:53,914 PUT ME ON THE COACH, WHO IS THE 2286 01:18:53,914 --> 01:18:55,382 COACH, FIRST OF ALL, TO PUT ME 2287 01:18:55,382 --> 01:19:00,353 AS A PLAYER IN THE PLAYING 2288 01:19:00,353 --> 01:19:00,687 FIELD? 2289 01:19:00,687 --> 01:19:03,523 COACH, HE PUT YOU ON THE BENCH, 2290 01:19:03,523 --> 01:19:04,758 YOU'RE GOING TO BE BENCH, NOBODY 2291 01:19:04,758 --> 01:19:06,593 WILL SEE HOW GOOD YOU ARE. 2292 01:19:06,593 --> 01:19:09,596 THAT PRINCIPLE CAME BACK TO ME 2293 01:19:09,596 --> 01:19:10,664 WHEN WE'RE CREATING 2294 01:19:10,664 --> 01:19:11,765 INTERVENTIONS, THAT'S WHEN WE 2295 01:19:11,765 --> 01:19:13,433 NEED TO REMEMBER THAT AT THAT 2296 01:19:13,433 --> 01:19:14,601 POINT WE'RE ALSO THE COACH. 2297 01:19:14,601 --> 01:19:17,103 WE NEED TO BRING THAT COME IN, 2298 01:19:17,103 --> 01:19:19,005 IN THOSE PLACES AS A PLAYER. 2299 01:19:19,005 --> 01:19:23,276 THAT THE PEOPLE WITH THE LIVED 2300 01:19:23,276 --> 01:19:31,585 EXPERIENCE ARE THE EXPERTS. 2301 01:19:31,585 --> 01:19:34,187 WHEN I STUDY, WHAT DO I KNOW? 2302 01:19:34,187 --> 01:19:36,523 WHEN I KNOW A WOMAN WITH 2303 01:19:36,523 --> 01:19:37,624 HYPERTENSION, HEART BREAK, LOST 2304 01:19:37,624 --> 01:19:39,826 A BABY, HAD THAT EXPERIENCE, BUT 2305 01:19:39,826 --> 01:19:45,265 IN THAT TIME I'M THE COACH, NOT 2306 01:19:45,265 --> 01:19:45,899 THE PLAYER. 2307 01:19:45,899 --> 01:19:47,534 THEY HAVE A ROLE. 2308 01:19:47,534 --> 01:19:49,603 I THINK RESEARCHERS HAVE TO 2309 01:19:49,603 --> 01:19:51,605 REMEMBER THAT CO-CREATION IS A 2310 01:19:51,605 --> 01:19:53,673 VERY CRITICAL PART OF HOW YOU 2311 01:19:53,673 --> 01:19:55,308 TAKE THIS INFORMATION DOWN TO 2312 01:19:55,308 --> 01:19:57,944 THE POPULATION, BUT ALSO HOW YOU 2313 01:19:57,944 --> 01:19:59,946 EMPOWER WOMEN TO BECOME 2314 01:19:59,946 --> 01:20:01,448 SELF-ADVOCATE BECAUSE IN BEING 2315 01:20:01,448 --> 01:20:07,787 PART OF THAT CO-CREATION HAVE 2316 01:20:07,787 --> 01:20:08,488 LIVED EXPERIENCE. 2317 01:20:08,488 --> 01:20:11,091 IT'S WHAT WE'VE DONE AS AN 2318 01:20:11,091 --> 01:20:14,294 ORGANIZATION, WE'RE NOT SAYING 2319 01:20:14,294 --> 01:20:14,961 EVERY PROGRAM, EVERY 2320 01:20:14,961 --> 01:20:19,766 INTERVENTION, THERE MUST BE A 2321 01:20:19,766 --> 01:20:21,735 PROCESS OF CO-CREATION, TRYING 2322 01:20:21,735 --> 01:20:24,938 TO DEVELOP PALLIATIVE CARE FOR 2323 01:20:24,938 --> 01:20:27,841 SICKLE CELL DISEASE, I HAVE A-S, 2324 01:20:27,841 --> 01:20:30,710 I ADVOCATE IF YOU GO TO MY 2325 01:20:30,710 --> 01:20:33,346 LINKED IN EVERY SEPTEMBER I PUT 2326 01:20:33,346 --> 01:20:37,183 A POST ABOUT MY HAVING A.S. SO 2327 01:20:37,183 --> 01:20:37,851 PEOPLE CAN UNDERSTAND. 2328 01:20:37,851 --> 01:20:41,254 WHEN I WANTED TO GIVE -- I MET 2329 01:20:41,254 --> 01:20:44,090 MY WIFE, SHOOK HER HAND, I'M 2330 01:20:44,090 --> 01:20:44,424 A.S. 2331 01:20:44,424 --> 01:20:47,794 SHE STARTED LAUGHING. 2332 01:20:47,794 --> 01:20:49,029 THE TRUTH, BECAUSE MY DAD, THEY 2333 01:20:49,029 --> 01:20:50,530 TOLD ME ABOUT IT. 2334 01:20:50,530 --> 01:20:52,966 I SCREENED, MY DAD KNOW HE WAS 2335 01:20:52,966 --> 01:20:59,739 A.S., AND THEN HE GOT A WIFE NOT 2336 01:20:59,739 --> 01:21:01,141 SO, I HAVE GENOTYPE, HE TOLD ME 2337 01:21:01,141 --> 01:21:03,677 I WANT YOU TO KNOW ABOUT IT. 2338 01:21:03,677 --> 01:21:09,149 WHEN I KNEW ABOUT IT, I PUT IT 2339 01:21:09,149 --> 01:21:09,382 FORWARD. 2340 01:21:09,382 --> 01:21:10,550 MY SON HAVE A.S. 2341 01:21:10,550 --> 01:21:11,451 I PUT THAT OUT THERE. 2342 01:21:11,451 --> 01:21:13,720 BEING ABLE TO TALK ABOUT IT, THE 2343 01:21:13,720 --> 01:21:15,488 SAME WAY YOU MAKE YOURSELF, SO 2344 01:21:15,488 --> 01:21:17,791 IN SOME CASES I AM ADVOCATING 2345 01:21:17,791 --> 01:21:19,659 FOR MYSELF, MAKING PEOPLE TO 2346 01:21:19,659 --> 01:21:20,860 GIVE THEM THE -- TO SAY YOU CAN 2347 01:21:20,860 --> 01:21:22,262 TALK ABOUT THESE THINGS. 2348 01:21:22,262 --> 01:21:23,163 I'M TALKING ABOUT MY OWN. 2349 01:21:23,163 --> 01:21:24,898 YOU CAN TALK ABOUT YOUR OWN. 2350 01:21:24,898 --> 01:21:25,999 ALSO REMEMBERING WHEN YOU'RE THE 2351 01:21:25,999 --> 01:21:27,567 COACH TO PUT THEM ON THE PLAYING 2352 01:21:27,567 --> 01:21:32,238 FIELD SO THEY CAN ADVOCATE FOR 2353 01:21:32,238 --> 01:21:33,773 THEMSELVES. 2354 01:21:33,773 --> 01:21:35,208 >> GO AHEAD REALLY QUICK. 2355 01:21:35,208 --> 01:21:36,409 >> THAT'S THE AFRICAN 2356 01:21:36,409 --> 01:21:42,082 AMERICANNESS OF US TRUTH -- 2357 01:21:42,082 --> 01:21:44,150 THAT'S THE AFRICANNESS. 2358 01:21:44,150 --> 01:21:44,951 WHEN YOU'RE THE PATRIARCHY, 2359 01:21:44,951 --> 01:21:51,391 SOMETIMES YOU'RE THE HIERARCHY. 2360 01:21:51,391 --> 01:21:53,026 NEW ORLEANS IS THE MOST IN THE 2361 01:21:53,026 --> 01:21:53,993 UNITED STATES, SOMETIMES YOU'RE 2362 01:21:53,993 --> 01:21:55,195 THE COACH, SOMETIMES YOU'RE THE 2363 01:21:55,195 --> 01:21:55,729 PLAYER. 2364 01:21:55,729 --> 01:21:57,063 >> I WOULD LIKE TO THANK YOU 2365 01:21:57,063 --> 01:22:00,567 BOTH FOR YOUR KEYNOTES, FOR YOUR 2366 01:22:00,567 --> 01:22:01,768 TIME, SUPPORTING THIS WORKSHOP. 2367 01:22:01,768 --> 01:22:03,937 WE'LL TAKE A BREAK EARLY, WE'RE 2368 01:22:03,937 --> 01:22:07,040 TRYING TO SHIFT THE PROGRAM FOR 2369 01:22:07,040 --> 01:22:08,475 EASE OF OTHER SPEAKERS. 2370 01:22:08,475 --> 01:22:12,178 WE'LL BREAK NOW AND THEN WE'LL 2371 01:22:12,178 --> 01:22:13,179 RECONVENE AT 11:25. 2372 01:22:13,179 --> 01:22:14,914 IT'S A QUICK BREAK BUT WE'LL 2373 01:22:14,914 --> 01:22:24,207 COME RIGHT BACK. THANK YOU. 2374 01:22:24,207 --> 01:22:26,943 >> WE HAVE FOUR RESEARCHERS FROM 2375 01:22:26,943 --> 01:22:28,378 AROUND THE WORLD, THROUGH THE 2376 01:22:28,378 --> 01:22:35,246 LENS OF IMPLEMENTATION SCIENCE. 2377 01:22:35,246 --> 01:22:38,316 I WILL ONLY BRIEFLY INTRODUCE 2378 01:22:38,316 --> 01:22:39,517 EACH PANELIST BEFORE THEIR 2379 01:22:39,517 --> 01:22:40,952 TALKS. 2380 01:22:40,952 --> 01:22:43,021 REFER TO THE WORKSHOP BOOKLET 2381 01:22:43,021 --> 01:22:48,726 FOR INFORMATION. 2382 01:22:48,726 --> 01:22:50,862 FIRST UP DR. BHUTTA, INSTITUTE 2383 01:22:50,862 --> 01:22:54,198 OF GLOBAL HEALTH AND 2384 01:22:54,198 --> 01:23:00,872 DEVELOPMENT, AGA KHAN 2385 01:23:00,872 --> 01:23:03,641 UNIVERSITY, RESERVE ON 2386 01:23:03,641 --> 01:23:04,475 REPRODUCTIVE AND NEWBORN CHILD 2387 01:23:04,475 --> 01:23:12,784 HEALTH INTERVENTION LOW INCOME 2388 01:23:12,784 --> 01:23:20,825 SETTINGS. 2389 01:23:20,825 --> 01:23:23,227 DR. CREANGA FOCUSES ON PERINATAL 2390 01:23:23,227 --> 01:23:24,662 QUALITY AND SAFETY INTERVENTIONS 2391 01:23:24,662 --> 01:23:30,168 WITH KEY INTEREST IN MEASUREMENT 2392 01:23:30,168 --> 01:23:31,135 INNOVATION. 2393 01:23:31,135 --> 01:23:34,105 DR. MUNDLE, ALL INDIA INSTITUTE 2394 01:23:34,105 --> 01:23:36,507 OF MEDICAL SCIENCES IN NAGPUR, 2395 01:23:36,507 --> 01:23:38,776 HIGH RISK OBSTETRICS AND SAFE 2396 01:23:38,776 --> 01:23:40,178 ABORTION, INVOLVED IN MULTIPLE 2397 01:23:40,178 --> 01:23:47,351 GLOBAL RESEARCH INITIATIVES IN 2398 01:23:47,351 --> 01:23:48,653 THIS AREA. 2399 01:23:48,653 --> 01:23:49,454 DR. BANNERMAN, UC-SAN DIEGO, 2400 01:23:49,454 --> 01:23:52,924 CURRENT PRESIDENT OF THE SOCIETY 2401 01:23:52,924 --> 01:23:57,862 OF MATERNAL-FETAL MEDICINE, 2402 01:23:57,862 --> 01:23:59,363 RESEARCH IS ON PRE-TERM BIRTH 2403 01:23:59,363 --> 01:24:00,565 PREVENTION. 2404 01:24:00,565 --> 01:24:03,000 IN TERMS OF FORMAT, SPEAKERS 2405 01:24:03,000 --> 01:24:09,540 WILL PRESENT TALKS IN SEQUENCE 2406 01:24:09,540 --> 01:24:13,478 FOLLOWED BY Q&A. 2407 01:24:13,478 --> 01:24:15,246 DR. BHUTTA WILL NEED TO LEAVE 2408 01:24:15,246 --> 01:24:17,014 EARLY SO PERHAPS WE CAN FIELD 2409 01:24:17,014 --> 01:24:23,254 QUESTIONS FOR HIM AFTER HIS 2410 01:24:23,254 --> 01:24:23,588 PRESENTATION. 2411 01:24:23,588 --> 01:24:24,222 NEXT SLIDE. 2412 01:24:24,222 --> 01:24:27,191 >> THANK YOU FOR THIS 2413 01:24:27,191 --> 01:24:27,925 OPPORTUNITY. 2414 01:24:27,925 --> 01:24:29,594 AND FOR GIVING ME THE PLATFORM 2415 01:24:29,594 --> 01:24:32,530 TO SPEAK ABOUT ONE OF THE MAJOR 2416 01:24:32,530 --> 01:24:39,103 GLOBAL CHALLENGES GLOBALLY. 2417 01:24:39,103 --> 01:24:47,445 NEXT SLIDE PLEASE. 2418 01:24:47,445 --> 01:24:53,251 PREECLAMPSIA IS RESPONSE FOR 2419 01:24:53,251 --> 01:24:54,318 MORTALITY GLOBALLY. 2420 01:24:54,318 --> 01:25:00,124 AS YOU CAN SEE, PREGNANCY 2421 01:25:00,124 --> 01:25:03,628 INDUCED HYPERTENSION 2422 01:25:03,628 --> 01:25:04,595 SPECIFICALLY PREECLAMPSIA AND 2423 01:25:04,595 --> 01:25:12,036 ECLAMPSIA IS ASSOCIATED WITH A 2424 01:25:12,036 --> 01:25:13,471 QUARTER OF MATERNAL DEATHS. 2425 01:25:13,471 --> 01:25:17,175 THIS IS COMMON ACROSS MANY LOW- 2426 01:25:17,175 --> 01:25:17,842 AND MIDDLE-INCOME COUNTRIES, 2427 01:25:17,842 --> 01:25:20,945 SPECIFICALLY SOUTH ASIA, WHILE A 2428 01:25:20,945 --> 01:25:24,348 BIG CHUNK TAKE PLACE IN FACILITY 2429 01:25:24,348 --> 01:25:26,617 SETTINGS, SOME TAKE PLACE EN 2430 01:25:26,617 --> 01:25:28,386 ROUTE TO CLINICAL CARE AND 2431 01:25:28,386 --> 01:25:29,720 HEALTH SERVICES, AROUND A 2432 01:25:29,720 --> 01:25:32,657 QUARTER SADLY AT HOME. 2433 01:25:32,657 --> 01:25:38,362 REFLECTING THE VARIATIONS IN 2434 01:25:38,362 --> 01:25:40,364 DETECTION PATTERNS, DANGER SIGN 2435 01:25:40,364 --> 01:25:42,333 RECOGNITION AND HEALTH SYSTEM 2436 01:25:42,333 --> 01:25:42,633 FIDELITY. 2437 01:25:42,633 --> 01:25:45,703 THIS IS REFLECTED, NEXT SLIDE, 2438 01:25:45,703 --> 01:25:47,405 IN THE GEOSPATIAL PATTERNS IN 2439 01:25:47,405 --> 01:25:50,441 VARIOUS PARTS OF THE COUNTRY. 2440 01:25:50,441 --> 01:25:52,944 IN PAKISTAN IF YOU TAKE CARE BY 2441 01:25:52,944 --> 01:25:57,114 SKILLED PROVIDERS FROM THE LAST 2442 01:25:57,114 --> 01:25:58,516 DEMOGRAPHIC SURVEY PRE-PANDEMIC 2443 01:25:58,516 --> 01:25:59,951 YOU RECOGNIZE MAJOR POCKETS OF 2444 01:25:59,951 --> 01:26:06,991 THE COUNTRY BOTH IN SOUTH AND 2445 01:26:06,991 --> 01:26:08,392 SOUTHWEST WHERE COVERAGE RATES 2446 01:26:08,392 --> 01:26:09,860 ARE LESS THAN 20 TO 30%, WHAT 2447 01:26:09,860 --> 01:26:13,130 ELSE CAN BE DONE IN TERMS OF 2448 01:26:13,130 --> 01:26:15,199 RECOGNIZING DANGER SIGNS, RISK 2449 01:26:15,199 --> 01:26:25,710 FACTORS AND I'D LIKE TO SHARE 2450 01:26:26,410 --> 01:26:29,647 FINDINGS FROM A LARGE 2451 01:26:29,647 --> 01:26:34,452 COMMUNITY-BASED INTERVENTION 2452 01:26:34,452 --> 01:26:40,258 PROJECT UNDERTAKEN FOR 2453 01:26:40,258 --> 01:26:41,792 PREECLAMPSIA IN BRITISH 2454 01:26:41,792 --> 01:26:43,227 COLUMBIA, IN FOUR COUNTRIES 2455 01:26:43,227 --> 01:26:46,163 ACROSS ASIA AND AFRICA, THREE 2456 01:26:46,163 --> 01:26:56,641 WERE ABLE TO COMPLETE TRIAL 2457 01:26:58,909 --> 01:26:59,110 PROTOCOL. 2458 01:26:59,110 --> 01:27:01,479 IT WAS TO TRAIN AND EQUIP 2459 01:27:01,479 --> 01:27:06,717 COMMUNITY HEALTH WORKERS, LADY 2460 01:27:06,717 --> 01:27:11,322 HEALTH WORKERS AS THEY ARE 2461 01:27:11,322 --> 01:27:15,459 CALLED IN PAKISTAN TO DETECT 2462 01:27:15,459 --> 01:27:18,763 HYPERTENSION IN PREGNANCY, 2463 01:27:18,763 --> 01:27:19,930 RECOGNIZE SEVERITY AND PROMPTLY 2464 01:27:19,930 --> 01:27:21,332 REFER, IN CASE REFERRAL WAS 2465 01:27:21,332 --> 01:27:24,335 DELAYED, TO INSTITUTE OR 2466 01:27:24,335 --> 01:27:30,875 MANAGEMENT WITH MAG MAGNESIUM 2467 01:27:30,875 --> 01:27:33,277 SULFATE AS THEY WERE REFERRED. 2468 01:27:33,277 --> 01:27:35,246 THIS WAS A FAIRLY LARGE TRIAL 2469 01:27:35,246 --> 01:27:37,748 AND JUST IN PAKISTAN ALONE WE 2470 01:27:37,748 --> 01:27:41,719 WERE ABLE TO RECRUIT AROUND 2471 01:27:41,719 --> 01:27:42,386 40,000 WOMEN, APPROXIMATELY 2472 01:27:42,386 --> 01:27:50,361 20,000 IN EACH GROUP. 2473 01:27:50,361 --> 01:27:52,229 NEXT SLIDE PLEASE. 2474 01:27:52,229 --> 01:27:54,732 THE TRIAL WAS UPDATE TAKEN, WE 2475 01:27:54,732 --> 01:28:00,971 UNDERTOOK THIS TRIAL OVER 2476 01:28:00,971 --> 01:28:03,708 TWO-YEAR PERIOD, THROUGH LADY 2477 01:28:03,708 --> 01:28:05,876 HEALTH WORKERS TRAINED. 2478 01:28:05,876 --> 01:28:06,644 THE PRIMARY OUTCOME DATA GIVEN 2479 01:28:06,644 --> 01:28:12,583 THE SIZE OF THE TRIAL WAS A 2480 01:28:12,583 --> 01:28:14,985 COMPOSITE OF STILLBIRTHS, 2481 01:28:14,985 --> 01:28:16,420 NEONATAL MORTALITY AND NEONATAL 2482 01:28:16,420 --> 01:28:17,855 MORTALITY. 2483 01:28:17,855 --> 01:28:20,257 WHAT DID WE FIND? 2484 01:28:20,257 --> 01:28:23,427 AS YOU CAN SEE, IN THE BOTH 2485 01:28:23,427 --> 01:28:25,396 INTERVENTION AND CONTROL GROUPS, 2486 01:28:25,396 --> 01:28:28,899 20 CLUSTERS, BROADLY THE 2487 01:28:28,899 --> 01:28:31,102 POPULATION WAS COMPARABLE WITH 2488 01:28:31,102 --> 01:28:34,372 WOMEN, WITH THE MEAN AGE AT 2489 01:28:34,372 --> 01:28:38,309 AROUND 28, IN BOTH AGE GROUPS, 2490 01:28:38,309 --> 01:28:42,346 AND AROUND PARITY OF TWO, PLUS 2491 01:28:42,346 --> 01:28:44,215 OR MINUS ONE. 2492 01:28:44,215 --> 01:28:46,417 MOST RECRUITED SECOND TRIMESTER, 2493 01:28:46,417 --> 01:28:49,687 LESS THAN 1% HAD MULTIPLE 2494 01:28:49,687 --> 01:28:50,121 PREGNANCIES. 2495 01:28:50,121 --> 01:28:51,455 NEXT SLIDE PLEASE. 2496 01:28:51,455 --> 01:28:54,992 WE DID NOT FIND DIFFERENCE IN 2497 01:28:54,992 --> 01:28:56,894 COMPOSITE OUTCOME. 2498 01:28:56,894 --> 01:29:03,467 IF YOU TAKE NEWBORN DEATH, 2499 01:29:03,467 --> 01:29:04,201 MATERNAL MORTALITY, STILLBIRTH, 2500 01:29:04,201 --> 01:29:08,506 NOT ABLE TO SHOW A SIGNIFICANT 2501 01:29:08,506 --> 01:29:08,806 DIFFERENCE. 2502 01:29:08,806 --> 01:29:12,009 WHEN YOU LOOKED AT OUTCOMES IN 2503 01:29:12,009 --> 01:29:14,178 RELATION TO INTENSITY OR WOMEN 2504 01:29:14,178 --> 01:29:17,381 WHO HAD RECEIVED MORE THAN FOUR 2505 01:29:17,381 --> 01:29:20,017 OR EIGHT VISITS FROM LADY HEALTH 2506 01:29:20,017 --> 01:29:25,523 WORKERS IN PREGNANCY YOU CAN SEE 2507 01:29:25,523 --> 01:29:27,258 A SIGNIFICANT REDUCTION IN RATES 2508 01:29:27,258 --> 01:29:31,195 OF ADVERSE OUTCOMES FOR 2509 01:29:31,195 --> 01:29:33,097 STILLBIRTHS, MATERNITY 2510 01:29:33,097 --> 01:29:35,766 MORTALITY, EARLY AND NEONATE 2511 01:29:35,766 --> 01:29:38,502 MORTALITY, CONSISTENT ACROSS THE 2512 01:29:38,502 --> 01:29:40,905 IPD UNDERTAKEN. 2513 01:29:40,905 --> 01:29:43,541 WE FOUND, NEXT, THAT VISITS, THE 2514 01:29:43,541 --> 01:29:45,543 FREQUENCY, THOSE MORE THAN FOUR 2515 01:29:45,543 --> 01:29:47,778 OR EIGHT, WERE ALSO EXTREMELY 2516 01:29:47,778 --> 01:29:50,381 COST EFFECTIVE WHEN IT CAME TO 2517 01:29:50,381 --> 01:29:52,883 CALCULATIONS IN THIS AGE GROUP. 2518 01:29:52,883 --> 01:29:54,218 NOW, ONE CAN IMAGINE THAT 2519 01:29:54,218 --> 01:29:55,719 DESPITE ALL OF THIS IF YOU DID 2520 01:29:55,719 --> 01:29:58,489 NOT SEE IMPACT ON MORTALITY, ONE 2521 01:29:58,489 --> 01:29:59,990 RAISES QUESTIONS AS TO WHY THEY 2522 01:29:59,990 --> 01:30:01,192 DID NOT HAPPEN. 2523 01:30:01,192 --> 01:30:04,395 WELL, IT REALLY DID NOT HAPPEN 2524 01:30:04,395 --> 01:30:06,363 OVERALL BECAUSE DESPITE THIS 2525 01:30:06,363 --> 01:30:07,698 IMPROVEMENT IN CARE, AT 2526 01:30:07,698 --> 01:30:08,632 COMMUNITY LEVEL, THE QUALITY OF 2527 01:30:08,632 --> 01:30:11,936 CARE IN SOME OF THE REFERRAL 2528 01:30:11,936 --> 01:30:15,473 FACILITIES NOT JUST SECONDARY 2529 01:30:15,473 --> 01:30:17,441 BUT REFERRAL FACILITIES DID NOT 2530 01:30:17,441 --> 01:30:19,944 IMPROVE CONSISTENTLY AT THE SAME 2531 01:30:19,944 --> 01:30:23,013 PATTERN TO ALLOW SIGNIFICANT 2532 01:30:23,013 --> 01:30:23,881 MORTALITY REDUCTION 2533 01:30:23,881 --> 01:30:25,282 NOTWITHSTANDING REFERRAL. 2534 01:30:25,282 --> 01:30:28,919 AND THEREFORE IT'S IMPORTANT TO 2535 01:30:28,919 --> 01:30:31,555 RECOGNIZE NOT JUST ONE COMPONENT 2536 01:30:31,555 --> 01:30:33,190 BUT MANAGEMENT WITHIN THE HEALTH 2537 01:30:33,190 --> 01:30:39,763 FACILITY HAS TO IMPROVE IN 2538 01:30:39,763 --> 01:30:39,997 TANDEM. 2539 01:30:39,997 --> 01:30:41,532 OUR FINDINGS FROM THE CLIP TRIAL 2540 01:30:41,532 --> 01:30:44,034 WE WERE ABLE TO REACH THREUP THE 2541 01:30:44,034 --> 01:30:46,871 COMMUNITY HEALTH WORKERS, CLOSE 2542 01:30:46,871 --> 01:30:49,306 TO AROUND 60% OF ALL 2543 01:30:49,306 --> 01:30:51,141 PREGNANCIES, ALMOST UNIVERSAL 2544 01:30:51,141 --> 01:30:53,244 BLOOD PRESSURE MEASURE; QUITE AN 2545 01:30:53,244 --> 01:30:53,577 ACHIEVEMENT. 2546 01:30:53,577 --> 01:30:55,212 THAT THESE COMMUNITY HEALTH 2547 01:30:55,212 --> 01:30:57,948 WORKERS WERE ABLE TO RECOGNIZE 2548 01:30:57,948 --> 01:31:00,184 AND MANAGE AND REFER A 2549 01:31:00,184 --> 01:31:02,152 SIGNIFICANT PROPORTION OF WOMEN 2550 01:31:02,152 --> 01:31:05,756 THAT THEY RECOGNIZED HAD RISK 2551 01:31:05,756 --> 01:31:09,059 FACTORS FOR SEVERE PREECLAMPSIA 2552 01:31:09,059 --> 01:31:11,795 AND POSSIBLY ADVERSE OUTCOMES. 2553 01:31:11,795 --> 01:31:14,098 WE RECOGNIZE ALL OF THOSE AS 2554 01:31:14,098 --> 01:31:16,033 POSITIVE DEVELOPMENTS IN THE 2555 01:31:16,033 --> 01:31:18,002 QUEST TO OPTIMIZE MANAGEMENT OF 2556 01:31:18,002 --> 01:31:18,769 HYPERTENSIVE DISEASES IN 2557 01:31:18,769 --> 01:31:21,839 PREGNANCY, IN REAL HEALTH 2558 01:31:21,839 --> 01:31:23,507 SYSTEMS, WITH COMBINATION OF 2559 01:31:23,507 --> 01:31:25,676 COMMUNITY BASED DETECTION AND 2560 01:31:25,676 --> 01:31:26,544 MANAGEMENT, COUPLED WITH 2561 01:31:26,544 --> 01:31:28,612 IMPROVED QUALITY OF CARE WITHIN 2562 01:31:28,612 --> 01:31:29,813 HEALTH FACILITIES. 2563 01:31:29,813 --> 01:31:33,751 SO HOPEFULLY THE NEXT PACKAGE OF 2564 01:31:33,751 --> 01:31:34,418 HYPERTENSIVE DISORDERS, 2565 01:31:34,418 --> 01:31:36,520 PREVENTION, AND MANAGEMENT IN 2566 01:31:36,520 --> 01:31:38,789 HEALTH SYSTEMS WOULD CONSIST OF 2567 01:31:38,789 --> 01:31:40,424 ALL OF THOSE COMPONENTS 2568 01:31:40,424 --> 01:31:41,525 EVALUATED IN REAL HEALTH 2569 01:31:41,525 --> 01:31:41,759 SYSTEMS. 2570 01:31:41,759 --> 01:31:44,261 THANK YOU VERY MUCH FOR YOUR 2571 01:31:44,261 --> 01:31:44,528 ATTENTION. 2572 01:31:44,528 --> 01:31:52,136 I'LL BE HAPPY TO TAKE QUESTIONS 2573 01:31:52,136 --> 01:31:52,703 IF THERE ARE ANY. 2574 01:31:52,703 --> 01:31:56,640 >> THANK YOU FOR THE EXCELLENT 2575 01:31:56,640 --> 01:31:58,876 PRESENTATION ABOUT A TRIAL IN A 2576 01:31:58,876 --> 01:32:00,811 COMMUNITY SETTING IN RURAL 2577 01:32:00,811 --> 01:32:01,078 PAKISTAN. 2578 01:32:01,078 --> 01:32:03,480 THERE ARE AS I MENTIONED 2579 01:32:03,480 --> 01:32:06,350 EARLIER, WE'LL TAKE SPECIFIC 2580 01:32:06,350 --> 01:32:09,320 QUESTIONS FOR HIM NOW, HE WILL 2581 01:32:09,320 --> 01:32:10,955 JOIN REMOTELY HOPEFULLY FOR THE 2582 01:32:10,955 --> 01:32:13,357 FULL Q&A DISCUSSION AS WELL. 2583 01:32:13,357 --> 01:32:18,629 FIRST SPECIFIC QUESTION FOR YOU 2584 01:32:18,629 --> 01:32:21,332 HOW DO YOU PREVENT CONTAMINATION 2585 01:32:21,332 --> 01:32:23,968 IN THE CLUSTER RANDOMIZED TRIAL. 2586 01:32:23,968 --> 01:32:26,804 >> MOST OF ALL, TO RESTRICT THE 2587 01:32:26,804 --> 01:32:28,906 RECRUITMENT OF COMMUNITY HEALTH 2588 01:32:28,906 --> 01:32:30,741 WORKERS, LADY HEALTH WORKERS TO 2589 01:32:30,741 --> 01:32:32,943 BASIC HEALTH UNITS WHERE THEY 2590 01:32:32,943 --> 01:32:35,346 ARE GENERALLY PROVIDED OUTREACH 2591 01:32:35,346 --> 01:32:39,083 TRAINING AND OUT OUTREACH. 2592 01:32:39,083 --> 01:32:40,384 THEY WERE PROVIDED THAT 2593 01:32:40,384 --> 01:32:44,421 DIFFERENT FROM THOSE IN CONTROL 2594 01:32:44,421 --> 01:32:45,289 CLUSTERS, THERE'S SOME 2595 01:32:45,289 --> 01:32:46,724 GEOGRAPHIC DISPERSION ALSO AND 2596 01:32:46,724 --> 01:32:47,591 SUPERVISORS WERE DISTINCT, SO 2597 01:32:47,591 --> 01:32:50,894 THERE WAS VERY LITTLE TO NONE. 2598 01:32:50,894 --> 01:32:56,700 AND LASTLY WE ALL HAD HANDHELD 2599 01:32:56,700 --> 01:32:58,969 TOOLS, DEVICES WHERE 2600 01:32:58,969 --> 01:32:59,970 NON-CONTROLLED CLUSTERS DID NOT. 2601 01:32:59,970 --> 01:33:04,141 WE COULD NOT SEPARATE HEALTH 2602 01:33:04,141 --> 01:33:05,442 FACILITIES, SECONDARY AND 2603 01:33:05,442 --> 01:33:07,478 TERTIARY IN THESE ARE COMMON AND 2604 01:33:07,478 --> 01:33:09,380 SHARED, ONE OF THE REASONS WHY 2605 01:33:09,380 --> 01:33:10,914 IN THE COMMUNITY TRIAL WE 2606 01:33:10,914 --> 01:33:19,423 LARGELY FOCUSED ON WHAT COULD BE 2607 01:33:19,423 --> 01:33:22,626 DONE AT THAT LEVEL. 2608 01:33:22,626 --> 01:33:24,261 >> WERE THESE WOMEN FOLLOWED, 2609 01:33:24,261 --> 01:33:26,230 WOMEN WITH HYPERTENSION IN 2610 01:33:26,230 --> 01:33:28,098 PREGNANCY, WERE THEY FOLLOWED 2611 01:33:28,098 --> 01:33:28,399 POSTPARTUM? 2612 01:33:28,399 --> 01:33:29,733 >> THEY WERE FOLLOWED FOR A 2613 01:33:29,733 --> 01:33:32,803 RELATIVELY SHORT PERIOD OF TIME. 2614 01:33:32,803 --> 01:33:34,471 THERE OTHER STUDIES WITH LONGER 2615 01:33:34,471 --> 01:33:39,376 FOLLOW-UPS OF WOMEN WHO HAVE HAD 2616 01:33:39,376 --> 01:33:40,577 PREGNANCY-RELATED OR 2617 01:33:40,577 --> 01:33:42,212 PREGNANCY-INDUCED HYPERTENSION, 2618 01:33:42,212 --> 01:33:44,081 AND THERE'S A PROPORTION TO GO 2619 01:33:44,081 --> 01:33:49,586 ON TO HAVE OTHER DEMONSTRATIVE 2620 01:33:49,586 --> 01:33:53,090 EFFECTS OF NCDs, PERHAPS 2621 01:33:53,090 --> 01:33:56,326 GREATER DIASTOLIC PRESSURE FOR A 2622 01:33:56,326 --> 01:33:59,863 WHILE BUT NO FOLLOW-UP. 2623 01:33:59,863 --> 01:34:01,598 >> A QUESTION, PROCESSES FOR 2624 01:34:01,598 --> 01:34:03,901 MANAGEMENT DID NOT RESULT IN 2625 01:34:03,901 --> 01:34:05,402 POSITIVE COMPOSITE OUTCOMES BUT 2626 01:34:05,402 --> 01:34:06,737 SINGLE OUTCOMES. 2627 01:34:06,737 --> 01:34:12,976 ANY LESSONS LEARNED WHAT 2628 01:34:12,976 --> 01:34:19,149 IMPLEMENTATION STRATEGY? 2629 01:34:19,149 --> 01:34:20,918 >> YOU EQUIP AND TRAIN TO A 2630 01:34:20,918 --> 01:34:22,619 LEVEL OF RECOGNITION OF THE 2631 01:34:22,619 --> 01:34:24,488 PROBLEM AND ESPECIALLY WITH I.T. 2632 01:34:24,488 --> 01:34:25,723 TOOLS, THAT THE REST OF THE 2633 01:34:25,723 --> 01:34:27,658 HEALTH SYSTEM DOES NOT HAVE. 2634 01:34:27,658 --> 01:34:31,028 YOU CAN WELL IMAGINE IF THE 2635 01:34:31,028 --> 01:34:33,664 COMMUNITY HAS WORKER REFERRALS, 2636 01:34:33,664 --> 01:34:35,099 WHERE A PHYSICIAN DOES NOT HAVE 2637 01:34:35,099 --> 01:34:38,602 ACCESS TO THE SAME HANDHELD 2638 01:34:38,602 --> 01:34:40,571 DEVICE AND TRIAGE SYSTEM CREATES 2639 01:34:40,571 --> 01:34:40,904 CHALLENGES. 2640 01:34:40,904 --> 01:34:44,508 WE'VE SEEN THIS FOR EXAMPLE WITH 2641 01:34:44,508 --> 01:34:45,809 OXYGEN SATURATION MEASUREMENT 2642 01:34:45,809 --> 01:34:47,044 THROUGH HANDHELD DEVICES THROUGH 2643 01:34:47,044 --> 01:34:48,112 COMMUNITY HEALTH WORKERS, THE 2644 01:34:48,112 --> 01:34:49,646 HEALTH SYSTEM DOES NOT HAVE THE 2645 01:34:49,646 --> 01:34:50,547 SAME TECHNOLOGY AND TOOLS 2646 01:34:50,547 --> 01:34:52,950 THERE'S A LEVEL OF DISBELIEF. 2647 01:34:52,950 --> 01:34:54,585 SO THE CHALLENGES THAT WE FACED 2648 01:34:54,585 --> 01:34:57,554 IN THIS PROJECT FROM 2649 01:34:57,554 --> 01:34:58,522 IMPLEMENTATION SCIENCE ARE 2650 01:34:58,522 --> 01:35:00,924 HUGELY ILLUSTRATIVE OF THE FACT 2651 01:35:00,924 --> 01:35:02,459 THAT STRENGTHENING FACILITIES 2652 01:35:02,459 --> 01:35:03,660 AND STRENGTHENING TECHNOLOGIES 2653 01:35:03,660 --> 01:35:06,396 AND TOOLS AT ONE LEVEL OF THE 2654 01:35:06,396 --> 01:35:08,332 HEALTH SYSTEM IS INEFFICIENT 2655 01:35:08,332 --> 01:35:10,434 WITHOUT LIFTING THE ENTIRE SHIP. 2656 01:35:10,434 --> 01:35:12,069 THEREFORE, AS A SUBSEQUENT 2657 01:35:12,069 --> 01:35:14,371 FOLLOW-UP TO THIS, THERE WAS A 2658 01:35:14,371 --> 01:35:15,472 VERY DELIBERATE EFFORT IN THIS 2659 01:35:15,472 --> 01:35:16,373 PARTICULAR DISTRICT TO IMPROVE 2660 01:35:16,373 --> 01:35:18,809 THE QUALITY OF CARE MANAGEMENT 2661 01:35:18,809 --> 01:35:21,912 AND ALSO KNOWLEDGE AND SKILLS OF 2662 01:35:21,912 --> 01:35:29,853 THE FACILITY-BASED HEALTH CARE 2663 01:35:29,853 --> 01:35:34,224 PROVIDERS, NOT JUST DOCTORS AND 2664 01:35:34,224 --> 01:35:37,728 NURSES BUT LADY HEALTH CARE 2665 01:35:37,728 --> 01:35:38,929 WORKERS AND SUPERVISORS. 2666 01:35:38,929 --> 01:35:40,364 >> I THINK THIS IS -- THOSE ARE 2667 01:35:40,364 --> 01:35:43,634 ALL THE QUESTIONS FOR YOU 2668 01:35:43,634 --> 01:35:44,635 SPECIFICALLY AT THE MOMENT. 2669 01:35:44,635 --> 01:35:45,602 THANK YOU SO MUCH. 2670 01:35:45,602 --> 01:35:47,337 >> I'LL TRY MY BEST TO JOIN FROM 2671 01:35:47,337 --> 01:35:48,906 THE AIRPORT. 2672 01:35:48,906 --> 01:35:51,742 THANK YOU, I'M LEAVING FOR 2673 01:35:51,742 --> 01:35:52,910 AFRICA. 2674 01:35:52,910 --> 01:35:55,579 >> THANK YOU FOR YOUR 2675 01:35:55,579 --> 01:35:56,914 FLEXIBILITY. 2676 01:35:56,914 --> 01:35:58,148 >> NEXT SLIDE. 2677 01:35:58,148 --> 01:36:04,454 NEXT WE HAVE DR. CREANGA. 2678 01:36:04,454 --> 01:36:07,991 >> GOOD MORNING, GOOD AFTERNOON, 2679 01:36:07,991 --> 01:36:09,259 GOOD EVEN, EVERYONE. 2680 01:36:09,259 --> 01:36:12,663 I'M GOING TO TALK ABOUT OUR 2681 01:36:12,663 --> 01:36:13,363 LEARNINGS FROM SEVERE MORBIDITY 2682 01:36:13,363 --> 01:36:14,965 SURVEILLANCE IN THE STATE OF 2683 01:36:14,965 --> 01:36:15,365 MARYLAND. 2684 01:36:15,365 --> 01:36:16,733 NEXT SLIDE. 2685 01:36:16,733 --> 01:36:18,702 THIS WORK IS PART OF THE 2686 01:36:18,702 --> 01:36:19,503 MARYLAND MATERNAL HEALTH 2687 01:36:19,503 --> 01:36:22,739 INNOVATION PROGRAM THAT WE 2688 01:36:22,739 --> 01:36:25,909 STARTED IN 2019, FUNDED BY HRSA. 2689 01:36:25,909 --> 01:36:27,444 NEXT SLIDE. 2690 01:36:27,444 --> 01:36:28,212 SO WE ARE IMPLEMENTING 2691 01:36:28,212 --> 01:36:31,515 SURVEILLANCE IN THE STATE OF 2692 01:36:31,515 --> 01:36:34,551 MARYLAND, PART OF SERIES OF 2693 01:36:34,551 --> 01:36:36,653 INITIATIVES AND PROGRAMS THAT 2694 01:36:36,653 --> 01:36:40,891 WE'RE IMPLEMENTING AT THE SAME 2695 01:36:40,891 --> 01:36:42,326 TIME. 2696 01:36:42,326 --> 01:36:44,561 SO IN CONJUNCTION, WE WORKED ON 2697 01:36:44,561 --> 01:36:45,062 INEQUITY INITIATIVES IN 2698 01:36:45,062 --> 01:36:48,832 HOSPITALS TRYING TO PROVIDE 2699 01:36:48,832 --> 01:36:53,604 TRAINING TO PROVIDERS, AWARENESS 2700 01:36:53,604 --> 01:36:55,172 OF IMPLICIT BIAS, STARTED 2701 01:36:55,172 --> 01:37:00,010 TELEHEALTH INITIATIVE FOR SEVERE 2702 01:37:00,010 --> 01:37:03,280 HYPERTENSION DISTRIBUTING FREE 2703 01:37:03,280 --> 01:37:04,147 BLOOD PRESSURE CUFFS PREGNANT 2704 01:37:04,147 --> 01:37:10,954 WHOM WOULD NEED THEM, THROUGH 2705 01:37:10,954 --> 01:37:11,922 HOSPITALS. 2706 01:37:11,922 --> 01:37:12,689 RESOURCE MAP, 2500 RESOURCES 2707 01:37:12,689 --> 01:37:15,659 MET, AND GENERAL PUBLIC 2708 01:37:15,659 --> 01:37:16,994 PROVIDERS TO USE. 2709 01:37:16,994 --> 01:37:19,496 IMPLEMENTING MOTHERS AND BABIES 2710 01:37:19,496 --> 01:37:22,566 PROGRAM TO ALSO ADDRESS 2711 01:37:22,566 --> 01:37:23,133 PREVENTION OF POSTPARTUM 2712 01:37:23,133 --> 01:37:26,270 DEPRESSION, ALSO TRAINING FOR 2713 01:37:26,270 --> 01:37:28,739 PROVIDERS TO SUPPORT AFTER THEIR 2714 01:37:28,739 --> 01:37:31,241 EXPERIENCED SEVERE MATERNAL 2715 01:37:31,241 --> 01:37:31,909 EVENTS. 2716 01:37:31,909 --> 01:37:33,243 NEXT SLIDE I'M SHOWING 2717 01:37:33,243 --> 01:37:35,646 DEFINITION CURRENTLY BEING USED 2718 01:37:35,646 --> 01:37:39,249 FOR SEVERE MATERNAL MORBIDITY, 2719 01:37:39,249 --> 01:37:40,584 CDC DEFINITION ENDORSED BY 2720 01:37:40,584 --> 01:37:42,853 MANIERS IS, INCLUDING INSPECTED 2721 01:37:42,853 --> 01:37:44,721 OUTCOMES OF LABOR AND DELIVERY 2722 01:37:44,721 --> 01:37:46,423 RESULTS IN SIGNIFICANT SHORT OR 2723 01:37:46,423 --> 01:37:48,592 LONG-TERM CONSEQUENCES TO A 2724 01:37:48,592 --> 01:37:48,926 WOMAN'S HELD. 2725 01:37:48,926 --> 01:37:52,963 AS YOU KNOW THERE IS A WIDE 2726 01:37:52,963 --> 01:37:54,398 VARIETY OF MATERNAL MORBIDITY 2727 01:37:54,398 --> 01:37:59,970 AND SEVERITY, MAKING MEASURE. 2728 01:37:59,970 --> 01:38:00,871 DIVERSITY -- MEASUREMENT 2729 01:38:00,871 --> 01:38:01,138 DIFFICULT. 2730 01:38:01,138 --> 01:38:04,875 WE USE THE ALGORITHM USING 21 2731 01:38:04,875 --> 01:38:06,543 INDICATORS OF ORGAN SYSTEM 2732 01:38:06,543 --> 01:38:09,279 DYSFUNCTION, USING THIS DEAF, 2733 01:38:09,279 --> 01:38:11,448 NEXT SLIDE, SHOWING BOTH IN 2734 01:38:11,448 --> 01:38:14,518 MARYLAND AND NATIONALLY WE HAVE 2735 01:38:14,518 --> 01:38:16,253 SEEN SMM INCREASING STEADILY 2736 01:38:16,253 --> 01:38:18,889 OVER THE PAST I WOULD SAY TWO 2737 01:38:18,889 --> 01:38:20,324 DECADES, DATA SHOWN HERE FROM 2738 01:38:20,324 --> 01:38:23,060 2010 AND AFTER. 2739 01:38:23,060 --> 01:38:25,128 SO, GIVEN THE LIMITATIONS FOR 2740 01:38:25,128 --> 01:38:30,267 THIS ICD ALGORITHM THAT IS 2741 01:38:30,267 --> 01:38:36,573 CURRENTLY BEING USED THROUGHOUT 2742 01:38:36,573 --> 01:38:38,108 THROUGH THE 2743 01:38:38,108 --> 01:38:41,144 UNITED STATES, I'M SHOWING 2744 01:38:41,144 --> 01:38:42,679 FACILITY-BASED IDENTIFICATION OF 2745 01:38:42,679 --> 01:38:45,916 REVIEW OF SEVERE MATERNITY 2746 01:38:45,916 --> 01:38:49,152 MORBIDITY, PROPOSING TWO-FACTOR 2747 01:38:49,152 --> 01:38:50,454 DEFINITION INCLUDING ICU 2748 01:38:50,454 --> 01:38:52,122 ADMISSION, AND/OR RECEIVED 4 OR 2749 01:38:52,122 --> 01:38:55,625 MORE UNITS OF BLOOD PRODUCT. 2750 01:38:55,625 --> 01:39:00,230 THE PERIOD FOR SURVEILLANCE IS 2751 01:39:00,230 --> 01:39:03,166 BETWEEN ONE SESSION AND 42 DAYS 2752 01:39:03,166 --> 01:39:04,167 POSTPARTUM. 2753 01:39:04,167 --> 01:39:05,469 THE OBJECTIVE IS TO LEARN CLOSE 2754 01:39:05,469 --> 01:39:07,904 TO REAL TIME AS POSSIBLE HOW TO 2755 01:39:07,904 --> 01:39:12,909 PREVENT FUTURE SMM EVENTS FROM 2756 01:39:12,909 --> 01:39:14,011 OCCURRING. 2757 01:39:14,011 --> 01:39:15,312 NEXT SLIDE. 2758 01:39:15,312 --> 01:39:16,913 THIS IS THE SMM SURVEILLANCE 2759 01:39:16,913 --> 01:39:19,383 CYCLE FOR MARYLAND, FOR OUR 2760 01:39:19,383 --> 01:39:20,917 PROJECT. 2761 01:39:20,917 --> 01:39:22,452 WE HAVE HOSPITAL DATA 2762 01:39:22,452 --> 01:39:23,754 ABSTRACTOR, ABSTRACTING CASE 2763 01:39:23,754 --> 01:39:25,722 INFORMATION INTO A COMMON 2764 01:39:25,722 --> 01:39:28,458 DATABASE AT OUR UNIVERSITY. 2765 01:39:28,458 --> 01:39:29,760 HOSPITAL REVIEW COMMITTEES 2766 01:39:29,760 --> 01:39:31,094 REVIEW THIS INFORMATION. 2767 01:39:31,094 --> 01:39:33,597 OUR TEAM AT HOPKINS DEDICATING 2768 01:39:33,597 --> 01:39:38,835 TIME TO ANALYZE DATA AND 2769 01:39:38,835 --> 01:39:39,336 DISSEMINATING FINDINGS, 2770 01:39:39,336 --> 01:39:41,271 INFORMATION THAT GOES TO THE 2771 01:39:41,271 --> 01:39:43,006 HOSPITALS CONTRIBUTING TO THE 2772 01:39:43,006 --> 01:39:46,043 PROJECT, DATA BRIEFS FOR THE 2773 01:39:46,043 --> 01:39:47,244 STATE SHOWING INFORMATION OF 2774 01:39:47,244 --> 01:39:50,414 COMMON INTEREST ACROSS THE 2775 01:39:50,414 --> 01:39:53,984 HOSPITALS, ALSO PUBLICATIONS. 2776 01:39:53,984 --> 01:39:54,851 NEXT SLIDE. 2777 01:39:54,851 --> 01:39:56,787 THIS IS THE INFORMATION THAT 2778 01:39:56,787 --> 01:40:00,090 WE'RE COLLECTING ON ALL THE 2779 01:40:00,090 --> 01:40:02,259 SEVERE MORBIDITIES IN HOSPITAL 2780 01:40:02,259 --> 01:40:04,895 ON OUR DATABASE, LOOKING AT 2781 01:40:04,895 --> 01:40:07,431 TIMING OF MORBIDITY, INFORMATION 2782 01:40:07,431 --> 01:40:11,668 ON DEMOGRAPHICS, PRENATAL CARE, 2783 01:40:11,668 --> 01:40:16,907 DELIVERY INFORMATION, ICU OR CCU 2784 01:40:16,907 --> 01:40:20,877 ADMISSION, MAJOR SURGERY AS WEL 2785 01:40:20,877 --> 01:40:22,212 AS COVID-19 DATA. 2786 01:40:22,212 --> 01:40:23,413 WE'RE COLLECTING INFORMATION ON 2787 01:40:23,413 --> 01:40:25,715 COVID VACCINATION, THIS WAS 2788 01:40:25,715 --> 01:40:27,551 STARTED IN 2020, SO THIS IS WHAT 2789 01:40:27,551 --> 01:40:29,219 WE CONTINUE TO DO. 2790 01:40:29,219 --> 01:40:32,189 WE DO HAVE A CASE NARRATIVE FOR 2791 01:40:32,189 --> 01:40:34,458 EACH CASE, THE TIME OF KEY 2792 01:40:34,458 --> 01:40:37,627 EVENTS, ALL THIS INFORMATION IS 2793 01:40:37,627 --> 01:40:39,162 COMPLETED AFTER REVIEW COMMITTEE 2794 01:40:39,162 --> 01:40:42,833 MEETING BY DATA ABSTRACTORS. 2795 01:40:42,833 --> 01:40:46,703 DURING THE HOSPITAL REVIEWS, WE 2796 01:40:46,703 --> 01:40:48,105 HAVE COMMITTEES, 2797 01:40:48,105 --> 01:40:51,108 MULTI-DISCIPLINARY COMMITTEES IN 2798 01:40:51,108 --> 01:40:54,711 MOST HOSPITALS, ASSIGNING CAUSES 2799 01:40:54,711 --> 01:40:57,347 OF MORTALITY, THAT YOU MAY BE 2800 01:40:57,347 --> 01:40:59,015 MORE FAMILIAR WITH, WE HAVE 2801 01:40:59,015 --> 01:41:00,951 REVIEW COMMITTEE TALK ABOUT 2802 01:41:00,951 --> 01:41:02,719 SEQUENCE OF CLINICAL EVENTS AND 2803 01:41:02,719 --> 01:41:04,454 CAUSES OF MORBIDITY AND THEY 2804 01:41:04,454 --> 01:41:06,857 HAVE A FINAL ANALYSIS WHERE BY 2805 01:41:06,857 --> 01:41:11,228 THEY ARE LOOKING AT 2806 01:41:11,228 --> 01:41:13,363 OPPORTUNITIES TO ALTER OUTCOMES, 2807 01:41:13,363 --> 01:41:15,699 PRACTICES DONE WELL, SHOULD BE 2808 01:41:15,699 --> 01:41:17,234 READY TO REPORT, OVERALL 2809 01:41:17,234 --> 01:41:21,505 RECOMMENDATIONS FOR IMPROVEMENT. 2810 01:41:21,505 --> 01:41:22,539 NEXT SLIDE. 2811 01:41:22,539 --> 01:41:26,776 SO IN TERMS OF ASSESSING 2812 01:41:26,776 --> 01:41:28,645 OPPORTUNITIES TO ALTER OUTCOME, 2813 01:41:28,645 --> 01:41:31,481 PREVENT MORBIDITY, WE PROVIDE A 2814 01:41:31,481 --> 01:41:32,782 STANDARDIZED DEFINITION SHOWN 2815 01:41:32,782 --> 01:41:36,853 HERE AND A GUIDE TO HAVE 2816 01:41:36,853 --> 01:41:38,388 COMMUNITIES TRY DETERMINATION OR 2817 01:41:38,388 --> 01:41:41,758 ASSESSMENT WHETHER THE SMM EVENT 2818 01:41:41,758 --> 01:41:44,194 WAS PREVENTIBLE OR NOT. 2819 01:41:44,194 --> 01:41:45,996 SHOWING DATA FROM -- TELLING YOU 2820 01:41:45,996 --> 01:41:48,565 FIRST WE HAVE 27 OF 32 BIRTHING 2821 01:41:48,565 --> 01:41:50,867 HOSPITALS IN THE STATE CURRENTLY 2822 01:41:50,867 --> 01:41:51,801 PARTICIPATING IN OUR 2823 01:41:51,801 --> 01:41:53,470 SURVEILLANCE COVERING 80% OF THE 2824 01:41:53,470 --> 01:41:55,438 BIRTHS IN MARYLAND, WE STARTED 2825 01:41:55,438 --> 01:41:59,609 IN 2020 WITH PILOT PROGRAM, WITH 2826 01:41:59,609 --> 01:42:00,877 ONLY SIX HOSPITALS, WE'RE NOW 2827 01:42:00,877 --> 01:42:04,881 WORKING WITH 27 OF THE 32. 2828 01:42:04,881 --> 01:42:08,218 HERE I'M SHOWING DATA FROM 279 2829 01:42:08,218 --> 01:42:10,387 SMM EVENTS IDENTIFIED AND 2830 01:42:10,387 --> 01:42:13,089 REVIEWED IN 2023. 2831 01:42:13,089 --> 01:42:18,228 AS YOU SEE, ABOUT 43% ICU 2832 01:42:18,228 --> 01:42:18,762 ADMISSIONS, 37% BLOOD 2833 01:42:18,762 --> 01:42:21,998 TRANSFUSIONS, 22% OF THE CASES 2834 01:42:21,998 --> 01:42:24,801 MET BOTH CRITERIA IN OUR 2835 01:42:24,801 --> 01:42:26,203 DEFINITION, ICU ADMISSION AND 2836 01:42:26,203 --> 01:42:28,004 BLOOD TRANSFUSION WITH MORE THAN 2837 01:42:28,004 --> 01:42:29,306 FOUR UNITS. 2838 01:42:29,306 --> 01:42:32,509 WE SEE 40 TO 45% OF THESE EVENTS 2839 01:42:32,509 --> 01:42:36,313 OCCUR IN WOMEN 35 TO 39 YEARS, 2840 01:42:36,313 --> 01:42:38,615 ANOTHER 40, 45% IN WOMEN OVER 40 2841 01:42:38,615 --> 01:42:41,351 YEARS OF AGE. 2842 01:42:41,351 --> 01:42:45,622 AND OVERALL, THE SMM RATE IN 2843 01:42:45,622 --> 01:42:48,124 2023 WAS 97 FOR 10,000 2844 01:42:48,124 --> 01:42:50,293 DELIVERIES, NON-HISPANIC BLACK 2845 01:42:50,293 --> 01:42:52,529 WOMEN HAVE TWICE THE RATE OF 2846 01:42:52,529 --> 01:42:53,396 MAJORITY GROUP OF NON-HISPANIC 2847 01:42:53,396 --> 01:42:56,866 WHITE WOMEN. 2848 01:42:56,866 --> 01:42:59,502 NEXT SLIDE IS SHOWING MEDICAL 2849 01:42:59,502 --> 01:43:00,203 HISTORY INFORMATION. 2850 01:43:00,203 --> 01:43:02,839 SO, IT'S IMPORTANT TO NOTE THE 2851 01:43:02,839 --> 01:43:08,345 FIRST FIGURE IN THE TABLE OF THE 2852 01:43:08,345 --> 01:43:11,414 279 CASES REVIEWED, 80% HAD 2853 01:43:11,414 --> 01:43:13,483 SIGNIFICANT MEDICAL HISTORY. 2854 01:43:13,483 --> 01:43:15,685 SO WE HAD 39% OF THE PATIENTS 2855 01:43:15,685 --> 01:43:16,753 WITH OBESITY. 2856 01:43:16,753 --> 01:43:20,390 WE HAD 19% OF PATIENTS WITH 2857 01:43:20,390 --> 01:43:24,661 CHRONIC HYPERTENSION, ALSO 9% OF 2858 01:43:24,661 --> 01:43:26,062 THE PATIENTS WITH PREGNANCY 2859 01:43:26,062 --> 01:43:28,031 CARDIOVASCULAR CONDITION. 2860 01:43:28,031 --> 01:43:28,698 COMPLICATIONS IN PRIOR 2861 01:43:28,698 --> 01:43:33,003 PREGNANCY, 43% OF ALL OUR 2862 01:43:33,003 --> 01:43:35,372 POPULATION HAVING EXPERIENCED 2863 01:43:35,372 --> 01:43:37,574 PREGNANCY LOSS, AND 19 OR 20%, 2864 01:43:37,574 --> 01:43:40,977 SO ONE IN FIVE HAVING HAD 2865 01:43:40,977 --> 01:43:43,380 HYPERTENSIVE DISORDER IN A PRIOR 2866 01:43:43,380 --> 01:43:43,647 PREGNANCY. 2867 01:43:43,647 --> 01:43:47,817 AND THEN ALSO OF NOTE, 30% OF 2868 01:43:47,817 --> 01:43:51,354 WOMEN IN 2023 WHO WERE IN OUR 2869 01:43:51,354 --> 01:43:58,695 DATABASE HAVE HAD DIAGNOSIS OF 2870 01:43:58,695 --> 01:43:59,996 HYPERTENSIVE DISORDER OF 2871 01:43:59,996 --> 01:44:00,997 PREGNANCY WITH A SPECIFIC 2872 01:44:00,997 --> 01:44:02,432 PROGRAM FOR THESE POPULATIONS. 2873 01:44:02,432 --> 01:44:03,600 IN TERMS OF DELIVERY 2874 01:44:03,600 --> 01:44:06,269 CHARACTERISTICS IN THIS SERIES 2875 01:44:06,269 --> 01:44:10,740 WE HAVE ALMOST 4 IN 5 SMM EVENTS 2876 01:44:10,740 --> 01:44:11,975 DURING THE DELIVERY 2877 01:44:11,975 --> 01:44:13,243 HOSPITALIZATION, SO MORE THAN 2878 01:44:13,243 --> 01:44:16,846 20% OCCURRED OUTSIDE OF THE 2879 01:44:16,846 --> 01:44:19,082 DELIVERY HOSPITALIZATION. 2880 01:44:19,082 --> 01:44:21,584 THESE PATIENTS, 74% HAD CASAREAN 2881 01:44:21,584 --> 01:44:29,693 DELIVERY, HALF OF THE 2882 01:44:29,693 --> 01:44:30,694 DELIVERIES WERE EMERGENCY 2883 01:44:30,694 --> 01:44:33,296 DIFFERENCES. 2884 01:44:33,296 --> 01:44:34,831 STILL BIRTH OR FETAL DEATH IN 2885 01:44:34,831 --> 01:44:38,001 10% OF THE CASES IN THIS SERIES. 2886 01:44:38,001 --> 01:44:41,171 THE PRIMARY CAUSE OF SEVERE 2887 01:44:41,171 --> 01:44:42,138 MATERNAL MORBIDITY, ALSO 2888 01:44:42,138 --> 01:44:44,007 HEMORRHAGE CONTRIBUTED MORE THAN 2889 01:44:44,007 --> 01:44:46,743 HALF, 55% OF THE CASES, AND THEN 2890 01:44:46,743 --> 01:44:49,946 OF INTEREST FOR THE WORKSHOP 2891 01:44:49,946 --> 01:44:52,582 TODAY 12% WERE CONTRIBUTED BY 2892 01:44:52,582 --> 01:44:54,884 HYPERTENSIVE DISORDERS OF 2893 01:44:54,884 --> 01:44:56,186 PREGNANCY, 5% CARDIOVASCULAR 2894 01:44:56,186 --> 01:45:00,256 CONDITIONS, AND WILL 3% BY 2895 01:45:00,256 --> 01:45:00,490 STROKE. 2896 01:45:00,490 --> 01:45:02,225 NEXT SLIDE. 2897 01:45:02,225 --> 01:45:03,827 IN THE PREVENTABILITY OVERALL 2898 01:45:03,827 --> 01:45:08,164 ABOUT A THIRD OF CASES WERE 2899 01:45:08,164 --> 01:45:08,798 DEEMED PREVENTIBLE BY HOSPITAL 2900 01:45:08,798 --> 01:45:09,799 REVIEW COMMITTEES. 2901 01:45:09,799 --> 01:45:11,568 IN TERMS OF HYPERTENSIVE 2902 01:45:11,568 --> 01:45:14,104 DISORDERS OF PREGNANCY 2 IN 5 2903 01:45:14,104 --> 01:45:17,974 PREVENTIBLE, IN TERMS OF 2904 01:45:17,974 --> 01:45:20,744 CARDIOVASCULAR, 1 IN 5 EVENTS 2905 01:45:20,744 --> 01:45:23,079 WERE PREVENTIBLE. 2906 01:45:23,079 --> 01:45:25,248 I'M HERE SHOWING DATA FROM 2907 01:45:25,248 --> 01:45:30,286 ACROSS THE PERIOD 2020 TO 2024, 2908 01:45:30,286 --> 01:45:35,859 THE FULL SAMPLE, 724 EVENTS, I'M 2909 01:45:35,859 --> 01:45:46,403 COMPARING PATIENTS WHO HAD BE ON 2910 01:45:48,738 --> 01:45:49,139 OBSTETRIC HEMORRHAGE. 2911 01:45:49,139 --> 01:45:53,276 THE IN THE SECOND COLUMN 55% OF 2912 01:45:53,276 --> 01:45:56,913 THESE CASES OF WOMEN WITH 2913 01:45:56,913 --> 01:45:58,214 HYPERTENSIVE IN PREGNANCY 2914 01:45:58,214 --> 01:46:08,591 NON-HISPANIC BLACK, 25% 2915 01:46:08,591 --> 01:46:10,794 NON-HISPANIC WHITES, CHRONIC 2916 01:46:10,794 --> 01:46:14,397 HYPERTENSION ACCOMPANIED 38% OF 2917 01:46:14,397 --> 01:46:20,437 THESE CASES. 2918 01:46:20,437 --> 01:46:25,241 42% POSTPARTUM, 36 ANTE-PARTUM. 2919 01:46:25,241 --> 01:46:28,912 OF THESE CASES, 40% IN WOMEN 2920 01:46:28,912 --> 01:46:30,079 AGED 35+. 2921 01:46:30,079 --> 01:46:32,749 AND WE SEE THAT CHRONIC 2922 01:46:32,749 --> 01:46:33,716 HYPERTENSION ACCOMPANIED ABOUT 2923 01:46:33,716 --> 01:46:37,420 20% OF THE CASES IN THE SERIES, 2924 01:46:37,420 --> 01:46:40,824 56% OF THESE WOMEN WERE OBESE. 2925 01:46:40,824 --> 01:46:47,730 AND THEN IMPORTANTLY TO NOTE 2926 01:46:47,730 --> 01:46:49,132 HERE, THEY EVENTS WERE ANTE 2927 01:46:49,132 --> 01:46:52,001 PARTUM IN 50% OF THE CASES. 2928 01:46:52,001 --> 01:46:53,503 NEXT SLIDE. 2929 01:46:53,503 --> 01:46:55,605 SO, OUTSIDE OF DATA COLLECTION 2930 01:46:55,605 --> 01:46:56,906 PROCESS, WE'RE SOLICITING 2931 01:46:56,906 --> 01:47:01,177 INFORMATION ABOUT HOSPITAL LEVEL 2932 01:47:01,177 --> 01:47:04,581 POLICY CHANGES AND HAPPY TO SHOW 2933 01:47:04,581 --> 01:47:05,114 EXAMPLES. 2934 01:47:05,114 --> 01:47:07,550 RESULT OF PARTICIPATION, WE'VE 2935 01:47:07,550 --> 01:47:10,620 SEEN HOSPITALS CHANGING THEIR 2936 01:47:10,620 --> 01:47:13,790 POLICIES, CHANGING THEIR -- THE 2937 01:47:13,790 --> 01:47:15,658 WAY THEY EDUCATE THEIR 2938 01:47:15,658 --> 01:47:17,861 TECHNICIANS AND THEIR STAFF, 2939 01:47:17,861 --> 01:47:21,898 THEIR PROVIDERS, WE SEE THAT 2940 01:47:21,898 --> 01:47:23,433 THEY ARE INCLUDING 2941 01:47:23,433 --> 01:47:25,835 ANESTHESIOLOGISTS TO UNDERSTAND 2942 01:47:25,835 --> 01:47:28,805 SOME -- WHAT WERE KEY CONCERNS 2943 01:47:28,805 --> 01:47:31,074 AND THE LAST QUOTE ON THE STAGE 2944 01:47:31,074 --> 01:47:32,342 FROM ONE, WE'VE NOT HAD ANYTHING 2945 01:47:32,342 --> 01:47:35,678 LIKE THIS BEFORE IN TERMS OF 2946 01:47:35,678 --> 01:47:38,281 ENGAGEMENT ACROSS DISCIPLINES. 2947 01:47:38,281 --> 01:47:38,648 LAST SLIDE. 2948 01:47:38,648 --> 01:47:42,252 SO I WANT TO END BY HIGHLIGHTING 2949 01:47:42,252 --> 01:47:43,853 IMPORTANCE OF ADVOCACY AND 2950 01:47:43,853 --> 01:47:45,622 TALKING TO LEGISLATORS AND 2951 01:47:45,622 --> 01:47:48,024 MAKING A CASE FOR LEGISLATION IN 2952 01:47:48,024 --> 01:47:49,459 SUPPORT OF OUR PROGRAMMING IN 2953 01:47:49,459 --> 01:47:49,893 MATERNAL HEALTH. 2954 01:47:49,893 --> 01:47:52,729 WE'VE DONE THIS IN THE PATH WITH 2955 01:47:52,729 --> 01:47:53,596 THE SURVEILLANCE PROJECT, ABLE 2956 01:47:53,596 --> 01:47:57,333 TO START THE PROJECT IN MARYLAND 2957 01:47:57,333 --> 01:47:58,535 IN 2020, THROUGH LEGISLATION, 2958 01:47:58,535 --> 01:48:00,737 AND AS OF MAY OF THIS YEAR 2959 01:48:00,737 --> 01:48:02,839 THROUGH THE MARYLAND MATERNAL 2960 01:48:02,839 --> 01:48:05,208 HEALTH ACT OF 2024 THIS 2961 01:48:05,208 --> 01:48:06,709 PARTICULAR PIECE OF LEGISLATION 2962 01:48:06,709 --> 01:48:08,912 MANDATES ALL HOSPITALS IN THE 2963 01:48:08,912 --> 01:48:09,913 STATES TO PARTICIPATE IN OUR 2964 01:48:09,913 --> 01:48:10,780 SURVEILLANCE PROGRAM. 2965 01:48:10,780 --> 01:48:13,516 SO WE'RE GOING TO GO FROM 27 2966 01:48:13,516 --> 01:48:15,752 HOSPITALS WE WORK WITH CURRENTLY 2967 01:48:15,752 --> 01:48:19,522 TO COVER ALL 32. 2968 01:48:19,522 --> 01:48:20,423 2969 01:48:20,423 --> 01:48:21,624 NEXT SLIDE. 2970 01:48:21,624 --> 01:48:23,159 I'M GOING ACTUALLY END BY 2971 01:48:23,159 --> 01:48:26,663 TELLING YOU THAT WE'RE ALWAYS 2972 01:48:26,663 --> 01:48:27,730 ADDING ADDITIONAL PIECES TO THE 2973 01:48:27,730 --> 01:48:29,599 PROGRAM, SO WE'LL HAVE ALL 2974 01:48:29,599 --> 01:48:31,134 HOSPITALS IN THE STATE 2975 01:48:31,134 --> 01:48:31,801 PARTICIPATE STARTING IN OCTOBER 2976 01:48:31,801 --> 01:48:33,670 OF THIS YEAR. 2977 01:48:33,670 --> 01:48:36,272 WE'RE GOING TO ADD OPTIONAL 2978 01:48:36,272 --> 01:48:37,707 EQUITY REVIEW MODEL FOR HOSPITAL 2979 01:48:37,707 --> 01:48:42,412 REVIEWS COMMITTEES TO USE TO 2980 01:48:42,412 --> 01:48:43,513 UNDERSTAND CONTRIBUTION OF 2981 01:48:43,513 --> 01:48:46,349 RACISM, BIASES, AND TRY TO DO A 2982 01:48:46,349 --> 01:48:47,951 RE-REVIEW OF RANDOM SAMPLE OF 2983 01:48:47,951 --> 01:48:51,721 10% OF CASES AS PART OF A 2984 01:48:51,721 --> 01:48:53,256 STATEWIDE COMMITTEE. 2985 01:48:53,256 --> 01:48:53,890 THIS IS ALL. 2986 01:48:53,890 --> 01:48:54,891 THANK YOU SO MUCH. 2987 01:48:54,891 --> 01:49:03,099 I WELCOME YOUR QUESTIONS. 2988 01:49:03,099 --> 01:49:04,734 THANK YOU. 2989 01:49:04,734 --> 01:49:05,868 >> WE'RE GOING TO DO ALL THE 2990 01:49:05,868 --> 01:49:08,004 QUESTIONS AT THE END IF 2991 01:49:08,004 --> 01:49:09,072 EVERYBODY COULD HOLD THE 2992 01:49:09,072 --> 01:49:13,710 QUESTIONS TO THE Q&A SECTION. 2993 01:49:13,710 --> 01:49:18,081 THANK YOU SO MUCH FOR YOU TALK 2994 01:49:18,081 --> 01:49:21,184 OF A HEALTH SYSTEM BASED 2995 01:49:21,184 --> 01:49:23,720 INTERVENTION AND IMPLICATIONS 2996 01:49:23,720 --> 01:49:24,020 NATIONALLY. 2997 01:49:24,020 --> 01:49:24,687 DEFINITELY STATEWIDE ALREADY. 2998 01:49:24,687 --> 01:49:35,164 I'LL HAPPENED IT OVER TO DR. 2999 01:49:41,104 --> 01:49:41,371 MONDEL. 3000 01:49:41,371 --> 01:49:43,439 I THINK YOU'RE ON MUTE. 3001 01:49:43,439 --> 01:49:49,646 NOW WE CAN HEAR YOU. 3002 01:49:49,646 --> 01:49:51,414 >> THANK YOU FOR BEING PART OF 3003 01:49:51,414 --> 01:49:52,615 THIS IMPORTANT PANEL. 3004 01:49:52,615 --> 01:49:55,918 TODAY I'M GOING TO SPEAK OF 3005 01:49:55,918 --> 01:49:58,855 CHALLENGES AND INNOVATIONS IN 3006 01:49:58,855 --> 01:50:01,357 CARDIOVASCULAR HEALTH IN 3007 01:50:01,357 --> 01:50:01,791 PREGNANCY. 3008 01:50:01,791 --> 01:50:03,660 CARDIOVASCULAR DISEASE IS 3009 01:50:03,660 --> 01:50:05,294 IMPORTANT, EXISTING DISEASE 3010 01:50:05,294 --> 01:50:05,995 REQUIRES CAREFUL MANAGEMENT 3011 01:50:05,995 --> 01:50:06,929 DURING PREGNANCY. 3012 01:50:06,929 --> 01:50:08,898 YOU KNOW THE CHALLENGES. 3013 01:50:08,898 --> 01:50:11,668 INCREASED RISK OF COMPLICATIONS 3014 01:50:11,668 --> 01:50:15,171 SUCH AS HEART FAILURE, 3015 01:50:15,171 --> 01:50:16,139 ARRHYTHMIA, AND MANAGING 3016 01:50:16,139 --> 01:50:17,240 PREEXISTING DISEASE IS IMPORTANT 3017 01:50:17,240 --> 01:50:22,178 IN CONTEXT OF PREGNANCY 3018 01:50:22,178 --> 01:50:24,380 INCREASED PLASMA VOLUME, CARDIAC 3019 01:50:24,380 --> 01:50:27,216 OUTPUT, CAN CHANGE OUTCOME OF 3020 01:50:27,216 --> 01:50:29,519 PREGNANCY, ALSO A PROBLEM FOR 3021 01:50:29,519 --> 01:50:30,319 MANAGING PREEXISTING DISEASE. 3022 01:50:30,319 --> 01:50:30,720 NEXT SLIDE PLEASE. 3023 01:50:30,720 --> 01:50:31,821 NEXT SLIDE PLEASE. 3024 01:50:31,821 --> 01:50:38,361 SO, WHAT ARE THE INNOVATIONS WE 3025 01:50:38,361 --> 01:50:39,896 CAN HAVE IN IMPLEMENTING THESE 3026 01:50:39,896 --> 01:50:42,532 INTEGRATED APPROACH? 3027 01:50:42,532 --> 01:50:45,935 WE COULD HAVE BETTER DIAGNOSTIC 3028 01:50:45,935 --> 01:50:47,236 APPROACHES FOR DELINEATING 3029 01:50:47,236 --> 01:50:55,011 CARDIAC DISEASES AND CARDIAC 3030 01:50:55,011 --> 01:50:58,848 LESIONS, WE COULD HAVE 3031 01:50:58,848 --> 01:51:02,885 CERTIFICATION TOOLS LOCALLY 3032 01:51:02,885 --> 01:51:03,119 USEFUL. 3033 01:51:03,119 --> 01:51:04,754 MULTI-DISCIPLINARY APPROACH AND 3034 01:51:04,754 --> 01:51:05,822 NATIONAL GLOBAL REGISTRY OF 3035 01:51:05,822 --> 01:51:07,156 CARDIOVASCULAR DISEASES TO SEE 3036 01:51:07,156 --> 01:51:10,660 WHAT IS THE PREVALENCE OR RISK 3037 01:51:10,660 --> 01:51:10,893 FACTORS. 3038 01:51:10,893 --> 01:51:13,396 NEXT SLIDE PLEASE. 3039 01:51:13,396 --> 01:51:16,032 SO, LET'S TALK ABOUT THE STAGES 3040 01:51:16,032 --> 01:51:22,805 OF OBSTETRIC TRANSITION WHERE WE 3041 01:51:22,805 --> 01:51:26,309 ARE DIRECTLY RELATED TO CAUSES 3042 01:51:26,309 --> 01:51:29,579 OF DEATH TO STAGE 4, WHERE 3043 01:51:29,579 --> 01:51:30,680 MOSTLY MATERNAL MORTALITIES 3044 01:51:30,680 --> 01:51:32,982 RELATED TO INDIRECT CAUSES MAY 3045 01:51:32,982 --> 01:51:40,890 BE CARDIAC, RENAL, LIVER HEPATC 3046 01:51:40,890 --> 01:51:43,860 DISORDERS. 3047 01:51:43,860 --> 01:51:48,097 NEXT SLIDE PLEASE. 3048 01:51:48,097 --> 01:51:50,633 WE HAVE INCREASED MATERNITY 3049 01:51:50,633 --> 01:51:58,074 CARE, AGING MATERNAL POPULATION, 3050 01:51:58,074 --> 01:51:58,741 INCREASED INTERVENTION, 3051 01:51:58,741 --> 01:52:00,409 C-SECTION RATE IS HIGH, A 3052 01:52:00,409 --> 01:52:01,144 CHALLENGE FOR THE 3053 01:52:01,144 --> 01:52:01,511 ADMINISTRATION. 3054 01:52:01,511 --> 01:52:04,013 MOST OF THE STATES ESPECIALLY 3055 01:52:04,013 --> 01:52:05,982 NORTHERN PART OF THE COUNTRY 3056 01:52:05,982 --> 01:52:10,787 STILL IN A STAGE 3 WHERE THE 3057 01:52:10,787 --> 01:52:11,621 MATERNAL MORTALITY IS HIGH YET 3058 01:52:11,621 --> 01:52:13,256 WE HAVE STATES IN THE SOUTHERN 3059 01:52:13,256 --> 01:52:23,166 PART WHERE WE ARE IN A STATE OF 3060 01:52:23,166 --> 01:52:24,801 TRANSITION THE INDIRECT CAUSES 3061 01:52:24,801 --> 01:52:29,739 PLAY ROLE. 3062 01:52:29,739 --> 01:52:31,941 HEART DISEASE COMPLICATES, AND 3063 01:52:31,941 --> 01:52:38,514 INDIA AND SOUTH ASIA. 3064 01:52:38,514 --> 01:52:42,652 THE CHALLENGES IN INDIA, LACK OF 3065 01:52:42,652 --> 01:52:44,520 AWARENESS, PAUCITY OF HIGH 3066 01:52:44,520 --> 01:52:49,659 QUALITY INDIAN DATA, ABSENCE OF 3067 01:52:49,659 --> 01:52:51,427 INDIGENOUS RISK STRATIFICATION 3068 01:52:51,427 --> 01:52:56,332 TOOLS, LACK OF WELL-DEFINED 3069 01:52:56,332 --> 01:52:56,999 MANAGEMENT PROTOCOL, 3070 01:52:56,999 --> 01:52:58,768 INSUFFICIENT COORDINATION 3071 01:52:58,768 --> 01:53:06,309 BETWEEN HEALTH FACILITIES, 3072 01:53:06,309 --> 01:53:07,276 SUBOPTIMAL ADMINISTRATIVE 3073 01:53:07,276 --> 01:53:08,444 SUPPORT, LACK OF MANAGEMENT OF 3074 01:53:08,444 --> 01:53:14,183 THESE DISORDERS. 3075 01:53:14,183 --> 01:53:18,020 NEXT SLIDE PLEASE. 3076 01:53:18,020 --> 01:53:21,624 SO THIS STUDY INCLUDED 26 3077 01:53:21,624 --> 01:53:21,858 STUDIES. 3078 01:53:21,858 --> 01:53:22,391 NEXT. 3079 01:53:22,391 --> 01:53:23,259 META-ANALYSIS, WHAT ARE THE 3080 01:53:23,259 --> 01:53:25,895 CAUSES OF HEART DISEASE IN 3081 01:53:25,895 --> 01:53:28,197 PREGNANCY FOR WOMEN IN SOUTH 3082 01:53:28,197 --> 01:53:30,933 ASIA. 3083 01:53:30,933 --> 01:53:31,267 NEXT. 3084 01:53:31,267 --> 01:53:39,342 WE SHOWED THAT DRAMATIC HEART 3085 01:53:39,342 --> 01:53:43,279 DISEASE CONTRIBUTES 3086 01:53:43,279 --> 01:53:45,047 SIGNIFICANTLY VALVE HEART 3087 01:53:45,047 --> 01:53:47,316 DISEASE, A PROBLEM OF LOW 3088 01:53:47,316 --> 01:53:49,185 SOCIOECONOMIC COUNTRIES. 3089 01:53:49,185 --> 01:53:49,719 CARDIOVASCULAR DISEASE IS 3090 01:53:49,719 --> 01:53:52,154 UPCOMING 18% OF THE CASES OF 3091 01:53:52,154 --> 01:53:53,456 HEART DISEASE ARE RELATED TO 3092 01:53:53,456 --> 01:53:54,457 CARDIAC DISEASE. 3093 01:53:54,457 --> 01:53:56,092 MATERNAL MORTALITY IN THESE 3094 01:53:56,092 --> 01:54:01,797 CASES IS HIGH, AS HIGH AS 26, 3095 01:54:01,797 --> 01:54:05,868 PRE-TERM MORTALITY AS HIGH AS 3096 01:54:05,868 --> 01:54:06,402 50%. 3097 01:54:06,402 --> 01:54:10,239 THERE ARE CERTAIN TOOLS THAT CAN 3098 01:54:10,239 --> 01:54:12,541 ASSESS RISK OF MORTALITY, 3099 01:54:12,541 --> 01:54:16,379 BECAUSE OF HEART DISEASE. 3100 01:54:16,379 --> 01:54:19,982 THESE SCORES SPEAK ABOUT 3101 01:54:19,982 --> 01:54:24,387 CLASSIFICATION, WE HAVE THE 3102 01:54:24,387 --> 01:54:27,990 ZAHARA SCORE RELATED TO CON 3103 01:54:27,990 --> 01:54:28,958 CONGENITAL HEART DISEASE. 3104 01:54:28,958 --> 01:54:30,593 DO WE HAVE SOMETHING THAT SCORES 3105 01:54:30,593 --> 01:54:35,298 WHAT'S PREVALENT IN THE LOCAL 3106 01:54:35,298 --> 01:54:37,300 HEART DISEASE, VALVULAR HEART 3107 01:54:37,300 --> 01:54:39,602 DISEASE, THIS STUDY WAS DONE IN 3108 01:54:39,602 --> 01:54:41,537 A SINGLE CENTER WHERE PREDICTION 3109 01:54:41,537 --> 01:54:42,905 OF ADVERSE CARDIAC EVENTS DONE 3110 01:54:42,905 --> 01:54:46,909 ON THE BASIS OF FACTORS THAT 3111 01:54:46,909 --> 01:54:50,947 WERE INDIGENOUS ESPECIALLY IN 3112 01:54:50,947 --> 01:54:53,149 THE WOMEN WITH VALVULAR HEART 3113 01:54:53,149 --> 01:54:57,219 DISEASE, EVALUATED AGAINST THE 3114 01:54:57,219 --> 01:54:59,055 SCORE, SHOWED IT HAS A GOOD 3115 01:54:59,055 --> 01:55:00,022 PREDICTION OF ADVERSE OUTCOME 3116 01:55:00,022 --> 01:55:03,092 WHEN THIS WAS USED, ESPECIALLY 3117 01:55:03,092 --> 01:55:06,829 IN THE WOMEN WITH VALVULAR HEART 3118 01:55:06,829 --> 01:55:07,129 DISEASE. 3119 01:55:07,129 --> 01:55:08,831 NEXT SLIDE PLEASE. 3120 01:55:08,831 --> 01:55:10,333 ANOTHER IMPORTANT STUDY THAT WAS 3121 01:55:10,333 --> 01:55:11,867 UNDERTAKEN IN THE COUNTRY WAS 3122 01:55:11,867 --> 01:55:13,502 PREGNANCY OUTCOMES IN WOMEN WITH 3123 01:55:13,502 --> 01:55:18,975 HEART DISEASE DONE AT MADRAS 3124 01:55:18,975 --> 01:55:20,276 MEDICAL COLLEGE. 3125 01:55:20,276 --> 01:55:20,710 NEXT. 3126 01:55:20,710 --> 01:55:23,913 THIS WAS THE STUDY THAT WAS THE 3127 01:55:23,913 --> 01:55:24,981 LARGEST SINGLE-CENTER STUDY, 3128 01:55:24,981 --> 01:55:26,515 PREGNANT WOMEN WITH HEART 3129 01:55:26,515 --> 01:55:30,386 DISEASE WERE INCLUDED. 3130 01:55:30,386 --> 01:55:34,390 THERE WAS ABOUT 1005 WOMEN, 1029 3131 01:55:34,390 --> 01:55:35,925 PREGNANCIES, VALVULAR HEART 3132 01:55:35,925 --> 01:55:37,360 DISEASE WAS THE COMMONEST THAT 3133 01:55:37,360 --> 01:55:40,429 WE SEE, HEART FAILURE WAS THE 3134 01:55:40,429 --> 01:55:41,497 MOST COMMON ADVERSE CARDIAC 3135 01:55:41,497 --> 01:55:46,569 EVENT SEEN IN THE STUDY. 3136 01:55:46,569 --> 01:55:46,769 NEXT. 3137 01:55:46,769 --> 01:55:47,670 SURPRISINGLY, THE STUDY, IT WAS 3138 01:55:47,670 --> 01:55:50,606 DONE IN THE SOUTHERN INDIA, DID 3139 01:55:50,606 --> 01:55:59,482 SHOW 60% OF WOMEN RECEIVED 3140 01:55:59,482 --> 01:56:02,752 FIRST-EVER HEART DISEASE IN 3141 01:56:02,752 --> 01:56:04,820 PREGNANCY, 26 TO 69% DIAGNOSED 3142 01:56:04,820 --> 01:56:06,022 FOR HEART DISEASE DURING 3143 01:56:06,022 --> 01:56:11,127 PREGNANCY SHOWING THAT A LACK OF 3144 01:56:11,127 --> 01:56:12,461 AWARENESS ABOUT CARDIAC DISEASES 3145 01:56:12,461 --> 01:56:15,631 IN WOMEN IN GENERAL AND LACK OF 3146 01:56:15,631 --> 01:56:18,367 ANTE NATAL OR PROPER CARE FOR 3147 01:56:18,367 --> 01:56:24,373 WOMEN WITH HEART DISEASE OUTSIDE 3148 01:56:24,373 --> 01:56:26,475 OF PREGNANCY. 3149 01:56:26,475 --> 01:56:33,783 SO WITH THIS STUDY, THE BASIS OF 3150 01:56:33,783 --> 01:56:34,884 THE NATIONAL PREGNANCY REGISTRY, 3151 01:56:34,884 --> 01:56:37,386 NEXT SLIDE, THIS IS A STUDY 3152 01:56:37,386 --> 01:56:39,588 SUPPORTED BY THE INDIAN COUNCIL 3153 01:56:39,588 --> 01:56:43,759 OF MEDICAL RESEARCH ACROSS THE 3154 01:56:43,759 --> 01:56:45,828 COUNTRY WHEREABOUT MORE THAN 50 3155 01:56:45,828 --> 01:56:47,129 MAJOR INSTITUTIONS IN THE 3156 01:56:47,129 --> 01:56:50,533 COUNTRY, PRIVATE AND PUBLIC, 3157 01:56:50,533 --> 01:56:51,834 WILL BE PARTICIPATING FOR 3158 01:56:51,834 --> 01:56:55,137 GIVING -- FOR COLLECTING DATA 3159 01:56:55,137 --> 01:56:57,206 WHICH WILL BE DEVELOPING 3160 01:56:57,206 --> 01:56:59,175 PROTOCOL FOR MANAGING PREGNANCY 3161 01:56:59,175 --> 01:57:02,011 IN WOMEN WITH HEART DISEASE, 3162 01:57:02,011 --> 01:57:03,379 BASED ON SYSTEMATICALLY 3163 01:57:03,379 --> 01:57:06,415 COLLECTED DATA ACROSS THE 3164 01:57:06,415 --> 01:57:08,350 NATION, DEVELOPING INDIGENOUS 3165 01:57:08,350 --> 01:57:08,884 STRATIFICATION TOOLS, 3166 01:57:08,884 --> 01:57:10,886 IMPLEMENTING THEM IN THE 3167 01:57:10,886 --> 01:57:12,088 DAY-TO-DAY MANAGEMENT. 3168 01:57:12,088 --> 01:57:14,390 THE OUTCOME MIGHT BE A CHANGE IN 3169 01:57:14,390 --> 01:57:17,526 PRACTICE PATTERNS, CARE OF WOMEN 3170 01:57:17,526 --> 01:57:20,896 FOR HEART DISEASE, MIGHT EVEN 3171 01:57:20,896 --> 01:57:21,630 IMPROVE THE MATERNAL-FETAL 3172 01:57:21,630 --> 01:57:22,298 OUTCOME, THE HYPOTHESIS, IT'S 3173 01:57:22,298 --> 01:57:24,867 GOING TO BE A LONG-TERM STUDY, 3174 01:57:24,867 --> 01:57:28,471 SEE WHAT WE GET OUT OF THE 3175 01:57:28,471 --> 01:57:28,671 STUDY. 3176 01:57:28,671 --> 01:57:31,907 NEXT SLIDE. 3177 01:57:31,907 --> 01:57:33,275 NEXT SLIDE. 3178 01:57:33,275 --> 01:57:36,579 SO, SORRY, CAN WE MOVE BACK. 3179 01:57:36,579 --> 01:57:38,314 THIS COLLABORATIVE RESEARCH 3180 01:57:38,314 --> 01:57:40,082 WILL -- THIS NATIONAL DATA WILL 3181 01:57:40,082 --> 01:57:42,718 GIVE US PREVALENCE AND OUTCOME 3182 01:57:42,718 --> 01:57:44,453 AND MANAGEMENT, IT WILL ALSO 3183 01:57:44,453 --> 01:57:47,089 PROVIDE VALUABLE INSIGHT INTO 3184 01:57:47,089 --> 01:57:50,926 REGIONAL VARIATIONS THAT HAD 3185 01:57:50,926 --> 01:57:52,561 HEALTH STRATEGIES ACCORDINGLY. 3186 01:57:52,561 --> 01:57:54,864 WE WOULD BE TAKING HEALTH CARE, 3187 01:57:54,864 --> 01:57:58,801 CARE OF ELECTRONIC HEALTH 3188 01:57:58,801 --> 01:58:00,903 RECORDS, STREAMLINING DATA 3189 01:58:00,903 --> 01:58:01,770 COLLECTION, FACILITATE 3190 01:58:01,770 --> 01:58:04,507 MONITORING AND ALSO FORMULATED 3191 01:58:04,507 --> 01:58:08,344 RISK SCORES AND STANDARDIZED 3192 01:58:08,344 --> 01:58:08,611 PROTOCOLS. 3193 01:58:08,611 --> 01:58:11,614 NEXT SLIDE. 3194 01:58:11,614 --> 01:58:14,917 THIS IS AN EXAMPLE OF 3195 01:58:14,917 --> 01:58:16,118 COLLABORATION BETWEEN ACADEMIC 3196 01:58:16,118 --> 01:58:18,954 INSTITUTIONS, AND HAVING 3197 01:58:18,954 --> 01:58:21,257 INNOVATION HUBS. 3198 01:58:21,257 --> 01:58:22,591 NEXT SLIDE. 3199 01:58:22,591 --> 01:58:24,660 YES, THAT WILL STANDARDIZE THE 3200 01:58:24,660 --> 01:58:29,899 CARE AND HAVE LOCAL CLINICAL 3201 01:58:29,899 --> 01:58:30,199 GUIDELINES. 3202 01:58:30,199 --> 01:58:30,766 NEXT SLIDE. 3203 01:58:30,766 --> 01:58:32,101 SPECIALIZED TRAINING PROGRAMS 3204 01:58:32,101 --> 01:58:34,170 WILL BE PART OF THIS PROGRAM 3205 01:58:34,170 --> 01:58:36,238 WHICH ALSO WILL HAVE 3206 01:58:36,238 --> 01:58:43,245 MULTI-DISCIPLINARY APPROACH 3207 01:58:43,245 --> 01:58:44,013 WHERE OBSTETRICIANS AND 3208 01:58:44,013 --> 01:58:45,648 CARDIOLOGISTS WILL WORK TOGETHER 3209 01:58:45,648 --> 01:58:46,749 TO GIVE COMPREHENSIVE CARE TO 3210 01:58:46,749 --> 01:58:54,924 WOMEN WITH HEART DISEASE. 3211 01:58:54,924 --> 01:58:56,492 WE'RE TALKING ABOUT 3212 01:58:56,492 --> 01:58:57,259 POINT-OF-CAREDIAGNOSIS, 3213 01:58:57,259 --> 01:59:02,831 ESPECIALLY THOSE WITH VALVULAR 3214 01:59:02,831 --> 01:59:04,700 HEART DISEASE, DIAGNOSTIC TESTS 3215 01:59:04,700 --> 01:59:05,901 USEFUL IN DIAGNOSIS 3216 01:59:05,901 --> 01:59:07,336 POINT-OF-CARE TESTS WHICH WILL 3217 01:59:07,336 --> 01:59:09,271 DIAGNOSE CARDIAC DISEASE, ALSO 3218 01:59:09,271 --> 01:59:11,240 RISK FACTORS FOR PREECLAMPSIA 3219 01:59:11,240 --> 01:59:13,342 AND HYPERTENSION DISORDERS. 3220 01:59:13,342 --> 01:59:14,543 NEXT SLIDES. 3221 01:59:14,543 --> 01:59:17,513 NEXT SLIDE PLEASE. 3222 01:59:17,513 --> 01:59:20,382 WE HAVE ANOTHER INNOVATION, 3223 01:59:20,382 --> 01:59:21,951 mHEALTH, THIS IS A STRATEGY, 3224 01:59:21,951 --> 01:59:28,791 NEXT SLIDE, WHICH HAS BEEN USED 3225 01:59:28,791 --> 01:59:31,327 IN THE NORTHERN PART OF THE 3226 01:59:31,327 --> 01:59:34,863 COUNTRY WHICH IS HELPING TO 3227 01:59:34,863 --> 01:59:36,398 IMPROVE ANTENATAL CARE, 3228 01:59:36,398 --> 01:59:37,600 MONITORING PREGNANCY, MONITORING 3229 01:59:37,600 --> 01:59:38,934 BIRTH AND POST-NATAL EVENTS IN A 3230 01:59:38,934 --> 01:59:39,568 PATIENT'S LIFE. 3231 01:59:39,568 --> 01:59:41,971 THIS IS A TOOL THAT IS GIVEN IN 3232 01:59:41,971 --> 01:59:44,039 THE HANDS OF THE COMMUNITY 3233 01:59:44,039 --> 01:59:47,009 HEALTH WORKERS WHICH TRACKS 3234 01:59:47,009 --> 01:59:49,745 PREGNANCY AND THIS HAS 3235 01:59:49,745 --> 01:59:52,348 IMPROVED -- THIS HAS SHOWN 3236 01:59:52,348 --> 01:59:53,782 SIGNIFICANT IMPROVEMENT IN 3237 01:59:53,782 --> 01:59:54,683 ACCESS TO HEALTHCARE, SOMETHING 3238 01:59:54,683 --> 01:59:57,720 THAT COULD ALSO BE USED FOR 3239 01:59:57,720 --> 01:59:58,621 TRACKING CARDIOVASCULAR DISEASE 3240 01:59:58,621 --> 02:00:00,889 IN PREGNANCY. 3241 02:00:00,889 --> 02:00:03,325 NEXT SLIDE. 3242 02:00:03,325 --> 02:00:05,294 SO MOBILE HEALTH IS THE 3243 02:00:05,294 --> 02:00:11,767 SOLUTIONS WITH HELP OF TELEMED 3244 02:00:11,767 --> 02:00:13,068 MEDICINE AND TELECONSULTATIONS, 3245 02:00:13,068 --> 02:00:14,937 USEFUL ESPECIALLY IN CARDIAC 3246 02:00:14,937 --> 02:00:15,271 HEALTH. 3247 02:00:15,271 --> 02:00:16,472 NEXT SLIDE. 3248 02:00:16,472 --> 02:00:19,742 WE WOULD NEED SOME INNOVATIONS 3249 02:00:19,742 --> 02:00:20,409 IN SURGERY, MEDICATION, DEVICES, 3250 02:00:20,409 --> 02:00:24,246 BECAUSE WE KNOW WE HAVE TO HAVE 3251 02:00:24,246 --> 02:00:25,014 SOME INNOVATIONS IN 3252 02:00:25,014 --> 02:00:35,457 PROSPECTIVELY TO GIVE THE 3253 02:00:37,660 --> 02:00:39,795 PATIENT BETTER CHANCE OF 3254 02:00:39,795 --> 02:00:42,665 PREGNANCY OUTCOME. 3255 02:00:42,665 --> 02:00:44,433 NEXT. 3256 02:00:44,433 --> 02:00:50,873 NEXT SLIDE PLEASE. 3257 02:00:50,873 --> 02:00:53,175 AFFORDABLE MEDICATIONS THAT ARE 3258 02:00:53,175 --> 02:00:54,743 AVAILABLE AND ACCESSIBLE TO 3259 02:00:54,743 --> 02:00:57,546 WOMEN WOULD GO A LONG WAY IN 3260 02:00:57,546 --> 02:00:58,981 WOMEN ESPECIALLY WITH PROSTHETIC 3261 02:00:58,981 --> 02:01:01,283 HEART VALVES. 3262 02:01:01,283 --> 02:01:03,452 NEXT SLIDE. 3263 02:01:03,452 --> 02:01:05,854 WE NEED COMMUNITY-BASED 3264 02:01:05,854 --> 02:01:07,723 INTERVENTION, COMMUNITY 3265 02:01:07,723 --> 02:01:09,158 PARTICIPATION, AND IMPROVING THE 3266 02:01:09,158 --> 02:01:11,327 CARDIOVASCULAR HEALTH, WHERE THE 3267 02:01:11,327 --> 02:01:12,328 COMMUNITY HAS WORKERS IDENTIFY 3268 02:01:12,328 --> 02:01:16,899 EARLY SIGNS OF CARDIOVASCULAR 3269 02:01:16,899 --> 02:01:17,800 PROBLEMS, AND REFER APPROPRIATE 3270 02:01:17,800 --> 02:01:19,668 HEALTHCARE FACILITIES. 3271 02:01:19,668 --> 02:01:21,503 NEXT SLIDE. 3272 02:01:21,503 --> 02:01:23,572 SO, INTEGRATION OF 3273 02:01:23,572 --> 02:01:24,907 CARDIOVASCULAR HEALTH, NATIONAL 3274 02:01:24,907 --> 02:01:26,675 HEALTH PROGRAMS IS IMPORTANT 3275 02:01:26,675 --> 02:01:27,776 BECAUSE ADVOCACY FOR MATERNAL 3276 02:01:27,776 --> 02:01:31,747 HEALTH AND FUNDING IS IMPORTANT 3277 02:01:31,747 --> 02:01:35,084 TO CARRY ON THESE AMBITIOUS 3278 02:01:35,084 --> 02:01:38,687 PROGRAMS OF NATIONAL HEALTHCARE 3279 02:01:38,687 --> 02:01:41,090 DATA AND BRINGING ALL 3280 02:01:41,090 --> 02:01:43,292 MULTI-DISCIPLINARY APPROACH INTO 3281 02:01:43,292 --> 02:01:46,895 MANAGEMENT OF CARDIOVASCULAR 3282 02:01:46,895 --> 02:01:47,463 DISEASES. 3283 02:01:47,463 --> 02:01:48,964 NEXT SLIDE. 3284 02:01:48,964 --> 02:01:50,499 IN SUMMARIZING TO IMPROVE 3285 02:01:50,499 --> 02:01:51,934 MATERNAL CARDIOVASCULAR DISEASE 3286 02:01:51,934 --> 02:01:58,374 WE NEED AWARENESS REGARDING OPT 3287 02:01:58,374 --> 02:01:58,907 OPTIMAL STRATEGIES, RISK 3288 02:01:58,907 --> 02:02:08,550 STRATIFICATION IF TOOLS AND 3289 02:02:08,550 --> 02:02:09,685 GUIDELINES, INTERDISCIPLINARY 3290 02:02:09,685 --> 02:02:10,285 COORDINATION, ADMINISTRATIVE 3291 02:02:10,285 --> 02:02:11,754 SUPPORT, AWARENESS OF MEDICAL 3292 02:02:11,754 --> 02:02:13,856 AND SOCIAL ISSUES AT ALL LEVELS 3293 02:02:13,856 --> 02:02:14,189 OF HEALTHCARE. 3294 02:02:14,189 --> 02:02:24,500 THANK YOU SO MUCH. 3295 02:02:26,835 --> 02:02:27,936 >> THANK YOU FORETHAT EXCELLENT 3296 02:02:27,936 --> 02:02:30,139 PRESENTATION OF THE OVERVIEW OF 3297 02:02:30,139 --> 02:02:30,906 CARDIOVASCULAR HEALTH IN 3298 02:02:30,906 --> 02:02:38,547 MATERNAL HEALTH IN INDIA AND 3299 02:02:38,547 --> 02:02:42,151 IMPLEMENTATION APPROACHES. 3300 02:02:42,151 --> 02:02:42,684 NEXT DR. GYAMFI-BANNERMAN. 3301 02:02:42,684 --> 02:02:44,820 >> THANKS FOR HAVING ME AT THIS 3302 02:02:44,820 --> 02:02:47,089 VERY IMPORTANT MEETING. 3303 02:02:47,089 --> 02:02:47,956 NEXT SLIDE PLEASE. 3304 02:02:47,956 --> 02:02:51,493 SO, I THINK WE'RE ALL FAMILIAR 3305 02:02:51,493 --> 02:02:56,098 WITH PREECLAMPSIA LEADING TO 3306 02:02:56,098 --> 02:02:56,932 LONG-TERM CARDIOVASCULAR 3307 02:02:56,932 --> 02:02:58,400 IMPLEMENTATIONS BUT I WAS ASKED 3308 02:02:58,400 --> 02:03:00,936 TO SPEAK ABOUT PRE-TERM BIRTH. 3309 02:03:00,936 --> 02:03:04,606 WE KNOW OBSTETRIC HISTORY IS A 3310 02:03:04,606 --> 02:03:05,941 WINDOW INTO FUTURE HEALTH. 3311 02:03:05,941 --> 02:03:07,476 THERE'S PREVENTION OF CHRONIC 3312 02:03:07,476 --> 02:03:11,213 DISEASES IN ADULT IT'S AND 3313 02:03:11,213 --> 02:03:13,415 CHILDREN, A PRIORITY, AND SIGNS 3314 02:03:13,415 --> 02:03:15,517 AND SYMPTOMS DIFFER BETWEEN MEN 3315 02:03:15,517 --> 02:03:18,921 AND WOMEN, WITH WOMEN OFTEN 3316 02:03:18,921 --> 02:03:19,788 BEING UNDERDIAGNOSED. 3317 02:03:19,788 --> 02:03:19,988 NEXT. 3318 02:03:19,988 --> 02:03:21,523 IN GENERAL WOMEN HAVE THREE 3319 02:03:21,523 --> 02:03:23,292 ENTRY POINTS TO CARE. 3320 02:03:23,292 --> 02:03:25,360 FIRST WHEN THEY THEMSELVES ARE 3321 02:03:25,360 --> 02:03:26,128 AN INFANT. 3322 02:03:26,128 --> 02:03:28,163 SECOND AT THE DEVELOPMENT OF 3323 02:03:28,163 --> 02:03:29,665 CHRONIC DISEASE. 3324 02:03:29,665 --> 02:03:33,402 THIRD, DURING PREGNANCY AND IN 3325 02:03:33,402 --> 02:03:34,403 THE POSTPARTUM PERIOD. 3326 02:03:34,403 --> 02:03:36,438 NEXT SLIDE PLEASE. 3327 02:03:36,438 --> 02:03:38,106 SO, THERE'S VERY IMPORTANT 3328 02:03:38,106 --> 02:03:39,541 COMPONENTS IN THE PRIOR 3329 02:03:39,541 --> 02:03:41,376 PREGNANCY HISTORY THAT ARE 3330 02:03:41,376 --> 02:03:42,144 IMPORTANT FOR THE 3331 02:03:42,144 --> 02:03:43,445 NON-OBSTETRICIAN TO KEEP IN MIND 3332 02:03:43,445 --> 02:03:44,713 AS YOU'RE SEEING THESE PATIENTS. 3333 02:03:44,713 --> 02:03:47,182 ONE WOULD BE THE NUMBER OF 3334 02:03:47,182 --> 02:03:48,617 PREGNANCIES AND PREGNANCY 3335 02:03:48,617 --> 02:03:49,818 LOSSES. 3336 02:03:49,818 --> 02:03:55,491 ANOTHER WOULD BE GESTATION AGE, 3337 02:03:55,491 --> 02:03:56,158 GESTATIONAL WEIGHT, AND 3338 02:03:56,158 --> 02:03:59,094 IMPORTANTLY WHAT WERE THE 3339 02:03:59,094 --> 02:04:01,730 PREGNANCIES COMPLICATIONS, 3340 02:04:01,730 --> 02:04:02,297 PREECLAMPSIA OR GESTATIONAL 3341 02:04:02,297 --> 02:04:03,999 HYPERTENSION, IF A PATIENT 3342 02:04:03,999 --> 02:04:04,900 DOESN'T REMEMBER THOSE SPECIFICS 3343 02:04:04,900 --> 02:04:08,637 YOU CAN ASK DID YOU SEE 3344 02:04:08,637 --> 02:04:09,638 MAGNESIUM SULFATE, THAT USUALLY 3345 02:04:09,638 --> 02:04:12,241 WILL REMEMBER THAT PIECE. 3346 02:04:12,241 --> 02:04:12,941 DID THEY HAVE GESTATIONAL 3347 02:04:12,941 --> 02:04:15,844 DIABETES OR DID THEY HAVE A 3348 02:04:15,844 --> 02:04:16,478 PRE-TERM DELIVERY, WHETHER IT'S 3349 02:04:16,478 --> 02:04:26,889 RESPONSIBLE -- SPONTANEOUS. 3350 02:04:26,889 --> 02:04:30,759 LOOK LOOK AT THE OVERVIEW OF 3351 02:04:30,759 --> 02:04:32,594 PRE-TERM DELIVERY, SPEAKING 3352 02:04:32,594 --> 02:04:34,363 ABOUT SPONTANEOUS PRE-TERM 3353 02:04:34,363 --> 02:04:34,730 DELIVERY. 3354 02:04:34,730 --> 02:04:38,734 AND THIS IS FROM TIME 3355 02:04:38,734 --> 02:04:40,802 IMMEMORIAL, INDICATED PRE-TERM 3356 02:04:40,802 --> 02:04:44,773 BIRTH OR IATROGENIC IS A THIRD, 3357 02:04:44,773 --> 02:04:49,678 30 TO 35%, SPONTANEOUS IS 65 TO 3358 02:04:49,678 --> 02:04:52,080 70%, WITHIN SPONTANEOUS ABOUT 3359 02:04:52,080 --> 02:04:58,554 2/3 PRE-TERM LABOR WITH INTACT 3360 02:04:58,554 --> 02:05:00,188 MEMBRANES, 1/3 RUPTURE OF INTACT 3361 02:05:00,188 --> 02:05:00,856 MEMBRANES. 3362 02:05:00,856 --> 02:05:03,191 WHEN YOU THINK ABOUT 3363 02:05:03,191 --> 02:05:05,227 PATHOGENESIS THERE'S SO MANY 3364 02:05:05,227 --> 02:05:07,863 FACTORS THAT GO INTO WHAT MIGHT 3365 02:05:07,863 --> 02:05:13,268 CAUSE A PREGNANCY TO DELIVER 3366 02:05:13,268 --> 02:05:13,835 PRE-TERM. 3367 02:05:13,835 --> 02:05:14,036 NEXT. 3368 02:05:14,036 --> 02:05:20,943 SO, WHEN WE'RE THINKING ABOUT 3369 02:05:20,943 --> 02:05:24,012 SPONTANEOUS, YOU SEE WHAT'S 3370 02:05:24,012 --> 02:05:26,081 COMMON WITH TWINS, EXPWROAS 3371 02:05:26,081 --> 02:05:27,649 REASON ACTION, CERVICAL DISEASE, 3372 02:05:27,649 --> 02:05:32,321 STRESS HAS BEEN A WELL DESCRIBED 3373 02:05:32,321 --> 02:05:35,490 CAUSE OF PRE-TERM DELIVERY, 3374 02:05:35,490 --> 02:05:36,792 INKNOWN AND INFECTIOUS 3375 02:05:36,792 --> 02:05:37,459 ETIOLOGIES. 3376 02:05:37,459 --> 02:05:38,026 NEXT. 3377 02:05:38,026 --> 02:05:41,296 WHEN YOU LOOK AT PRE-TERM BIRTH 3378 02:05:41,296 --> 02:05:43,265 THAT'S DUE TO PREECLAMPSIA WE 3379 02:05:43,265 --> 02:05:44,900 FOCUS ON VASCULAR DISORDERS AS 3380 02:05:44,900 --> 02:05:48,737 THE MAIN CAUSE FOR THAT TYPE OF 3381 02:05:48,737 --> 02:05:49,504 PRE-TERM BIRTH. 3382 02:05:49,504 --> 02:05:49,938 NEXT. 3383 02:05:49,938 --> 02:05:52,107 YOU CAN SEE THERE'S OVERLAP 3384 02:05:52,107 --> 02:05:52,908 BETWEEN SPONTANEOUS AND 3385 02:05:52,908 --> 02:05:57,512 INDICATED WHERE YOU CAN HAVE 3386 02:05:57,512 --> 02:06:02,184 BREAKDOWN OF MATERNAL TOLERANCE, 3387 02:06:02,184 --> 02:06:02,851 STRESS, UNKNOWN. 3388 02:06:02,851 --> 02:06:03,151 NEXT. 3389 02:06:03,151 --> 02:06:06,955 AND SO AS I'VE MENTIONED, I 3390 02:06:06,955 --> 02:06:08,991 THINK WE'RE ALL AWARE 3391 02:06:08,991 --> 02:06:10,626 PREECLAMPSIA HERALDS FUTURE 3392 02:06:10,626 --> 02:06:12,594 CARDIOVASCULAR DISEASE, SO THIS 3393 02:06:12,594 --> 02:06:14,396 SLIDE SUMS THAT LITERATURE. 3394 02:06:14,396 --> 02:06:21,903 THERE ARE META-ANALYSES, 3395 02:06:21,903 --> 02:06:22,437 ASSESSING 6-POINT MILLION 3396 02:06:22,437 --> 02:06:32,848 PREGNANCY, 258,000 WOMEN WITH 3397 02:06:32,848 --> 02:06:33,181 PREECLAMPSIA. 3398 02:06:33,181 --> 02:06:35,584 CORONARY HEART DISEASE 2 1/2 3399 02:06:35,584 --> 02:06:37,219 INCREASE OVER NOT HAVING AGAIN 3400 02:06:37,219 --> 02:06:38,754 HISTORY OF PREECLAMPSIA. 3401 02:06:38,754 --> 02:06:40,922 DEATH FROM CARDIOVASCULAR 3402 02:06:40,922 --> 02:06:42,924 DISEASE WAS INCREASED, STROKE 3403 02:06:42,924 --> 02:06:44,359 INCREASED, 80%. 3404 02:06:44,359 --> 02:06:47,062 AND THESE ASSOCIATIONS WERE 3405 02:06:47,062 --> 02:06:48,930 PERSISTING AFTER ADJUSTING FOR 3406 02:06:48,930 --> 02:06:51,266 AGE, BMI, AND STATUS OF 3407 02:06:51,266 --> 02:06:51,533 DIABETES. 3408 02:06:51,533 --> 02:06:53,235 NEXT SLIDE PLEASE. 3409 02:06:53,235 --> 02:06:56,405 ONE OF THE FIRST IN FACT STUDIES 3410 02:06:56,405 --> 02:06:59,241 THAT LOOKED AT SPONTANEOUS 3411 02:06:59,241 --> 02:07:01,009 PRE-TERM BIRTH IN FUTURE HEALTH, 3412 02:07:01,009 --> 02:07:02,744 THEY WERE LOOKING AT LONG-TERM 3413 02:07:02,744 --> 02:07:05,514 MORTALITY OF MOTHERS AND FATHERS 3414 02:07:05,514 --> 02:07:06,982 AFTER PREECLAMPSIA, POPULATION 3415 02:07:06,982 --> 02:07:09,117 BASED COHORT STUDY, RISK OF 3416 02:07:09,117 --> 02:07:12,287 MORTALITY IN MOTHERS AND FATHERS 3417 02:07:12,287 --> 02:07:13,955 AFTER PREGNANCY WITH 3418 02:07:13,955 --> 02:07:15,791 PREECLAMPSIA, OVER 600,000 3419 02:07:15,791 --> 02:07:17,659 BIRTHS IN NORWAY, FOUND THE 3420 02:07:17,659 --> 02:07:19,394 MOTHERS HAD INCREASED MORTALITY 3421 02:07:19,394 --> 02:07:20,495 BUT FATHERS DID NOT. 3422 02:07:20,495 --> 02:07:23,565 THIS IS TRYING TO GET INTO SOME 3423 02:07:23,565 --> 02:07:26,068 OF THE GENETIC LINKS THERE. 3424 02:07:26,068 --> 02:07:26,868 NEXT PLEASE. 3425 02:07:26,868 --> 02:07:28,570 YOU CAN SEE WHEN YOU LOOK AT 3426 02:07:28,570 --> 02:07:32,841 COMPARISON GROUPS THEY LOOK AT 3427 02:07:32,841 --> 02:07:37,145 PREGNANCY WITH PREECLAMPSIA TERM 3428 02:07:37,145 --> 02:07:42,651 VEERS US PRE-TERM, AND WITHOUT 3429 02:07:42,651 --> 02:07:42,984 PREECLAMPSIA. 3430 02:07:42,984 --> 02:07:44,219 FOCUSING ON OUTCOMES WE'LL GO TO 3431 02:07:44,219 --> 02:07:47,656 THE FINDINGS IN THE NEXT SLIDE. 3432 02:07:47,656 --> 02:07:51,593 SO WHEN THEY LOOKED AT PRE-TERM 3433 02:07:51,593 --> 02:07:53,228 BIRTH WITHOUT PREECLAMPSIA, 3434 02:07:53,228 --> 02:07:54,996 HAVING THE REFERENCE GROUP BE 3435 02:07:54,996 --> 02:07:56,198 TERM BIRTH WITHOUT PREECLAMPSIA 3436 02:07:56,198 --> 02:07:58,834 YOU'LL SEE THERE WAS INCREASE IN 3437 02:07:58,834 --> 02:08:02,471 THE RELATIVE RISK OF DEATH, 3438 02:08:02,471 --> 02:08:05,073 HAZARD RATIO 1.56, AND 3439 02:08:05,073 --> 02:08:05,974 CARDIOVASCULAR DEATH, INCREASED 3440 02:08:05,974 --> 02:08:06,274 THREE-FOLD. 3441 02:08:06,274 --> 02:08:11,012 ALL OF A SUDDEN WE START TO SEE 3442 02:08:11,012 --> 02:08:12,114 THAT EVEN WHEN PREECLAMPSIA WAS 3443 02:08:12,114 --> 02:08:15,851 OUT OF THE PICTURE, THERE WAS 3444 02:08:15,851 --> 02:08:17,252 SEEMINGLY INCREASED RISK FOR 3445 02:08:17,252 --> 02:08:23,391 PRE-TERM BIRTH IN AND OF ITSELF 3446 02:08:23,391 --> 02:08:28,930 AND CARDIOVASCULAR DISEASE. 3447 02:08:28,930 --> 02:08:30,732 THIS STUDY STARTED TO GET TO THE 3448 02:08:30,732 --> 02:08:32,367 QUESTION OF PRE-TERM BIRTH 3449 02:08:32,367 --> 02:08:35,871 LOOKING AT EFFECT ON GESTATIONAL 3450 02:08:35,871 --> 02:08:37,506 AGE AND FETAL GROWTH ON 3451 02:08:37,506 --> 02:08:38,273 LONG-TERM CARDIOVASCULAR 3452 02:08:38,273 --> 02:08:38,840 DISEASE. 3453 02:08:38,840 --> 02:08:42,544 THIS IS A POPULATION BASED STUDY 3454 02:08:42,544 --> 02:08:44,846 FROM A SWEDISH REGISTRY LOOKING 3455 02:08:44,846 --> 02:08:47,482 AT WHETHER GESTATIONAL AGE OR 3456 02:08:47,482 --> 02:08:49,885 SMALL FOR GESTATIONAL AGE 3457 02:08:49,885 --> 02:08:51,720 INDEPENDENTLY CORRELATED WITH 3458 02:08:51,720 --> 02:08:53,054 FUTURE CARDIOVASCULAR DISEASE. 3459 02:08:53,054 --> 02:08:54,990 923,000 WOMEN, WITH ONE PRIOR 3460 02:08:54,990 --> 02:08:58,627 DELIVERY, AND WITHOUT 3461 02:08:58,627 --> 02:09:00,695 PRE-EXISTING CARDIOVASCULAR, NO 3462 02:09:00,695 --> 02:09:03,431 PREVIOUS HEART DISEASE, HEART 3463 02:09:03,431 --> 02:09:06,601 FAILURE, STROKE OR DEATH. 3464 02:09:06,601 --> 02:09:08,570 ADJUSTED FOR MATERNAL AGE, 3465 02:09:08,570 --> 02:09:12,908 INCOME AND EDUCATION, AND 3466 02:09:12,908 --> 02:09:13,742 CHRONIC HYPERTENSION, 3467 02:09:13,742 --> 02:09:15,944 PRE-GESTATIONAL DIABETES, 3468 02:09:15,944 --> 02:09:17,913 GESTATIONAL DIABETES, 3469 02:09:17,913 --> 02:09:18,847 GESTATIONAL HYPERTENSION, 3470 02:09:18,847 --> 02:09:19,381 PREECLAMPSIA, IMPORTANTLY 3471 02:09:19,381 --> 02:09:20,015 ADJUSTED HERE FOR PREECLAMPSIA 3472 02:09:20,015 --> 02:09:22,050 AND LOOKING AT THE BIRTH 3473 02:09:22,050 --> 02:09:25,554 OUTCOMES BY GESTATIONAL AGE. 3474 02:09:25,554 --> 02:09:26,221 NEXT SLIDE PLEASE. 3475 02:09:26,221 --> 02:09:28,957 HERE IS WHAT THEY FOUND. 3476 02:09:28,957 --> 02:09:30,525 TERM AGAIN BEING REFERENCE 3477 02:09:30,525 --> 02:09:31,893 GROUP, GREATER THAN 27 WEEKS. 3478 02:09:31,893 --> 02:09:36,364 BUT IF YOU DELIVERED MODERATELY 3479 02:09:36,364 --> 02:09:37,833 PRE-TERM FROM 32 TO 36 WEEKS 3480 02:09:37,833 --> 02:09:40,902 INCREASED RISK OF CARDIOVASCULAR 3481 02:09:40,902 --> 02:09:41,870 DISEASE, ADJUSTED BY AGE, 3482 02:09:41,870 --> 02:09:50,512 ADJUSTED BY OTHER VARIABLES, 3483 02:09:50,512 --> 02:09:52,747 EXTREMELY PRE-TERM BIRTH SIMILAR 3484 02:09:52,747 --> 02:09:53,915 FINDINGS, INCREASED IN 3485 02:09:53,915 --> 02:09:55,016 CARDIOVASCULAR DISEASE BY 3486 02:09:55,016 --> 02:09:58,119 GESTATIONAL AGE AT WHICH YOU 3487 02:09:58,119 --> 02:09:58,753 DELIVERED. 3488 02:09:58,753 --> 02:09:59,087 NEXT SLIDE. 3489 02:09:59,087 --> 02:10:03,458 THIS GROUP DID LOOK AT FETAL 3490 02:10:03,458 --> 02:10:06,394 GROWTH, AND SO IF THE CHILD WAS 3491 02:10:06,394 --> 02:10:06,895 LESS THAN TWO STANDARD 3492 02:10:06,895 --> 02:10:08,830 DEVIATIONS OF THE MEAN AT BIRTH 3493 02:10:08,830 --> 02:10:10,232 THERE WAS INCREASE IN MATERNAL 3494 02:10:10,232 --> 02:10:12,634 CARDIOVASCULAR DISEASE. 3495 02:10:12,634 --> 02:10:15,637 AND THEN MODERATELY SMALL EVEN A 3496 02:10:15,637 --> 02:10:18,540 SMALLER CHANGE IN THE FETAL SIZE 3497 02:10:18,540 --> 02:10:19,975 WAS ASSOCIATED WITH INCREASED 3498 02:10:19,975 --> 02:10:20,475 CARDIOVASCULAR DISEASE. 3499 02:10:20,475 --> 02:10:23,044 SO INTERESTINGLY THINGS YOU CAN 3500 02:10:23,044 --> 02:10:25,580 FIND OUT AND RISK STRATIFY A 3501 02:10:25,580 --> 02:10:28,750 PERSON YOU SEE IN FRONT OF YOU 3502 02:10:28,750 --> 02:10:30,852 TO SAY, WELL, YOUR PREGNANCY 3503 02:10:30,852 --> 02:10:33,288 HISTORY ACTUALLY PUTS YOU IN 3504 02:10:33,288 --> 02:10:36,925 HIGHER RISK CATEGORY FOR ADVERSE 3505 02:10:36,925 --> 02:10:37,425 CARDIOVASCULAR DISEASE. 3506 02:10:37,425 --> 02:10:38,827 NEXT SLIDE PLEASE. 3507 02:10:38,827 --> 02:10:43,999 HERE IS ANOTHER STUDY WHERE THEY 3508 02:10:43,999 --> 02:10:48,937 LOOKED AT RISK OF ISCHEMIC HEART 3509 02:10:48,937 --> 02:10:52,207 DISEASE, SPONTANEOUS PRE-TERM 3510 02:10:52,207 --> 02:10:53,742 DELIVERY, ELECTIVE MEANT 3511 02:10:53,742 --> 02:10:57,679 IATROGENIC OR INDICATED PRE-TERM 3512 02:10:57,679 --> 02:11:00,215 BIRTH, A STUDY OF 750 3513 02:11:00,215 --> 02:11:04,352 PREGNANCIES, 750,000. 3514 02:11:04,352 --> 02:11:06,988 AGAIN, FIRST MORTALITY AND THEN 3515 02:11:06,988 --> 02:11:07,789 ISCHEMIC HEART DISEASE EVENTS, 3516 02:11:07,789 --> 02:11:10,392 BUT YOU CAN SEE AGAIN FOR ALL 3517 02:11:10,392 --> 02:11:12,694 PRE-TERM AND THEY BROKE OUT 3518 02:11:12,694 --> 02:11:17,866 SPONTANEOUS AND INDICATED AND 3519 02:11:17,866 --> 02:11:20,035 NOW REALLY HONING IN, NOT 3520 02:11:20,035 --> 02:11:23,038 RELATED TO PREECLAMPSIA OR 3521 02:11:23,038 --> 02:11:24,572 CHRONIC HYPERTENSION, INCREASED 3522 02:11:24,572 --> 02:11:26,541 RISK OF CARDIOVASCULAR DISEASE 3523 02:11:26,541 --> 02:11:28,176 AND THEN CARDIOVASCULAR EVENTS, 3524 02:11:28,176 --> 02:11:29,177 VERY SIMILAR. 3525 02:11:29,177 --> 02:11:33,782 YOU CAN SEE THAT FOR BOTH 3526 02:11:33,782 --> 02:11:34,316 GROUPS. 3527 02:11:34,316 --> 02:11:38,053 AND THIS PAPER CAME OUT THIS 3528 02:11:38,053 --> 02:11:41,289 YEAR, AND VERY SIMILAR FINDINGS. 3529 02:11:41,289 --> 02:11:44,926 THEY TOOK ALL OF THE MORE COMMON 3530 02:11:44,926 --> 02:11:47,262 ADVERSE PREGNANCY OUTCOMES, 3531 02:11:47,262 --> 02:11:48,763 PRE-TERM BIRTH, PREECLAMPSIA, 3532 02:11:48,763 --> 02:11:51,299 REALLY ALL OF THEM, AND LINKED 3533 02:11:51,299 --> 02:11:52,968 THAT WITH WHAT WAS THE LONG-TERM 3534 02:11:52,968 --> 02:11:54,669 RISK OF MORTALITY IN WOMEN. 3535 02:11:54,669 --> 02:11:57,305 SO, AGAIN, FOR THIS TALK WE'LL 3536 02:11:57,305 --> 02:11:58,239 FOCUS ON PRE-TERM DELIVERY, AND 3537 02:11:58,239 --> 02:11:59,708 TO SHOW YOU, I DON'T KNOW IF YOU 3538 02:11:59,708 --> 02:12:01,443 CAN SEE MY MOUSE HERE, BUT THIS 3539 02:12:01,443 --> 02:12:06,181 IS THE NUMBER OF YEARS AFTER THE 3540 02:12:06,181 --> 02:12:06,614 EVENT. 3541 02:12:06,614 --> 02:12:14,723 PRE-TERM DELIVERY LESS THAN 10 3542 02:12:14,723 --> 02:12:15,490 YEARS, 10-19, 20-29, 30-46, 3543 02:12:15,490 --> 02:12:18,326 LOOKING AT RISK OF MORTALITY 3544 02:12:18,326 --> 02:12:19,094 THERE'S INCREASE IN MORTALITY, 3545 02:12:19,094 --> 02:12:22,697 ALL OF THE TIME PERIODS IF YOU 3546 02:12:22,697 --> 02:12:25,867 HAD PRE-TERM DELIVERY. 3547 02:12:25,867 --> 02:12:26,735 NEXT SLIDE PLEASE. 3548 02:12:26,735 --> 02:12:28,903 SO WHAT ARE THE MECHANISMS, 3549 02:12:28,903 --> 02:12:30,171 BECAUSE WE'RE SEEING THIS OVER 3550 02:12:30,171 --> 02:12:34,442 AND OVER AGAIN IN OUR 3551 02:12:34,442 --> 02:12:35,844 EPIDEMIOLOGIC STUDIES. 3552 02:12:35,844 --> 02:12:37,712 ONE GROUP HYPOTHESIZED MAYBE 3553 02:12:37,712 --> 02:12:38,913 C-REACTIVE PROTEIN MIGHT BE 3554 02:12:38,913 --> 02:12:41,549 IMPORTANT HERE. 3555 02:12:41,549 --> 02:12:42,650 BECAUSE IT'S INFLAMMATORY 3556 02:12:42,650 --> 02:12:44,552 MARKER, LEADING TO PRE-TERM 3557 02:12:44,552 --> 02:12:47,022 BIRTH, ASSOCIATED WITH 3558 02:12:47,022 --> 02:12:49,357 CARDIOVASCULAR DISEASE. 3559 02:12:49,357 --> 02:12:53,828 SO THIS PARTICULAR GROUP LOOKED 3560 02:12:53,828 --> 02:12:56,564 AT CRP, CHOLESTEROL, ASSOCIATION 3561 02:12:56,564 --> 02:12:58,566 WITH SPONTANEOUS PRE-TERM 3562 02:12:58,566 --> 02:12:58,833 DELIVERY. 3563 02:12:58,833 --> 02:13:00,335 AND BASICALLY FOUND THERE WAS 3564 02:13:00,335 --> 02:13:03,705 INCREASE OF THE ODDS RATIO 6.4 3565 02:13:03,705 --> 02:13:07,208 IF YOU HAVE BOTH CRP AND 3566 02:13:07,208 --> 02:13:08,743 ELEVATED CHOLESTEROL PRESENCE. 3567 02:13:08,743 --> 02:13:09,511 SO REALLY INTERESTING FINDINGS 3568 02:13:09,511 --> 02:13:12,247 THAT START TO GET TO THE 3569 02:13:12,247 --> 02:13:12,514 MECHANISM. 3570 02:13:12,514 --> 02:13:14,549 NEXT SLIDE PLEASE. 3571 02:13:14,549 --> 02:13:16,084 ANOTHER GROUP ALSO TRIED TO TAKE 3572 02:13:16,084 --> 02:13:17,819 A NICE DEEP DIVE TO SEE, WELL, 3573 02:13:17,819 --> 02:13:21,222 WHAT COULD BE THE POSSIBLE 3574 02:13:21,222 --> 02:13:24,592 CAUSE, THEY LOOKED AT PULSE WAVE 3575 02:13:24,592 --> 02:13:25,727 VELOCITY MEASURES MEASURING 3576 02:13:25,727 --> 02:13:27,028 ARTERIAL STIFFNESS, THAT CAN 3577 02:13:27,028 --> 02:13:28,329 PRECEDE ONSET OF CARDIOVASCULAR 3578 02:13:28,329 --> 02:13:28,797 DISEASE. 3579 02:13:28,797 --> 02:13:35,003 THE GROUP THOUGHT WHAT ABOUT 3580 02:13:35,003 --> 02:13:37,205 LOOKING AT ASSESSING PREGNANCY 3581 02:13:37,205 --> 02:13:39,607 RISK IN FIRST TRIMESTER LOOKING 3582 02:13:39,607 --> 02:13:44,312 AT WOMEN WITH SPONTANEOUS 3583 02:13:44,312 --> 02:13:45,513 PRE-TERM BIRTH AND COMPARED TO 3584 02:13:45,513 --> 02:13:47,148 THOSE WHO DELIVERED AT TERM. 3585 02:13:47,148 --> 02:13:48,917 THEY FOUND DIFFERENCE IN 3586 02:13:48,917 --> 02:13:52,053 STIFFNESS ONLY IN THE INDICATED 3587 02:13:52,053 --> 02:13:55,990 OR IATROGENIC BUT NOT 3588 02:13:55,990 --> 02:13:57,092 SPONTANEOUS PRE-TERM BIRTH, NOT 3589 02:13:57,092 --> 02:13:58,159 THE MECHANISM BUT INTERESTING 3590 02:13:58,159 --> 02:14:02,564 WAY TO LOOK TO SEE WHAT WAS 3591 02:14:02,564 --> 02:14:05,200 POTENTIALLY CAUSING THIS. 3592 02:14:05,200 --> 02:14:06,234 NEXT SLIDE PLEASE. 3593 02:14:06,234 --> 02:14:08,470 WHAT ARE GAPS IN KNOWLEDGE? 3594 02:14:08,470 --> 02:14:10,205 SHOULD THERE BE AN EARLIER 3595 02:14:10,205 --> 02:14:10,972 CARDIOVASCULAR RISK ASSESSMENT 3596 02:14:10,972 --> 02:14:14,576 IN WOMEN WITH PRIOR SPONTANEOUS 3597 02:14:14,576 --> 02:14:15,877 PRE-TERM BIRTH, WHAT IS THE 3598 02:14:15,877 --> 02:14:16,144 MECHANISM. 3599 02:14:16,144 --> 02:14:19,614 WE DON'T KNOW THE ANSWER. 3600 02:14:19,614 --> 02:14:22,117 IS THERE AN IMPLEMENT STRATEGY? 3601 02:14:22,117 --> 02:14:22,884 LIFESTYLE MODIFICATION WITH 3602 02:14:22,884 --> 02:14:26,721 KNOWLEDGE OF HISTORY THAT PUTS 3603 02:14:26,721 --> 02:14:28,156 YOU AT RISK, DOES THAT MITIGATE 3604 02:14:28,156 --> 02:14:29,290 THE RISK FOR CARDIOVASCULAR 3605 02:14:29,290 --> 02:14:32,327 DISEASE FOR WOMEN WITH PRE-TERM 3606 02:14:32,327 --> 02:14:33,061 DELIVERY AND WOULD THIS 3607 02:14:33,061 --> 02:14:35,563 MODIFICATION CHANGE THE RISK FOR 3608 02:14:35,563 --> 02:14:37,465 PRE-TERM BIRTH. 3609 02:14:37,465 --> 02:14:42,704 IS THERE A BEST PRACTICE THAT 3610 02:14:42,704 --> 02:14:47,876 CAN MITIGATE THESE ASSOCIATIONS. 3611 02:14:47,876 --> 02:14:49,511 WHEN YOU SEE THIS, ASCERTAIN 3612 02:14:49,511 --> 02:14:51,012 THAT HISTORY. 3613 02:14:51,012 --> 02:14:52,680 IF YOU'RE THE OBSTETRIC 3614 02:14:52,680 --> 02:14:54,315 PROVIDER, INFORM THE PATIENT 3615 02:14:54,315 --> 02:14:55,683 THAT SHE HAS INCREASED RISK AND 3616 02:14:55,683 --> 02:14:57,585 REFER HER BACK TO PRIMARY CARE 3617 02:14:57,585 --> 02:14:59,120 PROVIDER FOR ROUTINE CARE. 3618 02:14:59,120 --> 02:15:02,624 IF YOU'RE THE PRIMARY CARE 3619 02:15:02,624 --> 02:15:03,591 PROVIDER, OBTAIN THOROUGH 3620 02:15:03,591 --> 02:15:05,793 OBSTETRIC HISTORY INCLUDING 3621 02:15:05,793 --> 02:15:07,762 PRIOR PRE-TERM BIRTH, 3622 02:15:07,762 --> 02:15:08,429 PREECLAMPSIA, SMALL GESTATIONAL 3623 02:15:08,429 --> 02:15:10,131 AGE, ALL IMPORTANT ELEMENTS 3624 02:15:10,131 --> 02:15:12,567 WHICH WE'VE SHOWN LINK TO 3625 02:15:12,567 --> 02:15:13,668 INCREASED CARDIOVASCULAR 3626 02:15:13,668 --> 02:15:14,569 DISEASE. 3627 02:15:14,569 --> 02:15:18,039 AND THEN ENCOURAGE ANNUAL 3628 02:15:18,039 --> 02:15:22,644 FOLLOW-UP AND EVIDENCE-BASED 3629 02:15:22,644 --> 02:15:23,444 PREVENTIVE STRATEGIES. 3630 02:15:23,444 --> 02:15:25,613 PRE-TERM BIRTHS ARE ASSOCIATED 3631 02:15:25,613 --> 02:15:26,748 WITH FUTURE CARDIOVASCULAR 3632 02:15:26,748 --> 02:15:27,849 DISEASE, OBSTETRIC HISTORY IS 3633 02:15:27,849 --> 02:15:29,884 IMPORTANT AND HELPFUL AT RISK 3634 02:15:29,884 --> 02:15:31,419 STRATIFICATION, COMMUNICATION 3635 02:15:31,419 --> 02:15:32,954 WITH PATIENT AND PROVIDER ARE 3636 02:15:32,954 --> 02:15:33,955 IMPORTANT. 3637 02:15:33,955 --> 02:15:41,262 AND WE NEED MORE PROSPECTIVE 3638 02:15:41,262 --> 02:15:42,497 STUDIES TO MITIGATE RISKS ONCE 3639 02:15:42,497 --> 02:15:43,231 WE IDENTIFY THEM. 3640 02:15:43,231 --> 02:15:45,233 THANK YOU FOR YOUR ATTENTION. 3641 02:15:45,233 --> 02:15:51,673 I GUESS WE'LL GO INTO THE PANEL 3642 02:15:51,673 --> 02:15:52,207 NEXT. 3643 02:15:52,207 --> 02:15:54,776 >> THANK YOU SO MUCH. 3644 02:15:54,776 --> 02:15:58,913 WE'LL NOW START TO KICK OFF THE 3645 02:15:58,913 --> 02:16:07,021 Q&A, AND TO START OFF WE'LL HAVE 3646 02:16:07,021 --> 02:16:08,790 QUESTIONS FOR ALL PANELISTS. 3647 02:16:08,790 --> 02:16:11,292 TO START WE'LL TAKE QUESTIONS 3648 02:16:11,292 --> 02:16:12,060 FROM THE AUDIENCE EVENTUALLY BUT 3649 02:16:12,060 --> 02:16:14,128 I WANTED TO START WITH A 3650 02:16:14,128 --> 02:16:16,764 QUESTION FOR EVERYBODY, THAT IN 3651 02:16:16,764 --> 02:16:18,933 YOUR VIEW WHAT INNOVATIVE 3652 02:16:18,933 --> 02:16:20,602 EVIDENCE-BASED APPROACHES HAVE 3653 02:16:20,602 --> 02:16:22,770 THE POTENTIAL TO DRIVE DOWN HIGH 3654 02:16:22,770 --> 02:16:24,205 PREVALENCE OF CARDIOVASCULAR 3655 02:16:24,205 --> 02:16:24,973 SEVERE MATERNAL OUTCOMES, FOR 3656 02:16:24,973 --> 02:16:27,041 EXAMPLE YOU MAY WANT TO TALK 3657 02:16:27,041 --> 02:16:29,344 ABOUT INTEGRATED OR 3658 02:16:29,344 --> 02:16:31,012 INTERSECTIONAL APPROACHES, WHAT 3659 02:16:31,012 --> 02:16:32,280 MOONSHOT TRIALS COULD BE 3660 02:16:32,280 --> 02:16:33,414 IMPLEMENTED, AND YOUR RESPONSES 3661 02:16:33,414 --> 02:16:35,049 COULD YOU PLEASE COMMENT ON 3662 02:16:35,049 --> 02:16:38,987 RESEARCH GAPS FROM 3663 02:16:38,987 --> 02:16:40,121 IMPLEMENTATION PERSPECTIVE, 3664 02:16:40,121 --> 02:16:42,390 CHALLENGES AND BARRIERS FOR 3665 02:16:42,390 --> 02:16:43,825 EVIDENCE-BASED, AND FOR -- WHAT 3666 02:16:43,825 --> 02:16:47,629 IS SCOPE FOR ADAPTATION OF 3667 02:16:47,629 --> 02:16:48,396 SUCCESSFUL EVENTS-BASED 3668 02:16:48,396 --> 02:16:58,039 INTERVENTIONS IN OTHER SETTINGS 3669 02:16:58,039 --> 02:16:59,240 GLOBALLY AND DOMESTICALLY. 3670 02:16:59,240 --> 02:17:00,775 FEEL FREE TO UNMUTE YOURSELF IF 3671 02:17:00,775 --> 02:17:03,645 YOU'D LIKE TO ANSWER THAT. 3672 02:17:03,645 --> 02:17:06,247 >> YES, THE MOST IMPORTANT WOULD 3673 02:17:06,247 --> 02:17:12,620 BE WE NEED TO HAVE RISK CODES, 3674 02:17:12,620 --> 02:17:15,790 GOOD DATA TO BE USED FOR THE 3675 02:17:15,790 --> 02:17:18,092 LOCAL POPULATION, AND 3676 02:17:18,092 --> 02:17:21,162 UNDERSTANDING WHICH OF THEM AT 3677 02:17:21,162 --> 02:17:22,030 RISK FOR INCREASE THE MORBIDITY 3678 02:17:22,030 --> 02:17:24,899 AND MORTALITY, BECAUSE OF THE 3679 02:17:24,899 --> 02:17:28,503 HEART DISEASE THEY ARE HAVING. 3680 02:17:28,503 --> 02:17:30,805 MAKING AVAILABLE RESOURCES FOR 3681 02:17:30,805 --> 02:17:41,316 MANAGING THESE HEART DISEASES, 3682 02:17:45,820 --> 02:17:46,220 ESPECIALLY INNOVATIONS 3683 02:17:46,220 --> 02:17:48,323 ANTICOAGULANTS, POINT OF CARE 3684 02:17:48,323 --> 02:17:50,525 DIAGNOSIS WHERE WOMEN ARE 3685 02:17:50,525 --> 02:17:52,026 SCREENED DURING NORMAL PREGNANCY 3686 02:17:52,026 --> 02:17:54,095 FOR EVIDENCE OF UNDERLYING 3687 02:17:54,095 --> 02:17:56,898 DISORDER, WHEN OFFERED MEDICINES 3688 02:17:56,898 --> 02:17:59,267 OR MAYBE OFFERED CORRECTIVE 3689 02:17:59,267 --> 02:18:01,202 SURGERIES TO CORRECT CONGENITAL 3690 02:18:01,202 --> 02:18:02,870 HEART DEFECTS, THIS COULD BE -- 3691 02:18:02,870 --> 02:18:04,939 WE KNOWS THESE ARE PRESENT BUT 3692 02:18:04,939 --> 02:18:08,910 HAVE TO BE VERY GENERALIZABLE, 3693 02:18:08,910 --> 02:18:11,612 SHOULD BE AVAILABLE TO 3694 02:18:11,612 --> 02:18:13,881 MARGINALIZED SECTION, RURAL AND 3695 02:18:13,881 --> 02:18:20,922 TRIBAL WOMEN, AND NEED TO HAVE 3696 02:18:20,922 --> 02:18:23,324 THE HEALTH MULTI-DISCIPLINARY 3697 02:18:23,324 --> 02:18:25,727 APPROACH, ALL THE PERSONNEL 3698 02:18:25,727 --> 02:18:27,261 ATTUNED TO HAVE BASIC UNIFORM 3699 02:18:27,261 --> 02:18:31,766 PROTOCOL FOR MANAGEMENT OF THESE 3700 02:18:31,766 --> 02:18:32,500 DISORDERS. 3701 02:18:32,500 --> 02:18:35,903 I THINK THE APPLICATION OF 3702 02:18:35,903 --> 02:18:37,572 MOBILE TECHNOLOGY WHERE BASIC 3703 02:18:37,572 --> 02:18:39,974 GROUND LEVEL COMMUNITY HAS A 3704 02:18:39,974 --> 02:18:45,113 LEVEL WORKER, PICKS UP THESE 3705 02:18:45,113 --> 02:18:47,115 DISORDERS, MAYBE HAS THEM ENROLL 3706 02:18:47,115 --> 02:18:49,984 AND GIVES THEIR DATA TO 3707 02:18:49,984 --> 02:18:51,452 SPECIALISTS AT THE HIGH LEVEL SO 3708 02:18:51,452 --> 02:18:52,653 THEY KNOW THERE'S SOMETHING 3709 02:18:52,653 --> 02:18:53,888 WRONG WITH WOMEN WHO HAVE A 3710 02:18:53,888 --> 02:18:54,756 DIAGNOSED HEART DISEASE TOO 3711 02:18:54,756 --> 02:18:57,825 NEEDS TO BE HELPED, COME INTO 3712 02:18:57,825 --> 02:19:03,965 TERTIARY HEALTH CARE CENTER FOR 3713 02:19:03,965 --> 02:19:07,135 MANAGEMENT. 3714 02:19:07,135 --> 02:19:08,536 THESE ARE THINGS WE KNOW THEY 3715 02:19:08,536 --> 02:19:10,505 ARE OPPORTUNITIES, A QUESTION OF 3716 02:19:10,505 --> 02:19:11,806 IMPLEMENTING ALL THESE 3717 02:19:11,806 --> 02:19:13,307 ESPECIALLY IN THE CONTEXT OF 3718 02:19:13,307 --> 02:19:17,645 CARDIOVASCULAR DISEASE. 3719 02:19:17,645 --> 02:19:19,747 THANK YOU. 3720 02:19:19,747 --> 02:19:22,016 >> DEVELOPING AND TESTING 3721 02:19:22,016 --> 02:19:24,419 POINT-OF-CARE SPECIFICALLY. 3722 02:19:24,419 --> 02:19:25,853 SPECIFIC CONTEXTS, YES. 3723 02:19:25,853 --> 02:19:28,256 >> YEAH, I WOULD ADD AND SAY 3724 02:19:28,256 --> 02:19:30,258 THAT FOR ME THE MOONSHOT STUDY 3725 02:19:30,258 --> 02:19:36,664 WOULD BE TO BE ABLE TO LOOK AT 3726 02:19:36,664 --> 02:19:38,433 INDIVIDUAL WHO HAD FIRST 3727 02:19:38,433 --> 02:19:40,635 PREGNANCY, ADVERSE OUTCOME 3728 02:19:40,635 --> 02:19:41,702 WHETHER PRE-TERM BIRTH, 3729 02:19:41,702 --> 02:19:42,804 PREECLAMPSIA, ANYTHING THAT 3730 02:19:42,804 --> 02:19:47,975 INCREASED THEIR RISK, AND THEN 3731 02:19:47,975 --> 02:19:49,076 FOLLOW THEM PROSPECTIVELY, AN 3732 02:19:49,076 --> 02:19:51,579 INTERVENTION THAT MIGHT SHOW WE 3733 02:19:51,579 --> 02:19:53,214 CAN MITIGATE THESE RISKS AND 3734 02:19:53,214 --> 02:19:55,616 FOLLOW THEM DOWNSTREAM. 3735 02:19:55,616 --> 02:19:56,918 IT SEEMS VERY CHALLENGING IN 3736 02:19:56,918 --> 02:19:59,554 WHAT WE DO TO HAVE LONGITUDINAL 3737 02:19:59,554 --> 02:20:01,389 TYPE STUDIES WHERE WE ARE 3738 02:20:01,389 --> 02:20:03,157 FOLLOWING A COHORT MAYBE WITH AN 3739 02:20:03,157 --> 02:20:04,492 INTERVENTION BUT FOLLOWING THEM 3740 02:20:04,492 --> 02:20:07,195 TO SEE IF WE CAN HAVE EFFECT ON 3741 02:20:07,195 --> 02:20:08,930 THAT OUTCOME, TO ME WOULD BE 3742 02:20:08,930 --> 02:20:09,931 WONDERFUL. 3743 02:20:09,931 --> 02:20:11,799 THE OTHER THING THAT I THINK 3744 02:20:11,799 --> 02:20:12,900 JUST REALLY COMES OUT LOUD AND 3745 02:20:12,900 --> 02:20:14,435 CLEAR IN THESE TYPES OF STUDIES 3746 02:20:14,435 --> 02:20:19,140 BUT ALSO IN THE CONVERSATION 3747 02:20:19,140 --> 02:20:21,442 BEFORE ABOUT THE MORTALITY, 3748 02:20:21,442 --> 02:20:22,410 THERE ARE POINTS WHICH 3749 02:20:22,410 --> 02:20:23,611 DIFFERENCE TYPES OF PROVIDERS 3750 02:20:23,611 --> 02:20:28,916 ARE WITH PATIENT AND ON THE 3751 02:20:28,916 --> 02:20:33,821 OBSTETRICS SIDE YOU HAVE YOUR 3752 02:20:33,821 --> 02:20:35,356 MFNs, MID WIVES, OBs, BUT WE 3753 02:20:35,356 --> 02:20:37,425 HAND THEM OFF TO PRIMARY CARE 3754 02:20:37,425 --> 02:20:38,860 PROVIDER AT SOME POINT WHO MIGHT 3755 02:20:38,860 --> 02:20:42,163 MISS THAT HISTORY OR NOT 3756 02:20:42,163 --> 02:20:43,664 UNDERSTAND OR THEY MIGHT 3757 02:20:43,664 --> 02:20:46,868 UNDERSTAND ONE PIECE AND NOT 3758 02:20:46,868 --> 02:20:47,301 ANOTHER PIECE. 3759 02:20:47,301 --> 02:20:49,370 WE PROBABLY IN THE LAST FIVE TO 3760 02:20:49,370 --> 02:20:50,371 TEN YEARS HAVE DONE I THINK A 3761 02:20:50,371 --> 02:20:54,175 LOT OF GOOD WORK IN EDUCATING 3762 02:20:54,175 --> 02:20:56,043 EMERGENCY ROOM DOCTORS BECAUSE A 3763 02:20:56,043 --> 02:20:56,911 LOT OF POSTPARTUM PATIENTS SHOW 3764 02:20:56,911 --> 02:20:59,213 UP IN THE EMERGENCY ROOM, THAT 3765 02:20:59,213 --> 02:21:00,648 HISTORY OF RECENT PREGNANCY OR 3766 02:21:00,648 --> 02:21:02,083 PREGNANCY THAT WAS SEVERAL 3767 02:21:02,083 --> 02:21:03,150 MONTHS AGO IS MISSED. 3768 02:21:03,150 --> 02:21:06,888 SO I THINK WE CAN DO A BETTER 3769 02:21:06,888 --> 02:21:08,656 JOB OF HAVING OUTSIDE 3770 02:21:08,656 --> 02:21:10,391 COMMUNICATION WITH PRIMARY CARE 3771 02:21:10,391 --> 02:21:11,392 PROVIDERS AND INTERNAL AND 3772 02:21:11,392 --> 02:21:12,360 FAMILY MEDICINE DOCS SO EVERYONE 3773 02:21:12,360 --> 02:21:16,864 IS LOOKING AT THE SAME 3774 02:21:16,864 --> 02:21:18,566 PARAMETERS FOR EACH PATIENT. 3775 02:21:18,566 --> 02:21:21,569 >> I COULD BUILD ON THE POINT. 3776 02:21:21,569 --> 02:21:26,474 >> SORRY, PLEASE GO ON. 3777 02:21:26,474 --> 02:21:28,676 >> BUILD ON THE POINT EARLIER, 3778 02:21:28,676 --> 02:21:31,178 THERE'S A LOT OF DATA AVAILABLE 3779 02:21:31,178 --> 02:21:33,080 TO US, THE HOSPITAL LEVEL, 3780 02:21:33,080 --> 02:21:34,482 DEFINITELY, ALSO AT THE STATE 3781 02:21:34,482 --> 02:21:36,117 AND NATIONAL LEVEL THAT WE'RE 3782 02:21:36,117 --> 02:21:37,752 NOT ACTUALLY LEARNING ENOUGH 3783 02:21:37,752 --> 02:21:37,952 FROM. 3784 02:21:37,952 --> 02:21:44,225 SO I THINK THERE'S ROOM FOR 3785 02:21:44,225 --> 02:21:46,394 ADDITIONAL LEARNING FROM STATES, 3786 02:21:46,394 --> 02:21:47,828 COMMITTEES, REPORTS, EFFORTS TO 3787 02:21:47,828 --> 02:21:48,896 REVIEW MORBIDITY IN HOSPITALS 3788 02:21:48,896 --> 02:21:51,899 LIKE WE DO IN MARYLAND. 3789 02:21:51,899 --> 02:21:54,602 THIS HAPPENS MAYBE NOT STATEWIDE 3790 02:21:54,602 --> 02:21:57,805 BUT MANY HOSPITALS AROUND THE 3791 02:21:57,805 --> 02:21:58,673 COUNTRY. 3792 02:21:58,673 --> 02:21:59,907 THERE ARE MANY PROJECTS FUNDED 3793 02:21:59,907 --> 02:22:01,509 BY THE GOVERNMENT OVER THE PAST 3794 02:22:01,509 --> 02:22:08,482 COUPLE OF I WOULD SAY ALMOST A 3795 02:22:08,482 --> 02:22:10,585 DECADE NOW, ALL OF THESE LARGE 3796 02:22:10,585 --> 02:22:12,119 SCALE QUALITY IMPROVEMENT 3797 02:22:12,119 --> 02:22:16,857 EFFORTS THAT COULD BE, YOU KNOW, 3798 02:22:16,857 --> 02:22:19,694 BETTER EVALUATED, AND MAYBE 3799 02:22:19,694 --> 02:22:21,095 RESULTS BETTER DISSEMINATED. 3800 02:22:21,095 --> 02:22:23,297 NUMBER TWO, I AGREE WE NEED 3801 02:22:23,297 --> 02:22:25,066 DATA, NEED TO UNDERSTAND 3802 02:22:25,066 --> 02:22:27,335 PATTERNS AND PATHWAYS TO SEVERE 3803 02:22:27,335 --> 02:22:28,436 OUTCOMES AND ADVERSE OUTCOMES 3804 02:22:28,436 --> 02:22:30,071 FOR MOTHERS. 3805 02:22:30,071 --> 02:22:31,939 AND INFANTS AS WELL. 3806 02:22:31,939 --> 02:22:33,908 SO USING LINKED DATA SOURCES 3807 02:22:33,908 --> 02:22:35,743 THAT'S A POSSIBILITY, SOME 3808 02:22:35,743 --> 02:22:38,913 STATES ARE ALREADY LINKING DATA 3809 02:22:38,913 --> 02:22:43,017 ACROSS MULTIPLE PROJECTS, 3810 02:22:43,017 --> 02:22:44,752 STARTING WITH VITAL STATISTICS, 3811 02:22:44,752 --> 02:22:46,487 MEDICAID, CLAIMS DATA, AN 3812 02:22:46,487 --> 02:22:50,758 EXAMPLE, THE PELL PROGRAM IN 3813 02:22:50,758 --> 02:22:51,525 MASSACHUSETTS. 3814 02:22:51,525 --> 02:22:53,394 ALSO STARTING TO MAKE BETTER USE 3815 02:22:53,394 --> 02:22:55,896 OF THE EHR DATA THAT WE HAVE. 3816 02:22:55,896 --> 02:23:02,803 SO MAYBE USING DEAF DEFINITELYN 3817 02:23:02,803 --> 02:23:04,639 DATA ELEMENTS, EFFORTS TO 3818 02:23:04,639 --> 02:23:06,073 STANDARDIZE IN MATERNAL HEALTH, 3819 02:23:06,073 --> 02:23:08,809 ALSO USING COMMON DATA MODELS 3820 02:23:08,809 --> 02:23:10,011 LIKE OMOP, TRYING TO STANDARDIZE 3821 02:23:10,011 --> 02:23:14,048 MEDICAL TERMINOLOGY WE LOOK AT, 3822 02:23:14,048 --> 02:23:15,750 ACROSS NOT ONLY THE U.S. AND 3823 02:23:15,750 --> 02:23:18,719 STATES WITHIN BUT ALSO GLOBALLY. 3824 02:23:18,719 --> 02:23:21,656 SO INVOLVING COUNTRIES LIKE 3825 02:23:21,656 --> 02:23:22,156 INDIA, PAKISTAN, AFRICAN 3826 02:23:22,156 --> 02:23:24,291 COLLEAGUES AS WELL, THERE ARE 3827 02:23:24,291 --> 02:23:25,926 SOME COUNTRIES USING -- OR SOME 3828 02:23:25,926 --> 02:23:28,663 HOSPITALS EVEN IN THESE 3829 02:23:28,663 --> 02:23:32,933 COUNTRIES USING EHR DATA. 3830 02:23:32,933 --> 02:23:35,336 JUST A FEW IDEAS. 3831 02:23:35,336 --> 02:23:37,538 >> THAT'S AN IMPORTANT POINT, 3832 02:23:37,538 --> 02:23:39,507 HIGHLIGHTING METRICS AND ALL THE 3833 02:23:39,507 --> 02:23:41,242 DATA THAT WE HAVE, PILES AN 3834 02:23:41,242 --> 02:23:44,311 PILES OF IT AT OUR FINGERTIPS 3835 02:23:44,311 --> 02:23:47,148 BUT NOT USING IT AND LINKING IT 3836 02:23:47,148 --> 02:23:52,386 EFFECTIVELY IS AN EXCELLENT 3837 02:23:52,386 --> 02:23:52,586 POINT. 3838 02:23:52,586 --> 02:23:54,388 DR. BHUTT HAS JOINED US 3839 02:23:54,388 --> 02:23:54,655 REMOTELY. 3840 02:23:54,655 --> 02:23:57,491 I ASKED THE PANEL A KICKOFF 3841 02:23:57,491 --> 02:23:59,860 QUESTION, WHAT IN YOUR VIEW ARE 3842 02:23:59,860 --> 02:24:00,795 INNOVATIVE AND EVIDENCE-BASED 3843 02:24:00,795 --> 02:24:02,730 APPROACHES WHICH HAVE POTENTIAL 3844 02:24:02,730 --> 02:24:05,566 TO DRIVE DOWN HIGH PREVALENCE OF 3845 02:24:05,566 --> 02:24:06,200 CARDIOVASCULAR SEVERE MATERNAL 3846 02:24:06,200 --> 02:24:08,102 OUTCOMES AND I ASKED THE PANEL 3847 02:24:08,102 --> 02:24:10,271 TO COMMENT ON INTEGRATED OR 3848 02:24:10,271 --> 02:24:12,373 INTERSECTIONAL APPROACHES WHERE 3849 02:24:12,373 --> 02:24:13,774 THE GAPS ARE, CHALLENGES, 3850 02:24:13,774 --> 02:24:16,644 BARRIERS, WHAT IS THE SCOPE FOR 3851 02:24:16,644 --> 02:24:21,782 ADAPTATION OF SUCCESSFUL 3852 02:24:21,782 --> 02:24:24,852 INTERVENTIONS AND DIFFERENT 3853 02:24:24,852 --> 02:24:27,354 SETTINGS. 3854 02:24:27,354 --> 02:24:27,888 YOU'RE ON MUTE. 3855 02:24:27,888 --> 02:24:29,323 >> SO THANK YOU. 3856 02:24:29,323 --> 02:24:30,424 APOLOGIES FOR THE BACKGROUND 3857 02:24:30,424 --> 02:24:30,825 NOISE. 3858 02:24:30,825 --> 02:24:35,329 I'M IN A NOISY AIRPORT. 3859 02:24:35,329 --> 02:24:37,398 LET ME START WITH OF THE POINT 3860 02:24:37,398 --> 02:24:39,400 THAT WAS MADE ON INFORMATION AND 3861 02:24:39,400 --> 02:24:39,934 DATA. 3862 02:24:39,934 --> 02:24:41,469 I COULDN'T AGREE MORE. 3863 02:24:41,469 --> 02:24:43,671 I THINK WHAT WE NEED START WITH 3864 02:24:43,671 --> 02:24:45,306 IN MANY HEALTH SYSTEMS, I'M 3865 02:24:45,306 --> 02:24:47,742 LARGELY TALKING ABOUT DISTRICT 3866 02:24:47,742 --> 02:24:49,009 HEALTH SYSTEMS, IS WAYS AND 3867 02:24:49,009 --> 02:24:51,512 MEANS OF NOT ONLY MONITORING 3868 02:24:51,512 --> 02:24:53,447 WHAT PEOPLE COLLECT AND DON'T 3869 02:24:53,447 --> 02:24:56,684 USE, AND A LOT OF DHIS, DISTRICT 3870 02:24:56,684 --> 02:24:58,652 HEALTH INFORMATION SYSTEMS, THE 3871 02:24:58,652 --> 02:25:00,287 COMMUNITY HAS WORKER MANAGEMENT 3872 02:25:00,287 --> 02:25:01,822 INFORMATION SYSTEMS, THOSE DATA 3873 02:25:01,822 --> 02:25:05,226 ARE REALLY NOT USED EFFECTIVELY. 3874 02:25:05,226 --> 02:25:06,527 TOOLS AND TECHNOLOGIES THESE 3875 02:25:06,527 --> 02:25:10,131 DAYS, PARTICULARLY USE OF A.I., 3876 02:25:10,131 --> 02:25:11,332 FOR COLLATING AND SYNTHESIZING 3877 02:25:11,332 --> 02:25:13,534 IN REAL TIME IS A STARTING 3878 02:25:13,534 --> 02:25:14,168 POINT. 3879 02:25:14,168 --> 02:25:15,736 IT'S A STARTING POINT TO 3880 02:25:15,736 --> 02:25:17,571 RECOGNITION OF WHAT ARE 3881 02:25:17,571 --> 02:25:21,175 IMPORTANT CAUSES OF MORBIDITY, 3882 02:25:21,175 --> 02:25:23,477 IMPORTANT CAUSES OF COMORBIDITY 3883 02:25:23,477 --> 02:25:25,112 IN MANY INSTANCES, AND WHAT WE 3884 02:25:25,112 --> 02:25:26,647 BELIEVE ARE THE MAIN DRIVERS FOR 3885 02:25:26,647 --> 02:25:28,449 MORTALITY IN MANY OF THESE 3886 02:25:28,449 --> 02:25:29,316 SETTINGS. 3887 02:25:29,316 --> 02:25:31,018 THE OTHER IS EFFECTIVE USE OF 3888 02:25:31,018 --> 02:25:32,820 TECHNOLOGY AND TOOLS. 3889 02:25:32,820 --> 02:25:35,356 I DO BELIEVE FOR MANY 3890 02:25:35,356 --> 02:25:37,224 CARDIOVASCULAR DISEASES THAT WE 3891 02:25:37,224 --> 02:25:40,594 SEE IN COMMUNITY SETTINGS, LARGE 3892 02:25:40,594 --> 02:25:41,595 SCALE POPULATION SETTINGS, 3893 02:25:41,595 --> 02:25:46,634 RELATED TO HYPERTENSION, RISK OF 3894 02:25:46,634 --> 02:25:47,835 CARDIOVASCULAR DISEASE, EVEN 3895 02:25:47,835 --> 02:25:50,371 ADVERSITIES ONE ENCOUNTERS IN 3896 02:25:50,371 --> 02:25:51,472 PREGNANCY RECOGNIZABLE BY 3897 02:25:51,472 --> 02:25:53,440 ULTRASOUND AND DOPPLERS, USE OF 3898 02:25:53,440 --> 02:25:54,742 MANY TOOLS AND TECHNOLOGIES NOW 3899 02:25:54,742 --> 02:25:58,145 OFFERS A VERY EXCITING 3900 02:25:58,145 --> 02:25:59,680 OPPORTUNITY FOR DEMOCRATIZATION 3901 02:25:59,680 --> 02:26:01,982 OF APPROPRIATE HELP, USE OF, 3902 02:26:01,982 --> 02:26:05,352 LET'S SAY, SMALL HANDHELD 3903 02:26:05,352 --> 02:26:07,087 DEVICES LIKE ULTRASOUND 3904 02:26:07,087 --> 02:26:09,089 MACHINES, AND USE OF DEVICES 3905 02:26:09,089 --> 02:26:11,692 SUCH AS ONES WE PILOTED IN OUR 3906 02:26:11,692 --> 02:26:14,662 TRIAL OF ADEQUATE MEASUREMENT OF 3907 02:26:14,662 --> 02:26:18,165 BLOOD PRESSURE AND PERHAPS 3908 02:26:18,165 --> 02:26:20,901 ADDITIONAL MEASURES SUCH AS 3909 02:26:20,901 --> 02:26:22,203 HEART RATE AND OXYGEN SATURATION 3910 02:26:22,203 --> 02:26:23,737 ARE TOOLS THAT WOULD HELP TRIAGE 3911 02:26:23,737 --> 02:26:28,108 THOSE WHO ARE AT GREATER RISK OF 3912 02:26:28,108 --> 02:26:30,311 ADVERSE OUTCOMES FOR EFFECTIVE 3913 02:26:30,311 --> 02:26:31,412 REFERRAL AND PERHAPS 3914 02:26:31,412 --> 02:26:32,246 STABILIZATION. 3915 02:26:32,246 --> 02:26:35,816 BUT AS I SAID, THESE THINGS CAN 3916 02:26:35,816 --> 02:26:37,852 ONLY WORK IF YOU IMPLEMENT THEM 3917 02:26:37,852 --> 02:26:39,053 ACROSS THE HEALTH SYSTEM. 3918 02:26:39,053 --> 02:26:41,689 THEY CAN'T JUST WORK AT ONE 3919 02:26:41,689 --> 02:26:41,889 TIER. 3920 02:26:41,889 --> 02:26:44,058 FOR EXAMPLE PROVISION OF THESE 3921 02:26:44,058 --> 02:26:49,230 SERVICES AT FACILITIES WHEN YOU 3922 02:26:49,230 --> 02:26:59,740 DON'T HAVE TRANSPORT DOES NOT 3923 02:27:01,442 --> 02:27:01,575 VENT. 3924 02:27:01,575 --> 02:27:06,113 WE NEED TO LINK TO EXISTING 3925 02:27:06,113 --> 02:27:06,847 ACCOUNTABILITY AND OVERSIGHT 3926 02:27:06,847 --> 02:27:08,382 MECHANISMS THAT EXIST IN MANY 3927 02:27:08,382 --> 02:27:12,086 PLACES BUT ARE NOT UTILIZED IN 3928 02:27:12,086 --> 02:27:14,855 REASONABLE ENOUGH OR NEAR, YOU 3929 02:27:14,855 --> 02:27:16,156 KNOW, REAL TIME OVERSIGHT. 3930 02:27:16,156 --> 02:27:18,592 I THINK THOSE ARE JUST SOME 3931 02:27:18,592 --> 02:27:18,959 STARTING POINTS. 3932 02:27:18,959 --> 02:27:20,928 THERE'S A LOT THAT CAN BE DONE. 3933 02:27:20,928 --> 02:27:24,098 THERE'S A LOT THAT CAN BE 3934 02:27:24,098 --> 02:27:24,999 PILOTED AT REASONABLE LEVEL 3935 02:27:24,999 --> 02:27:28,302 BEFORE YOU SCALE UP. 3936 02:27:28,302 --> 02:27:32,973 THANK YOU. 3937 02:27:32,973 --> 02:27:34,408 >> GREAT, THANK YOU. 3938 02:27:34,408 --> 02:27:37,344 I WILL NOW OPEN IT UP TO THE 3939 02:27:37,344 --> 02:27:38,879 QUESTIONS FROM THE AUDIENCE. 3940 02:27:38,879 --> 02:27:47,121 WE HAVE ONE QUESTION, TO WHAT 3941 02:27:47,121 --> 02:27:48,622 EXTENT DOES PRE-PREGNANCY 3942 02:27:48,622 --> 02:27:49,723 HYPERTENSION, OBESITY AND 3943 02:27:49,723 --> 02:27:53,594 DIABETES CONTRIBUTE TO PRE-TERM 3944 02:27:53,594 --> 02:27:55,763 BIRTH AND SHOULD PRE-PREGNANCY 3945 02:27:55,763 --> 02:27:57,965 HEALTH STATUS BE ASSESSED BY 3946 02:27:57,965 --> 02:27:58,198 OB/GYN? 3947 02:27:58,198 --> 02:28:00,234 >> DEFINITELY THESE ARE RISK 3948 02:28:00,234 --> 02:28:02,236 FACTORS, EVEN OBESITY IS A RISK 3949 02:28:02,236 --> 02:28:04,371 FACTOR FOR VERY EARLY PRE-TERM 3950 02:28:04,371 --> 02:28:07,007 BIRTH, AGAIN BECAUSE OF THE 3951 02:28:07,007 --> 02:28:09,376 INFLAMMATION THAT'S BEEN SEEN IN 3952 02:28:09,376 --> 02:28:13,414 MANY EPIDEMIOLOGIC STUDIES. 3953 02:28:13,414 --> 02:28:23,924 YOU KNOW, I THINK IATROGENIC. 3954 02:28:37,204 --> 02:28:38,472 WE WOULD LOVE TO SEE A PATIENT 3955 02:28:38,472 --> 02:28:41,208 BEFORE SHE COMES TO OUR FLOOR OR 3956 02:28:41,208 --> 02:28:42,609 CLINICS WITH ALL THESE RISK 3957 02:28:42,609 --> 02:28:45,913 FACTORS, AND NOW WE HAVE TO -- 3958 02:28:45,913 --> 02:28:48,082 WE DON'T NEED A SCREENING TEST, 3959 02:28:48,082 --> 02:28:50,951 OBVIOUSLY THIS PERSON IS AT HIGH 3960 02:28:50,951 --> 02:28:51,618 RISK. 3961 02:28:51,618 --> 02:28:52,553 WE DO PRE-CONCEPTION CONSULTS, 3962 02:28:52,553 --> 02:28:55,322 WE TRY TO DO ALL THE TIME, BUT A 3963 02:28:55,322 --> 02:28:56,957 LOT OF PATIENTS PARTICULARLY 3964 02:28:56,957 --> 02:28:59,259 MOST NEEDY WON'T COME INTO CARE 3965 02:28:59,259 --> 02:29:01,562 BEFORE THEY ARE PREGNANT. 3966 02:29:01,562 --> 02:29:04,198 AND THIS IS EXACTLY WHY THE 3967 02:29:04,198 --> 02:29:07,034 ABILITY TO HAVE FAMILY PLANNING 3968 02:29:07,034 --> 02:29:09,570 IS DIRECTLY RELATED TO MATERNAL 3969 02:29:09,570 --> 02:29:09,837 MORTALITY. 3970 02:29:09,837 --> 02:29:11,638 BECAUSE IF SOMEONE CAN'T PLAN 3971 02:29:11,638 --> 02:29:12,906 THEIR FAMILY APPROPRIATELY 3972 02:29:12,906 --> 02:29:14,141 YOU'LL SEE MATERNAL DEATHS WHEN 3973 02:29:14,141 --> 02:29:18,512 THEY COME IN, WE WOULD HAVE SAD 3974 02:29:18,512 --> 02:29:19,980 YOU SHOULD NOT BE PREGNANT AND 3975 02:29:19,980 --> 02:29:20,814 THEY ARE. 3976 02:29:20,814 --> 02:29:29,056 YES, I AGREE OB/GYN AND MATERNAL 3977 02:29:29,056 --> 02:29:29,656 MATERNAL-FETAL MEDICINE WOULD 3978 02:29:29,656 --> 02:29:31,692 LIKE TO SEE THEM BEFORE HAND, 3979 02:29:31,692 --> 02:29:36,497 BUT THIS IS NOT WHAT HAPPENS IN 3980 02:29:36,497 --> 02:29:36,830 REALITY. 3981 02:29:36,830 --> 02:29:38,432 >> I WOULD PARTICULARLY ADD TO 3982 02:29:38,432 --> 02:29:40,768 THIS WHAT HAS BEEN JUST SAID, 3983 02:29:40,768 --> 02:29:41,869 CYNTHIA, WE WOULD PARTICULARLY 3984 02:29:41,869 --> 02:29:45,139 LIKE TO SEE PATIENTS WHO HAVE A 3985 02:29:45,139 --> 02:29:47,307 CARDIAC DISORDER BEFORE SHE EVEN 3986 02:29:47,307 --> 02:29:49,076 THINKS ABOUT PREGNANCY BECAUSE 3987 02:29:49,076 --> 02:29:51,111 THEN GETTING INTO PREGNANCY AND 3988 02:29:51,111 --> 02:29:52,913 ASKING HER THIS IS SOMETHING 3989 02:29:52,913 --> 02:29:54,114 THAT'S GOING TO ADVERSELY AFFECT 3990 02:29:54,114 --> 02:29:55,482 HER WHOLE LIFE IS SOMETHING WE 3991 02:29:55,482 --> 02:29:57,518 WOULD NEVER WANT TO DO. 3992 02:29:57,518 --> 02:30:00,621 SO IT WOULD ALWAYS BE BETTER TO 3993 02:30:00,621 --> 02:30:01,522 HAVE THEM IN BEFORE. 3994 02:30:01,522 --> 02:30:07,294 IT COULD BE THE PHYSICIAN, 3995 02:30:07,294 --> 02:30:10,597 TREATING PHYSICIAN'S CONNECTION 3996 02:30:10,597 --> 02:30:12,800 WITH OBSTETRICIAN TO REFER THEM 3997 02:30:12,800 --> 02:30:15,736 BEFORE PREGNANCY, SO GOOD 3998 02:30:15,736 --> 02:30:16,403 CONNECTIONS BETWEEN PHYSICIAN 3999 02:30:16,403 --> 02:30:18,906 AND OBSTETRICIAN IS IMPORTANT 4000 02:30:18,906 --> 02:30:23,844 EVEN BEFORE THE ADVENT OF A 4001 02:30:23,844 --> 02:30:24,111 PREGNANCY. 4002 02:30:24,111 --> 02:30:26,380 >> SO I WANTED TO ADD IS SOME OF 4003 02:30:26,380 --> 02:30:29,416 MY COLLEAGUES HAVE RECENTLY 4004 02:30:29,416 --> 02:30:30,951 DOCUMENTED AND ABSOLUTELY 4005 02:30:30,951 --> 02:30:33,687 UNRECORDED AND UNRECOGNIZED HIGH 4006 02:30:33,687 --> 02:30:34,822 BURDEN OF RHEUMATIC HEART 4007 02:30:34,822 --> 02:30:36,890 DISEASE IN YOUNG ADOLESCENT 4008 02:30:36,890 --> 02:30:38,192 GIRLS, PARTICULARLY IN RURAL 4009 02:30:38,192 --> 02:30:40,594 PAKISTAN, AND THOSE ARE THINGS 4010 02:30:40,594 --> 02:30:43,664 THAT OBVIOUSLY CAN BE RECOGNIZED 4011 02:30:43,664 --> 02:30:46,200 EARLY, CAN BE AMENABLE TO 4012 02:30:46,200 --> 02:30:47,968 EARLIER MANAGEMENT, OBVIOUSLY 4013 02:30:47,968 --> 02:30:51,138 OPEN THE DOOR TO PROPHYLAXIS AND 4014 02:30:51,138 --> 02:30:52,873 PREVENTION IN EARLY CHILDHOOD. 4015 02:30:52,873 --> 02:30:55,609 ALSO WE'RE RECOGNIZING QUITE A 4016 02:30:55,609 --> 02:30:59,113 SIGNIFICANT BURDEN OF SEVERE 4017 02:30:59,113 --> 02:30:59,613 ANEMIA, WITH ASSOCIATED 4018 02:30:59,613 --> 02:31:00,681 CARDIOVASCULAR COMPLICATIONS 4019 02:31:00,681 --> 02:31:02,015 THAT HAPPEN IN PREGNANCY, AND 4020 02:31:02,015 --> 02:31:05,052 THOSE THINGS DO REQUIRE THAT WE 4021 02:31:05,052 --> 02:31:06,487 DO HAVE PREVENTIVE STRATEGIES 4022 02:31:06,487 --> 02:31:07,654 PUT IN HEALTH SYSTEMS IN TERMS 4023 02:31:07,654 --> 02:31:10,290 OF PICKING UP SOME OF THOSE HIGH 4024 02:31:10,290 --> 02:31:15,129 RISK SUBGROUPS. 4025 02:31:15,129 --> 02:31:16,763 THANK YOU. 4026 02:31:16,763 --> 02:31:21,034 >> NOT JUST VALVULAR, WE COULD 4027 02:31:21,034 --> 02:31:22,436 TALK ABOUT CONGENITAL EFFECTS, 4028 02:31:22,436 --> 02:31:25,172 WE NEED TO MAKE IT AVAILABLE AT 4029 02:31:25,172 --> 02:31:26,707 AN AFFORDABLE COST FOR GIRLS, 4030 02:31:26,707 --> 02:31:29,109 EVEN IN THE PEDIATRIC AGE GROUP 4031 02:31:29,109 --> 02:31:31,411 TO UNDERGO SURGERIES TO CORRECT 4032 02:31:31,411 --> 02:31:35,349 THESE DISORDERS BEFORE THEY HAVE 4033 02:31:35,349 --> 02:31:36,250 SOMETHING THAT CANNOT BE 4034 02:31:36,250 --> 02:31:39,720 AMENABLE TO ANY SORT OF 4035 02:31:39,720 --> 02:31:42,356 TREATMENT ALONG THE 4036 02:31:42,356 --> 02:31:42,689 CONSEQUENCES. 4037 02:31:42,689 --> 02:31:46,760 SO AVAILABILITY OF AFFORDABILITY 4038 02:31:46,760 --> 02:31:48,061 OF SURGERIES, FOR CONGENITAL 4039 02:31:48,061 --> 02:31:55,068 DEFECTS IS VERY IMPORTANT ACROSS 4040 02:31:55,068 --> 02:31:56,870 ALL SECTIONS OF SOCIETY. 4041 02:31:56,870 --> 02:31:59,406 >> GLOBALLY A NEED IN THE UNITED 4042 02:31:59,406 --> 02:32:01,308 STATES AND LOW- AND 4043 02:32:01,308 --> 02:32:02,609 MIDDLE-INCOME COUNTRIES FOR 4044 02:32:02,609 --> 02:32:04,011 BETTER PRE-CONCEPTION ACCESS TO 4045 02:32:04,011 --> 02:32:06,780 CARE AND MANAGEMENT AND FAMILY 4046 02:32:06,780 --> 02:32:08,282 PLANNING IS A BIG PART OF THAT, 4047 02:32:08,282 --> 02:32:13,420 OF COURSE, BUT ALSO JUST ACCESS 4048 02:32:13,420 --> 02:32:14,955 TO HEALTH CARE AND COMMUNICATION 4049 02:32:14,955 --> 02:32:16,190 BETWEEN DIFFERENT LEVELS OF THE 4050 02:32:16,190 --> 02:32:18,392 HEALTH SYSTEM AND DIFFERENT 4051 02:32:18,392 --> 02:32:20,227 TYPES OF PROVIDERS. 4052 02:32:20,227 --> 02:32:27,234 >> I WOULD ADD, YOU KNOW, THAT 4053 02:32:27,234 --> 02:32:28,669 DETERMINANTS OF HEALTH, WE CAN 4054 02:32:28,669 --> 02:32:32,806 CAPTURE, A COMMITTEE FROM ACOG 4055 02:32:32,806 --> 02:32:35,909 BACK IN 2017, 2018 TO HIGHLIGHT 4056 02:32:35,909 --> 02:32:37,211 IMPORTANCE OF SOCIAL 4057 02:32:37,211 --> 02:32:38,312 DETERMINANTS OF HEALTH, HEALTH 4058 02:32:38,312 --> 02:32:39,179 LITERACY FOR OUR PATIENTS. 4059 02:32:39,179 --> 02:32:42,216 THAT WOULD BE IMPORTANT TO 4060 02:32:42,216 --> 02:32:45,185 CAPTURE AND THIS IS GOING ABOVE 4061 02:32:45,185 --> 02:32:49,289 AND BEYOND, KNOWING PREGNANCY 4062 02:32:49,289 --> 02:32:50,657 HEALTH DATA, KNOWING COMORBID 4063 02:32:50,657 --> 02:32:51,992 CONDITION THE PATIENT ENTERS 4064 02:32:51,992 --> 02:32:53,627 PREGNANCY WITH. 4065 02:32:53,627 --> 02:32:54,728 STARTING TO HIGHLIGHT THESE 4066 02:32:54,728 --> 02:32:56,029 ISSUES, TRYING TO BRING THEM TO 4067 02:32:56,029 --> 02:32:57,231 LIGHT, THEY ARE VERY IMPORTANT 4068 02:32:57,231 --> 02:32:59,967 AND I THINK THIS CAME OUT 4069 02:32:59,967 --> 02:33:01,835 ALREADY IN THE KEYNOTE 4070 02:33:01,835 --> 02:33:03,036 PRESENTATIONS AND FROM EVERYONE 4071 02:33:03,036 --> 02:33:10,677 ON THIS PANEL. 4072 02:33:10,677 --> 02:33:12,012 THANK YOU. 4073 02:33:12,012 --> 02:33:13,981 >> I HAD ANOTHER QUESTION WHICH 4074 02:33:13,981 --> 02:33:15,315 POINTS TO LARGER SYSTEMIC THINGS 4075 02:33:15,315 --> 02:33:19,486 WE'VE BEEN TALKING ABOUT, HOW DO 4076 02:33:19,486 --> 02:33:21,255 WE BEST PROMOTE COLLABORATION 4077 02:33:21,255 --> 02:33:22,689 BETWEEN CLINICIAN-SCIENTISTS 4078 02:33:22,689 --> 02:33:24,891 THAT IS IMPLEMENTATION 4079 02:33:24,891 --> 02:33:26,059 RESEARCHERS LIKE YOURSELVES, 4080 02:33:26,059 --> 02:33:27,828 HEALTHCARE SYSTEMS, HEALTH 4081 02:33:27,828 --> 02:33:30,030 POLICY, GOVERNMENTS, COMMUNITY 4082 02:33:30,030 --> 02:33:31,832 ORGANIZATIONS, BIRTHING PEOPLE? 4083 02:33:31,832 --> 02:33:33,300 WHAT ARE SOME COLLABORATIVE 4084 02:33:33,300 --> 02:33:38,772 STRATEGIES? 4085 02:33:38,772 --> 02:33:40,607 >> THE BEST EXAMPLE COULD BE 4086 02:33:40,607 --> 02:33:42,476 ABOUT THE REGISTRY THAT IS 4087 02:33:42,476 --> 02:33:44,978 ONGOING IN THE COUNTRY. 4088 02:33:44,978 --> 02:33:47,614 THE CARDIAC DISEASES PREGNANCY 4089 02:33:47,614 --> 02:33:49,249 REGISTRY, WHICH IS ACROSS ALMOST 4090 02:33:49,249 --> 02:33:53,420 50 SITES, ALL OVER THE COUNTRY, 4091 02:33:53,420 --> 02:33:55,589 ACROSS A WIDE AREA. 4092 02:33:55,589 --> 02:33:58,358 WHETHER IT'S A PARTICIPATION 4093 02:33:58,358 --> 02:34:00,093 ALSO OF THE ADMINISTRATION, 4094 02:34:00,093 --> 02:34:02,829 POLICYMAKERS ARE PART OF IT, 4095 02:34:02,829 --> 02:34:04,264 UNIFORM STRATEGIES, UNIFORM 4096 02:34:04,264 --> 02:34:04,531 PROTOCOLS. 4097 02:34:04,531 --> 02:34:09,303 THERE'S AN OWN GOING TRAINING 4098 02:34:09,303 --> 02:34:11,705 EVEN FOR DATA COLLECTION WHERE 4099 02:34:11,705 --> 02:34:14,775 ALL HEALTH RESEARCHERS ALONG 4100 02:34:14,775 --> 02:34:16,910 WITH THEIR COLLABORATORS ARE 4101 02:34:16,910 --> 02:34:19,279 BEING TRAINED TO HAVE SYSTEMATIC 4102 02:34:19,279 --> 02:34:21,648 COLLECTION OF DATA, HAVING 4103 02:34:21,648 --> 02:34:23,016 REGISTERED ALL THE PATIENTS 4104 02:34:23,016 --> 02:34:25,052 THROUGHOUT THE PREGNANCY, EVEN 4105 02:34:25,052 --> 02:34:27,788 FOR THE NEXT PREGNANCY, SOME 4106 02:34:27,788 --> 02:34:30,624 NATIONAL REGISTRIES, SOMETHING 4107 02:34:30,624 --> 02:34:32,926 WHERE YOU COULD HAVE 4108 02:34:32,926 --> 02:34:34,127 COLLABORATION ACROSS ALL SITES, 4109 02:34:34,127 --> 02:34:43,437 ALL INSTITUTIONS IN THE COUNTRY. 4110 02:34:43,437 --> 02:34:46,940 >> SO I THINK WE NEED TO 4111 02:34:46,940 --> 02:34:47,474 ENCOURAGE NON-TRADITIONAL 4112 02:34:47,474 --> 02:34:48,575 PARTNERSHIPS, WHAT WE HEARD FROM 4113 02:34:48,575 --> 02:34:52,079 ONE OF THE KEYNOTE SPEAK ABOUT 4114 02:34:52,079 --> 02:34:53,146 TRADITIONAL PARTNERSHIPS, HOW 4115 02:34:53,146 --> 02:34:55,816 WE'RE SWITCHING GEARS AND 4116 02:34:55,816 --> 02:34:58,518 CHANGING THE LANDSCAPE FOR 4117 02:34:58,518 --> 02:35:04,891 COLLABORATION BLOABLLY. -- 4118 02:35:04,891 --> 02:35:05,792 GLOBALLY, TO BRING PATIENT 4119 02:35:05,792 --> 02:35:10,497 VOICE, VOICES OF WOMEN WHO HAVE 4120 02:35:10,497 --> 02:35:11,765 LIVED THROUGH MULTI-MORBIDITY, 4121 02:35:11,765 --> 02:35:13,233 ADVERSE EVENTS, WOMEN WITH 4122 02:35:13,233 --> 02:35:14,568 SPECIAL NEEDS, DISABILITY AND SO 4123 02:35:14,568 --> 02:35:18,905 ON, NEED TO BE BROUGHT TO THE 4124 02:35:18,905 --> 02:35:19,373 TABLE. 4125 02:35:19,373 --> 02:35:21,108 THIS IS HELPING TO SOME EXTENT 4126 02:35:21,108 --> 02:35:26,480 IN THE PAST COUPLE OF YEARS BY 4127 02:35:26,480 --> 02:35:29,950 THE GOVERNMENT, BY -- WITH 4128 02:35:29,950 --> 02:35:30,650 EXPANDING OPPORTUNITIES AT 4129 02:35:30,650 --> 02:35:32,152 HELPING OVER THE PAST DECADE AS 4130 02:35:32,152 --> 02:35:34,588 I SAID BEFORE SO I REALLY THINK 4131 02:35:34,588 --> 02:35:36,089 THAT THE WAY THAT WE HAVE TRIED 4132 02:35:36,089 --> 02:35:37,691 TO DO IT AND HAVE SUCCESSFULLY 4133 02:35:37,691 --> 02:35:40,827 DONE IT IN THE PAST COUPLE YEARS 4134 02:35:40,827 --> 02:35:42,129 WE DECIDED GRANT OPPORTUNITIES 4135 02:35:42,129 --> 02:35:43,897 AND FUNDING I THINK THIS IS THE 4136 02:35:43,897 --> 02:35:48,502 WAY TO GO AND MOVE FORWARD. 4137 02:35:48,502 --> 02:35:54,541 4138 02:35:54,541 --> 02:35:59,913 4139 02:35:59,913 --> 02:36:04,951 >> I HAVE A QUESTION FROM THE 4140 02:36:04,951 --> 02:36:07,154 AUDIENCE, CAN YOU OFFER ADVICE 4141 02:36:07,154 --> 02:36:09,456 FOR EARLY INVESTIGATORS NEW TO 4142 02:36:09,456 --> 02:36:11,525 COMMUNITY ENGAGED RESEARCH, HOW 4143 02:36:11,525 --> 02:36:12,659 TO INVOLVE COMMUNITY PARTNERS 4144 02:36:12,659 --> 02:36:17,230 WHILE TRYING TO PLAN RESEARCH? 4145 02:36:17,230 --> 02:36:20,400 >> WELL, I MEAN, THERE'S NO 4146 02:36:20,400 --> 02:36:21,067 SHORTCUT. 4147 02:36:21,067 --> 02:36:22,836 FOR EARLY CAREER RESEARCH, ONE 4148 02:36:22,836 --> 02:36:24,271 BIT OF ADVICE TO JOIN HANDS WITH 4149 02:36:24,271 --> 02:36:25,338 PEOPLE WHO ARE ALREADY DOING 4150 02:36:25,338 --> 02:36:29,075 THIS IN THE COMMUNITY SETTINGS. 4151 02:36:29,075 --> 02:36:29,776 ESTABLISH PARTNERSHIPS. 4152 02:36:29,776 --> 02:36:30,811 AND PERHAPS SPEND A LITTLE BIT 4153 02:36:30,811 --> 02:36:34,648 OF TIME JUST LEARNING THE ROPES 4154 02:36:34,648 --> 02:36:37,951 AS TO HOW COMMUNITY LIAISON, 4155 02:36:37,951 --> 02:36:38,718 RELATIONSHIPS, AND 4156 02:36:38,718 --> 02:36:40,353 CO-DEVELOPMENT OF MANY RESEARCH 4157 02:36:40,353 --> 02:36:41,855 PROTOCOLS TAKES PLACE. 4158 02:36:41,855 --> 02:36:44,057 IN MANY OF THESE COMMUNITIES, 4159 02:36:44,057 --> 02:36:44,558 PARTICULARLY TRADITIONAL 4160 02:36:44,558 --> 02:36:45,258 COMMUNITIES, THERE'S NOTHING 4161 02:36:45,258 --> 02:36:53,900 THAT YOU CAN DO THAT'S IMPORTANT 4162 02:36:53,900 --> 02:36:55,035 WITHOUT ENGAGEMENT, ASSENT, PART 4163 02:36:55,035 --> 02:36:57,737 OF COMMUNITY MEMBERS LEADING TO 4164 02:36:57,737 --> 02:36:58,505 SOMETHING MEANINGFUL AND 4165 02:36:58,505 --> 02:36:58,772 SUSTAINED. 4166 02:36:58,772 --> 02:37:00,607 SINCE I DO A LOT OF WORK WITH 4167 02:37:00,607 --> 02:37:02,509 PUBLIC SECTOR PROGRAMS, BRING ON 4168 02:37:02,509 --> 02:37:05,111 PUBLIC SECTOR PARTNERS AS 4169 02:37:05,111 --> 02:37:06,746 CO-DEVELOPERS OR 4170 02:37:06,746 --> 02:37:07,314 CO-INVESTIGATORS IN PROJECTS 4171 02:37:07,314 --> 02:37:10,116 BECAUSE IF YOU HAVE FINDINGS, 4172 02:37:10,116 --> 02:37:12,552 POSITIVE OR NEGATIVE, FROM LARGE 4173 02:37:12,552 --> 02:37:13,954 SCALE EVALUATIONS OR TRIALS, 4174 02:37:13,954 --> 02:37:15,622 THEN IT IS THEY WHO ARE 4175 02:37:15,622 --> 02:37:21,928 GENERALLY GOING TO BE RECIPIENTS 4176 02:37:21,928 --> 02:37:23,797 AND PERHAPS PROPPANTS HOW TO 4177 02:37:23,797 --> 02:37:26,433 TAKE THING FORWARD. 4178 02:37:26,433 --> 02:37:27,968 WE'VE LEARNED MORE FROM POSITIVE 4179 02:37:27,968 --> 02:37:34,841 THAN NEGATIVE INSTANCE IN MANY 4180 02:37:34,841 --> 02:37:35,108 INSTANCES. 4181 02:37:35,108 --> 02:37:36,610 BUT IT ALSO OFFERS A PLATFORM IN 4182 02:37:36,610 --> 02:37:38,011 MANY OF THESE SETTINGS FOR 4183 02:37:38,011 --> 02:37:39,346 BRINGING THE PRIVATE SECTOR. 4184 02:37:39,346 --> 02:37:43,083 I FIND IF YOU HAVE A SUCCESSFUL 4185 02:37:43,083 --> 02:37:45,185 PROGRAM IN A COMMUNITY RURAL 4186 02:37:45,185 --> 02:37:46,686 DISTRICT, ONE OF THE FIRST WHO 4187 02:37:46,686 --> 02:37:49,523 WANT TO JUMP ON BOARD AND LEARN 4188 02:37:49,523 --> 02:37:57,430 AND ENGAGE PRIVATE SECTORS, NOW 4189 02:37:57,430 --> 02:37:59,733 A GROWING BODY, LAST BUT NOT 4190 02:37:59,733 --> 02:38:02,802 LEAST TO LOOK AT TECHNOLOGY AND 4191 02:38:02,802 --> 02:38:05,005 INNOVATIONS WHICH ARE COST 4192 02:38:05,005 --> 02:38:05,438 EFFECTS. 4193 02:38:05,438 --> 02:38:10,043 WITH THE POLY CRISIS AND 4194 02:38:10,043 --> 02:38:11,244 ECONOMIC LIMITATIONS, IT IS 4195 02:38:11,244 --> 02:38:13,113 PERHAPS IMPORTANT FROM THE VERY 4196 02:38:13,113 --> 02:38:17,717 OUTSET TO LOOK AT INTERVENTIONS 4197 02:38:17,717 --> 02:38:23,390 THAT WILL BRING COST 4198 02:38:23,390 --> 02:38:25,258 EFFECTIVENESS WITHIN BUDGETS, 4199 02:38:25,258 --> 02:38:26,893 THAT ALWAYS REQUIRES ENGAGING 4200 02:38:26,893 --> 02:38:28,228 WITH MINISTRIES OR FINANCE, 4201 02:38:28,228 --> 02:38:29,296 DEPARTMENTS OF FINANCE, SO IT IS 4202 02:38:29,296 --> 02:38:30,964 A PARTNERSHIP THAT YOU DEVELOP 4203 02:38:30,964 --> 02:38:33,366 FROM THE GET-GO, WITH RELEVANT 4204 02:38:33,366 --> 02:38:36,736 AUTHORITIES AND TO YOUNG 4205 02:38:36,736 --> 02:38:37,537 INVESTIGATORS THERE'S NO 4206 02:38:37,537 --> 02:38:37,837 SHORTCUT. 4207 02:38:37,837 --> 02:38:39,172 JOINING HANDS WITH GROUPS DOING 4208 02:38:39,172 --> 02:38:44,411 THIS IS A GOOD START, A SAFE 4209 02:38:44,411 --> 02:38:44,611 START. 4210 02:38:44,611 --> 02:38:46,179 IF YOU DON'T HAVE PEOPLE IN YOUR 4211 02:38:46,179 --> 02:38:48,014 REGION DOING THIS PERHAPS 4212 02:38:48,014 --> 02:38:49,683 LEARNING FROM OTHERS DOING ITS 4213 02:38:49,683 --> 02:38:52,085 NEARBY OR IN NEIGHBORING 4214 02:38:52,085 --> 02:38:56,690 COUNTRIES IS ALSO A REASONABLE 4215 02:38:56,690 --> 02:38:57,557 START. 4216 02:38:57,557 --> 02:38:59,092 THANK YOU. 4217 02:38:59,092 --> 02:39:04,898 >> I COULD ADD TO THAT LIKE 4218 02:39:04,898 --> 02:39:06,866 YOUNGER RESEARCHERS WOULD 4219 02:39:06,866 --> 02:39:07,934 COLLABORATE WITH COMMUNITY 4220 02:39:07,934 --> 02:39:09,035 MEDICINE AND DEPARTMENTS, 4221 02:39:09,035 --> 02:39:10,904 TALKING ABOUT PUBLIC HOSPITAL, 4222 02:39:10,904 --> 02:39:12,906 GOING FOR PREVENTIVE PROGRAMS, 4223 02:39:12,906 --> 02:39:17,243 NO THE -- NOT HOSPITAL BASED BUT 4224 02:39:17,243 --> 02:39:19,045 COMMUNITY BASED, INVOLVING 4225 02:39:19,045 --> 02:39:19,879 COMMUNITY WORKERS, HEALTH 4226 02:39:19,879 --> 02:39:22,482 RESEARCHERS WORKING OVER THERE, 4227 02:39:22,482 --> 02:39:25,352 AND THE PRIMARY AND SECONDARY 4228 02:39:25,352 --> 02:39:27,654 LEVEL CARE OF RESEARCHERS OR 4229 02:39:27,654 --> 02:39:28,521 DOCTORS AT THEIR PROGRAMS, THEY 4230 02:39:28,521 --> 02:39:30,690 ARE THE PEOPLE WHO ARE GOING TO 4231 02:39:30,690 --> 02:39:31,358 IMPLEMENT YOUR POLICIES, 4232 02:39:31,358 --> 02:39:32,659 WHATEVER YOU HAVE. 4233 02:39:32,659 --> 02:39:33,927 SO THAT'S THE BEST WAY OF 4234 02:39:33,927 --> 02:39:34,694 UNDERSTANDING THE PROBLEMS IN 4235 02:39:34,694 --> 02:39:35,595 THE COMMUNITY. 4236 02:39:35,595 --> 02:39:37,697 IF YOU HAVE TO DO SOME RESEARCH, 4237 02:39:37,697 --> 02:39:39,466 TO START RIGHT FROM THE GRASS 4238 02:39:39,466 --> 02:39:42,068 ROOTS THROUGH THE COMMUNITY, AND 4239 02:39:42,068 --> 02:39:44,170 THEN COME UP, YOU CANNOT DO 4240 02:39:44,170 --> 02:39:45,372 HOSPITAL-BASED RESEARCH AND GET 4241 02:39:45,372 --> 02:39:48,074 TO KNOW THE PROBLEM. 4242 02:39:48,074 --> 02:39:49,442 SO, ONCE THEY GO INTO THE 4243 02:39:49,442 --> 02:39:50,577 COMMUNITY THAT'S THE ONLY WAY 4244 02:39:50,577 --> 02:39:52,045 YOUNG RESEARCHERS ARE GOING TO 4245 02:39:52,045 --> 02:39:53,213 UNDERSTAND THE PROBLEMS, THEY 4246 02:39:53,213 --> 02:39:55,281 ARE GOING TO UNDERSTAND WE HAVE 4247 02:39:55,281 --> 02:39:57,917 A LOT OF PROGRAMS, ASKING THEM 4248 02:39:57,917 --> 02:39:59,986 TO IMPLEMENT. 4249 02:39:59,986 --> 02:40:02,622 WE HAVE PROTOCOLS, CHECKLISTS, 4250 02:40:02,622 --> 02:40:05,025 BUT THERE'S SOME ISSUES THAT MAY 4251 02:40:05,025 --> 02:40:06,893 PREVENT THEM AND UNDERSTANDING 4252 02:40:06,893 --> 02:40:09,429 OF THAT ONLY COMES WITHIN THE 4253 02:40:09,429 --> 02:40:10,196 COMMUNITY FROM THE HEALTH 4254 02:40:10,196 --> 02:40:12,499 WORKERS THAT ARE WORKING AT THE 4255 02:40:12,499 --> 02:40:13,133 COMMUNITY LEVELS, THE PROBLEMS 4256 02:40:13,133 --> 02:40:16,569 OF THE PEOPLE WHO ARE COMING IN 4257 02:40:16,569 --> 02:40:18,938 FROM THE -- THEY ARE PROBLEMS OF 4258 02:40:18,938 --> 02:40:23,243 ACCESS TO HEALTH CARE, PROBLEMS 4259 02:40:23,243 --> 02:40:26,046 OF AFFORDABILITY, THEY ARE 4260 02:40:26,046 --> 02:40:30,283 ENGAGEMENTS IN POPULATION, HOW 4261 02:40:30,283 --> 02:40:32,385 THEY REACH THE HEALTH, THEY NEED 4262 02:40:32,385 --> 02:40:34,254 TO UNDERSTAND WHAT ARE THE 4263 02:40:34,254 --> 02:40:36,322 LIMITATIONS SHE HAS TO GO 4264 02:40:36,322 --> 02:40:36,556 THROUGH. 4265 02:40:36,556 --> 02:40:38,658 THESE ARE SOMETHING THAT YOUNG 4266 02:40:38,658 --> 02:40:40,894 RESEARCHERS IF THEY UNDERSTAND 4267 02:40:40,894 --> 02:40:42,562 ARE THE GRASS ROOT LEVELS IT'S 4268 02:40:42,562 --> 02:40:45,298 GOING TO GO A LONG WAY 4269 02:40:45,298 --> 02:40:46,199 IMPLEMENTING WHATEVER 4270 02:40:46,199 --> 02:40:48,168 STRATEGIES, WHATEVER PROTOCOLS 4271 02:40:48,168 --> 02:40:52,172 WE HAVE, IMPROVING THE HEALTH 4272 02:40:52,172 --> 02:40:52,405 CARE. 4273 02:40:52,405 --> 02:40:53,707 >> GREAT POINTS ABOUT MAKING 4274 02:40:53,707 --> 02:40:55,475 SURE THAT IF YOU'RE INTERESTED 4275 02:40:55,475 --> 02:40:57,877 IN COMMUNITY RESEARCH AND THE 4276 02:40:57,877 --> 02:40:58,978 YOUNG INVESTIGATORS TO START AT 4277 02:40:58,978 --> 02:41:00,613 THE COMMUNITY LEVEL TO MAKE SURE 4278 02:41:00,613 --> 02:41:04,884 THAT YOU HAVE SOME UNDERSTANDING 4279 02:41:04,884 --> 02:41:07,620 OF THE GRASS ROOTS. 4280 02:41:07,620 --> 02:41:07,954 DR. BANNERMAN? 4281 02:41:07,954 --> 02:41:11,458 >> I HAVE TO SAY THAT, YOU KNOW, 4282 02:41:11,458 --> 02:41:13,760 BEING A CHAIR OF A DEPARTMENT, I 4283 02:41:13,760 --> 02:41:15,528 THINK THAT IT'S VERY IMPORTANT 4284 02:41:15,528 --> 02:41:17,130 FOR US HERE IN SAN DIEGO, WE 4285 02:41:17,130 --> 02:41:18,331 INVOLVE OUR COMMUNITY IN JUST 4286 02:41:18,331 --> 02:41:21,968 ABOUT EVERYTHING THAT WE DO. 4287 02:41:21,968 --> 02:41:24,237 WE HAVE A COMMUNITY BOARD WHERE 4288 02:41:24,237 --> 02:41:26,239 WE PRESENT, YOU KNOW, OUR -- 4289 02:41:26,239 --> 02:41:28,007 JUST ON A REGULAR BASIS THE 4290 02:41:28,007 --> 02:41:30,410 FINDINGS OF THE THINGS GOING ON 4291 02:41:30,410 --> 02:41:31,845 IN OUR DEPARTMENTS. 4292 02:41:31,845 --> 02:41:33,913 WE ENGAGE WITH THEM IN RESEARCH. 4293 02:41:33,913 --> 02:41:36,649 IT HAS TO BE LIKE I THINK OTHERS 4294 02:41:36,649 --> 02:41:38,418 ARE SAYING FROM THE VERY 4295 02:41:38,418 --> 02:41:40,253 BEGINNING BECAUSE THEN ONCE YOU 4296 02:41:40,253 --> 02:41:42,122 WANT TO TRY TO FIND SOLUTIONS, I 4297 02:41:42,122 --> 02:41:44,424 THINK IT'S TOO LATE TO ENGAGE 4298 02:41:44,424 --> 02:41:45,625 THE COMMUNITY WHEN YOU'RE 4299 02:41:45,625 --> 02:41:46,292 PROBLEM SOLVING. 4300 02:41:46,292 --> 02:41:55,034 YOU JUST WANT A COLLEGIAL GROUP 4301 02:41:55,034 --> 02:41:55,902 THAT CELEBRATES EVERYTHING, 4302 02:41:55,902 --> 02:41:57,871 THINKS THROUGH THINGS, YOU HAVE 4303 02:41:57,871 --> 02:41:59,072 A MORE CAPTIVE AUDIENCE TO HELP 4304 02:41:59,072 --> 02:42:02,375 US ALL WORK TOGETHER TO FIND 4305 02:42:02,375 --> 02:42:04,978 RESEARCH QUESTIONS WE NEED TO 4306 02:42:04,978 --> 02:42:12,652 ANSWER AND HOW DO WE ANSWER THEM 4307 02:42:12,652 --> 02:42:13,019 BEST. 4308 02:42:13,019 --> 02:42:14,821 >> WE HAVE ANOTHER QUESTION IN 4309 02:42:14,821 --> 02:42:21,828 THE AUDIENCE FOR DR. CREANGA, 4310 02:42:21,828 --> 02:42:23,563 STRUCK BY THE HIGH NUMBER OF 4311 02:42:23,563 --> 02:42:25,131 THOSE ARE SMM IN MARYLAND. 4312 02:42:25,131 --> 02:42:27,000 YOU MENTIONED AT THE END YOU 4313 02:42:27,000 --> 02:42:28,334 WILL NOW INCLUDE RACISM IN THE 4314 02:42:28,334 --> 02:42:28,535 DATA. 4315 02:42:28,535 --> 02:42:31,704 CAN YOU EXPLAIN HOW YOU WOULD 4316 02:42:31,704 --> 02:42:35,108 ASSESS RACISM, STRUCTURAL 4317 02:42:35,108 --> 02:42:37,110 RACISM, ARE THERE COMPONENTS OF 4318 02:42:37,110 --> 02:42:39,746 SOCIAL DETERMINANTS OF HEALTH 4319 02:42:39,746 --> 02:42:40,213 INCLUDED? 4320 02:42:40,213 --> 02:42:42,482 >> YES, THANK YOU FOR THAT 4321 02:42:42,482 --> 02:42:43,016 QUESTION. 4322 02:42:43,016 --> 02:42:45,318 YES, WE'RE NOW STARTING DOING 4323 02:42:45,318 --> 02:42:47,520 INTERVIEWS WITH PATIENTS WHO 4324 02:42:47,520 --> 02:42:50,690 HAVE EXPERIENCED SMM AND WE'RE 4325 02:42:50,690 --> 02:42:53,860 DOING IN-DEPTH INTERVIEWS WITH 4326 02:42:53,860 --> 02:42:55,595 ABOUT 35, 35 TO 40, THAT'S THE 4327 02:42:55,595 --> 02:42:58,464 PLAN. 4328 02:42:58,464 --> 02:42:59,699 WE WANT TO UNDERSTAND THE THE 4329 02:42:59,699 --> 02:43:02,969 ROLE OF SOCIAL DETERMINANTS OF 4330 02:43:02,969 --> 02:43:08,007 HEALTH IN HEALTH PREDISPOSING 4331 02:43:08,007 --> 02:43:09,542 INDIVIDUALS TO DEVELOP AND 4332 02:43:09,542 --> 02:43:11,177 EXPERIENCE SMM, TRYING TO 4333 02:43:11,177 --> 02:43:12,812 UNDERSTAND THE EXPERIENCE ON 4334 02:43:12,812 --> 02:43:14,447 PATHWAYS TO SMM AND TO 4335 02:43:14,447 --> 02:43:16,649 UNDERSTAND OVERALL EXPERIENCE 4336 02:43:16,649 --> 02:43:16,983 GIVING BIRTH. 4337 02:43:16,983 --> 02:43:19,686 SO THAT INCLUDES, YOU KNOW, 4338 02:43:19,686 --> 02:43:20,887 EFFECTS OF THEIR INTERACTION 4339 02:43:20,887 --> 02:43:22,322 WITH THE HEALTHCARE SYSTEM, 4340 02:43:22,322 --> 02:43:24,390 THEIR NEEDS, NEEDS THAT WERE 4341 02:43:24,390 --> 02:43:28,528 MET, NEEDS NOT MET, AND 4342 02:43:28,528 --> 02:43:30,196 IMPLICATION OF RACISM ON THE 4343 02:43:30,196 --> 02:43:33,366 CARE THEY RECEIVE. 4344 02:43:33,366 --> 02:43:34,567 SO WE'RE RESTRICTING OUR 4345 02:43:34,567 --> 02:43:36,903 INTERVIEWS TO PATIENTS WHO HAVE 4346 02:43:36,903 --> 02:43:38,838 EXPERIENCED SMM IN THE PAST 4347 02:43:38,838 --> 02:43:41,574 THREE YEARS, AND WE'RE NOT 4348 02:43:41,574 --> 02:43:45,178 LINKING DATA FROM INTERVIEWS TO 4349 02:43:45,178 --> 02:43:47,480 OUR SMM SURVEILLANCE, TRYING TO 4350 02:43:47,480 --> 02:43:49,249 MAKE SURE THERE'S NO POTENTIAL 4351 02:43:49,249 --> 02:43:50,450 BIAS AFFECTING THE DATA THEY ARE 4352 02:43:50,450 --> 02:43:56,890 GOING TO COLLECT, WORKING WITH 4353 02:43:56,890 --> 02:44:00,593 THE BALTIMORE HEALTH COHORT, A 4354 02:44:00,593 --> 02:44:01,327 COMMUNITY ORGANIZATION, HOME 4355 02:44:01,327 --> 02:44:03,897 VISITING PROGRAM AND LARGE SET 4356 02:44:03,897 --> 02:44:06,065 OF INTERVENTIONS AND PROGRAMS 4357 02:44:06,065 --> 02:44:08,902 FOR PREGNANT AND POSTPARTUM 4358 02:44:08,902 --> 02:44:09,369 PATIENTS. 4359 02:44:09,369 --> 02:44:12,105 >> YES, WE'RE LOOKING 4360 02:44:12,105 --> 02:44:16,476 SPECIFICALLY, USING A 4361 02:44:16,476 --> 02:44:17,243 QUESTIONNAIRE TO ASSESS HEALTH 4362 02:44:17,243 --> 02:44:19,412 AND ADAPT FROM ONE OF THE ACOG 4363 02:44:19,412 --> 02:44:21,314 COMMUNITY OPINIONS THAT I 4364 02:44:21,314 --> 02:44:23,816 MENTIONED BEFORE. 4365 02:44:23,816 --> 02:44:25,351 4366 02:44:25,351 --> 02:44:26,219 >> WE'RE ACTUALLY NEARING THE 4367 02:44:26,219 --> 02:44:28,187 END OF OUR TIME TODAY BUT I DID 4368 02:44:28,187 --> 02:44:30,690 WANT TO END WITH ONE QUESTION 4369 02:44:30,690 --> 02:44:32,792 SPECIFICALLY FOR THE ENTIRE 4370 02:44:32,792 --> 02:44:34,427 PANEL RATHER. 4371 02:44:34,427 --> 02:44:36,429 WHAT CHALLENGES, SOLUTIONS, AND 4372 02:44:36,429 --> 02:44:37,964 LESSONS, SINCE WE'VE LEARNED 4373 02:44:37,964 --> 02:44:40,600 ABOUT, YOU KNOW, SIGNIFICANT 4374 02:44:40,600 --> 02:44:43,870 CHALLENGES IN BOTH THE UNITED 4375 02:44:43,870 --> 02:44:46,572 STATES AND GLOBALLY, WITH -- 4376 02:44:46,572 --> 02:44:49,342 ACROSS INCOME SETTINGS, WHAT 4377 02:44:49,342 --> 02:44:50,310 CHALLENGES, SOLUTIONS, AND 4378 02:44:50,310 --> 02:44:52,078 LESSONS COULD APPLY THE TWO 4379 02:44:52,078 --> 02:44:53,746 SETTINGS, THE USA AND GLOBALLY, 4380 02:44:53,746 --> 02:44:57,684 WHERE WE HAVE DIFFERENT TYPES OF 4381 02:44:57,684 --> 02:44:58,985 MATERNAL HEALTH CRISES 4382 02:44:58,985 --> 02:44:59,752 OCCURRING, CARDIOVASCULAR 4383 02:44:59,752 --> 02:45:01,287 HEALTH, BUT EQUALLY IN BOTH 4384 02:45:01,287 --> 02:45:01,688 PLACES. 4385 02:45:01,688 --> 02:45:03,890 WHAT RESEARCH OPPORTUNITIES DO 4386 02:45:03,890 --> 02:45:05,892 YOU FORESEE FOR GLOBAL 4387 02:45:05,892 --> 02:45:06,492 CORROBORATION IN LOW-RESOURCE 4388 02:45:06,492 --> 02:45:08,895 SETTINGS IN THE UNITED STATES OR 4389 02:45:08,895 --> 02:45:16,069 IN THE WEST, BUT SPECIFICALLY 4390 02:45:16,069 --> 02:45:21,607 THE USA AND INTERNATIONALLY. 4391 02:45:21,607 --> 02:45:24,143 >> MAYBE I CAN HAVE THE FIRST GO 4392 02:45:24,143 --> 02:45:24,477 HERE. 4393 02:45:24,477 --> 02:45:28,581 SO AS IN SO MANY THINGS IN 4394 02:45:28,581 --> 02:45:30,616 GLOBAL HEALTH, AISHA, I THINK 4395 02:45:30,616 --> 02:45:32,785 BUILDING A COMMUNITY OF 4396 02:45:32,785 --> 02:45:33,453 PRACTICE, PARTICULARLY AMONGST 4397 02:45:33,453 --> 02:45:35,188 PEOPLE WHO ARE WILLING TO 4398 02:45:35,188 --> 02:45:38,157 UNDERTAKE A DEEP DIVE IN THESE 4399 02:45:38,157 --> 02:45:41,627 ISSUES, NOT JUST FOR ADVOCACY 4400 02:45:41,627 --> 02:45:43,730 BUT ALSO FOR MEANINGFUL RESEARCH 4401 02:45:43,730 --> 02:45:44,330 PARTICULARLY AROUND PRIORITY 4402 02:45:44,330 --> 02:45:46,499 GAPS IS ONE OF THE MOST 4403 02:45:46,499 --> 02:45:47,500 IMPORTANT INITIAL STEPS. 4404 02:45:47,500 --> 02:45:48,701 AND I HOPE ONE OF MIGHT HAVE 4405 02:45:48,701 --> 02:45:50,670 REASONS FOR BEING INTERESTED IN 4406 02:45:50,670 --> 02:45:52,772 THIS PARTICULAR WORKSHOP WAS 4407 02:45:52,772 --> 02:45:53,840 THAT WE DESPERATELY NEEDED 4408 02:45:53,840 --> 02:45:55,675 COMMUNITY OF PRACTICE AROUND 4409 02:45:55,675 --> 02:45:57,677 SOME OF THESE ISSUES RELATED TO 4410 02:45:57,677 --> 02:46:00,913 MATERNAL HEALTH, WOMEN'S HEALTH 4411 02:46:00,913 --> 02:46:03,016 GLOBALLY, AROUND THE BASIC 4412 02:46:03,016 --> 02:46:04,117 MECHANISMS, UNDERSTANDING OF 4413 02:46:04,117 --> 02:46:05,084 SOME OF THE BIOLOGY, PHYSIOLOGY, 4414 02:46:05,084 --> 02:46:06,619 WHAT NEEDS TO BE DONE WITHIN 4415 02:46:06,619 --> 02:46:15,094 HEALTH SYSTEM FOR ADDRESSING THE 4416 02:46:15,094 --> 02:46:16,496 BURDEN OF NON-COMMUNICABLES, AND 4417 02:46:16,496 --> 02:46:18,698 FINDING AN OPPORTUNITY TO BUILD 4418 02:46:18,698 --> 02:46:20,900 A MORE HOLISTIC RESEARCH AND 4419 02:46:20,900 --> 02:46:23,936 INTERVENTION AGENDA THAT BRINGS 4420 02:46:23,936 --> 02:46:25,171 IN ELEMENTS BEYOND THE NARROW 4421 02:46:25,171 --> 02:46:26,806 DISCIPLINARY INTERESTS THAT WE 4422 02:46:26,806 --> 02:46:27,240 HAVE. 4423 02:46:27,240 --> 02:46:32,078 FOR EXAMPLE, IN REAL LIFE, 4424 02:46:32,078 --> 02:46:32,845 CARDIOVASCULAR DISEASES, 4425 02:46:32,845 --> 02:46:33,613 METABOLIC DISEASES, SOME OF 4426 02:46:33,613 --> 02:46:36,115 THESE ADVERSE ISSUES THAT WOMEN 4427 02:46:36,115 --> 02:46:37,984 FACE, ARE NOT DEALING FROM WHAT 4428 02:46:37,984 --> 02:46:39,852 MY COLLEAGUE WAS TALKING ABOUT, 4429 02:46:39,852 --> 02:46:41,587 THE SOCIAL DETERMINANTS OF 4430 02:46:41,587 --> 02:46:42,488 HEALTH, ISSUES WITH GENDER-BASED 4431 02:46:42,488 --> 02:46:44,857 VIOLENCE, THAT HAVE TO DO WITH 4432 02:46:44,857 --> 02:46:47,593 MARGINALIZATION, ISSUES THAT 4433 02:46:47,593 --> 02:46:50,229 HAVE TO DO WITH MENTAL HEALTH 4434 02:46:50,229 --> 02:46:53,633 AND THE POLY CRISIS MANY WOMEN 4435 02:46:53,633 --> 02:46:54,801 FACE. 4436 02:46:54,801 --> 02:46:57,003 IN SOUTH ASIA TODAY, INDIA AND 4437 02:46:57,003 --> 02:46:59,305 PAKISTAN, SOME OF THE MOST 4438 02:46:59,305 --> 02:47:01,274 IMPORTANT EMERGING AGENDA FOR 4439 02:47:01,274 --> 02:47:03,576 RESEARCH IN WOMEN DURING 4440 02:47:03,576 --> 02:47:04,343 PREGNANCY ARE EXPOSURES TO 4441 02:47:04,343 --> 02:47:07,647 EXTREME HEAT AND IMPACT THAT IT 4442 02:47:07,647 --> 02:47:09,916 HAS ON THEIR METABOLISM, 4443 02:47:09,916 --> 02:47:10,683 PHYSIOLOGY, IMPORTANTLY BIRTH 4444 02:47:10,683 --> 02:47:12,018 OUTCOMES, NOT JUST FOR THE FETUS 4445 02:47:12,018 --> 02:47:16,089 BUT ALSO FOR THE WOMAN HERSELF. 4446 02:47:16,089 --> 02:47:20,226 SO THOSE KIND OF INTERPOLATED 4447 02:47:20,226 --> 02:47:22,328 RESEARCH AGENDAS CANNOT BE MET 4448 02:47:22,328 --> 02:47:23,963 BY ONE RESEARCH GROUP ALONE. 4449 02:47:23,963 --> 02:47:25,531 ONE THING I'VE LEARNED IN 40 4450 02:47:25,531 --> 02:47:27,767 YEARS IN GLOBAL HEALTH STARTING 4451 02:47:27,767 --> 02:47:30,002 WITH MDGs IS THAT WE COULD NOT 4452 02:47:30,002 --> 02:47:31,971 ACHIEVE ANYTHING AROUND MATERNAL 4453 02:47:31,971 --> 02:47:34,073 AND CHILD MORTALITY REDUCTION IN 4454 02:47:34,073 --> 02:47:38,111 THE MDG PERIOD, FOCUS ON 4455 02:47:38,111 --> 02:47:39,545 MORTALITY REDUCTION, WITHOUT 4456 02:47:39,545 --> 02:47:40,213 PARTNERSHIPS. 4457 02:47:40,213 --> 02:47:41,180 COLLABORATIONS AROUND BRIDGING 4458 02:47:41,180 --> 02:47:41,380 GAPS. 4459 02:47:41,380 --> 02:47:42,849 WE DIDN'T BRIDGE EVERY GAP BUT 4460 02:47:42,849 --> 02:47:46,119 BRIDGED A LOT OF GAPS IN TERMS 4461 02:47:46,119 --> 02:47:48,087 OF EFFECTIVE INTERVENTIONS, 4462 02:47:48,087 --> 02:47:48,988 INTERVENTIONS AT SCALE, 4463 02:47:48,988 --> 02:47:50,623 MONITORING EVALUATION, 4464 02:47:50,623 --> 02:47:51,390 ACCOUNTABILITY. 4465 02:47:51,390 --> 02:47:58,931 AS WE MOVE INTO SBGs, GRANULAR 4466 02:47:58,931 --> 02:48:04,137 AGENDA, NOWHERE NEAR MEETING 4467 02:48:04,137 --> 02:48:06,405 TARGETS, THAT CANNOT BE MET 4468 02:48:06,405 --> 02:48:07,840 WITHOUT DEVELOPING A COMMUNITY 4469 02:48:07,840 --> 02:48:08,608 OF PRACTICE. 4470 02:48:08,608 --> 02:48:12,879 AND A COMMUNITY OF RESEARCH 4471 02:48:12,879 --> 02:48:13,546 COLLABORATION. 4472 02:48:13,546 --> 02:48:15,715 WITH LINKS TO POLICYMAKERS, TO 4473 02:48:15,715 --> 02:48:16,716 COMMUNITIES, AND OTHERS, TO 4474 02:48:16,716 --> 02:48:18,017 CREATE MOMENTUM THAT WILL TAKE 4475 02:48:18,017 --> 02:48:20,219 US FORWARD AND THAT IS WHAT IS 4476 02:48:20,219 --> 02:48:28,528 REQUIRED AT THIS POINT IN TIME 4477 02:48:28,528 --> 02:48:28,895 GLOBALLY. 4478 02:48:28,895 --> 02:48:30,062 THANK YOU. 4479 02:48:30,062 --> 02:48:34,033 >> I COULDN'T AGREE WITH MORE 4480 02:48:34,033 --> 02:48:36,502 WITH WHAT DR. BHUTTT WAS SAYING. 4481 02:48:36,502 --> 02:48:38,004 I DON'T CALL IT COMMUNITY OF 4482 02:48:38,004 --> 02:48:39,572 PRACTICE BECAUSE I THINK MORE 4483 02:48:39,572 --> 02:48:41,941 ABOUT QUALITY IMPROVEMENT AND 4484 02:48:41,941 --> 02:48:44,744 WHAT WE DO, HERE IN MARYLAND. 4485 02:48:44,744 --> 02:48:48,114 GLOBAL WORLD, I KIND OF TALK 4486 02:48:48,114 --> 02:48:48,881 ABOUT RESEARCH NETWORKS, 4487 02:48:48,881 --> 02:48:49,982 COLLABORATIONS ACROSS COUNTRIES 4488 02:48:49,982 --> 02:48:51,517 AND BORDERS. 4489 02:48:51,517 --> 02:48:53,920 SO I FULLY AGREE WE NEED TO 4490 02:48:53,920 --> 02:48:54,921 UNDERSTAND STILLBIRTHS, NOT ONLY 4491 02:48:54,921 --> 02:48:57,123 IN THE U.S., THERE'S AN 4492 02:48:57,123 --> 02:48:57,990 OPPORTUNITY TO UNDERSTAND 4493 02:48:57,990 --> 02:49:01,060 STILLBIRTH BY WORKING TOGETHER 4494 02:49:01,060 --> 02:49:04,330 WITH COLLEAGUES AT THE LONDON 4495 02:49:04,330 --> 02:49:05,565 SCHOOL, PAKISTAN, INDIA AND 4496 02:49:05,565 --> 02:49:06,866 OTHERS ALREADY DOING FANTASTIC 4497 02:49:06,866 --> 02:49:07,200 RESEARCH. 4498 02:49:07,200 --> 02:49:08,734 THERE'S SO MUCH TO LEARN ONLY IN 4499 02:49:08,734 --> 02:49:10,803 THIS SPACE. 4500 02:49:10,803 --> 02:49:14,640 THEN OF COURSE MATERNAL 4501 02:49:14,640 --> 02:49:15,741 MORBIDITY AND MORTALITY, EVEN 4502 02:49:15,741 --> 02:49:17,910 FURTHER INFANT HEALTH AS WELL. 4503 02:49:17,910 --> 02:49:20,446 RESEARCH COLLABORATIONS ARE VERY 4504 02:49:20,446 --> 02:49:20,746 MUCH NEEDED. 4505 02:49:20,746 --> 02:49:25,918 ESPECIALLY IF WE ARE TO USE THE 4506 02:49:25,918 --> 02:49:32,058 SAME DATA ELEMENT, SAME 4507 02:49:32,058 --> 02:49:34,894 METHODOLOGIES, HR SYSTEMS WHERE 4508 02:49:34,894 --> 02:49:35,895 THEY EXIST, RICH DATA SOURCES 4509 02:49:35,895 --> 02:49:40,900 THAT CAN BE USED ACROSS BORDERS 4510 02:49:40,900 --> 02:49:41,801 AND GLOBALLY. 4511 02:49:41,801 --> 02:49:42,668 >> DR. BANNERMAN? 4512 02:49:42,668 --> 02:49:44,537 >> I WANT TO SAY FIRST OF ALL I 4513 02:49:44,537 --> 02:49:47,206 AGREE WITH THE PRIOR TWO 4514 02:49:47,206 --> 02:49:48,140 SPEAKERS WHOLEHEARTEDLY, 4515 02:49:48,140 --> 02:49:49,675 PARTICULARLY IN THE CONTEXT OF 4516 02:49:49,675 --> 02:49:50,543 HAVING COMMON DATA ELEMENTS TO 4517 02:49:50,543 --> 02:49:52,712 HELP US UNDERSTAND WHAT'S GOING 4518 02:49:52,712 --> 02:49:53,779 WITH OUR PATIENTS. 4519 02:49:53,779 --> 02:49:56,349 WE HERE IN SAN DIEGO HAVE 4520 02:49:56,349 --> 02:49:57,550 COLLABORATIONS AROUND THE WORLD, 4521 02:49:57,550 --> 02:49:59,752 EVEN WITH SOME SPEAKERS WHO ARE 4522 02:49:59,752 --> 02:50:03,122 PARTICIPATING IN THE NEXT COUPLE 4523 02:50:03,122 --> 02:50:03,322 DAYS. 4524 02:50:03,322 --> 02:50:05,558 BUT I DO HAVE TO SAY THAT AS 4525 02:50:05,558 --> 02:50:08,628 LARGE AS THE WORLD APPEARS, EVEN 4526 02:50:08,628 --> 02:50:09,929 SMALLER THAN IT SEEMS LIVING IN 4527 02:50:09,929 --> 02:50:12,431 A BORDER STATE IN A BORDER CITY 4528 02:50:12,431 --> 02:50:13,966 WHERE WE SEE PATIENTS THAT COME 4529 02:50:13,966 --> 02:50:20,206 FROM ALL OVER THE WORLD, JUST 4530 02:50:20,206 --> 02:50:21,540 INTO SAN DIEGO, HAVE INCREDIBLE 4531 02:50:21,540 --> 02:50:23,075 CARDIOVASCULAR DISEASE UP FRONT 4532 02:50:23,075 --> 02:50:24,277 FROM REALLY PLACES YOU WOULDN'T 4533 02:50:24,277 --> 02:50:25,478 IMAGINE AROUND THE WORLD. 4534 02:50:25,478 --> 02:50:27,346 AND SO WE'RE TAKING CARE OF 4535 02:50:27,346 --> 02:50:29,448 THESE PATIENTS AND THINKING 4536 02:50:29,448 --> 02:50:31,050 ABOUT POLICIES AND RESEARCH, 4537 02:50:31,050 --> 02:50:32,918 THINKING ABOUT ALL THAT 4538 02:50:32,918 --> 02:50:36,756 TOGETHER, BUT WE DO NEED I THINK 4539 02:50:36,756 --> 02:50:38,190 BETTER WAYS TO WORK TOGETHER, TO 4540 02:50:38,190 --> 02:50:39,392 REALLY TAKE CARE OF SOME 4541 02:50:39,392 --> 02:50:41,027 PATIENTS THAT ARE VERY 4542 02:50:41,027 --> 02:50:43,229 ACTIONABLE BECAUSE WE ARE SEEING 4543 02:50:43,229 --> 02:50:44,764 THIS COME ACROSS OUR HOSPITALS 4544 02:50:44,764 --> 02:50:53,272 ALL THE TIME. 4545 02:50:53,272 --> 02:50:57,343 >> IF I CAN COME BACK ON ONE 4546 02:50:57,343 --> 02:50:58,878 POINT, AS I CLOSE, IN SOME 4547 02:50:58,878 --> 02:51:00,646 RECENT WORK THAT WE'VE BEEN 4548 02:51:00,646 --> 02:51:04,450 DOING MY GROUP'S BEEN DOING WITH 4549 02:51:04,450 --> 02:51:06,085 THE GATES FOUNDATION AND GATES 4550 02:51:06,085 --> 02:51:07,620 VENTURES ON WOMEN'S HEALTH AND 4551 02:51:07,620 --> 02:51:09,055 WELL-BEING ACROSS THE LIFE 4552 02:51:09,055 --> 02:51:12,425 COURSE, WHAT IS VERY CLEAR IS 4553 02:51:12,425 --> 02:51:13,626 THE INTERCONNECTEDNESS OF WHAT 4554 02:51:13,626 --> 02:51:16,395 HAPPENS IN EARLY LIFE, WHAT 4555 02:51:16,395 --> 02:51:18,030 HAPPENS IN THE MOST PRODUCTIVE 4556 02:51:18,030 --> 02:51:19,665 REPRODUCTIVE PERIOD OF WOMEN AND 4557 02:51:19,665 --> 02:51:20,766 WHAT HAPPENS LATER ON. 4558 02:51:20,766 --> 02:51:24,270 I THINK THERE'S AN OPPORTUNITY 4559 02:51:24,270 --> 02:51:30,276 IN ANY SCIENCE AGENDA RELATED TO 4560 02:51:30,276 --> 02:51:32,044 WOMENS HEALTH EVEN THE 4561 02:51:32,044 --> 02:51:33,212 REPRODUCTIVE PERIOD, HOW DOES 4562 02:51:33,212 --> 02:51:34,980 AFFECT WELL-BEING ACROSS THE 4563 02:51:34,980 --> 02:51:35,581 LIFE COWS PEOPLE ARE BEGINNING 4564 02:51:35,581 --> 02:51:38,050 TO LOOK AT WOMEN'S HEALTH NOT 4565 02:51:38,050 --> 02:51:44,223 THROUGH THE LENS OF REPRODUCTION 4566 02:51:44,223 --> 02:51:49,995 BEER INTERGENERATIONAL TRANSFER 4567 02:51:49,995 --> 02:51:53,399 OF HUMAN CAPITAL. 4568 02:51:53,399 --> 02:51:56,635 SORRY TO HAVE INTERJECTED. 4569 02:51:56,635 --> 02:51:58,738 >> I THINK mHEALTH IS 4570 02:51:58,738 --> 02:52:04,443 SOMETHING THAT COULD BE USED, IN 4571 02:52:04,443 --> 02:52:06,178 POPULATING, KNOWING WHICH WOMAN 4572 02:52:06,178 --> 02:52:08,047 IS GOING THROUGH WHAT EVENT. 4573 02:52:08,047 --> 02:52:10,449 WOMEN SHOULD HAVE THE HEALTH IN 4574 02:52:10,449 --> 02:52:13,619 THEIR OWN HANDS. 4575 02:52:13,619 --> 02:52:16,455 WE HAVE DIGITIZATION OF DATA, 4576 02:52:16,455 --> 02:52:18,324 WOMEN HAVE A MOBILE IN THEIR 4577 02:52:18,324 --> 02:52:20,192 HANDS, THAT SHOULD BE ONE WAY OF 4578 02:52:20,192 --> 02:52:24,029 REACHING OUT TO WOMEN, TO IMPART 4579 02:52:24,029 --> 02:52:26,232 EDUCATION ABOUT HEALTH, AND 4580 02:52:26,232 --> 02:52:29,635 WHERE THEY COULD BE -- WE SEE 4581 02:52:29,635 --> 02:52:31,036 COMPLETE INDIGENOUSIZATION ALL 4582 02:52:31,036 --> 02:52:32,805 OVER THE COUNTRY, ESPECIALLY IN 4583 02:52:32,805 --> 02:52:35,107 THE CONTEXT OF INDIA, WHERE ALL 4584 02:52:35,107 --> 02:52:38,944 THE INFORMATION IS THERE AT THE 4585 02:52:38,944 --> 02:52:39,245 FINGERTIPS. 4586 02:52:39,245 --> 02:52:40,913 WHY COULDN'T WE ADD HEALTH, 4587 02:52:40,913 --> 02:52:43,649 IMPORTANT HEALTH PARAMETERS TO 4588 02:52:43,649 --> 02:52:44,283 THIS DATA? 4589 02:52:44,283 --> 02:52:47,119 WE COULD JUST START WITH EARLY 4590 02:52:47,119 --> 02:52:48,888 CHILDHOOD, RIGHT FROM CHILDHOOD, 4591 02:52:48,888 --> 02:52:50,523 GOING TO THE REPRODUCTIVE YEARS, 4592 02:52:50,523 --> 02:52:52,958 THERE'S SOMETHING WHICH COULD BE 4593 02:52:52,958 --> 02:52:59,165 ADDED AND WHICH COULD BE DONE IF 4594 02:52:59,165 --> 02:53:01,367 THE GOVERNMENTS ARE TRACKING 4595 02:53:01,367 --> 02:53:03,769 CERTAIN THINGS, WHY DO NOT THEY 4596 02:53:03,769 --> 02:53:05,638 TRACK THE HEALTH OF OUR NATIONS, 4597 02:53:05,638 --> 02:53:10,209 AND THAT IS IMPORTANT IF YOU'RE 4598 02:53:10,209 --> 02:53:13,045 TRACKING THE REPRODUCTIVE CAREER 4599 02:53:13,045 --> 02:53:17,116 FOR WOMEN IF SHE HAS UNDERLYING 4600 02:53:17,116 --> 02:53:18,417 DISORDERS, IMPORTANT DATA THE 4601 02:53:18,417 --> 02:53:23,389 WOMAN CAN FEED HERSELF, LINK TO 4602 02:53:23,389 --> 02:53:25,891 HER OWN ID, THAT COULD BE 4603 02:53:25,891 --> 02:53:29,061 SOMETHING WITH RED FLAGS USED TO 4604 02:53:29,061 --> 02:53:30,596 OFFER HER SERVICES. 4605 02:53:30,596 --> 02:53:33,098 SO THAT'S ONE TECHNOLOGY THAT 4606 02:53:33,098 --> 02:53:37,136 COULD BE USED FOR THE 4607 02:53:37,136 --> 02:53:39,805 IMPROVEMENT OF HEALTH ACROSS THE 4608 02:53:39,805 --> 02:53:43,309 SOCIETY. 4609 02:53:43,309 --> 02:53:44,577 >> THANK YOU SO MUCH. 4610 02:53:44,577 --> 02:53:48,681 WELL, WE'RE AT THE END OF OUR 4611 02:53:48,681 --> 02:53:49,114 TIME. 4612 02:53:49,114 --> 02:53:50,316 AND WE STILL HAVE A FEW 4613 02:53:50,316 --> 02:53:51,750 QUESTIONS BUT HOPEFULLY I CAN 4614 02:53:51,750 --> 02:53:53,986 SEND THEM LATER ON TO SOME OF 4615 02:53:53,986 --> 02:53:54,353 YOU. 4616 02:53:54,353 --> 02:53:57,022 I WANT TO THANK EVERYBODY SO 4617 02:53:57,022 --> 02:54:01,193 MUCH FOR YOUR TIME AND FOR YOUR 4618 02:54:01,193 --> 02:54:03,496 INTERESTING THOUGHT-PROVOKING 4619 02:54:03,496 --> 02:54:05,965 COMMENTS AND PRESENTATIONS. 4620 02:54:05,965 --> 02:54:10,202 WE WILL BREAK FOR LUNCH AND SEE 4621 02:54:10,202 --> 02:54:12,071 EVERYBODY BACK AT 1:35 EASTERN 4622 02:54:12,071 --> 02:54:14,715 TIME. THANK YOU. 4623 02:54:14,715 --> 02:54:15,816 >> HI, EVERYONE. 4624 02:54:15,816 --> 02:54:17,351 WELCOME BACK TO OUR LUNCH BREAK. 4625 02:54:17,351 --> 02:54:18,986 I'M HONORED TO INTRODUCE THE 4626 02:54:18,986 --> 02:54:22,289 NEXT PANEL ON HEMATOLOGY AND 4627 02:54:22,289 --> 02:54:26,793 BLOOD TRANSFUSION, FAX YACHTER 4628 02:54:26,793 --> 02:54:29,196 IN MATERNAL MORBIDITY AND 4629 02:54:29,196 --> 02:54:31,164 MORTALITY, EXPLORING ADVANCING 4630 02:54:31,164 --> 02:54:32,132 IMPLEMENTATION RESEARCH, 4631 02:54:32,132 --> 02:54:33,267 TRAINING, CAPACITY BUILDING AS 4632 02:54:33,267 --> 02:54:36,069 RELATES TO MANAGING BLOOD 4633 02:54:36,069 --> 02:54:38,372 DISEASES AND MATERNAL HEALTH 4634 02:54:38,372 --> 02:54:39,806 THROUGH THE GLOBAL PERSPECTIVE. 4635 02:54:39,806 --> 02:54:41,909 WE HAVE AN EXCEPTIONAL LINEUP OF 4636 02:54:41,909 --> 02:54:42,643 SPEAKERS, IN THE INTEREST OF 4637 02:54:42,643 --> 02:54:46,914 TIME I'LL NOT GO THROUGH FULL 4638 02:54:46,914 --> 02:54:48,882 CREDENTIALS AND BACKGROUND BUT 4639 02:54:48,882 --> 02:54:51,318 LOOK AT THE PROGRAM BOOKLET FOR 4640 02:54:51,318 --> 02:54:51,752 INFORMATION. 4641 02:54:51,752 --> 02:54:56,023 THE FIRST SPEAKER IS DR. MAKANI, 4642 02:54:56,023 --> 02:54:56,990 POLICY AND PARTNERSHIPS, 4643 02:54:56,990 --> 02:54:58,425 IMPROVING MATERNAL HEALTH 4644 02:54:58,425 --> 02:55:00,727 OUTCOMES THROUGH HEMATOLOGY AND 4645 02:55:00,727 --> 02:55:02,362 PLOD TRANSFUSION. 4646 02:55:02,362 --> 02:55:05,098 SECONDS IS DR. PECKER, 4647 02:55:05,098 --> 02:55:06,099 DISCUSSING TRANSFORMING 4648 02:55:06,099 --> 02:55:09,703 PREGNANCY OUTCOMES FOR PEOPLE 4649 02:55:09,703 --> 02:55:13,006 WITH SICKLE CELL DISEASE. 4650 02:55:13,006 --> 02:55:14,207 DR. OPPONG AND DR. ASARE WILL 4651 02:55:14,207 --> 02:55:17,911 GIVE A JOINT PRESENTATION 4652 02:55:17,911 --> 02:55:18,912 ADDRESSING DISPROPORTIONATELY 4653 02:55:18,912 --> 02:55:20,547 HIGH MATERNAL AND PERINATAL 4654 02:55:20,547 --> 02:55:23,450 ASSOCIATED WITH SICKLE CELL 4655 02:55:23,450 --> 02:55:24,718 DISEASE IN A LOW AND MIDDLE 4656 02:55:24,718 --> 02:55:27,354 INCOME COUNTRY, ROLE OF 4657 02:55:27,354 --> 02:55:30,390 MULTI-DISCIPLINARY CARE. 4658 02:55:30,390 --> 02:55:32,392 FINALLY DR. PEPRA HAD ADDRESS 4659 02:55:32,392 --> 02:55:33,894 STRUCTURAL RACISM IN THE 4660 02:55:33,894 --> 02:55:35,195 SUCCESS, SUCCESS AND CHALLENGES 4661 02:55:35,195 --> 02:55:36,396 OF INTERVENTION AND 4662 02:55:36,396 --> 02:55:36,763 IMPLEMENTATION. 4663 02:55:36,763 --> 02:55:42,436 WITH THAT, I WILL NOW TURN IT 4664 02:55:42,436 --> 02:55:46,807 OVER TO DR. MAKANI. 4665 02:55:46,807 --> 02:55:48,141 >> HELLO. 4666 02:55:48,141 --> 02:55:50,310 THANK YOU VERY MUCH, DR. 4667 02:55:50,310 --> 02:55:50,577 GOLDBERG. 4668 02:55:50,577 --> 02:55:53,046 HELLO, EVERYONE. 4669 02:55:53,046 --> 02:55:58,518 I'M PROFESSOR JULIE MAKANI, 4670 02:55:58,518 --> 02:55:59,953 CALLING FROM TANZANIA, IT'S AN 4671 02:55:59,953 --> 02:56:01,922 HONOR TO PARTICIPATE IN THIS 4672 02:56:01,922 --> 02:56:02,155 SESSION. 4673 02:56:02,155 --> 02:56:03,991 I APOLOGIZE BUT I'M GOING TO 4674 02:56:03,991 --> 02:56:07,294 SWITCH MY VIDEO OFF AND SPEAK 4675 02:56:07,294 --> 02:56:09,262 FOR TEN MINUTES WITHOUT MY VIDEO 4676 02:56:09,262 --> 02:56:19,773 O THANK YOU FOR INVITING ME. 4677 02:56:19,773 --> 02:56:20,307 THANK YOU. 4678 02:56:20,307 --> 02:56:22,476 WHAT I'LL DO IS TALK ABOUT 4679 02:56:22,476 --> 02:56:23,710 POLICY AND PARTNERSHIPS, AND THE 4680 02:56:23,710 --> 02:56:25,012 IMPORTANCE OF POLICY AND 4681 02:56:25,012 --> 02:56:27,414 PARTNERSHIPS WHEN IT COMES TO 4682 02:56:27,414 --> 02:56:28,181 IMPROVING MATERNAL HEALTH 4683 02:56:28,181 --> 02:56:29,816 OUTCOMES THROUGH HEM TOLLING AND 4684 02:56:29,816 --> 02:56:30,717 BLOOD TRANSFUSION. 4685 02:56:30,717 --> 02:56:32,886 I WOULD LIKE TO ACKNOWLEDGE THAT 4686 02:56:32,886 --> 02:56:35,422 THIS IS WORK THAT'S BEEN DONE BY 4687 02:56:35,422 --> 02:56:40,994 MANY PEOPLE OVER MANY YEARS, AND 4688 02:56:40,994 --> 02:56:45,565 FROM MANY COUNTRIES AND PLACES. 4689 02:56:45,565 --> 02:56:46,767 SECONDLY TO RANCH PATIENT'S 4690 02:56:46,767 --> 02:56:48,969 COMMUNITY AS WELL AS FUNDERS. 4691 02:56:48,969 --> 02:56:51,471 I WILL TALK ABOUT THREE MAIN 4692 02:56:51,471 --> 02:56:51,805 AREAS. 4693 02:56:51,805 --> 02:56:53,140 POLICY AND PARTNERSHIPS, 4694 02:56:53,140 --> 02:56:55,308 MATERNAL HEALTH, AND HEMATOLOGY 4695 02:56:55,308 --> 02:56:55,876 AND BLOOD TRANSFUSION. 4696 02:56:55,876 --> 02:56:58,045 SO WHEN IT COMES TO POLICY AND 4697 02:56:58,045 --> 02:56:59,446 PARTNERSHIPS, WHAT I WILL DO IS 4698 02:56:59,446 --> 02:57:02,449 TALK ABOUT POLICY IN THE CONTEXT 4699 02:57:02,449 --> 02:57:05,185 OF FOUR MAIN SECTORS OR AREAS OR 4700 02:57:05,185 --> 02:57:08,688 MINISTERS WHEN WE THINK ABOUT 4701 02:57:08,688 --> 02:57:11,324 THE PERSPECTIVE OF GOVERNMENT 4702 02:57:11,324 --> 02:57:14,728 MINISTRIES IN AFRICA OR 4703 02:57:14,728 --> 02:57:18,532 DEPARTMENTS OF -- IN OTHER 4704 02:57:18,532 --> 02:57:18,799 COUNTRIES. 4705 02:57:18,799 --> 02:57:20,534 THERE'S FOUR POLICIES I'LL BE 4706 02:57:20,534 --> 02:57:22,135 REFERRING TO, ONE IS POLICY IN 4707 02:57:22,135 --> 02:57:23,136 HEALTH. 4708 02:57:23,136 --> 02:57:25,439 SECOND IS POLICY IN EDUCATION 4709 02:57:25,439 --> 02:57:27,074 FOCUSING ON HIGHER EDUCATION. 4710 02:57:27,074 --> 02:57:30,477 THIRD AREA IS RESEARCH. 4711 02:57:30,477 --> 02:57:32,746 SO WHAT ARE THE POLICY PLATFORMS 4712 02:57:32,746 --> 02:57:36,483 THAT ARE IN PLACE THAT WILL 4713 02:57:36,483 --> 02:57:38,218 SUPPORT HEMATOLOGY AND BLOOD 4714 02:57:38,218 --> 02:57:39,786 TRANSFUSION TO IMPROVE MATERNAL 4715 02:57:39,786 --> 02:57:42,289 HEALTH OUT, SO SCIENCE, 4716 02:57:42,289 --> 02:57:43,356 TECHNOLOGY, INNOVATION. 4717 02:57:43,356 --> 02:57:44,691 FOURTH AREA IS FOREIGN. 4718 02:57:44,691 --> 02:57:46,660 MAINLY BECAUSE AS A GLOBAL 4719 02:57:46,660 --> 02:57:48,295 COMMUNITY WE WANT TO LOOK HOW WE 4720 02:57:48,295 --> 02:57:49,930 CAN WORK WITH OTHER COUNTRIES, 4721 02:57:49,930 --> 02:57:52,466 HOW WE CAN WORK WITH 4722 02:57:52,466 --> 02:57:53,867 INSTITUTIONS IN OTHER AREAS, AND 4723 02:57:53,867 --> 02:57:59,372 SO BEING ABLE TO UNDERSTAND 4724 02:57:59,372 --> 02:58:00,107 FOREIGN POLICY PLATFORMS IN 4725 02:58:00,107 --> 02:58:01,308 PLACE IS QUITE IMPORTANT. 4726 02:58:01,308 --> 02:58:04,377 THE SECOND AREA IS PARTNERSHIPS. 4727 02:58:04,377 --> 02:58:08,215 THIS IS PARTNERSHIP FROM CONTEXT 4728 02:58:08,215 --> 02:58:09,850 OF MULTI-DISCIPLINARY, TWO 4729 02:58:09,850 --> 02:58:11,384 DISCIPLINES HERE ARE HEMATOLOGY 4730 02:58:11,384 --> 02:58:12,619 AND BLOOD TRANSFUSION, AND 4731 02:58:12,619 --> 02:58:13,920 MATERNAL AND CHILD HEALTH. 4732 02:58:13,920 --> 02:58:16,123 BUT THEN THE OTHER AREAS IN 4733 02:58:16,123 --> 02:58:21,795 TERMS OF PARTNERSHIPS 4734 02:58:21,795 --> 02:58:23,430 MULTI-SECTORIAL, GEOGRAPHIC. 4735 02:58:23,430 --> 02:58:25,832 WHEN WE TALK ABOUT IMPROVING 4736 02:58:25,832 --> 02:58:28,034 MATERNAL HEALTH OUTCOMES WE'RE 4737 02:58:28,034 --> 02:58:28,935 TALKING ABOUT MATERNAL HEALTH, 4738 02:58:28,935 --> 02:58:31,638 HEALTH OF THE WOMAN, PREGNANT 4739 02:58:31,638 --> 02:58:33,273 WOMAN, BEFORE, DURING, AFTER 4740 02:58:33,273 --> 02:58:33,540 DELIVERY. 4741 02:58:33,540 --> 02:58:36,243 AND WE'RE ALSO TALKING ABOUT 4742 02:58:36,243 --> 02:58:36,910 MATERNAL HEALTH FROM PERSPECTIVE 4743 02:58:36,910 --> 02:58:39,412 OF WELL WOMAN BECAUSE WE WANT TO 4744 02:58:39,412 --> 02:58:40,714 BE ABLE TO UNDERSTAND WHAT ARE 4745 02:58:40,714 --> 02:58:41,915 THE INTERVENTIONS THAT NEED TO 4746 02:58:41,915 --> 02:58:44,551 BE PUT IN PLACE BEFORE A WOMAN 4747 02:58:44,551 --> 02:58:48,288 STARTS HER REPRODUCTIVE CAREER. 4748 02:58:48,288 --> 02:58:50,457 THE SECOND ASPECT IS REALLY 4749 02:58:50,457 --> 02:58:52,025 IMPORTANT TO THINK ABOUT HEALTH 4750 02:58:52,025 --> 02:58:53,093 OUTCOME, NOT JUST OF THE MOTHER 4751 02:58:53,093 --> 02:58:55,061 BUT OF THE CHILD AS WELL. 4752 02:58:55,061 --> 02:58:57,497 AND SO WHEN WE'RE TALKING ABOUT 4753 02:58:57,497 --> 02:59:00,200 POLICY AND PARTNERSHIPS, WE HAVE 4754 02:59:00,200 --> 02:59:01,301 TO CONTEXTUALIZE MATERNAL HEALTH 4755 02:59:01,301 --> 02:59:05,739 AS WELL AS CHILD HEALTH ASPECT 4756 02:59:05,739 --> 02:59:06,439 OF THINGS. 4757 02:59:06,439 --> 02:59:08,441 WHEN WE TALK ABOUT HEMATOLOGY 4758 02:59:08,441 --> 02:59:10,177 AND BLOOD TRANSFUSION, WE REALLY 4759 02:59:10,177 --> 02:59:13,346 WANT TO LOOK AT OBSTETRIC 4760 02:59:13,346 --> 02:59:14,814 HEMATOLOGY AND HEMATOLOGY IN 4761 02:59:14,814 --> 02:59:15,916 GYNECOLOGY OR HEMATOLOGY IN 4762 02:59:15,916 --> 02:59:18,451 WOMEN BEFORE THEY EVEN COME TO A 4763 02:59:18,451 --> 02:59:20,954 HEALTH FACILITY, AND THREE MAIN 4764 02:59:20,954 --> 02:59:24,558 AREAS IN THIS SECTOR THAT ARE 4765 02:59:24,558 --> 02:59:25,325 IMPORTANT IS PERIPARTUM 4766 02:59:25,325 --> 02:59:27,093 HEMORRHAGE, PROBABLY IN THE TOP 4767 02:59:27,093 --> 02:59:28,929 THREE CAUSES OF MATERNAL 4768 02:59:28,929 --> 02:59:32,132 MORBIDITY AND MORTALITY, IN MANY 4769 02:59:32,132 --> 02:59:35,435 COUNTRIES IN AFRICA. 4770 02:59:35,435 --> 02:59:38,538 ANEMIA, AND THIS IS PERTINENT 4771 02:59:38,538 --> 02:59:38,872 PRE-PREGNANCY. 4772 02:59:38,872 --> 02:59:41,975 AND IT HAS A BIG BEARING BECAUSE 4773 02:59:41,975 --> 02:59:45,245 IF WOMEN GO INTO PREGNANCY WITH 4774 02:59:45,245 --> 02:59:47,347 A SEVERE ANEMIA OR LOW LEVEL OF 4775 02:59:47,347 --> 02:59:50,283 HEMOGLOBIN THIS WILL HAVE A HUGE 4776 02:59:50,283 --> 02:59:51,284 IMPACT WITH REGARDS TO MORBIDITY 4777 02:59:51,284 --> 02:59:53,587 AND MORTALITY AND THE OTHER 4778 02:59:53,587 --> 02:59:56,223 HEMATOLOGICAL CONDITIONS JUST AS 4779 02:59:56,223 --> 02:59:56,723 IMPORTANT. 4780 02:59:56,723 --> 02:59:59,292 CLOTTING, BLEEDING, OTHER 4781 02:59:59,292 --> 03:00:01,695 COMPLICATIONS THAT MAY RESULT. 4782 03:00:01,695 --> 03:00:03,129 WHEN WE TALK ABOUT TRANSFUSION 4783 03:00:03,129 --> 03:00:04,097 THIS IS PERTINENT. 4784 03:00:04,097 --> 03:00:09,336 WHEN YOU THINK, IF ANYONE GOES 4785 03:00:09,336 --> 03:00:10,570 TO A TRANSFUSION CENTER, EITHER 4786 03:00:10,570 --> 03:00:13,673 WITHIN THE HOSPITAL OR WITHIN A 4787 03:00:13,673 --> 03:00:14,441 BLOOD TRANSFUSION SERVICE, THEY 4788 03:00:14,441 --> 03:00:18,645 WILL TELL YOU THAT THE TOP TWO 4789 03:00:18,645 --> 03:00:21,948 USERS OF BLOOD TRANSFUSION ARE 4790 03:00:21,948 --> 03:00:23,717 PREGNANT WOMEN OR OBSTETRIC 4791 03:00:23,717 --> 03:00:28,855 WARD, AND SECOND IS ANEMIA -- OR 4792 03:00:28,855 --> 03:00:29,322 PEDIATRICS. 4793 03:00:29,322 --> 03:00:32,359 PEDIATRIC, THE DEMAND IS IN 4794 03:00:32,359 --> 03:00:33,793 TERMS OF NUMBERS, WHERE FOR 4795 03:00:33,793 --> 03:00:38,064 PREGNANT WOMEN THE DEMAND IS IN 4796 03:00:38,064 --> 03:00:39,266 TERMS OF VOLUME. 4797 03:00:39,266 --> 03:00:44,738 SO BLOOD BANKS AND BLOOD 4798 03:00:44,738 --> 03:00:50,644 TRANSFUSION CENTERS REALLY 4799 03:00:50,644 --> 03:00:52,279 APPRECIATE THE INTERLING WITH 4800 03:00:52,279 --> 03:00:55,248 TRANSFORM AND HEMATOLOGY AND 4801 03:00:55,248 --> 03:00:56,583 MATERNAL AND CHILD HEALTH 4802 03:00:56,583 --> 03:00:56,850 OUTCOMES. 4803 03:00:56,850 --> 03:00:58,551 WITH POLICIES ONE OF THE THINGS 4804 03:00:58,551 --> 03:01:01,821 I WANT TO SAY IS THAT WE ARE 4805 03:01:01,821 --> 03:01:02,889 VERY FORTUNATE. 4806 03:01:02,889 --> 03:01:06,426 WHEN I SAY WE, IT'S REFERRING TO 4807 03:01:06,426 --> 03:01:08,395 COUNTRIES IN AFRICA. 4808 03:01:08,395 --> 03:01:09,496 WE'RE VERY FORTUNATE BECAUSE 4809 03:01:09,496 --> 03:01:10,463 THERE HAVE BEEN POLICIES THAT 4810 03:01:10,463 --> 03:01:12,666 HAVE BEEN PUT IN PLACE THAT HAVE 4811 03:01:12,666 --> 03:01:15,702 RESULTED IN QUITE AN EXTENSIVE 4812 03:01:15,702 --> 03:01:17,804 IMPROVEMENT IN HEALTH FACILITIES 4813 03:01:17,804 --> 03:01:19,139 AS PRIMARY, SECONDARY, TERTIARY 4814 03:01:19,139 --> 03:01:19,472 LEVELS. 4815 03:01:19,472 --> 03:01:21,841 WHEN YOU LOOK AT MOST AFRICAN 4816 03:01:21,841 --> 03:01:23,610 COUNTRIES, THEY HAVE ADOPTED AND 4817 03:01:23,610 --> 03:01:24,711 HAVE BEEN WORKING STEADILY OVER 4818 03:01:24,711 --> 03:01:28,415 THE PAST FIVE TO TEN YEARS ON 4819 03:01:28,415 --> 03:01:29,949 UNIVERSAL HEALTH CARE, REALLY 4820 03:01:29,949 --> 03:01:32,285 FOCUSING ON COMMUNITY AND 4821 03:01:32,285 --> 03:01:34,020 POPULATION LEVEL HEALTH 4822 03:01:34,020 --> 03:01:34,321 FACILITIES. 4823 03:01:34,321 --> 03:01:36,056 WHICH MEANS THAT THERE ARE 4824 03:01:36,056 --> 03:01:37,957 PLATFORM THAT HAVE OPINION PUT 4825 03:01:37,957 --> 03:01:40,360 IN PLACE TO IMPROVE MATERNAL 4826 03:01:40,360 --> 03:01:41,127 HEALTH OUTINCLUDING HEMATOLOGY 4827 03:01:41,127 --> 03:01:43,296 AND BLOOD TRANSFUSION. 4828 03:01:43,296 --> 03:01:46,700 SECOND ASPECT, THIS WAS REALLY 4829 03:01:46,700 --> 03:01:49,002 ACCELERATED BY THE COVID-19 4830 03:01:49,002 --> 03:01:51,438 PANDEMIC WHEN THERE WAS GLOBAL 4831 03:01:51,438 --> 03:01:53,473 SHUTDOWNS, THERE WAS LIMITED 4832 03:01:53,473 --> 03:01:55,809 MOVEMENTS BETWEEN COUNTRIES, AND 4833 03:01:55,809 --> 03:01:58,778 THIS RESULTED IN ACCELERATION OF 4834 03:01:58,778 --> 03:02:00,313 IMPROVEMENT OF TERTIARY 4835 03:02:00,313 --> 03:02:01,614 HEALTHCARE FACILITIES, THESE ARE 4836 03:02:01,614 --> 03:02:03,583 TREATMENT CENTERS, CENTERS OF 4837 03:02:03,583 --> 03:02:05,752 EXCELLENCE, TERTIARY HOSPITALS, 4838 03:02:05,752 --> 03:02:09,155 AND REALLY FORCED COUNTRIES TO 4839 03:02:09,155 --> 03:02:09,723 LOOK AT REFERRAL PATHWAYS. 4840 03:02:09,723 --> 03:02:13,093 WHEN WE TALK ABOUT HEALTH POLICY 4841 03:02:13,093 --> 03:02:15,729 AND THE CONTEXT OF IMPROVING 4842 03:02:15,729 --> 03:02:17,764 MATERNAL HEALTH OUTCOMES, 4843 03:02:17,764 --> 03:02:18,598 HEMATOLOGY AND BLOOD 4844 03:02:18,598 --> 03:02:21,234 TRANSFUSION, PLATFORMS ARE IN 4845 03:02:21,234 --> 03:02:21,534 PLACE. 4846 03:02:21,534 --> 03:02:24,304 NOW WHAT WE CAN DO AS MEMBER 4847 03:02:24,304 --> 03:02:26,172 STATES OR COUNTRIES IN AFRICA, 4848 03:02:26,172 --> 03:02:27,907 PART OF THIS GLOBAL COMMUNITY, 4849 03:02:27,907 --> 03:02:29,576 IS WE NOW HAVE THE 4850 03:02:29,576 --> 03:02:30,643 INFRASTRUCTURE, WE HAVE THE 4851 03:02:30,643 --> 03:02:32,412 INFRASTRUCTURE IN PLACE AT 4852 03:02:32,412 --> 03:02:33,613 PRIMARY, SECONDARY AND TERTIARY 4853 03:02:33,613 --> 03:02:36,449 LEVEL; WE HAVE THE PEOPLE IN 4854 03:02:36,449 --> 03:02:39,419 PLACE AT THESE THREE LEVELS; AND 4855 03:02:39,419 --> 03:02:41,054 WE HAVE THE SYSTEMS IN PLACE 4856 03:02:41,054 --> 03:02:46,426 BECAUSE WHEN YOU LOOK AT BLOOD 4857 03:02:46,426 --> 03:02:48,395 TRANSFUSION SYSTEMS AND CHILD 4858 03:02:48,395 --> 03:02:49,696 AND MATERNAL HEALTH SYSTEMS 4859 03:02:49,696 --> 03:02:51,331 THESE HAVE BEEN STRENGTHENED 4860 03:02:51,331 --> 03:02:51,564 ACROSS. 4861 03:02:51,564 --> 03:02:53,199 THE GAP THAT I THINK IS THERE 4862 03:02:53,199 --> 03:02:56,669 WILL BE MET BY IMPLEMENTATION 4863 03:02:56,669 --> 03:02:59,305 SCIENCE BECAUSE IT'S REALLY 4864 03:02:59,305 --> 03:03:02,575 SAYING HOW CAN WE CONDUCT 4865 03:03:02,575 --> 03:03:04,344 IMPLEMENTATION SCIENCE AND 4866 03:03:04,344 --> 03:03:04,911 TRANSLATIONAL RESEARCH USING 4867 03:03:04,911 --> 03:03:06,312 THESE PLATFORMS THAT HAVE BEEN 4868 03:03:06,312 --> 03:03:10,250 PUT IN PLACE AND UNDERSTANDING 4869 03:03:10,250 --> 03:03:11,251 AND REVISING THE APPROACH THAT 4870 03:03:11,251 --> 03:03:12,652 WE HAVE. 4871 03:03:12,652 --> 03:03:14,087 WITHIN HEALTH POLICY, THE OTHER 4872 03:03:14,087 --> 03:03:15,522 THING THAT WE TALK ABOUT AND 4873 03:03:15,522 --> 03:03:17,590 YOU'LL HEAR A BIT MORE ABOUT 4874 03:03:17,590 --> 03:03:19,893 WITH MY OTHER COLLEAGUES IS 4875 03:03:19,893 --> 03:03:21,194 REALLY TRYING TO ADDRESS ACCESS 4876 03:03:21,194 --> 03:03:24,397 TO HEALTH CARE FROM AN EQUITY 4877 03:03:24,397 --> 03:03:25,365 PERSPECTIVE, QUALITY 4878 03:03:25,365 --> 03:03:27,700 PERSPECTIVE, FROM MAKING SURE 4879 03:03:27,700 --> 03:03:32,505 THAT ANY PREGNANT WOMAN DOES NOT 4880 03:03:32,505 --> 03:03:33,640 HAVE DIFFICULTY ACCESSING GOOD 4881 03:03:33,640 --> 03:03:35,375 QUALITY HEALTH CARE WHEN THEY 4882 03:03:35,375 --> 03:03:36,576 NEED IT, WHETHER NEAR THEIR 4883 03:03:36,576 --> 03:03:38,077 HOMES OR WHEN THEY NEED IT WHEN 4884 03:03:38,077 --> 03:03:41,481 THEY ARE REFERRED TO ANOTHER 4885 03:03:41,481 --> 03:03:41,915 HEALTH FACILITY. 4886 03:03:41,915 --> 03:03:44,451 SO IN TERMS OF POLICIES, THE 4887 03:03:44,451 --> 03:03:47,620 OTHER POLICIES THAT WE NEED TO 4888 03:03:47,620 --> 03:03:50,457 TAKE INTO ACCOUNT, POLICIES IN 4889 03:03:50,457 --> 03:03:51,658 EDUCATION, SCIENCE, AND 4890 03:03:51,658 --> 03:03:51,958 TECHNOLOGY. 4891 03:03:51,958 --> 03:03:53,126 AND, AGAIN, THIS IS IMPORTANT 4892 03:03:53,126 --> 03:03:58,097 BECAUSE WE NEED TO BE ABLE TO 4893 03:03:58,097 --> 03:03:59,666 CONVINCE THE POLICYMAKERS IN 4894 03:03:59,666 --> 03:04:01,434 EDUCATION, IN SCIENCE AND 4895 03:04:01,434 --> 03:04:03,837 TECHNOLOGY, THE ROLE AND THE 4896 03:04:03,837 --> 03:04:05,138 VALUE OF IMPLEMENTATION SCIENCE, 4897 03:04:05,138 --> 03:04:07,440 THE ROLE AND VALUE OF 4898 03:04:07,440 --> 03:04:09,175 TRANSLATIONAL RESEARCH, SO IT'S 4899 03:04:09,175 --> 03:04:11,811 NOT LOOKED AT AS A SEPARATE 4900 03:04:11,811 --> 03:04:14,013 THING BUT IT'S LOOKED AT AS PART 4901 03:04:14,013 --> 03:04:15,682 AND PARCEL OF HEALTH POLICIES. 4902 03:04:15,682 --> 03:04:17,951 THERE'S A TENDENCY OF LOOKING AT 4903 03:04:17,951 --> 03:04:20,720 THESE EITHER SEQUENTIALLY OR AS 4904 03:04:20,720 --> 03:04:22,555 TWO SEPARATE AREAS, AND IT'S 4905 03:04:22,555 --> 03:04:25,959 REALLY A ROLE, THIS IS WHERE, 4906 03:04:25,959 --> 03:04:28,061 AGAIN, IMPLEMENTATION SCIENCE 4907 03:04:28,061 --> 03:04:30,463 COMES IN TO IT, CREATING A 4908 03:04:30,463 --> 03:04:32,232 BRIDGE BETWEEN HEALTH POLICY, 4909 03:04:32,232 --> 03:04:32,932 EDUCATION POLICY, HEALTH 4910 03:04:32,932 --> 03:04:34,901 RESEARCH POLICY. 4911 03:04:34,901 --> 03:04:37,270 I THINK THE FINAL SECTION WITH 4912 03:04:37,270 --> 03:04:39,138 REGARDS TO POLICY, WHAT WE 4913 03:04:39,138 --> 03:04:41,241 MENTIONED BEFORE, WHEN WE TALK 4914 03:04:41,241 --> 03:04:41,875 ABOUT PUBLIC POLICY WE NEED TO 4915 03:04:41,875 --> 03:04:43,910 THINK ABOUT THIS IN THE CONTEXT 4916 03:04:43,910 --> 03:04:45,211 OF FOREIGN POLICY. 4917 03:04:45,211 --> 03:04:48,381 WE NEED TO ENGAGE OUR 4918 03:04:48,381 --> 03:04:49,249 GOVERNMENTS, ENGAGE OUR 4919 03:04:49,249 --> 03:04:50,884 POLICYMAKERS SO WE CAN EXPLAIN 4920 03:04:50,884 --> 03:04:53,353 TO THEM WHY IT'S IMPORTANT FOR 4921 03:04:53,353 --> 03:04:55,922 US IN TANZANIA TO WORK WITH 4922 03:04:55,922 --> 03:04:57,690 COLLEAGUES IN UGANDA, IN GHANA, 4923 03:04:57,690 --> 03:04:58,858 AS WELL AS COLLEAGUES IN THE 4924 03:04:58,858 --> 03:05:00,960 U.S., IN THE U.K., IN INDIA 4925 03:05:00,960 --> 03:05:03,730 BECAUSE WE NEED TO BE ABLE TO 4926 03:05:03,730 --> 03:05:09,068 LOOK AND WORK TOGETHER AT 4927 03:05:09,068 --> 03:05:10,603 BILATERAL LEVEL AND MOMENT 4928 03:05:10,603 --> 03:05:11,905 LATERAL LEVEL TO EXCHANGE 4929 03:05:11,905 --> 03:05:13,339 KNOWLEDGE AND LEARN FROM EACH 4930 03:05:13,339 --> 03:05:14,007 OTHER. 4931 03:05:14,007 --> 03:05:16,743 THE OTHER SECTOR IS INVESTMENT 4932 03:05:16,743 --> 03:05:18,177 FROM PLANNING, FROM FINANCE, 4933 03:05:18,177 --> 03:05:20,780 FROM TRADE AND INDUSTRY BECAUSE 4934 03:05:20,780 --> 03:05:22,782 WE KNOW THAT THERE'S BEEN QUITE 4935 03:05:22,782 --> 03:05:26,486 A LOT OF INVESTMENT IN BUILDING 4936 03:05:26,486 --> 03:05:27,387 OF PLATFORMS, INFRASTRUCTURE, 4937 03:05:27,387 --> 03:05:28,321 FACILITIES TRAINING PEOPLE, BUT 4938 03:05:28,321 --> 03:05:30,723 WE NEED TO DO MORE. 4939 03:05:30,723 --> 03:05:33,359 THERE ARE PLACES WITH GAPS, NOT 4940 03:05:33,359 --> 03:05:35,028 ENOUGH HUMAN RESOURCES IN 4941 03:05:35,028 --> 03:05:37,664 HEALTH, AND THEREFORE WE NEED TO 4942 03:05:37,664 --> 03:05:39,732 CONVINCE MINISTRY OF FINANCE, 4943 03:05:39,732 --> 03:05:41,167 MINISTRIES OF TRAINING, THEY 4944 03:05:41,167 --> 03:05:43,536 NEED TO INVEST IN THIS SECTOR 4945 03:05:43,536 --> 03:05:44,971 AND IT WILL HAVE A GOOD RETURN. 4946 03:05:44,971 --> 03:05:46,839 IN TERMS OF POLICY, IT'S REALLY 4947 03:05:46,839 --> 03:05:48,875 MAKING SURE THE POLICIES ARE IN 4948 03:05:48,875 --> 03:05:55,048 PLACE FOR THE PRIVATE SECTOR, 4949 03:05:55,048 --> 03:05:56,449 CIVIL SOCIETY ORGANIZATIONS, 4950 03:05:56,449 --> 03:05:58,117 PATIENT AND COMMUNITY-BASED 4951 03:05:58,117 --> 03:06:01,254 ORGANIZATIONS AND NON-STATE 4952 03:06:01,254 --> 03:06:01,588 ORGANIZATIONS. 4953 03:06:01,588 --> 03:06:03,356 THAT'S WHY I STARTED WITH 4954 03:06:03,356 --> 03:06:05,325 POLICY, TRYING TO EMPHASIZE THE 4955 03:06:05,325 --> 03:06:08,261 ROLE OF POLICY IN THIS SPACE AND 4956 03:06:08,261 --> 03:06:10,663 IN FACILITATING IMPLEMENTATION 4957 03:06:10,663 --> 03:06:13,099 SCIENCE IN THIS SPACE. 4958 03:06:13,099 --> 03:06:14,934 NOW I'LL SPEND THE NEXT THREE OR 4959 03:06:14,934 --> 03:06:16,469 FIVE MINUTES TALKING ABOUT 4960 03:06:16,469 --> 03:06:17,370 PARTNERSHIPS. 4961 03:06:17,370 --> 03:06:18,771 FIRST AS I MENTIONED IN TERMS OF 4962 03:06:18,771 --> 03:06:20,840 LOOKING AT PARTNERSHIP THERE'S 4963 03:06:20,840 --> 03:06:24,143 BEEN QUITE A LOT, I'M ENVIOUS 4964 03:06:24,143 --> 03:06:26,245 LOOKING AT COLLEAGUES IN 4965 03:06:26,245 --> 03:06:27,981 OBSTETRICS AND GYNECOLOGY, HOW 4966 03:06:27,981 --> 03:06:32,251 THEY HAVE REALLY PUT IN ROBUST 4967 03:06:32,251 --> 03:06:34,320 SYSTEMS TO IMPROVE ANTENATAL 4968 03:06:34,320 --> 03:06:36,055 CARE, PERIPARTUM CARE, TO REALLY 4969 03:06:36,055 --> 03:06:38,024 ADDRESS THE WELL WOMAN BEFORE 4970 03:06:38,024 --> 03:06:39,359 SHE STARTS HER REPRODUCTIVE 4971 03:06:39,359 --> 03:06:39,659 JOURNEY. 4972 03:06:39,659 --> 03:06:43,730 WHEN YOU LOOK AT CHILD HEALTH, 4973 03:06:43,730 --> 03:06:45,164 THERE ARE INCREDIBLY SUCCESSFUL 4974 03:06:45,164 --> 03:06:46,699 IN TERMS OF HUMANIZATION 4975 03:06:46,699 --> 03:06:49,636 PROGRAMS, MANY COUNTRIES WILL BE 4976 03:06:49,636 --> 03:06:51,971 ABLE TO TELL YOU THAT 4977 03:06:51,971 --> 03:06:53,506 IMMUNIZATION IS PROBABLY BETWEEN 4978 03:06:53,506 --> 03:06:58,277 80 TO 100%, WITH REGARDS TO 4979 03:06:58,277 --> 03:06:59,512 GETTING THE BABIES WHO NEED OR 4980 03:06:59,512 --> 03:07:04,417 WHO ARE PART OF THEIR PROGRAMS 4981 03:07:04,417 --> 03:07:05,852 OF IMMUNIZATION. 4982 03:07:05,852 --> 03:07:07,387 I THINK THERE ARE PLATFORMS IN 4983 03:07:07,387 --> 03:07:11,924 PLACE WITH REGARDS TO HIV IN 4984 03:07:11,924 --> 03:07:13,192 CHILD HEALTHS, PREVENTING 4985 03:07:13,192 --> 03:07:14,127 MOTHER-TO-CHILD TRANSMISSION, 4986 03:07:14,127 --> 03:07:17,030 PROGRAMS FOR EARLY INFANT 4987 03:07:17,030 --> 03:07:18,564 DIAGNOSIS, FANTASTIC PLATFORMS 4988 03:07:18,564 --> 03:07:20,099 FOR NEWBORN SCREENINGS FOR 4989 03:07:20,099 --> 03:07:22,835 SICKLE CELL DISEASE OR NEWBORN 4990 03:07:22,835 --> 03:07:24,671 SCREENING FOR OTHER HEMATOLOGIC 4991 03:07:24,671 --> 03:07:25,304 CONDITIONS. 4992 03:07:25,304 --> 03:07:31,144 THIS SEGUES IN QUITE WELL INTO 4993 03:07:31,144 --> 03:07:34,013 PROGRAMS FOR CHILD HEALTH, AN 4994 03:07:34,013 --> 03:07:36,516 EXAMPLE IS THE INTEGRATED 4995 03:07:36,516 --> 03:07:37,917 MANAGEMENT OF ILLNESSES. 4996 03:07:37,917 --> 03:07:39,285 THE PARTNERSHIPS, IT'S REALLY 4997 03:07:39,285 --> 03:07:40,553 LOOKING AT HEALTH, YOU'RE HEAR 4998 03:07:40,553 --> 03:07:42,221 ABOUT THAT BUT I WANTED TO 4999 03:07:42,221 --> 03:07:45,491 MENTION A FEW PARTNERSHIPS IN 5000 03:07:45,491 --> 03:07:45,725 HEALTH. 5001 03:07:45,725 --> 03:07:48,428 SICKLE CELL DISEASE AT CENTER 5002 03:07:48,428 --> 03:07:49,962 LEVEL, REGIONAL LEVEL WHERE, 5003 03:07:49,962 --> 03:07:51,731 EAST AFRICA, WEST AFRICA, 5004 03:07:51,731 --> 03:07:54,734 AFRICAN LEVEL WITH EXAMPLES LIKE 5005 03:07:54,734 --> 03:07:58,971 SICKLE IN AFRICA. 5006 03:07:58,971 --> 03:07:59,806 THIS AND OTHER HEMATOLOGIC 5007 03:07:59,806 --> 03:08:03,443 CONDITIONS ARE PART OF 5008 03:08:03,443 --> 03:08:03,943 NON-COMMUNICABLE DISEASE 5009 03:08:03,943 --> 03:08:06,279 NETWORK, W.H.O. AFRO COUNTRIES, 5010 03:08:06,279 --> 03:08:09,882 AFRICA AND REGION OFFICES IN 5011 03:08:09,882 --> 03:08:17,356 W.H.O., HAVE ADOPTED THE 5012 03:08:17,356 --> 03:08:21,694 STRATEGY FOR TYPE 1 DIABETES, 5013 03:08:21,694 --> 03:08:27,433 SICKLE CELL DISEASE, AND HEART 5014 03:08:27,433 --> 03:08:28,801 DISEASE. 5015 03:08:28,801 --> 03:08:30,103 BLOOD TRANSFUSION HAS BEEN 5016 03:08:30,103 --> 03:08:31,637 STRENGTHENED, PLATFORMS FOR 5017 03:08:31,637 --> 03:08:32,505 IMPLEMENTATION SCIENCE RESEARCH. 5018 03:08:32,505 --> 03:08:34,273 I WANTED TO MENTION ABOUT 5019 03:08:34,273 --> 03:08:36,776 SCIENCE AND TECHNOLOGY, HERE THE 5020 03:08:36,776 --> 03:08:39,112 NIH WORKING WITH PARTNERS 5021 03:08:39,112 --> 03:08:40,847 FUNDING HEALTH RESEARCH HAVE, 5022 03:08:40,847 --> 03:08:43,549 AGAIN, OVER THE PAST TEN, 5023 03:08:43,549 --> 03:08:45,218 FIFTEEN YEARS, STRENGTHED 5024 03:08:45,218 --> 03:08:46,119 GENOMIC RESEARCH THROUGH 5025 03:08:46,119 --> 03:08:47,286 H3AFRICA DATA SCIENCE RESEARCH 5026 03:08:47,286 --> 03:08:50,022 AS WELL AS SICK UNTIL AFRICA, 5027 03:08:50,022 --> 03:08:51,324 THESE ARE NETWORKS THAT CAN THEN 5028 03:08:51,324 --> 03:08:54,393 NOW BE USED FOR IMPLEMENTATION 5029 03:08:54,393 --> 03:08:55,828 SCIENCE AND TRANSLATIONAL 5030 03:08:55,828 --> 03:08:56,095 RESEARCH. 5031 03:08:56,095 --> 03:09:00,433 BLOOD TRANSFUSION EXAMPLES OF 5032 03:09:00,433 --> 03:09:01,968 PLATFORMS ARE RED, BLOOD SAFE 5033 03:09:01,968 --> 03:09:07,740 GENE AND CELL THERAPY IS PART OF 5034 03:09:07,740 --> 03:09:09,408 THE CELL INITIATIVE. 5035 03:09:09,408 --> 03:09:11,577 THE OTHER IS FINANCING 5036 03:09:11,577 --> 03:09:12,345 PARTNERSHIPS. 5037 03:09:12,345 --> 03:09:13,780 NO ONE FUNDER, NO ONE ENTITY 5038 03:09:13,780 --> 03:09:15,148 WILL BE ABLE TO ADDRESS THE 5039 03:09:15,148 --> 03:09:17,817 NEEDS SO WE NEED TO THINK ABOUT 5040 03:09:17,817 --> 03:09:21,120 FUNDING PARTNERSHIPS, AND BEING 5041 03:09:21,120 --> 03:09:22,655 ABLE TO LOOK AND INTEGRATE AND 5042 03:09:22,655 --> 03:09:24,857 LOOK FOR AREAS OF CONVERGENCE. 5043 03:09:24,857 --> 03:09:28,227 FINALLY, THIS IS MY LAST 5044 03:09:28,227 --> 03:09:29,762 COMMENT, IN CLOSING TO EMPHASIZE 5045 03:09:29,762 --> 03:09:31,063 THREE THINGS. 5046 03:09:31,063 --> 03:09:34,033 THE FIRST IS WE NEED TO BE ABLE 5047 03:09:34,033 --> 03:09:36,302 TO ADDRESS AND HAVE AN IMPACT ON 5048 03:09:36,302 --> 03:09:37,870 THE PATIENTS. 5049 03:09:37,870 --> 03:09:39,705 AT THE SAME TIME WE NEED TO HAVE 5050 03:09:39,705 --> 03:09:40,873 AN IMPACT ON THE POPULATION, 5051 03:09:40,873 --> 03:09:51,584 THIS IS WHERE I WHERE THE IMPLN 5052 03:09:53,820 --> 03:09:55,121 SCIENCE IS ABLE TO BRIDGE. 5053 03:09:55,121 --> 03:09:59,358 WE START DOING IT NOW, CHANGE, 5054 03:09:59,358 --> 03:10:00,693 REVISE AND MODIFY, AND 5055 03:10:00,693 --> 03:10:01,727 IMPLEMENTATION SCIENCE PROVIDES 5056 03:10:01,727 --> 03:10:06,165 THAT FRAMEWORK TO DO THAT. 5057 03:10:06,165 --> 03:10:08,000 IT'S REALLY EMPHASIZING WE 5058 03:10:08,000 --> 03:10:08,901 CANNOT DO THIS ALONE. 5059 03:10:08,901 --> 03:10:09,902 WE HAVE TO PARTNER WITH EACH 5060 03:10:09,902 --> 03:10:11,204 OTHER AND HAVE THE RIGHT 5061 03:10:11,204 --> 03:10:13,606 POLICIES IN PLACE TO MAKE AN 5062 03:10:13,606 --> 03:10:15,775 IMPACT IN IMPROVING THE HEALTH 5063 03:10:15,775 --> 03:10:18,411 OF PREGNANT WOMEN OR IMPROVING 5064 03:10:18,411 --> 03:10:19,612 THE MATERNAL HEALTH OUTTHROUGH 5065 03:10:19,612 --> 03:10:22,248 THE LENS OF HEMATOLOGY AND BLOOD 5066 03:10:22,248 --> 03:10:22,548 TRANSFUSION. 5067 03:10:22,548 --> 03:10:32,992 THANK YOU FOR LISTENING. 5068 03:10:36,662 --> 03:10:39,765 OVER TO YOU. 5069 03:10:39,765 --> 03:10:40,633 >> GOOD AFTERNOON FROM 5070 03:10:40,633 --> 03:10:40,900 BALTIMORE. 5071 03:10:40,900 --> 03:10:43,936 IT'S A PLEASURE TO TALK TO YOU 5072 03:10:43,936 --> 03:10:44,804 ABOUT PREGNANCY OUTCOMES FOR 5073 03:10:44,804 --> 03:10:45,571 PEOPLE WITH SICKLE CELL. 5074 03:10:45,571 --> 03:10:51,444 MY FOCUS WILL BE ON THE U.S., 5075 03:10:51,444 --> 03:10:52,078 CONTEXT, HOWEVER, OUTCOMES ARE 5076 03:10:52,078 --> 03:10:53,112 SUFFICIENTLY POOR IN THE UNITED 5077 03:10:53,112 --> 03:10:54,881 STATES, THIS IS AN AREA WE HAVE 5078 03:10:54,881 --> 03:10:57,516 TO KEEP LEARNING AND 5079 03:10:57,516 --> 03:10:58,217 COLLABORATING INTERNATIONALLY 5080 03:10:58,217 --> 03:11:00,119 AND PARTNERSHIPS WITH FOLKS 5081 03:11:00,119 --> 03:11:03,055 ACROSS DIVERSE RESOURCED 5082 03:11:03,055 --> 03:11:03,322 SETTINGS. 5083 03:11:03,322 --> 03:11:05,391 NEXT SLIDE PLEASE. 5084 03:11:05,391 --> 03:11:07,026 THESE ARE MY DISCLOSURES, LUCKY 5085 03:11:07,026 --> 03:11:10,429 TO HAVE RESEARCH FUNDING AND DO 5086 03:11:10,429 --> 03:11:12,932 CONSULTING WORK, CO-FOUNDER OF 5087 03:11:12,932 --> 03:11:15,568 SICKLE CELL REPRODUCTIVE HEALTH 5088 03:11:15,568 --> 03:11:17,570 EDUCATION DIRECTIVE AND SERVE ON 5089 03:11:17,570 --> 03:11:18,437 THE ADVISORY COMMITTEE FOR 5090 03:11:18,437 --> 03:11:19,639 FOUNDATION FOR WOMEN AND GIRLS 5091 03:11:19,639 --> 03:11:24,977 WITH BLOOD DISEASE. DISEASE. 5092 03:11:24,977 --> 03:11:26,646 THIS IS A BRIEF OVERVIEW FOR 5093 03:11:26,646 --> 03:11:29,048 PEOPLE WITH SICKLE CELL DISEASE 5094 03:11:29,048 --> 03:11:30,917 PARTICULARLY PEOPLE WITH OVARIES 5095 03:11:30,917 --> 03:11:32,418 IN CONTEMPORARY SICKLE CELL 5096 03:11:32,418 --> 03:11:34,720 DISEASE CARE. 5097 03:11:34,720 --> 03:11:37,990 AND THESE CONCERNS NOW BEGIN 5098 03:11:37,990 --> 03:11:40,860 WITH REALLY QUITE MOMENTOUS 5099 03:11:40,860 --> 03:11:43,162 TREATMENT CHOICES LIKE BONE 5100 03:11:43,162 --> 03:11:47,433 NARROW TRANSPLANT, GENE THERAPY, 5101 03:11:47,433 --> 03:11:53,639 BOTH GONADOTOXIC AT THE MOMENT, 5102 03:11:53,639 --> 03:11:54,974 REQUIRED PRESSURE FOR 5103 03:11:54,974 --> 03:11:59,245 POLICYMAKERS TO IMPROVE ACCESS 5104 03:11:59,245 --> 03:12:00,579 TO FERTILITY RESERVATION AND 5105 03:12:00,579 --> 03:12:00,780 CARE. 5106 03:12:00,780 --> 03:12:01,547 ANOTHER STEP FOR PEOPLE WERE 5107 03:12:01,547 --> 03:12:05,384 SICKLE CELL DISEASE IS MAKING 5108 03:12:05,384 --> 03:12:06,485 COMPLEX PRE-CONCEPTION 5109 03:12:06,485 --> 03:12:08,754 REPRODUCTIVE HEALTH DECISIONS. 5110 03:12:08,754 --> 03:12:09,889 I WANTED TO POINT FOLKS' 5111 03:12:09,889 --> 03:12:12,091 ATTENTION TO THE FACT THAT THE 5112 03:12:12,091 --> 03:12:14,060 CENTER FOR DISEASE CONTROL AND 5113 03:12:14,060 --> 03:12:16,662 PREVENTION RELEASED THEIR NEW 5114 03:12:16,662 --> 03:12:18,331 MEDICAL ELIGIBILITY CRITERIA FOR 5115 03:12:18,331 --> 03:12:20,399 CONTRACEPTION WITH CHANGED 5116 03:12:20,399 --> 03:12:21,934 RECOMMENDATIONS FOR FIRST LINE 5117 03:12:21,934 --> 03:12:22,702 CONTRACEPTION FOR INDIVIDUALS 5118 03:12:22,702 --> 03:12:25,871 WITH SICKLE CELL DISEASE, THESE 5119 03:12:25,871 --> 03:12:26,839 RECOMMENDATIONS IN BRIEF MAKE 5120 03:12:26,839 --> 03:12:28,174 PROGESTERONE ONLY CONTRACEPTION 5121 03:12:28,174 --> 03:12:30,910 FIRST LINE FOR SICKLE CELL 5122 03:12:30,910 --> 03:12:33,312 DISEASE, AND PUT MORE TIGHTER 5123 03:12:33,312 --> 03:12:37,683 RESTRICTIONS ON RECOMMENDATIONS 5124 03:12:37,683 --> 03:12:38,184 FOR ESTROGEN-CONTAINING 5125 03:12:38,184 --> 03:12:40,653 CONTRACEPTIVE USE BECAUSE OF 5126 03:12:40,653 --> 03:12:47,226 THROMBOTIC RISKS ASSOCIATED WITH 5127 03:12:47,226 --> 03:12:48,627 ESTROGEN BALANCING AGAINST 5128 03:12:48,627 --> 03:12:50,896 THROMBOTIC RISK OF PREGNANCY AND 5129 03:12:50,896 --> 03:12:52,131 HIGH RISK PREGNANCY, AN ABIDING 5130 03:12:52,131 --> 03:12:53,699 CONCERN FOR YOUR COMMUNITIES. 5131 03:12:53,699 --> 03:12:55,468 NEXT SLIDE PLEASE. 5132 03:12:55,468 --> 03:12:57,937 SO JUST A BACKGROUND, IN JAMAICA 5133 03:12:57,937 --> 03:13:01,007 AND THE UNITED STATES AND MANY, 5134 03:13:01,007 --> 03:13:01,640 I SUSPECT, OTHER PLACES, 5135 03:13:01,640 --> 03:13:02,775 MORBIDITY AND MORTALITY FOR 5136 03:13:02,775 --> 03:13:04,410 PREGNANT PEOPLE WITH SICKLE CELL 5137 03:13:04,410 --> 03:13:05,711 DISEASE IS STAGNANT. 5138 03:13:05,711 --> 03:13:11,183 HOWEVER, AS WE'LL HEAR FROM MY 5139 03:13:11,183 --> 03:13:12,518 AMAZING COLLEAGUES, EXISTING 5140 03:13:12,518 --> 03:13:13,719 TREATMENT AND MULTI-DISCIPLINARY 5141 03:13:13,719 --> 03:13:16,422 CARE MODELS HAVE THE POTENTIAL 5142 03:13:16,422 --> 03:13:17,323 TO TRANSFORM OUTCOMES. 5143 03:13:17,323 --> 03:13:19,759 AND TODAY I'M GOING TO TALK 5144 03:13:19,759 --> 03:13:20,493 BRIEFLY ABOUT WHY THE DATA 5145 03:13:20,493 --> 03:13:22,328 POINTS OF THE FACT THAT IN 5146 03:13:22,328 --> 03:13:24,130 SETTINGS WHERE THERE ARE SAFE 5147 03:13:24,130 --> 03:13:25,765 ACCESS TO RED BLOOD CELLS FOR 5148 03:13:25,765 --> 03:13:27,500 INDIVIDUALS WITH SICKLE CELL 5149 03:13:27,500 --> 03:13:28,501 DISEASE, EACH PREGNANT PERSON 5150 03:13:28,501 --> 03:13:32,972 WITH SICKLE NEEDS TO BE 5151 03:13:32,972 --> 03:13:34,640 EVALUATED FOR INDICATION FOR 5152 03:13:34,640 --> 03:13:39,979 PROPHYLACTIC RED CELL 5153 03:13:39,979 --> 03:13:41,180 TRANSFUSION DURING PREGNANCY. 5154 03:13:41,180 --> 03:13:44,583 MY SUMMARY OF THIS SLIDE WHY 5155 03:13:44,583 --> 03:13:48,654 WOULD THE PLACENTA BE NORMAL. 5156 03:13:48,654 --> 03:13:49,955 PATHOPHYSIOLOGIES ARE COMPLEX, 5157 03:13:49,955 --> 03:13:50,756 MULTI-FACTORIAL, AFFECTING MANY 5158 03:13:50,756 --> 03:13:52,691 ORGANS OF THE BODY. 5159 03:13:52,691 --> 03:13:53,893 WE INCREASINGLY APPRECIATE AND 5160 03:13:53,893 --> 03:13:55,861 ACKNOWLEDGE THAT AMONG THOSE 5161 03:13:55,861 --> 03:13:57,196 ORGANS ARE THE OVARIES, 5162 03:13:57,196 --> 03:14:00,266 PLACENTA, FOR A BRIEF TIME THE 5163 03:14:00,266 --> 03:14:00,800 FETUS. 5164 03:14:00,800 --> 03:14:03,636 AND SO JUST TO REVIEW THOSE 5165 03:14:03,636 --> 03:14:07,440 PATHOPHYSIOLOGIES, THIS INCLUDES 5166 03:14:07,440 --> 03:14:10,943 THE CLASSIC DEFECTS, HEMOGLOBIN 5167 03:14:10,943 --> 03:14:18,951 POLYMERIZATION WHICH CAUSES RED 5168 03:14:18,951 --> 03:14:23,022 CELL HOMOLYSIS, NASTY SCREECHING 5169 03:14:23,022 --> 03:14:24,223 ON ENDOTHELIAL CAUSING INCREASED 5170 03:14:24,223 --> 03:14:24,990 ADHESION AND INFLAMMATION. 5171 03:14:24,990 --> 03:14:28,928 THERE ARE MANY REASONS TO BE 5172 03:14:28,928 --> 03:14:29,662 INTERESTED IN MULTI-FACTORIAL 5173 03:14:29,662 --> 03:14:31,330 PATHWAYS, WE HAVE A GROWING 5174 03:14:31,330 --> 03:14:33,065 NUMBER OF THERAPEUTICS THAT 5175 03:14:33,065 --> 03:14:36,135 TARGET DIFFERENT PLACES IN THIS 5176 03:14:36,135 --> 03:14:36,502 PATHWAY. 5177 03:14:36,502 --> 03:14:39,105 AND THIS SLIDE IS INTENDED TO 5178 03:14:39,105 --> 03:14:40,406 PROVIDE OVERVIEW OF THOSE 5179 03:14:40,406 --> 03:14:45,211 PATHOPHYSIOLOGIES ANDS THINK 5180 03:14:45,211 --> 03:14:47,179 ABOUT IMPLICATION OF THOSE 5181 03:14:47,179 --> 03:14:47,847 PATHOPHYSIOLOGIES FOR PREGNANT 5182 03:14:47,847 --> 03:14:50,349 PEOPLE IN A DISEASES THAT CAUSES 5183 03:14:50,349 --> 03:14:51,584 ANEMIA, WE SEE MATERNAL ANEMIA, 5184 03:14:51,584 --> 03:14:54,820 IN A DISEASE THAT CAUSES VASAL 5185 03:14:54,820 --> 03:15:00,192 OCCLUSION WE SEE PLACEBO SEVEN 5186 03:15:00,192 --> 03:15:01,627 -- PLACENTAL DAMAGE, WE 5187 03:15:01,627 --> 03:15:02,728 SEE EXPANDING BLOOD VOLUME, 5188 03:15:02,728 --> 03:15:05,764 NORMAL RESPONSE TO PREGNANCY 5189 03:15:05,764 --> 03:15:13,105 THAT CAUSES CARDIO PULMONARY 5190 03:15:13,105 --> 03:15:16,175 STRESS, INCREASES IN 5191 03:15:16,175 --> 03:15:17,143 PROGESTERONE, VASCULAR 5192 03:15:17,143 --> 03:15:26,752 RESISTANCE CHANGES STRESS SIS 5193 03:15:26,752 --> 03:15:27,419 SYSTEMS. 5194 03:15:27,419 --> 03:15:28,621 HYPERESTROGENEMIA, AND EXPANDING 5195 03:15:28,621 --> 03:15:35,628 UTERUS INCREASES RISK FOR PAIN, 5196 03:15:35,628 --> 03:15:37,163 UNCOMFORTABLE, AT FETUSES GROW, 5197 03:15:37,163 --> 03:15:41,867 COMPRESSING LUNG SPACE LEADING 5198 03:15:41,867 --> 03:15:43,736 TO RISK OF ACUTE CHEST SYNDROME. 5199 03:15:43,736 --> 03:15:46,272 THESE ARE THE MOST REASONS DATA 5200 03:15:46,272 --> 03:15:47,339 FROM NATIONAL INPATIENT SAMPLE 5201 03:15:47,339 --> 03:15:49,842 IN THE UNITED STATES. 5202 03:15:49,842 --> 03:15:51,377 THIS IS THE CDC'S SEVERE 5203 03:15:51,377 --> 03:15:53,145 MATERNAL MORTALITY INDEX. 5204 03:15:53,145 --> 03:15:57,516 WE DID THIS STUDY TO COMPARE 5205 03:15:57,516 --> 03:15:59,151 OUTCOMES OF PREGNANT PEOPLE WITH 5206 03:15:59,151 --> 03:16:00,686 SICKLE CELL TO OTHER 5207 03:16:00,686 --> 03:16:01,554 POPULATIONS, RESTRICTED TO BLACK 5208 03:16:01,554 --> 03:16:04,089 FOLKS WITH SICKLE CELL DISEASE 5209 03:16:04,089 --> 03:16:06,492 AND -- I'M SORRY, BLACK FOLKS 5210 03:16:06,492 --> 03:16:09,328 WITH SICKLE IN ORANGE AND YELLOW 5211 03:16:09,328 --> 03:16:10,329 PLOTS, WITHOUT SICKLE CELL 5212 03:16:10,329 --> 03:16:12,398 DISEASE WHO ARE PREGNANT IN 5213 03:16:12,398 --> 03:16:14,934 PURPLE AND BLUE SLOTS. 5214 03:16:14,934 --> 03:16:20,172 THE ONE IS PEOPLE IDENTIFIED AS 5215 03:16:20,172 --> 03:16:21,607 WHITE WITHOUT SICKLE CELL 5216 03:16:21,607 --> 03:16:23,275 DISEASE. 5217 03:16:23,275 --> 03:16:25,444 I HOPE YOU CAN SEE MOST OF THE 5218 03:16:25,444 --> 03:16:27,179 MARKERS OF THE RISK IN SICKLE 5219 03:16:27,179 --> 03:16:30,916 CELL DISEASE IS SIGNIFICANTLY 5220 03:16:30,916 --> 03:16:33,419 GREATER THAN RACIAL MATERNAL 5221 03:16:33,419 --> 03:16:34,520 MORTALITY STATISTICS, AND 5222 03:16:34,520 --> 03:16:37,289 CERTAINLY THAN WHITE FOLKS 5223 03:16:37,289 --> 03:16:39,358 WITHOUT SICKLE CELL DISEASE. 5224 03:16:39,358 --> 03:16:43,729 WHERE EVENTS ARE RARE LIKE 5225 03:16:43,729 --> 03:16:44,730 CEREBROVASCULAR THE RISK OF 5226 03:16:44,730 --> 03:16:46,999 SICKLE IS HIGHER THAN THE 5227 03:16:46,999 --> 03:16:50,936 GENERAL POPULATION. 5228 03:16:50,936 --> 03:16:52,605 OUR PAPER DOESN'T STAND ALONE, 5229 03:16:52,605 --> 03:16:54,006 OTHER PEOPLE FIND THE SAME 5230 03:16:54,006 --> 03:16:55,541 THING, IT'S NOT NICE BUT DOES 5231 03:16:55,541 --> 03:16:57,176 CONFIRM WE HAVE A REAL PROBLEM 5232 03:16:57,176 --> 03:16:59,778 AND WE NEED TO ACT TO DO 5233 03:16:59,778 --> 03:17:01,146 SOMETHING DIFFERENTLY. 5234 03:17:01,146 --> 03:17:02,348 NEXT SLIDE PLEASE. 5235 03:17:02,348 --> 03:17:04,750 THIS IS TO FURTHER SHOW FETUSES 5236 03:17:04,750 --> 03:17:08,354 ARE ALSO ADVERSELY AFFECTED IN 5237 03:17:08,354 --> 03:17:09,888 ADDITION TO FETAL DEMISE, 5238 03:17:09,888 --> 03:17:14,927 PRE-TERM DELIVERY, BABIES ARE 5239 03:17:14,927 --> 03:17:15,594 SMALL FOR GESTATIONAL AGE, 5240 03:17:15,594 --> 03:17:17,763 INCREASED RISK OF DEATH. 5241 03:17:17,763 --> 03:17:18,998 AS A POINT OF INFORMATION 5242 03:17:18,998 --> 03:17:24,436 SHARING SEVERE MORBIDITY AND 5243 03:17:24,436 --> 03:17:29,041 MORTALITY INDEX BY CDC CARS 5244 03:17:29,041 --> 03:17:30,175 VASOOCCLUSIVE A MARKER, PAINFUL 5245 03:17:30,175 --> 03:17:31,477 IN 50% OF PREGNANT PEOPLE WITH 5246 03:17:31,477 --> 03:17:32,578 SICKLE CELL DISEASE. 5247 03:17:32,578 --> 03:17:34,346 WE DIDN'T REPORT THEM BECAUSE WE 5248 03:17:34,346 --> 03:17:40,819 HOPED THE NUMBER OF 5249 03:17:40,819 --> 03:17:45,524 VASOOCCLUSIVE CRISIS WOULD BE 5250 03:17:45,524 --> 03:17:45,791 NEAR ZERO. 5251 03:17:45,791 --> 03:17:50,562 HERE ARE CONCLUSIONS FROM MY 5252 03:17:50,562 --> 03:17:51,563 COLLEAGUE IN CALIFORNIA, LARGE 5253 03:17:51,563 --> 03:17:52,765 CALIFORNIA DATABASE. 5254 03:17:52,765 --> 03:17:58,470 HERE IS OUR CONCLUSION FROM 5255 03:17:58,470 --> 03:17:59,438 NATIONAL INPATIENT SAMPLE, 5256 03:17:59,438 --> 03:18:01,307 COMPLICATIONS DID NOT CHANGE 5257 03:18:01,307 --> 03:18:03,709 OVER THREE DECADES IN THIS STUDY 5258 03:18:03,709 --> 03:18:06,578 FROM CALIFORNIA, AND FROM THE 5259 03:18:06,578 --> 03:18:07,112 NATIONAL INPATIENT SAMPLE 5260 03:18:07,112 --> 03:18:08,547 PREGNANCY MORBIDITY AND 5261 03:18:08,547 --> 03:18:11,283 MORTALITY WAS UNCHANGED OVER 15 5262 03:18:11,283 --> 03:18:12,718 TO 25 YEARS. 5263 03:18:12,718 --> 03:18:13,819 NEXT SLIDE PLEASE. 5264 03:18:13,819 --> 03:18:15,321 THESE ARE THREE MAPS FROM THE 5265 03:18:15,321 --> 03:18:16,655 UNITED STATES. 5266 03:18:16,655 --> 03:18:18,490 ONE IN UPPER LEFT-HAND CORNER 5267 03:18:18,490 --> 03:18:19,825 SHOWING DISTRIBUTION OF 5268 03:18:19,825 --> 03:18:20,426 INDIVIDUALS LIVING WITH SICKLE 5269 03:18:20,426 --> 03:18:21,894 CELL DISEASE IN THE UNITED 5270 03:18:21,894 --> 03:18:25,597 STATES. 5271 03:18:25,597 --> 03:18:26,598 BENEATH THAT IS CARE. 5272 03:18:26,598 --> 03:18:27,966 YOU CAN SEE THERE'S A PROBLEM, 5273 03:18:27,966 --> 03:18:29,668 NOT ENOUGH PEOPLE TO CARE FOR 5274 03:18:29,668 --> 03:18:30,502 INDIVIDUALS WITH SICKLE CELL 5275 03:18:30,502 --> 03:18:32,838 DISEASE IN THE UNITED STATES. 5276 03:18:32,838 --> 03:18:36,342 AND IF YOU SUPERIMPOSE IN YOUR 5277 03:18:36,342 --> 03:18:39,611 MIND'S EYE THE GRAPH, PICTORIAL 5278 03:18:39,611 --> 03:18:42,247 REPRESENTATION ON THE RIGHT, A 5279 03:18:42,247 --> 03:18:43,215 MAP OF MATERNITY CARE DESERTS IN 5280 03:18:43,215 --> 03:18:45,651 THE UNITED STATES IT'S EASY TO 5281 03:18:45,651 --> 03:18:47,286 SAY SIGNIFICANT OVERLAP BETWEEN 5282 03:18:47,286 --> 03:18:50,656 WHERE THERE ARE MATERNITY CARE 5283 03:18:50,656 --> 03:18:53,292 DESERTS, SICKLE CELL CARE 5284 03:18:53,292 --> 03:19:02,835 DESERTS AND WHERE THERE ARE 5285 03:19:02,835 --> 03:19:05,771 SICKLE CELL PATIENTS. 5286 03:19:05,771 --> 03:19:08,340 OVER TURNING PROTECTION OF 5287 03:19:08,340 --> 03:19:08,941 APPORTION WILL COMPROMISE THE 5288 03:19:08,941 --> 03:19:09,775 REPRODUCTIVE HEALTH CARE OF 5289 03:19:09,775 --> 03:19:11,543 MILLIONS OF AMERICANS. 5290 03:19:11,543 --> 03:19:13,479 WHAT WE'VE BEEN LEARNING AND 5291 03:19:13,479 --> 03:19:15,347 WHAT WILL BE ILLUSTRATED, THIS 5292 03:19:15,347 --> 03:19:16,782 IS MULTI-DISCIPLINARY CARE. 5293 03:19:16,782 --> 03:19:20,152 THIS IS A FAMOUS SICKLE CELL 5294 03:19:20,152 --> 03:19:21,253 STAMP ISSUED TO COMMEMORATE 5295 03:19:21,253 --> 03:19:22,254 NEWBORN SCREENING IN THE UNITED 5296 03:19:22,254 --> 03:19:22,488 STATES. 5297 03:19:22,488 --> 03:19:25,624 BUT WHEN I LOOKED AT THIS WITH 5298 03:19:25,624 --> 03:19:26,725 MATERNAL-FETAL HEALTH EXPERT SHE 5299 03:19:26,725 --> 03:19:27,926 SAID IT NEVER OCCURRED TO ME IT 5300 03:19:27,926 --> 03:19:29,261 WAS THE BABY WHO HAD SICKLE CELL 5301 03:19:29,261 --> 03:19:29,895 DISEASE. 5302 03:19:29,895 --> 03:19:31,530 I THOUGHT IT WAS THE MOM. 5303 03:19:31,530 --> 03:19:32,965 I LOVE THAT BECAUSE I THINK IT'S 5304 03:19:32,965 --> 03:19:35,033 REALLY IMPORTANT THAT WE KNOW 5305 03:19:35,033 --> 03:19:41,707 WHEN HEMATOLOGISTS AND 5306 03:19:41,707 --> 03:19:42,708 OBSTETRICIANS SEE THINGS 5307 03:19:42,708 --> 03:19:44,576 DIFFERENTLY, IT CAN BE OUR 5308 03:19:44,576 --> 03:19:46,712 STRENGTH IN WORKING TOGETHER. 5309 03:19:46,712 --> 03:19:47,613 NEXT SLIDE PLEASE. 5310 03:19:47,613 --> 03:19:50,115 SO WHAT DO WE KNOW ABOUT 5311 03:19:50,115 --> 03:19:50,883 TRANSFUSIONS IN SICKLE CELL 5312 03:19:50,883 --> 03:19:52,885 DISEASE PREGNANCY? 5313 03:19:52,885 --> 03:19:53,652 WE HAVE A BEAUTIFUL 5314 03:19:53,652 --> 03:19:56,021 META-ANALYSIS BY OUR COLLEAGUES 5315 03:19:56,021 --> 03:19:58,457 IN TORONTO IN 2015. 5316 03:19:58,457 --> 03:20:00,759 AMONG THE COMPLICATIONS THAT 5317 03:20:00,759 --> 03:20:03,061 THEY STUDIED WERE MORTALITY, 5318 03:20:03,061 --> 03:20:06,899 PAINFUL CRISES, DIMENSIONS OF 5319 03:20:06,899 --> 03:20:07,399 PULMONARY COMPLICATIONS, 5320 03:20:07,399 --> 03:20:08,333 PERINATAL MORTALITY, NEONATAL 5321 03:20:08,333 --> 03:20:09,835 DEATH AND PRE-TERM BIRTH. 5322 03:20:09,835 --> 03:20:11,603 ON THE FAR RIGHT CHRONIC 5323 03:20:11,603 --> 03:20:21,780 TRANSFUSION, THOUSANDS OF -- 5324 03:20:21,780 --> 03:20:24,850 THOUSANDS WERE COMPILED, 5325 03:20:24,850 --> 03:20:26,051 COMPLICATIONS SIGNIFICANT 5326 03:20:26,051 --> 03:20:26,318 REREDUCED. 5327 03:20:26,318 --> 03:20:28,253 TRANSFUSION IS LOW RISK IN HIGH 5328 03:20:28,253 --> 03:20:28,854 RESOURCE SETTINGS. 5329 03:20:28,854 --> 03:20:30,355 THE FIRST BULLET POINT IS 5330 03:20:30,355 --> 03:20:30,789 INCOMPLETE. 5331 03:20:30,789 --> 03:20:32,958 SHOULD SAY IN THE U.S. CONTEXT 5332 03:20:32,958 --> 03:20:35,160 WE HAVE ACCESS TO SAFE BLOOD 5333 03:20:35,160 --> 03:20:35,427 SUPPLY. 5334 03:20:35,427 --> 03:20:40,632 OUR CONCERNS INCLUDE TRANSFUSION 5335 03:20:40,632 --> 03:20:42,801 REACTIONS, IN SECTIONS, IT'S OUR 5336 03:20:42,801 --> 03:20:44,236 PRIVILEGE TO WORRY LESS THAN IN 5337 03:20:44,236 --> 03:20:45,971 OTHER PLACES. 5338 03:20:45,971 --> 03:20:48,740 IRON OVERLOAD IS A LONG-TERM 5339 03:20:48,740 --> 03:20:52,978 COMPLICATION, NOT A SHORT-TERM. 5340 03:20:52,978 --> 03:20:53,912 WE WORRY ABOUT ALLOIMMUNIZATION 5341 03:20:53,912 --> 03:20:55,914 BUT AT THE MOMENT WE DON'T HAVE 5342 03:20:55,914 --> 03:20:58,684 DATA TO SUGGEST PEOPLE GIVEN 5343 03:20:58,684 --> 03:20:59,751 PROPHYLACTIC TRANSFUSIONS VERSUS 5344 03:20:59,751 --> 03:21:03,222 ON-DEMANDS ARE AT DIFFERENT RISK 5345 03:21:03,222 --> 03:21:04,690 FOR ALLOIMMUNIZATION. 5346 03:21:04,690 --> 03:21:10,362 CAN BEING CAN BE REDUCED WITH 5347 03:21:10,362 --> 03:21:11,029 PROPHYLACTIC MEDICATIONS, WE 5348 03:21:11,029 --> 03:21:13,165 DON'T HAVE ANY GOOD DATA ON 5349 03:21:13,165 --> 03:21:16,702 HEMOLYTIC DISEASE OF THE 5350 03:21:16,702 --> 03:21:17,169 NEWBORN. 5351 03:21:17,169 --> 03:21:19,438 MOST CAN BE PREVENTED OR 5352 03:21:19,438 --> 03:21:21,206 REDUCED, RISKS ARE LOW COMPARED 5353 03:21:21,206 --> 03:21:23,108 TO POTENTIAL BENEFITS FOR 5354 03:21:23,108 --> 03:21:25,143 INDIVIDUALS WITH SICKLE CELL. 5355 03:21:25,143 --> 03:21:27,112 NEXT SLIDE PLEASE. 5356 03:21:27,112 --> 03:21:28,547 DOWNSTREAM BENEFITS OF 5357 03:21:28,547 --> 03:21:29,748 PREVENTING PAIN WITH 5358 03:21:29,748 --> 03:21:30,315 PROPHYLACTIC TRANSFUSION IN 5359 03:21:30,315 --> 03:21:32,584 PREGNANCY SHOULD BE UNDERSTOOD 5360 03:21:32,584 --> 03:21:34,453 TO BE SIGNIFICANT. 5361 03:21:34,453 --> 03:21:39,358 WHEN YOU KEEP PEOPLE OUT OF PAIN 5362 03:21:39,358 --> 03:21:42,127 THEY ARE OUT OF EMERGENCY CARE 5363 03:21:42,127 --> 03:21:44,196 SETTINGS, REDUCING FETAL 5364 03:21:44,196 --> 03:21:54,606 EXPOSURE TO OPIOIDS, . 5365 03:22:09,154 --> 03:22:11,290 AN PAIN CRISIS IS ACCEPTED 5366 03:22:11,290 --> 03:22:13,258 INDICATION FOR DISEASE MODIFYING 5367 03:22:13,258 --> 03:22:13,959 THERAPY, EVERY TREMENDOUS FOR 5368 03:22:13,959 --> 03:22:16,528 SICKLE CELL EXCEPT ONE IS FDA 5369 03:22:16,528 --> 03:22:18,263 APPROVED BECAUSE IT PREVENTS 5370 03:22:18,263 --> 03:22:19,164 PAIN AND TRANSFUSIONS PREVENT 5371 03:22:19,164 --> 03:22:20,799 PAIN FOR PEOPLE PREGNANT BUT DO 5372 03:22:20,799 --> 03:22:26,805 NOT HAVE A WIDE AND ACCEPTED 5373 03:22:26,805 --> 03:22:27,239 INDICATION. 5374 03:22:27,239 --> 03:22:30,208 IT CAN REDUCE NEED FOR EMERGENCY 5375 03:22:30,208 --> 03:22:31,443 TRANSFUSION AND HOSPITALIZATION 5376 03:22:31,443 --> 03:22:34,046 AND BLOOD EXPOSURE AND CRISIS 5377 03:22:34,046 --> 03:22:36,014 AND HELP IMPROVE INFANT 5378 03:22:36,014 --> 03:22:38,083 SURVIVAL, GROWTH, EXPOSURE TO 5379 03:22:38,083 --> 03:22:41,920 SORT OF TOXIC MATERNAL 5380 03:22:41,920 --> 03:22:45,958 CONDITIONS LIKE PREECLAMPSIA AND 5381 03:22:45,958 --> 03:22:49,227 OPIOID EXPOSURE. 5382 03:22:49,227 --> 03:22:49,861 IN CONCLUSION, SICKLE PREGNANCY 5383 03:22:49,861 --> 03:22:56,568 OUTCOMES IN THE U.S. ARE 5384 03:22:56,568 --> 03:22:58,670 STAGNANT AND POOR. 5385 03:22:58,670 --> 03:22:59,972 CHRONIC TRANSFUSIONS ARE DEEMED 5386 03:22:59,972 --> 03:23:04,242 LOW RISK BY AMERICAN SOCIETY OF 5387 03:23:04,242 --> 03:23:05,344 HEMATOLOGY AND POTENTIALLY 5388 03:23:05,344 --> 03:23:05,644 BENEFICIAL. 5389 03:23:05,644 --> 03:23:12,684 WE SHOULD OFFER TREATMENT MORE 5390 03:23:12,684 --> 03:23:13,385 AGGRESSIVELY. 5391 03:23:13,385 --> 03:23:17,089 WE NEED RESEARCH, GUIDELINES AND 5392 03:23:17,089 --> 03:23:17,723 INCENTIVES TO BUILD 5393 03:23:17,723 --> 03:23:19,024 MULTI-DISCIPLINARY CARE TEAMS. 5394 03:23:19,024 --> 03:23:20,125 THANKS FOR HAVING ME. 5395 03:23:20,125 --> 03:23:30,636 IT'S A PLEASURE TO SPEAK WITH 5396 03:23:40,946 --> 03:23:46,351 YOU TODAY. 5397 03:23:46,351 --> 03:23:49,755 >> EVENING FROM ACCRA. 5398 03:23:49,755 --> 03:23:54,893 >> PLEASE GO AHEAD. 5399 03:23:54,893 --> 03:24:05,470 >> GOOD EVENING, I'M DOING THIS 5400 03:24:06,004 --> 03:24:11,443 PRESENTATION WITH DR. ASARE. 5401 03:24:11,443 --> 03:24:14,346 I'M AN OBJECTS VISION 5402 03:24:14,346 --> 03:24:17,983 GYNECOLOGIST, LEADINGS A CLINIC 5403 03:24:17,983 --> 03:24:20,385 IN AKKRA, AND DR. ASARE IS A 5404 03:24:20,385 --> 03:24:22,020 HEMATOLOGIST WHO WORKS AT THE 5405 03:24:22,020 --> 03:24:24,089 SAME CLINIC WITH ME. 5406 03:24:24,089 --> 03:24:25,290 NEXT SLIDE PLEASE. 5407 03:24:25,290 --> 03:24:30,896 SO, WE DON'T HAVE ANY CONFLICTS, 5408 03:24:30,896 --> 03:24:32,431 ANY DISCLOSURES. 5409 03:24:32,431 --> 03:24:32,664 NEXT. 5410 03:24:32,664 --> 03:24:34,499 SO THIS WILL BE OUR LEARNING 5411 03:24:34,499 --> 03:24:34,966 OBJECTIVES. 5412 03:24:34,966 --> 03:24:39,771 WE HOPE BY THE END OF THIS 5413 03:24:39,771 --> 03:24:41,573 PRESENTATION OR DEMONSTRATES 5414 03:24:41,573 --> 03:24:43,408 PREVALENCE OF SICKLE CELL 5415 03:24:43,408 --> 03:24:44,910 DISEASE IN GHANA, HIGHLIGHT 5416 03:24:44,910 --> 03:24:47,446 INCREASE OF MATERNAL AND 5417 03:24:47,446 --> 03:24:48,146 PERINATAL MORBIDITY AND 5418 03:24:48,146 --> 03:24:50,515 MORTALITY, ASSOCIATED WITH 5419 03:24:50,515 --> 03:24:52,117 SICKLE CELL DISEASE, ALSO LOOK 5420 03:24:52,117 --> 03:24:55,087 AT THE VALUE OF 5421 03:24:55,087 --> 03:24:56,288 MULTI-DISCIPLINARY SICKLE CELL 5422 03:24:56,288 --> 03:25:04,396 OBSTETRIC TEAM APPROACH TO CARE. 5423 03:25:04,396 --> 03:25:07,265 THIS DEMONSTRATES HIGH BURDEN OF 5424 03:25:07,265 --> 03:25:11,036 SICKLE CELL DISEASE IN AFRICA, 5425 03:25:11,036 --> 03:25:21,513 SUGGESTING BY THE YEAR 2030 5426 03:25:28,987 --> 03:25:31,523 300,000 WILL BE BORN WITH THIS. 5427 03:25:31,523 --> 03:25:33,625 IN GHANA IT'S A COMMON 5428 03:25:33,625 --> 03:25:34,092 CONDITION. 5429 03:25:34,092 --> 03:25:36,728 IT'S SO BECAUSE THERE'S HIGH 5430 03:25:36,728 --> 03:25:44,302 PREVALENCE OF HEMOGLOBIN S GENE, 5431 03:25:44,302 --> 03:25:46,471 30% OF INDIVIDUALS WITH SG. 5432 03:25:46,471 --> 03:25:54,479 NEAR BI2% OF ALL NEWBORNS HAVE 5433 03:25:54,479 --> 03:25:55,247 SICKLE CELL, TRANSLATES TO 5434 03:25:55,247 --> 03:25:57,682 18,000 NEWBORNS EVERY YEAR, A 5435 03:25:57,682 --> 03:26:01,153 HUGE NUMBER WHEN COMPARED TO THE 5436 03:26:01,153 --> 03:26:08,794 U.S., 2400 PER YEAR, AND 300 IN 5437 03:26:08,794 --> 03:26:12,697 THE U.K. 5438 03:26:12,697 --> 03:26:15,967 NEXT SLIDE. 5439 03:26:15,967 --> 03:26:19,437 NOW, WHERE I WORK, WE SEE ABOUT 5440 03:26:19,437 --> 03:26:22,407 1400 INDIVIDUALS WITH SICKLE 5441 03:26:22,407 --> 03:26:23,842 CELL DISEASE, OR WOMEN WITH 5442 03:26:23,842 --> 03:26:28,880 SICKLE CELL WITHIN THAT AGE 5443 03:26:28,880 --> 03:26:30,415 GROUP. 5444 03:26:30,415 --> 03:26:35,654 OBSTETRIC UNIT, 1 ^50 WOMEN ARE 5445 03:26:35,654 --> 03:26:39,424 DELIVERED THERE EACH YEAR. 5446 03:26:39,424 --> 03:26:42,127 SICKLE CELL DISEASE DURING 5447 03:26:42,127 --> 03:26:44,529 PREGNANCY IS LIFE-THREATENING 5448 03:26:44,529 --> 03:26:44,963 COMPLICATION. 5449 03:26:44,963 --> 03:26:49,568 NOW, THIS STEPS FROM HIGH -- 5450 03:26:49,568 --> 03:26:50,335 STEMS FROM COMPLICATIONS 5451 03:26:50,335 --> 03:26:52,838 ASSOCIATED WITH SICKLE CELL 5452 03:26:52,838 --> 03:26:53,939 DISEASE. 5453 03:26:53,939 --> 03:26:57,008 NEXT SLIDE. 5454 03:26:57,008 --> 03:26:58,109 NOW, THE COMMON PERINATAL 5455 03:26:58,109 --> 03:27:01,279 COMPLICATIONS INCLUDE FETAL 5456 03:27:01,279 --> 03:27:02,814 GROUP RESTRICTION, PRE-TERM 5457 03:27:02,814 --> 03:27:07,319 DEATH, LOW BIRTH WEIGHT, AND 5458 03:27:07,319 --> 03:27:08,286 PERINATAL MORTALITY COMPARED TO 5459 03:27:08,286 --> 03:27:14,526 WOMEN WITHOUT SICKLE CELL 5460 03:27:14,526 --> 03:27:14,759 DISEASE. 5461 03:27:14,759 --> 03:27:17,863 NEXT SLIDE. 5462 03:27:17,863 --> 03:27:20,832 WHEN IT COMES TO MATERNAL 5463 03:27:20,832 --> 03:27:21,900 COMPLICATION, PREECLAMPSIA, 5464 03:27:21,900 --> 03:27:24,002 ECLAMPSIAS ARE COMMON, MOST 5465 03:27:24,002 --> 03:27:25,770 IMPORTANTLY MATERNAL MORTALITY 5466 03:27:25,770 --> 03:27:28,640 RATIO IS OVER TEN-FOLD INCREASE 5467 03:27:28,640 --> 03:27:30,775 IN WOMEN WITH SICKLE CELL 5468 03:27:30,775 --> 03:27:31,343 DISEASE COMPARED TO 5469 03:27:31,343 --> 03:27:31,676 COUNTERPARTS. 5470 03:27:31,676 --> 03:27:35,714 THIS IS TRUE ALL AROUND THE 5471 03:27:35,714 --> 03:27:38,783 WORLD. 5472 03:27:38,783 --> 03:27:40,852 NEXT SLIDE. 5473 03:27:40,852 --> 03:27:42,320 AGAIN, COMPLICATIONS ARE 5474 03:27:42,320 --> 03:27:52,864 COMPLICATION, FREQUENT AND NEED 5475 03:27:53,865 --> 03:27:55,200 HOSPITALIZATION, NEARLY 35 TO 5476 03:27:55,200 --> 03:27:59,037 50% DURING THE PREGNANCY PERIOD. 5477 03:27:59,037 --> 03:28:05,176 EPISODE IS CLOSELY RELATED TO 5478 03:28:05,176 --> 03:28:13,184 ACUTE TEST SYNDROME. 5479 03:28:13,184 --> 03:28:14,252 PULMONARY EVENTS ARE COMMON 5480 03:28:14,252 --> 03:28:17,422 DURING PREGNANCY. 5481 03:28:17,422 --> 03:28:19,624 NEXT SLIDE. 5482 03:28:19,624 --> 03:28:22,794 THIS SLIDE SHOWS US THE RELATIVE 5483 03:28:22,794 --> 03:28:25,730 DISTRIBUTION OF MATERNAL 5484 03:28:25,730 --> 03:28:26,731 MORTALITY RATIO FROM THE 5485 03:28:26,731 --> 03:28:27,933 HIGH-INCOME COUNTRIES AROUND THE 5486 03:28:27,933 --> 03:28:28,133 WORLD. 5487 03:28:28,133 --> 03:28:31,036 IF YOU LOOK AT THE FIGURE FOR 5488 03:28:31,036 --> 03:28:35,473 THE U.S. OF A, PUBLISHED IN THE 5489 03:28:35,473 --> 03:28:38,576 YEAR 2020, WAS 21 PER 100,000 5490 03:28:38,576 --> 03:28:41,446 LIVE BIRTHS, RELATIVELY HIGH 5491 03:28:41,446 --> 03:28:44,282 COMPARED TO WESTERN COUNTRIES. 5492 03:28:44,282 --> 03:28:47,118 NEXT SLIDE. 5493 03:28:47,118 --> 03:28:48,019 NOW IN AFRICA, MATERNAL 5494 03:28:48,019 --> 03:28:49,254 MORTALITY RATIO IN WOMEN WITH 5495 03:28:49,254 --> 03:28:57,228 AND WITHOUT SICKLE CELL DISEASE 5496 03:28:57,228 --> 03:28:59,965 IS 551 DEATHS PER 100,000 LIVE 5497 03:28:59,965 --> 03:29:00,198 BIRTHS. 5498 03:29:00,198 --> 03:29:04,569 IF I IS ASTRO NOMICALLY HIGH 5499 03:29:04,569 --> 03:29:06,538 WHEN WE CONCENTRATION ON SICKLE 5500 03:29:06,538 --> 03:29:09,808 CELL POPULATION ALONE. 5501 03:29:09,808 --> 03:29:12,610 IN SUB-SAHARAN AFRICA THE RATIO 5502 03:29:12,610 --> 03:29:15,513 IS ALMOST 4,400 PER 100,000 LIVE 5503 03:29:15,513 --> 03:29:18,917 BIRTHS, WITHOUT INTERVENTION. 5504 03:29:18,917 --> 03:29:19,684 NEXT SLIDE. 5505 03:29:19,684 --> 03:29:23,455 NOW WHAT ARE THE KEY ISSUES TO 5506 03:29:23,455 --> 03:29:23,788 BE ADDRESSED? 5507 03:29:23,788 --> 03:29:26,124 WE THINK THERE'S A GLOBAL HEALTH 5508 03:29:26,124 --> 03:29:27,826 INEQUITY IN SERVICE DELIVERY TO 5509 03:29:27,826 --> 03:29:32,230 PREGNANT WOMEN WITH SICKLE CELL 5510 03:29:32,230 --> 03:29:32,464 DISEASE. 5511 03:29:32,464 --> 03:29:34,733 AGAIN, THE OPTIMAL APPROACH TO 5512 03:29:34,733 --> 03:29:35,967 REDUCE MATERNAL MORBIDITY AND 5513 03:29:35,967 --> 03:29:39,671 MORTALITY HAS NOT BEEN 5514 03:29:39,671 --> 03:29:44,242 ADEQUATELY ADDRESSED. 5515 03:29:44,242 --> 03:29:49,447 NEXT SLIDE. 5516 03:29:49,447 --> 03:29:53,118 THE QUESTION THEN, DOES 5517 03:29:53,118 --> 03:29:54,352 MULTI-DISCIPLINARY CARE REDUCE 5518 03:29:54,352 --> 03:29:56,221 MORBIDITY AND MORTALITY IN WOMEN 5519 03:29:56,221 --> 03:29:59,457 WITH SICKLE CELL. 5520 03:29:59,457 --> 03:30:03,528 NEXT SLIDE. 5521 03:30:03,528 --> 03:30:08,333 NOW, BETWEEN 2011 AND 2014 WHEN 5522 03:30:08,333 --> 03:30:12,437 THERE WAS NO CLINIC ACCRA, THE 5523 03:30:12,437 --> 03:30:14,506 RATIO WAS MORE THAN 10,000 5524 03:30:14,506 --> 03:30:21,279 DEATHS PER 100,000 LIVE BIRTHS. 5525 03:30:21,279 --> 03:30:23,014 NEXT SLIDE. 5526 03:30:23,014 --> 03:30:28,820 SO IN 2014, OUR TEAM STARTED A 5527 03:30:28,820 --> 03:30:35,160 MULTI-DISCIPLINARY CARE SYSTEM 5528 03:30:35,160 --> 03:30:43,735 IN ACCRA, COMPRISED OF 5529 03:30:43,735 --> 03:30:44,369 OBSERVATIONS, HEMATOLOGISTS. 5530 03:30:44,369 --> 03:30:45,570 NEXT SLIDE. 5531 03:30:45,570 --> 03:30:48,873 NOW, DURING THAT PERIOD WE DID 5532 03:30:48,873 --> 03:30:51,709 REVIEW OF DATA OF THE MORTALITY 5533 03:30:51,709 --> 03:30:54,212 DATA AT OUR FACILITY. 5534 03:30:54,212 --> 03:30:55,980 WHICH TO HIGHLIGHT THE MAIN 5535 03:30:55,980 --> 03:30:59,451 CAUSES OF THE MATERNAL MORTALITY 5536 03:30:59,451 --> 03:31:02,454 AMONG WOMEN WITH SICKLE CELL 5537 03:31:02,454 --> 03:31:02,787 DISEASE. 5538 03:31:02,787 --> 03:31:04,089 NEXT SLIDE. 5539 03:31:04,089 --> 03:31:12,497 WE ALSO FOUND OUT ACUTE PAINED 5540 03:31:12,497 --> 03:31:14,599 SEWED IS LEADING CAUSE, AND THE 5541 03:31:14,599 --> 03:31:18,536 LEADING CAUSE OF DEATH IN 5542 03:31:18,536 --> 03:31:18,903 PREGNANCY. 5543 03:31:18,903 --> 03:31:22,340 NEXT SLIDE. 5544 03:31:22,340 --> 03:31:24,109 WE REALIZED SYNDROME CONTRIBUTED 5545 03:31:24,109 --> 03:31:26,644 TO 86% OF ALL MATERNAL DEATHS. 5546 03:31:26,644 --> 03:31:29,047 WHAT WAS CRITICAL ABOUT THAT 5547 03:31:29,047 --> 03:31:32,884 REVIEW WAS THAT IT HIGHLIGHTED 5548 03:31:32,884 --> 03:31:33,918 SERVICE DELIVERY FAILURES AND 5549 03:31:33,918 --> 03:31:35,420 SOME CHALLENGES WITHIN THE 5550 03:31:35,420 --> 03:31:37,055 HEALTH CARE DELIVERY SYSTEM 5551 03:31:37,055 --> 03:31:37,722 PARTICULARLY FOR WOMEN WITH 5552 03:31:37,722 --> 03:31:39,691 SICKLE CELL DISEASE. 5553 03:31:39,691 --> 03:31:41,993 AGAIN GIVES US AN OPPORTUNITY 5554 03:31:41,993 --> 03:31:43,728 FOR PROVIDERS TO DEVELOP NEW 5555 03:31:43,728 --> 03:31:44,729 ACCEPTABLE AND FEES ABLE 5556 03:31:44,729 --> 03:31:49,100 SOLUTIONS TO ADDRESS THE 5557 03:31:49,100 --> 03:31:49,534 PROBLEM. 5558 03:31:49,534 --> 03:31:51,402 NEXT SLIDE. 5559 03:31:51,402 --> 03:31:52,504 NOW BEFORE WE COULD IMPLEMENT 5560 03:31:52,504 --> 03:31:59,277 OUR APPROACH TO CARE WE NEEDED 5561 03:31:59,277 --> 03:32:02,213 TO GET BACKGROUND DEFINITION, 5562 03:32:02,213 --> 03:32:04,749 ONE IS DEFINITION OF ACUTE CHEST 5563 03:32:04,749 --> 03:32:06,384 SYNDROME, AN ACUTE PAIN WHICH 5564 03:32:06,384 --> 03:32:08,253 CAN BE DISTINGUISHED FROM LABOR 5565 03:32:08,253 --> 03:32:12,090 PAIN, BASED ON ABSENCE OF 5566 03:32:12,090 --> 03:32:13,391 UTERINE CONTRACTION, EVIDENCE OF 5567 03:32:13,391 --> 03:32:15,160 LABOR PROGRESSION AND DELIVERY. 5568 03:32:15,160 --> 03:32:19,097 IF IT'S A PATIENT SELF-REPORTED 5569 03:32:19,097 --> 03:32:21,166 SICKLE CELL, WE CONSIDER IT 5570 03:32:21,166 --> 03:32:23,701 ACUTE PAIN EPISODE. 5571 03:32:23,701 --> 03:32:25,336 NEXT SLIDE. 5572 03:32:25,336 --> 03:32:27,772 AGAIN, IT WAS IMPORTANT TO 5573 03:32:27,772 --> 03:32:30,909 REDEFINE ACUTE CHEST SYNDROME 5574 03:32:30,909 --> 03:32:33,011 BECAUSE WE REALIZED THERE WAS NO 5575 03:32:33,011 --> 03:32:34,312 STANDARD DEFINITION FOR ACUTE 5576 03:32:34,312 --> 03:32:37,348 CHEST SYNDROME ESPECIALLY AS 5577 03:32:37,348 --> 03:32:39,684 RELATED TO PREGNANCY. 5578 03:32:39,684 --> 03:32:43,454 WE CAME OUT WITH THIS 5579 03:32:43,454 --> 03:32:45,924 DEFINITION, A PARAMETER, BE A 5580 03:32:45,924 --> 03:32:47,025 NORMAL CLINICAL FIND ON LUNG 5581 03:32:47,025 --> 03:32:48,426 EXAMINATION AND PRESENCE OF AT 5582 03:32:48,426 --> 03:32:51,496 LEAST TWO OF THE FOLLOWING 5583 03:32:51,496 --> 03:32:51,930 CRITERIA. 5584 03:32:51,930 --> 03:32:56,434 THAT'S A FEVER OF MORE THAN 38 5585 03:32:56,434 --> 03:32:57,635 DEGREES CELSIUS, INCREASED 5586 03:32:57,635 --> 03:33:03,942 RESPIRATORY GREAT GREATER THAN 5587 03:33:03,942 --> 03:33:07,712 90th PERCENTILE, POSITIVE 5588 03:33:07,712 --> 03:33:09,981 CHEST PAIN, INCREASED OXYGEN 5589 03:33:09,981 --> 03:33:12,317 RETIREMENT, DROP IN BASELINE 5590 03:33:12,317 --> 03:33:15,687 GREATER THAN 3%, OR NEW 5591 03:33:15,687 --> 03:33:23,561 RADIODENSITY ON CHEST X-RAY. 5592 03:33:23,561 --> 03:33:24,796 NEXT SLIDE. 5593 03:33:24,796 --> 03:33:29,367 NOW, OUR WORK HYPOTHESIS WAS 5594 03:33:29,367 --> 03:33:30,668 IMPLEMENTING A 5595 03:33:30,668 --> 03:33:32,136 MULTI-DISCIPLINARY TEAM IN 5596 03:33:32,136 --> 03:33:33,538 LOW-RESOURCE SETTING WOULD 5597 03:33:33,538 --> 03:33:35,540 REDUCE MATERNAL AND PERINATAL 5598 03:33:35,540 --> 03:33:36,841 MORTALITY RATES IN BEFORE AND 5599 03:33:36,841 --> 03:33:41,512 AFTER STUDY DESIGN. 5600 03:33:41,512 --> 03:33:42,080 NEXT SLIDE. 5601 03:33:42,080 --> 03:33:45,917 SOME OF THE THINGS WE DID WAS TO 5602 03:33:45,917 --> 03:33:47,885 IMPLEMENT SIMPLE PROTOCOLS FOR 5603 03:33:47,885 --> 03:33:49,854 MATERNAL AND PERINATAL CARE. 5604 03:33:49,854 --> 03:33:52,490 SO, WE ENSURED THAT THERE WAS 5605 03:33:52,490 --> 03:33:54,892 CLOSE MONITORING OF MOTHERS AND 5606 03:33:54,892 --> 03:33:59,163 BABIES DURING THEIR PREGNANCY 5607 03:33:59,163 --> 03:33:59,731 PERIOD. 5608 03:33:59,731 --> 03:34:03,434 FOR THE BABIES SERIAL ULTRASOUND 5609 03:34:03,434 --> 03:34:05,703 IN THE THIRD TRIMESTER TO 5610 03:34:05,703 --> 03:34:09,774 MONITOR FETAL GROWTH. 5611 03:34:09,774 --> 03:34:14,612 WHERE THERE WAS SUSPECTED GROWTH 5612 03:34:14,612 --> 03:34:15,146 RESTRICTION. 5613 03:34:15,146 --> 03:34:19,984 NEXT SLIDE. 5614 03:34:19,984 --> 03:34:27,725 WE IMPLEMENTED MULTI-DISCIPLINE 5615 03:34:27,725 --> 03:34:33,064 CARE APPROACH, USED SPIROMETRY, 5616 03:34:33,064 --> 03:34:37,502 AND WHERE PATIENTS COULD NOT, WE 5617 03:34:37,502 --> 03:34:44,809 USED LATEX-FREE BALLOONS. 5618 03:34:44,809 --> 03:34:46,010 NEXT SLIDE. 5619 03:34:46,010 --> 03:34:48,646 AGAIN, DURING ACUTE PAIN 5620 03:34:48,646 --> 03:34:52,016 EPISODES, ROUTINE MONITORING OF 5621 03:34:52,016 --> 03:34:59,457 OXYGEN SATURATION, USE OF PULSE 5622 03:34:59,457 --> 03:35:01,326 OXY METERS, IMPLEMENTED BLOOD 5623 03:35:01,326 --> 03:35:02,960 TRANSFUSION, PREGNANT WOMEN THAT 5624 03:35:02,960 --> 03:35:07,899 WAY ADMITTED AND REQUIRED 5625 03:35:07,899 --> 03:35:11,703 INPATIENT CARE WERE DESIGNATED 5626 03:35:11,703 --> 03:35:13,338 TO WARDS WHERE THEY WERE 5627 03:35:13,338 --> 03:35:14,005 MANAGED. 5628 03:35:14,005 --> 03:35:15,973 NEXT SLIDE. 5629 03:35:15,973 --> 03:35:19,143 NOW, AFTER IMPLEMENTING THIS 5630 03:35:19,143 --> 03:35:25,083 APPROACH TO CARE FOR 13 MONTHS, 5631 03:35:25,083 --> 03:35:27,018 THE MATERNAL MORTALITY RATIO 5632 03:35:27,018 --> 03:35:37,462 REDUCED FROM OVER 10,000. 5633 03:35:39,797 --> 03:35:42,934 NEXT SLIDE PLEASE. 5634 03:35:42,934 --> 03:35:48,606 AGAIN, THE PERINATAL MORTALITY 5635 03:35:48,606 --> 03:35:52,043 RATE REDUCED FROM ABOUT 60 PER 5636 03:35:52,043 --> 03:35:56,848 THOUSAND LIVE BIRTHS TO 23, 5637 03:35:56,848 --> 03:35:58,349 62.2% RELATIVE RISK REDUCTION IN 5638 03:35:58,349 --> 03:36:01,252 MORTALITY RATES. 5639 03:36:01,252 --> 03:36:01,552 NEXT SLIDE. 5640 03:36:01,552 --> 03:36:04,689 FIRST, THIS RESULT WAS PRESENTED 5641 03:36:04,689 --> 03:36:06,924 AT ONE OF THE CONFERENCES, LATER 5642 03:36:06,924 --> 03:36:11,329 PUBLISHED IN THE "NEW YORK 5643 03:36:11,329 --> 03:36:11,629 TIMES." 5644 03:36:11,629 --> 03:36:12,296 NEXT SLIDE. 5645 03:36:12,296 --> 03:36:14,599 NOW, HOW HAS THE LOW MATERNAL 5646 03:36:14,599 --> 03:36:15,900 MORTALITY RATE IN WOMEN WITH 5647 03:36:15,900 --> 03:36:20,271 SICKLE CELL DISEASE BEEN ATTEND 5648 03:36:20,271 --> 03:36:26,944 OVER THE YEARS, NEXT SLIDE. 5649 03:36:26,944 --> 03:36:29,580 SO, AFTER ABOUT THREE YEARS OF 5650 03:36:29,580 --> 03:36:31,883 PUBLISHING THIS DATA WE WENT 5651 03:36:31,883 --> 03:36:35,920 BACK TO SEE WHETHER THIS WAS 5652 03:36:35,920 --> 03:36:38,856 ACHIEVED WITH WOMEN WITH SICKLE 5653 03:36:38,856 --> 03:36:42,727 CELL WAS SUSTAINABLE. 5654 03:36:42,727 --> 03:36:44,796 REVIEW DEMONSTRATED YES, WE HAVE 5655 03:36:44,796 --> 03:36:47,331 SUSTAINED LOW MATERNAL MORTALITY 5656 03:36:47,331 --> 03:36:50,168 AND PERINATAL RATE AT THE 5657 03:36:50,168 --> 03:36:50,935 HOSPITALS, STILL USING 5658 03:36:50,935 --> 03:36:54,205 MULTI-DISCIPLINARY CARE 5659 03:36:54,205 --> 03:36:55,106 APPROACH. 5660 03:36:55,106 --> 03:36:56,307 NEXT SLIDE. 5661 03:36:56,307 --> 03:36:59,477 SO WHAT ARE IMPLEMENTATION 5662 03:36:59,477 --> 03:37:01,245 STRATEGIES FOR 5663 03:37:01,245 --> 03:37:02,547 MULTI-DISCIPLINARY SICKLE CELL 5664 03:37:02,547 --> 03:37:04,282 OBSTETRICS APPROACH IN GHANA? 5665 03:37:04,282 --> 03:37:04,749 NEXT SLIDE. 5666 03:37:04,749 --> 03:37:07,351 NOW, THE CURRENT SITUATION IS 5667 03:37:07,351 --> 03:37:11,088 THAT WE HAVE DEMONSTRATED 5668 03:37:11,088 --> 03:37:12,390 POSITIVE IMPACT OF 5669 03:37:12,390 --> 03:37:13,591 MULTI-DISCIPLINARY TEAM AT THE 5670 03:37:13,591 --> 03:37:23,568 HOSPITAL, WHICH IS THE LEADING 5671 03:37:23,568 --> 03:37:28,039 TEACHING HOSPITAL IN ACCRA, WE 5672 03:37:28,039 --> 03:37:32,076 RESTRICTED TO OUR HOSPITAL BUT 5673 03:37:32,076 --> 03:37:34,178 THEREFORE SEVERAL OTHERS ACROSS 5674 03:37:34,178 --> 03:37:35,813 THE COUNTRY. 5675 03:37:35,813 --> 03:37:38,449 OUR WORK IS AT A LOW REACH, 5676 03:37:38,449 --> 03:37:40,184 THEREFORE THE CURRENT REACH WE 5677 03:37:40,184 --> 03:37:46,657 CAN'T SAY IT MAKES MAKES MUCH C 5678 03:37:46,657 --> 03:37:51,028 HEALTH IMPACT BECAUSE THERE ARE 5679 03:37:51,028 --> 03:37:51,996 MANY MORE WOMEN WITH SICKLE CELL 5680 03:37:51,996 --> 03:37:53,564 DISEASE ALL OVER THE COUNTRY. 5681 03:37:53,564 --> 03:37:53,898 NEXT SLIDE. 5682 03:37:53,898 --> 03:37:56,100 SO WHAT ARE OUR PLANS? 5683 03:37:56,100 --> 03:37:59,470 OUR PLAN IS TO SCALE UP, TO AT 5684 03:37:59,470 --> 03:38:03,674 LEAST EVERY REGION IN GHANA, 5685 03:38:03,674 --> 03:38:08,279 GHANA CURRENTLY HAS ABOUT 16 5686 03:38:08,279 --> 03:38:11,015 POLITICAL REGIONS, MOST HAVE 5687 03:38:11,015 --> 03:38:13,851 SECONDARY LEVEL HOSPITALS BUT 5688 03:38:13,851 --> 03:38:15,453 THEY DON'T HAVE 5689 03:38:15,453 --> 03:38:16,254 MULTI-DISCIPLINARY OBSTETRIC 5690 03:38:16,254 --> 03:38:20,458 CARE PROGRAM AT ANY FACILITIES 5691 03:38:20,458 --> 03:38:20,658 HERE. 5692 03:38:20,658 --> 03:38:22,860 WE'RE THEREFORE ABOUT FOUR OR 5693 03:38:22,860 --> 03:38:24,695 FIVE SITES EARMARKED TO MOVE TO 5694 03:38:24,695 --> 03:38:28,099 THE NEXT COUPLE OF YEARS. 5695 03:38:28,099 --> 03:38:34,639 AND COLLECTIVELY THESE FOUR 5696 03:38:34,639 --> 03:38:38,009 SITES COMBINE OVER 600 PREGNANT 5697 03:38:38,009 --> 03:38:39,277 WOMAN WITH SICKLE CELL DISEASE 5698 03:38:39,277 --> 03:38:42,213 THAT DELIVER EACH YEAR. 5699 03:38:42,213 --> 03:38:50,121 THIS IS BETWEEN 5,000 TO 5700 03:38:50,121 --> 03:38:51,088 THOUSAND MATERNAL DEATHS PER 5701 03:38:51,088 --> 03:38:52,623 100,000 LIVE BIRTHS. 5702 03:38:52,623 --> 03:38:56,794 IF WE CAN REDUCE ACROSS FOUR 5703 03:38:56,794 --> 03:38:58,429 SITES BY 50%, WE'LL HAVE MADE 5704 03:38:58,429 --> 03:39:02,600 SOME IMPACT. 5705 03:39:02,600 --> 03:39:06,537 NEXT SLIDE. 5706 03:39:06,537 --> 03:39:10,908 WHAT IS UNIQUE ABOUT 5707 03:39:10,908 --> 03:39:12,109 MULTI-DISCIPLINARY TEAM IN 5708 03:39:12,109 --> 03:39:12,310 ACCRA? 5709 03:39:12,310 --> 03:39:15,279 WE HAVE A VIBRANT TEAM OF 5710 03:39:15,279 --> 03:39:16,814 WILLING PEOPLE EAGER AND READY 5711 03:39:16,814 --> 03:39:17,582 TO WORK TOGETHER. 5712 03:39:17,582 --> 03:39:23,354 WE ALSO HAVE THE BENEFIT OF A 5713 03:39:23,354 --> 03:39:26,657 GLOBAL MENTOR WHOSE ADVICE HAS 5714 03:39:26,657 --> 03:39:30,027 BEEN SUPPORTING THIS WORK IN 5715 03:39:30,027 --> 03:39:32,563 MANY -- AT MANY LEVELS. 5716 03:39:32,563 --> 03:39:34,665 THE TEAM HAS REGULAR MEETINGS AT 5717 03:39:34,665 --> 03:39:40,004 WHICH WE DISCUSS NEARLY EVERY 5718 03:39:40,004 --> 03:39:43,274 CASE OF ACUTE PAIN EPISODE OR 5719 03:39:43,274 --> 03:39:44,508 ACUTE CHEST SYNDROME. 5720 03:39:44,508 --> 03:39:47,011 THE TEAM HAS AGREED TO REVIEW 5721 03:39:47,011 --> 03:39:48,779 AND EDUCATE EVERY CASE OF 5722 03:39:48,779 --> 03:39:51,515 MATERNAL MORTALITY TO FIND A 5723 03:39:51,515 --> 03:39:53,250 CAUSE AND FIND MEANS OF 5724 03:39:53,250 --> 03:39:54,652 PREVENTING SUCH EVENT FROM 5725 03:39:54,652 --> 03:39:58,823 OCCURRING AGAIN. 5726 03:39:58,823 --> 03:40:00,224 NEXT SLIDE. 5727 03:40:00,224 --> 03:40:04,195 THIS PROGRAM IS NOT WITHOUT 5728 03:40:04,195 --> 03:40:04,495 CHALLENGES. 5729 03:40:04,495 --> 03:40:06,464 WE WORK CURRENTLY, ONE OF THE 5730 03:40:06,464 --> 03:40:09,433 BIGGEST PROBLEMS IS ISSUES WITH 5731 03:40:09,433 --> 03:40:09,967 SPACE. 5732 03:40:09,967 --> 03:40:12,403 A LOCATION OF STAFF, THIS IS AN 5733 03:40:12,403 --> 03:40:13,270 ENTIRELY NEW CONCEPT. 5734 03:40:13,270 --> 03:40:16,440 SO WHEN PEOPLE HAVE TO MOVE FROM 5735 03:40:16,440 --> 03:40:17,975 THE DIFFERENT ROOMS TO A AGREE 5736 03:40:17,975 --> 03:40:20,378 TO COME TOGETHER, TO HAVE THIS 5737 03:40:20,378 --> 03:40:22,880 JOINT TEAM, IT DOESN'T COME 5738 03:40:22,880 --> 03:40:23,114 EASILY. 5739 03:40:23,114 --> 03:40:24,582 BUT WHEN YOU HAVE WILLING PEOPLE 5740 03:40:24,582 --> 03:40:29,286 READY TO WORK TO MAKE AN IMPACT, 5741 03:40:29,286 --> 03:40:33,224 WE'RE ABLE TO MAKE SOME INROADS. 5742 03:40:33,224 --> 03:40:36,193 AGAIN, WE NEED DEDICATED STAFF. 5743 03:40:36,193 --> 03:40:38,262 OF COURSE, FUNDING SUPPORT TO DO 5744 03:40:38,262 --> 03:40:40,998 SOME OF THE BUSY THINGS FOR 5745 03:40:40,998 --> 03:40:42,466 PREGNANT WOMEN WHEN THEY COME TO 5746 03:40:42,466 --> 03:40:42,867 THE CLINIC. 5747 03:40:42,867 --> 03:40:44,902 A LOT OF SICKLE CELL DISEASE 5748 03:40:44,902 --> 03:40:47,238 PATIENTS ALSO HAVE A LOW 5749 03:40:47,238 --> 03:40:48,973 SOCIOECONOMIC STATUS, SOME 5750 03:40:48,973 --> 03:40:53,010 BECAUSE OF THEIR DISEASE STATUS 5751 03:40:53,010 --> 03:40:57,848 ARE NOT IN MEANINGFUL EMPLOYMENT 5752 03:40:57,848 --> 03:40:59,250 SO AFFORDING BASIC HEALTHCARE IS 5753 03:40:59,250 --> 03:41:03,854 CHALLENGE, A MEANS OF SUPPORTING 5754 03:41:03,854 --> 03:41:05,489 THIS CLINIC, SUSTAIN INTEREST IN 5755 03:41:05,489 --> 03:41:06,824 THE CLINIC WILL BE USEFUL TO 5756 03:41:06,824 --> 03:41:08,726 MAKE SURE WE ENSURE PROGRESS. 5757 03:41:08,726 --> 03:41:11,962 THE QUESTION IS, IS IT EVERY 5758 03:41:11,962 --> 03:41:12,596 SECTOR? 5759 03:41:12,596 --> 03:41:14,031 EVERY COMMUNITY, OR EVERY 5760 03:41:14,031 --> 03:41:16,133 HOSPITAL THAT WILL ACCEPT THIS 5761 03:41:16,133 --> 03:41:16,934 SORT OF PROGRAM? 5762 03:41:16,934 --> 03:41:22,773 PEOPLE ARE USED TO RUNNING 5763 03:41:22,773 --> 03:41:24,308 ANTENATAL CLINICS SEPARATE, 5764 03:41:24,308 --> 03:41:26,310 HEMATOLOGY CLINICS RUN 5765 03:41:26,310 --> 03:41:29,680 SEPARATELY, PULMONOLOGY CLINICS 5766 03:41:29,680 --> 03:41:30,581 RUN SEPARATELY. 5767 03:41:30,581 --> 03:41:36,187 BRINGING THESE TOGETHER IN ONE 5768 03:41:36,187 --> 03:41:38,889 CLINTON TO DISCUSS CASES IS THE 5769 03:41:38,889 --> 03:41:43,294 OLD SYSTEM OF REFERRING, 5770 03:41:43,294 --> 03:41:44,361 SOMETIMES CHALLENGING. 5771 03:41:44,361 --> 03:41:47,231 AGAIN, WE NEED TO CONSIDER 5772 03:41:47,231 --> 03:41:50,835 BRINGING PATIENT PARTNERS, TO 5773 03:41:50,835 --> 03:42:01,045 ALSO SUPPORT SCREENING. 5774 03:42:01,045 --> 03:42:04,381 NEXT SLIDE. 5775 03:42:04,381 --> 03:42:05,883 NEXT SLIDE PLEASE. 5776 03:42:05,883 --> 03:42:09,253 HOW DO WE OVERCOME CHALLENGES OF 5777 03:42:09,253 --> 03:42:10,554 CREATING A GOOD 5778 03:42:10,554 --> 03:42:11,122 MULTI-DISCIPLINARY OBSTETRIC 5779 03:42:11,122 --> 03:42:11,322 CARE? 5780 03:42:11,322 --> 03:42:13,624 WE NEED WORK WITH OTHER MEMBERS 5781 03:42:13,624 --> 03:42:17,795 OF THIS TRIANGLE, WITH THE 5782 03:42:17,795 --> 03:42:19,463 HEALTH FACILITIES AND RECOGNIZE 5783 03:42:19,463 --> 03:42:21,599 THE ROLE OF THE PREGNANT WOMEN 5784 03:42:21,599 --> 03:42:23,868 AS IMPORTANT STAKEHOLDERS IN 5785 03:42:23,868 --> 03:42:25,436 EVERYTHING THAT WE'RE DOING. 5786 03:42:25,436 --> 03:42:30,908 WE CAN'T WORK FOR THESE PREGNANT 5787 03:42:30,908 --> 03:42:33,744 WOMEN AND SEEK BETTER OUTCOME 5788 03:42:33,744 --> 03:42:35,079 FOR PREGNANCY WITHOUT INVOLVING 5789 03:42:35,079 --> 03:42:35,446 THEM. 5790 03:42:35,446 --> 03:42:36,580 WE NEED TO ENGAGE THEM IN 5791 03:42:36,580 --> 03:42:38,649 EVERYTHING THAT WE DO RIGHT FROM 5792 03:42:38,649 --> 03:42:46,891 THE BEGINNING. 5793 03:42:46,891 --> 03:42:51,362 NEXT SLIDE. 5794 03:42:51,362 --> 03:42:52,029 NOW, MULTI-DISCIPLINARY APPROACH 5795 03:42:52,029 --> 03:42:54,298 SHOULD BE THE GOLD STANDARD 5796 03:42:54,298 --> 03:42:56,534 BECAUSE WE'RE SEEING IT SEEMS TO 5797 03:42:56,534 --> 03:42:58,702 HAVE HIGHEST IMPACT ON REDUCING 5798 03:42:58,702 --> 03:43:02,273 MORBIDITY AND MORTALITY RATES AS 5799 03:43:02,273 --> 03:43:07,444 DEMONSTRATED IN LOW RESOURCE 5800 03:43:07,444 --> 03:43:07,745 ENVIRONMENT. 5801 03:43:07,745 --> 03:43:09,547 IMPLEMENTING MULTI-DISCIPLINARY 5802 03:43:09,547 --> 03:43:12,583 APPROACH INCLUDING HEMATOLOGIST 5803 03:43:12,583 --> 03:43:13,184 CAN REDUCE MATERNAL MORBIDITY 5804 03:43:13,184 --> 03:43:20,958 AND MORTALITY IN THIS COHORT. 5805 03:43:20,958 --> 03:43:21,826 NEXT SLIDE. 5806 03:43:21,826 --> 03:43:26,197 WE JUST TALKED ABOUT THIS. 5807 03:43:26,197 --> 03:43:26,664 NEXT SLIDE. 5808 03:43:26,664 --> 03:43:35,439 NEXT SLIDE. 5809 03:43:35,439 --> 03:43:37,842 NEXT SLIDE. 5810 03:43:37,842 --> 03:43:41,879 NEXT SLIDE. 5811 03:43:41,879 --> 03:43:44,582 SO IN CONCLUSION WE SAY PREGNANT 5812 03:43:44,582 --> 03:43:45,916 WOMEN WITH SICKLE CELL DISEASE 5813 03:43:45,916 --> 03:43:48,752 HAVE ONE OF THE HIGHEST 5814 03:43:48,752 --> 03:43:54,024 MORTALITY RATES OF ANY 5815 03:43:54,024 --> 03:43:55,559 PREEXISTING CONDITIONS IN BOTH 5816 03:43:55,559 --> 03:43:57,628 RESOURCE LOW AND RESOURCE RICH 5817 03:43:57,628 --> 03:43:59,396 ENVIRONMENT. 5818 03:43:59,396 --> 03:44:03,334 ACUTE PAIN AND ACUTE CHEST 5819 03:44:03,334 --> 03:44:04,335 SYNDROME ARE LEADING CAUSES, 5820 03:44:04,335 --> 03:44:07,271 THIS YEAR LEADING CAUSE OF 5821 03:44:07,271 --> 03:44:08,372 MATERNAL DEATH ACCOUNTING FOR 5822 03:44:08,372 --> 03:44:16,347 80% OF ALL DEATHS IN PREGNANCY 5823 03:44:16,347 --> 03:44:17,014 WOMEN. 5824 03:44:17,014 --> 03:44:20,618 MOST ACUTE PAIN, ACUTE CHEST 5825 03:44:20,618 --> 03:44:28,259 SYNDROME AND PULMONARY THROMBO 5826 03:44:28,259 --> 03:44:31,762 THROMBOEMBOLISM INCLUDE IN THIRD 5827 03:44:31,762 --> 03:44:32,029 TRIMESTER. 5828 03:44:32,029 --> 03:44:33,430 THIS SHOULD BE THE GOLD STANDARD 5829 03:44:33,430 --> 03:44:35,566 OF CARE. 5830 03:44:35,566 --> 03:44:36,600 NEXT SLIDE. 5831 03:44:36,600 --> 03:44:38,569 THANK YOU VERY MUCH. 5832 03:44:38,569 --> 03:44:48,779 THANK YOU. 5833 03:44:53,550 --> 03:44:55,085 >> I HOPE EVERYBODY CAN HEAR ME. 5834 03:44:55,085 --> 03:44:56,921 IT'S A PLEASURE TO BE HERE. 5835 03:44:56,921 --> 03:44:58,656 I THANK THE ORGANIZERS FOR 5836 03:44:58,656 --> 03:45:00,124 ALLOWING ME TO TALK ABOUT SOME 5837 03:45:00,124 --> 03:45:05,062 OF THE WORK WE'RE DOING. 5838 03:45:05,062 --> 03:45:06,063 NEXT SLIDE. 5839 03:45:06,063 --> 03:45:07,898 SO I HAVE NO CONFLICTS OF 5840 03:45:07,898 --> 03:45:09,433 INTEREST TO DISCLOSE. 5841 03:45:09,433 --> 03:45:16,974 OF COURSE, THESE ARE MY NIH 5842 03:45:16,974 --> 03:45:17,374 GRANTS. 5843 03:45:17,374 --> 03:45:19,410 I WANT TO HIGHLIGHT THAT WHAT 5844 03:45:19,410 --> 03:45:22,012 I'M GOING TO PRESENT HAS BEEN 5845 03:45:22,012 --> 03:45:25,082 REALLY A TEAM EFFORT, SO FIRST I 5846 03:45:25,082 --> 03:45:27,785 WANT TO HIGHLIGHT THAT THIS 5847 03:45:27,785 --> 03:45:29,653 SCOPE AND REVIEW WITH US DONE BY 5848 03:45:29,653 --> 03:45:32,389 INDIVIDUALS IN MY LAB, 5849 03:45:32,389 --> 03:45:34,058 SPECIFICALLY THE PROFESSOR ON 5850 03:45:34,058 --> 03:45:36,126 THE RIGHT, THE MEDICAL LIBRARIAN 5851 03:45:36,126 --> 03:45:39,630 WHO OVERSAW THIS, AND ON THE FAR 5852 03:45:39,630 --> 03:45:43,734 LEFT IS DR. RYAN, WHO WAS A 5853 03:45:43,734 --> 03:45:45,102 POSTDOCTORAL FELLOW, NOW AT THE 5854 03:45:45,102 --> 03:45:45,869 CDC. 5855 03:45:45,869 --> 03:45:47,638 WE HAVE SOME PHENOMENAL STUDENTS 5856 03:45:47,638 --> 03:45:53,210 WHO ARE NOW GRADUATES OF THE 5857 03:45:53,210 --> 03:45:54,745 SCHOOL OF GLOBAL PUBLIC HEALTH, 5858 03:45:54,745 --> 03:45:58,582 AND THIS DATA I'M PRESENTING WAS 5859 03:45:58,582 --> 03:46:01,885 DISCUSSED AT THE PUBLIC HEALTH 5860 03:46:01,885 --> 03:46:02,619 PARTNERSHIP CONFERENCE IN 2021 5861 03:46:02,619 --> 03:46:05,589 AND WE ARE IN THE PROCESS OF 5862 03:46:05,589 --> 03:46:06,991 REVISING IT FOR SUBMISSION. 5863 03:46:06,991 --> 03:46:09,093 BUT THANK YOU SO MUCH. 5864 03:46:09,093 --> 03:46:09,960 NEXT SLIDE. 5865 03:46:09,960 --> 03:46:13,731 SO THIS IS AN OVERVIEW OF MY 5866 03:46:13,731 --> 03:46:17,067 TALK, TALKING ABOUT THE 5867 03:46:17,067 --> 03:46:20,137 BACKGROUND A LITTLE BIT, OUR 5868 03:46:20,137 --> 03:46:21,472 OBJECTIVES, OUR RESULTS AND 5869 03:46:21,472 --> 03:46:24,174 CONCLUSIONS AND FINAL THOUGHTS. 5870 03:46:24,174 --> 03:46:24,875 NEXT SLIDE. 5871 03:46:24,875 --> 03:46:27,244 SO I DON'T THINK I NEED REALLY 5872 03:46:27,244 --> 03:46:30,781 SPEND TOO MUCH ON THIS, BUT JUST 5873 03:46:30,781 --> 03:46:36,253 TO PULL OUT SOME INTERESTING 5874 03:46:36,253 --> 03:46:36,520 FACTS. 5875 03:46:36,520 --> 03:46:40,958 IN 2022, 817 WOMEN DIED IN THE 5876 03:46:40,958 --> 03:46:43,460 UNITED STATES, RELATED 5877 03:46:43,460 --> 03:46:47,431 COMPLICATIONS FROM PREGNANCY, 5878 03:46:47,431 --> 03:46:48,732 DELIVERY, POSTPARTUM -- DURING 5879 03:46:48,732 --> 03:46:49,400 FIRST YEAR POSTPARTUM. 5880 03:46:49,400 --> 03:46:52,469 WE KNOW BASED ON EVIDENCE 60% OF 5881 03:46:52,469 --> 03:46:53,670 THESE DEATHS ARE PREVENTIBLE. 5882 03:46:53,670 --> 03:46:56,740 OF COURSE, MANY OF MY COLLEAGUES 5883 03:46:56,740 --> 03:46:58,042 HAVE TALKED ABOUT THE 5884 03:46:58,042 --> 03:46:59,109 SIGNIFICANT DISPARITY THAT WOMEN 5885 03:46:59,109 --> 03:47:03,080 OF COLOR FACE IN TERMS OF BLACK 5886 03:47:03,080 --> 03:47:04,681 WOMEN, IN TERMS OF AMERICAN 5887 03:47:04,681 --> 03:47:06,250 INDIAN, ALASKA NATIVE SO I'M NOT 5888 03:47:06,250 --> 03:47:08,952 GOING TO DISCUSS THAT TOO MUCH. 5889 03:47:08,952 --> 03:47:11,922 THE ISSUE IS THAT THE RATES IN 5890 03:47:11,922 --> 03:47:14,324 TERMS OF MATERNAL MORTALITY ARE 5891 03:47:14,324 --> 03:47:19,463 COMPARABLE IN THE UNITED STATES 5892 03:47:19,463 --> 03:47:20,664 TO RESOURCE CONSTRAINED 5893 03:47:20,664 --> 03:47:22,866 SETTINGS, ASTONISHING AND ALMOST 5894 03:47:22,866 --> 03:47:24,835 UNFORGIVABLE IN THIS CONTEXT. 5895 03:47:24,835 --> 03:47:25,836 WHAT ARE THE CONTRIBUTORS TO 5896 03:47:25,836 --> 03:47:27,371 THIS? 5897 03:47:27,371 --> 03:47:28,806 WE KNOW THAT THE CONTRIBUTORS TO 5898 03:47:28,806 --> 03:47:33,143 THIS DISPARITY OF WOMEN OF COLOR 5899 03:47:33,143 --> 03:47:34,812 IS CHRONIC EXPOSURE TO RACISM 5900 03:47:34,812 --> 03:47:37,648 WHICH HAS BEEN DISCUSSED. 5901 03:47:37,648 --> 03:47:40,384 WE KNOW WOMEN OF COLOR ARE 5902 03:47:40,384 --> 03:47:42,152 EXPOSED TO VARIOUS 5903 03:47:42,152 --> 03:47:44,421 MANIFESTATIONS OF RACISM WHICH 5904 03:47:44,421 --> 03:47:49,793 LEADS TO WEATHERING, AND OUR 5905 03:47:49,793 --> 03:47:50,994 COLLEAGUES TALKED ABOUT THAT. 5906 03:47:50,994 --> 03:47:57,301 THIS ALSO NEEDS TO INCREASED 5907 03:47:57,301 --> 03:47:59,002 SUSCEPTIBILITY TO HYPERTENSION, 5908 03:47:59,002 --> 03:48:00,537 CARDIOVASCULAR DISEASE, 5909 03:48:00,537 --> 03:48:02,172 DIABETES, OTHER CHRONIC 5910 03:48:02,172 --> 03:48:06,677 CONDITIONS. 5911 03:48:06,677 --> 03:48:07,778 ANOTHER MAIN CONTRIBUTOR, WOMEN 5912 03:48:07,778 --> 03:48:10,948 OF COLOR FIND IT MORE 5913 03:48:10,948 --> 03:48:13,150 CHALLENGING TO ACCESS PROPER AND 5914 03:48:13,150 --> 03:48:15,419 COMPETENT QUALITY OF MATERNAL 5915 03:48:15,419 --> 03:48:18,822 CARE DUE TO RACISM. 5916 03:48:18,822 --> 03:48:19,723 NEXT SLIDE. 5917 03:48:19,723 --> 03:48:24,962 SO WE CAN THINK ABOUT RACISM AS 5918 03:48:24,962 --> 03:48:27,564 BEING STRATIFIED IN THESE 5919 03:48:27,564 --> 03:48:27,798 LAYERS. 5920 03:48:27,798 --> 03:48:30,667 FOR INDIVIDUAL ASPECT, WHICH IS 5921 03:48:30,667 --> 03:48:33,604 BASICALLY BELIEFS AND ATTITUDES, 5922 03:48:33,604 --> 03:48:35,439 INTERPERSONAL ASPECTS WHICH IS 5923 03:48:35,439 --> 03:48:37,441 BASICALLY PUBLIC EXPRESSIONS OF 5924 03:48:37,441 --> 03:48:40,811 RACISM BETWEEN INDIVIDUALS, AND 5925 03:48:40,811 --> 03:48:41,879 THEN ALSO THE INSTITUTIONAL 5926 03:48:41,879 --> 03:48:43,881 ASPECT IN TERMS OF INSTITUTIONAL 5927 03:48:43,881 --> 03:48:44,815 RACISM. 5928 03:48:44,815 --> 03:48:46,183 AND WE KNOW THAT INSTITUTIONAL 5929 03:48:46,183 --> 03:48:49,586 RACISM IS IMPORTANT BECAUSE IT 5930 03:48:49,586 --> 03:48:53,090 TAKES THE FORM OF DISCRIMINATORY 5931 03:48:53,090 --> 03:48:57,928 TREATMENT ON FAIR PRACTICES, 5932 03:48:57,928 --> 03:49:03,500 BIASES BASED ON RACE, INEQUITY 5933 03:49:03,500 --> 03:49:03,634 E 5934 03:49:03,634 --> 03:49:04,468 QUITABLE OUTCOMES. 5935 03:49:04,468 --> 03:49:06,770 A WOMAN OF COLOR COULD 5936 03:49:06,770 --> 03:49:13,677 EXPERIENCE IMPLICIT BIAS WHEN 5937 03:49:13,677 --> 03:49:15,412 DELIVERIES PERCEIVE FALSELY SHE 5938 03:49:15,412 --> 03:49:20,317 HAS A HIGHER PAIN TOLERANCE, 5939 03:49:20,317 --> 03:49:20,984 PRESCRIBED LESS MEDICATION, 5940 03:49:20,984 --> 03:49:24,087 LOWER QUALITY OF CARE. 5941 03:49:24,087 --> 03:49:25,489 THERE'S STRUCTURAL RACISM 5942 03:49:25,489 --> 03:49:28,892 ELEMENT, RACIAL BIAS ACROSS BOTH 5943 03:49:28,892 --> 03:49:30,294 INSTITUTIONS AND SOCIETY. 5944 03:49:30,294 --> 03:49:32,829 STRUCTURAL RACISM CAN BE 5945 03:49:32,829 --> 03:49:33,697 DESCRIBED AS MUTUALLY 5946 03:49:33,697 --> 03:49:35,666 REINFORCING FORMS OF 5947 03:49:35,666 --> 03:49:38,735 DISCRIMINATION THAT INCLUDE 5948 03:49:38,735 --> 03:49:41,138 NEIGHBORHOOD DEPRIVATION, 5949 03:49:41,138 --> 03:49:42,573 ECONOMIC INEQUALITY, EDUCATIONAL 5950 03:49:42,573 --> 03:49:43,574 DISPARITIES, DIFFERENTIAL ACCESS 5951 03:49:43,574 --> 03:49:46,276 TO HEALTH CARE. 5952 03:49:46,276 --> 03:49:46,944 THESE FACTORS ALSO INCLUDE 5953 03:49:46,944 --> 03:49:48,278 SOCIAL DETERMINANTS OF HEALTH, 5954 03:49:48,278 --> 03:49:50,781 WHICH ARE OF COURSE DEFINED AS 5955 03:49:50,781 --> 03:49:52,649 CONDITIONS IN WHICH PEOPLE ARE 5956 03:49:52,649 --> 03:49:57,054 BORN, GROW, WORK, LIVE, AND AGE. 5957 03:49:57,054 --> 03:49:58,989 SO, THIS WAS AN IMPORTANT 5958 03:49:58,989 --> 03:50:01,959 ELEMENT IN TERMS OF THINKING 5959 03:50:01,959 --> 03:50:03,160 THROUGH THE ISSUES AROUND 5960 03:50:03,160 --> 03:50:06,897 MATERNAL HEALTH. 5961 03:50:06,897 --> 03:50:07,965 NEXT SLIDE. 5962 03:50:07,965 --> 03:50:11,435 SO, THERE HAVE BEEN MANY EFFORTS 5963 03:50:11,435 --> 03:50:13,237 TO REDUCE MATERNAL MORTALITY 5964 03:50:13,237 --> 03:50:16,740 WHICH HAVE GIVEN RISE TO 5965 03:50:16,740 --> 03:50:18,175 IMPROVEMENTS IN MATERNAL HEALTH 5966 03:50:18,175 --> 03:50:27,451 BUT WE'VE NOT SEE THE CHANGE 5967 03:50:27,451 --> 03:50:27,985 AT 5968 03:50:27,985 --> 03:50:30,120 THE POPULATION LEVEL. 5969 03:50:30,120 --> 03:50:34,157 WE WANTED TO UNDERTAKE THIS 5970 03:50:34,157 --> 03:50:35,559 SCOPING REVIEW. 5971 03:50:35,559 --> 03:50:37,094 SO, OUR OBJECTIVES WERE 5972 03:50:37,094 --> 03:50:38,862 BASICALLY TO UNDERSTAND FIRST 5973 03:50:38,862 --> 03:50:41,932 STRUGGLE FOR MATERNAL HEALTH AND 5974 03:50:41,932 --> 03:50:46,036 MOTHERHOOD INCLUDES OF COURSE 5975 03:50:46,036 --> 03:50:48,105 DAILY RESISTANCE TO RACISM, 5976 03:50:48,105 --> 03:50:49,773 CLASSISM, SEXISM, OTHER FORMS OF 5977 03:50:49,773 --> 03:50:50,207 VIOLENCE. 5978 03:50:50,207 --> 03:50:53,377 WE CAN SEE THIS IN TERMS OF 5979 03:50:53,377 --> 03:50:59,449 EXAMPLE OF SERENA WILLIAMS, WHO 5980 03:50:59,449 --> 03:51:04,254 HAD A SIGNIFICANT POOR MATERNAL 5981 03:51:04,254 --> 03:51:04,988 OUTCOMES. 5982 03:51:04,988 --> 03:51:07,758 IF SHE CAN EXPERIENCE THESE 5983 03:51:07,758 --> 03:51:08,525 SIGNIFICANT DISPARITIES, WITH 5984 03:51:08,525 --> 03:51:10,727 RESOURCES, WE KNOW THEY EXIST. 5985 03:51:10,727 --> 03:51:13,563 THROUGH THIS PRESENTATION WE 5986 03:51:13,563 --> 03:51:17,301 WANTED TO ASSESS INTERVENTIONS 5987 03:51:17,301 --> 03:51:18,368 AND IMPLEMENTATION STRATEGIES 5988 03:51:18,368 --> 03:51:19,603 THAT ADDRESS MATERNAL HEALTH 5989 03:51:19,603 --> 03:51:21,471 RISK FACTORS RELATED TO 5990 03:51:21,471 --> 03:51:25,075 STRUCTURAL RACISM, IN THE U.S., 5991 03:51:25,075 --> 03:51:27,611 OR DISCRIMINATION IN HEALTH CARE 5992 03:51:27,611 --> 03:51:29,112 DURING PREGNANCY AT DELIVERY OR 5993 03:51:29,112 --> 03:51:30,781 UP TO THE YEAR POSTPARTUM 5994 03:51:30,781 --> 03:51:37,220 AMONGST WOMEN OF COLOR. 5995 03:51:37,220 --> 03:51:38,121 NEXT SLIDE. 5996 03:51:38,121 --> 03:51:39,956 THIS IS AN OVERVIEW. 5997 03:51:39,956 --> 03:51:42,359 WE CONDUCTED A SCOPING REVIEW TO 5998 03:51:42,359 --> 03:51:44,127 SORT OF UNDERSTAND LITERATURE ON 5999 03:51:44,127 --> 03:51:47,631 THIS IN TERMS OF LANDSCAPE. 6000 03:51:47,631 --> 03:51:48,932 NEXT SLIDE. 6001 03:51:48,932 --> 03:51:54,504 SO WE SEARCHED ABOUT SIX 6002 03:51:54,504 --> 03:51:56,807 DATABASES USING THE PRISMA 6003 03:51:56,807 --> 03:51:58,475 GUIDELINES, WITH OVER 3,000 6004 03:51:58,475 --> 03:52:02,179 STUDIES IMPORTED FROM VARIOUS 6005 03:52:02,179 --> 03:52:02,446 DATABASES. 6006 03:52:02,446 --> 03:52:08,318 AFTER SCREENING, THOSE STUDIES 6007 03:52:08,318 --> 03:52:11,688 WE, 38 WERE ELIGIBLE, AND WE DID 6008 03:52:11,688 --> 03:52:13,123 FURTHER SCREENING. 6009 03:52:13,123 --> 03:52:16,293 WE HAD TO OMIT EIGHT STUDIES 6010 03:52:16,293 --> 03:52:19,429 BECAUSE THOSE EIGHT STUDIES DID 6011 03:52:19,429 --> 03:52:21,565 NOT INCLUDE INTERVENTION OR 6012 03:52:21,565 --> 03:52:23,100 IMPLEMENTATION ASSESSMENT, DID 6013 03:52:23,100 --> 03:52:25,168 NOT ADDRESS MATERNAL HEALTH RISK 6014 03:52:25,168 --> 03:52:27,337 FACTORS RELATED TO STRUCTURAL 6015 03:52:27,337 --> 03:52:31,441 RACISM, DID NOT ADDRESS 6016 03:52:31,441 --> 03:52:32,743 STRUCTURAL RACEISM, MATERNAL 6017 03:52:32,743 --> 03:52:33,410 HEALTH CARE, AND POPULATION THAT 6018 03:52:33,410 --> 03:52:36,012 WAS STUDY WAS NOT WOMEN OF COLOR 6019 03:52:36,012 --> 03:52:39,282 BETWEEN THE REPRODUCTIVE AGE AND 6020 03:52:39,282 --> 03:52:40,851 IN THE U.S. 6021 03:52:40,851 --> 03:52:44,654 WHICH LEFT US WITH 30 STUDIES. 6022 03:52:44,654 --> 03:52:48,358 NEXT SLIDE. 6023 03:52:48,358 --> 03:52:55,499 SO WE NOTED THERE ARE EIGHT 6024 03:52:55,499 --> 03:52:56,466 PATHWAYS. 6025 03:52:56,466 --> 03:52:58,902 THE FIRST ONE WAS THAT DURING 6026 03:52:58,902 --> 03:53:00,404 OUR REVIEW WE FOUND 6027 03:53:00,404 --> 03:53:02,506 INTERVENTIONS THAT ADDRESS 6028 03:53:02,506 --> 03:53:03,206 SOCIAL ECONOMIC DISADVANTAGE 6029 03:53:03,206 --> 03:53:06,243 WHICH ARE THESE THAT AIM TO 6030 03:53:06,243 --> 03:53:08,645 ADDRESS THE SOCIAL DETERMINANTS 6031 03:53:08,645 --> 03:53:10,180 OF HEALTH UNDERLYING INEQUALITY, 6032 03:53:10,180 --> 03:53:11,915 WE ALSO LOOKED AT INTERVENTION 6033 03:53:11,915 --> 03:53:15,452 TO ADDRESS MATERNAL HEALTH RISK 6034 03:53:15,452 --> 03:53:16,953 FACTORS, TO PRENATAL CARE, TO 6035 03:53:16,953 --> 03:53:19,356 HELP IDENTIFY THOSE AT INCREASED 6036 03:53:19,356 --> 03:53:20,524 RISK OF COMORBIDITIES. 6037 03:53:20,524 --> 03:53:24,961 AND THEN WE ALSO LOOKED AT THE 6038 03:53:24,961 --> 03:53:26,263 IMPORTANCE OF ADDRESSING QUALITY 6039 03:53:26,263 --> 03:53:27,898 OF CARE BECAUSE WE KNOW THAT 6040 03:53:27,898 --> 03:53:30,200 ACCESS TO HEALTH CARE IS NOT 6041 03:53:30,200 --> 03:53:31,968 ONLY IMPORTANT BUT ACCESS TO 6042 03:53:31,968 --> 03:53:33,937 QUALITY HEALTH CARE IS VERY, 6043 03:53:33,937 --> 03:53:39,743 VERY IMPORTANT AND IT HAS TO BE 6044 03:53:39,743 --> 03:53:40,010 ADDRESSED. 6045 03:53:40,010 --> 03:53:40,844 NEXT SLIDE. 6046 03:53:40,844 --> 03:53:44,548 THESE ARE SOME THINGS WE FOUND 6047 03:53:44,548 --> 03:53:47,717 LOOKING AT PATHWAYS THAT WE 6048 03:53:47,717 --> 03:53:51,755 MAPPED PREVIOUSLY, EXAMPLES OF 6049 03:53:51,755 --> 03:53:54,624 STUDIES WITHIN THE LITERATURE 6050 03:53:54,624 --> 03:53:57,461 THAT TRIED TO ADDRESS 6051 03:53:57,461 --> 03:54:01,765 DISPARITIES DUE TO RACISM. 6052 03:54:01,765 --> 03:54:04,935 ONE STUDY WAS FOCUSED ON RURAL 6053 03:54:04,935 --> 03:54:07,671 OREGON, THE PRENATAL PROGRAM, 6054 03:54:07,671 --> 03:54:10,841 WHICH BLENDED CARE WITH OUTREACH 6055 03:54:10,841 --> 03:54:12,509 BY USING BILINGUAL AND 6056 03:54:12,509 --> 03:54:20,283 BICULTURAL WORKERS WITH LINKS TO 6057 03:54:20,283 --> 03:54:25,422 AMERICAN HERITAGE COMMUNITY. 6058 03:54:25,422 --> 03:54:26,857 FACILITATING ACCESS TO ANTENATAL 6059 03:54:26,857 --> 03:54:27,624 CARE. 6060 03:54:27,624 --> 03:54:29,326 OTHER PROGRAMS FOR EXAMPLE TO 6061 03:54:29,326 --> 03:54:31,127 ADDRESS SOCIAL DISADVANTAGE, 6062 03:54:31,127 --> 03:54:33,730 THIS WAS A COLLABORATION BETWEEN 6063 03:54:33,730 --> 03:54:34,965 BOSTON HOUSING AUTHORITY AND 6064 03:54:34,965 --> 03:54:36,066 BOSTON PUBLIC HEALTH COMMISSION 6065 03:54:36,066 --> 03:54:42,405 TO DEVELOP THE PROGRAM CALLED 6066 03:54:42,405 --> 03:54:43,707 HEALTHY START, PROVIDED PRIORITY 6067 03:54:43,707 --> 03:54:46,443 ACCESS TO HOUSING IN THE CITY'S 6068 03:54:46,443 --> 03:54:49,045 TRADITIONAL HOUSING DEVELOPMENTS 6069 03:54:49,045 --> 03:54:51,481 TO HOMELESS AND HOUSING INSECURE 6070 03:54:51,481 --> 03:54:54,651 PREGNANT WOMEN WHO HAD EXISTING 6071 03:54:54,651 --> 03:54:56,620 OR EXPERIENCING MEDICAL RISK 6072 03:54:56,620 --> 03:54:58,154 ASSOCIATED WITH WITH POOR HEALTH 6073 03:54:58,154 --> 03:55:00,590 OUTCOMES AND FOUND SEVERAL 6074 03:55:00,590 --> 03:55:05,962 STUDIES THAT DOCUMENTED. 6075 03:55:05,962 --> 03:55:10,000 NEXT SLIDE. 6076 03:55:10,000 --> 03:55:13,370 SO, QUALITY CARE CAUSAL PATHWAY 6077 03:55:13,370 --> 03:55:18,108 ELUCIDATED CHALLENGES AS WELL. 6078 03:55:18,108 --> 03:55:22,012 FOR EXAMPLE, WE INCLUDED OR 6079 03:55:22,012 --> 03:55:24,447 LOOKED AT OBSTETRIC HEMORRHAGE 6080 03:55:24,447 --> 03:55:26,950 SAFETY BUNDLE TO REDUCE 6081 03:55:26,950 --> 03:55:27,484 DISPARITIES. 6082 03:55:27,484 --> 03:55:30,554 THE INTERVENTION CONSISTED OF 17 6083 03:55:30,554 --> 03:55:31,154 EVIDENCE-BASED RECOMMENDATIONS 6084 03:55:31,154 --> 03:55:33,723 TO PREVENT AND IMPROVE OUTCOMES 6085 03:55:33,723 --> 03:55:35,625 FOR MATERNAL HEMORRHAGE. 6086 03:55:35,625 --> 03:55:39,195 THE ISSUE WE FOUND ALTHOUGH 6087 03:55:39,195 --> 03:55:41,398 INTERVENTION IMPROVED OUTCOMES, 6088 03:55:41,398 --> 03:55:42,732 ESPECIALLY AMONG BLACK MOTHERS, 6089 03:55:42,732 --> 03:55:46,670 PRIMARY SOURCE OF RACIAL AND 6090 03:55:46,670 --> 03:55:47,737 ETHNIC DISPARITIES SUCH AS 6091 03:55:47,737 --> 03:55:49,039 SOCIAL DETERMINANTS OF HEALTH 6092 03:55:49,039 --> 03:55:52,242 UNDERLYING RISK FACTORS AND 6093 03:55:52,242 --> 03:55:53,343 STRUCTURAL RACISM MEDICAL 6094 03:55:53,343 --> 03:55:57,914 MISTRUST AND CARE OF CARE WERE 6095 03:55:57,914 --> 03:56:02,752 NOT ADDRESSED WHICH WILL 6096 03:56:02,752 --> 03:56:03,954 CONSIDERABLY IMPACT LONG-TERM 6097 03:56:03,954 --> 03:56:04,487 SUSTAINABILITY. 6098 03:56:04,487 --> 03:56:04,921 NEXT SLIDE. 6099 03:56:04,921 --> 03:56:07,991 SO WHEN WE THINK ABOUT 6100 03:56:07,991 --> 03:56:09,326 IMPLEMENTATION CHALLENGES, WE 6101 03:56:09,326 --> 03:56:10,393 FOUND DURING THE SCOPING REVIEW 6102 03:56:10,393 --> 03:56:13,797 FOR EXAMPLE IN THE LITERATURE 6103 03:56:13,797 --> 03:56:14,631 REPORTING ON IMPLEMENTATIONAL 6104 03:56:14,631 --> 03:56:16,666 PROGRAMS AND POLICIES TO 6105 03:56:16,666 --> 03:56:22,772 INTERVENING AT VARIOUS POINTS 6106 03:56:22,772 --> 03:56:24,541 ALONG THE PATHWAY, CRITICAL 6107 03:56:24,541 --> 03:56:26,610 EXAMINATION OF MULTIPLE FACTORS 6108 03:56:26,610 --> 03:56:27,711 SHAPING SUCCESSFUL 6109 03:56:27,711 --> 03:56:28,912 IMPLEMENTATION OF THESE 6110 03:56:28,912 --> 03:56:30,847 INTERVENTIONS HAS NOT BEEN 6111 03:56:30,847 --> 03:56:32,415 PRIORITIZED THROUGH THE 6112 03:56:32,415 --> 03:56:33,350 LITERATURE. 6113 03:56:33,350 --> 03:56:35,151 FOR EXAMPLE, PERINATAL CARE 6114 03:56:35,151 --> 03:56:39,255 PARTICIPATION REMAINS A 6115 03:56:39,255 --> 03:56:46,563 CHALLENGE, MOST NOTABLY WITH 6116 03:56:46,563 --> 03:56:50,400 MULTIPLE PROBLEMS, AND LIVING IN 6117 03:56:50,400 --> 03:56:53,003 DIFFICULT CIRCUMSTANCES. 6118 03:56:53,003 --> 03:56:54,971 WE DID FIND SUCCESSES, FOR 6119 03:56:54,971 --> 03:56:55,639 EXAMPLE APPROPRIATENESS OF 6120 03:56:55,639 --> 03:57:01,011 INTERVENTION, ACCEPTABILITY OF 6121 03:57:01,011 --> 03:57:04,414 THE INTERVENTION. 6122 03:57:04,414 --> 03:57:05,482 NEXT SLIDE. 6123 03:57:05,482 --> 03:57:07,884 SO IN CONCLUSION THERE REMAINS A 6124 03:57:07,884 --> 03:57:09,219 GREAT NEED TO REDUCE MATERNAL 6125 03:57:09,219 --> 03:57:11,187 HEALTH DISPARITIES IN THE U.S., 6126 03:57:11,187 --> 03:57:13,023 AS WE HAVE NOTED. 6127 03:57:13,023 --> 03:57:14,557 STRUCTURAL RACISM IS A 6128 03:57:14,557 --> 03:57:17,193 CONTRIBUTING FACTOR TO THESE 6129 03:57:17,193 --> 03:57:19,596 DISPARITIES AND INTERVENTIONS TO 6130 03:57:19,596 --> 03:57:20,997 ADDRESS STRUCTURAL RACISM 6131 03:57:20,997 --> 03:57:22,966 DESPERATELY NEEDED. 6132 03:57:22,966 --> 03:57:26,503 SPECIFICALLY DURING OUR REVIEW 6133 03:57:26,503 --> 03:57:28,238 WE FOUND EVIDENCE-BASED 6134 03:57:28,238 --> 03:57:36,346 INTERVENTIONS TO REDUCE BY 6135 03:57:36,346 --> 03:57:38,381 ADDRESSING STRUCTURAL RACISM. 6136 03:57:38,381 --> 03:57:39,783 FIRST INTERVENTIONS ADDRESSING 6137 03:57:39,783 --> 03:57:42,519 INCREASED RISK OF POOR HEALTH 6138 03:57:42,519 --> 03:57:43,653 OUTCOMES, SECOND THAT ADDRESS 6139 03:57:43,653 --> 03:57:46,823 LOW QUALITY OF CARE AND THIRD, 6140 03:57:46,823 --> 03:57:47,924 INTERVENTIONS, EVIDENCE-BASED 6141 03:57:47,924 --> 03:57:50,427 INTERVENTIONS THAT ADDRESS 6142 03:57:50,427 --> 03:57:51,528 SOCIAL ECONOMIC DISADVANTAGES. 6143 03:57:51,528 --> 03:57:56,466 SO SUCCESS OF THESE 6144 03:57:56,466 --> 03:57:57,500 INTERVENTIONS EXTENDING SUPPORT 6145 03:57:57,500 --> 03:57:58,635 BEYOND PROXIMAL HEALTH CARE 6146 03:57:58,635 --> 03:58:01,504 NEEDS TO INCLUDE SOCIAL AND 6147 03:58:01,504 --> 03:58:03,907 ECONOMIC FACTORS ASSOCIATED WITH 6148 03:58:03,907 --> 03:58:04,708 IMPROVED MATERNAL HEALTH 6149 03:58:04,708 --> 03:58:06,743 OUTCOMES SHOULD BE AN 6150 03:58:06,743 --> 03:58:07,477 IMPORTANT -- SHOULD BE 6151 03:58:07,477 --> 03:58:11,548 IMPLEMENTED IN FUTURE OR 6152 03:58:11,548 --> 03:58:12,482 EXISTING STUDIES. 6153 03:58:12,482 --> 03:58:15,251 INTERVENTION CHALLENGES EXIST IN 6154 03:58:15,251 --> 03:58:17,887 TERMS OF IN OUR CONTEXT, BUT WE 6155 03:58:17,887 --> 03:58:21,725 ALSO NOTE AS MENTIONED BY OTHER 6156 03:58:21,725 --> 03:58:23,493 COLLEAGUES IMPLEMENTATION 6157 03:58:23,493 --> 03:58:26,529 SCIENCE RESEARCH WITHIN MATERNAL 6158 03:58:26,529 --> 03:58:29,899 HEALTH CAN ELUCIDATE BARRIERS TO 6159 03:58:29,899 --> 03:58:30,934 EFFECTIVE ADOPTION UPTAKE OF 6160 03:58:30,934 --> 03:58:33,436 EVIDENCE-BASED INTERVENTIONS. 6161 03:58:33,436 --> 03:58:37,741 THANK YOU SO MUCH.. 6162 03:58:37,741 --> 03:58:41,010 >> THANK YOU TO ALL OF OUR PANEL 6163 03:58:41,010 --> 03:58:41,978 SPEAKERS. 6164 03:58:41,978 --> 03:58:47,117 NOW WE'RE GOING TO GO INTO A Q&A 6165 03:58:47,117 --> 03:58:48,518 FOR THE PANEL. 6166 03:58:48,518 --> 03:58:49,652 WE HAVE HAD SOME QUESTIONS COME 6167 03:58:49,652 --> 03:58:53,456 UP IN THE CHAT SO I WILL START 6168 03:58:53,456 --> 03:58:54,124 WITH THAT. 6169 03:58:54,124 --> 03:58:56,860 THIS IS FOR THE GHANA TEAM. 6170 03:58:56,860 --> 03:58:58,061 NUTRITION ASSESSMENT IS ONE OF 6171 03:58:58,061 --> 03:59:03,199 THE COMPONENTS OF THE 6172 03:59:03,199 --> 03:59:04,934 MULTI-DISCIPLINARY TEAM IN KBTH. 6173 03:59:04,934 --> 03:59:08,171 CAN YOU COMMENT ON NUTRITION 6174 03:59:08,171 --> 03:59:18,715 CARE MANAGEMENT THAT SICKLE CELL 6175 03:59:20,016 --> 03:59:24,020 DISEASE PATIENTS RECEIVE? 6176 03:59:24,020 --> 03:59:27,290 >> WE RECOGNIZE THIS IS HIGH 6177 03:59:27,290 --> 03:59:29,259 METABOLIC STATE, NUTRITIONAL 6178 03:59:29,259 --> 03:59:31,461 CARE AND SUPPORT ACTUALLY 6179 03:59:31,461 --> 03:59:33,096 SIGNIFICANT AND WILL ACTUALLY 6180 03:59:33,096 --> 03:59:36,032 MAKE IMPACT, IF WE ARE TO 6181 03:59:36,032 --> 03:59:38,134 IMPROVE THE OUTCOME. 6182 03:59:38,134 --> 03:59:41,838 UNFORTUNATELY, WE DON'T HAVE A 6183 03:59:41,838 --> 03:59:44,174 SYSTEMATIC NUTRITIONAL SUPPORT 6184 03:59:44,174 --> 03:59:46,776 FOR PREGNANT WOMEN HERE IN 6185 03:59:46,776 --> 03:59:50,313 GHANA, APART FROM THE USUAL 6186 03:59:50,313 --> 03:59:51,815 ANTENATAL EDUCATION ABOUT 6187 03:59:51,815 --> 03:59:55,118 IMPROVEMENT IN NUTRITION DURING 6188 03:59:55,118 --> 03:59:57,387 PREGNANCY. 6189 03:59:57,387 --> 04:00:01,357 ONE OF OUR RECENT STUDIES 6190 04:00:01,357 --> 04:00:03,760 ONGOING IS ASSESSING IMPACT OF 6191 04:00:03,760 --> 04:00:06,162 MATERNAL NUTRITION ON PREGNANCY 6192 04:00:06,162 --> 04:00:07,063 OUTCOMES IN WOMEN. 6193 04:00:07,063 --> 04:00:11,534 OUR HOPE IS THAT THE NEXT FEW 6194 04:00:11,534 --> 04:00:15,471 MONTHS OR BY NEXT YEAR THE 6195 04:00:15,471 --> 04:00:18,741 RESULT WILL COME OUT. 6196 04:00:18,741 --> 04:00:20,043 AND THEN WILL PROBABLY SEE MORE 6197 04:00:20,043 --> 04:00:20,810 LIGHT. 6198 04:00:20,810 --> 04:00:24,214 IF IT BECOMES NECESSARY WE'LL 6199 04:00:24,214 --> 04:00:27,217 PROBABLY HAVE TO CONSIDER 6200 04:00:27,217 --> 04:00:28,051 PRIORITIZING NUTRITIONAL 6201 04:00:28,051 --> 04:00:29,352 INTERVENTION. 6202 04:00:29,352 --> 04:00:30,587 YES, IT IS AN IMPORTANT SUBJECT 6203 04:00:30,587 --> 04:00:32,755 MATTER THAT NEEDS TO BE LOOKED 6204 04:00:32,755 --> 04:00:32,956 AT. 6205 04:00:32,956 --> 04:00:34,757 WE DON'T KNOW WHAT IMPACT IT 6206 04:00:34,757 --> 04:00:38,528 MAKES ON PREGNANCY OUTCOME FOR 6207 04:00:38,528 --> 04:00:39,996 THIS PARTICULAR POPULATION IN 6208 04:00:39,996 --> 04:00:41,631 PARTICULAR BUT HOPEFULLY VERY 6209 04:00:41,631 --> 04:00:47,971 SOON WE'LL GET TO KNOW. 6210 04:00:47,971 --> 04:00:48,738 THANK YOU. 6211 04:00:48,738 --> 04:00:50,173 >> ANOTHER QUESTION ABOUT 6212 04:00:50,173 --> 04:00:53,676 STRATEGIES THAT COULD OVERCOME 6213 04:00:53,676 --> 04:00:55,311 POTENTIAL CHALLENGES IN CARE 6214 04:00:55,311 --> 04:00:56,946 COORDINATION IN RURAL OR 6215 04:00:56,946 --> 04:00:57,547 DISPERSED POPULATIONS OF 6216 04:00:57,547 --> 04:00:59,349 INDIVIDUALS LIVING WITH SICKLE 6217 04:00:59,349 --> 04:00:59,883 CELL DISEASE. 6218 04:00:59,883 --> 04:01:01,117 I DON'T KNOW IF YOU HAVE 6219 04:01:01,117 --> 04:01:04,087 THOUGHTS ON THERE FOR THE U.S. 6220 04:01:04,087 --> 04:01:04,587 POPULATION, DR. PECKER? 6221 04:01:04,587 --> 04:01:07,390 >> THIS IS A REAL HUMDINGER FOR 6222 04:01:07,390 --> 04:01:11,427 OUR PATIENTS. 6223 04:01:11,427 --> 04:01:13,496 AND WE KNOW THERE IS 6224 04:01:13,496 --> 04:01:14,030 INFRASTRUCTURE DEVELOPED, 6225 04:01:14,030 --> 04:01:16,266 DEVELOPING ALL OVER THE COUNTRY, 6226 04:01:16,266 --> 04:01:19,302 WITH MODEL OF CLINICIAN 6227 04:01:19,302 --> 04:01:27,310 EDUCATION, ECHO OR TELEECHO. 6228 04:01:27,310 --> 04:01:28,611 WE INVITE YOU TO JOIN US AT 6229 04:01:28,611 --> 04:01:32,582 JOHNS HOPKINS AND AROUND THE 6230 04:01:32,582 --> 04:01:33,983 WORLD, AND INDIVIDUALS WITH 6231 04:01:33,983 --> 04:01:37,320 SICKLE CELL DISEASE ARE COMPLEX. 6232 04:01:37,320 --> 04:01:38,788 WE'RE HAPPY TO EXTEND CARE. 6233 04:01:38,788 --> 04:01:40,089 ANOTHER THING THAT NEEDS TO 6234 04:01:40,089 --> 04:01:43,159 HAPPEN FOR RURAL COMMUNITIES IS 6235 04:01:43,159 --> 04:01:45,895 TO HAVE A HUB AND SPOKE SO THESE 6236 04:01:45,895 --> 04:01:46,796 INDIVIDUALS ARE BEING SEEN AT 6237 04:01:46,796 --> 04:01:49,565 LEAST A FEW TIMES DURING THE 6238 04:01:49,565 --> 04:01:54,137 PREGNANCY BY HIGH RISK 6239 04:01:54,137 --> 04:01:55,338 OBSTETRICS AND HEMATOLOGISTS 6240 04:01:55,338 --> 04:01:57,073 THAT CAN PROVIDE GUIDANCE BUT WE 6241 04:01:57,073 --> 04:01:59,842 CAN WORK TOGETHER. 6242 04:01:59,842 --> 04:02:03,446 DR. ASARE AND DR. OPPONG ARE 6243 04:02:03,446 --> 04:02:04,447 DOING THIS ACROSS GHANA, SURELY 6244 04:02:04,447 --> 04:02:06,215 WE CAN FIGURE OUT HOW TO DO THIS 6245 04:02:06,215 --> 04:02:07,850 ACROSS THE UNITED STATES. 6246 04:02:07,850 --> 04:02:08,952 THERE IS TELEHEALTH 6247 04:02:08,952 --> 04:02:09,819 INFRASTRUCTURE TO SUPPORT 6248 04:02:09,819 --> 04:02:12,655 CLINICIAN WHO IS ARE INTERESTED 6249 04:02:12,655 --> 04:02:17,927 IN PROVIDING THIS CARE. 6250 04:02:17,927 --> 04:02:18,227 >> THANKS. 6251 04:02:18,227 --> 04:02:20,330 ANY THOUGHTS FROM THE GHANA TEAM 6252 04:02:20,330 --> 04:02:27,437 ON HOW YOU'RE DOING IT AND 6253 04:02:27,437 --> 04:02:30,840 LESSONS LEARNED? 6254 04:02:30,840 --> 04:02:32,608 >> DEFINITELY GHANA HAS A LOT OF 6255 04:02:32,608 --> 04:02:33,676 RURAL COMMUNITIES, PROBABLY MORE 6256 04:02:33,676 --> 04:02:34,677 THAN THE U.S. 6257 04:02:34,677 --> 04:02:38,181 THE CHALLENGES IN YOU U.S. YOU 6258 04:02:38,181 --> 04:02:39,182 CAN IMAGINE GHANA WILL HAVE 6259 04:02:39,182 --> 04:02:42,118 MULTIPLE ON THAT. 6260 04:02:42,118 --> 04:02:43,453 SOMETIMES ASSETS, GEOGRAPHIC 6261 04:02:43,453 --> 04:02:45,955 ASSETS IS A BIG PROBLEM. 6262 04:02:45,955 --> 04:02:47,056 BEYOND THAT FINANCIAL ASSETS 6263 04:02:47,056 --> 04:02:49,692 BECOMES A BIGGER CHALLENGE. 6264 04:02:49,692 --> 04:02:52,462 MORE IMPORTANTLY, ACCESS TO 6265 04:02:52,462 --> 04:02:56,165 HEALTHCARE SERVICE, IN GHANA AS 6266 04:02:56,165 --> 04:03:01,871 WE MOVE FURTHER AWAY FROM URBAN 6267 04:03:01,871 --> 04:03:03,506 AREAS, DISTRIBUTION OF 6268 04:03:03,506 --> 04:03:05,808 HEALTHCARE PROVIDERS BECOMES 6269 04:03:05,808 --> 04:03:06,042 ACUTE. 6270 04:03:06,042 --> 04:03:12,682 IF YOU'RE THINKING OF SCALING UP 6271 04:03:12,682 --> 04:03:13,416 THIS MULTI-DISCIPLINARY CARE, WE 6272 04:03:13,416 --> 04:03:14,917 UNDERSTAND THERE'S GOING TO BE A 6273 04:03:14,917 --> 04:03:17,020 LOT OF CHALLENGES. 6274 04:03:17,020 --> 04:03:25,294 SO, ONE STRATEGY WE THINK ON 6275 04:03:25,294 --> 04:03:28,931 WORK WOULD BE -- - FOR INSTANCE 6276 04:03:28,931 --> 04:03:31,567 IN HEMATOLOGY, CAN GENERAL 6277 04:03:31,567 --> 04:03:37,340 PHYSICIANS BE TRAINED TO TAKE UP 6278 04:03:37,340 --> 04:03:40,643 THE PATH OF HEMATOLOGY, THAT WAY 6279 04:03:40,643 --> 04:03:42,812 THEY MAY NOT BE HEMATOLOGIST IN 6280 04:03:42,812 --> 04:03:45,782 THAT PART OF THE COUNTRY 6281 04:03:45,782 --> 04:03:47,417 PATIENTS WOULD STILL BE 6282 04:03:47,417 --> 04:03:48,951 RECEIVING SOME FORM OF 6283 04:03:48,951 --> 04:03:50,486 HEMATOLOGY CARE, THAT WAY STILL 6284 04:03:50,486 --> 04:03:53,222 BE ABLE TO CREATE THE SITE 6285 04:03:53,222 --> 04:03:57,160 SPECIFIC OR FACILITY SPECIFIC 6286 04:03:57,160 --> 04:03:57,894 MULTI-DISCIPLINARY CARE SYSTEM 6287 04:03:57,894 --> 04:04:02,198 FOR THE NEED OF THE PEOPLE. 6288 04:04:02,198 --> 04:04:03,399 AGAIN, STRENGTHENING THE NETWORK 6289 04:04:03,399 --> 04:04:06,235 AMONG THE CARE PROVIDERS IS ONE 6290 04:04:06,235 --> 04:04:07,236 WAY OUT. 6291 04:04:07,236 --> 04:04:08,671 CURRENTLY, WE ARE ABLE TO 6292 04:04:08,671 --> 04:04:10,406 RECEIVE PHONE CALLS FROM OUR 6293 04:04:10,406 --> 04:04:12,475 COLLEAGUES FROM THE OTHER SIDE, 6294 04:04:12,475 --> 04:04:14,010 PLANNING, WHAT WE'RE PLANNING TO 6295 04:04:14,010 --> 04:04:17,413 IMPLEMENT THIS PROGRAM. 6296 04:04:17,413 --> 04:04:19,916 WE ALSO INVITE THEM TO JOIN THE 6297 04:04:19,916 --> 04:04:21,584 MEETINGS, SHARE IDEAS AND 6298 04:04:21,584 --> 04:04:22,518 COMMUNICATE. 6299 04:04:22,518 --> 04:04:24,520 WHERE IT BECOMES NECESSARY FOR 6300 04:04:24,520 --> 04:04:26,789 THEM TO REFER, CONTACTS HAVE 6301 04:04:26,789 --> 04:04:28,257 BEEN ESTABLISHED, SO THE SYSTEM 6302 04:04:28,257 --> 04:04:29,892 CAN TAKE CARE OF THE REST OF IT. 6303 04:04:29,892 --> 04:04:34,030 WE NEED TO WORK WITH WHAT IS 6304 04:04:34,030 --> 04:04:34,897 AVAILABLE, AND DESIGN SOMETHING 6305 04:04:34,897 --> 04:04:38,501 WITHIN THE CONTEXT OF WHAT'S 6306 04:04:38,501 --> 04:04:39,502 AVAILABLE AND TRY AND IMPLEMENT 6307 04:04:39,502 --> 04:04:42,905 IT THAT WAY. 6308 04:04:42,905 --> 04:04:46,843 THANK YOU. 6309 04:04:46,843 --> 04:04:48,845 >> WE HAVE A COUPLE QUESTIONS 6310 04:04:48,845 --> 04:04:51,180 ASKING HOW THE FOUR ADDITIONAL 6311 04:04:51,180 --> 04:04:53,883 SITES WERE SELECTED, AND WITH 6312 04:04:53,883 --> 04:04:56,686 THE SELECTING OF THESE 6313 04:04:56,686 --> 04:04:58,754 ADDITIONAL SITES WHAT ARE THE 6314 04:04:58,754 --> 04:05:03,693 SCALING OF THE INTERVENTIONS AND 6315 04:05:03,693 --> 04:05:05,228 STRATEGIES, CAN YOU TOUCH ON 6316 04:05:05,228 --> 04:05:06,362 VARIATIONS THAT MAY INFLUENCE 6317 04:05:06,362 --> 04:05:10,032 THE STUDY DESIGN IN THE NORTHERN 6318 04:05:10,032 --> 04:05:15,838 TERRITORY AS COMPARED TO ACCRA 6319 04:05:15,838 --> 04:05:17,373 TERRITORY? 6320 04:05:17,373 --> 04:05:21,410 >> MAYBE DR. ASRAE CAN TAKE THAT 6321 04:05:21,410 --> 04:05:22,178 ONE. 6322 04:05:22,178 --> 04:05:23,613 >> YES, THEY SITES WERE SELECTED 6323 04:05:23,613 --> 04:05:27,250 BASE ON THE FACT WE ALREADY 6324 04:05:27,250 --> 04:05:29,218 WORKED WITH OBSTETRICIANS, THEY 6325 04:05:29,218 --> 04:05:31,287 KNEW THE PROTOCOL, WERE 6326 04:05:31,287 --> 04:05:33,055 COMMITTED TO CARE FOR THE MEN 6327 04:05:33,055 --> 04:05:36,659 WITH SICKLE CELL DISEASE AND 6328 04:05:36,659 --> 04:05:37,727 RECOGNIZED THE NEED, RECOGNIZING 6329 04:05:37,727 --> 04:05:39,829 THE HIGH RATES AMONG THIS 6330 04:05:39,829 --> 04:05:40,129 POPULATION. 6331 04:05:40,129 --> 04:05:45,401 THEY SITES DO NOT HAVE 6332 04:05:45,401 --> 04:05:47,904 HEMATOLOGISTS, SO WE TEST SHIP, 6333 04:05:47,904 --> 04:05:49,839 CONSTANTLY ENGAGING THEM BY 6334 04:05:49,839 --> 04:05:52,175 PHONE CALLS, IF THEY HAVE 6335 04:05:52,175 --> 04:05:54,143 DIFFICULT CASE WE DISCUSS WITH 6336 04:05:54,143 --> 04:05:57,013 THEM, WE SENT THEM REFERRAL 6337 04:05:57,013 --> 04:05:58,648 SITES, THE REFERRAL PATHWAYS, SO 6338 04:05:58,648 --> 04:06:00,950 THEY CAN EASILY REACH US IF THEY 6339 04:06:00,950 --> 04:06:03,786 NEED ADVICE. 6340 04:06:03,786 --> 04:06:09,025 SOMETIMES WE HAVE AN MDT, WITH 6341 04:06:09,025 --> 04:06:10,660 AN MDT. 6342 04:06:10,660 --> 04:06:14,397 THAT'S IMPROVED CARE. 6343 04:06:14,397 --> 04:06:17,667 YES, WITH STRUCTURAL VARIATIONS 6344 04:06:17,667 --> 04:06:19,869 WE RECOGNIZE MOST PEOPLE IN THE 6345 04:06:19,869 --> 04:06:23,372 NORTH ARE MUSLIM, IT'S A MUSLIM 6346 04:06:23,372 --> 04:06:23,639 COMMUNITY. 6347 04:06:23,639 --> 04:06:27,877 SOMETIMES THEY DO -- WOMEN DO 6348 04:06:27,877 --> 04:06:29,612 REQUIRE PERMISSION FROM THEIR 6349 04:06:29,612 --> 04:06:32,481 HUSBANDS OR PARTNERS BEFORE THEY 6350 04:06:32,481 --> 04:06:39,755 SEEK HEALTHCARE SO WHAT WE'RE 6351 04:06:39,755 --> 04:06:43,459 DOING IS OBSTETRICIAN, TRAINING 6352 04:06:43,459 --> 04:06:44,994 TO ADVOCATING FOR THEIR OWN 6353 04:06:44,994 --> 04:06:46,362 CARE, TO SEEK HEALTH CARE 6354 04:06:46,362 --> 04:06:49,765 PROPERLY WHEN THEY HAVE 6355 04:06:49,765 --> 04:06:50,032 PROBLEMS. 6356 04:06:50,032 --> 04:06:51,667 THE OTHER THING WE'RE DOING WE 6357 04:06:51,667 --> 04:06:54,337 HELP THEM BUILD THEIR OWN 6358 04:06:54,337 --> 04:06:59,075 CAPACITY, BUILD THEIR HEALTH 6359 04:06:59,075 --> 04:06:59,976 CARE NEEDS, FACILITY SPECIFICS, 6360 04:06:59,976 --> 04:07:01,944 AND DOING CONTINUOUS TRAINING 6361 04:07:01,944 --> 04:07:04,547 FOR THEM AS WELL, AND THEN OF 6362 04:07:04,547 --> 04:07:06,849 COURSE WE'RE GETTING HOSPITAL TO 6363 04:07:06,849 --> 04:07:08,951 BE PART OF THE 6364 04:07:08,951 --> 04:07:09,819 MULTI-DISCIPLINARY TEAM SUCH 6365 04:07:09,819 --> 04:07:11,988 THAT OTHER PEOPLE WHO HAVE BEEN 6366 04:07:11,988 --> 04:07:14,991 TRAINED TO MANAGE THESE COHORTS 6367 04:07:14,991 --> 04:07:19,795 WOULD BE MANAGING THE CLINIC, 6368 04:07:19,795 --> 04:07:21,797 NOT SHIFTED AS USUALLY HAPPENS, 6369 04:07:21,797 --> 04:07:23,299 LOW AND MIDDLE INCOME, SOMETIMES 6370 04:07:23,299 --> 04:07:25,034 THEY SHIFT DOCTORS AND NURSE AS 6371 04:07:25,034 --> 04:07:25,735 BIT. 6372 04:07:25,735 --> 04:07:29,005 THOSE ARE SOME STRATEGIES WE'RE 6373 04:07:29,005 --> 04:07:38,381 EMPLOYING HERE TO HELP REDUCE 6374 04:07:38,381 --> 04:07:39,849 MORTALITY AMONG THIS POPULATION. 6375 04:07:39,849 --> 04:07:42,885 >> I LOVE HOW WE LEARN GLOBALLY 6376 04:07:42,885 --> 04:07:43,552 FROM ACROSS DIFFERENT 6377 04:07:43,552 --> 04:07:47,023 STRUCTURES, AS WE FIGURE OUT 6378 04:07:47,023 --> 04:07:47,290 SOLUTIONS. 6379 04:07:47,290 --> 04:07:48,124 I'M GOING TO CHANGE GEARS 6380 04:07:48,124 --> 04:07:49,392 BECAUSE WE'VE HAD A COUPLE 6381 04:07:49,392 --> 04:07:56,399 QUESTIONS COME UP IN THE CHAT. 6382 04:07:56,399 --> 04:07:58,134 HOW CAN TRAINING FOR HEALTH CARE 6383 04:07:58,134 --> 04:07:59,669 PROFESSIONALS BE IMPROVED TO 6384 04:07:59,669 --> 04:08:03,839 ADDRESS IMPLICIT BIAS AND RACISM 6385 04:08:03,839 --> 04:08:05,241 IN MATERNAL HEALTHCARE? 6386 04:08:05,241 --> 04:08:13,149 >> THANK YOU FOR THAT QUESTION. 6387 04:08:13,149 --> 04:08:14,784 >> PEPPER NOT PECKER, SORRY. 6388 04:08:14,784 --> 04:08:16,319 >> LYDIA, PLEASE GO AHEAD. 6389 04:08:16,319 --> 04:08:17,887 I THINK YOU HAVE SOME 6390 04:08:17,887 --> 04:08:18,187 EXPERIENCE. 6391 04:08:18,187 --> 04:08:18,354 IVE 6392 04:08:18,354 --> 04:08:19,288 >> DEFER TO YOU. 6393 04:08:19,288 --> 04:08:21,824 I JUST WANTED TO SAY ONE THING 6394 04:08:21,824 --> 04:08:23,693 ABOUT SICKLE CELL DISEASE, WE 6395 04:08:23,693 --> 04:08:25,428 TALK ABOUT RACISM BECAUSE YOU 6396 04:08:25,428 --> 04:08:26,529 CANNOT SEPARATE SICKLE CELL 6397 04:08:26,529 --> 04:08:27,763 DISEASE FROM RACISM. 6398 04:08:27,763 --> 04:08:29,598 RACISM IS THE WATER WE SWIM IN 6399 04:08:29,598 --> 04:08:31,267 IN THE UNITED STATES, SO LIKE 6400 04:08:31,267 --> 04:08:32,335 NOBODY'S GETTING OUT OF THE 6401 04:08:32,335 --> 04:08:33,002 POOL, RIGHT? 6402 04:08:33,002 --> 04:08:34,136 WE'RE ALL HERE TOGETHER. 6403 04:08:34,136 --> 04:08:38,040 BUT I THINK THE THING ABOUT 6404 04:08:38,040 --> 04:08:40,676 SICKLE, HOW WE CREATE SICKLE 6405 04:08:40,676 --> 04:08:41,777 CELL ANTI-RACIST CARE 6406 04:08:41,777 --> 04:08:42,645 STRUCTURES, WE CREATE SYSTEMS 6407 04:08:42,645 --> 04:08:45,314 THAT PROVIDE EXPERT CARE FOR THE 6408 04:08:45,314 --> 04:08:45,715 PEOPLE. 6409 04:08:45,715 --> 04:08:47,450 WE TALK ABOUT THIS DISEASE AND 6410 04:08:47,450 --> 04:08:50,519 WHAT IT REQUIRES. 6411 04:08:50,519 --> 04:08:51,053 YES, IT'S IMPOSSIBLE TO 6412 04:08:51,053 --> 04:08:52,021 DISAMBIGUATE FROM THE FACT THE 6413 04:08:52,021 --> 04:08:53,022 FACE OF SICKLE CELL DISEASE IN 6414 04:08:53,022 --> 04:08:55,324 THE UNITED STATES IS THAT OF A 6415 04:08:55,324 --> 04:08:56,959 PERSON THAT IN THIS COUNTRY WE 6416 04:08:56,959 --> 04:08:57,626 CALL BLACK. 6417 04:08:57,626 --> 04:09:00,262 BUT I REALLY THINK WE NEED TO BE 6418 04:09:00,262 --> 04:09:04,300 SURE THIS IS ABOUT MEETING, 6419 04:09:04,300 --> 04:09:05,501 MEETING PEOPLE AND PROVIDING 6420 04:09:05,501 --> 04:09:10,539 EXPERT CARE TO PEOPLE. 6421 04:09:10,539 --> 04:09:12,408 DR. PEP PEPRAH, TEACH US ABOUT 6422 04:09:12,408 --> 04:09:13,275 THE STRUCTURES. 6423 04:09:13,275 --> 04:09:14,043 >> THAT'S A FANTASTIC ANSWER, 6424 04:09:14,043 --> 04:09:14,810 NUMBER ONE. 6425 04:09:14,810 --> 04:09:17,012 NUMBER TWO, IN TERMS OF THINKING 6426 04:09:17,012 --> 04:09:18,247 HOW WE REALLY SORT OF 6427 04:09:18,247 --> 04:09:19,815 DISENTANGLE AND BREAK DOWN THESE 6428 04:09:19,815 --> 04:09:23,252 BARRIERS, I THINK WE HAVE TO 6429 04:09:23,252 --> 04:09:29,725 LOOK AT THE STRIATA. 6430 04:09:29,725 --> 04:09:31,060 OVERT AND COVERT RACISM, 6431 04:09:31,060 --> 04:09:32,795 INTERPERSONAL WE CAN ADDRESS IN 6432 04:09:32,795 --> 04:09:33,796 TERMS OF INSTITUTIONAL POLICIES, 6433 04:09:33,796 --> 04:09:36,499 WE CAN CHANGE THOSE TO MAKE SURE 6434 04:09:36,499 --> 04:09:37,600 THAT THERE IS LESS RACIAL BIAS 6435 04:09:37,600 --> 04:09:39,235 IN TERMS OF IT. 6436 04:09:39,235 --> 04:09:41,404 AND THEN ALSO LOOK AT THOSE 6437 04:09:41,404 --> 04:09:44,173 ISSUES AROUND SORT OF THE 6438 04:09:44,173 --> 04:09:44,807 STRUCTURES. 6439 04:09:44,807 --> 04:09:48,444 NOW WE CANNOT DIVORCE MATERNAL 6440 04:09:48,444 --> 04:09:51,547 HEALTH OUTCOMES FROM HOUSING, 6441 04:09:51,547 --> 04:09:52,214 FROM ECONOMIC DISADVANTAGE, IN 6442 04:09:52,214 --> 04:09:53,616 TERMS OF ALL OF THESE. 6443 04:09:53,616 --> 04:09:56,051 SO ALL OF THESE SORT OF IMPINGE 6444 04:09:56,051 --> 04:09:58,654 UPON THIS. 6445 04:09:58,654 --> 04:10:03,159 I LOVE WHAT WHAT WAS SET ABOUT 6446 04:10:03,159 --> 04:10:04,460 INCORPORATING POLICY, ULTIMATELY 6447 04:10:04,460 --> 04:10:06,028 HEALTHCARE PRACTITIONERS WE CAN 6448 04:10:06,028 --> 04:10:11,700 TRY OUR BEST TO PROVIDE CARE FOR 6449 04:10:11,700 --> 04:10:13,769 INDIVIDUALS, EVEN PROVIDE 6450 04:10:13,769 --> 04:10:15,438 SPECIFIC OPPORTUNITIES TO HELP 6451 04:10:15,438 --> 04:10:17,406 PATIENTS GET TO THOSE OTHER 6452 04:10:17,406 --> 04:10:20,576 AREAS IN TERMS OF ACCESS, BEYOND 6453 04:10:20,576 --> 04:10:22,978 THE HEALTHCARE FACILITY, BUT 6454 04:10:22,978 --> 04:10:24,847 ULTIMATELY IT'S POLICY IN TERMS 6455 04:10:24,847 --> 04:10:29,385 OF MAKING SURE THESE STRUCTURES 6456 04:10:29,385 --> 04:10:31,120 THAT HAVE EXISTED NEED TO CHANGE 6457 04:10:31,120 --> 04:10:34,723 SO POLICIES HAVE TO CHANGE THAT 6458 04:10:34,723 --> 04:10:35,357 EMBOLDEN THESE UNEQUAL TREATMENT 6459 04:10:35,357 --> 04:10:36,358 IN TERMS OF IT. 6460 04:10:36,358 --> 04:10:37,827 I THINK IT'S IMPORTANT THAT WE 6461 04:10:37,827 --> 04:10:40,729 DISCUSS THAT. 6462 04:10:40,729 --> 04:10:41,697 BACK TO DR. PECKER'S POINT WE 6463 04:10:41,697 --> 04:10:44,567 HAVE TO TREAT THE INDIVIDUAL, 6464 04:10:44,567 --> 04:10:46,535 TREAT PEOPLE, HAVE SYSTEMS THAT 6465 04:10:46,535 --> 04:10:47,403 TREAT INDIVIDUALS. 6466 04:10:47,403 --> 04:10:49,038 AT THIS POINT WE DON'T BECAUSE 6467 04:10:49,038 --> 04:10:55,845 OF DISPARITIES THAT EXIST. 6468 04:10:55,845 --> 04:10:59,181 THANK YOU. 6469 04:10:59,181 --> 04:11:03,419 >> AND, DR. PEPRAH, I THINK 6470 04:11:03,419 --> 04:11:05,020 ABOUT MY COLLEAGUES, AMAZING 6471 04:11:05,020 --> 04:11:07,323 SICKLE CELL DOCTORS THAT LOOK 6472 04:11:07,323 --> 04:11:08,057 DIFFERENT, BUT HAVE PHYSICIANS, 6473 04:11:08,057 --> 04:11:09,291 EDUCATED LIKE ME, HAVE FAMILIES 6474 04:11:09,291 --> 04:11:11,694 LIKE ME, WHEN THEY UNLIKE ME GO 6475 04:11:11,694 --> 04:11:14,029 INTO A HOSPITAL PREGNANT FOR 6476 04:11:14,029 --> 04:11:15,130 CARE THEIR RISK OF ADVERSE 6477 04:11:15,130 --> 04:11:16,999 OUTCOMES IS DIFFERENT BECAUSE OF 6478 04:11:16,999 --> 04:11:19,835 THE COLOR OF THEIR SKIN, A 6479 04:11:19,835 --> 04:11:20,703 SOBERING REALITY FOR PHYSICIANS, 6480 04:11:20,703 --> 04:11:21,670 SHOULDN'T BE TRUE FOR ANYBODY 6481 04:11:21,670 --> 04:11:25,641 BUT TO PUT A NAME ON HOW RACISM 6482 04:11:25,641 --> 04:11:25,941 WORKS. 6483 04:11:25,941 --> 04:11:27,710 AND SO I THINK ALSO ONE OF THE 6484 04:11:27,710 --> 04:11:28,444 PRINCIPLES OF TREATING 6485 04:11:28,444 --> 04:11:29,345 INDIVIDUALS WITH SICKLE CELL 6486 04:11:29,345 --> 04:11:30,346 DISEASE IS TO BELIEVE THEM WHEN 6487 04:11:30,346 --> 04:11:33,148 PEOPLE SAY THEY ARE IN PAIN, YOU 6488 04:11:33,148 --> 04:11:34,049 BELIEVE THEM. 6489 04:11:34,049 --> 04:11:38,787 SO MUCH OF WHEN I THINK ABOUT 6490 04:11:38,787 --> 04:11:41,190 WHAT -- ANECDOTES OF WHAT'S GONE 6491 04:11:41,190 --> 04:11:42,057 TERRIBLY WRONG IN CARING FOR 6492 04:11:42,057 --> 04:11:47,429 BLACK WOMEN THAT ARE PREGNANT IN 6493 04:11:47,429 --> 04:11:48,831 THIS COUNTRY, THEY COME INTO THE 6494 04:11:48,831 --> 04:11:51,333 HOSPITAL, THEY ARE NOT BELIEVED. 6495 04:11:51,333 --> 04:11:52,101 THEY ARE TOLD COME BACK 6496 04:11:52,101 --> 04:11:53,769 TOMORROW, WHAT WOULD IT MEAN TO 6497 04:11:53,769 --> 04:11:55,437 HAVE A HEALTHCARE SYSTEM WHEN 6498 04:11:55,437 --> 04:11:57,706 EVERYBODY IS TREATED WITH THE 6499 04:11:57,706 --> 04:11:59,008 DIGNITY OF BEING BELIEVED, 6500 04:11:59,008 --> 04:11:59,408 RIGHT? 6501 04:11:59,408 --> 04:12:02,611 AND HOW IF WE STARTED THERE, 6502 04:12:02,611 --> 04:12:06,215 WHAT WOULD CARE LOOK LIKE? 6503 04:12:06,215 --> 04:12:06,882 >> WELL SAID. 6504 04:12:06,882 --> 04:12:11,420 NO OTHER COMMENTS. 6505 04:12:11,420 --> 04:12:14,356 >> VERY POWERFUL. 6506 04:12:14,356 --> 04:12:16,225 THANK YOU BOTH. 6507 04:12:16,225 --> 04:12:20,696 GOING INTO SOME OF THE GLOBAL 6508 04:12:20,696 --> 04:12:22,665 PERSPECTIVES HERE, MAYBE DR. 6509 04:12:22,665 --> 04:12:25,301 MAKANI CAN WEIGH IN ON THIS ONE. 6510 04:12:25,301 --> 04:12:28,003 BUT, YOU KNOW, WE KNOW THE 6511 04:12:28,003 --> 04:12:34,944 MATERNAL MORTALITY IS QUITE HIGH 6512 04:12:34,944 --> 04:12:36,378 IN AFRICA. 6513 04:12:36,378 --> 04:12:38,314 WHAT SUGGESTIONS DO YOU HAVE TO 6514 04:12:38,314 --> 04:12:40,182 TRANSLATE WHAT WE'RE LEARNING IN 6515 04:12:40,182 --> 04:12:45,854 GHANA AND OTHER PLACES TO OTHER 6516 04:12:45,854 --> 04:12:47,423 AFRICAN COUNTRIES AND LOW- AND 6517 04:12:47,423 --> 04:12:49,925 MIDDLE-INCOME COUNTRIES WITH 6518 04:12:49,925 --> 04:12:51,126 HIGH MORBIDITY AND MORTALITY? 6519 04:12:51,126 --> 04:12:52,661 >> THANK YOU VERY MUCH. 6520 04:12:52,661 --> 04:12:57,266 THAT'S A REALLY GREAT QUESTION. 6521 04:12:57,266 --> 04:13:00,536 AND I THINK ONE OF THE SOLUTIONS 6522 04:13:00,536 --> 04:13:01,437 IS PARTNERSHIPS. 6523 04:13:01,437 --> 04:13:03,706 WHAT WE FOUND WHEN WE WERE 6524 04:13:03,706 --> 04:13:06,241 SETTING UP THE SICKLE IN AFRICA 6525 04:13:06,241 --> 04:13:08,611 NETWORK IS THAT THERE WERE 6526 04:13:08,611 --> 04:13:09,945 INDIVIDUAL POCKETS OF EXCELLENCE 6527 04:13:09,945 --> 04:13:11,680 WITHIN COUNTRIES LIKE YOU SAY, 6528 04:13:11,680 --> 04:13:13,616 YOU FIND WITHIN A COUNTRY 6529 04:13:13,616 --> 04:13:16,285 THERE'S QUITE A LOT OF VARIATION 6530 04:13:16,285 --> 04:13:21,323 BUT THERE WERE POCKETS OFES 6531 04:13:21,323 --> 04:13:21,624 EXCELLENCE. 6532 04:13:21,624 --> 04:13:27,563 WOULD YOU HAVE EXCELLENCE MAYBE 6533 04:13:27,563 --> 04:13:35,237 IN ACCRA OR MARSI, ALSO SICKLE 6534 04:13:35,237 --> 04:13:36,438 CELL EXCELLENCE, ALSO OBSTETRIC 6535 04:13:36,438 --> 04:13:36,839 EXCELLENCE. 6536 04:13:36,839 --> 04:13:39,775 THAT'S THE SAME THING AT AFRICA 6537 04:13:39,775 --> 04:13:40,943 LEVEL. 6538 04:13:40,943 --> 04:13:43,612 YOU'D FIND AS EXAMPLE GHANA 6539 04:13:43,612 --> 04:13:46,582 WOULD HAVE EXPERIENCE WITH 6540 04:13:46,582 --> 04:13:48,317 NEWBORN SCREENING, MAYBE SOUTH 6541 04:13:48,317 --> 04:13:50,085 AFRICA WOULD HAVE EXPERIENCE AND 6542 04:13:50,085 --> 04:13:51,020 EXPERTISE IN MANAGING DATA, ET 6543 04:13:51,020 --> 04:13:53,122 CETERA, ET CETERA, ET CETERA. 6544 04:13:53,122 --> 04:13:55,090 AND THE WAY THAT WE'VE BEEN 6545 04:13:55,090 --> 04:13:57,326 WORKING FOR THE PAST OVER TEN 6546 04:13:57,326 --> 04:13:59,962 YEARS IS REALLY JUST COMING 6547 04:13:59,962 --> 04:14:01,697 TOGETHER AS CENTERS, AS 6548 04:14:01,697 --> 04:14:02,464 COUNTRIES, AND SAYING WHAT CAN 6549 04:14:02,464 --> 04:14:03,832 WE LEARN FROM EACH OTHER, WHO IS 6550 04:14:03,832 --> 04:14:07,302 THE BEST PERSON TO LEAD IN THIS 6551 04:14:07,302 --> 04:14:08,270 PARTICULAR AREA? 6552 04:14:08,270 --> 04:14:09,805 BECAUSE THE EXPECTATION AND 6553 04:14:09,805 --> 04:14:11,674 SITUATION IS VERY DIFFERENT. 6554 04:14:11,674 --> 04:14:14,410 NOW, THIS KIND OF BIDIRECTIONAL 6555 04:14:14,410 --> 04:14:17,680 LEARNING AND CIRCULATION OF 6556 04:14:17,680 --> 04:14:20,783 KNOWLEDGE APPLIES IN BOTH DR. 6557 04:14:20,783 --> 04:14:24,720 PECKER AND DR. PEPRAR, 6558 04:14:24,720 --> 04:14:27,089 EMPHASIZING LEARNING NOT JUST 6559 04:14:27,089 --> 04:14:30,292 GLOBAL SOUTH AND GLOBAL NORTH, 6560 04:14:30,292 --> 04:14:34,997 SOUTH-SOUTH AND BIDIRECTIONAL. 6561 04:14:34,997 --> 04:14:40,235 WHEN YOU LOOK AT EXPERIENCE 6562 04:14:40,235 --> 04:14:41,336 AVAILABLE, MATERNAL HEALTH OR 6563 04:14:41,336 --> 04:14:42,638 SICKLE CELL DISEASE ASKING 6564 04:14:42,638 --> 04:14:44,740 IRONICALLY THAT NOW LESSONS CAN 6565 04:14:44,740 --> 04:14:46,141 BE LEARNED THE OTHER WAY AROUND 6566 04:14:46,141 --> 04:14:49,311 WHERE THE U.S. CAN COME AND 6567 04:14:49,311 --> 04:14:58,053 LEARN FROM YOUR UGANDA OR GHAND 6568 04:14:58,053 --> 04:15:00,689 THIS DOES ENCOURAGE HEALTHCARE 6569 04:15:00,689 --> 04:15:02,324 PRACTITIONERS, PATIENTS, TO 6570 04:15:02,324 --> 04:15:03,425 REALLY HAVE THAT HUMILITY AND 6571 04:15:03,425 --> 04:15:04,960 LEARN FROM EACH OTHER. 6572 04:15:04,960 --> 04:15:07,896 I THINK ONE OF THE OTHER POINTS, 6573 04:15:07,896 --> 04:15:10,766 ONE, THAT WHOLE THING WITH 6574 04:15:10,766 --> 04:15:11,266 PARTNERSHIPS, NETWORKS, 6575 04:15:11,266 --> 04:15:12,868 ENCOURAGING PEOPLE TO TALK TO 6576 04:15:12,868 --> 04:15:13,869 EACH OTHER ACROSS DISCIPLINES, 6577 04:15:13,869 --> 04:15:14,970 ET CETERA. 6578 04:15:14,970 --> 04:15:19,007 THE OTHER ASPECT I WANTED TO 6579 04:15:19,007 --> 04:15:21,110 TOUCH ON ABOUT IS REALLY 6580 04:15:21,110 --> 04:15:23,846 APPROACHING IT AS A TEAM. 6581 04:15:23,846 --> 04:15:26,882 THIS NOTION THAT THIS CAN ONLY 6582 04:15:26,882 --> 04:15:29,885 BE DEALT WITH BY SPECIALISTS IN 6583 04:15:29,885 --> 04:15:32,287 OBSTETRICS AND GYNECOLOGY OR IN 6584 04:15:32,287 --> 04:15:33,722 HEMATOLOGY, I THINK THAT DOESN'T 6585 04:15:33,722 --> 04:15:35,991 WORK AT ALL. 6586 04:15:35,991 --> 04:15:36,892 IRRESPECTIVE HOW MANY 6587 04:15:36,892 --> 04:15:39,061 HEMATOLOGISTS YOU HAVE OR HOW 6588 04:15:39,061 --> 04:15:45,200 FEW YOU HAVE, YOU'VE GOT TO BE 6589 04:15:45,200 --> 04:15:47,436 MULTI-DISCIPLINARY ACROSS ALL 6590 04:15:47,436 --> 04:15:49,138 THE CADRES OF HEALTH CARE 6591 04:15:49,138 --> 04:15:49,471 PRACTITIONERS. 6592 04:15:49,471 --> 04:15:50,472 THIS IS IMPORTANT. 6593 04:15:50,472 --> 04:15:58,447 WE'VE SEEN HOW BY USING THESE 6594 04:15:58,447 --> 04:16:06,755 TRAINED NURSES, MORE EFFECT 6595 04:16:06,755 --> 04:16:07,422 EFFECTIVE, 6596 04:16:07,422 --> 04:16:08,857 MORE EFFECTIVE TO TRAIN NURSES, 6597 04:16:08,857 --> 04:16:11,460 COMMUNITY HEALTH WORKERS WHO 6598 04:16:11,460 --> 04:16:13,996 WILL GIVE MORE ROBUST CARE 6599 04:16:13,996 --> 04:16:14,897 ESPECIALLY WITH PREGNANCY, 6600 04:16:14,897 --> 04:16:16,198 DELIVERY, COMPLICATIONS AROUND 6601 04:16:16,198 --> 04:16:16,398 THAT. 6602 04:16:16,398 --> 04:16:18,400 I THINK THOSE WOULD BE THE TWO 6603 04:16:18,400 --> 04:16:18,700 THINGS. 6604 04:16:18,700 --> 04:16:21,436 ONE IS THE PARTNERSHIP. 6605 04:16:21,436 --> 04:16:22,971 LEARNING FROM EACH OTHER WITHIN 6606 04:16:22,971 --> 04:16:24,406 AFRICA AND OUTSIDE AFRICA AT 6607 04:16:24,406 --> 04:16:29,878 GLOBAL LEVEL, THE OTHER THING IS 6608 04:16:29,878 --> 04:16:32,414 REALLY JUST BROADENING THE 6609 04:16:32,414 --> 04:16:35,918 PERSONNEL PROVIDING CARE SO IT 6610 04:16:35,918 --> 04:16:37,219 GOES BEYOND TRADITIONAL APPROACH 6611 04:16:37,219 --> 04:16:45,460 OF ONLY RELYING ON ONE TWO 6612 04:16:45,460 --> 04:16:50,999 MEDICAL DOCTORS, A HUGE CADRE 6613 04:16:50,999 --> 04:16:53,001 HAVE BEEN TRAINED, THAT KNOW HOW 6614 04:16:53,001 --> 04:16:55,437 TO DO THINGS THAT WILL BE 6615 04:16:55,437 --> 04:16:55,704 UTILIZED. 6616 04:16:55,704 --> 04:16:58,273 >> THANK YOU. 6617 04:16:58,273 --> 04:17:00,876 IT'S BEEN A POWERFUL PANEL WITH 6618 04:17:00,876 --> 04:17:01,777 POWERFUL RESPONSES. 6619 04:17:01,777 --> 04:17:04,513 ONE LAST QUESTION TO STAY ON 6620 04:17:04,513 --> 04:17:05,480 TIME. 6621 04:17:05,480 --> 04:17:08,016 I WILL LEAVE MY E-MAIL IN THE 6622 04:17:08,016 --> 04:17:10,185 CHAT AFTERWARDS AND IF PEOPLE 6623 04:17:10,185 --> 04:17:10,819 HAVE FOLLOW-ON QUESTIONS PLEASE 6624 04:17:10,819 --> 04:17:12,287 LET ME KNOW AND I WILL MAKE SURE 6625 04:17:12,287 --> 04:17:15,357 TO GET THEM TO THE PANELISTS AND 6626 04:17:15,357 --> 04:17:16,859 GET YOU RESPONSES. 6627 04:17:16,859 --> 04:17:19,494 WE'VE HAD SO MUCH DISCUSSION, SO 6628 04:17:19,494 --> 04:17:21,029 MANY GOOD TALKS, I'M GOING TO 6629 04:17:21,029 --> 04:17:23,665 ADDRESS TO THE WHOLE PANEL. 6630 04:17:23,665 --> 04:17:25,934 WHAT GENERAL AD VICE DO YOU HAVE 6631 04:17:25,934 --> 04:17:27,903 FOR PATIENTS WITH SICKLE CELL, 6632 04:17:27,903 --> 04:17:29,338 BLOOD DISORDERS, THAT ARE 6633 04:17:29,338 --> 04:17:32,741 PREGNANT OR THINKING OF GETTING 6634 04:17:32,741 --> 04:17:33,809 PREGNANT, HOW SHOULD THEY PLAN 6635 04:17:33,809 --> 04:17:36,478 FOR THIS AND HOW SHOULD YOU 6636 04:17:36,478 --> 04:17:38,780 REALLY THINK ABOUT INTERACTING 6637 04:17:38,780 --> 04:17:40,749 WITH, AS DR. PECKER SAID, THE 6638 04:17:40,749 --> 04:17:41,450 INDIVIDUAL PATIENT. 6639 04:17:41,450 --> 04:17:43,385 WE'VE HAD PEOPLE FROM ALL 6640 04:17:43,385 --> 04:17:45,787 CULTURES, ALL BACKGROUNDS, ALL 6641 04:17:45,787 --> 04:17:47,756 COUNTRIES, AND WHAT SHOULD WE 6642 04:17:47,756 --> 04:17:49,625 KEEP IN MIND WHEN WE'RE TREATING 6643 04:17:49,625 --> 04:17:53,896 THESE PATIENTS SO THEY GET THE 6644 04:17:53,896 --> 04:17:56,298 BEST POSSIBLE CARE? 6645 04:17:56,298 --> 04:17:59,101 >> I'M HAPPY TO JUMP IN. 6646 04:17:59,101 --> 04:18:01,270 I THINK AT INDIVIDUAL LEVEL IT'S 6647 04:18:01,270 --> 04:18:04,239 REALLY FOR PATIENTS TO BE THEIR 6648 04:18:04,239 --> 04:18:05,774 OWN ADVOCATES AND THEREFORE IF 6649 04:18:05,774 --> 04:18:09,811 THEY CAN'T TO RELY ON OTHER 6650 04:18:09,811 --> 04:18:12,347 PATIENTS, TO DEMAND, ASK FOR 6651 04:18:12,347 --> 04:18:13,548 MORE. 6652 04:18:13,548 --> 04:18:16,518 AND BY DOING THIS, IF THEY GO 6653 04:18:16,518 --> 04:18:17,819 AND SEE A HEALTHCARE 6654 04:18:17,819 --> 04:18:21,223 PRACTITIONERS TO TRY AND SEE IF 6655 04:18:21,223 --> 04:18:23,058 -- ENCOURAGE THEM, IT'S 6656 04:18:23,058 --> 04:18:25,260 COMPLICATED, BUT ENCOURAGE THEM 6657 04:18:25,260 --> 04:18:26,995 TO HAVE A MULTI-DISCIPLINARY 6658 04:18:26,995 --> 04:18:29,831 APPROACH TO THINGS AND SAY HAVE 6659 04:18:29,831 --> 04:18:34,670 YOU SPOKEN TO THE OBSTETRICIAN, 6660 04:18:34,670 --> 04:18:39,241 PEOPLE IN HEMATOLOGY. 6661 04:18:39,241 --> 04:18:40,042 AND SOMETIMES IT'S MORE 6662 04:18:40,042 --> 04:18:40,809 EFFECTIVE. 6663 04:18:40,809 --> 04:18:41,843 CERTAINLY IN MY PRACTICE, WITHIN 6664 04:18:41,843 --> 04:18:43,412 THE NETWORK, THIS IS WHAT WE END 6665 04:18:43,412 --> 04:18:43,979 UP DOING. 6666 04:18:43,979 --> 04:18:47,249 IF WE SAY IT'S EASIER FOR YOU AS 6667 04:18:47,249 --> 04:18:53,188 A PATIENT TO ASK YOUR DOCTOR FOR 6668 04:18:53,188 --> 04:18:54,389 ONE, TWO, THREE, WHEREAS IF YOU 6669 04:18:54,389 --> 04:18:55,891 AS A DOCTOR SAY TO ANOTHER 6670 04:18:55,891 --> 04:18:57,426 DOCTOR OR HEALTH CARE PROVIDER, 6671 04:18:57,426 --> 04:19:02,965 YOU NEED TO DO XYZ, THAT CAN 6672 04:19:02,965 --> 04:19:03,999 CAUSE POTENTIAL CONFLICT IF YOU 6673 04:19:03,999 --> 04:19:05,867 DON'T KNOW EACH OTHER. 6674 04:19:05,867 --> 04:19:08,170 IF THE PATIENTS AND MOST HEALTH 6675 04:19:08,170 --> 04:19:10,806 FACILITIES, NOT JUST IN AFRICA 6676 04:19:10,806 --> 04:19:13,842 BUT EVERY WHERE IN THE WORLD ARE 6677 04:19:13,842 --> 04:19:15,944 STARTING TO APPRECIATE VALUE AND 6678 04:19:15,944 --> 04:19:18,046 IMPORTANCE OF PATIENT ADVOCACY 6679 04:19:18,046 --> 04:19:19,681 AND LISTENING TO PATIENTS. 6680 04:19:19,681 --> 04:19:22,117 SO THAT'S ONE WAY OF DOING THAT. 6681 04:19:22,117 --> 04:19:28,490 THANK YOU. 6682 04:19:28,490 --> 04:19:31,426 >> THANK YOU ALL SO MUCH. 6683 04:19:31,426 --> 04:19:33,762 THE TIMING, WE'RE OUT OF TIME. 6684 04:19:33,762 --> 04:19:37,466 I DID SEE DR. PECKER PUT A 6685 04:19:37,466 --> 04:19:40,102 RESPONSE IN THE CHAT. 6686 04:19:40,102 --> 04:19:42,070 PRE-CONCEPTION CARE, PRENATAL 6687 04:19:42,070 --> 04:19:42,938 CARE, POSTPARTUM CARE, 6688 04:19:42,938 --> 04:19:45,674 ESPECIALLY IN THE U.S., 6689 04:19:45,674 --> 04:19:47,209 TRANSLATED INTO SPANISH, REALLY 6690 04:19:47,209 --> 04:19:48,176 EMPOWERING PATIENTS TO BRING 6691 04:19:48,176 --> 04:19:49,945 EDUCATION TOOLS TO THE DOCS. 6692 04:19:49,945 --> 04:19:51,680 ONCE AGAIN, THANK YOU ALL SO 6693 04:19:51,680 --> 04:19:53,982 MUCH FOR AN EXCELLENT PANEL. 6694 04:19:53,982 --> 04:19:55,083 THERE WERE MORE QUESTIONS, I 6695 04:19:55,083 --> 04:19:57,419 WILL LEAVE MY E-MAIL IN THE 6696 04:19:57,419 --> 04:20:01,423 CHAT, AND GET BACK TO EVERYONE. 6697 04:20:01,423 --> 04:20:04,826 NOW I WILL PASS WORKSHOP TO DR. 6698 04:20:04,826 --> 04:20:11,833 PRICE TO START OUR NEXT PANEL. 6699 04:20:11,833 --> 04:20:12,701 >> GOOD AFTERNOON. 6700 04:20:12,701 --> 04:20:16,171 WELCOME TO THE LAST PANEL OF DAY 6701 04:20:16,171 --> 04:20:16,571 1. 6702 04:20:16,571 --> 04:20:19,808 I'M DR. PRICE, PROGRAM DIRECTOR 6703 04:20:19,808 --> 04:20:21,209 FROM THE DIVISION OF 6704 04:20:21,209 --> 04:20:23,412 CARDIOVASCULAR SCIENCE AT NHLBI. 6705 04:20:23,412 --> 04:20:26,148 AND CO-SIGN ACTIVIC PROGRAM LEAD 6706 04:20:26,148 --> 04:20:35,023 FOR NHLBI MATERNAL HEALTH 6707 04:20:35,023 --> 04:20:36,124 COMMUNITY IMPLEMENTATION 6708 04:20:36,124 --> 04:20:40,896 PROGRAM, IMPLEMENTING MATERNAL 6709 04:20:40,896 --> 04:20:43,432 HEALTH OUTCOMES FOR EVERYONE, 6710 04:20:43,432 --> 04:20:45,167 THESE EMPOWER COMMUNITIES TO 6711 04:20:45,167 --> 04:20:47,569 ENGAGE FULLY IN RESEARCH, TO 6712 04:20:47,569 --> 04:20:50,305 REDUCE MATERNAL MORBIDITY AND 6713 04:20:50,305 --> 04:20:50,839 MORTALITY. 6714 04:20:50,839 --> 04:20:56,745 THIS NEXT PANEL WILL SPOTLIGHT 6715 04:20:56,745 --> 04:20:57,412 THE RESEARCH TEAMS. 6716 04:20:57,412 --> 04:20:59,714 REFER TO THE PROGRAM BOOKLET AS 6717 04:20:59,714 --> 04:21:02,651 YOU'VE BEEN DOING THROUGHOUT THE 6718 04:21:02,651 --> 04:21:06,822 WORKSHOP FOR A FULL DESCRIPTION 6719 04:21:06,822 --> 04:21:11,626 OF THE SPEAKERS, BRIEFLY PART 6720 04:21:11,626 --> 04:21:13,528 PATING DR. NATALIE HERNANDEZ, 6721 04:21:13,528 --> 04:21:15,063 CENTER FOR MATERNAL HEALTH 6722 04:21:15,063 --> 04:21:19,534 EQUITY MOREHOUSE SCHOOL OF 6723 04:21:19,534 --> 04:21:19,901 MEDICINE. 6724 04:21:19,901 --> 04:21:20,969 HER COMMUNITY PARTNER JOINING 6725 04:21:20,969 --> 04:21:24,139 HER TODAY IS MARY NICHOLSON 6726 04:21:24,139 --> 04:21:26,675 JACKSON, CO-PRESIDENT OF THE 6727 04:21:26,675 --> 04:21:27,876 GEORGIA BREASTFEEDING COALITION, 6728 04:21:27,876 --> 04:21:29,177 CO-FOUNDER AND COMMUNITY 6729 04:21:29,177 --> 04:21:31,913 ENGAGEMENT DIRECTOR OF REACHING 6730 04:21:31,913 --> 04:21:35,750 OUR SISTERS FOR EVERYONE 6731 04:21:35,750 --> 04:21:36,084 INCORPORATED. 6732 04:21:36,084 --> 04:21:37,486 KNOWN AS ROSE. 6733 04:21:37,486 --> 04:21:43,725 FOLLOWING THAT WE'LL HEAR FROM 6734 04:21:43,725 --> 04:21:45,560 DR. WILLIAMS, ASSOCIATE 6735 04:21:45,560 --> 04:21:47,028 PROFESSOR AT NEW YORK 6736 04:21:47,028 --> 04:21:52,934 UNIVERSITY, AND HER COMMUNITY 6737 04:21:52,934 --> 04:21:55,437 PARTNER DAMALIA JACKSON. 6738 04:21:55,437 --> 04:21:58,406 TEXAS TECH, DR. CHRISTINE 6739 04:21:58,406 --> 04:22:00,809 GARNER, ASSOCIATE PROFESSOR OF 6740 04:22:00,809 --> 04:22:02,010 OBSTETRICS AND GYNECOLOGY, 6741 04:22:02,010 --> 04:22:04,412 RESEARCHER IN THE INFANT RISK 6742 04:22:04,412 --> 04:22:05,914 CENTER, ASSISTANT VICE PRESIDENT 6743 04:22:05,914 --> 04:22:08,150 OF RESEARCH AT TEXAS TECH 6744 04:22:08,150 --> 04:22:10,452 UNIVERSITIES HEALTH SCIENCES 6745 04:22:10,452 --> 04:22:11,353 CENTER. 6746 04:22:11,353 --> 04:22:16,591 REPRESENTING HER COMMUNITY 6747 04:22:16,591 --> 04:22:17,559 PARTNER CASIE STOUGHTON, 6748 04:22:17,559 --> 04:22:21,630 AMARILLO PUBLIC HEALTH. 6749 04:22:21,630 --> 04:22:27,402 WE'RE HEAR FROM DR. MENARD, 6750 04:22:27,402 --> 04:22:28,103 UNIVERSITY OF NORTH CAROLINA 6751 04:22:28,103 --> 04:22:30,805 SCHOOL OF MEDICINE. 6752 04:22:30,805 --> 04:22:35,443 JOINED BY HER COMMUNITY PARTNER 6753 04:22:35,443 --> 04:22:36,645 KAMARA BARNETT, COMMUNITY 6754 04:22:36,645 --> 04:22:38,380 COLLABORATOR FOR THE ACHIEVE 6755 04:22:38,380 --> 04:22:38,713 STUDY. 6756 04:22:38,713 --> 04:22:41,983 YOU'LL HEAR MORE THAT DURING THE 6757 04:22:41,983 --> 04:22:42,517 PRESENTATION. 6758 04:22:42,517 --> 04:22:47,989 LAST BUT NOT LEAST WE'LL BE 6759 04:22:47,989 --> 04:22:50,959 JOINED BY DR. KIRSTEN DORANS, 6760 04:22:50,959 --> 04:22:51,960 TULANE UNIVERSITY SCHOOL OF 6761 04:22:51,960 --> 04:22:54,596 PUBLIC HEALTH AND TROPICAL 6762 04:22:54,596 --> 04:22:58,166 MEDICINE, COMMUNITY PARTNER MARY 6763 04:22:58,166 --> 04:23:00,936 SCHULTHEIS, PRESIDENT AND CEO OF 6764 04:23:00,936 --> 04:23:02,337 CRESCENT CITY FAMILY SERVICES. 6765 04:23:02,337 --> 04:23:05,307 I ENCOURAGE YOU AS YOU LISTEN TO 6766 04:23:05,307 --> 04:23:07,042 OUR PANELISTS SPEAK TODAY FEEL 6767 04:23:07,042 --> 04:23:09,444 FREE TO ENTER YOUR QUESTIONS IN 6768 04:23:09,444 --> 04:23:14,149 THE CHAT AND WE WILL GET TO 6769 04:23:14,149 --> 04:23:16,451 THOSE QUESTIONS DURING OUR Q&A 6770 04:23:16,451 --> 04:23:17,786 FOLLOWING THE CONCLUSION OF THE 6771 04:23:17,786 --> 04:23:18,420 PRESENTATIONS. 6772 04:23:18,420 --> 04:23:21,823 WITH THAT I WILL TURN IT OVER TO 6773 04:23:21,823 --> 04:23:26,094 THE FIRST SPEAKER, DR. HERNANDEZ 6774 04:23:26,094 --> 04:23:27,729 AND MS. JACKSON, IMPROVING 6775 04:23:27,729 --> 04:23:29,998 PRE-CONCEPTION ACTION IN AND 6776 04:23:29,998 --> 04:23:32,100 CHOICES FOR TOMORROW. 6777 04:23:32,100 --> 04:23:33,435 >> THANK YOU. 6778 04:23:33,435 --> 04:23:34,402 GOOD AFTERNOON. 6779 04:23:34,402 --> 04:23:39,441 NATALIE HERNANDEZ GREEN, I'M AN 6780 04:23:39,441 --> 04:23:40,909 SOCIAL PROFESSOR, EXCITED TO 6781 04:23:40,909 --> 04:23:44,346 CO-PRESENT WITH ONE OF OUR MAJOR 6782 04:23:44,346 --> 04:23:45,313 COMMUNITY PARTNERS, I'M WEARING 6783 04:23:45,313 --> 04:23:46,414 A SHIRT REPRESENTING THE 6784 04:23:46,414 --> 04:23:50,585 ORGANIZATION REACHING OUR SISTER 6785 04:23:50,585 --> 04:23:51,553 EVERYWHERE WITH MARY NICHOLSON 6786 04:23:51,553 --> 04:23:52,020 JACKSON. 6787 04:23:52,020 --> 04:23:53,521 NEXT SLIDE. 6788 04:23:53,521 --> 04:23:56,725 JUST FOR SOME BACKGROUND 6789 04:23:56,725 --> 04:24:00,228 INFORMATION, OUR TOPIC AND 6790 04:24:00,228 --> 04:24:01,429 EVIDENCE-BASED INTERVENTION THAT 6791 04:24:01,429 --> 04:24:02,831 WE CHOSE BECAUSE WE'VE GATHERED 6792 04:24:02,831 --> 04:24:05,600 A LOT OF FORMATIVE WORK WITH 6793 04:24:05,600 --> 04:24:07,669 COMMUNITIES FOR OVER THE LAST 6794 04:24:07,669 --> 04:24:11,706 SIX YEARS WAS PRE-CONCEPTION 6795 04:24:11,706 --> 04:24:14,309 COUNSELING, PRE-CONCEPTION CARE. 6796 04:24:14,309 --> 04:24:16,278 IMPROVING HEALTH BEFORE, DURING, 6797 04:24:16,278 --> 04:24:18,480 AFTER PREGNANCY REMAINS A 6798 04:24:18,480 --> 04:24:21,650 STRATEGIC OBJECTIVE OF HEALTHY 6799 04:24:21,650 --> 04:24:23,184 PEOPLE 2030. 6800 04:24:23,184 --> 04:24:24,919 IT PROVIDES PLATFORM FOR EARLY 6801 04:24:24,919 --> 04:24:26,988 DETECTION AND MANAGEMENT OF 6802 04:24:26,988 --> 04:24:28,857 HEALTH RISKS, ENSURES THAT 6803 04:24:28,857 --> 04:24:30,558 INDIVIDUALS OF REPRODUCTIVE AGE 6804 04:24:30,558 --> 04:24:33,662 BEGIN PREGNANCY IN A STATE OF 6805 04:24:33,662 --> 04:24:34,663 OPTIMAL HEALTH. 6806 04:24:34,663 --> 04:24:36,298 WE KNOW CARDIOVASCULAR DISEASE 6807 04:24:36,298 --> 04:24:37,065 PARTICULARLY FOR BLACK WOMEN IS 6808 04:24:37,065 --> 04:24:40,935 ONE OF THE LEADING CAUSES OF 6809 04:24:40,935 --> 04:24:46,408 PREGNANCY-RELATED DEATH. 6810 04:24:46,408 --> 04:24:47,609 AND MORBIDITY. 6811 04:24:47,609 --> 04:24:51,012 CLINICAL RELEVANCE OF A CONCEPT 6812 04:24:51,012 --> 04:24:51,880 TARGETING IN PRE-CONCEPTION 6813 04:24:51,880 --> 04:24:54,382 COUNSELING WAS HIGH LIGHTED IN A 6814 04:24:54,382 --> 04:24:56,785 JOINT PRESIDENTIAL ADVISORY FROM 6815 04:24:56,785 --> 04:24:59,120 THE AMERICAN HEART ASSOCIATION 6816 04:24:59,120 --> 04:25:01,189 AND AMERICAN COLLEGE OF 6817 04:25:01,189 --> 04:25:03,291 OBSTETRICS AND GYNECOLOGISTS TO 6818 04:25:03,291 --> 04:25:04,159 HIGHLIGHT THE ROLE 6819 04:25:04,159 --> 04:25:07,429 PRE-CONCEPTION HEALTH PLAYS IN 6820 04:25:07,429 --> 04:25:10,031 OPTIMIZING CARDIOVASCULAR 6821 04:25:10,031 --> 04:25:18,373 DISEASE OF PREGNANCY CAPABLE 6822 04:25:18,373 --> 04:25:18,673 INDIVIDUALS. 6823 04:25:18,673 --> 04:25:20,375 MOSTLY CONDUCTED IN CLINICAL 6824 04:25:20,375 --> 04:25:22,177 SETTINGS AND THROUGH THE 6825 04:25:22,177 --> 04:25:23,411 IMPLEMENTATION PROJECTS A UNIQUE 6826 04:25:23,411 --> 04:25:29,417 OPPORTUNITY TO MEET A LOT OF 6827 04:25:29,417 --> 04:25:30,452 INDIVIDUALS IN THE SOUTHEAST 6828 04:25:30,452 --> 04:25:32,787 WHERE 30% DO NOT HAVE ACCESS TO 6829 04:25:32,787 --> 04:25:34,422 HEALTH CARE TO MEET THEM IN 6830 04:25:34,422 --> 04:25:35,290 COMMUNITY SETTINGS. 6831 04:25:35,290 --> 04:25:39,561 HOW DO WE THINK ABOUT 6832 04:25:39,561 --> 04:25:40,795 IMPLEMENTING PRE-CONCEPTION 6833 04:25:40,795 --> 04:25:47,569 COUNSELING WITH COMMUNITY 6834 04:25:47,569 --> 04:25:49,337 MEMBERS IN COMMUNITY-BASED 6835 04:25:49,337 --> 04:25:49,704 SETTINGS. 6836 04:25:49,704 --> 04:25:51,773 THE PROJECT HAD TWO PHASES. 6837 04:25:51,773 --> 04:25:55,009 PHASE 1 WE CONDUCTED A PILOT 6838 04:25:55,009 --> 04:25:57,245 TEST OF PRE-CONCEPTION 6839 04:25:57,245 --> 04:25:58,413 COUNSELING, THINKING ABOUT HOW 6840 04:25:58,413 --> 04:26:01,182 DO WE DO THIS, HOW DO YOU EVEN 6841 04:26:01,182 --> 04:26:04,119 BEGIN TO TAKE SOMETHING THAT 6842 04:26:04,119 --> 04:26:05,320 SEEMS FAIRLY COMPLICATED, THAT 6843 04:26:05,320 --> 04:26:08,156 CLINICIANS ARE USED TO DOING, 6844 04:26:08,156 --> 04:26:10,358 HAVING PERSONS LIKE YOU AND ME 6845 04:26:10,358 --> 04:26:11,993 IN COMMUNITY SETTINGS BEING ABLE 6846 04:26:11,993 --> 04:26:17,565 TO IMPLEMENT SOMETHING LIKE 6847 04:26:17,565 --> 04:26:17,799 THIS. 6848 04:26:17,799 --> 04:26:20,001 PEOPLE TEND TO FOCUS ON NEEDS 6849 04:26:20,001 --> 04:26:21,836 BUT WE WANTED TO AMPLIFY ASSETS 6850 04:26:21,836 --> 04:26:23,605 IN THE COMMUNITIES. 6851 04:26:23,605 --> 04:26:28,209 WE DID A PRE-CONCEPTION HEALTH 6852 04:26:28,209 --> 04:26:28,777 SURVEY, FATHER FRIENDLINESS 6853 04:26:28,777 --> 04:26:31,346 SURVEY, WE WERE INTERESTED IN 6854 04:26:31,346 --> 04:26:33,114 HOW TWO PEOPLE PARTICULARLY 6855 04:26:33,114 --> 04:26:35,417 PARTNERS, FATHERS, ARE INVOLVED 6856 04:26:35,417 --> 04:26:38,553 IN PRE-CONCEPTION HEALTH AND 6857 04:26:38,553 --> 04:26:41,222 HOLDING SOME FOCUS GROUPS TO GET 6858 04:26:41,222 --> 04:26:42,857 AT WHAT IS THE COMMUNITY 6859 04:26:42,857 --> 04:26:44,392 PRIORITIZING AS NEED. 6860 04:26:44,392 --> 04:26:49,531 WE DID A PILOT INTERVENTION AND 6861 04:26:49,531 --> 04:26:51,065 IMPLEMENTATION, USING EXPERT 6862 04:26:51,065 --> 04:26:52,267 MODEL TO DELIVER PRE-CONCEPTION 6863 04:26:52,267 --> 04:26:53,568 COUNSELING, THAT WAS SOMETHING 6864 04:26:53,568 --> 04:26:55,970 THAT WE HEARD FROM 6865 04:26:55,970 --> 04:26:56,838 COMMUNITY-BASED ORGANIZATIONS 6866 04:26:56,838 --> 04:26:58,606 THAT THEY WERE FAMILIAR WITH, 6867 04:26:58,606 --> 04:27:02,110 HOW DO WE UTILIZE MODEL IN THAT 6868 04:27:02,110 --> 04:27:03,678 WAY TO PRESENT PRE-CONCEPTION 6869 04:27:03,678 --> 04:27:07,515 COUNSELING AND THEN DID A POST 6870 04:27:07,515 --> 04:27:08,616 IMPLEMENTATION ASSESSMENT USING 6871 04:27:08,616 --> 04:27:11,453 FOLLOW-UP INTERVIEWS WITH OUR 6872 04:27:11,453 --> 04:27:22,030 COMMUNITY MEMBERS AND PARTNERS 6873 04:27:23,164 --> 04:27:24,165 PHASE 2, HYBRID EFFECTIVENESS 6874 04:27:24,165 --> 04:27:27,202 IMPLEMENT AGO TRIAL WITH SITES 6875 04:27:27,202 --> 04:27:28,136 WITH LOW INCOME AFRICAN AMERICAN 6876 04:27:28,136 --> 04:27:29,170 WOMEN IN GEORGIA, NORTH 6877 04:27:29,170 --> 04:27:30,705 CAROLINA, SOUTH CAROLINA, 6878 04:27:30,705 --> 04:27:34,309 WORKING ON PARTNERSHIPS IN 6879 04:27:34,309 --> 04:27:35,243 TENNESSEE. 6880 04:27:35,243 --> 04:27:39,447 SO WITH THIS HYBRID TO 6881 04:27:39,447 --> 04:27:40,448 EFFECTIVENESS IMPLEMENTATION, 6882 04:27:40,448 --> 04:27:42,617 RCT, INDIVIDUALS WILL BE 6883 04:27:42,617 --> 04:27:45,920 RANDOMIZED INTO TWO ARMS, ONE 6884 04:27:45,920 --> 04:27:47,889 LOOKING AT STRUCTURE FOLLOW-UP, 6885 04:27:47,889 --> 04:27:48,756 SO WE'RE STILL WORKING WITH 6886 04:27:48,756 --> 04:27:50,225 COMMUNITIES TO SEE WHAT THAT 6887 04:27:50,225 --> 04:27:53,027 LOOKS LIKE BUT RIGHT NOW WE KNOW 6888 04:27:53,027 --> 04:27:55,363 MOST PEOPLE DO MAILED 6889 04:27:55,363 --> 04:27:56,764 INFORMATIONAL FLYERS AND 6890 04:27:56,764 --> 04:27:58,433 ENHANCED STRUCTURED FOLLOW-UP. 6891 04:27:58,433 --> 04:28:00,502 HOW DO WE UTILIZE TECHNOLOGY OR 6892 04:28:00,502 --> 04:28:01,936 TOOLS THAT COMMUNITY SITES ARE 6893 04:28:01,936 --> 04:28:03,671 ALREADY USING AS WELL AS 6894 04:28:03,671 --> 04:28:04,873 ADDITIONAL INFORMATION SO THAT 6895 04:28:04,873 --> 04:28:07,742 IT'S ENHANCED AND NOT YOUR 6896 04:28:07,742 --> 04:28:17,352 STANDARD WAY OF DELIVERING 6897 04:28:17,352 --> 04:28:21,523 INFORMATION. 6898 04:28:21,523 --> 04:28:24,893 THE FRAMEWORKS ARE EXPLORATION, 6899 04:28:24,893 --> 04:28:30,732 PREPARATION, IMPLEMENTATION, 6900 04:28:30,732 --> 04:28:32,333 SUSTAINMENT FRAMEWORK, AND PRISM 6901 04:28:32,333 --> 04:28:32,767 MODEL. 6902 04:28:32,767 --> 04:28:35,203 TWO KEY COMPONENTS OF THE MODELS 6903 04:28:35,203 --> 04:28:41,342 IS THAT LASTING OF 6904 04:28:41,342 --> 04:28:42,043 SUSTAINABILITY. 6905 04:28:42,043 --> 04:28:44,512 MAIN GOAL IS LOOKING AT 6906 04:28:44,512 --> 04:28:45,813 IMPLEMENTATION OUTCOME. 6907 04:28:45,813 --> 04:28:48,550 ONCE THIS PROJECT LEAVES, HOW 6908 04:28:48,550 --> 04:28:49,551 ARE THESE COMMUNITY-BASED 6909 04:28:49,551 --> 04:28:51,085 ORGANIZATIONS ABLE TO SUSTAIN 6910 04:28:51,085 --> 04:28:54,556 AND CONTINUE THIS PROGRAM AT 6911 04:28:54,556 --> 04:28:55,990 SCALE AND FOR YEARS TO COME. 6912 04:28:55,990 --> 04:28:58,293 THIS PROJECT IS A FIVE-YEAR 6913 04:28:58,293 --> 04:28:59,827 PROJECT, THOSE TWO LAST YEARS 6914 04:28:59,827 --> 04:29:02,564 WILL BE WORKING ON 6915 04:29:02,564 --> 04:29:07,368 SUSTAINABILITY WITH OUR 6916 04:29:07,368 --> 04:29:07,669 COMMUNITIES. 6917 04:29:07,669 --> 04:29:10,238 NEXT SLIDE. 6918 04:29:10,238 --> 04:29:12,740 THIS IS JUST THE -- THESE ARE 6919 04:29:12,740 --> 04:29:15,376 COMMUNITY PARTNERSHIPS THAT I 6920 04:29:15,376 --> 04:29:17,579 MENTIONED WITHIN THE STATES. 6921 04:29:17,579 --> 04:29:20,048 OF GEORGIA, NORTH CAROLINA, 6922 04:29:20,048 --> 04:29:21,149 SOUTH CAROLINA. 6923 04:29:21,149 --> 04:29:23,284 A LOT ARE SIMILAR IN THE TYPE OF 6924 04:29:23,284 --> 04:29:24,852 POPULATION THEY SERVE, THE TYPES 6925 04:29:24,852 --> 04:29:26,821 OF PROGRAMS AND SO YOU'LL SEE 6926 04:29:26,821 --> 04:29:29,324 WE'RE WORKING WITH FIRST STEPS 6927 04:29:29,324 --> 04:29:30,758 PROGRAMS, HEALTHY START 6928 04:29:30,758 --> 04:29:32,927 PROGRAMS, AND THAT WAS IMPORTANT 6929 04:29:32,927 --> 04:29:36,998 BECAUSE WE WANTED THESE BRICK 6930 04:29:36,998 --> 04:29:38,499 AND MORTAR PROGRAMS THAT WERE 6931 04:29:38,499 --> 04:29:39,634 SIMILAR AND WOULD HAVE SIMILAR 6932 04:29:39,634 --> 04:29:45,306 WAYS OF HOW THEY ARE 6933 04:29:45,306 --> 04:29:45,640 IMPLEMENTING. 6934 04:29:45,640 --> 04:29:53,348 AND THEN I'LL HAND OVER TO MISS 6935 04:29:53,348 --> 04:29:53,748 MARY. 6936 04:29:53,748 --> 04:29:59,454 >> GOOD AFTERNOON. 6937 04:29:59,454 --> 04:30:02,757 NEXT SLIDE. 6938 04:30:02,757 --> 04:30:03,625 6939 04:30:03,625 --> 04:30:05,693 AS A COMMUNITY-BASED 6940 04:30:05,693 --> 04:30:10,298 ORGANIZATION AND SITE WE HAD 6941 04:30:10,298 --> 04:30:14,702 REGIONAL ADVISORY BOARD, RAB, WE 6942 04:30:14,702 --> 04:30:16,871 HAD 20 MEMBERS, WE ALSO THROUGH 6943 04:30:16,871 --> 04:30:20,508 THOSE MEMBERSHIPS AND SITES WERE 6944 04:30:20,508 --> 04:30:23,911 ABLE TO GAIN COLLABORATION, ALSO 6945 04:30:23,911 --> 04:30:26,180 ABLE TO PROVIDE INFORMATION TO 6946 04:30:26,180 --> 04:30:31,219 EACH OF US, BUT ALSO SHARE 6947 04:30:31,219 --> 04:30:32,987 INFORMATION TO OUR OTHER -- TO 6948 04:30:32,987 --> 04:30:37,358 OUR SITES AND PARTICIPANTS. 6949 04:30:37,358 --> 04:30:38,826 NEXT SLIDE. 6950 04:30:38,826 --> 04:30:42,897 WE HAD A MEETING IN MARCH, WITH 6951 04:30:42,897 --> 04:30:47,735 ALL OF THE TEN SITES, AND WE 6952 04:30:47,735 --> 04:30:50,038 DISCUSSED THERE AT THE STRATEGY 6953 04:30:50,038 --> 04:30:51,539 MEETING ON THE NEXT PHASE, WHICH 6954 04:30:51,539 --> 04:30:52,974 IS OUR YEAR 2. 6955 04:30:52,974 --> 04:30:57,812 WE WERE ABLE TO PROVIDE SOME 6956 04:30:57,812 --> 04:31:00,014 INFORMATION AND FEEDBACK TO THE 6957 04:31:00,014 --> 04:31:05,586 PROJECT MANAGERS AND COME UP 6958 04:31:05,586 --> 04:31:07,655 WITH OUR NEXT 2 TO 5 YEAR 6959 04:31:07,655 --> 04:31:11,459 STRATEGY ON WHICH WAY TO GO, HOW 6960 04:31:11,459 --> 04:31:18,533 WE WOULD IMPLEMENT THE 6961 04:31:18,533 --> 04:31:18,833 INFORMATION. 6962 04:31:18,833 --> 04:31:19,300 NEXT SLIDE. 6963 04:31:19,300 --> 04:31:24,138 >> THE WAY WE WORK WITH OUR 6964 04:31:24,138 --> 04:31:25,640 COMMUNITY-BASED SITES, 6965 04:31:25,640 --> 04:31:26,741 CONTINUING SITE ORIENTATION AND 6966 04:31:26,741 --> 04:31:28,276 TRAININGS, THESE WERE HELD IN 6967 04:31:28,276 --> 04:31:28,710 PERSON. 6968 04:31:28,710 --> 04:31:35,216 A WHOLE DAY WHERE WE DISCUSSED A 6969 04:31:35,216 --> 04:31:37,685 PROJECT BACKGROUND, PHASE 1 6970 04:31:37,685 --> 04:31:38,453 FINDINGS, PROGRAM DELIVERY. 6971 04:31:38,453 --> 04:31:45,359 WE ALSO MADE SURE WE HAD SITE 6972 04:31:45,359 --> 04:31:45,893 LIAISONS, PRIMARY PROJECT 6973 04:31:45,893 --> 04:31:47,095 CORRESPONDENCE FOR TWO TO THREE 6974 04:31:47,095 --> 04:31:48,730 PARTNER SITES EACH, HAVE OUR 6975 04:31:48,730 --> 04:31:51,399 SITE LIAISONS FROM OUR TEAM HAVE 6976 04:31:51,399 --> 04:31:52,934 BIMONTHLY AND MONTHLY MEETING 6977 04:31:52,934 --> 04:31:55,236 CHECK-INS WITH SITES ABOUT 6978 04:31:55,236 --> 04:31:56,337 RECRUITMENT AND IMPLEMENTATION, 6979 04:31:56,337 --> 04:32:00,341 WE ALSO DO MONTHLY NEWSLETTERS 6980 04:32:00,341 --> 04:32:03,010 WITH PROJECT IMPACT REMINDERS, 6981 04:32:03,010 --> 04:32:03,678 MATERNAL HEALTH RELATED 6982 04:32:03,678 --> 04:32:05,213 INFORMATION, EVENTS HAPPENING IN 6983 04:32:05,213 --> 04:32:07,815 THE COMMUNITIES, WE DO A LOT OF 6984 04:32:07,815 --> 04:32:08,716 CAPACITY BUILDING OPPORTUNITIES 6985 04:32:08,716 --> 04:32:10,351 WITH OUR SITES. 6986 04:32:10,351 --> 04:32:12,887 WE ALSO SEND HOLIDAY CARDS, 6987 04:32:12,887 --> 04:32:14,822 CONDOLENCE MESSAGES, JUST TO 6988 04:32:14,822 --> 04:32:17,358 MAKE IT MORE PERSONABLE SO WE'RE 6989 04:32:17,358 --> 04:32:18,359 BUILDING TRUST AND RAPPORT WITH 6990 04:32:18,359 --> 04:32:20,328 EACH OF THE COMMUNITY SITES. 6991 04:32:20,328 --> 04:32:22,396 AND LASTLY WE CREATED A RESOURCE 6992 04:32:22,396 --> 04:32:25,500 HUB WHICH WAS TO HOUSE ALL 6993 04:32:25,500 --> 04:32:26,601 RESOURCES COMPILED FOR 6994 04:32:26,601 --> 04:32:28,035 PARTICIPANTS AND REFERRAL LISTS 6995 04:32:28,035 --> 04:32:28,803 FROM PARTNER SITES. 6996 04:32:28,803 --> 04:32:33,074 AND THESE ARE TO BE AVAILABLE 6997 04:32:33,074 --> 04:32:38,846 FOR YOU UTILIZATION DURING YEARS 6998 04:32:38,846 --> 04:32:43,818 2 TO 4 THROUGHOUT THE 6999 04:32:43,818 --> 04:32:44,919 PRE-CONCEPTION COUNSELINGS, 7000 04:32:44,919 --> 04:32:46,554 THROUGH THE EIGHT SESSIONS, 7001 04:32:46,554 --> 04:32:48,623 SOCIAL DETERMINANTS OF HEALTH, 7002 04:32:48,623 --> 04:32:51,125 NUTRITION, PHYSICAL ACTIVITY, AS 7003 04:32:51,125 --> 04:32:53,861 WELL AS DIABETES, GENETIC 7004 04:32:53,861 --> 04:32:54,629 HISTORY, FAMILY PLANNING, 7005 04:32:54,629 --> 04:32:55,129 CONTRACEPTION. 7006 04:32:55,129 --> 04:32:56,264 THAT'S IT. 7007 04:32:56,264 --> 04:32:58,466 IT'S A REALLY QUICK LIGHTNING 7008 04:32:58,466 --> 04:32:59,000 TALK. 7009 04:32:59,000 --> 04:33:00,968 AND NEXT SLIDE, WE JUST THANK 7010 04:33:00,968 --> 04:33:03,738 YOU, HERE'S SOME MORE 7011 04:33:03,738 --> 04:33:06,374 INFORMATION ABOUT OUR 7012 04:33:06,374 --> 04:33:07,575 ORGANIZATION WHICH INCLUDES 7013 04:33:07,575 --> 04:33:08,409 PARTNER ORGS AND WEBSITE. 7014 04:33:08,409 --> 04:33:18,019 THANK YOU FOR YOUR TIME. 7015 04:33:18,019 --> 04:33:22,557 >> WE'LL HAVE OUR NEXT PANELIST, 7016 04:33:22,557 --> 04:33:25,760 DR. NATASHA WILLIAMS AND 7017 04:33:25,760 --> 04:33:26,928 COMMUNITY PARTNER, MS. JACKSON, 7018 04:33:26,928 --> 04:33:28,729 TO TALK ABOUT THE JUST MOST 7019 04:33:28,729 --> 04:33:28,963 PROJECT. 7020 04:33:28,963 --> 04:33:29,931 >> THANK YOU. 7021 04:33:29,931 --> 04:33:32,433 GOOD AFTERNOON, EVERYONE. 7022 04:33:32,433 --> 04:33:34,101 I'M DR. WILLIAMS, THE CONTACT 7023 04:33:34,101 --> 04:33:36,804 PRINCIPAL INVESTIGATOR FOR THIS 7024 04:33:36,804 --> 04:33:37,104 INITIATIVE. 7025 04:33:37,104 --> 04:33:40,007 WE LOOK FORWARD TO PRESENTING 7026 04:33:40,007 --> 04:33:42,944 WITH MY COLLEAGUE DAMALIA 7027 04:33:42,944 --> 04:33:43,511 JACKSON. 7028 04:33:43,511 --> 04:33:45,246 WE DO NOT HAVE CONFLICTS OF 7029 04:33:45,246 --> 04:33:45,847 INTEREST. 7030 04:33:45,847 --> 04:33:47,215 I WANT TO ACKNOWLEDGE THE NIH 7031 04:33:47,215 --> 04:33:53,254 AGREEMENT THAT WE HAVE FOR THIS 7032 04:33:53,254 --> 04:33:53,754 INITIATIVE. 7033 04:33:53,754 --> 04:33:54,322 NEXT SLIDE. 7034 04:33:54,322 --> 04:33:56,858 SO IT TAKES A VILLAGE. 7035 04:33:56,858 --> 04:33:59,227 I WANT TO ACKNOWLEDGE ALL OF THE 7036 04:33:59,227 --> 04:34:00,461 AMAZING COLLABORATORS. 7037 04:34:00,461 --> 04:34:03,231 THIS IS A PARTNERSHIP WITH NEW 7038 04:34:03,231 --> 04:34:05,299 YORK CITY HEALTH AND HOSPITALS 7039 04:34:05,299 --> 04:34:06,200 CORPORATION, THE LARGEST PUBLIC 7040 04:34:06,200 --> 04:34:10,104 HEALTH SYSTEM IN THE COUNTRY, 7041 04:34:10,104 --> 04:34:16,277 FAMILY HEALTH CENTERS AT NYU 7042 04:34:16,277 --> 04:34:20,081 LANGONE, AND SEVERAL OTHER STAFF 7043 04:34:20,081 --> 04:34:22,717 MEMBERS, RESEARCH SUPPORT 7044 04:34:22,717 --> 04:34:25,786 STUDENTS, ADMIN, STUDY 7045 04:34:25,786 --> 04:34:26,754 PARTICIPANTS. 7046 04:34:26,754 --> 04:34:27,221 NEXT SLIDE. 7047 04:34:27,221 --> 04:34:29,190 SO ALSO AS DR. HERNANDEZ SHARED 7048 04:34:29,190 --> 04:34:33,261 IN HER TALK THIS WAS A 7049 04:34:33,261 --> 04:34:35,329 MULTI-PHASE STUDY, SO PHASE 1 7050 04:34:35,329 --> 04:34:37,531 THESE ARE SOME OF THE COMMUNITY 7051 04:34:37,531 --> 04:34:40,034 PARTNERS THAT WE'VE WORKED WITH, 7052 04:34:40,034 --> 04:34:41,903 AS WELL AS OUR PHASE 2 7053 04:34:41,903 --> 04:34:43,337 INITIATIVE AS WELL. 7054 04:34:43,337 --> 04:34:45,306 BUT I WANT TO ACKNOWLEDGE ALL OF 7055 04:34:45,306 --> 04:34:47,708 THE AMAZING WORK THAT THEY HAVE 7056 04:34:47,708 --> 04:34:49,343 ALL CONTRIBUTED TO THROUGHOUT 7057 04:34:49,343 --> 04:34:52,280 THIS INITIATIVE. 7058 04:34:52,280 --> 04:34:53,514 NEXT SLIDE. 7059 04:34:53,514 --> 04:34:57,785 SO IN OUR PHASE 1 INITIATIVE FOR 7060 04:34:57,785 --> 04:35:00,621 THE -- THE JUST MOTHERS PROGRAM, 7061 04:35:00,621 --> 04:35:02,690 WE ALSO CONDUCTED A COMMUNITY 7062 04:35:02,690 --> 04:35:04,025 NEEDS ASSESSMENT. 7063 04:35:04,025 --> 04:35:06,560 WE LOOKED SPECIFICALLY AT THE 7064 04:35:06,560 --> 04:35:07,528 DATA THAT'S AVAILABLE IN NEW 7065 04:35:07,528 --> 04:35:10,598 YORK CITY, WHICH IS WHERE OUR 7066 04:35:10,598 --> 04:35:11,933 PROGRAM IS LOCATED. 7067 04:35:11,933 --> 04:35:14,335 AND WE ARE WORKING WITH BOTH 7068 04:35:14,335 --> 04:35:19,273 BLACK AND LATINA BIRTHING 7069 04:35:19,273 --> 04:35:19,740 PEOPLE, WHO HAVE 7070 04:35:19,740 --> 04:35:20,474 DISPROPORTIONATE MATERNAL 7071 04:35:20,474 --> 04:35:21,242 MORBIDITY AND MORTALITY. 7072 04:35:21,242 --> 04:35:22,977 BASED ON DATA AT OUR LEVEL AT 7073 04:35:22,977 --> 04:35:26,447 NEW YORK CITY AND STATE AS WELL 7074 04:35:26,447 --> 04:35:28,649 AS NATIONALLY, MANY OF THE 7075 04:35:28,649 --> 04:35:29,984 PREGNANCY-RELATED DEATHS ARE 7076 04:35:29,984 --> 04:35:30,284 PREVENTIBLE. 7077 04:35:30,284 --> 04:35:33,187 WE'RE FOCUSED ON OUR INITIATIVE 7078 04:35:33,187 --> 04:35:34,555 TO ADDRESS SOCIAL DETERMINANTS 7079 04:35:34,555 --> 04:35:36,190 OF HEALTH AND LIFESTYLE, 7080 04:35:36,190 --> 04:35:38,392 NUTRITION, AND OTHER FACTORS 7081 04:35:38,392 --> 04:35:39,694 RELATED TO MATERNAL MORBIDITY 7082 04:35:39,694 --> 04:35:42,897 AND MORTALITY. 7083 04:35:42,897 --> 04:35:44,198 NEXT SLIDE. 7084 04:35:44,198 --> 04:35:47,601 OUR PHASE 2 INITIATIVE INCLUDES 7085 04:35:47,601 --> 04:35:49,537 CLUSTER RANDOMIZED STEPPED WEDGE 7086 04:35:49,537 --> 04:35:50,838 TRIAL. 7087 04:35:50,838 --> 04:35:52,606 IT IS A TYPE 3 HYBRID 7088 04:35:52,606 --> 04:35:54,275 IMPLEMENTATION TRIAL. 7089 04:35:54,275 --> 04:35:56,811 WE ARE ADOPTING THE ORIGINAL 7090 04:35:56,811 --> 04:35:58,879 EVIDENCE-BASED PROGRAM WHICH IS 7091 04:35:58,879 --> 04:36:00,748 THE STARTING EARLY PROGRAM, ALSO 7092 04:36:00,748 --> 04:36:02,249 KNOWN AS STEP. 7093 04:36:02,249 --> 04:36:05,219 IT IS A LIFESTYLE PRENATAL 7094 04:36:05,219 --> 04:36:07,722 COUNSELING AND NUTRITION PROGRAM 7095 04:36:07,722 --> 04:36:09,924 THAT'S TRADITIONALLY DELIVERED 7096 04:36:09,924 --> 04:36:12,026 BY REGISTERED DIETITIANS, IT IS 7097 04:36:12,026 --> 04:36:15,496 DONE IN PERSON, AND IS REALLY A 7098 04:36:15,496 --> 04:36:18,799 FAMILY APPROACH THAT FOCUSES ON 7099 04:36:18,799 --> 04:36:20,434 NUTRITION, PHYSICAL ACTIVITY, 7100 04:36:20,434 --> 04:36:22,303 AND STRESS REDUCTION, AND SOCIAL 7101 04:36:22,303 --> 04:36:29,643 SUPPORT FOR A HEALTHY PREGNANCY 7102 04:36:29,643 --> 04:36:31,512 WE'RE WORKING WITH TWO NEW YORK 7103 04:36:31,512 --> 04:36:33,447 CITY PRENATAL CLINICS AND 7104 04:36:33,447 --> 04:36:34,648 INDIVIDUALS RECEIVING THEIR CARE 7105 04:36:34,648 --> 04:36:39,253 ARE ELIGIBLE AS LONG AS THEY ARE 7106 04:36:39,253 --> 04:36:42,623 18 OR OLDER, ENGLISH OR SPANISH 7107 04:36:42,623 --> 04:36:43,457 SPEAKING. 7108 04:36:43,457 --> 04:36:45,459 THE MAJORITY OF INDIVIDUALS 7109 04:36:45,459 --> 04:36:53,134 IDENTIFY AS BLACK AND/OR LATINA 7110 04:36:53,134 --> 04:36:54,035 PATIENTS. 7111 04:36:54,035 --> 04:36:56,871 NEXT SLIDE. 7112 04:36:56,871 --> 04:37:02,877 FOR ADAPTATION WE'RE GUIDED BY 7113 04:37:02,877 --> 04:37:05,413 CFIR, AS WELL AS PRINCIPLES OF 7114 04:37:05,413 --> 04:37:07,448 COMMUNITY BASED PARTICIPATORY 7115 04:37:07,448 --> 04:37:07,715 RESEARCH. 7116 04:37:07,715 --> 04:37:11,152 SO ALL FACETS OF THIS INITIATIVE 7117 04:37:11,152 --> 04:37:13,421 INCLUDES OUR COMMUNITY PARTNERS. 7118 04:37:13,421 --> 04:37:15,456 THE ADAPTATION INCLUDES A 7119 04:37:15,456 --> 04:37:17,258 TECHNOLOGY BASED PROGRAM, 7120 04:37:17,258 --> 04:37:19,994 mHEALTH, AND THAT'S REALLY 7121 04:37:19,994 --> 04:37:21,429 DESIGNED TO IMPROVE THE 7122 04:37:21,429 --> 04:37:23,297 ACCESSIBILITY OF THE PROGRAM 7123 04:37:23,297 --> 04:37:25,699 WHICH WAS TRADITIONAL DELIVERED 7124 04:37:25,699 --> 04:37:27,668 BY REGISTERED DIETITIANS, IN 7125 04:37:27,668 --> 04:37:30,104 PERSON, SO THE ADAPTATION IS A 7126 04:37:30,104 --> 04:37:31,639 VIRTUAL PROGRAM. 7127 04:37:31,639 --> 04:37:34,475 WE'VE DEVELOPED A MOBILE HEALTH 7128 04:37:34,475 --> 04:37:36,877 WEB-BASED PLATFORM THAT'S 7129 04:37:36,877 --> 04:37:39,280 AVAILABLE TO OFFER ASYNCHRONOUS 7130 04:37:39,280 --> 04:37:41,148 AND SYNCHRONOUS LEARNING. 7131 04:37:41,148 --> 04:37:43,984 WE EMPLOY AND TRAIN COMMUNITY 7132 04:37:43,984 --> 04:37:45,486 HEALTH WORKERS, OR MATERNAL 7133 04:37:45,486 --> 04:37:47,822 COMMUNITY HEALTH WORKERS, TWO 7134 04:37:47,822 --> 04:37:48,823 SCREEN FOR SOCIAL DETERMINANTS 7135 04:37:48,823 --> 04:37:50,991 OF HEALTH AND OTHER 7136 04:37:50,991 --> 04:37:52,827 HEALTH-RELATED SOCIAL NEEDS. 7137 04:37:52,827 --> 04:37:55,029 AND WE HAVE STRIVED TO ENSURE 7138 04:37:55,029 --> 04:37:59,533 THAT THE PROGRAM IS CULTURALLY 7139 04:37:59,533 --> 04:38:01,068 RESPONSIVE, TAKING INTO DEEP 7140 04:38:01,068 --> 04:38:02,937 CONSIDERATION THE HISTORICAL AND 7141 04:38:02,937 --> 04:38:04,572 SOCIAL CONTEXT OF THE POPULATION 7142 04:38:04,572 --> 04:38:08,309 THAT WE'RE WORKING WITH FOR THE 7143 04:38:08,309 --> 04:38:09,610 PROGRAM, UNDERSTANDING LITERACY 7144 04:38:09,610 --> 04:38:12,046 AND HEALTH LITERACY, AS WELL AS 7145 04:38:12,046 --> 04:38:16,517 LANGUAGE ISSUES AS WELL. 7146 04:38:16,517 --> 04:38:17,518 NEXT SLIDE. 7147 04:38:17,518 --> 04:38:20,254 THESE ARE PRIMARY AND SECONDARY 7148 04:38:20,254 --> 04:38:21,021 AIMS. 7149 04:38:21,021 --> 04:38:22,223 I JUST INCLUDE OUR LOGO HERE 7150 04:38:22,223 --> 04:38:24,058 WHICH IS A LINK TO THE STUDY 7151 04:38:24,058 --> 04:38:26,927 SITE BUT IT IS NOT PUBLICLY 7152 04:38:26,927 --> 04:38:27,361 FACING. 7153 04:38:27,361 --> 04:38:30,831 IT IS FOR STUDY PARTICIPANTS. 7154 04:38:30,831 --> 04:38:33,134 NEXT SLIDE. 7155 04:38:33,134 --> 04:38:34,335 OUR IMPLEMENTATION STRATEGIES 7156 04:38:34,335 --> 04:38:38,606 FOCUS ON TECHNOLOGY THAT WE'VE 7157 04:38:38,606 --> 04:38:40,274 DEVELOPED INCLUDING SCRIPTS FOR 7158 04:38:40,274 --> 04:38:41,475 VIDEOS, CONTENT FROM THE 7159 04:38:41,475 --> 04:38:42,343 ORIGINAL PROGRAM, TEXT MESSAGES 7160 04:38:42,343 --> 04:38:45,312 AS WELL THAT ARE DELIVERED TO 7161 04:38:45,312 --> 04:38:46,947 PARTICIPANTS, AND THEN THE ROLE 7162 04:38:46,947 --> 04:38:51,318 OF OUR COMMUNITY HEALTH WORKER 7163 04:38:51,318 --> 04:38:56,357 THAT WILL PROVIDE LIVE 7164 04:38:56,357 --> 04:38:58,659 COUNSELING SESSIONS VIRTUALLY 7165 04:38:58,659 --> 04:39:01,395 AND THROUGH THE WEB-BASED 7166 04:39:01,395 --> 04:39:03,464 PLATFORM. 7167 04:39:03,464 --> 04:39:03,764 NEXT SLIDE. 7168 04:39:03,764 --> 04:39:06,033 WE HAVE CONVENED A COMMUNITY 7169 04:39:06,033 --> 04:39:07,935 OVERSIGHT GROUP, JUST TO BRIEFLY 7170 04:39:07,935 --> 04:39:09,803 SHARE THE STRUCTURE OF THAT 7171 04:39:09,803 --> 04:39:12,740 GROUP, IT'S CO-CHAIRED BY TWO OF 7172 04:39:12,740 --> 04:39:15,376 OUR COMMUNITY PARTNERS, WE 7173 04:39:15,376 --> 04:39:16,377 PARTICIPATE IN MONTHLY VIRTUAL 7174 04:39:16,377 --> 04:39:18,245 MEETINGS, AND ALL OF OUR 7175 04:39:18,245 --> 04:39:20,447 MEETINGS ARE OPEN TO COMMUNITY 7176 04:39:20,447 --> 04:39:21,515 PARTNERS TO ATTEND. 7177 04:39:21,515 --> 04:39:24,585 SO IT IS NOT UNCOMMON TO FIND 7178 04:39:24,585 --> 04:39:27,988 THAT COMMUNITY PARTNERS ARE 7179 04:39:27,988 --> 04:39:30,024 ATTENDING MEETINGS AROUND THE 7180 04:39:30,024 --> 04:39:34,094 RESEARCH STRATEGY AND 7181 04:39:34,094 --> 04:39:38,132 IMPLEMENTATION, AS WELL AS OUR 7182 04:39:38,132 --> 04:39:39,366 PRINCIPAL AND CO-PRINCIPAL 7183 04:39:39,366 --> 04:39:41,335 INVESTIGATORS ATTEND AS WELL, 7184 04:39:41,335 --> 04:39:43,437 INTEGRATED INTO THE STUDY 7185 04:39:43,437 --> 04:39:43,671 DESIGN. 7186 04:39:43,671 --> 04:39:44,305 NEXT SLIDE. 7187 04:39:44,305 --> 04:39:45,940 AND THEN JUST TO SHARE BRIEFLY 7188 04:39:45,940 --> 04:39:48,142 SOME OF THE FUNCTIONS THAT WE 7189 04:39:48,142 --> 04:39:52,179 THINK ABOUT ALONG THE CONTINUUM 7190 04:39:52,179 --> 04:39:54,582 OF ENGAGEMENT, INCLUDING 7191 04:39:54,582 --> 04:39:55,783 COLLABORATION, INVOLVEMENT, 7192 04:39:55,783 --> 04:39:57,351 CONSULTATION AND OUTREACH, WITH 7193 04:39:57,351 --> 04:39:58,419 OUR PARTNERS, WITH REALLY 7194 04:39:58,419 --> 04:40:04,992 THINKING ABOUT THE GOAL TO HAVE 7195 04:40:04,992 --> 04:40:06,327 RESPECTFUL CULTURALLY RESPONSIVE 7196 04:40:06,327 --> 04:40:12,800 UNDERSTANDING 7197 04:40:12,800 --> 04:40:13,400 UNDERSTANDING COMPASSION, SO 7198 04:40:13,400 --> 04:40:24,078 THERE'S DIVERSE PEP SPEER PERS. 7199 04:40:26,647 --> 04:40:28,215 DAMALIA IS GOING TO SHARE 7200 04:40:28,215 --> 04:40:28,749 EXAMPLES. 7201 04:40:28,749 --> 04:40:32,586 OVER TO YOU. 7202 04:40:32,586 --> 04:40:33,387 >> NEXT SLIDE. 7203 04:40:33,387 --> 04:40:33,721 OKAY. 7204 04:40:33,721 --> 04:40:37,758 SO, THIS IS ONE EXAMPLE OF HOW 7205 04:40:37,758 --> 04:40:38,959 THE COMMUNITY OVERSIGHT GROUP IS 7206 04:40:38,959 --> 04:40:43,230 INVOLVED IN THE PROJECT. 7207 04:40:43,230 --> 04:40:44,732 SO, THIS INVOLVED US LOOKING AT 7208 04:40:44,732 --> 04:40:50,471 VIDEOS THAT WOULD BE PART OF THE 7209 04:40:50,471 --> 04:40:53,874 INTERVENTION, THAT'S HOSTED ON 7210 04:40:53,874 --> 04:40:55,442 THE NYU LH SITE. 7211 04:40:55,442 --> 04:40:58,112 WE GOT A CHANCE TO LOOK AT THIS 7212 04:40:58,112 --> 04:40:59,913 VIDEO BEFORE THEY WERE MADE 7213 04:40:59,913 --> 04:41:00,881 AVAILABLE TO THE PARTICIPANTS. 7214 04:41:00,881 --> 04:41:02,950 THESE WERE SOME OF THE FEEDBACK 7215 04:41:02,950 --> 04:41:06,687 THAT MYSELF AND SOME OF THE 7216 04:41:06,687 --> 04:41:13,127 OTHER COMMUNITY OVERSIGHT GROUP 7217 04:41:13,127 --> 04:41:14,161 PROVIDED. 7218 04:41:14,161 --> 04:41:16,297 SO INCLUSIVE IMAGES, ADD MORE 7219 04:41:16,297 --> 04:41:17,631 PICTURES OF WOMEN BREASTFEEDING, 7220 04:41:17,631 --> 04:41:19,133 THOUGHT IMAGES WERE APPROPRIATE 7221 04:41:19,133 --> 04:41:23,337 FOR TARGET AUDIENCE. 7222 04:41:23,337 --> 04:41:24,538 NEXT SLIDE. 7223 04:41:24,538 --> 04:41:29,543 ONCE THIS FEEDBACK WAS RECEIVED, 7224 04:41:29,543 --> 04:41:31,745 THIS FEEDBACK WAS INCORPORATED 7225 04:41:31,745 --> 04:41:34,381 INTO THE VIDEOS, AND THESE ARE A 7226 04:41:34,381 --> 04:41:37,251 FEW EXAMPLES OF THE INCORPORATED 7227 04:41:37,251 --> 04:41:41,055 FEEDBACK, INCLUSION OF MORE 7228 04:41:41,055 --> 04:41:43,157 ETHNIC FOODS, REALISTIC HEALTH 7229 04:41:43,157 --> 04:41:44,224 FOOD SUBSTITUTIONS BECAUSE NOT 7230 04:41:44,224 --> 04:41:45,426 EVERYBODY HAS ACCESS TO 7231 04:41:45,426 --> 04:41:48,696 VEGETABLES ALL THE TIME. 7232 04:41:48,696 --> 04:41:59,239 INSTEAD OF REPLACING ENTIRE FAST 7233 04:42:00,841 --> 04:42:06,780 FOOD MEAL, FRIES WERE REPLACED 7234 04:42:06,780 --> 04:42:07,514 WITH VEGETABLES. 7235 04:42:07,514 --> 04:42:09,950 THE PARTICIPANTS IN THE GROUP 7236 04:42:09,950 --> 04:42:13,354 NOT ONLY INVOLVED FEEDBACK ON 7237 04:42:13,354 --> 04:42:15,522 INTERVENTION AND RESEARCH STUDY 7238 04:42:15,522 --> 04:42:18,926 BUT PROVIDED WITH MINI GRANTS, 7239 04:42:18,926 --> 04:42:22,429 TWO EXAMPLES OF WHAT THE MEMBERS 7240 04:42:22,429 --> 04:42:24,164 USED THEIR MINI GRANTS FOR. 7241 04:42:24,164 --> 04:42:26,133 FIRST IS A STAFF TEAM BUILDING 7242 04:42:26,133 --> 04:42:28,569 EVENT, THESE ARE STAFF WHO WILL 7243 04:42:28,569 --> 04:42:30,738 AS COMMUNITY HEALTH WORKERS WITH 7244 04:42:30,738 --> 04:42:33,707 MOTHERS AND CHILDREN, THE OTHER 7245 04:42:33,707 --> 04:42:35,976 EXAMPLE WAS ANOTHER PARTNER DID 7246 04:42:35,976 --> 04:42:43,550 A COMMUNITY CAR SEAT SAFETY 7247 04:42:43,550 --> 04:42:43,817 WORKSHOP. 7248 04:42:43,817 --> 04:42:45,953 NEXT SLIDE. 7249 04:42:45,953 --> 04:42:47,721 AND THESE ARE -- THIS IS ANOTHER 7250 04:42:47,721 --> 04:42:50,124 EXAMPLE, SO WE'VE HAD MANY 7251 04:42:50,124 --> 04:42:51,658 OPPORTUNITIES TO SHARE OUR 7252 04:42:51,658 --> 04:42:53,060 STORIES AND OUR EXPERIENCE 7253 04:42:53,060 --> 04:42:55,763 WORKING IN THE COMMUNITY WITH 7254 04:42:55,763 --> 04:42:56,663 THOSE WHO ARE IMPACTED BY THIS 7255 04:42:56,663 --> 04:42:58,499 ISSUE AND ARE PART OF THE 7256 04:42:58,499 --> 04:42:59,266 RESEARCH STUDY. 7257 04:42:59,266 --> 04:43:02,336 SO THESE ARE JUST THREE 7258 04:43:02,336 --> 04:43:06,039 EXAMPLES, THERE WAS A MATERNAL 7259 04:43:06,039 --> 04:43:08,709 HEALTH ROUNDTABLE THAT THE 7260 04:43:08,709 --> 04:43:10,878 MEMBERS HAD, SAY, IN DECIDING 7261 04:43:10,878 --> 04:43:12,746 WHAT WOULD BE THE TOPIC OF THE 7262 04:43:12,746 --> 04:43:13,046 ROUNDTABLE. 7263 04:43:13,046 --> 04:43:15,449 AND HERE YOU SEE ONE OF THE 7264 04:43:15,449 --> 04:43:18,619 MEMBERS SPEAKING TO THE 7265 04:43:18,619 --> 04:43:18,886 ATTENDEES. 7266 04:43:18,886 --> 04:43:21,922 MEMBERS HAVE ALSO BEEN ABLE TO 7267 04:43:21,922 --> 04:43:24,992 DIRECTLY ADDRESS POLICYMAKERS AT 7268 04:43:24,992 --> 04:43:27,628 THE STATE LEVEL. 7269 04:43:27,628 --> 04:43:31,231 AND OUR CO-CHAIR, MISS HELENA 7270 04:43:31,231 --> 04:43:35,502 GRANT, PRESENTED AS A KEYNOTE 7271 04:43:35,502 --> 04:43:36,603 SPEAKER AT THE ANNUAL FORUM. 7272 04:43:36,603 --> 04:43:38,772 THIS IS A PICTURE OF THE LOVELY 7273 04:43:38,772 --> 04:43:40,474 MEMBERS OF THE COMMUNITY 7274 04:43:40,474 --> 04:43:41,842 OVERSIGHT GROUP. 7275 04:43:41,842 --> 04:43:43,944 AS YOU CAN SEE, IT'S 7276 04:43:43,944 --> 04:43:45,446 REPRESENTATIVE OF MANY GROUPS 7277 04:43:45,446 --> 04:43:52,686 WHO WORK WITH MOTHERS AND 7278 04:43:52,686 --> 04:43:54,054 CHILDREN, PROGRAM MANAGERS, 7279 04:43:54,054 --> 04:43:56,824 DOULAS, MOST IMPORTANTLY 7280 04:43:56,824 --> 04:43:57,825 MOTHERS. 7281 04:43:57,825 --> 04:43:58,125 NEXT SLIDE. 7282 04:43:58,125 --> 04:43:59,460 THAT'S IT. 7283 04:43:59,460 --> 04:44:00,027 THANK YOU. 7284 04:44:00,027 --> 04:44:00,394 >> WONDERFUL. 7285 04:44:00,394 --> 04:44:02,863 THANK YOU SO MUCH. 7286 04:44:02,863 --> 04:44:09,736 NOW WE'LL MOVE ON TO DR. GARNER 7287 04:44:09,736 --> 04:44:12,039 AND COMMUNITY PARTNER. 7288 04:44:12,039 --> 04:44:13,040 >> GOOD AFTERNOON. 7289 04:44:13,040 --> 04:44:16,643 I'M THE DIRECTOR OF PUBLIC 7290 04:44:16,643 --> 04:44:19,346 HEALTH FOR PUBLIC HEALTH 7291 04:44:19,346 --> 04:44:21,014 DEPARTMENT IN AMARILLO TEXAS, 7292 04:44:21,014 --> 04:44:25,819 JOINED BY DR. CHRISTINE GARNER, 7293 04:44:25,819 --> 04:44:28,422 PRINCIPAL INVESTIGATOR FOR 7294 04:44:28,422 --> 04:44:31,191 VIBRANT MOMS PROJECT. 7295 04:44:31,191 --> 04:44:31,625 NEXT SLIDE. 7296 04:44:31,625 --> 04:44:34,228 WE DO NOT HAVE ANY CONFLICTS OF 7297 04:44:34,228 --> 04:44:37,297 INTEREST TO DISCLOSE. 7298 04:44:37,297 --> 04:44:38,398 NEXT SLIDE. 7299 04:44:38,398 --> 04:44:41,134 THE TEAM AT VIBRANT MOMS IS 7300 04:44:41,134 --> 04:44:43,003 WORKING HARD TO IDENTIFY 7301 04:44:43,003 --> 04:44:44,838 MATERNAL HEALTH PRIORITIES AND 7302 04:44:44,838 --> 04:44:46,139 ADDRESS DISPARITIES THROUGH 7303 04:44:46,139 --> 04:44:47,441 COMMUNITY ENGAGEMENT IN THE 7304 04:44:47,441 --> 04:44:48,809 TEXAS PANHANDLE. 7305 04:44:48,809 --> 04:44:52,613 WE HAVE A ROBUST AND ENGAGED 7306 04:44:52,613 --> 04:44:53,814 COALITION, SUPPORTING VIBRANT 7307 04:44:53,814 --> 04:44:54,581 MOMS PROJECT. 7308 04:44:54,581 --> 04:44:56,016 THE ACADEMIC LEADS FOR THE 7309 04:44:56,016 --> 04:44:58,752 PROJECT ARE FROM TEXAS TECH 7310 04:44:58,752 --> 04:44:59,520 HEALTH SCIENCES CENTER, 7311 04:44:59,520 --> 04:45:00,687 AMARILLO, TEXAS. 7312 04:45:00,687 --> 04:45:03,323 COMMUNITY LEADS ARE FROM 7313 04:45:03,323 --> 04:45:03,991 AMARILLO PUBLIC HEALTH AND 7314 04:45:03,991 --> 04:45:06,293 WESLEY COMMUNITY CENTER. 7315 04:45:06,293 --> 04:45:09,363 WE HAVE DYNAMIC CHAIRS FROM WIC 7316 04:45:09,363 --> 04:45:11,665 AND CATHOLIC CHARITIES JOSEPHS 7317 04:45:11,665 --> 04:45:11,999 PROJECT. 7318 04:45:11,999 --> 04:45:13,500 WE HAVE SUPPORT AND EXPERTISE 7319 04:45:13,500 --> 04:45:19,306 FROM A WIDE RANGE OF COMMUNITY 7320 04:45:19,306 --> 04:45:19,540 MEMBERS. 7321 04:45:19,540 --> 04:45:20,641 NEXT SLIDE. 7322 04:45:20,641 --> 04:45:24,044 TEXAS HAS HIGH MATERNAL AND 7323 04:45:24,044 --> 04:45:24,912 MORBIDITY RATES. 7324 04:45:24,912 --> 04:45:26,413 90% OF MATERNAL DEATHS WERE 7325 04:45:26,413 --> 04:45:29,483 DEEMED TO HAVE BEEN PREVENTIBLE. 7326 04:45:29,483 --> 04:45:32,753 ACROSS TEXAS, MORE THAN 20% OF 7327 04:45:32,753 --> 04:45:34,421 PREGNANT INDIVIDUALS RECEIVED 7328 04:45:34,421 --> 04:45:36,390 INADEQUATE PREGNANCY RELATED 7329 04:45:36,390 --> 04:45:36,857 CARE. 7330 04:45:36,857 --> 04:45:39,993 PREECLAMPSIA RATES ACROSS THE 7331 04:45:39,993 --> 04:45:41,962 STATE HAVE INCREASED OVER 37% IN 7332 04:45:41,962 --> 04:45:44,698 RECENT YEARS. 7333 04:45:44,698 --> 04:45:47,434 IN TEXAS, 46% OF COUNTIES ARE 7334 04:45:47,434 --> 04:45:48,535 CONSIDERED MATERNITY CARE 7335 04:45:48,535 --> 04:45:49,670 DESERTS. 7336 04:45:49,670 --> 04:45:50,971 AND THESE ARE PARTICULARLY 7337 04:45:50,971 --> 04:45:54,975 CONCENTRATED IN THE TEXAS 7338 04:45:54,975 --> 04:45:55,542 PANHANDLE RENAL. 7339 04:45:55,542 --> 04:45:58,145 THIS IS A MAP OF COUNTIES WHICH 7340 04:45:58,145 --> 04:46:00,247 CARE DESERTS WITH INDICATED IN 7341 04:46:00,247 --> 04:46:02,783 RED, AND COUNTIES WITH LOW 7342 04:46:02,783 --> 04:46:04,618 ACCESS ARE IN ORANGE. 7343 04:46:04,618 --> 04:46:06,820 OF THE SIX COUNTIES REACHED BY 7344 04:46:06,820 --> 04:46:09,256 OUR PROJECT, THREE OF THEM ARE 7345 04:46:09,256 --> 04:46:10,424 CONSIDERED DESERTS. 7346 04:46:10,424 --> 04:46:14,294 AND ONE IS CONSIDERED A LOW 7347 04:46:14,294 --> 04:46:15,495 ACCESS COUNTY. 7348 04:46:15,495 --> 04:46:17,898 AMONG SIX COUNTIES ENGAGED 7349 04:46:17,898 --> 04:46:20,467 BETWEEN 22 AND 42% HAVE RECEIVED 7350 04:46:20,467 --> 04:46:22,636 NO PRENATAL CARE IN THE FIRST 7351 04:46:22,636 --> 04:46:25,339 TRIMESTER OF PREGNANCY. 7352 04:46:25,339 --> 04:46:26,673 AND UP TO 48% ENTER PREGNANCY 7353 04:46:26,673 --> 04:46:32,245 WITH A CHRONIC HEALTH CONDITION. 7354 04:46:32,245 --> 04:46:34,648 FINALLY, THE MATERNAL 7355 04:46:34,648 --> 04:46:37,384 VULNERABILITY SCORE IS HIGH WITH 7356 04:46:37,384 --> 04:46:39,453 AVERAGE MATERNAL VULNERABILITY 7357 04:46:39,453 --> 04:46:42,456 SCORE OF 72%. 7358 04:46:42,456 --> 04:46:43,657 NEXT SLIDE. 7359 04:46:43,657 --> 04:46:45,826 THE TEXAS PANHANDLE IS A 7360 04:46:45,826 --> 04:46:46,827 WONDERFUL PLACE WITH AMAZING 7361 04:46:46,827 --> 04:46:47,494 PEOPLE. 7362 04:46:47,494 --> 04:46:50,097 AS YOU CAN SEE, THE MIX OF URBAN 7363 04:46:50,097 --> 04:46:52,165 AND RURAL IS ABSOLUTELY 7364 04:46:52,165 --> 04:46:53,166 STUNNING. 7365 04:46:53,166 --> 04:46:54,868 WHILE WE HAVE CHALLENGES, 7366 04:46:54,868 --> 04:46:58,839 DISPARITIES, AND INEQUITIES, WE 7367 04:46:58,839 --> 04:46:59,473 ALSO HAVE HARD-WORKING PARTNERS 7368 04:46:59,473 --> 04:47:01,141 WHO COME TO THE TABLE READY TO 7369 04:47:01,141 --> 04:47:02,242 TAKE ON ANY CHALLENGE. 7370 04:47:02,242 --> 04:47:03,877 I'M EXCITED TO HAND THE 7371 04:47:03,877 --> 04:47:05,112 PRESENTATION OVER TO DR. GARNER 7372 04:47:05,112 --> 04:47:11,218 TO TALK MORE ABOUT THE VIBRANT 7373 04:47:11,218 --> 04:47:11,985 MOMS PROJECT. 7374 04:47:11,985 --> 04:47:16,790 >> THANK YOU. 7375 04:47:16,790 --> 04:47:17,891 NEXT SLIDE. 7376 04:47:17,891 --> 04:47:19,960 SO, THE PREVIOUS SPEAKERS WHO 7377 04:47:19,960 --> 04:47:22,162 PRECEDED US ARE CURRENTLY IN 7378 04:47:22,162 --> 04:47:25,098 PHASE 2 PROJECTS, WE'RE STILL IN 7379 04:47:25,098 --> 04:47:28,168 A PHASE 1 PROJECT, WE'RE A YEAR 7380 04:47:28,168 --> 04:47:30,837 INTO A TWO-YEAR PROJECT. 7381 04:47:30,837 --> 04:47:34,374 VIBRANT MOMS IS A 7382 04:47:34,374 --> 04:47:35,609 COMMUNITY-DRIVEP PROJECT THAT 7383 04:47:35,609 --> 04:47:36,977 INVOLVES NEEDS ASSESSMENT AND 7384 04:47:36,977 --> 04:47:38,345 PLANNING FOR PHASE 2 7385 04:47:38,345 --> 04:47:39,246 IMPLEMENTATION TRIAL. 7386 04:47:39,246 --> 04:47:42,049 WE HAVE THREE MAIN OBJECTIVES. 7387 04:47:42,049 --> 04:47:43,583 THOSE ARE TO IDENTIFY COMMUNITY 7388 04:47:43,583 --> 04:47:44,818 PRIORITIES AND MATERNAL HEALTH 7389 04:47:44,818 --> 04:47:47,888 NEEDS IN OUR SIX COUNTIES, TO 7390 04:47:47,888 --> 04:47:49,956 IDENTIFY BARRIERS TO AND 7391 04:47:49,956 --> 04:47:52,592 FACILITATORS FOR IMPLEMENTATION 7392 04:47:52,592 --> 04:47:53,794 OF EVIDENCE-BASED INTERVENTIONS, 7393 04:47:53,794 --> 04:47:54,561 AND, THIRD, DEVELOP 7394 04:47:54,561 --> 04:47:55,996 IMPLEMENTATION STRATEGIES TO 7395 04:47:55,996 --> 04:47:56,430 BRING EVIDENCE-BASED 7396 04:47:56,430 --> 04:47:59,499 INTERVENTIONS TO THE PEOPLE WHO 7397 04:47:59,499 --> 04:48:00,701 NEED THEM. 7398 04:48:00,701 --> 04:48:02,335 OUR OVER ARCHING GOAL IS IMPROVE 7399 04:48:02,335 --> 04:48:12,879 CARE COORDINATION AND ACCESS TO 7400 04:48:13,313 --> 04:48:13,780 ENHANCE PREECLAMPSIA AND 7401 04:48:13,780 --> 04:48:14,981 MITIGATE HEALTH DISPARITIES. 7402 04:48:14,981 --> 04:48:21,922 WE'RE USING CONSOLIDATED 7403 04:48:21,922 --> 04:48:28,995 FRAMEWORK 2.0, USING A MIXED 7404 04:48:28,995 --> 04:48:30,997 METHODS APPROACH, FIVE TIMES OF 7405 04:48:30,997 --> 04:48:31,298 DATA. 7406 04:48:31,298 --> 04:48:34,367 THE SURVEY IS LED BY THE 7407 04:48:34,367 --> 04:48:36,470 AMARILLO PUBLIC HEALTH DISTRICT 7408 04:48:36,470 --> 04:48:39,973 DIRECTED BY CASEY, WHO WE JUST 7409 04:48:39,973 --> 04:48:41,708 HEARD FROM. 7410 04:48:41,708 --> 04:48:43,176 INPATIENT HOSPITAL DATA OBTAINED 7411 04:48:43,176 --> 04:48:45,679 FROM THE STATE, REVIEWS TO 7412 04:48:45,679 --> 04:48:47,347 DETERMINE PREVALENCE OF MATERNAL 7413 04:48:47,347 --> 04:48:50,150 MORBIDITIES IN SIX COUNTIES 7414 04:48:50,150 --> 04:48:51,818 WE'RE REACHING. 7415 04:48:51,818 --> 04:48:55,655 ASSET MAPPING AND FOCUS GROUPS 7416 04:48:55,655 --> 04:49:03,430 BEING CONDUCTED AMONG PREGNANT 7417 04:49:03,430 --> 04:49:06,066 AND POSTPARTUM INDIVIDUALS, AND 7418 04:49:06,066 --> 04:49:09,870 INTERVIEWS AMONG STAKEHOLDERS. 7419 04:49:09,870 --> 04:49:12,038 PARTNERS ASSISTED IN IDENTIFYING 7420 04:49:12,038 --> 04:49:12,939 PARTICIPANTS, RECRUITING AND 7421 04:49:12,939 --> 04:49:14,474 FOCUS GROUPS. 7422 04:49:14,474 --> 04:49:16,777 WE'VE TRAINED A COUPLE COMMUNITY 7423 04:49:16,777 --> 04:49:18,311 MEMBERS WHO HAVE DIRECTLY BEEN 7424 04:49:18,311 --> 04:49:23,450 INVOLVED WITH DATA COLLECTION. 7425 04:49:23,450 --> 04:49:24,651 NEXT SLIDE PLEASE. 7426 04:49:24,651 --> 04:49:26,520 COMMUNITY ENGAGEMENT HAS BEEN 7427 04:49:26,520 --> 04:49:29,022 CENTRAL TO OUR COALITION, AS WE 7428 04:49:29,022 --> 04:49:31,858 DISCUSS AND ENSURE THAT OUR 7429 04:49:31,858 --> 04:49:32,959 COALITION IS MUTUALLY BENEFICIAL 7430 04:49:32,959 --> 04:49:38,999 BETWEEN AND AND COMMUNITY 7431 04:49:38,999 --> 04:49:39,432 PARTNERS. 7432 04:49:39,432 --> 04:49:41,601 FULL COALITION MEETS QUARTERLY 7433 04:49:41,601 --> 04:49:42,836 WHERE THE BIGGEST DECISIONS ARE 7434 04:49:42,836 --> 04:49:44,137 MADE INCLUDING TIMES OF 7435 04:49:44,137 --> 04:49:46,106 QUESTIONS THAT WE INCLUDED IN 7436 04:49:46,106 --> 04:49:49,609 OUR DATA COLLECTION TOOLS, AND 7437 04:49:49,609 --> 04:49:51,578 MOST RECENTLY COALITION DECIDED 7438 04:49:51,578 --> 04:49:53,313 ON THE MATERNAL HEALTH PRIORITY 7439 04:49:53,313 --> 04:49:57,017 OR CONCERN THAT WE'LL FOCUS ON 7440 04:49:57,017 --> 04:49:58,819 FOR PHASE 2, PREECLAMPSIA. 7441 04:49:58,819 --> 04:50:01,221 WE ALSO HAVE MONTHLY MEETINGS 7442 04:50:01,221 --> 04:50:04,624 WITH CORE TEAM WHOM CASEY 7443 04:50:04,624 --> 04:50:06,693 MENTIONED PREVIOUSLY AND WE HAVE 7444 04:50:06,693 --> 04:50:09,563 SOMETHING CASUAL, COFFEE AND 7445 04:50:09,563 --> 04:50:10,897 CONVERSATIONS, VIRTUAL MONTHLY 7446 04:50:10,897 --> 04:50:12,465 MEET-UPS WHERE PEOPLE CAN POP IN 7447 04:50:12,465 --> 04:50:14,701 AND OUT FOR OVER THE COURSE OF A 7448 04:50:14,701 --> 04:50:17,571 COUPLE HOURS, BRING NEEDS TO THE 7449 04:50:17,571 --> 04:50:24,778 TABLE, SUCH AS WE NEED DATA FOR 7450 04:50:24,778 --> 04:50:25,779 GRANT APPLICATIONS, AND 7451 04:50:25,779 --> 04:50:27,514 DISCUSSED DIFFERENT IDEAS. 7452 04:50:27,514 --> 04:50:31,351 WE'VE ASSEMBLED WORKING GROUPS 7453 04:50:31,351 --> 04:50:32,953 ON AS-NEEDED BASES TO DIRECT 7454 04:50:32,953 --> 04:50:35,155 DIFFERENT PIECES OF THE PROJECT 7455 04:50:35,155 --> 04:50:36,056 AND PARTICIPATE IN COMMUNITY 7456 04:50:36,056 --> 04:50:38,792 EVENTS WHERE WE BUILD 7457 04:50:38,792 --> 04:50:40,126 RELATIONSHIPS AND JUST CONNECT 7458 04:50:40,126 --> 04:50:44,631 WITH COMMUNITY MEMBERS. 7459 04:50:44,631 --> 04:50:47,167 NEXT SLIDE PLEASE. 7460 04:50:47,167 --> 04:50:51,738 WE'RE NOW IN THE PLANNING PHASE 7461 04:50:51,738 --> 04:50:56,576 FOR -- TO PRAISE FOR -- TO 7462 04:50:56,576 --> 04:50:59,412 PREPARE FOR PHASE 2, PRESENTING 7463 04:50:59,412 --> 04:51:01,715 DATA AT COALITION MEETINGS 7464 04:51:01,715 --> 04:51:02,716 GUIDING NEXT STEPS. 7465 04:51:02,716 --> 04:51:05,585 WE DETERMINED OUR PRIOR WE'LL BE 7466 04:51:05,585 --> 04:51:12,058 ADDRESSING WILL BE PREECLAMPSI. 7467 04:51:12,058 --> 04:51:13,460 IN NOVEMBER WE'LL IDENTIFY AND 7468 04:51:13,460 --> 04:51:18,265 STRATEGIES FOR SCREENING AND 7469 04:51:18,265 --> 04:51:20,333 INTERVENTION FOR PREECLAMPSIA. 7470 04:51:20,333 --> 04:51:22,202 GIVEN THE SHORTENED TIMELINE WE 7471 04:51:22,202 --> 04:51:24,504 DECIDED TO CREATE AND DISTRIBUTE 7472 04:51:24,504 --> 04:51:25,839 VIDEOS FOR OUR STAKEHOLDERS 7473 04:51:25,839 --> 04:51:28,642 ABOUT OUR PHASE 2 PLAN. 7474 04:51:28,642 --> 04:51:30,277 AND TO SOLICIT FEEDBACK IN THAT 7475 04:51:30,277 --> 04:51:30,443 WAY. 7476 04:51:30,443 --> 04:51:34,481 AND THEN THAT WILL BE LATER 7477 04:51:34,481 --> 04:51:37,450 FOLLOWED UP BY IN-PERSON TOWN 7478 04:51:37,450 --> 04:51:39,185 HALL MEETINGS AND THROUGHOUT OUR 7479 04:51:39,185 --> 04:51:43,256 SIX COUNTIES THAT WE'RE 7480 04:51:43,256 --> 04:51:44,457 REACHING. 7481 04:51:44,457 --> 04:51:45,859 NEXT SLIDE PLEASE. 7482 04:51:45,859 --> 04:51:48,495 LAST BUT NOT LEAST, THESE ARE 7483 04:51:48,495 --> 04:51:49,930 OUR 30 PARTNERING ORGANIZATIONS 7484 04:51:49,930 --> 04:51:51,564 MEMBERS OF OUR COALITION. 7485 04:51:51,564 --> 04:51:53,767 AS YOU CAN SEE OUR PARTNERS 7486 04:51:53,767 --> 04:51:56,269 RANGE FROM ACADEMIC INSTITUTIONS 7487 04:51:56,269 --> 04:51:59,673 AND HEALTHCARE FACILITIES TO DAY 7488 04:51:59,673 --> 04:52:00,540 CARES, LOCAL NON-PROFITS, 7489 04:52:00,540 --> 04:52:03,276 GOVERNMENT AND SOCIAL SERVICE 7490 04:52:03,276 --> 04:52:04,477 ORGANIZATIONS, AND TOGETHER THIS 7491 04:52:04,477 --> 04:52:07,447 GROUP IS DEFINING THE NEXT STEPS 7492 04:52:07,447 --> 04:52:10,951 FOR IMPROVING MATERNAL HEALTH IN 7493 04:52:10,951 --> 04:52:11,484 THE TEXAS PANHANDLE. 7494 04:52:11,484 --> 04:52:12,953 THANK YOU SO MUCH FOR INVITING 7495 04:52:12,953 --> 04:52:21,461 US TO SPEAK WITH YOU ALL TODAY. 7496 04:52:21,461 --> 04:52:31,504 NEXT DR. MENARD AND HER 7497 04:52:31,504 --> 04:52:32,906 COMMUNITY PARTNER. 7498 04:52:32,906 --> 04:52:33,273 >> THANK YOU. 7499 04:52:33,273 --> 04:52:34,607 THANK YOU FOR THE OPPORTUNITY TO 7500 04:52:34,607 --> 04:52:35,608 SHARE OUR WORK. 7501 04:52:35,608 --> 04:52:37,911 I'M THE PRINCIPAL INVESTIGATOR 7502 04:52:37,911 --> 04:52:43,583 FOR THE ACHIEVE STUDY, 7503 04:52:43,583 --> 04:52:45,018 CO-PRESENTING WITH MISS BARNETT, 7504 04:52:45,018 --> 04:52:47,320 COMMUNITY COLLABORATOR AND LEAD 7505 04:52:47,320 --> 04:52:49,189 OF PATIENT ACTION GROUP, NEXT 7506 04:52:49,189 --> 04:52:50,724 SLIDE PLEASE. 7507 04:52:50,724 --> 04:52:52,058 PRESENTING ON A LARGE UNIVERSITY 7508 04:52:52,058 --> 04:52:54,561 OF NORTH CAROLINA ACADEMIC AND 7509 04:52:54,561 --> 04:52:57,097 REGIONAL COMMUNITY PARTNERS, 7510 04:52:57,097 --> 04:52:59,432 SHARED PURPOSE TO REDUCE 7511 04:52:59,432 --> 04:53:08,475 MATERNAL MATERNITY BY ACHIEVING 7512 04:53:08,475 --> 04:53:11,177 AND IMPROVE RECOGNITION 7513 04:53:11,177 --> 04:53:11,678 PREGNANCY HYPERTENSION. 7514 04:53:11,678 --> 04:53:13,847 WE'LL DESCRIBE PRESSING NEED FOR 7515 04:53:13,847 --> 04:53:15,448 IMPROVEMENT IN PREGNANCY RELATED 7516 04:53:15,448 --> 04:53:16,683 HYPERTENSION, TREATMENT, ORIGIN 7517 04:53:16,683 --> 04:53:19,085 OF THE STUDY CONCEPT, AND THEN 7518 04:53:19,085 --> 04:53:19,853 OUR STUDY GOALS. 7519 04:53:19,853 --> 04:53:21,721 FOCUS TODAY IS ON ENGAGEMENT 7520 04:53:21,721 --> 04:53:23,957 PROCESSES WITHIN THE CONTEXT OF 7521 04:53:23,957 --> 04:53:25,325 IMPLEMENTATION SCIENCE STUDY, 7522 04:53:25,325 --> 04:53:26,526 THERE ARE TWO PHASES TO THE 7523 04:53:26,526 --> 04:53:29,162 PROJECT AS YOU'VE SEEN IN 7524 04:53:29,162 --> 04:53:30,030 PREVIOUS PRESENTATIONS. 7525 04:53:30,030 --> 04:53:32,232 PHASE 1 WAS FORMATIVE WORK IN 7526 04:53:32,232 --> 04:53:34,734 OUR COMMUNITY. 7527 04:53:34,734 --> 04:53:36,169 WE APPLIED LESSONS LEARNED TO 7528 04:53:36,169 --> 04:53:42,675 CURRENT PHASE 2 STUDY, COMMUNITY 7529 04:53:42,675 --> 04:53:44,044 ENGAGED TYPE 3 STUDY. 7530 04:53:44,044 --> 04:53:46,780 NEXT SLIDE PLEASE. 7531 04:53:46,780 --> 04:53:49,282 SO LET'S START WITH WHY. 7532 04:53:49,282 --> 04:53:49,849 HYPERTENSION DISORDERS IN 7533 04:53:49,849 --> 04:53:51,451 PREGNANCY ARE A MAJOR 7534 04:53:51,451 --> 04:53:53,219 CONTRIBUTOR TO MATERNAL 7535 04:53:53,219 --> 04:53:58,291 MORBIDITY AND MORTALITY AND 7536 04:53:58,291 --> 04:54:00,026 INCREASE LIFETIME RISK. 7537 04:54:00,026 --> 04:54:06,366 BLACK BIRTHING PEOPLE, RURAL 7538 04:54:06,366 --> 04:54:11,438 AREAS AND LOWER INCOME HAVE 7539 04:54:11,438 --> 04:54:11,938 HIGHER RATES. 7540 04:54:11,938 --> 04:54:13,373 DELIVERING RESPECTFUL QUALITY 7541 04:54:13,373 --> 04:54:18,845 CARE CAN PREVENT HYPERTENSION 7542 04:54:18,845 --> 04:54:19,746 AND RELATED MORBIDITY AND 7543 04:54:19,746 --> 04:54:22,348 PREGNANCY RELATED DEATH. 7544 04:54:22,348 --> 04:54:23,650 NEXT SLIDE. 7545 04:54:23,650 --> 04:54:25,518 AS PART OF A STATEWIDE PUBLIC 7546 04:54:25,518 --> 04:54:26,853 HEALTH INITIATIVE TO ADDRESS 7547 04:54:26,853 --> 04:54:28,488 DISPARITIES IN MATERNAL HEALTH 7548 04:54:28,488 --> 04:54:31,091 IN NORTH CAROLINA, WE ASK 7549 04:54:31,091 --> 04:54:31,758 PROVIDERS IN PERINATAL REGION 4 7550 04:54:31,758 --> 04:54:33,760 WHAT CAN WE DO TO PREVENT 7551 04:54:33,760 --> 04:54:35,361 MATERNAL MORBIDITY AND 7552 04:54:35,361 --> 04:54:35,628 MORTALITY. 7553 04:54:35,628 --> 04:54:36,696 COMMUNITY BASED PROVIDERS WERE 7554 04:54:36,696 --> 04:54:36,930 CLEAR. 7555 04:54:36,930 --> 04:54:40,667 WE NEED TO DO A BETTER JOB 7556 04:54:40,667 --> 04:54:44,037 IDENTIFYING AND RESPONDING TO 7557 04:54:44,037 --> 04:54:47,440 PREGNANCY-RELATED HYPERTENSION. 7558 04:54:47,440 --> 04:54:50,610 NEXT PLEASE. 7559 04:54:50,610 --> 04:54:54,447 THE ALLIANCE OF -- YOU CAN GO TO 7560 04:54:54,447 --> 04:54:56,749 THE NEXT SLIDE PLEASE. 7561 04:54:56,749 --> 04:55:02,522 THE ALLIANCE FOR INNOVATION ON 7562 04:55:02,522 --> 04:55:04,591 MATERNAL HEALTH, WE CALL THAT 7563 04:55:04,591 --> 04:55:06,993 THE HYPERTENSION BUNDLE, AND THE 7564 04:55:06,993 --> 04:55:09,229 AIM PROVIDES HOSPITALS WITH SET 7565 04:55:09,229 --> 04:55:11,698 OF PROCESSES THAT THEY CAN USE 7566 04:55:11,698 --> 04:55:12,999 TO IMPLEMENT EVIDENCE-BASED 7567 04:55:12,999 --> 04:55:14,134 GUIDELINES FOR TIMELY 7568 04:55:14,134 --> 04:55:16,302 RECOGNITION AND RESPONSE TO 7569 04:55:16,302 --> 04:55:18,171 SEVERE HYPERTENSION DURING 7570 04:55:18,171 --> 04:55:18,638 PREGNANCY. 7571 04:55:18,638 --> 04:55:20,473 MULTIPLE STUDIES DEMONSTRATED 7572 04:55:20,473 --> 04:55:21,241 THIS HYPERTENSION BUNDLE'S 7573 04:55:21,241 --> 04:55:23,643 EFFECTIVENESS, IMPROVING TIME TO 7574 04:55:23,643 --> 04:55:25,078 TREATMENT AND REDUCING MATERNAL 7575 04:55:25,078 --> 04:55:30,250 MORBIDITY IN INPATIENT SETTING 7576 04:55:30,250 --> 04:55:34,053 BUT MOST OFTEN PRESENT IN 7577 04:55:34,053 --> 04:55:35,155 OUTPATIENT SETTING. 7578 04:55:35,155 --> 04:55:36,890 WE BIRTHED THIS EVERYDAY TO 7579 04:55:36,890 --> 04:55:38,892 RESPOND TO COMMUNITY ASK AND 7580 04:55:38,892 --> 04:55:40,760 ADDRESSED SEVERE HYPERTENSION BY 7581 04:55:40,760 --> 04:55:43,263 ADAPTING AIM HYPERTENSION BUNDLE 7582 04:55:43,263 --> 04:55:44,564 TO THE OUTPATIENT SETTING. 7583 04:55:44,564 --> 04:55:46,432 NEXT SLIDE PLEASE. 7584 04:55:46,432 --> 04:55:49,102 DURING PHASE 1, WE CONDUCTED 7585 04:55:49,102 --> 04:55:51,437 FORMATIVE ASSESSMENT AND WHILE 7586 04:55:51,437 --> 04:55:53,773 ENGAGING COMMUNITY PROVIDERS IN 7587 04:55:53,773 --> 04:55:55,642 THREE RURAL COMMUNITY HEALTH 7588 04:55:55,642 --> 04:55:56,643 CENTERS ADAPTED HYPERTENSION 7589 04:55:56,643 --> 04:55:58,278 BUNDLE TO THE OUTPATIENT 7590 04:55:58,278 --> 04:55:59,779 SETTING. 7591 04:55:59,779 --> 04:56:02,015 IN PHASE 2 WE'RE FOCUSING ON 7592 04:56:02,015 --> 04:56:03,850 OUTPATIENT CLINICS THAT SERVE 7593 04:56:03,850 --> 04:56:05,385 BLACK IDENTIFYING, RURAL, LOW 7594 04:56:05,385 --> 04:56:06,719 INCOME PEOPLE, WE CHOSE A 7595 04:56:06,719 --> 04:56:08,021 MULTIPLE BASELINE DESIGN WITH 7596 04:56:08,021 --> 04:56:11,090 THREE COHORTS OF UP TO 20 7597 04:56:11,090 --> 04:56:14,127 CLINICS IN OUR PERINATAL REGION. 7598 04:56:14,127 --> 04:56:15,662 COHORT 1 IN ACTIVE 7599 04:56:15,662 --> 04:56:17,430 IMPLEMENTATION PHASE, WE HOPE TO 7600 04:56:17,430 --> 04:56:23,069 DEMONSTRATE IMPACT OF 7601 04:56:23,069 --> 04:56:25,205 MULTI-COMPONENT STRATEGY ON HIGH 7602 04:56:25,205 --> 04:56:26,072 QUALITY IMPLEMENTATION OF 7603 04:56:26,072 --> 04:56:29,576 OUTPATIENT BUNDLE IN SETTINGS 7604 04:56:29,576 --> 04:56:32,645 THAT REACH THOSE AT GREATEST 7605 04:56:32,645 --> 04:56:32,946 RISK. 7606 04:56:32,946 --> 04:56:35,615 A PICTURE OF THE TIMELINE, THE 7607 04:56:35,615 --> 04:56:37,884 GOAL BEING THE BASELINE DATA 7608 04:56:37,884 --> 04:56:40,520 DIRECTION, BUT BEING LIVE 7609 04:56:40,520 --> 04:56:44,357 IMPLEMENTATION, GRAY SUSTAINMENT 7610 04:56:44,357 --> 04:56:44,557 PHASE. 7611 04:56:44,557 --> 04:56:44,991 NEXT SLIDE. 7612 04:56:44,991 --> 04:56:47,527 AT THE CORE IS INTEGRATION OF 7613 04:56:47,527 --> 04:56:49,696 COMMUNITY ENGAGEMENT AND 7614 04:56:49,696 --> 04:56:50,196 IMPLEMENTATION SCIENCE. 7615 04:56:50,196 --> 04:56:56,369 I'LL TURN IT OVER TO KAMARA TO 7616 04:56:56,369 --> 04:56:59,772 DESCRIBE THE APPROACH. 7617 04:56:59,772 --> 04:57:01,074 >> FROM CONCEPTION ACHIEVES WORK 7618 04:57:01,074 --> 04:57:03,276 HAS BEEN COMMUNITY WORK AND 7619 04:57:03,276 --> 04:57:04,611 EQUITY INFORMED, SOON AFTER WE 7620 04:57:04,611 --> 04:57:06,312 LAUNCHED PHASE 2 THE NATIONAL 7621 04:57:06,312 --> 04:57:07,981 ACADEMY OF MEDICINE CAME OUT 7622 04:57:07,981 --> 04:57:10,650 WITH A FRAMEWORK ASSESSING 7623 04:57:10,650 --> 04:57:11,618 MEANINGFUL COMMUNITY ENGAGEMENT, 7624 04:57:11,618 --> 04:57:13,686 CONCEPTUAL MODEL TO ADVANCE 7625 04:57:13,686 --> 04:57:15,355 HEALTH EQUALITY THROUGH 7626 04:57:15,355 --> 04:57:20,393 TRANSFORMED SYSTEMS FOR HEALTH. 7627 04:57:20,393 --> 04:57:23,563 ON THE PETALS REPRESENTING THE 7628 04:57:23,563 --> 04:57:25,531 FRAMEWORK FOUR DOMAINS, 7629 04:57:25,531 --> 04:57:26,866 STRENGTHENED PARTNERSHIPS, 7630 04:57:26,866 --> 04:57:29,002 ALLIANCES, EXPANDED KNOWLEDGE, 7631 04:57:29,002 --> 04:57:33,172 IMPROVED HEALTH, HEALTH CARE 7632 04:57:33,172 --> 04:57:36,909 PROGRAMS WITH THE GOAL OF 7633 04:57:36,909 --> 04:57:38,544 CONTRIBUTING TO THRIVING 7634 04:57:38,544 --> 04:57:38,978 COMMUNITIES. 7635 04:57:38,978 --> 04:57:41,614 TO STRENGTHEN PARTNERSHIPS WE 7636 04:57:41,614 --> 04:57:45,585 BUILT A COALITION, THREE LEVELS, 7637 04:57:45,585 --> 04:57:47,086 PATIENT, CLINIC PROVIDERS AND 7638 04:57:47,086 --> 04:57:48,187 STAFF, THE BROADER COMMUNITY. 7639 04:57:48,187 --> 04:57:51,124 WE USE A RANGE OF STRATEGIES TO 7640 04:57:51,124 --> 04:57:53,660 INVOLVE THEM IN PROVIDING 7641 04:57:53,660 --> 04:57:55,495 GUIDANCE, INSIGHT, FROM EACH 7642 04:57:55,495 --> 04:57:58,097 LEVEL, EARLY ON OUR GOAL WAS TO 7643 04:57:58,097 --> 04:57:59,332 BUILD RELATIONSHIPS, TRUST, 7644 04:57:59,332 --> 04:58:02,068 SENSE OF PARTNERSHIP. 7645 04:58:02,068 --> 04:58:03,202 AS WORK EVOLVED THE COALITION 7646 04:58:03,202 --> 04:58:06,039 TOOK ON A MORE ENGAGED ROLE 7647 04:58:06,039 --> 04:58:08,441 CONTRIBUTING TO CO-CREATION AND 7648 04:58:08,441 --> 04:58:09,208 PROCESSES AND PRODUCTS. 7649 04:58:09,208 --> 04:58:10,643 NEXT SLIDE PLEASE. 7650 04:58:10,643 --> 04:58:21,154 IN TERMS OF THE SECOND PETAL, 7651 04:58:23,489 --> 04:58:24,123 PRIORITIZING LIMITS OF 7652 04:58:24,123 --> 04:58:29,395 COMPONENTS OF THE BUNDLE AND 7653 04:58:29,395 --> 04:58:30,897 TRAILER STRATEGIES TO ADDRESS 7654 04:58:30,897 --> 04:58:31,664 DETERMINANTS. 7655 04:58:31,664 --> 04:58:33,299 FOCUSING ON THREE COMPONENTS, 7656 04:58:33,299 --> 04:58:35,168 TAILORED FOR OUTPATIENT SETTING. 7657 04:58:35,168 --> 04:58:37,470 FIRST PROPER BLOOD PRESSURE 7658 04:58:37,470 --> 04:58:37,837 MEASUREMENT. 7659 04:58:37,837 --> 04:58:39,439 SECOND RECOGNITION OF SEVERE 7660 04:58:39,439 --> 04:58:41,741 HYPERTENSION AND EARLY WARNING 7661 04:58:41,741 --> 04:58:41,941 SIGNS. 7662 04:58:41,941 --> 04:58:43,409 AND THIRD TIMELY EVALUATION, 7663 04:58:43,409 --> 04:58:48,114 TREATMENT, ESCALATION OF CARE 7664 04:58:48,114 --> 04:58:51,451 FOR PATIENTS EXPERIENCING SEVERE 7665 04:58:51,451 --> 04:58:52,051 HYPERTENSION. 7666 04:58:52,051 --> 04:58:54,087 FORMATIVE WORK HIGHLIGHTED 7667 04:58:54,087 --> 04:58:56,122 IMPORTANCE OF RESPECTFUL CARE, 7668 04:58:56,122 --> 04:58:56,756 ENHANCED COMMUNICATION, 7669 04:58:56,756 --> 04:58:59,425 BIDIRECTIONAL COMMUNICATION. 7670 04:58:59,425 --> 04:59:01,327 NEXT SLIDE PLEASE. 7671 04:59:01,327 --> 04:59:02,762 >> A KEY FINDING FROM PHASE 1 TO 7672 04:59:02,762 --> 04:59:07,266 PHASE 2 WAS IMPORTANCE OF 7673 04:59:07,266 --> 04:59:07,500 MOVING 7674 04:59:07,500 --> 04:59:10,670 AT THE SPEED OF TRUST, 7675 04:59:10,670 --> 04:59:12,071 BOLSTERING OUR ENGAGEMENT AS WE 7676 04:59:12,071 --> 04:59:13,973 EXPAND OUR WORK IN PHASE 2 7677 04:59:13,973 --> 04:59:15,908 PROVIDING NEW OPPORTUNITIES, NEW 7678 04:59:15,908 --> 04:59:16,676 CHALLENGES. 7679 04:59:16,676 --> 04:59:18,978 HOW TO EXPAND MEANINGFUL 7680 04:59:18,978 --> 04:59:20,213 ENGAGEMENT ACROSS COUNTIES, 7681 04:59:20,213 --> 04:59:22,715 COMMUNITIES, CLINICS. 7682 04:59:22,715 --> 04:59:23,783 NEXT SLIDE PLEASE. 7683 04:59:23,783 --> 04:59:28,388 >> BASED ON LEARNING FROM PHASE 7684 04:59:28,388 --> 04:59:28,755 PHASE 7685 04:59:28,755 --> 04:59:31,457 1 WE EXPANDED, INTEGRATING TWO 7686 04:59:31,457 --> 04:59:34,727 CATEGORIES THAT ALIGN WITH THE 7687 04:59:34,727 --> 04:59:35,027 COMPENDIUM. 7688 04:59:35,027 --> 04:59:36,829 STRATEGIES TO ENGAGE COMMUNITY 7689 04:59:36,829 --> 04:59:38,564 PARTNERS, COALITION AND PATIENT 7690 04:59:38,564 --> 04:59:39,232 ACTION GROUPS. 7691 04:59:39,232 --> 04:59:42,068 AND SECOND, STRATEGIES TO 7692 04:59:42,068 --> 04:59:43,269 SUPPORT CLINIC-LEVEL INTEGRATION 7693 04:59:43,269 --> 04:59:46,773 OF ADAPTED BUNDLE, BEING 7694 04:59:46,773 --> 04:59:47,774 FACILITATION, TRAINING, 7695 04:59:47,774 --> 04:59:48,408 SIMULATION, AND EDUCATION 7696 04:59:48,408 --> 04:59:48,975 MATERIALS. 7697 04:59:48,975 --> 04:59:51,978 THE GOAL OF THE WORK TO ACHIEVE 7698 04:59:51,978 --> 04:59:55,882 THAT THIRD DOMAIN, PETAL OF 7699 04:59:55,882 --> 04:59:56,983 IMPROVED HEALTH CARE. 7700 04:59:56,983 --> 04:59:57,984 NEXT SLIDE PLEASE. 7701 04:59:57,984 --> 05:00:00,820 >> WE'RE ALSO INSPIRED BY THE 7702 05:00:00,820 --> 05:00:04,724 FOURTH PETAL DOMAIN, THRIVING 7703 05:00:04,724 --> 05:00:12,532 COMMUNITIES, IN PHASE PHASE 2 7704 05:00:12,532 --> 05:00:13,666 EXPANDING COALITION, PRIOR TO 7705 05:00:13,666 --> 05:00:15,635 ACTIVE IMPLEMENTATION IN EACH 7706 05:00:15,635 --> 05:00:16,369 COHORT. 7707 05:00:16,369 --> 05:00:18,271 WE'VE ALSO CREATED WORK GROUPS, 7708 05:00:18,271 --> 05:00:20,873 PATIENT ACTION GROUPS, TO ENSURE 7709 05:00:20,873 --> 05:00:21,974 THE VOICE AND PERSPECTIVE OF 7710 05:00:21,974 --> 05:00:24,076 PEOPLE WITH LIVED EXPERIENCE ARE 7711 05:00:24,076 --> 05:00:25,244 FULLY INVOLVED. 7712 05:00:25,244 --> 05:00:27,013 I LEADED PEG FOR BLACK 7713 05:00:27,013 --> 05:00:28,548 IDENTIFYING BIRTHING PERSONS. 7714 05:00:28,548 --> 05:00:33,453 WE HAVE ALSO LINKED EFFORTS WITH 7715 05:00:33,453 --> 05:00:34,587 SPANISH SPEAKING GROUPS WHICH 7716 05:00:34,587 --> 05:00:40,359 SERVE AS A PEG, PROVIDING 7717 05:00:40,359 --> 05:00:43,196 INSIGHT AND PERSPECTIVE FROM 9 7718 05:00:43,196 --> 05:00:44,730 LATINO AND HISPANIC POPULATIONS. 7719 05:00:44,730 --> 05:00:46,265 WE HAVE IDENTIFIED PATHWAYS TO 7720 05:00:46,265 --> 05:00:48,034 BRING PATIENT AND COMMUNITY 7721 05:00:48,034 --> 05:00:49,235 CENTERED PERSPECTIVES AND 7722 05:00:49,235 --> 05:00:50,770 APPROACHES TO CLINIC PHASE TO 7723 05:00:50,770 --> 05:00:52,738 CHANGE HOW THINGS ARE DONE, BOTH 7724 05:00:52,738 --> 05:00:55,908 PEGS ARE CENTRALLY INVOLVED IN 7725 05:00:55,908 --> 05:00:58,077 TRANSLATING FINDINGS INTO USEFUL 7726 05:00:58,077 --> 05:00:58,845 EDUCATIONAL MATERIALS, TO 7727 05:00:58,845 --> 05:01:03,149 PROVIDE CLINICAL PRACTICE. 7728 05:01:03,149 --> 05:01:04,584 NEXT SLIDE PLEASE. 7729 05:01:04,584 --> 05:01:06,552 AS ONE EXAMPLE WE CREATED A 7730 05:01:06,552 --> 05:01:07,987 VIDEO INCORPORATING THE KEY 7731 05:01:07,987 --> 05:01:11,491 MESSAGES WE GAINED FROM PATIENT 7732 05:01:11,491 --> 05:01:12,258 PARTNERS ABOUT WHAT RESPECTFUL 7733 05:01:12,258 --> 05:01:14,427 CARE MEANS AND HOW PROVIDERS AND 7734 05:01:14,427 --> 05:01:16,062 STAFFER CAN COMMUNICATE TO MEET 7735 05:01:16,062 --> 05:01:16,395 PATIENT NEEDS. 7736 05:01:16,395 --> 05:01:18,698 THIS VIDEO IS USED IN TRAINING 7737 05:01:18,698 --> 05:01:20,800 AND COACHING TO UNDERLINE THE 7738 05:01:20,800 --> 05:01:22,768 KEY ELEMENTS OF RESPECTFUL CARE. 7739 05:01:22,768 --> 05:01:24,670 WITH THE HELP OF WONDERFUL 7740 05:01:24,670 --> 05:01:26,806 PARTNERS WE'RE TO HAVE A GREAT 7741 05:01:26,806 --> 05:01:29,208 START AND LOOK FORWARD TO 7742 05:01:29,208 --> 05:01:32,378 SHARING RESULTS IN THE FUTURE 7743 05:01:32,378 --> 05:01:33,412 AND HOPE THIS MULTI-COMPONENT 7744 05:01:33,412 --> 05:01:36,549 STRATEGY WILL PROVE TO BE A 7745 05:01:36,549 --> 05:01:38,284 WIDELY REPLICABLE IN SETTINGS 7746 05:01:38,284 --> 05:01:42,221 THAT REACH THOSE AT GREATEST 7747 05:01:42,221 --> 05:01:43,089 RISK FOR HYPERTENSION-RELATED 7748 05:01:43,089 --> 05:01:45,391 MATERNAL MORBIDITY AND 7749 05:01:45,391 --> 05:01:45,725 MORTALITY. 7750 05:01:45,725 --> 05:01:46,826 THANK YOU ALL. 7751 05:01:46,826 --> 05:01:47,293 >> WONDERFUL. 7752 05:01:47,293 --> 05:01:50,663 THANK YOU. 7753 05:01:50,663 --> 05:01:52,798 AS WE COME UPON THE LAST 7754 05:01:52,798 --> 05:01:53,766 PANELIST PREPARE TO PUT YOUR 7755 05:01:53,766 --> 05:01:57,803 QUESTIONS IN THE CHAT. 7756 05:01:57,803 --> 05:02:00,239 50EU8 7757 05:02:00,239 --> 05:02:05,144 50EU8 I WILL TURN IT OVER TO 7758 05:02:05,144 --> 05:02:08,214 KIRSTEN DORANS AND HER PARTNER. 7759 05:02:08,214 --> 05:02:09,849 >> I'M HAVING RESIDUAL INTERNET 7760 05:02:09,849 --> 05:02:11,517 PROBLEMS, SO I'M JOINING BY 7761 05:02:11,517 --> 05:02:11,717 PHONE. 7762 05:02:11,717 --> 05:02:14,120 LET ME KNOW IF YOU HAVE TROUBLE 7763 05:02:14,120 --> 05:02:14,987 HEARING ME. 7764 05:02:14,987 --> 05:02:18,591 SO, THANK YOU FOR THIS 7765 05:02:18,591 --> 05:02:18,891 OPPORTUNITY. 7766 05:02:18,891 --> 05:02:21,661 I'M AN ASSISTANT PROFESSOR IN 7767 05:02:21,661 --> 05:02:25,831 EPIDEMIOLOGY AT TULANE, 7768 05:02:25,831 --> 05:02:29,101 CO-LEADING THIS PROJECT ALONG 7769 05:02:29,101 --> 05:02:33,940 WITH WITH DR. JIANG HE AND MARY 7770 05:02:33,940 --> 05:02:35,708 SCHULTHEI, FROM CRESCENT CITY 7771 05:02:35,708 --> 05:02:37,009 FAMILY SERVICES WHICH PROVIDES 7772 05:02:37,009 --> 05:02:39,845 WIC AND RELATED SERVICES TO MOMS 7773 05:02:39,845 --> 05:02:41,714 AND FAMILIES IN GRETNA, 7774 05:02:41,714 --> 05:02:46,519 LOUISIANA, AND NEW ORLEANS AREA. 7775 05:02:46,519 --> 05:02:49,255 NEXT SLIDE PLEASE. 7776 05:02:49,255 --> 05:02:51,891 WE HAVE NO DISCLOSURES, NO 7777 05:02:51,891 --> 05:02:54,093 CONFLICTS INTEREST TO DISCLOSE. 7778 05:02:54,093 --> 05:02:55,962 NEXT SLIDE PLEASE. 7779 05:02:55,962 --> 05:03:01,100 SO WITHIN THE PROJECT WE'RE 7780 05:03:01,100 --> 05:03:03,069 FOCUSING ON DIABETES PREVENTION 7781 05:03:03,069 --> 05:03:06,072 IN WIC CLINICS. 7782 05:03:06,072 --> 05:03:07,239 THE DPP IS A YEAR-LONG PROGRAM 7783 05:03:07,239 --> 05:03:13,479 WHICH FOLKS USES US -- FOCUSESN 7784 05:03:13,479 --> 05:03:15,481 HEALTHY EATING, PHYSICAL 7785 05:03:15,481 --> 05:03:17,350 ACTIVITY, WEIGHT LOSS, SHOWN TO 7786 05:03:17,350 --> 05:03:19,952 REDUCE RISK OF DEVELOPING TYPE 2 7787 05:03:19,952 --> 05:03:22,388 DIABETES AMONG THOSE AT HIGH 7788 05:03:22,388 --> 05:03:22,688 RISK. 7789 05:03:22,688 --> 05:03:24,023 WITHIN THIS PARTICULAR PROJECT 7790 05:03:24,023 --> 05:03:26,659 WE FORMED A COMMUNITY ACADEMIC 7791 05:03:26,659 --> 05:03:28,628 PARTNERSHIP, TESTING DIFFERENT 7792 05:03:28,628 --> 05:03:30,162 STRATEGIES FOR IMPLEMENTING DPP 7793 05:03:30,162 --> 05:03:33,099 IN WIC IN LOUISIANA FOR 7794 05:03:33,099 --> 05:03:34,967 POSTPARTUM WOMEN AT HIGHER RISK 7795 05:03:34,967 --> 05:03:36,268 OF DEVELOPING TYPE 2 DIABETES IN 7796 05:03:36,268 --> 05:03:37,036 THE FUTURE. 7797 05:03:37,036 --> 05:03:39,071 THOSE WITH A HISTORY OF 7798 05:03:39,071 --> 05:03:42,074 GESTATIONAL DIABETES OR A BODY 7799 05:03:42,074 --> 05:03:47,880 MASS INDEX GREATER THAN 30. 7800 05:03:47,880 --> 05:03:50,383 NEXT SLIDE PLEASE. 7801 05:03:50,383 --> 05:03:52,585 SO WITHIN THIS PROJECT WE'VE 7802 05:03:52,585 --> 05:03:54,620 FORMED A STRONG PARTNERSHIP 7803 05:03:54,620 --> 05:03:57,189 BETWEEN LOUISIANA WIC AT THE 7804 05:03:57,189 --> 05:03:58,491 STATE, REGIONAL, CLINIC LEVEL, 7805 05:03:58,491 --> 05:04:00,459 WITH TULANE AND OTHER ACADEMIC 7806 05:04:00,459 --> 05:04:00,826 PARTNERS. 7807 05:04:00,826 --> 05:04:03,396 MARY WILL TOUCH MORE ON THIS IN 7808 05:04:03,396 --> 05:04:05,131 A FEW SLIDES. 7809 05:04:05,131 --> 05:04:06,999 BUT WE SPECIFICALLY DECIDED TO 7810 05:04:06,999 --> 05:04:09,201 FOCUS ON WIC BECAUSE THE 7811 05:04:09,201 --> 05:04:10,703 DIABETES PREVENTION PROGRAM 7812 05:04:10,703 --> 05:04:12,571 GENERALLY HAS LOW UPTAKE IN MOMS 7813 05:04:12,571 --> 05:04:14,206 DURING THE POSTPARTUM PERIOD. 7814 05:04:14,206 --> 05:04:19,378 IT'S A CHALLENGING TIME PERIOD. 7815 05:04:19,378 --> 05:04:24,483 BUT THE WIC HAS A HIGH REACH, 7816 05:04:24,483 --> 05:04:27,253 REACHES NEARLY 7 MILLION PEOPLE, 7817 05:04:27,253 --> 05:04:28,988 40% OF INFANTS ACROSS 12,000 7818 05:04:28,988 --> 05:04:30,189 COMMUNITIES, EMBEDDED WITHIN 7819 05:04:30,189 --> 05:04:32,058 COMMUNITIES FOR MORE THAN 50 7820 05:04:32,058 --> 05:04:34,026 YEARS, SO THAT LONGSTANDING 7821 05:04:34,026 --> 05:04:35,094 INTEGRATION WITHIN COMMUNITIES 7822 05:04:35,094 --> 05:04:37,630 HAS LED TO A LOT OF TRUST. 7823 05:04:37,630 --> 05:04:41,367 AND SO THIS IS REALLY INTEGRAL 7824 05:04:41,367 --> 05:04:42,768 AND CRITICAL FOR 7825 05:04:42,768 --> 05:04:43,436 COMMUNITY-ENGAGED IMPLEMENTATION 7826 05:04:43,436 --> 05:04:43,869 RESEARCH. 7827 05:04:43,869 --> 05:04:46,505 SO WE DECIDED TO FOCUS ON WIC TO 7828 05:04:46,505 --> 05:04:49,909 MEET MOMS WHERE THEY ARE ALREADY 7829 05:04:49,909 --> 05:04:53,345 RECEIVING NUTRITIONAL-RELATED 7830 05:04:53,345 --> 05:04:53,612 SERVICES. 7831 05:04:53,612 --> 05:05:00,219 IT'S EFFECTIVE, ACCESSIBLE, 7832 05:05:00,219 --> 05:05:00,820 FEASIBLE. 7833 05:05:00,820 --> 05:05:01,854 DELIVERY COULD BE SUSTAINABLE 7834 05:05:01,854 --> 05:05:02,321 AND SCALABLE. 7835 05:05:02,321 --> 05:05:04,290 NEXT SLIDE PLEASE. 7836 05:05:04,290 --> 05:05:05,925 SO, AS THE EARLIER PRESENTATION 7837 05:05:05,925 --> 05:05:08,527 ALSO IN THIS PANEL, WE ALSO HAVE 7838 05:05:08,527 --> 05:05:10,529 A TWO-PHASE PROJECT. 7839 05:05:10,529 --> 05:05:13,466 OUR FIRST PHASE WE SPENT A YEAR 7840 05:05:13,466 --> 05:05:14,867 DOING FORMATIVE WORK, 7841 05:05:14,867 --> 05:05:17,937 IDENTIFYING INTERESTS IN THE DPP 7842 05:05:17,937 --> 05:05:19,572 PROGRAM WITHIN WIC, BARRIERS AND 7843 05:05:19,572 --> 05:05:20,406 FACILITATORS TO IMPLEMENTATION 7844 05:05:20,406 --> 05:05:21,307 WITHIN WIC. 7845 05:05:21,307 --> 05:05:24,176 IN ORDER TO DO THIS WE USED THE 7846 05:05:24,176 --> 05:05:26,145 EPIS FRAMEWORK AS OUR FOURTH 7847 05:05:26,145 --> 05:05:28,647 DOWN DAYS, WE BUILT OFF THE 7848 05:05:28,647 --> 05:05:29,482 COMMUNITY PARTNERSHIPS, WHICH 7849 05:05:29,482 --> 05:05:32,818 WAS LED BY MARY. 7850 05:05:32,818 --> 05:05:35,988 WORKING DOING FOCUS GROUPS AND 7851 05:05:35,988 --> 05:05:39,425 INTERVIEWS WITH MOMS, WIC STAFF, 7852 05:05:39,425 --> 05:05:44,530 AND OTHER KEY COMMUNITY PARTNERS 7853 05:05:44,530 --> 05:05:45,831 IN RELATED AREAS. 7854 05:05:45,831 --> 05:05:47,199 ONE MAJOR BARRIER WAS COMING IN 7855 05:05:47,199 --> 05:05:50,202 PERSON TO AS MANY SESSIONS AS IS 7856 05:05:50,202 --> 05:05:51,837 TYPICALLY REQUIRED WITHIN THE 7857 05:05:51,837 --> 05:05:54,273 DPP. 7858 05:05:54,273 --> 05:05:55,808 SO WE'RE NOW TESTING, NEXT SLIDE 7859 05:05:55,808 --> 05:05:59,512 PLEASE, IN PHASE 2, TWO 7860 05:05:59,512 --> 05:06:00,312 DIFFERENT STRATEGIES FOR 7861 05:06:00,312 --> 05:06:02,248 IMPLEMENTING DPP. 7862 05:06:02,248 --> 05:06:05,351 FIRST IS AN IN-PERSON STANDARD, 7863 05:06:05,351 --> 05:06:06,852 DPP, 24 SESSION WHERE IS MOMS 7864 05:06:06,852 --> 05:06:08,721 COME AND MEET WITH HEALTH COACH 7865 05:06:08,721 --> 05:06:11,590 IN PERCH AT A WIC CLINIC FOR 24 7866 05:06:11,590 --> 05:06:15,728 SESSIONS OVER A ONE-YEAR PERIOD. 7867 05:06:15,728 --> 05:06:18,264 OUR COMPARISON IS A STRATEGY IN 7868 05:06:18,264 --> 05:06:21,801 WHICH THE MOMS ARE COMING IN FOR 7869 05:06:21,801 --> 05:06:22,635 IN-PERSON GROUP SESSIONS 12 7870 05:06:22,635 --> 05:06:27,673 TIMES IN THE YEAR BUT THEN ALSO 7871 05:06:27,673 --> 05:06:29,041 RECEIVING SUPPLEMENTAL 7872 05:06:29,041 --> 05:06:31,610 ASYNCHRONOUS SUPPORT, RECEIVING 7873 05:06:31,610 --> 05:06:32,077 SESSION MATERIAL, 7874 05:06:32,077 --> 05:06:32,778 ASYNCHRONOUSLY, CHATTING WITH 7875 05:06:32,778 --> 05:06:34,580 OTHER MOMS IN THE GROUP AND 7876 05:06:34,580 --> 05:06:36,649 THEIR COACHES, AND ALSO BEING 7877 05:06:36,649 --> 05:06:39,718 ABLE TO RECEIVE FEEDBACK ON 7878 05:06:39,718 --> 05:06:41,253 PROGRESS FROM COACHES REMOTELY 7879 05:06:41,253 --> 05:06:43,656 AS WELL. 7880 05:06:43,656 --> 05:06:44,657 WE HAVE HYPOTHESIZED THIS 7881 05:06:44,657 --> 05:06:46,425 STRATEGY MIGHT BE MORE FEASIBLE 7882 05:06:46,425 --> 05:06:50,563 FOR BOTH MOMS AND CLINICS, MAYBE 7883 05:06:50,563 --> 05:06:52,765 MORE SUSTAINABLE AND MORE 7884 05:06:52,765 --> 05:06:54,934 ACCESSIBLE, WON'T BE WORSE FOR 7885 05:06:54,934 --> 05:06:55,801 MORE HEALTH-RELATED OR 7886 05:06:55,801 --> 05:06:58,971 CLINICALLY RELATED OUTCOMES SUH 7887 05:06:58,971 --> 05:06:59,972 AS WEIGHT LOSS. 7888 05:06:59,972 --> 05:07:01,574 NOW OVER TO MISS MARY. 7889 05:07:01,574 --> 05:07:02,241 THANK YOU. 7890 05:07:02,241 --> 05:07:03,909 NEXT SLIDE PLEASE. 7891 05:07:03,909 --> 05:07:06,212 >> GOOD EVENING, EVERYONE. 7892 05:07:06,212 --> 05:07:06,879 THANK YOU. 7893 05:07:06,879 --> 05:07:09,415 I'M SO HONORED TO BE ON THIS 7894 05:07:09,415 --> 05:07:12,117 CALL TODAY NOT ONLY AS A 7895 05:07:12,117 --> 05:07:13,452 COMMUNITY PARTNER BUT ALSO AS 7896 05:07:13,452 --> 05:07:15,187 BEING GIVEN THE OPPORTUNITY TO 7897 05:07:15,187 --> 05:07:18,390 BE A CO-P.I., SO DR. DORANS, I 7898 05:07:18,390 --> 05:07:19,925 THANK YOU FOR THIS OPPORTUNITY. 7899 05:07:19,925 --> 05:07:23,329 ON THIS SLIDE I THINK THE 7900 05:07:23,329 --> 05:07:24,597 BEAUTIFUL THING ABOUT THIS 7901 05:07:24,597 --> 05:07:28,334 PARTNERSHIP, I'LL USE THE WORD 7902 05:07:28,334 --> 05:07:29,768 PARTNERSHIP, THE COMMUNITY 7903 05:07:29,768 --> 05:07:31,203 ENGAGEMENT ECHOED OVER TODAY AND 7904 05:07:31,203 --> 05:07:31,971 TODAY IN EVERYONE'S 7905 05:07:31,971 --> 05:07:32,371 PRESENTATION. 7906 05:07:32,371 --> 05:07:40,179 I WANT TO GIVE A SHOUT OUT TO 7907 05:07:40,179 --> 05:07:41,480 DR. CREAR-PERRY, STARTING POST 7908 05:07:41,480 --> 05:07:42,882 KATRINA, I'M GRATEFUL FOR THAT. 7909 05:07:42,882 --> 05:07:46,619 IN THIS PICTURE IT WAS THAT LONG 7910 05:07:46,619 --> 05:07:48,921 LASTING RELATIONSHIP THAT WAS 7911 05:07:48,921 --> 05:07:50,356 ALREADY TRUSTED IN PLACE WITH 7912 05:07:50,356 --> 05:07:52,758 STATE LOUISIANA AS A WIC SERVICE 7913 05:07:52,758 --> 05:07:55,094 PROVIDER, I HAD THAT 7914 05:07:55,094 --> 05:07:58,130 RELATIONSHIP, SO IT WAS SO GOOD 7915 05:07:58,130 --> 05:07:59,999 WHEN DR. DARANS CAME IN EARLY OF 7916 05:07:59,999 --> 05:08:00,966 THE APPLICATION BEING PUT 7917 05:08:00,966 --> 05:08:03,469 TOGETHER FOR THIS GRANT SHE 7918 05:08:03,469 --> 05:08:06,438 ENGAGED US AND WIC WAS AT THE 7919 05:08:06,438 --> 05:08:08,941 TABLE IN THE BEGINNING. 7920 05:08:08,941 --> 05:08:10,576 WE HAVE JENNIFER NICKLAS, THE 7921 05:08:10,576 --> 05:08:14,413 DIRECTOR OF OUR WIC SERVICE, AND 7922 05:08:14,413 --> 05:08:15,447 JENNIFER IS REPRESENTING 7923 05:08:15,447 --> 05:08:17,149 LOUISIANA WELL, SHE'S AT A 7924 05:08:17,149 --> 05:08:24,290 NATIONAL LEVEL, SHE'S ACTUALLY 7925 05:08:24,290 --> 05:08:26,025 THE PRESIDENT-ELECT FOR NATIONAL 7926 05:08:26,025 --> 05:08:28,527 WIC, SHE'S ABLE TO LIFT OUR 7927 05:08:28,527 --> 05:08:33,799 VOICES AT A HIGHER LEVEL. 7928 05:08:33,799 --> 05:08:36,068 LEASELY LEWIS AND CELIA 7929 05:08:36,068 --> 05:08:38,470 BRIDGEFORTH, GREAT HAVING THIS 7930 05:08:38,470 --> 05:08:39,038 TRUSTED RELATIONSHIP ALREADY 7931 05:08:39,038 --> 05:08:41,340 BUILT AND BEING ABLE TO MOVE 7932 05:08:41,340 --> 05:08:42,641 FORWARD, OUR INITIATIVE WITH 7933 05:08:42,641 --> 05:08:43,642 COMMUNITY ACTION NETWORK THAT 7934 05:08:43,642 --> 05:08:45,644 WAS ALREADY IN PLACE, ALREADY 7935 05:08:45,644 --> 05:08:47,246 HAD STAKEHOLDERS AT THE TABLE, 7936 05:08:47,246 --> 05:08:49,214 ALL WE HAD TO DO WAS BRING OUR 7937 05:08:49,214 --> 05:08:52,384 ACADEMIC PARTNER IN AND BRIDGE 7938 05:08:52,384 --> 05:08:55,020 THE GAP. 7939 05:08:55,020 --> 05:08:55,821 NEXT SLIDE PLEASE. 7940 05:08:55,821 --> 05:08:59,191 YOU CAN SEE A LIST OF ALL 7941 05:08:59,191 --> 05:08:59,525 STAKEHOLDERS. 7942 05:08:59,525 --> 05:09:03,128 YOU CAN SEE FAITH BASED, WIC 7943 05:09:03,128 --> 05:09:05,097 SERVICE HEALTH DEPARTMENTS, 7944 05:09:05,097 --> 05:09:05,864 FQHCs, INSURANCE PROVIDERS, 7945 05:09:05,864 --> 05:09:08,500 NON-PROFITS, WE HAVE A LARGE 7946 05:09:08,500 --> 05:09:11,070 GROUP OF COMMUNITY ADVISORY 7947 05:09:11,070 --> 05:09:14,740 COMMITTEE MEMBERS, THIS IS 7948 05:09:14,740 --> 05:09:15,074 GREAT. 7949 05:09:15,074 --> 05:09:16,275 NEXT SLIDE PLEASE. 7950 05:09:16,275 --> 05:09:19,578 AND ONE THING THAT HAS BEEN 7951 05:09:19,578 --> 05:09:20,779 GREAT, STUDY STEERING COMMITTEE, 7952 05:09:20,779 --> 05:09:23,182 YOU CAN SEE WE DO REPRESENT THE 7953 05:09:23,182 --> 05:09:24,383 LOCAL, THE STATE, THE NATIONAL 7954 05:09:24,383 --> 05:09:24,950 LEVEL. 7955 05:09:24,950 --> 05:09:27,319 BEING ABLE TO HAVE ALL OF OUR 7956 05:09:27,319 --> 05:09:28,787 WIC SERVICE PROVIDERS, STATE 7957 05:09:28,787 --> 05:09:29,989 REPRESENTATION, AND THEN BEING 7958 05:09:29,989 --> 05:09:32,925 ABLE TO TAKE OUR INITIATIVE AND 7959 05:09:32,925 --> 05:09:34,360 DO SOME NATIONAL CONFERENCES, BE 7960 05:09:34,360 --> 05:09:37,296 ABLE TO PRESENT AT NATIONAL WIC 7961 05:09:37,296 --> 05:09:37,896 ASSOCIATION CONFERENCE, BEING 7962 05:09:37,896 --> 05:09:39,932 ABLE TO SEE THAT GREAT 7963 05:09:39,932 --> 05:09:41,133 ENGAGEMENT AT ALL LEVELS HAS 7964 05:09:41,133 --> 05:09:43,435 BEEN REALLY GOOD. 7965 05:09:43,435 --> 05:09:44,203 HAVING QUARTERLY MEETINGS, MEET 7966 05:09:44,203 --> 05:09:49,008 THANKSGIVING 7967 05:09:49,008 --> 05:09:57,983 -- MEETINGS THAT ARE 7968 05:09:57,983 --> 05:10:00,719 REGULAR. 7969 05:10:00,719 --> 05:10:04,456 I GIVE CREDIT TO THE COALITION, 7970 05:10:04,456 --> 05:10:05,758 AMAZING GROUPS PUT TOGETHER, 7971 05:10:05,758 --> 05:10:07,426 HIGHLIGHTING THE MOMS ADVISORY 7972 05:10:07,426 --> 05:10:09,795 GROUP WHICH WAS LED BY COURTNEY 7973 05:10:09,795 --> 05:10:14,266 MARTIN, WHO DID AN AMAZING JOB 7974 05:10:14,266 --> 05:10:15,801 LEADING THE GROUP. 7975 05:10:15,801 --> 05:10:17,136 THE WOMEN SHARED BARRIERS, 7976 05:10:17,136 --> 05:10:20,105 ANYTHING TO MOVE IT FORWARD. 7977 05:10:20,105 --> 05:10:20,973 THEY PRESENTED GREAT 7978 05:10:20,973 --> 05:10:22,174 INFORMATION, EVEN DESIGNED A 7979 05:10:22,174 --> 05:10:23,909 LOGO FOR THE PROJECT SO HAVING 7980 05:10:23,909 --> 05:10:26,211 THE VOICES OF OUR MOMS LIFTED 7981 05:10:26,211 --> 05:10:28,180 HAS BEEN AN AMAZING OPPORTUNITY 7982 05:10:28,180 --> 05:10:30,149 AND THEN EXPANDING OUR COALITION 7983 05:10:30,149 --> 05:10:31,683 AND ADVISORY GROUP LATER ON 7984 05:10:31,683 --> 05:10:33,886 BRING IN MORE MEMBERS AT ALL 7985 05:10:33,886 --> 05:10:34,420 LEVELS. 7986 05:10:34,420 --> 05:10:39,825 THAT'S BEEN GREAT. 7987 05:10:39,825 --> 05:10:42,127 NEXT SLIDE. 7988 05:10:42,127 --> 05:10:42,761 EXPANDING THE PARTNERSHIP HAS 7989 05:10:42,761 --> 05:10:44,830 BEEN GREAT. 7990 05:10:44,830 --> 05:10:45,931 WE'RE IN REGIONS 1-6, ALSO 7991 05:10:45,931 --> 05:10:48,067 REGION 9. 7992 05:10:48,067 --> 05:10:51,170 AS WE WENT OUT TO MEET SERVICE 7993 05:10:51,170 --> 05:10:52,371 PROVIDERS EVERYONE KNOWS WIC HAS 7994 05:10:52,371 --> 05:10:54,573 BEEN AROUND FOR OVER 50 YEARS. 7995 05:10:54,573 --> 05:10:59,278 WE HAD A CHANCE TO JUST MAKEUP 7996 05:10:59,278 --> 05:11:01,580 LIFTING -- UPLIFT THE WIC STAFF, 7997 05:11:01,580 --> 05:11:04,950 WHETHER IN WIC ONE DAY, THE 7998 05:11:04,950 --> 05:11:06,385 LONGEST EMPLOYEE WAS THERE FOR 7999 05:11:06,385 --> 05:11:09,822 49 YEARS DOING THIS GREAT WORK. 8000 05:11:09,822 --> 05:11:12,458 WE NEED TO GET OUT, GO TO THE 8001 05:11:12,458 --> 05:11:16,595 CLINIC, MEET THEM IN PERSON 8002 05:11:16,595 --> 05:11:18,030 APPRECIATE THEM. 8003 05:11:18,030 --> 05:11:19,898 WE'VE BEEN ABLE TO IDENTIFY IN 8004 05:11:19,898 --> 05:11:21,300 THE REGION OTHER CLINICS THAT 8005 05:11:21,300 --> 05:11:22,534 WANT TO PARTICIPATE. 8006 05:11:22,534 --> 05:11:26,138 SO THAT'S BEEN REALLY GOOD. 8007 05:11:26,138 --> 05:11:26,905 NEXT SLIDE. 8008 05:11:26,905 --> 05:11:30,843 I WANT TO GIVE A LOT OF 8009 05:11:30,843 --> 05:11:31,844 ACKNOWLEDGMENTS TO LOUISIANA WIC 8010 05:11:31,844 --> 05:11:33,479 AT THE STATE LEVEL. 8011 05:11:33,479 --> 05:11:36,215 IT'S BEEN AMAZING, AT THE 8012 05:11:36,215 --> 05:11:37,850 REGIONAL LEVEL, MOMS ADVISORY 8013 05:11:37,850 --> 05:11:39,051 GROUP, COMMUNITY ADVISORY 8014 05:11:39,051 --> 05:11:39,585 COMMITTEE. 8015 05:11:39,585 --> 05:11:41,019 WE COULD NOT DO THIS WITHOUT 8016 05:11:41,019 --> 05:11:42,654 EACH OTHER. 8017 05:11:42,654 --> 05:11:43,956 SOMEONE MENTIONED EARLY ON ABOUT 8018 05:11:43,956 --> 05:11:45,390 HAVING THE TEAM, BEING ABLE TO 8019 05:11:45,390 --> 05:11:46,892 WORK AS A TEAM. 8020 05:11:46,892 --> 05:11:49,761 YOU HAVE THE -- I TELL PEOPLE 8021 05:11:49,761 --> 05:11:51,163 THE QUARTERBACK, WIDE RECEIVERS, 8022 05:11:51,163 --> 05:11:52,698 RUNNING BACKS, WE WANT TO MAKE A 8023 05:11:52,698 --> 05:11:53,332 TOUCHDOWN IN THIS. 8024 05:11:53,332 --> 05:11:56,768 I GUARANTEE WE'LL DO IT. 8025 05:11:56,768 --> 05:11:59,938 I CAN SEE EPIS STUDY, THE WORD 8026 05:11:59,938 --> 05:12:00,906 FOR ME IS SUSTAINABILITY, AND I 8027 05:12:00,906 --> 05:12:03,008 COULDN'T THINK OF A BETTER 8028 05:12:03,008 --> 05:12:04,643 PARTNER THAN WIC BECAUSE WIC IS 8029 05:12:04,643 --> 05:12:06,612 PUBLIC HEALTH AT ITS FINEST. 8030 05:12:06,612 --> 05:12:08,380 EVERYONE WHO KNOWS IT, IT'S THE 8031 05:12:08,380 --> 05:12:10,449 LAST PROGRAM THAT EXISTS THAT WE 8032 05:12:10,449 --> 05:12:11,617 STILL HAVE A GREAT ENGAGEMENT 8033 05:12:11,617 --> 05:12:13,285 WITH OUR MOMS, OUR FAMILIES, OUR 8034 05:12:13,285 --> 05:12:14,853 BABIES AND INFANTS. 8035 05:12:14,853 --> 05:12:16,788 JUST BEING ABLE TO SUPPORT THEM 8036 05:12:16,788 --> 05:12:23,996 AND KNOW WE'RE HERE FOR THEM., 8037 05:12:23,996 --> 05:12:25,497 WE'VE BEEN HERE 50 YEARS AND 8038 05:12:25,497 --> 05:12:27,232 WANT TO BE HERE ANOTHER 50 8039 05:12:27,232 --> 05:12:28,367 YEARS. 8040 05:12:28,367 --> 05:12:31,170 HERE IS THIS LIST OF OUR 8041 05:12:31,170 --> 05:12:31,603 COMMUNITY PARTNERS. 8042 05:12:31,603 --> 05:12:32,738 TOGETHER WE CAN DO IT. 8043 05:12:32,738 --> 05:12:34,907 THAT'S WHAT WE'VE BEEN ABLE TO 8044 05:12:34,907 --> 05:12:35,174 DO. 8045 05:12:35,174 --> 05:12:36,642 I KNOW THAT BEING ABLE TO 8046 05:12:36,642 --> 05:12:39,077 CONTINUE TO WORK WITH OUR 8047 05:12:39,077 --> 05:12:41,513 COMMUNITY PARTNERS AND VALUE 8048 05:12:41,513 --> 05:12:42,814 THEM, VALUE CLIENTS, CONSUMERS, 8049 05:12:42,814 --> 05:12:43,782 CUSTOMERS WHO RECEIVE THE 8050 05:12:43,782 --> 05:12:46,652 SERVICES FROM US, I WANT TO 8051 05:12:46,652 --> 05:12:48,620 THANK DR. DARANS AND HER TEAM 8052 05:12:48,620 --> 05:12:50,155 OUT IN THE COMMUNITY, GETTING 8053 05:12:50,155 --> 05:12:52,658 FACE TO FACE WITH FAMILIES, AND 8054 05:12:52,658 --> 05:12:55,060 JUST THIS PAST WEEKEND WE WERE 8055 05:12:55,060 --> 05:12:56,828 ALL TOGETHER SEEING HOW WE CAN 8056 05:12:56,828 --> 05:12:58,463 INTEGRATE OUR PROGRAMS INTO THE 8057 05:12:58,463 --> 05:12:58,897 COMMUNITY. 8058 05:12:58,897 --> 05:13:03,602 I CAN ASSURE YOU THAT THIS 8059 05:13:03,602 --> 05:13:06,205 INTERVENTION WILL BE SUSTAINED 8060 05:13:06,205 --> 05:13:06,672 IN WIC. 8061 05:13:06,672 --> 05:13:08,640 NEXT SLIDE. 8062 05:13:08,640 --> 05:13:11,176 I THANK EVERYONE. 8063 05:13:11,176 --> 05:13:14,313 THAT MIGHT BE MY LAST SLIDE. 8064 05:13:14,313 --> 05:13:15,380 STUDY TEAM MEMBERS, STUDY TEAMS 8065 05:13:15,380 --> 05:13:18,050 WORKING HARD IN THE CLINIC TO 8066 05:13:18,050 --> 05:13:19,251 DELIVER THE INTERVENTION, VERY 8067 05:13:19,251 --> 05:13:20,552 GRATEFUL FOR EACH AND EVERY ONE 8068 05:13:20,552 --> 05:13:22,321 OF THEM. 8069 05:13:22,321 --> 05:13:24,389 EVERYBODY WHO SUPPORTED AT 8070 05:13:24,389 --> 05:13:26,191 TULANE UNIVERSITY, BRINGING 8071 05:13:26,191 --> 05:13:28,227 GREAT INITIATIVES IN 8072 05:13:28,227 --> 05:13:30,796 MATERNAL/CHILD HEALTH, TOGETHER 8073 05:13:30,796 --> 05:13:32,264 WE'LL IMPROVE MATERNAL/CHILD 8074 05:13:32,264 --> 05:13:34,533 HEALTH AND BIRTH OUTCOMES AND 8075 05:13:34,533 --> 05:13:37,202 ADDRESS THOSE MATERNAL MORBIDITY 8076 05:13:37,202 --> 05:13:38,270 AND MORTALITY AND CONCERNS IN 8077 05:13:38,270 --> 05:13:40,706 THE COMMUNITY AND STATE OF 8078 05:13:40,706 --> 05:13:41,640 LOUISIANA. 8079 05:13:41,640 --> 05:13:41,907 THANK YOU. 8080 05:13:41,907 --> 05:13:44,309 DAY 1 HAS BEEN GREAT. 8081 05:13:44,309 --> 05:13:45,510 Y'ALL ARE LOOKING FORWARD TO DAY 8082 05:13:45,510 --> 05:13:45,744 2. 8083 05:13:45,744 --> 05:13:47,479 I LEARNED A LOT AND HEARD GREAT 8084 05:13:47,479 --> 05:13:49,881 MESSAGES AND I'M THE PROUD 8085 05:13:49,881 --> 05:13:51,750 MOTHER TODAY OF MY TWINS, I WAS 8086 05:13:51,750 --> 05:13:53,619 A HIGH RISK PREGNANCY BUT MY 8087 05:13:53,619 --> 05:13:56,655 TWINS MADE 36 AND I'M SO PROUD 8088 05:13:56,655 --> 05:14:02,995 TO SAY HAPPY BIRTHDAY TO THEM 8089 05:14:02,995 --> 05:14:04,863 AND DR. DORAN, ALSO A VIRGO. 8090 05:14:04,863 --> 05:14:06,965 >> THANK YOU TO ALL PANELISTS. 8091 05:14:06,965 --> 05:14:09,801 HAPPY BIRTHDAY TO YOUR TWINS, 8092 05:14:09,801 --> 05:14:10,002 MARY. 8093 05:14:10,002 --> 05:14:12,537 WE HAVE TIME MAYBE FOR ONE 8094 05:14:12,537 --> 05:14:13,839 QUESTION FROM, MAYBE TWO 8095 05:14:13,839 --> 05:14:14,506 QUESTIONS IF ANYONE HAS ANY 8096 05:14:14,506 --> 05:14:16,708 IMMEDIATE QUESTIONS. 8097 05:14:16,708 --> 05:14:18,076 I DON'T SEE ANYTHING JUST YET IN 8098 05:14:18,076 --> 05:14:18,977 THE CHAT. 8099 05:14:18,977 --> 05:14:21,079 THANK YOU FOR MENTIONING HOW YOU 8100 05:14:21,079 --> 05:14:26,151 ESTABLISHED HUER PARTNERSHIP -- 8101 05:14:26,151 --> 05:14:26,652 YOUR PARTNERSHIPS. 8102 05:14:26,652 --> 05:14:28,620 IF YOU COULD LIMIT YOUR RESPONSE 8103 05:14:28,620 --> 05:14:30,155 TO ONE MINUTE, TALK ABOUT 8104 05:14:30,155 --> 05:14:31,990 FORMATIVE WORK THAT WENT INTO 8105 05:14:31,990 --> 05:14:32,891 ESTABLISHING YOUR COMMUNITY 8106 05:14:32,891 --> 05:14:35,961 PARTNERSHIPS, WHETHER NIECE WERE 8107 05:14:35,961 --> 05:14:37,029 ESTABLISHED BEFORE PHASE 1 BEGAN 8108 05:14:37,029 --> 05:14:47,506 OR THROUGHOUT THE COURSE OF 8109 05:14:48,173 --> 05:14:50,208 PHASE 1. 8110 05:14:50,208 --> 05:14:51,176 >> REAL QUICKLY MANY 8111 05:14:51,176 --> 05:14:53,378 PARTNERSHIPS FORMED FOR OTHER 8112 05:14:53,378 --> 05:14:54,479 INITIATIVES BEFORE WE GOT 8113 05:14:54,479 --> 05:14:54,713 STARTED. 8114 05:14:54,713 --> 05:14:58,617 SO THEY WERE ALREADY EXISTING. 8115 05:14:58,617 --> 05:14:59,718 HOWEVER, OVER TIME DIFFERENT 8116 05:14:59,718 --> 05:15:01,386 ORGANIZATIONS HAVE GONE ON TO 8117 05:15:01,386 --> 05:15:02,921 TAKE ON DIFFERENT INITIATIVES. 8118 05:15:02,921 --> 05:15:05,357 SO WE OFTEN RELY ON EXISTING 8119 05:15:05,357 --> 05:15:07,059 PARTNERS AS WELL TO SAY WHO ELSE 8120 05:15:07,059 --> 05:15:08,260 IS DOING THIS WORK IN THE 8121 05:15:08,260 --> 05:15:13,932 COMMUNITY THAT YOU THINK WOULD 8122 05:15:13,932 --> 05:15:16,902 BE A GOOD FIT. 8123 05:15:16,902 --> 05:15:18,203 >> I ECHO. 8124 05:15:18,203 --> 05:15:19,538 WE HAD PREVIOUS PARTNERSHIPS, 8125 05:15:19,538 --> 05:15:24,543 ALSO HAVE A GREAT AMBASSADOR, 8126 05:15:24,543 --> 05:15:25,977 DANET, WHO RECOMMENDED PARTNERS 8127 05:15:25,977 --> 05:15:27,079 THROUGH THE NATIONAL HEALTHY 8128 05:15:27,079 --> 05:15:29,348 START COALITION AS WELL AS OTHER 8129 05:15:29,348 --> 05:15:30,782 COALITIONS THAT SHE HAS BEEN A 8130 05:15:30,782 --> 05:15:32,417 PART OF. 8131 05:15:32,417 --> 05:15:34,519 SO SHE WAS INSTRUMENTAL HELPING 8132 05:15:34,519 --> 05:15:36,088 US ACHIEVE THAT AND OTHER STATES 8133 05:15:36,088 --> 05:15:40,759 WE NORMALLY HAVE NOT WORKED IN. 8134 05:15:40,759 --> 05:15:41,727 >> SPEAKING FOR THE NORTH 8135 05:15:41,727 --> 05:15:45,664 CAROLINA UNC WE STARTED IN PHASE 8136 05:15:45,664 --> 05:15:47,866 3, WITH CLINICAL PARTNERS. 8137 05:15:47,866 --> 05:15:50,635 I AS A SPECIALIST HAVE SUPPORTED 8138 05:15:50,635 --> 05:15:56,375 THESE FQHCs IN THE CARE OF 8139 05:15:56,375 --> 05:15:57,843 COMPLEX PATIENTS, PROVIDING 8140 05:15:57,843 --> 05:16:00,412 PRENATAL CARE IN THE LOCAL 8141 05:16:00,412 --> 05:16:00,612 AREAS. 8142 05:16:00,612 --> 05:16:02,180 DISTANT FROM FROM THE MAIN 8143 05:16:02,180 --> 05:16:02,781 HOSPITAL. 8144 05:16:02,781 --> 05:16:04,483 IT STARTED THERE. 8145 05:16:04,483 --> 05:16:05,917 THERE WAS A TRUSTING 8146 05:16:05,917 --> 05:16:08,720 RELATIONSHIP THAT STARTED. 8147 05:16:08,720 --> 05:16:09,788 GOSH, KAMARA, DO YOU WANT TO 8148 05:16:09,788 --> 05:16:14,626 CHIME IN WHEN YOU GOT INVOLVED? 8149 05:16:14,626 --> 05:16:16,728 I DON'T WANT TO PUT ON YOU THE 8150 05:16:16,728 --> 05:16:17,262 SPOT. 8151 05:16:17,262 --> 05:16:19,464 >> IT'S BEEN GREAT WORKING WITH 8152 05:16:19,464 --> 05:16:20,766 THE TEAM. 8153 05:16:20,766 --> 05:16:22,501 ADDING A LIVED EXPERIENCE, 8154 05:16:22,501 --> 05:16:26,505 ADDING MY PERSPECTIVE TO THE 8155 05:16:26,505 --> 05:16:28,473 GROUP, A VERY HOPE AND GREAT 8156 05:16:28,473 --> 05:16:29,674 GROUP TO WORK WITH. 8157 05:16:29,674 --> 05:16:31,643 >> SHE'S JUST BEEN ONE OF THE 8158 05:16:31,643 --> 05:16:35,247 PEOPLE THAT'S BEEN VERY 8159 05:16:35,247 --> 05:16:37,883 INSTRUMENTAL HELPING OUR PATIENT 8160 05:16:37,883 --> 05:16:40,085 ACTION GROUP, THE REPRESENTATION 8161 05:16:40,085 --> 05:16:42,821 OF VARIETY OF INDIVIDUALS FROM 8162 05:16:42,821 --> 05:16:43,822 DIFFERENT COUNTIES, THAT COME TO 8163 05:16:43,822 --> 05:16:49,628 YOUS WITH LIVED EXPERIENCE AND 8164 05:16:49,628 --> 05:16:56,435 INFORM OUR WORK. 8165 05:16:56,435 --> 05:16:58,069 >> THANK YOU. 8166 05:16:58,069 --> 05:16:58,336 >> MARY? 8167 05:16:58,336 --> 05:17:01,473 >>> MOREHOUSE REACHED OUT TO US, 8168 05:17:01,473 --> 05:17:06,611 WE'RE NOT AT THE CLINICAL 8169 05:17:06,611 --> 05:17:06,845 SETTING. 8170 05:17:06,845 --> 05:17:15,687 [AUDIO DISTORTION] 8171 05:17:15,687 --> 05:17:19,090 SO THAT WAS CLINICAL VERSUS THE 8172 05:17:19,090 --> 05:17:22,594 COMMUNITY SETTING, THAT'S BEEN 8173 05:17:22,594 --> 05:17:23,462 VERY, VERYING THERE. 8174 05:17:23,462 --> 05:17:25,564 >> THANK YOU ALL. 8175 05:17:25,564 --> 05:17:28,066 ONE MORE QUESTION, I DON'T SEE 8176 05:17:28,066 --> 05:17:30,168 ANY OTHERS SO I'LL ASK ANOTHER 8177 05:17:30,168 --> 05:17:31,903 ONE OF MY QUESTIONS. 8178 05:17:31,903 --> 05:17:34,306 TODAY WE HEARD A LOT ABOUT POWER 8179 05:17:34,306 --> 05:17:36,708 OF PARTNERSHIPS AND POSITIVE 8180 05:17:36,708 --> 05:17:38,577 IMPACT, IN YOUR PRESENTATIONS 8181 05:17:38,577 --> 05:17:40,212 TODAY EXEMPLIFYING BENEFITS OF 8182 05:17:40,212 --> 05:17:40,645 THESE COOPERATIONS. 8183 05:17:40,645 --> 05:17:44,382 ONE OF THE IMPORTANT PARTS, 8184 05:17:44,382 --> 05:17:47,886 ASPECT OF PROGRAMS IS TESTING OF 8185 05:17:47,886 --> 05:17:50,155 EVIDENCE-BASED INTERVENTION, 8186 05:17:50,155 --> 05:17:50,922 THAT HAVE ALREADY BEEN 8187 05:17:50,922 --> 05:17:52,357 EMPIRICALLY SHOWN TO BE 8188 05:17:52,357 --> 05:18:02,868 SUCCESSFUL IN IMPROVING HEALTH 8189 05:18:03,602 --> 05:18:04,903 OUTCOMES, SPEAKING OF BEING AN 8190 05:18:04,903 --> 05:18:10,041 INTEGRAL PART OF THE RESEARCH 8191 05:18:10,041 --> 05:18:12,444 TEAM. 8192 05:18:12,444 --> 05:18:14,513 >> I'LL START. 8193 05:18:14,513 --> 05:18:15,347 I THINK -- 8194 05:18:15,347 --> 05:18:19,985 >> GO AHEAD. 8195 05:18:19,985 --> 05:18:22,387 >> WITH OUR REACHING OUT TO 8196 05:18:22,387 --> 05:18:23,421 DIFFERENT COMMUNITIES AND 8197 05:18:23,421 --> 05:18:25,457 FINDING PEOPLE ON THE STREET AND 8198 05:18:25,457 --> 05:18:27,225 ASKING THEM IF THEY WANT TO BE 8199 05:18:27,225 --> 05:18:33,565 PART AND GETTING THEIR FEEDBACK 8200 05:18:33,565 --> 05:18:35,967 OF THEIR OVERWHELMING 8201 05:18:35,967 --> 05:18:38,270 EXCITEMENT, AND JUST AWARENESS 8202 05:18:38,270 --> 05:18:40,138 ABOUT PRE-CONCEPTION AND 8203 05:18:40,138 --> 05:18:43,074 ESPECIALLY THE MEN, THAT THEY 8204 05:18:43,074 --> 05:18:45,176 ARE NOT UNDERSTANDING THE 8205 05:18:45,176 --> 05:18:45,911 NUTRITION, EXERCISE, ALL OF 8206 05:18:45,911 --> 05:18:49,748 THAT, HOW THAT PLAYS AN IMPACT 8207 05:18:49,748 --> 05:18:51,950 IN ORGANIZATION AND SO FORTH, 8208 05:18:51,950 --> 05:18:55,353 AND THEN THE WOMEN, AGAIN, FROM 8209 05:18:55,353 --> 05:19:00,492 WHAT WE HAD, PARTICIPANTS WE HAD 8210 05:19:00,492 --> 05:19:01,493 PROBABLY 80% SHOWED 8211 05:19:01,493 --> 05:19:03,128 HYPERTENSION, SO REFERRING THEM 8212 05:19:03,128 --> 05:19:04,663 TO THE DOCTOR FOR ONE THING THAT 8213 05:19:04,663 --> 05:19:06,398 WAS VERY INTERESTING TO ME, THEY 8214 05:19:06,398 --> 05:19:08,366 DON'T REALLY REACH OUT TO THE 8215 05:19:08,366 --> 05:19:10,235 DOCTORS, AS MUCH. 8216 05:19:10,235 --> 05:19:15,607 THEY GO TO TIKTOK, I WAS VERY 8217 05:19:15,607 --> 05:19:19,878 SHOCKED BY THAT INFORMATION WHEN 8218 05:19:19,878 --> 05:19:21,112 WE TALKED ABOUT PRE-CONCEPTION 8219 05:19:21,112 --> 05:19:22,714 BUT ABLE TO PROVIDE THEM AND 8220 05:19:22,714 --> 05:19:24,916 REFER THEM TO THEIR PHYSICIANS 8221 05:19:24,916 --> 05:19:28,219 AND TALKING ABOUT WHY IT'S VERY 8222 05:19:28,219 --> 05:19:29,054 IMPORTANT. 8223 05:19:29,054 --> 05:19:30,322 >> IN THE INTEREST OF TIME I'M 8224 05:19:30,322 --> 05:19:35,226 GOING TO TURN IT OVER TO DR. 8225 05:19:35,226 --> 05:19:37,228 KAREN PLEVOCK-HAASE TO CLOSE OUT 8226 05:19:37,228 --> 05:19:38,396 DAY 1. 8227 05:19:38,396 --> 05:19:40,565 >> THANK YOU SO MUCH, CANDACE. 8228 05:19:40,565 --> 05:19:42,867 I'LL KEEP THIS BRIEF AS WE WRAP 8229 05:19:42,867 --> 05:19:43,101 UP. 8230 05:19:43,101 --> 05:19:45,136 WE WANT TO SAY HUGE THANK YOU TO 8231 05:19:45,136 --> 05:19:47,405 ALL OF OUR KEYNOTES AND 8232 05:19:47,405 --> 05:19:48,773 PANELISTS FOR SHARING TIME, 8233 05:19:48,773 --> 05:19:50,442 EXPERTISE, INSIGHTS. 8234 05:19:50,442 --> 05:19:51,977 THESE SESSIONS HAVE BEEN 8235 05:19:51,977 --> 05:19:53,111 INSPIRING AND HIGHLIGHT 8236 05:19:53,111 --> 05:19:54,579 IMPORTANT CONSIDERATIONS AS WE 8237 05:19:54,579 --> 05:19:56,548 SEEK TO IMPROVE MATERNAL HEALTH 8238 05:19:56,548 --> 05:19:59,618 OUTCOMES IN THE U.S. AND 8239 05:19:59,618 --> 05:20:00,285 GLOBALLY. 8240 05:20:00,285 --> 05:20:02,454 WE LOOK FORWARD TO REVISITING 8241 05:20:02,454 --> 05:20:04,122 THE TAKEHOMES TODAY IN THE 8242 05:20:04,122 --> 05:20:07,092 WRAP-UP AT THE END OF TOMORROW. 8243 05:20:07,092 --> 05:20:09,027 WE THANK THOSE ATTENDING ON ZOOM 8244 05:20:09,027 --> 05:20:10,462 AND VIDEOCAST FOR ACTIVELY 8245 05:20:10,462 --> 05:20:12,530 ENGAGING AND BEING PART OF THE 8246 05:20:12,530 --> 05:20:13,732 IMPORTANT DISCUSSIONS. 8247 05:20:13,732 --> 05:20:15,634 WE'RE VERY APPRECIATIVE OF YOUR 8248 05:20:15,634 --> 05:20:16,835 TIME AND THOUGHTFUL DISCUSSION 8249 05:20:16,835 --> 05:20:18,036 POINTS BROUGHT FORTH. 8250 05:20:18,036 --> 05:20:20,538 WE LOOK FORWARD TO CONTINUING ON 8251 05:20:20,538 --> 05:20:21,740 TOMORROW. 8252 05:20:21,740 --> 05:20:23,174 WE'LL HAVE A MORNING KEYNOTE 8253 05:20:23,174 --> 05:20:29,180 PRESENTATION AND THREE MORE 8254 05:20:29,180 --> 05:20:31,149 ENGAGING PANELS INCLUDING 8255 05:20:31,149 --> 05:20:31,816 IMPLEMENTATION SCIENCE, MATERNAL 8256 05:20:31,816 --> 05:20:33,218 LUNG HELD, SLEEP HEALTH, 8257 05:20:33,218 --> 05:20:34,653 INNOVATIVE CARE DELIVERY. 8258 05:20:34,653 --> 05:20:36,187 WE'RE EXCITED FOR CONTINUED 8259 05:20:36,187 --> 05:20:37,255 ENGAGEMENT AND VALUABLE 8260 05:20:37,255 --> 05:20:41,559 LEARNINGS AS WE MOVE INTO DAY 2. 8261 05:20:41,559 --> 05:20:43,528 WE'LL START AT 10 A.M. EASTERN 8262 05:20:43,528 --> 05:20:44,295 STANDARD TIME TOMORROW AND 8263 05:20:44,295 --> 05:20:46,131 YOU'LL USE THE SAME ZOOM LINK 8264 05:20:46,131 --> 05:20:48,333 YOU USED TO ATTEND TODAY. 8265 05:20:48,333 --> 05:20:49,634 THAT CONCLUDES OUR DAY 1. 8266 05:20:49,634 --> 05:20:51,936 I HOPE EVERYONE HAS A WONDERFUL 8267 05:20:51,936 --> 05:20:52,370 EVENING. 8268 05:20:52,370 --> 05:21:02,370 THANK YOU.