>> GOOD MORNING, GOOD AFTERNOON,
GOOD EVENING TO EVERYONE WHO
JOINED US FOR THIS GLOBAL
WORKSHOP.
I'M KAREN PLEVOCK-HAASE, I'M A
PROGRAM OFFICER AT THE NATIONAL
HEART, LUNG AND BLOOD INSTITUTE
IN THE CENTER FOR TRANSLATION
RESEARCH AND IMPLEMENTATION
SCIENCE.
ON BEHALF OF THE ORGANIZING
COMMITTEE AND MY CO-CHAIR MISS
VERONICA TONWE I WANT TO EXTEND
A WARM WELCOME AND THANK YOU FOR
JOINING US TODAY AND TOMORROW
FOR ENGAGING DISCUSSIONS AROUND
GLOBAL IMPLEMENTATION SCIENCE
APPROACHES TO IMPROVE MATERNAL
HEART LUNG BLOOD AND SLEEP
HEALTH OUTCOMES.
OVER THE NEXT FEW DAYS WE HAVE A
PACKED AGENDA IN A INCLUDES
KEYNOTE SPEECHES AND PANEL
DISCUSSIONS.
BEFORE WE MOVE INTO OUR
WELCOMING RACKS I WANTED TO GO
OVER THE FORMAT, OBJECTIVES AND
GOALS.
DAY 1 TWO KEYNOTE PRESENTATIONS,
THREE PANEL DISCUSSIONS, FOCUSED
ON IMPLEMENTATION SCIENCE AND
MATERNAL CARDIOVASCULAR HEALTH,
HEMATOLOGY, AND BLOOD
TRANSFUSIONS AS FACTORS IN
MATERNITY MORBIDITY AND
MORTALITY, AND A SPOTLIGHT ON
THE NIH SCIENCE PROGRAMS.
DAY 2 WILL START WITH A KEYNOTE
IMPROVING EVIDENCE BASE FOR
MATERNITY CARE, THREE PANELS
WHICH WILL INCLUDE A FOCUS ON
IMPLEMENTATION SCIENCE AND
MATERNAL LUNG HEALTH, SLEEP
HEALTH, INNOVATIVE CARE
DELIVERY.
SESSIONS ARE DESIGNED TO PARK
NEW IDEAS, HIGHLIGHT STRATEGIES,
AND ENCOURAGE COLLABORATION
ACROSS DISCIPLINES AND BORDERS.
IN TERMS OF THE WORKSHOP
OBJECTIVES, WE HOPE TO EXPLORE
MATERNAL HEALTH CRISIS IN THE
U.S. IN THE CONTEXT HEALTH
DISPARITIES AND, USING GLOBAL
SUCCESSES TO DETERMINE HOW
EVIDENCE-BASED PRACTICES CAN BE
CONTEXTUALLY ADAPTED TO IMPROVE
MATERNAL HEALTH IN VULNERABLE
POPULATIONS WORLDWIDE.
IMPORTANTLY, WE WANT TO EXPLORE
CHALLENGES AND OPPORTUNITIES FOR
ADVANCING IMPLEMENTATION
RESEARCH, TRAINING, CAPACITY
BUILDING FOR MATERNAL HEALTH,
WITH FOCUS ON HEART, LUNG,
BLOOD, AND SLEEP DISORDERS THAT
IMPACT PREGNANT WOMEN AND
MOTHERS IN THE U.S. AND ABROAD
INCLUDING LMICs.
WE WILL DISCUSS THE IMPORTANCE
OF ENGAGING THE COMMUNITY IN
MATERNAL HEALTH RESEARCH, AND
PROGRAMS TO IMPROVE HEALTH OF
MOTHERS IN PERINATAL AND
POSTPARTUM PERIOD.
SOMETHING WE WANT TO HIGHLIGHT
OVER THE NEXT FEW DAYS IS HOW WE
CAN FACILITATE RECIPROCAL
LEARNING AND SHARING OF INSIGHTS
BETWEEN GLOBAL AND DOMESTIC
SETTINGS TO FOSTER INNOVATIVE
SOLUTIONS AND CO-LEARNING
OPPORTUNITIES THAT ENHANCE
OUTCOMES.
OUR GOALS TO EXCHANGE
CUTTING-EDGE RESEARCH FINDINGS
AND BEST PRACTICES, IDENTIFY
KNOWLEDGE GAPS AND CRITICAL
UNMET NEEDS, AND UNCOVER
OPPORTUNITIES FOR IMPROVING
MATERNAL HEART, LUNG, BLOOD, AND
SLEEP HEALTH OUTCOMES USING
IMPLEMENTATION SCIENCE.
WE HOPE WE CAN FOSTER
PARTNERSHIPS AND COLLABORATIONS
THAT CAN DRIVE PROGRESS IN
MATERNAL HEALTH.
AS WE START THE FANTASTIC
SESSIONS I'D LIKE TO ENCOURAGE
YOU TO STAY ENGAGED THROUGH THE
QUESTION-AND-ANSWER BOX FOR
QUESTIONS AND CHAT FEATURE FOR
DISCUSSION.
MODERATORS WILL BE ACTIVELY
MONITORING THE QA BOX AND WILL
BRING COMMENTS AND QUESTIONS
INTO THE LIVE DISCUSSION.
I'M DELIGHTED WE HAVE DR. KARA
LOUIS FROM THE CENTER FOR
TRANSLATION RESEARCH AND
IMPLEMENT SCIENCE TO PROVIDE
BRIEF WELCOMING REMARKS.
I WILL PASS OVER TO DR. LEWIS.
THANK YOU.
>> GOOD MORNING, GOOD AFTERNOON,
GOOD EVENING, EVERYONE.
I'M DELIGHTED TO WELCOME YOU TO
THE WORKSHOP CENTERING GLOBAL
IMPLEMENTATION SCIENCE
APPROACHES TO IMPROVE MATERNAL
HEALTH, MATERNAL HEART, LUNG,
BLOOD, AND SLEEP HEALTH
OUTCOMES.
I'M CARA LEWIS, DEPUTY DIRECTOR
AT NHLBI CENTER FOR TRANSLATION
RESEARCH, CTRIS GOING FORWARD, A
GREAT PRIVILEGE TO EXTEND THE
WARM WELCOME ON BEHALF OF
LEADERSHIP AND STAFF OF NHLBI.
THANKS TO THOSE WHO MADE THIS
EVENT POSSIBLE.
I THANK THE MANY PANELISTS AND
EXPERTS WHO WILL BE SHARING
INSIGHTS ON THE CHALLENGES AND
SUCCESSES OF SUPPORTING
IMPLEMENTATION RESEARCH, WHICH
CAN REVEAL STRATEGIES TO
TRANSLATE BASIC SCIENCE
DISCOVERIES, EPIDEMIOLOGIC
INSIGHTS, INTERVENTION RESEARCH
FINDINGS TO IMPROVE MATERNAL
OUTCOMES.
IT'S AN HONOR TO SEE SUCH AN
ESTEEMED GROUP GATHERED HERE
TODAY.
I WANT TO TAKE THE OPPORTUNITY
TO THANK YOU, OUR ATTENDEES, WE
KNOW ALL OF YOU ARE VERY BUSY
WITH MULTIPLE COMPETING
PRIORITIES, IT MEANS A LOT TO US
AT NHLBI AND CTRIS THAT YOU
AGREED TO JOIN US AT THIS
WORKSHOP.
THANK YOU.
I'M EXCITED TO LEARN WITH AND
FROM YOU ALL TODAY.
NOW A FEW REMINDERS WHY WE'RE
HERE.
DESPITE SIGNIFICANT SCIENTIFIC
ADVANCES, MATERNAL MORBIDITY AND
MORTALITY REMAINS PRESSING
GLOBAL CHALLENGES PARTICULARLY
IN LOW-RESOURCE SETTINGS.
MATERNAL MORTALITY IS RISING IN
THE U.S. AND WE'RE SEEING
DISPARITIES EXACERBATED.
SOBERING FACT IN THE UNITED
STATES UP TO 80% OF THESE
MATERNAL DEATHS ARE PREVENTIBLE.
AND THIS IS WHERE WHERE THE T
SCIENCE COMES IN, TO PROMOTE
WELL-BEING FOR ALL, AT ALL AGES.
WE CAN LOOK TO NHLBI STRATEGIC
VISION GOAL NUMBER 4, ADVANCE
TRANSLATIONAL RESEARCH, TO
FACILITATE INNOVATION AND
ACCELERATE RESEARCH TRANSLATION
ACROSS THE RESEARCH SPECTRUM,
BRIDGING BASIC TO CLINICAL,
CLINICAL TO PRACTICE, POPULATION
TO HEALTH IMPACT, OBJECTIVE 6 TO
OPTIMIZE CLINICAL AND
IMPLEMENTATION RESEARCH TO
IMPROVE HEALTH AND REDUCE
DISEASE.
WHILE NEW INTERVENTIONS TO
IMPROVE MATERNAL HEALTH MAY BE
NECESSARY TO ROUND OUT THAT
WHICH IS AVAILABLE, ONE APPROACH
FORWARD IS TO CAPITALIZE ON THE
SCIENTIFIC RESEARCH INVESTMENTS
OF NIH AND OTHER AGENCIES TO
EXPLORE WAYS TO INCREASE
ACCESSIBILITY, UPTAKE, ADOPTION,
INTEGRATION OF EXISTING
EVIDENCE-BASED INTERVENTIONS,
ESPECIALLY FOR POPULATIONS THAT
ARE DISPROPORTIONATELY IMPACTED
AND FOR THOSE IN MATERNITY CARE
DESERTS.
IMPLEMENTATION RESEARCH IS
DESIGNED TO BRIDGE THIS GAP
USING THEORIES, MODELS,
FRAMEWORKS, MEASURES, METHODS,
TOOLS, THIS TYPE OF RESEARCH CAN
ELUCIDATE WAYS TO CUSTOMIZE OR
STREAMLINE OR OTHERWISE OPTIMIZE
EVIDENCE-BASED INTERVENTIONS FOR
ENHANCING THE REACH WE HOPE TO
SEE, THE IMPACT WE HOPE TO HAVE,
EQUITY FOR INSTANCE BY FOCUSING
ON STRATEGIES TO DELIVER, SCALE,
SPREAD INTERVENTIONS IN
PARTNERSHIP WITH COMMUNITIES TO
EXPLORE CONTEXTUAL ADAPTATIONS
AS NEEDED WE CAN ADDRESS
COMPLEXITIES THAT IMPACT
IMPLEMENTATION SUCCESS.
THIS WORKSHOP IS AN OPPORTUNITY
TO DELVE INTO NUANCES OF
IMPLEMENTATION RESEARCH, SHARE
INSIGHTS THAT CAN INCREASE
IMPACT OF EFFECTIVE MATERNAL
HEALTH INTERVENTIONS THAT
ADDRESS HEART, LUNG, BLOOD, AND
SLEEP DISEASES.
ONE OF THE CORE PRINCIPLES OF
THIS WORKSHOP IS RECIPROCAL
LEARNING.
THERE'S AN IMMENSE KNOWLEDGE
BASE TO BE SHARED AMONG
RESEARCHERS, PRACTITIONERS,
PROFESSIONALS AND THE PUBLIC
ACROSS THE GLOBE AND WE'RE HERE
TO LEARN IN ONE ANOTHER,
BRINGING GREAT MINDS TOGETHER
ENRICHING OUR UNDERSTANDING AND
FOSTERING SOLUTIONS.
COLLABORATION IS KEY TO
OVERCOMING THE COMPLEX
CHALLENGES THAT WE FACE IN
MATERNAL HEALTH AND BY WORKING
TOGETHER WE CAN CREATE SYNERGIES
THAT AMPLIFY OUR IMPACT.
SO, AS WE EMBARK ON THIS
JOURNEY, I ENCOURAGE YOU TO
PARTICIPATE, SHARE EXPERIENCES,
CHALLENGE CONVENTIONAL THINKING,
IDENTIFY GAPS AND OPPORTUNITIES
FOR FUTURE RESEARCH.
LET US USE THIS PLATFORM TO
INSPIRE, BE INSPIRED, INNOVATE
AND TO IMPLEMENT, AND TO MAKE A
TANGIBLE DIFFERENCE IN LIVES OF
MOTHERS AND FAMILIES AROUND THE
WORLD.
WE'RE ASKING YOU TO USE THIS
DIVERSE EXPERTISE GATHERED HERE
TODAY AND TOMORROW TO IDENTIFY
OPPORTUNITIES FOR ENHANCING WHAT
WE CALL LATE STAGE TRANSLATION
RESEARCH THAT LEVERAGES ALL THAT
WE CAN FOR HEART, LUNG, BLOOD,
AND SLEEP CONDITIONS.
THE NATIONAL HEART, LUNG AND
BLOOD INSTITUTE IS COMMITTED TO
ADVANCING THIS TYPE OF RESEARCH
THAT DIRECTLY TURNS DISCOVERIES
INTO REAL WORLD HEALTH IMPACTS.
CTRIS, THE STRATEGIC FOCAL POINT
FOR THE ACTIVITIES, IS EXCITED
TO HOST YOU TODAY.
A COUPLE LAST POINTS, I'M
REQUIRED TO REMIND THAT YOU
UNDER THE FEDERAL ADVISORY
COMMITTEE ACT, FACA, SIGNED INTO
LAW IN 1972, OUR WORKSHOPS ARE
NOT CONSTITUTED FOR YOU TO
ADVISE NHLBI OR MAKE SPECIFIC
RECOMMENDATIONS TO NHLBI OR NIH.
KEEP IN MIND WE ASK THAT YOU
FRAME THE INSIGHTS YOU SHARE
WITH US AS CHALLENGES THAT WE
OUGHT TO OVERCOME AND
OPPORTUNITIES FOR NHLBI TO
EXPLORE, NOT A SPECIFIC
RECOMMENDATION.
THE OPPORTUNITIES YOU IDENTIFY
WILL PLAY AN IMPORTANT ROLE AS
NHLBI AND ITS DIVISIONS DEVELOP
AND EXECUTE ON THEIR STRATEGIC
VISION IMPLEMENTATION PLANS FOR
THE FUTURE.
ONCE AGAIN, WELCOME TO THE
GLOBAL IMPLEMENTATION SCIENCE
APPROACHES TO IMPROVE MATERNAL
HEART, LUNG, BLOOD, AND SLEEP
HEALTH OUTCOMES WORKSHOP.
I LOOK FORWARD TO THE RICH
DISCUSSIONS AND MEANINGFUL
CONNECTIONS THAT WILL EMERGE
FROM OUR TIME TOGETHER.
THANK YOU FOR THE COMMITMENT TO
THIS VITAL CAUSE.
LET'S GET STARTED ON WHAT
PROMISES TO BE AN ENLIGHT AND
WORKSHOP.
OVER TO YOU, DR. WILLIAMS, TO
MODERATE.
>> THANK YOU.
GREETINGS.
I'M DR. MAKEDA WILLIAMS, NHLBI
GLOBAL HEALTH PROGRAM DIRECTOR.
IT'S MY GREAT PLEASURE TO WILL
BE YOU TO THIS KEYNOTE SESSION
ON MATERNAL HEALTH, A CRITICAL
FIELD THAT TOUCHES LIVES ACROSS
EVERY CORNER OF THE GLOBE.
IN THESE KEYNOTES WE'LL EXPLORE
TWO PIVOTAL DIMENSIONS OF
MATERNAL HEALTH, PURSUIT OF
MATERNAL BIRTH EQUITY IN THE
UNITED STATES, AND BROADER
GLOBAL EFFORTS TO ENHANCE
MATERNAL HEALTH THROUGH
IMPLEMENTATION SCIENCE.
FIRST SPEAKER IS A DISTINGUISHED
ADVOCATE FOR MATERNAL BIRTH
EQUITY, AT THE FOREFRONT OF
ADDRESSING DISPARITIES.
DR. JOII CREAR-PERRY WILL LOOK
AT SYSTEMIC BARRIERS THAT
CONTRIBUTE TO INEQUITABLE BIRTH
OUTCOMES IN THE UNITED STATES
AND SHARE INNOVATIVE STRATEGIES
HER ORGANIZATION IS DEPLOYING TO
ENSURE EVERY MOTHER REGARDS RES
OF RACE OR STATUS CYSTS .
DR. ECHE EZEANOLUI, A CLINTON
SCIENTIST WITH USING
IMPLEMENTATION SCIENCE TO
IMPROVE HEALTH SERVICES AND
OUTCOMES, INVOLVED IN SEVERAL
SIGNIFICANT PROJECTS INCLUDING
SERVING AS MULTIPLE P.I. FOR
ACCELERATING CERVICAL CANCER
ELIMINATION THROUGH INTEGRATION
OF SCREEN AND TREAT SERVICES IN
NIGERIA.
WITH VAST EXPERIENCE IN PROGRAM
IMPLEMENTATION AND EVALUATION,
HE HAS BEEN PART OF OVER 25
FUNDED PROJECTS IN THE UNITED
STATES AND NIGERIA, DR.
EZEANOLUI WILL DELVE INTO
IMPLEMENTATION SCIENCE ADVANCING
MATERNAL HEALTH WORLD WIDE,
HIGHLIGHTING INNOVATION,
COMMUNITY ENGAGEMENT, ADAPTION
OF EVIDENCE-BASED PRACTICES TO
MEET THE NEEDS OF VULNERABLE
POPULATIONS.
BOTH DOMESTICALLY AND
INTERNATIONALLY, BY EXAMINING
SUCCESSFUL CASE STUDIES AND
ONGOING PROJECTS, DR. EZEANOLUI
WILL PROVIDE UNDERSTANDING HOW
TO TRANSLATE GLOBAL BEST
PRACTICES INTO LOCAL CONTEXT.
THESE PRESENTATIONS TOGETHER
WILL ILLUMINATE CHALLENGES AND
KICK OFF THE TWO-DAY WORKSHOP
WHERE WE EXPLORE HOW
COLLECTIVELY EFFORTS CAN BE
BOLSTERED TO ENSURE SAFE AND
EQUITABLE CARE FOR ALL MOTHERS.
THANKS FOR JOINING.
RIGHT NOW IT APPEARS DR.
CREAR-PERRY MAY BE HAVING
TECHNICAL DIFFICULTIES SO I'LL
ASK DR. EZEANOLUI TO PROCEED AND
WE'LL COME BACK TO DR.
CREAR-PERRY.
ARE YOU ABLE TO BEGIN FIRST?
>> ABSOLUTELY.
>> THANK YOU SO MUCH.
CAN YOU HEAR ME WELL?
>> YES, WE CAN HEAR YOU VERY
WELL.
THANK YOU.
>> THANK YOU.
THANK YOU SO MUCH FOR THAT
INTRODUCTION.
ONE OF THE THINGS, NEXT SLIDE
PLEASE.
SO THIS IS MY DISCLOSURES,
NOTHING TO DISCLOSE EXCEPTION
FUNDING FROM NIH AND SOME OTHER
INSTITUTIONS.
NEXT SLIDE PLEASE.
I'M GOING TO TALK ABOUT OUR
EXPERIENCE IN COMMUNITY
ENGAGEMENT IN FOSTERING
INNOVATION AND HOW BEST WE HAVE
TRIED TO ADAPT BEST PRACTICES
AROUND THE GLOBE.
NEXT SLIDE.
SO ONE OF THE THINGS THAT WAS
IMPORTANT FOR ME STARTING MY
CAREER, WORKING IN LAS VEGAS AND
NIGERIA, PEPFAR.
WE RECOGNIZE THE EFFORT THAT THE
UNITED STATES PUTS TO THE UNITED
STATES FUND FOR AIDS RELIEF, ONE
FOR ME ONE OF THE MOST
TRANSFORMING THINGS, A FOCUS
INITIALLY MOVING OF CHILD
BEARING AGE TO IDENTIFY THESE
WOMEN EARLY IN PREGNANCY, TO
SCREEN THEM FOR HIV, TO PUT
INTERVENTION SO THE IDEA WAS TO
STOP THE NEW GENERATION OF
CHILDREN BEING BORN WITH HIV.
WHAT HAPPENED AT THAT TIME WAS
ALL THE FUNDING WAS RESTRICTED
FOR ONLY HIV AND HIV PROGRAM
ALONE.
THERE WAS NO -- IT WAS EXCLUDED
BY CONGRESS THAT THOSE FUNDS
SHOULD NOT BE USED FOR RESEARCH.
IT DIDN'T TAKE LONG FOR THE
COMMUNITY TO RECOGNIZE THAT
THESE WOMEN LIVING WITH HIV HAVE
OTHER PROBLEMS, CARDIOVASCULAR
DISEASE, TYPIER TENSION,
CERVICAL CANCER, OTHER PROBLEMS
NOT HIV, THIS BEGAN TO EXPAND TO
HIV AND RELATED DISEASES IN
RECOGNITION THAT THESE ARE NOT
WOMEN WITH HIV, WOMEN LIVING
WITH HIV AND OTHER PROBLEMS TOO
AND BEGAN TO RECOGNIZE
OPERATIONAL RESEARCH AND
IMPLEMENTATION SCIENCE WAS
NEEDED IN ORDER TO BUILD OUT
UNDERSTANDING HOW BEST TO USE
STRATEGIES THAT WE KNOW HAVE
WORKED SOMEWHERE ELSE, ADAPT,
APPLY THEM IN THIS SETTING IN A
WAY WE CAN ADVANCE
MATERNAL/CHILD HEALTH.
ONE THING THE PROGRAM WAS PUT IN
THIS G11 GRANT, A SMALL GRANT OF
THIRTY THOUSAND, TO TAKE A U.S.
INSTITUTION, PAIR WITH LMIC
INSTITUTION, BE ABLE TO DEVELOP
GRANT MANAGEMENT OFFICES IN
THESE INSTITUTIONS THAT CAN
DRIVE THE RESEARCH.
THIS IS THE SAME FUNCTION
PERFORMED AND ORGANIZED BY
NATIONAL COUNCIL UNIVERSITY
ADMINISTRATION IN THE UNITED
STATES.
SO THROUGH THIS LITTLE FUND, IT
WAS VERY IMPORTANT YOU STARTED
TO SEE THIS THOSE COLLABORATIONS
BUILD BETWEEN THE UNITED STATES
AND THE LMICs, GIVING AN
EXAMPLE OF NIGERIA YOU'LL SEE
PROGRAMS FROM HARVARD UNIVERSITY
WALKING IN NIGERIA, CREATING 18
NIGERIA, INITIALLY A
COLLABORATION BETWEEN HARVARD
UNIVERSITY AND TRANSITIONING
NIGERIAN LEADERSHIP.
YOU SEE THE SAME THING WITH
UNIVERSITY OF MARYLAND WORKING
WITH NIGERIA, OVER TIME
TRANSITIONING TO LEADERSHIP IN
NIGERIA.
SAME WITH COLUMBIA UNIVERSITY
WORKING WITH NIGERIA AND ENDING
UP WITH CIAHP, SOME BUILD UPON
THIS SMALL GRANT, VERY IMPORTANT
GRANT THAT BUILT OUT RESEARCH
INFRASTRUCTURE NECESSARY FOR
THESE INSTITUTIONS TO MANAGE
FUNDS THAT THEY ARE GIVING, BE
ABLE TO FOLLOW THEM AND COMPLY
WITH RULES ACCORDING TO THE
FUNDING AGENCY FROM THE UNITED
STATES.
NEXT SLIDE.
ONE THING WE WERE LUCKY TO GET
AFTER SPENDING 25 YEARS IN THE
UNITED STATES, I DECIDED IT WAS
TIME FOR ME, I WENT TO MEDICAL
SCHOOL AT UNIVERSITY OF NIGERIA,
AND UNIVERSITY PRESIDENT ASKED
IF I COULD HELP DEVELOP
PROGRAMS, RESEARCH PROGRAM AT
UNIVERSITY.
WHEN I WENT BACK TO UNIVERSITY
OF NIGERIA ONE OF THE THINGS
SURPRISING TO ME WAS IN MY OLD
COLLEGE OF MEDICINE DEPARTMENT,
WITH BIOSKETCH, YOU UNDERSTAND
THAT HAVEN'T BEEN DOING A LOT OF
RESEARCH SO ONE OF THE FIRST
IMPORTANT THINGS TO DO WAS TO
APPLY FOR G11 TO BUILD
INFRASTRUCTURE THAT CAN ACTUALLY
HELP THEM MANAGE FUNDING WHEN
THEY DO RECEIVE THEM, THIS WAS
CRITICALLY IMPORTANT.
SO I SOUGHT COLLABORATION OF
VERY GOOD FRIEND OF MINE, GREG
ARONS, AT UC SAN DIEGO, MANAGING
$1.5 BILLION IN GRANT FUNDING, I
BELIEVE THEY UNDERSTAND HOW TO
MANAGE THIS FUNDING AND THEY
HAVE DONE IT, THEY CAN TEACH US
HOW TO DO IT.
THAT'S ONE OF THE FUNDING WE
GOT.
NEXT SLIDE.
WHAT WE DID WAS TO TRY TO
DEVELOP RESEARCH INFRASTRUCTURE
SO THAT THE SCIENTIFIC FOCUS ON
SCIENCE, WHAT HAPPENED FOR US IS
THAT AS WE GOT FUNDING AT
UNIVERSITY OF NIGERIA WE ALSO
UNIVERSITY OF NIGERIA HAPPENED
TO BE ORGANIZING AGENCY FOR
IMPLEMENTATION SCIENCE ALLIANCE,
FROM ALL THE SIX REGIONS OF THE
COUNTRY.
WHAT WE DID WAS INSTEAD OF
LIMITING THAT TRAINING FOR
UNIVERSITY OF NIGERIA, WE
EXPANDED TO 12 CENTERS ACROSS
SIX REGIONS OF THE COUNTRY.
THAT'S ONE OF THE THINGS KNOWING
WHEN YOU HAVE AN OPPORTUNITY TO
DO SOMETHING, DO YOU DO IT JUST
IN LIMITED OR INTEGRATE INTO
EXISTING PROGRAMS SO IN THIS
CASE WE HAVE EXISTING
PRACTICE-BASED RESEARCH NETWORK,
THIS NETWORK HAS MEMBER
ORGANIZATION ACROSS THE COUNTRY,
AND WE SAID, WELL, IF WE'RE
TRAINING UNIVERSITY OF NIGERIA
CAN WE INTEGRATE TO OTHER
INSTITUTIONS TO SET UP GRANT
MANAGEMENT APPLICATIONS TO THEM.
WE'RE CURRENTLY WORKING TO
INCREASE THIS NUMBER TO DOUBLE
THAT, THE PRINCIPLE IF YOU'VE
SEEN ONE, YOU TEACH ONE.
IF YOU DO THAT, YOU'RE ABLE TO
DOUBLE THAT.
THE WHOLE IDEA IS THAT NIH
CANNOT FUND EVERY SINGLE
INSTITUTION IN LMIC TO BUILD
THIS INFRASTRUCTURE BUT WHAT
IT'S DOING IS FUND INSTITUTIONS
WHO BECOME LIKE A HUB, AND
INSTITUTIONS ARE EXPECTED TO
TRAIN OTHER INSTITUTIONS.
THAT IS NOT HAPPENING WELL.
THOSE ARE SOME OPPORTUNITIES WE
SEE.
THEY DEVELOP THAT FUNDING
INSTITUTION, IT STAYS IN THAT
INSTITUTION BUT NOW THE
INSTITUTION HAS SEEN, HAS DONE,
WE THINK IT'S TIME FOR THAT
INSTITUTION TO TEACH AND THERE
BY EXPAND NUMBER OF INSTITUTIONS
TO BE ABLE TO DO THAT.
THAT'S SOME OF THE APPROACH
WE'RE TRYING TO USE IN EXPANDING
THAT TO THE NIGERIAN AALLIANCE,
TO EXPAND IN OTHER INSTITUTIONS.
NEXT SLIDE.
AND ONCE WE HAVE THESE
STRUCTURES TO MANAGE THE
WORKFORCE, YOU SEE MANY
PROGRAMS, D43s FROM NIH
INSTITUTES SUPPORTING TRAINING
OF WORKFORCE IN IMPLEMENTATION
SCIENCE AND CANCER RESEARCH,
HIV, CARDIOVASCULAR DISEASE,
SICKLE CELL DISEASE, YOU CAN SEE
STRUCTURE OF VERY IMPORTANT,
BEGINS TO TRAIN THE WORKFORCE,
IMPORTANT IN YOU'RE GOING TO
HAVE AN EFFECTIVE INNOVATION
THIS HAPPENS WHEN ONE SIDE IS
WELL EQUIPPED WITH KNOWLEDGE,
WITH EXPERTISE, WITH EXPERIENCE
AND THEIR CONTEXT, AND HAVE
EXPERIENCE WITH OWN CONTEXT AND
KNOWLEDGE, EFFECTIVE RECIPROCAL
INVASION, THESE TRAINING GRANTS,
ESPECIALLY K43, CRITICAL, WHEN I
WAS TRAINING THIS PART OF THE
GRANT WAS NOT AVAILABLE.
EQUIVALENT OF K08 K01 FOR U.S.
CITIZENS WHO DO RESEARCH IN
LIMITED SETTINGS.
YOU COULDN'T COMPETE IN THIS
GRANT.
BY LEVELING THE GRANT FIELD, I
USED TO TELL THEM NOW BECAUSE
YOU CAN COMPETE AMONG PEOPLE
WITH THE SAME BARRIERS YOU HAVE,
SAME CHALLENGES, BE ABLE TO
STAND OUT.
COMPETING WITH ME OR SOMEBODY
ELSE FROM HOPKINS OR ANY OTHER
UNIVERSITY, SAME K01 OR OTHER
GRANTS, SO THE K43 WAS SPECIFIC
GRANT NIH ESTABLISHED, BECAME
ONE OF THE FOUNDATIONS WHAT
WE'RE TALKING ABOUT TODAY,
RECIPROCAL INNOVATION, WHICH
WE'LL HAVE STARTED, TALKING
ABOUT TRAINING THE WORKFORCE IN
LMIC.
YOU GET THEM GETTING U54, BEGIN
TO DO RESEARCH THAT REALLY DRIVE
PRACTICE AND POLICY.
AND IT'S THIS PRACTICE AND
POLICY CHANGE THAT GO ON FOR
OVERALL HEALTH OUTCOME FOR
WOMEN.
NEXT SLIDE.
THIS IS SOMETHING PEOPLE FORGET,
TO CONDUCT RESEARCH, ESPECIALLY
IN LMIC, AS IT IS, IN OTHER
PLACE, THERE'S A CRITICAL
PARTNER IN THIS, RESEARCH
COORDINATORS, THE MID-LEVEL
RESEARCH PEOPLE THAT ARE NOT THE
P.I.s, NOT PhDs, NOT
M.D.s, BUT CRITICAL FOR US TO
DO RESEARCH WELL.
FOR A LONG PERIOD OF TIME
PhDs, M.D.s WERE THE FOCUS
AND TRAINED TO THE D43 BUT
THERE'S RECOGNITION THERE'S NEED
FOR TRAINING OF COORDINATORS AND
RESEARCH ENGAGEMENT OFFICERS,
THE IDEA CAME FROM OUR
EXPERIENCE CONDUCTING TRIAL IN
NIGERIA TRYING TO WORK IN THE
COMMUNITIES, IN RECOGNITION OF
IMPLEMENTATION SCIENCE THAT THE
IDEA OF HOSPITAL FACILITY BASED
SCREENING OF WOMEN FOR SEVERAL
DISEASES WAS NOT THE WAY TO GO,
THAT WE NEED TO BE ABLE TO REACH
THE WOMEN, ESPECIALLY IN
NIGERIA, WHERE 40% OF THE WOMEN
DELIVER IN HOSPITALS, 60% OF
THEM DELIVER IN THE COMMUNITY.
SO EVEN IF YOU'RE TO CAPTURE AND
SCREEN EVERY WOMAN, YOU'RE STILL
AT 40% OF WOMEN.
AT THE BEGINNING OF
IMPLEMENTATION SCIENCE IN
NIGERIA, IT WAS ONE OF THE FIRST
IMPLEMENTATION SCIENCE STUDIES
FUNDED IN NIGERIA, TO ACTUALLY
GO TO WHERE THE CONGREGATIONAL
CENTERS, CHUMPS, MOSQUES,
COMMUNITY CENTERS.
AS WE DID THIS WE RECOGNIZED
NIGERIA WITH 250 DIFFERENT
CULTURE AND DIFFERENT LANGUAGES
THAT WE NEEDED PEOPLE IN THE
COMMUNITY WHO ARE TRAINED TO BE
ABLE TO COMMUNICATE THE
COMMUNITIES, RESPECTING THEIR
CULTURE, ALSO ANSWERING THEIR
QUESTIONS AND HELPING THEM
UNDERSTAND THE PROJECT THAT
WE'RE DOING IN THIS COMMUNITY.
THAT'S HOW WE DEVELOP THE
COMMUNITY RESEARCH ENGAGEMENT
OFFICERS.
THEIR ROLE IS TO BE IN THE
COMMUNITY, EDUCATE THE COMMUNITY
ABOUT PROJECTS.
SO THEY WILL BE THE ONES TALKING
ABOUT BREASTFEEDING, IN THE
CHURCHES TALKING ABOUT SCREENING
FOR HYPERTENSION, WHY SHOULD YOU
SCREEN FOR SOMETHING THAT IS NOT
GIVING YOU ANY SYMPTOM?
CERVICAL CANCER, ALL THOSE
THINGS THAT HAPPEN IN THE
FACILITY WHEN THE WOMAN GOES
THERE, AN OPPORTUNITY TO LOOK AT
SOMEONE IN THE COMMUNITY AND ASK
THE QUESTIONS THEY NEED TO ASK.
SO BY THE TIME THEY ACTUALLY
APPEAR AT THE HOSPITALS, AND
THERE'S ENOUGH COURAGE TO
PARTICIPATE IN CLINICAL TRIALS
OR RESEARCH BY THE RESEARCH
COORDINATORS, THEY ALREADY
UNDERSTAND WHY THEY SHOULD BE
INVOLVED IN CLINICAL TRIALS, WHY
THEY SHOULD PARTICIPATE IN THESE
PROGRAMS, WHY THEY SHOULD AND
WHY -- HOW IT DOES AFFECT THEIR
OWN HEALTH OUTCOME.
THIS IS ONE OF OUR TRAINING
WHERE WE BROUGHT IN COMMUNITY
RESEARCH ENGAGEMENT OFFICERS AND
RESEARCH COORDINATORS FROM ALL
THE SIX REGIONS AND OTHER 36
SITES THAT WERE PART OF THE
PRACTICE-BASED RESEARCH NETWORK
IN NIGERIA.
NEXT SLIDE.
SO, ONE OF THE THINGS AS YOU
BEGIN TO GROW THIS NUMBER OF
INDIVIDUALS YOU BEGIN TO HAVE
P.I.s THAT ARE WELL
KNOWLEDGED, NOW DEVELOPED, NOW
CAN APPLY AND MANAGE GRANTS.
WE BEGIN TO THINK HOW YOU TAKE
THINGS THAT HAVE BEEN KNOWN TO
WORK WHICH IS WHAT I SEE
IMPLEMENTATION SCIENCE.
MY FRAY WAS FROM THE INFECTIOUS
DISEASE SPECIALIST, WHO STARTED
ASKING QUESTIONS WHY THINGS ARE
NOT WORKING.
IF WE KNOW PAP SMEARS HELP WOMEN
IDENTIFY CERVICAL CANCER EARLY,
IDENTIFIED EARLY, IT CAN BE
TREATED.
WHY IS ONLY 10% OF WOMEN WITH
HIV -- HAVE A PAP SMEAR DONE?
IF WE KNOW WE CAN HELP WITH
INDIVIDUAL THROUGH SICKLE CELL,
HOW COME ONLY 25% OF PEOPLE WITH
SICKLE CELL, IF YOU KNOW ASPIRIN
CAN HELP, HOW COME ONLY 10% OF
THOSE WITH PREVIOUS HEART
ATTACK.
THESE WERE THE QUESTIONS AT THE
TIME DID I NOT RECOGNIZE WERE
THE BRAIN OF IMPLEMENT SCIENCE.
WE HAVE THE INTERVENTION THAT WE
KNOW THAT WORKS.
HOW DO WE GET THEM IN PLACES,
INTEGRATE THEM IN PLACES WHERE
THEY ARE ACTUALLY LEADING TO
HEALTH OUTCOME, AND NO PLACE IS
THAT AS IMPORTANT AS LMICs,
NOT A LOT OF RESOURCES TO TRY
NEW THINGS, BUT THIS BELIEF I
DON'T HAVE A REFERENCE, IF WE
IMPLEMENT THINGS WE ALREADY KNOW
WE CAN SOLVE 80% OF THE PROBLEM
WHICH MEANS IT'S ONLY ABOUT 20%
THAT REQUIRES NEW INFORMATION.
SO, WHAT ABOUT WE START WITH
FIRST OF ALL THE THINGS WE KNOW
THAT WORK.
ADAPT THEM, IMPLEMENT THEM IN
THESE SETTINGS, BE ABLE TO DRIVE
THE CHANGE IN PRACTICE AND
CHANGE IN POLICY THAT WE HAVE
KNOWN THAT LEADS TO BET OUTCOME
FOR WOMEN.
ADAPTATION AND CO-CREATION
STRATEGY BECAME A FOCUS.
WE WANTED TO ADAPT THE NCC
GUIDELINES FOR CANCER, FOR
INDIVIDUALS LIVING WITH CHRONIC
DISEASE.
WE STARTED TO FOCUS ON TO CREATE
PALLIATIVE CARE PACKAGE FOR
COMMUNITIES WITHOUT PALLIATIVE
CARE EXPERT.
NEXT SLIDE.
SO ONE OF THE THINGS WE DID WAS
CO-CREATE PACKAGE FOR
INDIVIDUALS LIVING WITH SICKLE
CELL DISEASE.
WE ASKED INDIVIDUALS LIVING WITH
SICKLE CELL, STAKEHOLDERS, IT'S
IMPORTANT TO IDENTIFY EVERYONE'S
SICKLE CELL, COMMUNITY
ENGAGEMENT.
WHEN YOU ACTUALLY ASK PEOPLE WHO
IS THIS STAKEHOLDER, PEOPLE WILL
TELL YOU IT'S POLICYMAKERS, THE
PEOPLE WHO ARE IMPLEMENTING, IT
IS THE RESEARCHERS.
IF YOU FIND OUT FOR EACH DISEASE
WHO IS THE LOCAL PARTNER
ACTUALLY
WE ASKED THEM AND FIND
CONSISTENTLY AGAIN AS YOU SEE
THAT THE RELIGIOUS LEADERS WERE
VERY KEY PART OF STAKEHOLDERS IN
THEIR COMMUNITY, THEY WERE THE
IMAMS IN THE COMMUNITIES, WHAT
WE CALL THE TRIBAL HEALERS IN
THEIR COMMUNITIES, WHICH MAY NOT
EXIST IN OTHER PLACES BUT WE'VE
DONE RESEARCH THAT SHOWS BEFORE
WOMEN APPEAR IN THE HOSPITAL,
THAT THEY MAY HAVE GONE TO
TRADITIONAL HEALER WHERES MORE
THAN 60% COME TO HOSPITAL.
WE INVITED DIVERSITY OF PEOPLE
FROM THE SIX REGIONS OF THE
COUNTRY TO SIT DOWN AND SAY WHAT
IS PALLIATIVE CARE?
YOU KNOW, YOU THAT IS LIVING,
INDIVIDUALS LIVING CAN SICKLE
CELL, PEDIATRICS, ADULT, WHAT
DOCTORS TAKE CARE OF THEM, TO
BRING THEM TO THE TABLE.
IN EACH OF THE TABLE YOU HAVE
REPRESENTATIVES OF THESE
STAKEHOLDERS, MULTIPLE TABLES.
WE ASKED THEM TO PUT TOGETHER A
PALLIATIVE CARE PACKAGE FOR
INDIVIDUALS WITH CHRONIC DISEASE
BUT IN THIS CASE FOCUS ON THE
INDIVIDUAL WITH SICKLE CELL
DISEASE.
THIS IS ONE OF THE THINGS WE'VE
SEEN ADAPTATION OF THINGS WE
KNOW THAT WORK IN OTHER COUNTRY
TO LMIC IS CRITICAL BUT ALSO
ADAPTATION FROM DISEASE TO
DISEASE IS ALSO VERY IMPORTANT.
THERE'S A LOT WE CAN LEARN FROM
WHAT HAPPENED WITH HIV PROGRAM
AS WE ADDRESS SICKLE CELL
DISEASE, ADDRESS THE CHRONIC
DISEASES LIKE HYPERTENSION OR
CANCER.
BEING ABLE TO ADAPT AND
UNDERSTAND HOW TO ADAPT PROGRAMS
THAT ALREADY KNOWN TO WORK BUT
UNDERSTAND YOU PUT THEM IN A
DIFFERENT SETTING IS VERY
CRITICAL.
THAT'S ONE OF THE THINGS THE
ALLIANCE FOCUSED ON TRAINING THE
WORKFORCE TO DO IT, CREATING
RESEARCH ENVIRONMENT TO DO THAT,
BUT ALSO SUPPORTING THE PROGRAMS
THAT ACTUALLY FORM THE
FOUNDATION OF THE IMPLEMENTATION
SCIENCE ALLIANCE TO SAY HOW DO
WE MAKE IT BETTER AND HOW DO WE
ACTUALLY DISSEMINATE THAT AND
SCALE IT UP ACROSS THE COUNTRY.
NEXT SLIDE.
SO, THIS AGAIN COMES TO ONE
THING THAT IS DIVERSITY IN
CLINICAL TRIALS.
IT'S SOMETHING THAT FDA HAS
IDENTIFIED, SOMETHING THAT FDA
SET OUT IN FIVE YEAR GOAL TO
INCREASE DIVERSITY IN CLINICAL
TRIALS IN THE UNITED STATES.
IT'S SOMETHING THAT THE FDA
REPORTED THAT IT FAILED IN DOING
THAT.
THAT DESPITE FIVE YEARS OF
INVESTMENT, THERE'S STILL NOT A
GOOD DIVERSITY IN CLINICAL
TRIALS.
SO WHERE PEOPLE END UP TAKING
MEDICATION NEVER TRIED SOMEONE
THAT LOOKS LIKE THEM.
THE FDA HAS BEEN VERY FOCUSED ON
TRY TO INCREASE THAT DIVERSITY
IN CLINICAL TRIALS.
SO YOU CAN IMAGINE WHERE YOU SEE
COUNTRIES LIKE NIGERIA, THE
LARGEST COUNTRY IN AFRICA,
PARTICIPATING IN CLINICAL TRIALS
AT THE RATE OF 1.3%, 3%, 5%, YOU
SEE THE OPPORTUNITY TO EXPAND
RETENTION, RECRUITMENT OF PEOPLE
IN CLINICAL TRIALS.
THAT STARTS WITH THE COMMUNITY
ENGAGEMENT THAT WE TALKED ABOUT.
FOR EXAMPLE, THAT STARTS WITH
SOME OF THE THINGS YOU HAVE TO
DO IN THE COMMUNITY TO MAKE THEM
UNDERSTAND.
SO WHEN WE STARTED TO LOOK AT
OUR PROJECT, RESEARCH PROJECT
FUNDED BY NHLBI, COMMUNITY
SCREENING FOR HYPERTENSION,
WE'RE CHALLENGED FURTHER WITH
SOMETHING IN THE HOSPITALS, 12
HOSPITALS ACROSS THE SIX
REGIONS, STARTED DOING A DRS
TRAINING FOR DOCTORS AND NURSES
IN THOSE HOSPITALS.
YOU WOULD THINK THAT'S STANDARD
IN THE U.S. BUT EVERY DOCTOR AND
EVERY NURSE THAT WORKS IN A
HOSPITAL HAS THEIR BLS, BUT ONE
OF THE THINGS WE'RE TRYING TO DO
TO DEVELOP THIS PROGRAM TO
UNDERSTAND BASIC LIFE SUPPORT.
ALL OF THOSE TRAINING, ACTUALLY
ONE OF THE THINGS I'VE BEEN
SHOWING IF THERE IS A
CARDIOVASCULAR EVENT, WE'VE
NEVER WITNESSED, BEING ABLE TO
DEPLOY THINGS IN BLS HAVE SAVED
MORE LIVING THAN ALL ICUs, WE
STARTED TO FOLLOW THE SAME
PRINCE TELL, SEE ONE, DO ONE,
TEACH ONE.
ACTUALLY WHY NOT?
YOU DON'T NEED TO BE A DOCTOR OR
NURSE TO DO BLS.
THAT'S SOMETHING THAT YOU'RE
GOING TO SPREAD.
IF SOMEONE WERE TO DROP IN THE
AIRPORT IN NIGERIA, PEOPLE WILL
BRING OUT CELL PICTURES TO TAKE
PICTURES TO PUT ON FACEBOOK,
SECOND BEGIN TO SHOUT IN THE
NAME OF GOD, WHAT YOU WOULD NOT
SEE IS SOMEBODY THAT JUMPS OUT
AND STARTS BASIC LIFE SUPPORT,
TERM THAT WE THINK BY TRAINING,
BY INCREASING THAT KNOWLEDGE,
YOU CAN EXPAND SURVIVAL ALONG
THE WAY.
NEXT SLIDE.
SO WHEN YOU DO ALL OF THESE, IN
YOUR SMALL SPACE, EACH ONE OF
COURSE HERE TODAY OCCUPY A VERY
SMALL SPACE, NO MATTER HOW BIG
THE PROGRAMS OR KNOWLEDGE MIGHT
BE WE'RE QUITE A SMALL PLACE.
ONE OF THE THINGS IS TO FIND A
PLAT
PLATFORM TO SHARE LESSONS
LEARNED.
IN NIGERIA FOR EXAMPLE THERE ARE
PROGRAMS FUNDED THAT DO NOT
WORK, WE SEE THAT FUNDED BY NIH,
SET UP DOES NOT WORK.
THE NEXT YEAR FUNDED BY W.H.O.
TO DO THE SAME THING WE KNOW
DOES NOT WORK.
SO THAT'S, AGAIN, BECAUSE THERE
IS THIS LACK OF DISSEMINATION OF
THINGS THAT HAPPEN.
BY THE WAY STUDIES HAVE ALREADY
BEEN PUBLISHED IN "LANCET,"
PRESENTED IN VERY GOOD
CONFERENCE IN WASHINGTON, D.C.
BUT YOU COME TO THE CAPITAL OF
NIGERIA, THEY SAY WHAT IS THAT?
THEY NEVER HEARD THE STUDY.
FIRST TIME IN NIGERIA, I
REMEMBER HAVING THE MINISTER OF
HEALTH IN A CONFERENCE IN
NIGERIAN ALLIANCE, HE USED TO
WRITE LETTERS OF SUPPORT FOR
PEOPLE WRITING A GRANT AND NEVER
HAD SOMEBODY COME BACK TO TELL
HIM, OH, WE GOT THE GRANT.
WHICH WAS IMPORTANT.
ONE OF THE THINGS WE'RE TRYING
TO DO IS BECAUSE THAT'S THE
EFFECT OF ENGAGEMENT OF
STAKEHOLDERS, THE GOVERNMENT,
THE GRANT IS SUPPORTED IN
WRITING, NOW YOU HAVE THE
FUNDING, IMPLEMENT IN THE
COUNTRY, YOU WANT POLICYMAKERS
INVOLVED TO LOOK FORWARD TO THE
RESULT THAT COMES THERE.
SO THE LIKELIHOOD OF ADOPTING
THOSE RESULTS WHEN THEY COME IS
CRITICAL AND IS IMPORTANT.
SO THAT EARLY ENGAGEMENT IS
CRITICAL.
ONE OF THE THINGS WE SET OUT
FOUR MAIN PLATFORMS.
ONE IS WEEKLY RESEARCH IN
PROGRESS.
THAT IS OPEN TO ANY INVESTIGATOR
IN NIGERIA WHO IS DOING
IMPLEMENTATION SCIENCE,
PRESENTING THE WORK, GET INPUT
FROM PEOPLE DOING SIMILAR WORK
IN DIFFERENT DISEASE AREAS, THEY
CAN HAVE THAT COMMUNITY OF
SHARED KNOWLEDGE.
THE OTHER THING IS MONTHLY
RESEARCH WEBINARS BRINGING IN
EXPERTS IN NIGERIA AND OUTSIDE,
BE ABLE TO HAVE THEM TALK ABOUT
SPECIFIC TOPICS.
THE QUARTERLY RESEARCH IS ONE OF
THE MOST POPULAR.
WE BRING IN EXPERTS, WE BRING IN
SOMEONE THAT DID THE FRAMEWORK,
WHO IN NIGERIA HAS USED THE
FRAMEWORK IN THEIR STUDY, PAY
THEM TO DELIVER THIS CONFERENCE.
THAT'S OUR BEGINNING PART OF
SEEING EQUAL LEADERSHIP, EQUAL
INVOLVEMENT, AND ANNUAL
IMPLEMENTATION SCIENCE, THIS
YEAR IN ABUJA WITH GLOBAL
INFORMATION SOCIETY.
NEXT SLIDE.
THIS IS JUST AN EXAMPLE OF THAT
IMPLEMENT SCIENCE.
YOU SEE WHAT WE'RE TALKING ABOUT
HERE.
YOU SEE A LOT OF INDIVIDUALS
FROM THE U.S., FROM AUSTRALIA,
WITH THEIR OWN EXPERTISE.
ALSO WHETHER WE'RE LOOKING ABOUT
WHERE IS THOSE AFRICANS WHO HAVE
USED THESE FRAMEWORKS, USED
THESE MODELS AND THEORIES IN
THEIR WORK.
HE TALK ABOUT SCIENCE
COMMUNICATION, TALK ABOUT EQUITY
IN RESEARCH, TALK ABOUT
IMPLEMENTATION SCIENCE
ENVIRONMENT.
YOU TALK ABOUT PRACTICE-BASED
RESEARCH NETWORKS, HOW THEY HAVE
EFFECT.
WE PAIR WITH PEOPLE IN THE
COUNTRY WHO HAVE ACTUALLY DONE
THIS, WHO UNDERSTAND THE CONTEXT
SPECIFIC TO THAT LMIC AND BE
ABLE TO DO THAT.
NEXT SLIDE.
THIS IS THE CONFERENCE THAT I
MENTIONED.
I HOPE MOST OF YOU CAN COME.
IF YOU WORK IN NIGERIA, IT'S AN
IMPORTANT PLACE BECAUSE THE
GOVERNMENT IS THERE.
THEY HAVE ALWAYS BEEN THERE.
NIH HAS ALWAYS BEEN THERE,
STARTED WITH THE FOGARTY
INSTITUTE IN 2015, AND SINCE
THEN THEY HAVE BEEN AT THIS
CONFERENCE EACH YEAR, EVERY YEAR
SINCE THEN.
THEY RECOGNIZE HOW MUCH IT HAS
DONE, FROM THIS ORGANIZATION,
EXPANDING OUT OF NIGERIA TO
OTHER COUNTRIES.
NEXT SLIDE.
AND THIS IS MY LAST SLIDE, I
WANT TO TALK ABOUT WHAT DAN SAID
WHEN HE TALKED ABOUT A CONNECTED
CULTURE.
WHAT WE WANT TO TALK ABOUT IS
INNOVATION, IMPORTANT FOR US TO
UNDERSTAND WHAT WE REALLY MEAN
BY A CONNECTED CULTURE.
A CONNECTED CULTURE STARTS WITH
RECIPROCAL LEADERSHIP, WHETHER
THERE'S MEETING OF EQUALS.
ONE THING NIH HAS DONE THAT GOT
IT RIGHT, THE IDEA OF MULTIPLE
P.I.s.
MULTIPLE P.I.s WAS A WAY TO
RECOGNIZE IF YOU'RE CONDUCTING
STUDY IN TANZANIA, YOU HAVE A
TEAM OF PEOPLE WHO IS GOING TO
GO INTO HOUSEHOLD AND INTERVIEW
60 HOUSEHOLD OF MUSLIM WOMEN,
THAT THOSE PEOPLE KNOW, TELLING
YOU THE CULTURE, THINGS WILL
ALLOW THESE PEOPLE, DO MARRIAGE,
SIT ON THE TABLE, RECOGNIZE THAT
LEADERSHIP WAS SOMETHING NIH HAS
DONE THAT I PERSONALLY THINK
HAVE INCREASED THAT DEVELOPMENT
OF THE SUPERVISION OF PEOPLE IN
LMICs WORKING WITH INDIVIDUALS
COMING IN, NO LONGER SHIFTED
FROM JUST THE PERSON WORKING ON
IT, THE PERSON RUNNING AROUND,
BUT THE RESEARCH TO THE TABLE
WHERE YOU ACTUALLY HAVE
SOMETHING TO BRING TO THE TABLE,
AND MULTIPLE P.I. YOU SHARE IN
THAT LEADERSHIP, ONE OF THE
THINGS DONE VERY WELL.
COLLABORATIVE LEARNING, THOSE
THINGS WE'RE TALKING ABOUT,
INSTEAD OF JUST HAVING ONE
PERSON GIVE LECTURES LET'S HAVE
TWO PEOPLE, I WANT TO TALK ABOUT
THE EPIS FRAMEWORK IN AFRICA,
HAVE THE COLLABORATIVE LEARNING,
THE EARLY ENGAGEMENT, CONSISTENT
STRATEGY NECESSARY.
I KNOW I HAVE 10 TO 15 MINUTES
TO DO THIS BUT I HOPE THAT I
HAVE OPENED UP SOME OF THE
DISCUSSION THAT'S GOING TO
HAPPEN IN THESE TWO DATES, EACH
OF THESE AREAS IS EXPANDED MORE.
I HOPE TO BE ABLE TO CONTRIBUTE
IN THE DISCUSSIONS OF OUR
EXPERIENCE COMING IN FROM MY
WORK HERE IN LAS VEGAS AND MY
WORK IN NIGERIA.
THANK YOU SO MUCH FOR HAVING ME
HERE.
THANK YOU.
>> THANK YOU SO MUCH, DR.
EZEANOLUI, FOR AN AWESOME
PRESENTATION.
WE DON'T HAVE DR. CREAR-PERRY
WITH US AT THIS TIME.
WE'LL OPEN UP FOR COMMENTS AND
QUESTIONS FOR DR. EZEANOLUI AND
WHILE PEOPLE ARE TEEING UP
QUESTIONS IN THE Q&A SECTION I
HAD A COUPLE OF QUESTIONS FOR
YOU, DR. EZEANOLUI, KIND OF
TYING INTO THE LASTING -- ONE OF
THE LAST THINGS ABOUT THE
CONFERENCE COMING UP, THAT THE
GOVERNMENT, THE DECISION MAKERS
AND POLICYMAKERS ARE ALWAYS
THERE.
SO WHAT IS IT THAT YOU CAN SHARE
WITH US REGARDING LESSONS
LEARNED ABOUT HAVING THE
COMMITMENT AND THE CONSTANT
INVOLVEMENT OF DECISION MAKERS
AND POLICYMAKERS WITH THE WORK
YOU'RE DOING IN COUNTRY?
>> SO, YES, THAT'S VERY
IMPORTANT.
I WAS MENTIONING ACTUALLY START
AT THE TIME YOU'RE APPLYING FOR
A PROJECT.
SO IF I AM APPLYING FOR RESEARCH
PROJECT, I ALWAYS MAKE SURE
THERE IS A POLICYMAKER BECAUSE
WHAT IS THE USE OF MY RESEARCH
IS THE RESEARCH IS JUST TO BE
PUBLISHED AND SHARED IN SOME BIG
JOURNAL THAT NOBODY -- WE ALL
KNOW ABOUT IMPLEMENTATION
SCIENCE, 1 1 -- 17 YEARS TO BE
IMPLEMENTED INTO PRACTICE.
ONE IS HOW WE FORM ORGANIZATION,
SECOND IS THE GOVERNMENT.
WHEN I GET A LETTER FROM THE
MINISTER OF HEALTH, PUBLIC
HEALTH DEPARTMENT, I TELL THEM
ABOUT THIS PROJECT WE'RE
PLANNING TO DO SO THEY ARE
NOT -- WE HAVEN'T EVEN GOTTEN
THE PROJECT, WRITE A LETTER TO
SAY THEY SUPPORT THE IDEA.
THEY KNOW WHAT WE'RE TRYING TO
DO.
SECOND, WE GOT THE FUNDING, I GO
BACK AND SAY WE GOT THE FUNDING,
AND I'M EXCITED.
I USE THAT OPPORTUNITY TO
EXTRACT IS IT OKAY IF I COME
BACK EVERY SIX MONTHS TO TELL
YOU HOW WE'RE DOING?
THE MINISTER SAYS OF COURSE.
THEN I GO BACK TO START THE
IMPLEMENTATION.
WHAT IT DOES, HE IS ACTUALLY
PART OF THAT PROJECT EVERY STEP
OF THE WAY.
SIX MONTHS, I COME BACK AND SAY,
YOU KNOW, WE'RE DOING SO WELL
RECRUITING 25% OF OUR SAMPLE
SIZE, THIS IS WHAT WE'RE LOOKING
AT.
YOU GET THEM INVOLVED AT EVERY
STAGE.
AT THE CONFER INSURES, IN EVERY
MEANING SINCE 2012 THE MINISTER
OF HEALTH HAS BEEN THERE.
HEAD OF AGENCIES HAVE ALL BEEN
THERE, IMPORTANT, THESE ARE THE
PEOPLE TO ADOPT IT.
YOU'RE JUST THE RESEARCHER.
YES, YOU PUBLISH, YOUR
COLLEAGUES KNOW WHAT YOU'RE
DOING BUT WHAT ABOUT THE PEOPLE
WHO ARE GOING TO MAKE IT PART OF
THEIR PRACTICE AND PART OF
POLICY MAKING?
SO EARLY ENGAGEMENT.
SUSTAINED ENGAGEMENT A WAY TO
MAKE SURE POLICYMAKERS,
IMPLEMENTING PARTNERS ARE
PARTNERS FROM THE BEGINNING AND
REMAIN SUSTAINED PARTNERS TO THE
END.
YOU NEED THEM WHEN YOU START TO
IMPLEMENT AND WHEN YOU
DISSEMINATE, WHEN YOU ADOPT
THOSE THINGS INTO POLICY.
THANK YOU SO MUCH.
>> YOU'RE VERY WELCOME.
I HAVE A FOLLOW-UP QUESTION TO
THAT, KNOWING THAT
IMPLEMENTATION SCIENCE, ALTHOUGH
NOT A NEW-NEW FIELD FROM SCRATCH
BUT THOSE OF US AND OTHERS ARE
STILL LEARNING ABOUT
IMPLEMENTATION SCIENCE SO WHEN
YOU ARE ENGAGING WITH THE
POLICYMAKERS AND DECISION
MAKERS, HOW ARE YOU MAKING THEM
QUOTE/UNQUOTE SCIENTIFICALLY --
[CROSSTALK]
>> ONE THING IS WHAT I ALREADY
EMPHASIZE, THERE'S A DIFFERENCE
BETWEEN IMPLEMENTATION SCIENCE
AND CLINICAL TRIALS IN THE WAY
WE UNDERSTOOD IT BEFORE.
A CLINICAL TRIAL IS WE'RE TRYING
TO TRY A NEW VACCINE FOR HIV,
TRYING TO SEE WHETHER OR NOT IT
WORKS.
IN A THE LOT OF IMPLEMENTATION
SCIENCE, WE KNOW INTERVENTION
WORKS, THAT'S A DIFFERENCE FOR
ME, THERE'S AN EVIDENCE FOR WHAT
WE'RE TRYING TO IMPLEMENT.
YOU'RE SAYING, YOU KNOW, THIS
THING HAS WORKED IN KENYA, ANY
HAS WORKED IN THE U.S.
THIS HAS WORKED IN SOUTH AFRICA.
THIS IS HOW WE WANT TO SEE
WHETHER THIS WILL WORK HERE LOOK
AT THE CONTEXT OF THE LARGEST
COUNTRY IN AFRICA, CAN THIS WORK
HERE?
SO THIS UNDERSTANDING, THIS IS
NOT SOMETHING THAT WE DON'T KNOW
THAT WORKS.
THIS IS SOMETHING WE KNOW THAT
WORKS.
SO HOW CAN WE ACTUALLY DO THAT
HERE IN A WAY -- YOU'RE SETTING
THE STAGE IF THIS WORKS, WILL WE
STARTED PRACTICE-BASED NETWORK
IN NIGERIA, WE SELECTED TWO
SITES FROM EACH REGION, CALLED
THEM MODEL RESEARCH AND
INNOVATION CENTER, THE IDEA IF
WE TRY EVERYTHING IN EACH OF
THOSE REGIONS WE HAVE ONE
INTERVENTION, ONE CONTROL SIDE,
DEPENDING ON STUDY SIDE, IF THAT
INTERVENTION WORKS WELL SCALING
UP THE GOVERNMENT CAN SEE MODEL
SITES, MODEL SITES IN THEIR
COMMUNITY, WE'RE NOT TALKING
ABOUT THE UNITED STATES BUT
SOUTH AFRICA, MODEL SITES IN
NIGERIA THAT HAVE DONE THIS.
THAT INVOLVEMENT AT THE
BEGINNING MAY BE THE BEST
AUDIENCE.
WHAT I'M NOTICING WHEN YOU TALK
TO THEM AS YOU APPLY FOR THAT
APPLICATION, SO NOT JUST THEY
WROTE YOU A LETTER, I DON'T JUST
GET A LETTER FROM THEM, NO, I
DON'T THINK THAT'S THE RIGHT WAY
TO DO IT.
I WANT TO EXPLAIN WHAT WE'RE
THINKING OF DOING.
GOING BACK TO SAY WE GOT IT,
THAT MAKES THEM -- THEY ARE NOT
LISTED, I SAY MISSING
INVESTIGATOR IN ALL THE GRANTS,
MINISTER FOR HEALTH DOES KNOW
WHAT'S GOING ON.
>> YES.
THANK YOU.
WE NOW HAVE DR. CREAR-PERRY.
I'M GOING TO PRESS PAUSE ON Q&A
AND GO BACK TO DR. CREAR-PERRY
TO GIVE HER AN OPPORTUNITY TO
PRESENT.
THANK YOU, AND WELCOME SO MUCH.
WE'RE NOT ABLE TO HEAR YOU.
YOU MIGHT BE ON MUTE.
THERE YOU ARE.
>> THANK YOU, I'M SO SORRY FOR
THE TARDINESS.
BLAME MY HEAD AND NOT MY HEART.
MY LIFE HAS BEEN A LITTLE
CHAOTIC LATELY.
WHEN I CAN GET ON A FEW MINUTES
TO SEE FAMILY MEMBERS, IT'S
EXCITING TO BE ABLE TO BE PART
OF THIS.
WE'RE GOING TO TALK ABOUT BLACK
MATERNAL HEALTH,
TRANSNATIONALLY, AND I'M GOING
TO SAY NEXT SLIDE TO WHOEVER IS
RUNNING MY SLIDES IF THAT'S
OKAY.
GREAT.
WE'LL GIVE HISTORICAL CONTEXT
ABOUT BIRTH EQUITY, DISCUSS
DEVELOPMENTS IN THE UNITED
STATES, DISCUSS HOW INEQUITIES
IN INFANT HEALTH ALSO CAUSE
PROBLEMS, AND IGNORE THE NEW
JERSEY PART, I COPIED AND PASTED
AN OLD SLIDE.
THE MISSION OF THE
COLLABORATIVE, NOW NINE YEARS
OLD, TO CREATE TRANSNATIONAL,
THE REASON I'M SPECIFIC ABOUT
THAT LANGUAGE, TRANSNATIONAL,
NOT GLOBAL, AS A BLACK AMERICAN
THEY USE WORDS LIKE GLOBAL SAY
THE U.S. IS SPECIAL SOMEHOW FROM
THE REST OF THE WORLD.
WE KNOW VERY MUCH SO THAT
TRANSNATIONALLY WE LEARNED FROM
THE COLLEAGUES IN KENYA AND
COLLEAGUES IN BRAZIL AND
COLLEAGUES AROUND THE WORLD SO
INSTEAD OF MAKING IT SEEM LIKE
WE'RE SPECIAL IN THE UNITED
STATES, ESPECIALLY CONSIDERING
WE HAVE THE WORST MATERNAL
HEALTH OUTCOMES IN THE WORLD, E
WANT TO BE PART OF THE BLACK
DIASPORA, LEANING INTO
TRANSNATIONAL INSTEAD OF USING
THE TERM GLOBAL BECAUSE LANGUAGE
MATTERS, PEOPLE HAVE BEEN USING
LANGUAGE TO HARM US, WE'RE GOING
TO RECLAIM TO SO SHOW
SOLIDARITY.
WE WANT TO THRIVE, LIVE OUR BEST
LIVES.
OUR SKIN IS POPPING, WE SHOULD
BE ABLE TO THRIVE, THAT MEANS
INSTANT HEALTH, SEXUAL HEALTH,
PEOPLE ARE NOT JUST BORN TO GET
PREGNANT AND MAKE BABIES.
REPRODUCTIVE HEALTH SO IF YOU
WANT TO HAVE A BABY YOU SHOULD
HAVE WELL-BEING, NOT JUST IN THE
HOSPITAL BUT DO YOU HAVE FOOD,
DO YOU FEEL SAFE, DO YOU HAVE
SPIRITUAL HEALING, ALL THE
THINGS THAT ALLOWS YOU TO
OPTIMIZE TRANSNATIONAL BLACK.
WE'RE BLACK, NOT AFRICAN
AMERICAN, BECAUSE ALTHOUGH FOR
TEN GENERATIONS MY FAMILY HAS
BEEN HERE SINCE STOLEN FROM THE
CONTINENT OF AFRICA MY BLACKNESS
IS ETHNICITY, IT'S A CULTURE, A
FEELING, A SPIRITUALITY, SO WE
CHOSE TO USE THE TERM BLACK
INSTEAD OF AFRICAN AMERICAN.
WE DO THIS THROUGH SHIFTING
SYSTEMS AND CULTURE BECAUSE IF
YOU JUST DO POLICY WITHOUT
SHIFTING HOW YOU FEEL AND THINK
AND MOVE, HOW THE SPIRIT MOVES
WITHIN YOU, YOU'RE NOT GOING TO
HAVE CHANGES IN YOUR HEALTH
OUTCOMES.
THAT'S THROUGH TRAININGS, WE DO
RESEARCH, TECHNICAL ASSISTANCE,
POLICY, ADVOCACY, COMMUNITY
CENTER COLLABORATION.
OUR VISION IS ALL BLACKS AROUND
THE WORLD, MAMAS, BABIES, AND
VILLAGES THRIVE.
NEXT SLIDE PLEASE.
OUR FOCUS IS MIXTURE OF CLINICAL
AND SOCIAL, AS ONOB/GYN WE WORK
TO DISMANTLE ON THE SOCIAL
DETERMINANTS OF HEALTH.
NEXT SLIDE PLEASE.
SO I HAD THE HONOR OF PRESENTING
AT THE U.N. MANY TIMES, BUT
FIRST TIME I NEVER HEARD OF THE
TERM IN THE UNITED STATES HUMAN
RIGHTS.
WE TALK ABOUT CIVIL RIGHTS BUT
IF YOU ASKED THE AVERAGE U.S.
CITIZEN WHAT HUMAN RIGHTS MEAN,
THEY COULD NOT TELL YOU.
JOE BIDEN IS THE FIRST U.S.
PRESIDENT TO SAY OUT LOUD THAT
HEALTH IS A HUMAN RIGHT.
SO IF HEALTH IS A HUMAN RIGHT,
THAT MEANS WE NEED TO KNOW NOW
THAT WE HAVE AGREED HEALTH IS A
HUMAN RIGHT IN THIS COUNTRY, WE
SHOULD LEARN WHAT HUMAN RIGHTS
ARE.
EVERY OTHER HIGH INCOME NATION
BELIEVES THE MOMENT YOU TAKE A
BREATH ... YOUR FIRST BREATH,
RIGHT?
WHEN YOU'RE BORN, THAT WOULD BE
MIKE MY SECOND CHILD WHO WEIGHED
LESS THAN A POUND WHEN BORN, 445
GRAMS, TOOK A FIRST BREATH ...
HE WAS FULLY HUMAN.
HE HAD THE RIGHT TO ALL THE
THINGS THAT MAKE ONE FULLY
HUMAN, RIGHT?
UNLIKE IF YOU WERE PREGNANT IN A
TUBE YOU'RE NOT HUMAN, YOU'RE
CELLS.
BUT THE MOMENT YOU TAKE A FULL
BREATH, YOU'RE A FULL SPIRIT,
HAVE YOU THE RIGHT WITHOUT
DISTINCTION OF RACE, COLOR, SEX,
LANGUAGE, RELIGION, POLITICAL OR
OTHER OPINION, NATIONAL OR
SOCIAL ORIGINAL YOU'RE ENTITLED
TO RIGHTS AND FREEDOMS SET
FORTH, RIGHT TO LIFE, LIBERTY,
SECURITY, OF ALL PERSONS,
STANDARD OF LIVING ADEQUATE FOR
HEALTH AND WELL-BEING OF
YOURSELF AND YOUR FAMILY.
AND MOTHERHOOD AND CHILDHOOD ARE
ENTITLED.
YOU HAVE A STANDARD BECAUSE YOU
TAKE A BREATH ... WHEN YOU'RE
BORN BUT MAMAS AND BABIES HAVE
SPECIAL PROTECTION BECAUSE WE
KNOW IF YOU AS A COUNTRY, A
GROUP OF PEOPLE, AS A HUMAN
BEING, CAN'T CARE FOR MOMS AND
BABIES AND PROTECT THEM, WHAT
ARE YOU HERE FOR?
NEXT SLIDE PLEASE.
SO REPRODUCTIVE JUSTICE MOVEMENT
WAS STARTED 30 YEARS AGO, 30th
ANNIVERSARY, BY 12 BLACK WOMEN,
FOUNDING MOTHERS, FOUNDING
MOTHERS OF REPRODUCTIVE JUSTICE.
IN 1994, THIS IS A PICTURE OF
MAMA LORETTA, THE TENETS ARE YOU
CAN DECIDE IF AND WHEN YOU WISH
TO HAVE A CHILD, SHOULD BE ABLE
TO PARENT THOSE CHILDREN IN SAFE
AND SUSTAINABLE COMMUNITIES, NOT
BEING AFRAID OF POLICE HARASSING
YOU, STALKING YOU, MAKING SURE
YOUR CHILD CAN PLAY OUTSIDE
WITHOUT BEING HARASSED,
ESPECIALLY IN THE UNITED STATES
WITH ROLLING BACK OF RIGHTS,
ABORTION RIGHTS BEING TAKEN
AWAY, TALKING ABOUT
CONTRACEPTION BEING TAKEN AWAY,
NOT BEING ABLE TO MOVE REFUGEES,
TALKING ABOUT BUILDING A WALL,
BUILDING A BARRICADE, WITHOUT
CREATING A SYSTEM FOR NOT HAVING
SEX TRAFFICKING, TRAFFICKING OF
CHILDREN, THE RIGHT TO PERSONAL
BODY AUTONOMY IS A GLOBAL RIGHT
BOLD BACK FROM AUTHORITARIANS
FROM PUTIN TO DONALD TRUMP.
WE HAVE TO FIGHT HARD AS A
COLLECTIVE MOVEMENT TO ENSURE
THAT WE'RE SAFE, THAT WE DON'T
LET FOLKS EITHER AUTHORITARIANS
ON THE CONTINENT, PLACES LIKE
KENYA OR PLACES LIKE RURAL
LOUISIANA WHERE I'M FROM.
NEXT SLIDE PLEASE.
THESE ARE A COUPLE BOOKS THAT AS
WELL.
REPRODUCTIVE JUSTICE, YOU HEAR
WHITE WOMAN TALK BIT ABOUT IT S
ABORTION.
I'M NOT HERE TO SAY YOU
SHOULDN'T HAVE THE RIGHT TO FULL
RANGE OF CARE, ALL THAT IS PART
OF HEALTH CARE.
I'M BE A OB/GYN, REPRODUCTIVE
HEALTH CARE IS WHAT WE PROVIDE.
THINGS LIKE ABORTION,
CONTRACEPTION, TUBAL LIGATION,
IUDs, INFERTILITY, ACCESS TO
MAKING SURE YOU DON'T BLEED TO
DEATH, DON'T HAVE INFECTION,
STDs, CHLAMYDIA, WE'RE SHOWING
WE'RE ONLY IMPORTANT TO CREATE
CAPITALISM, BODIES TO BE USED BY
WHITE MEN TO MAKE THEM MONEY.
WE'RE BIGGER THAN A UTERUS OR
VAGINA.
EDUCATION, INTIMATE PARTNER
VIOLENCE, PARENTING, BIRTHING
OUTCOMES, HIV, DISTANCE PORE
TAIGS, WE DON'T HAVE A RAILWAY
SYSTEM IN THE UNITED STATES,
FROM D.C. TO NEW YORK BUT THE
REST OF THE COUNTRY WE STILL
TREAT IT AS IF YOU NEED A GREEN
BOOK IF YOU'RE OF COLOR TO MOVE
FROM ONE PLACE TO ANOTHER.
HOUSING INSECURITY, PAY EQUITY,
CIVIL RIGHTS, ROLLING BACK
VOTING RIGHTS IN THIS COUNTRY,
ALL OF THESE.
WE DON'T WANT REPRODUCTIVE
CHOICE, A GROUP OF WOMEN TO WHO
CANNER ON CAPITOL HILL TO CHOOSE
WHICH OF THESE ISSUES WE HAVE
LEGISLATION FOR.
WE ALL HAVE -- IT'S IMPORTANT
FOR US -- SORRY, I SEE SOMEONE
HAS SOMETHING IN THE CHAT.
>> WE'LL DO QUESTIONS WHEN
YOU'RE COMPLETE WITH THE
PRESENTATION.
>> SOUNDS GREAT!
PERFECT FOR ME.
SO WE DON'T WANT A GROUP OF
WOMEN, WHITE WOMEN, BLACK WOMEN,
WHOEVER, TO BE IN D.C., CAPITOL
HILL, DECIDING WHICH ISSUES.
WE WANT ALL OF THEM EVERY YEAR,
TO FOCUS ON SEX ED, RACISM,
REPARATIONS, WE INSIST ALL
PEOPLE ACROSS THE WORLD WHO HAVE
BEEN OPPRESSED GET FREEDOM.
THAT'S REPRODUCTIVE JUSTICE.
NEXT SLIDE PLEASE.
SO HERE ARE SOME PEOPLE I WORK
WITH.
I ALREADY MENTIONED MAMA
LORETTA, RIGHT HERE.
THIS IS MONICA.
MONICA IS OVER SISTER SONG, THE
ORGANIZATION HOUSED IN ATLANTA,
THIS COMES FROM BLACK WOMEN'S --
THE ORGANIZATION THAT DOES THE
BLACK WOMEN REPRODUCTIVE JUSTICE
POLICY AGENDA, REGINA MOSS IS
THE LEADER HERE IN D.C.,
POLICIES AREN'T BLACK WOMEN'S
HEALTH.
AS RESEARCHERS ESPECIALLY AT NIH
YOU COME WITH A FRAMEWORK, WOULD
BE WHITE SUPREMACIST, EUGENESIS,
IF YOU PERCEIVE I'M BROKEN
BECAUSE I HAVE BLACK SKIN YOU'LL
SAY THINGS LIKE IF ONLY DR. JOIA
WOULD HAVE FEWER BABIES HER
BIRTH OUTCOME WOULD BE BETTER,
YOU SHOULD HAVE NO MORE THAN TWO
CHILDREN PER FAMILY, WHEN WE
KNOW PEOPLE LIKE DONALD TRUMP
FROM EIGHT CHILDREN, CLEARLY --
OR SIX MANY, HOWEVER MANY, THREE
DIFFERENT WOMAN, CLEARLY HAVING
PROBLEMS WITH HEALTH OUTCOMES,
THIS IDEA WE MUST LOOK AT A
PERSON BASED UPON OUR EUGENESIS
AND RACIST BELIEF AND PICK
INDICATORS IS WHAT WE MUST GET
FREEDOM FROM.
HOW WE SEE THE WORLD INSTEAD OF
WRITE SUPREMACY, PATRIARCHAL,
I'VE BEEN MARRIED TWICE, WE
WOULDN'T PICK MARITAL STATUS
INDICATOR SHOULD BE SOCIAL
SAFETY, SOCIAL SAFETY AND
CONNECTEDNESS, JUST BEING
MARRIED IF YOUR HUSBAND IS
ABUSING YOU DOESN'T MAKE YOU
SAFE AND DOESN'T PROTECT YOU.
JUST BEING MARRIED IF YOU'RE
BOTH UNDERRESOURCED AND LIVED IN
A COUNTRY THAT DOESN'T PROVIDE
FOR HOUSING, FOOD, SAFE PLACE TO
SLEEP AT NIGHT, IS NOT GOING
TO -- JUST MARRYING SOMEBODY
WON'T SAVE ARE YOU FROM HARMS OF
RACISM.
BIRTH EQUITY, A PHRASE WE USE, A
TERM I CREATED IN 2015, MANY
ORGANIZATIONS UTILIZE IT NOW AS
THE FRAMEWORK HOW THEY SEE THEIR
WORK INCLUDING AMERICAN NURSING
ASSOCIATING FOR POSTPARTUM
NURSES IN AMERICA.
IT'S NOT THIS IDEA IF I POINT MY
FINGER YOU'RE GOING TO DO BETTER
BECAUSE I SAY SO.
IT'S MY JOB AS A SYSTEM, MY JOB
AS A HUMAN BEING, TO ASSURE YOU
HAVE THE CONDITIONS FOR OPTIMAL
BIRTH, LIKE I SAID, YOU CAN
STRIFE AND THRIVE, BECAUSE
WHITENESS IS NOT THE GOAL.
FOR ALL PEOPLE.
SO YOU HAVE TO BE WILLING TO
ADDRESS RACIAL AND SOCIAL
INEQUITIES IN A SUSTAINED
EFFORT.
NEXT SLIDE PLEASE.
SO WHAT'S THE HISTORICAL
CONTEXT?
NEXT SLIDE PLEASE.
EVERYTHING, EVERYTHING FROM MY
COLLEAGUE DR. McCLEAN,
EVERYTHING IS A THING WITH A
SEVENTY RELATIONS.
REQUIRES WE KNOW SOMETHING ABOUT
HOW IT AROSE, AND DEVELOPED, AND
HOW IT FITS INTO THE LARGER
CONTEXT OR SYSTEM OF WHICH IT IS
A PART.
IT IS IMPORTANT TO NOTE WHEN WE
SPEAK THE SYSTEMS AND
INSTITUTIONS LIKE NIH OR LIKE
YOUR NON-PROFIT OR, I DON'T
KNOW, THE PENTAGON OR THE
KREMLIN, THAT IT'S BASED ON
PARTICULAR SET OF RULES AND
RELATIONS.
NEXT SLIDE PLEASE.
SO REPRODUCTIVE JUSTICE, THIS IS
A FAMOUS PAINTING, ONE OF OUR
FOUNDING FATHERS, WE LOVE HIM,
HE'S GREAT.
I LOVE HIM AS WELL.
HOWEVER, BEHIND THE SHAME,
SOMETHING WE'VE NEVER TALKED
ABOUT, BLACK WOMEN WHO ENSURED
HE WAS ABLE TO DO HIS JOB.
SO FROM 1619 TO 1719, I HOPE
YOU'VE SEEN THE 1619 PROJECT, WE
HAD NO BODY AUTONOMY, FOR 100
YEARS, STILL BEING STOLEN FROM
AFRICA, COULDN'T DECIDE IF AND
HOW TO GET PREGNANT.
ONCE THEY BANNED THE
TRANSATLANTA SLAVE TRAIT IN 1720
SLAVERY WAS STILL LEGAL, ANOTHER
100 YEARS AS THE MAIN ECONOMIC
ENGINE OF THE UNITED STATES OF
AMERICA, AS PRODUCING ENSLAVED
HUMAN BEINGS, OUR JOB AS BLACK
WOMEN, PEOPLE WHO ARE WHITE IN
THIS COUNTRY TODAY BECAME RICH,
OUR BODIES WERE THE FACTORY.
THERE WAS A FOCUS FROM 1821 TO
1921, COULD NO LONGER UTILIZE
LEGALLY, REPRESS OUR ABILITY
BECAUSE WE WERE NO LONGER
USEFUL.
YOU SEE INCREASE IN EUGENICS,
FAMILY PLANNING, DESIRE TO SAY
YOU NASTY DIRTY WOMEN, PLEASE
STOP HAVING BABIES, PLEASE STOP
HAVING SEX.
BLAME-EUGENICS TO TODAY.
>> YOU HAVE TWO MINUTES AND WE
HAVE TO GO TO Q&A.
THANK YOU.
>> PERFECT.
WHAT ARE THE SOCIAL DETERMINANTS
OF HEALTH?
THE CONDITIONS IN WHICH PEOPLE
ARE BORN, GROW, LIVE, WORK, AGE.
AND THESE CIRCUMSTANCES ARE
SHAPED BY DISTRIBUTION OF MONEY,
POWER, RESOURCES THAT THE
GLOBAL, NATIONAL, AND LOCAL
LEVELS.
SO EXAMPLES, GLOBALLY WE HAVE A
GLOBAL TRANSNATIONAL TRADE,
HOUSING, EDUCATION, HEALTH CARE,
PUBLIC SAFETY.
WE HAVE TO LOOK AT EVERY LEVEL
TO ENSURE WE CAN ALL THRIVE.
THAT'S IT.
THANK YOU.
WE CAN GO TO
QUESTION-AND-ANSWER.
>> THANK YOU SO MUCH.
I'M GLAD YOU WERE ABLE TO MAKE
IT.
WE'RE GOING TO GO BACK TO THE
QUESTION-AND-ANSWER SESSION.
I HAD A QUESTION THAT I WANTED
TO JUST WRAP UP WITH DR.
EZEANOLUI AND THEN TAKE
QUESTIONS.
>> IF YOU WANT ME TO STAY
AROUND, WHATEVER FITS YOUR
SCHEDULE.
I APOLOGIZE FOR MY LATENESS.
>> PLEASE STAY, IF YOU'RE ABLE
TO STAY, THERE MAY BE QUESTIONS
FOR YOU.
THANK YOU SO MUCH.
DR. EZEANOLUI, I WANTED TO ASK
ONE MORE QUESTION BEFORE I WENT
TO THE Q&A SECTION.
IT WAS REGARDING THE G11, HOW
THE INFRASTRUCTURE HAS IMPACTED
CLINICAL RESEARCH AS YOU
MENTIONED DIVERSITY IN CLINICAL
TRIALS.
HOW HAVE YOU LEVERAGED THE
INFRASTRUCTURE THAT YOU BUILT
WITH THAT G11 AWARD FOR CLINICAL
TRIALS?
>> THANK YOU SO MUCH.
SO, IF YOU REMEMBER, I TALKED
ABOUT THE PRACTICE BASED
RESEARCH NETWORK.
OF THE TWO SITES WE TAKE FROM
EVERY REGION OF THE COUNTRY, SO
THOSE 12 MODEL AND INNOVATION
RESEARCH CENTER WE CALL THEM
WERE PROGRAMS, HIGH VOLUME
PROGRAMS.
TO BE PART OF THE SITE YOU MUST
HAVE AT LEAST 1,000 WOMEN OF
CHILD BEARING AGE WITH HIV IN
YOUR PROGRAM.
SO THAT TELLS US THAT SERVES A
LARGE POPULATION, TO HAVE UP TO
1,000 WOMEN OF CHILD BEARING AGE
WITH HIV.
IN THAT PLACE.
THAT'S HOW THEY WERE SELECTED.
SOME SITES HAVE 2,000.
SO WHEN WE GOT THIS G11 ONE
THING WE TRIED TO DO WAS TAKE
THE 12 PROGRAMS AND TRAIN THEM
IN SETTING UP THE INFRASTRUCTURE
SO THAT EACH OF THOSE SITES
REPRESENTS A CENTER.
IT'S NOT LIKE JUST FUNDING.
WE GOT LIKE I SAID G11 IS VERY
SMALL FUNDING BUT VERY EFFECTIVE
FUNDING BECAUSE OF WHAT IT DID
FOR US, RELYING THAT PARTNERSHIP
WITH UC-SAN DIEGO, THEY TRAVELED
TO NIGERIA FOR TWO WEEKS BUT
INSTEAD OF US TAKING PEOPLE TO
UC SAN DIEGO, THEY CAME TO
NIGERIA FOR TWO WEEKS, WE
BROUGHT ALL THE COORDINATORS
FROM 12 SITES.
WE ENDED UP WITH 24 PEOPLE, ENDS
UP WITH 13 SITES.
THAT EXPANSION OF BEING ABLE TO
HANDLE PROJECTS, ONE OF THE
THINGS THEY DID, AFTER THE
TRAINING, WAS ACTUAL THROW BEGIN
TO TALK TO WOMEN ABOUT CLINICAL
TRIALS AND TO SAY, WILL YOU
PARTICIPATE IN CLINICAL TRIALS,
YOU WON'T BELIEVE THIS.
THEY HAVE 10,000 WOMEN SIGN A
CONSENT THAT THEY WOULD LIKE TO
BE APPROACHED WHEN THERE'S A
CLINICAL TRIAL OPPORTUNITY.
TEN THOUSAND SIGNED A CONSENT.
THIS IS NOT A CONSENT FOR ANY
PARTICULAR STUDY.
THIS IS A CONSENT THAT IF
THERE'S A CLINICAL TRIAL, WE
WANT TO BE -- YOU CAN CONTACT
US.
THEY GIVE THEIR CONTACT, THEIR
CONSENT TO CONSENT WITH CLINICAL
TRIAL.
THAT'S HUGE.
WHAT WE DID EMBARK ON A SECOND
PART, 10,000 WOMEN WITH HIV,
WEPT BACK TO HAVE AGE-MATCHED
10,000 WITHOUT HIV, IN THE END
WE'LL HAVE A 20,000 COHORT,
10,000 WITH HIV, 10,000 AGE
MATCH WITHOUT HIV.
WITH NO FUNDING.
YOU CAN WE ALREADY HAVE A GRANT
THAT IS ONGOING ON THE FUNDING
FOR NHLBI, FROM NCI, FOR
CERVICAL CANCER.
WE UTILIZE PEOPLE WORKING IN THE
PLACE TO DO THAT.
I TALK ABOUT BREAKING DOWN
SILOS.
JUST BECAUSE FUNDING IS FROM
NIH, FUNDING IS FROM NCI,
FUNDING IS FROM NHLBI, IF YOU
HAVE PEOPLE ON THE SITE WE CAN
USE THAT TO ENHANCE CARE FOR
WOMEN.
IF A WOMAN IS COMING IN FOR
EXAMPLE WITH CERVICAL CANCER,
WHY CAN'T SCREEN FOR BREAST
CANCER, SOMETHING WE'RE BUILDING
CLINICAL TRIAL, WITH THAT
STRUCTURE IN THERE TO SAY NOW
WE'RE DOING SOME OF THIS TO SAY
IF A WOMAN COMES IN, OUR FUNDING
IS FOR CERVICAL CANCER BUT WHILE
THEY ARE WAITING, CAN YOU GET
BLOOD PRESSURE?
THAT'S SOMETHING YOU CAN DO.
CAN YOU TEACH THEM HOW TO DO
BREAST SELF-EXAMINATION,
SOMETHING YOU CAN DO.
INTEGRATING AND BREAKING SILOS
OF FUNDING IS ONE OF THE WAYS TO
LOOK AT THESE INSTITUTIONS, LOOK
AT THEIR INFRASTRUCTURE,
FLUBBING HUMAN CAPITAL AND IN
PROGRAM.
>> I WANTED TO ASK DR.
CREAR-PERRY IF YOU HAVE ANYTHING
TO ADD AS RELATES TO BUILDING
TRUST.
>> EVERYTHING YOU SAID WAS MIND
BLOWING, HONESTLY.
I COULD TALK TO YOU FOR AN HOUR
ABOUT ALL OF THIS.
WE CAN'T GET BLACK PEOPLE IN THE
UNITED STATES TO SIGN UP FOR
CLINICAL TRIALS.
LET'S JUST START WITH THAT.
WE HAVE TO PAY THEM, BRIBE THEM.
THEY HAVE BEEN HARMED SO MUCH BY
THE HEALTHCARE SYSTEM THAT
USUALLY WHITE INSTITUTIONS COUNT
ON RELATIONSHIPS OF SMALL BLACK
PROVIDERS, PATIENTS, TO SEE IF
THEY WILL ASK THEM.
TO GET 10,000 TO VOLUNTEER, ALSO
WITH THE SMALL AMOUNT OF MONEY
YOU HAD, IN ORDER TO DO THIS
AMAZING WORK I'M IMPRESS AND
GRATEFUL, REMINDS REMINDS ME OK
HERE WITH SMALL BUDGETS.
BIGGEST WE GOT FOR $4 MILLION,
BIG FOR A NON-PROFIT, BUT
COMPARED TO -- I'M ON THE BOARD
OF UCSF SO THEY GIVE OUT
BILLIONS OF DOLLARS AROUND
HEALTH CARE AND DON'T GET THE
OUTCOMES WE GET.
WHAT THIS SAYS TO ME WHEN YOU
INVEST IN THE PEOPLE CLOSEST TO
THE PAIN, YOU ACTUALLY GET
PROGRESS.
WHEN YOU KEEP INVESTING IN LARGE
INSTITUTION WHO IS HAVE TO ASK
US HOW TO DO THE WORK WE'LL KEEP
HAVING THE POOR OUTCOMES WE
CURRENTLY HAVE.
THAT'S MY COMMENT.
>> YEAH, I WAS WONDERING IF HAD
YOU SOME EXAMPLES OF THINGS YOUR
COLLABORATIVE IS DOING WHERE YOU
ARE BUILDING THE TRUST AND HOW
THAT HAS BEEN IMPACTING JUST THE
HEALTH CARE, THE OUTCOMES, THE
COMMUNITY.
>> BUILDING TRUST IS HARD.
WE'VE BEEN HARMED SO MUCH, THERE
WAS A TIME I WOULD START WITH
ALL THE BUTTERFLIES AND RAINBOWS
ABOUT THE WORK.
RIGHT NOW I START WITH THE
TRAUMA.
I WOULDN'T TO PULL BACK AND
START SELLING SOME OF THE GOOD
THINGS WE'VE BEEN ABLE TO DO,
BUILD TRUST WITH RESPECT FOR
MATERNAL CARE TOOLKIT, WORKING
WITH ORGANIZATIONS LIKE KAISER
HOSPITAL SYSTEM, THE LARGEST
NON-PROFIT IN THE UNITED STATES,
TO WORK ON TRUST BUILDING,
TEACHING THE SAME TALK I JUST
GAVE, WE DON'T LEARN THAT IN THE
UNITED STATES.
YOU'LL KEEP BLAMING AND SHAMING
PATIENTS.
TRUST BUILDING STARTS WITH THE
TRUTH, HISTORY OF REPRODUCTIVE
OPPRESSION, THE SAME TALK TO
BUILD TRUST WITH THE ENTIRE
GATES FOUNDATION, I WAS THE
ANNUAL KEYNOTE SPEAKER.
WE'RE NOT GOING TO BE ABLE TO
BUILD TRUST ON LIES.
THE BEGINNING, YOU HAVE TO TELL
TRUTH HOW WE GOT HERE AND THEN
TALK ABOUT HOW WE CAN BUILD
TRUST AND GET THROUGH THE
TRAUMA.
>> THANK YOU SO MUCH.
FOR THOSE WHO HAVE QUESTIONS, IF
YOU COULD ENTER IT IN THE Q&A
SECTION, THAT WOULD BE HELPFUL.
I'M TRYING TO GO THROUGH SOME
QUESTIONS AND COMMENTS IN THE
CHAT, SO JUST BE PATIENT WITH ME
ON THAT.
ONE OF THE QUESTIONS ACTUALLY
IT'S A COMMENT FROM THE DIRECTOR
OF THE CENTER FOR TRANSLATION
RESEARCH AN IMPLEMENTATION
SCIENCE, OUTSTANDING
PRESENTATION, THANKS FOR YOUR
PRACTICE REAL WORLD STRATEGY FOR
ENGAGING POLICYMAKERS AND
CLARIFYING DIFFERENCE BETWEEN
EFFICACY, EFFECTIVENESS
RESEARCH, IMPLEMENTATION SCIENCE
RESEARCH, DR. GEORGE MENSAH.
I'M NOT SURE IF YOU WANT TO COME
OFF THE MIC AND VIDEO AND SAY A
FEW WORDS.
>> OH, I'D LOVE THAT.
>> MAYBE HE'S DEPARTED.
IF HE COMES BACK, I'LL BRING HIM
BACK TO SAY A COUPLE OF WORDS.
THERE'S ALSO A COMMENT ABOUT
TRANSLATING SCIENCE INTO POLICY
CONSUMABLE KNOWLEDGE PRODUCTS
SUCH AS POLICIES, BRIEFS,
POSITION PAGES, BULLETINS AND
BLOGS IS CRITICAL IN INFORMING
POLICYMAKERS.
DR. CREAR-PERRY, HOW IS YOUR
EXPERIENCE WITH THAT HERE IN THE
UNITED STATES?
>> I WOULD SAY FIRST TIME WAS
BACK IN 2016.
I DON'T KNOW IF YOU'VE HEARD
ABOUT THE BLACK MAMAS MATTER
ALLIANCE, BLACK WOMEN ARE DYING
IN THE UNITED STATES DESPITE
INCOME OR EDUCATION, HIGHER THAN
WHITE COUNTERPARTS.
WE HAD A HILL BRIEFING.
I CALLED MY FRIEND IN RICHMOND,
THE CHAIR OF CONGRESSIONAL BLACK
CAUCUS AT THE TIME, WE GOT THIS
DATA BLACK WOMEN ARE DIEING IN
CHILD BIRTH, WE WANT TO SHARE
AND NEED A ROOM.
HE GAVE US HEARING ROOM, BROUGHT
THE PRESIDENT OF THE AMERICAN
COLLEGE OF OB/GYN, THE SECOND
BLACK PERSON TO LEAD THIS AND
BRING IN ADVOCATES, DR. JACKSON,
YOU MAY BE FAMILIAR WITH, SHE
DID RESEARCH THAT SHOWED IF YOU
HAVE POLICE VIOLENCE IN A
COMMUNITY YOU'LL HAVE HIGHER
RATES OF INFANT MORTALITY.
IT'S NOT THAT THE POLICE ARE
PHYSICALLY SHOOTING MAMAS,
ALTHOUGH THEY RECENTLY DID, THE
STRESS OF HAVING SO MUCH POLICE
INFLUENCE IN YOUR COMMUNITY
MAKES YOU GO INTO LABOR EARLIER,
HORMONES ARE HIGHER.
WE'RE ABLE TO SHOW POLICYMAKERS
RACISM IS REAL AND CAUSES
BIOLOGICAL HARM TO YOUR BODY SO
ALTHOUGH A LOT OF COLLEAGUES
SPEND TIME LOOKING AT THE
BIOLOGICAL IMPACTS OF RACISM, TO
LOOK FOR A PILL OR SHOT, WE'RE
LOOKING FOR POLICYMAKERS TO
CHANGE POLICIES CAUSING RACISM
TO HARM OUR BODIES IN THE FIRST
PLACE.
>> JUST TO FOLLOW UP FROM YOU,
FROM DR. GEORGE MENSAH, THANK
YOU FOR THE OUTSTANDING
PRESENTATION, DR. CREAR-PERRY,
APPRECIATE YOU DELIVERING THIS
DESPITE THE CHALLENGES YOU
MENTIONED.
HE'S NOW ON VIDEO AND AUDIBLE.
WOULD YOU LIKE TO MAKE A
COMMENT?
>> THANKS A LOT.
IT'S BEEN A TERRIFIC WAY TO
BEGIN THE MORNING.
I WANTED TO MENTION REAL
APPRECIATION FOR THESE TWO
EXCELLENT PRESENTATIONS.
SO THANKS FOR GIVING ME THE
OPPORTUNITY.
BUT I WAS IN THE MIDDLE OF
ACTUALLY TYPING ANOTHER COMMENT,
SO I HAVE THE FLOOR LET ME GO
AHEAD AND SAY IT.
DR. CREAR-PERRY, I WAS MOVED BY
YOUR COMMENT IN YOU INVEST IN
THE PEOPLE CLOSEST TO THE PAIN,
YOU GET THE GREATEST PROGRESS.
AND I COMPLETELY AGREE WITH YOU.
SO THE QUESTION TO YOU, GIVEN
WHAT WE'VE HEARD FROM BOTH OF
YOU, HOW DO THE TWO OF YOU PUT
YOUR HEADS TOGETHER TO IDENTIFY
THE UNIQUE OPPORTUNITY FOR NIH
AND NHLBI TO BE ABLE TO IDENTIFY
THE 10,000 WOMEN, NOT JUST BLACK
WOMEN, BUT BLACK WOMEN,
INDIGENOUS WOMEN, AND WOMEN WHO
BEAR A HUGE DISPROPORTIONATE
BURDEN, HOW DO WE DO THE SAME
THING HERE, WHAT ARE YOUR
THOUGHTS BY WAY OF IDENTIFYING
OPPORTUNITIES?
>> I AM CURIOUS IF YOU'RE
RELATED TO ANY DR. MENSAH'S IN
NEW ORLEANS.
>> VIRTUAL COUSINS.
>> I WOULD SAY I WOULD BE SO
HONORED.
THIS IS WHAT THE WORK THAT OUR
TRANSNATIONAL TEAM WAS TRYING TO
DO TO SHOW EXPERIENCE AND IDEAS
YOU HAVE ALREADY CREATED IN
NIGERIA TO GET THESE 10,000
WOMEN, HOW CAN WE LEARN FROM YOU
SO WE CAN SHOW UNDERSTANDING WE
HAVE ABOUT RACISM BEING
OPERATIONALIZED.
I WAS TRAINED IN CONFEDERATE
MEDICINE, WHAT I CALL IT.
I UNDERSTAND THE SPOTS INSIDE
THE HEALTH CARE.
BLACK WOMEN MORE LIKELY TO DIE
IN HYPERTENSION, WE CAN USE HIV,
WE'VE KNOWN FOR DECADES BLACK
WOMEN ARE THE MOST LIKELY TO
HAVE HIV.
WE'VE BEEN DECREASING THE NUMBER
OF BLACK WOMEN IN THE UNITED
STATES.
WHEN YOU SAY THOSE NUMBERS HERE
THEY SEEM LARGE BECAUSE WE'VE
STARTED TO IMPLEMENT SOME THINGS
HERE BUT WE DON'T HAVE THE TRUST
THAT YOU HAVE IN NIGERIA, WHAT
IF WE COULD USE BOTH THE
MECHANICAL MEDICAL THINGS WE
LEARNED HERE PLUS TRUST OF
NIGERIA TO BUILD A GLOBAL WAY TO
END HIV GLOBALLY, INSTEAD OF
GIVING VACCINES AFTER THE FACT.
>> TAKING THIS MESSAGE TO THE
POPULATION, YOU TALK -- WE NEVER
PUBLISH A STUDY UNTIL WE PROVIDE
DATA TO THE COMMUNITY WHERE WE
DID THE STUDY.
SO THIS IS NO LONGER JUST ABOUT
PUBLICATIONS FOR US.
SO WHEN WE FINISH, WE GO BACK,
FOR EXAMPLE WHEN WE DID THE BABY
SHOWERS WE WENT, SOMETHING
HAPPENING IN THE U.S., WE WENT
TO WHERE THE PEOPLE ARE SO IF
YOU WANTED TO LOOK AT, EVEN IF
YOU'RE LOOKING AT PEOPLE MOST
AFFECTED, NEW IMMIGRANTS FOR THE
UNITED STATES, MOST OF THEM GO
TO THEIR PLACE OF WORSHIP, A
CHURCH, A MOSQUE, NOT READING A
JOURNAL IN "LANCET," RIGHT?
ONE THINGS WE DO IS GO BACK TO
THE COMMUNITIES, WE SCREENED IN
BABY SHOWER SCREENED 10,000
WOMEN, 7,000 MALE PARTNERS FOR
HIV AND SICKLE CELL.
AND HYPERTENSION.
THIS IS BECAUSE WHAT WE DID IN
THAT STUDY PEOPLE SAID NIH IS
NOT GOING TO FUNDS THIS.
THIS IS ALL ABOUT HIV.
I SAID THE WOMEN DOESN'T HAVE
HIV ALONE.
WHEN YOU DO HIV ONLY SCREENING
THAT'S STIGMATIZING THE WOMAN.
YOU KNOW, THAT'S NOT -- SO WEIR
WE WROTE A PROPOSAL OF BABY
SHOWER, AN AMERICAN CONCEPT.
>> IT IS.
>> WE JOINED BOTH OF THEM TO
PRESENT THIS INFRASTRUCTURE OF
THE BABY SHOWER WHERE TWO
DIFFERENT CULTURES, BUT
INTEGRATED APPROACH TO TESTING
SO BECAUSE YOU TAKE A BLOOD FROM
A WOMAN, I CAN DO HIV ON IT BUT
WHY CAN'T I DO SICKLE CELL AND
HEPATITIS B ON IT?
I HAVE THE SAME SAMPLE OF BLOOD.
THE WOMAN ABOUT COME BACK FROM
FOGARTY, ANOTHER INSTITUTION,
WE'RE GOING TO COLLECT YOUR
BLOOD, I HAVE THE SAMPLE.
TO PUT THE WOMAN AT THE CENTER
OF THE INTERVENTION, NOT THE
FUNDING, AND THE FUNDING STREAMS
TO SUPPORT THAT INTERVENTION.
SO WHEN WE DO THAT WE CAN GO
BACK TO COMMUNITIES AND TALK TO
THE COMMUNITIES, WE PICK
DISEASES SOMETHING WE COULD DO.
WE TALKED ABOUT NUTRITION DURING
PREGNANCY, TALKED ABOUT BLOOD
PRESSURE.
TALKED ABOUT DIABETES, HEPATITIS
B.
EVERYTHING THAT WE TAKE THERE WE
HAVE SOMETHING THAT CAN BE DONE.
IT'S NOT, YOU KNOW, CLINICAL
TRIAL TO IDENTIFY NEW THINGS.
IT'S WHAT CAN BE DONE THAT WE
ALREADY KNOW THAT WORKS.
WE TAKE THEM BACK, IN YOUR
COMMUNITY THIS IS A NUMBER OF
WOMEN SCREEN FOR HIV POSITIVE,
THIS IS THE NUMBER SCREENED FOR
HEPATITIS B, WE LINKED THEM TO
CARE SO THESE WOMEN WITH
HEPATITIS B THEIR CHILDREN WILL
GET FIRST DOSE IN THE HOSPITAL,
WHY THEY NEED TO DELIVER IN THE
HOSPITAL TO CHILDREN CAN GET
THAT BECAUSE MAJORITY OF
TRANSMISSION FOR HEPATITIS B IS
HERE.
WE TALK ABOUT SICKLE CELL, IF A
WOMAN IS A-S, WHEN WE SCREEN,
THERE'S A CHANCE FOR THE WOMEN
IRRESPECTIVE OF THE MALE PARTNER
A CHANCE FOR THAT PERSON TO HAVE
SICKLE CELL, MALE PARTNERS HAVE
A-S.
WE ARE TRYING TO PUT THAT POWER
ON 25% OF THOSE WOMEN THAT
SCREEN FOR AS, FOR SICKLE CELL.
TAKING THAT MESSAGE BACK TO THEM
INSTEAD OF FOCUSING ON
PUBLISHING THEM, TO TAKE BACK TO
THE COMMUNITY TO GIVE THEM THAT,
EVEN WHEN YOU PUBLISH, PART OF
THE PUBLICATION THEIR NAME IS
NOT THERE.
>> ONE STATEMENT ABOUT
PUBLICATION, IS THAT OKAY?
YEAH?
>> YES, GO AHEAD.
>> GREAT.
IN THE U.S., WE'RE TRYING TO
CHANGE THE PUBLICATIONS BECAUSE
IT'S PEER REVIEWED.
THERE ARE NO PEERS FOR THE WORK
YOU AND I DO.
THINK ABOUT WHAT WE TALKED
ABOUT. SO TRANSFORMATIONAL.
WHEN I SEND IN ARTICLES ABOUT
RACISM WHAT PEER DO I HAVE?
WE NEED TO THINK ABOUT CREATING
NEW JOURNALS, WE'RE TRYING TO
HOLD "THE LANCET," WHICH I'VE
WRITTEN MANY ARTICLES TO, IT'S
EASIER TO FINDS PEERS IN
"LANCET" THAN SOME OTHER ONES
BUT UNTIL WE CAN CHANGE THE IDEA
WHAT A PEER IS AND WHO YOU SEE
AS A PEER BECAUSE WHITE
SUPREMACY NEVER SEES US AS THEIR
PEER.
>> WE HAVE TIME FOR ONE MORE
QUESTION BEFORE WE GO TO BREAK.
THIS IS A QUESTION REGARDING
SELF-ADVOCACY FOR BOTH OF YOU.
IT'S A MAJOR ASPECT OF THE
MATERNAL EXPERIENCE.
WHAT IS YOUR ORGANIZATION DOING
TO HELP WOMEN, HOW DO YOU HELP
WOMEN SELF- ADVOCATE.
I'LL START WITH YOU.
>> I WAS ALREADY JUMPING IN.
>> I'M ALREADY SELF-ADVOCATING.
>> EXACTLY.
IT'S THE ONLY WAY WE CAN LIVE
TRUTHFULLY.
I'VE BEEN -- MY ORGANIZATION
THAT HAS
BEEN FOCUSING ON MAKING SURE
WE'RE NOT DOING IT BY OURSELVES.
WE'VE BEEN SUPPORTING EACH OTHER
SINCE HARRIETT TUBMAN, SHE TOLD
HER HUSBAND HE COULDN'T LIVE IF
HE WAS ENSLAVED.
HOW WE MAKE SURE WE HAVE
SUPPORT, TO ADVOCATE IS GETTING
INFORMATION, MAKING SURE YOU
NEVER GO SOMEWHERE BY YOURSELF.
WHEN I HAD MY SON WHO WEIGHED
LESS THAN A POUND, I DROVE
MYSELF TO THE HOSPITAL.
DIDN'T ASK MY THEN-HUSBAND TO
DRIVE ME, I DROVE.
NOT A GOOD IDEA.
BLACK WOMEN HAVE TO LET OTHERS
TAKE CARE OF THEM, TO NOT FEEL
LIKE WE HAVE TO TAKE OVER AND
THE WORLD NEEDS TO MEET US
THERE.
SO THAT'S WHERE I AM TRUTHFULLY.
>> DR. ECHE?
>> WHEN I CAME TO THE UNITED
STATES FROM NIGERIA 30 YEARS AGO
SOMEBODY TOLD ME NO MATTER HOW
GOOD THEIR PLAYER IS, A COACH
HAS TO PUT HIM ON THE PLAYING
FIELD.
I SCRATCH MY HEAD.
I HAD NOBODY.
I DIDN'T KNOW WHO IS GOING TO
PUT ME ON THE COACH, WHO IS THE
COACH, FIRST OF ALL, TO PUT ME
AS A PLAYER IN THE PLAYING
FIELD?
COACH, HE PUT YOU ON THE BENCH,
YOU'RE GOING TO BE BENCH, NOBODY
WILL SEE HOW GOOD YOU ARE.
THAT PRINCIPLE CAME BACK TO ME
WHEN WE'RE CREATING
INTERVENTIONS, THAT'S WHEN WE
NEED TO REMEMBER THAT AT THAT
POINT WE'RE ALSO THE COACH.
WE NEED TO BRING THAT COME IN,
IN THOSE PLACES AS A PLAYER.
THAT THE PEOPLE WITH THE LIVED
EXPERIENCE ARE THE EXPERTS.
WHEN I STUDY, WHAT DO I KNOW?
WHEN I KNOW A WOMAN WITH
HYPERTENSION, HEART BREAK, LOST
A BABY, HAD THAT EXPERIENCE, BUT
IN THAT TIME I'M THE COACH, NOT
THE PLAYER.
THEY HAVE A ROLE.
I THINK RESEARCHERS HAVE TO
REMEMBER THAT CO-CREATION IS A
VERY CRITICAL PART OF HOW YOU
TAKE THIS INFORMATION DOWN TO
THE POPULATION, BUT ALSO HOW YOU
EMPOWER WOMEN TO BECOME
SELF-ADVOCATE BECAUSE IN BEING
PART OF THAT CO-CREATION HAVE
LIVED EXPERIENCE.
IT'S WHAT WE'VE DONE AS AN
ORGANIZATION, WE'RE NOT SAYING
EVERY PROGRAM, EVERY
INTERVENTION, THERE MUST BE A
PROCESS OF CO-CREATION, TRYING
TO DEVELOP PALLIATIVE CARE FOR
SICKLE CELL DISEASE, I HAVE A-S,
I ADVOCATE IF YOU GO TO MY
LINKED IN EVERY SEPTEMBER I PUT
A POST ABOUT MY HAVING A.S. SO
PEOPLE CAN UNDERSTAND.
WHEN I WANTED TO GIVE -- I MET
MY WIFE, SHOOK HER HAND, I'M
A.S.
SHE STARTED LAUGHING.
THE TRUTH, BECAUSE MY DAD, THEY
TOLD ME ABOUT IT.
I SCREENED, MY DAD KNOW HE WAS
A.S., AND THEN HE GOT A WIFE NOT
SO, I HAVE GENOTYPE, HE TOLD ME
I WANT YOU TO KNOW ABOUT IT.
WHEN I KNEW ABOUT IT, I PUT IT
FORWARD.
MY SON HAVE A.S.
I PUT THAT OUT THERE.
BEING ABLE TO TALK ABOUT IT, THE
SAME WAY YOU MAKE YOURSELF, SO
IN SOME CASES I AM ADVOCATING
FOR MYSELF, MAKING PEOPLE TO
GIVE THEM THE -- TO SAY YOU CAN
TALK ABOUT THESE THINGS.
I'M TALKING ABOUT MY OWN.
YOU CAN TALK ABOUT YOUR OWN.
ALSO REMEMBERING WHEN YOU'RE THE
COACH TO PUT THEM ON THE PLAYING
FIELD SO THEY CAN ADVOCATE FOR
THEMSELVES.
>> GO AHEAD REALLY QUICK.
>> THAT'S THE AFRICAN
AMERICANNESS OF US TRUTH --
THAT'S THE AFRICANNESS.
WHEN YOU'RE THE PATRIARCHY,
SOMETIMES YOU'RE THE HIERARCHY.
NEW ORLEANS IS THE MOST IN THE
UNITED STATES, SOMETIMES YOU'RE
THE COACH, SOMETIMES YOU'RE THE
PLAYER.
>> I WOULD LIKE TO THANK YOU
BOTH FOR YOUR KEYNOTES, FOR YOUR
TIME, SUPPORTING THIS WORKSHOP.
WE'LL TAKE A BREAK EARLY, WE'RE
TRYING TO SHIFT THE PROGRAM FOR
EASE OF OTHER SPEAKERS.
WE'LL BREAK NOW AND THEN WE'LL
RECONVENE AT 11:25.
IT'S A QUICK BREAK BUT WE'LL
COME RIGHT BACK. THANK YOU.
>> WE HAVE FOUR RESEARCHERS FROM
AROUND THE WORLD, THROUGH THE
LENS OF IMPLEMENTATION SCIENCE.
I WILL ONLY BRIEFLY INTRODUCE
EACH PANELIST BEFORE THEIR
TALKS.
REFER TO THE WORKSHOP BOOKLET
FOR INFORMATION.
FIRST UP DR. BHUTTA, INSTITUTE
OF GLOBAL HEALTH AND
DEVELOPMENT, AGA KHAN
UNIVERSITY, RESERVE ON
REPRODUCTIVE AND NEWBORN CHILD
HEALTH INTERVENTION LOW INCOME
SETTINGS.
DR. CREANGA FOCUSES ON PERINATAL
QUALITY AND SAFETY INTERVENTIONS
WITH KEY INTEREST IN MEASUREMENT
INNOVATION.
DR. MUNDLE, ALL INDIA INSTITUTE
OF MEDICAL SCIENCES IN NAGPUR,
HIGH RISK OBSTETRICS AND SAFE
ABORTION, INVOLVED IN MULTIPLE
GLOBAL RESEARCH INITIATIVES IN
THIS AREA.
DR. BANNERMAN, UC-SAN DIEGO,
CURRENT PRESIDENT OF THE SOCIETY
OF MATERNAL-FETAL MEDICINE,
RESEARCH IS ON PRE-TERM BIRTH
PREVENTION.
IN TERMS OF FORMAT, SPEAKERS
WILL PRESENT TALKS IN SEQUENCE
FOLLOWED BY Q&A.
DR. BHUTTA WILL NEED TO LEAVE
EARLY SO PERHAPS WE CAN FIELD
QUESTIONS FOR HIM AFTER HIS
PRESENTATION.
NEXT SLIDE.
>> THANK YOU FOR THIS
OPPORTUNITY.
AND FOR GIVING ME THE PLATFORM
TO SPEAK ABOUT ONE OF THE MAJOR
GLOBAL CHALLENGES GLOBALLY.
NEXT SLIDE PLEASE.
PREECLAMPSIA IS RESPONSE FOR
MORTALITY GLOBALLY.
AS YOU CAN SEE, PREGNANCY
INDUCED HYPERTENSION
SPECIFICALLY PREECLAMPSIA AND
ECLAMPSIA IS ASSOCIATED WITH A
QUARTER OF MATERNAL DEATHS.
THIS IS COMMON ACROSS MANY LOW-
AND MIDDLE-INCOME COUNTRIES,
SPECIFICALLY SOUTH ASIA, WHILE A
BIG CHUNK TAKE PLACE IN FACILITY
SETTINGS, SOME TAKE PLACE EN
ROUTE TO CLINICAL CARE AND
HEALTH SERVICES, AROUND A
QUARTER SADLY AT HOME.
REFLECTING THE VARIATIONS IN
DETECTION PATTERNS, DANGER SIGN
RECOGNITION AND HEALTH SYSTEM
FIDELITY.
THIS IS REFLECTED, NEXT SLIDE,
IN THE GEOSPATIAL PATTERNS IN
VARIOUS PARTS OF THE COUNTRY.
IN PAKISTAN IF YOU TAKE CARE BY
SKILLED PROVIDERS FROM THE LAST
DEMOGRAPHIC SURVEY PRE-PANDEMIC
YOU RECOGNIZE MAJOR POCKETS OF
THE COUNTRY BOTH IN SOUTH AND
SOUTHWEST WHERE COVERAGE RATES
ARE LESS THAN 20 TO 30%, WHAT
ELSE CAN BE DONE IN TERMS OF
RECOGNIZING DANGER SIGNS, RISK
FACTORS AND I'D LIKE TO SHARE
FINDINGS FROM A LARGE
COMMUNITY-BASED INTERVENTION
PROJECT UNDERTAKEN FOR
PREECLAMPSIA IN BRITISH
COLUMBIA, IN FOUR COUNTRIES
ACROSS ASIA AND AFRICA, THREE
WERE ABLE TO COMPLETE TRIAL
PROTOCOL.
IT WAS TO TRAIN AND EQUIP
COMMUNITY HEALTH WORKERS, LADY
HEALTH WORKERS AS THEY ARE
CALLED IN PAKISTAN TO DETECT
HYPERTENSION IN PREGNANCY,
RECOGNIZE SEVERITY AND PROMPTLY
REFER, IN CASE REFERRAL WAS
DELAYED, TO INSTITUTE OR
MANAGEMENT WITH MAG MAGNESIUM
SULFATE AS THEY WERE REFERRED.
THIS WAS A FAIRLY LARGE TRIAL
AND JUST IN PAKISTAN ALONE WE
WERE ABLE TO RECRUIT AROUND
40,000 WOMEN, APPROXIMATELY
20,000 IN EACH GROUP.
NEXT SLIDE PLEASE.
THE TRIAL WAS UPDATE TAKEN, WE
UNDERTOOK THIS TRIAL OVER
TWO-YEAR PERIOD, THROUGH LADY
HEALTH WORKERS TRAINED.
THE PRIMARY OUTCOME DATA GIVEN
THE SIZE OF THE TRIAL WAS A
COMPOSITE OF STILLBIRTHS,
NEONATAL MORTALITY AND NEONATAL
MORTALITY.
WHAT DID WE FIND?
AS YOU CAN SEE, IN THE BOTH
INTERVENTION AND CONTROL GROUPS,
20 CLUSTERS, BROADLY THE
POPULATION WAS COMPARABLE WITH
WOMEN, WITH THE MEAN AGE AT
AROUND 28, IN BOTH AGE GROUPS,
AND AROUND PARITY OF TWO, PLUS
OR MINUS ONE.
MOST RECRUITED SECOND TRIMESTER,
LESS THAN 1% HAD MULTIPLE
PREGNANCIES.
NEXT SLIDE PLEASE.
WE DID NOT FIND DIFFERENCE IN
COMPOSITE OUTCOME.
IF YOU TAKE NEWBORN DEATH,
MATERNAL MORTALITY, STILLBIRTH,
NOT ABLE TO SHOW A SIGNIFICANT
DIFFERENCE.
WHEN YOU LOOKED AT OUTCOMES IN
RELATION TO INTENSITY OR WOMEN
WHO HAD RECEIVED MORE THAN FOUR
OR EIGHT VISITS FROM LADY HEALTH
WORKERS IN PREGNANCY YOU CAN SEE
A SIGNIFICANT REDUCTION IN RATES
OF ADVERSE OUTCOMES FOR
STILLBIRTHS, MATERNITY
MORTALITY, EARLY AND NEONATE
MORTALITY, CONSISTENT ACROSS THE
IPD UNDERTAKEN.
WE FOUND, NEXT, THAT VISITS, THE
FREQUENCY, THOSE MORE THAN FOUR
OR EIGHT, WERE ALSO EXTREMELY
COST EFFECTIVE WHEN IT CAME TO
CALCULATIONS IN THIS AGE GROUP.
NOW, ONE CAN IMAGINE THAT
DESPITE ALL OF THIS IF YOU DID
NOT SEE IMPACT ON MORTALITY, ONE
RAISES QUESTIONS AS TO WHY THEY
DID NOT HAPPEN.
WELL, IT REALLY DID NOT HAPPEN
OVERALL BECAUSE DESPITE THIS
IMPROVEMENT IN CARE, AT
COMMUNITY LEVEL, THE QUALITY OF
CARE IN SOME OF THE REFERRAL
FACILITIES NOT JUST SECONDARY
BUT REFERRAL FACILITIES DID NOT
IMPROVE CONSISTENTLY AT THE SAME
PATTERN TO ALLOW SIGNIFICANT
MORTALITY REDUCTION
NOTWITHSTANDING REFERRAL.
AND THEREFORE IT'S IMPORTANT TO
RECOGNIZE NOT JUST ONE COMPONENT
BUT MANAGEMENT WITHIN THE HEALTH
FACILITY HAS TO IMPROVE IN
TANDEM.
OUR FINDINGS FROM THE CLIP TRIAL
WE WERE ABLE TO REACH THREUP THE
COMMUNITY HEALTH WORKERS, CLOSE
TO AROUND 60% OF ALL
PREGNANCIES, ALMOST UNIVERSAL
BLOOD PRESSURE MEASURE; QUITE AN
ACHIEVEMENT.
THAT THESE COMMUNITY HEALTH
WORKERS WERE ABLE TO RECOGNIZE
AND MANAGE AND REFER A
SIGNIFICANT PROPORTION OF WOMEN
THAT THEY RECOGNIZED HAD RISK
FACTORS FOR SEVERE PREECLAMPSIA
AND POSSIBLY ADVERSE OUTCOMES.
WE RECOGNIZE ALL OF THOSE AS
POSITIVE DEVELOPMENTS IN THE
QUEST TO OPTIMIZE MANAGEMENT OF
HYPERTENSIVE DISEASES IN
PREGNANCY, IN REAL HEALTH
SYSTEMS, WITH COMBINATION OF
COMMUNITY BASED DETECTION AND
MANAGEMENT, COUPLED WITH
IMPROVED QUALITY OF CARE WITHIN
HEALTH FACILITIES.
SO HOPEFULLY THE NEXT PACKAGE OF
HYPERTENSIVE DISORDERS,
PREVENTION, AND MANAGEMENT IN
HEALTH SYSTEMS WOULD CONSIST OF
ALL OF THOSE COMPONENTS
EVALUATED IN REAL HEALTH
SYSTEMS.
THANK YOU VERY MUCH FOR YOUR
ATTENTION.
I'LL BE HAPPY TO TAKE QUESTIONS
IF THERE ARE ANY.
>> THANK YOU FOR THE EXCELLENT
PRESENTATION ABOUT A TRIAL IN A
COMMUNITY SETTING IN RURAL
PAKISTAN.
THERE ARE AS I MENTIONED
EARLIER, WE'LL TAKE SPECIFIC
QUESTIONS FOR HIM NOW, HE WILL
JOIN REMOTELY HOPEFULLY FOR THE
FULL Q&A DISCUSSION AS WELL.
FIRST SPECIFIC QUESTION FOR YOU
HOW DO YOU PREVENT CONTAMINATION
IN THE CLUSTER RANDOMIZED TRIAL.
>> MOST OF ALL, TO RESTRICT THE
RECRUITMENT OF COMMUNITY HEALTH
WORKERS, LADY HEALTH WORKERS TO
BASIC HEALTH UNITS WHERE THEY
ARE GENERALLY PROVIDED OUTREACH
TRAINING AND OUT OUTREACH.
THEY WERE PROVIDED THAT
DIFFERENT FROM THOSE IN CONTROL
CLUSTERS, THERE'S SOME
GEOGRAPHIC DISPERSION ALSO AND
SUPERVISORS WERE DISTINCT, SO
THERE WAS VERY LITTLE TO NONE.
AND LASTLY WE ALL HAD HANDHELD
TOOLS, DEVICES WHERE
NON-CONTROLLED CLUSTERS DID NOT.
WE COULD NOT SEPARATE HEALTH
FACILITIES, SECONDARY AND
TERTIARY IN THESE ARE COMMON AND
SHARED, ONE OF THE REASONS WHY
IN THE COMMUNITY TRIAL WE
LARGELY FOCUSED ON WHAT COULD BE
DONE AT THAT LEVEL.
>> WERE THESE WOMEN FOLLOWED,
WOMEN WITH HYPERTENSION IN
PREGNANCY, WERE THEY FOLLOWED
POSTPARTUM?
>> THEY WERE FOLLOWED FOR A
RELATIVELY SHORT PERIOD OF TIME.
THERE OTHER STUDIES WITH LONGER
FOLLOW-UPS OF WOMEN WHO HAVE HAD
PREGNANCY-RELATED OR
PREGNANCY-INDUCED HYPERTENSION,
AND THERE'S A PROPORTION TO GO
ON TO HAVE OTHER DEMONSTRATIVE
EFFECTS OF NCDs, PERHAPS
GREATER DIASTOLIC PRESSURE FOR A
WHILE BUT NO FOLLOW-UP.
>> A QUESTION, PROCESSES FOR
MANAGEMENT DID NOT RESULT IN
POSITIVE COMPOSITE OUTCOMES BUT
SINGLE OUTCOMES.
ANY LESSONS LEARNED WHAT
IMPLEMENTATION STRATEGY?
>> YOU EQUIP AND TRAIN TO A
LEVEL OF RECOGNITION OF THE
PROBLEM AND ESPECIALLY WITH I.T.
TOOLS, THAT THE REST OF THE
HEALTH SYSTEM DOES NOT HAVE.
YOU CAN WELL IMAGINE IF THE
COMMUNITY HAS WORKER REFERRALS,
WHERE A PHYSICIAN DOES NOT HAVE
ACCESS TO THE SAME HANDHELD
DEVICE AND TRIAGE SYSTEM CREATES
CHALLENGES.
WE'VE SEEN THIS FOR EXAMPLE WITH
OXYGEN SATURATION MEASUREMENT
THROUGH HANDHELD DEVICES THROUGH
COMMUNITY HEALTH WORKERS, THE
HEALTH SYSTEM DOES NOT HAVE THE
SAME TECHNOLOGY AND TOOLS
THERE'S A LEVEL OF DISBELIEF.
SO THE CHALLENGES THAT WE FACED
IN THIS PROJECT FROM
IMPLEMENTATION SCIENCE ARE
HUGELY ILLUSTRATIVE OF THE FACT
THAT STRENGTHENING FACILITIES
AND STRENGTHENING TECHNOLOGIES
AND TOOLS AT ONE LEVEL OF THE
HEALTH SYSTEM IS INEFFICIENT
WITHOUT LIFTING THE ENTIRE SHIP.
THEREFORE, AS A SUBSEQUENT
FOLLOW-UP TO THIS, THERE WAS A
VERY DELIBERATE EFFORT IN THIS
PARTICULAR DISTRICT TO IMPROVE
THE QUALITY OF CARE MANAGEMENT
AND ALSO KNOWLEDGE AND SKILLS OF
THE FACILITY-BASED HEALTH CARE
PROVIDERS, NOT JUST DOCTORS AND
NURSES BUT LADY HEALTH CARE
WORKERS AND SUPERVISORS.
>> I THINK THIS IS -- THOSE ARE
ALL THE QUESTIONS FOR YOU
SPECIFICALLY AT THE MOMENT.
THANK YOU SO MUCH.
>> I'LL TRY MY BEST TO JOIN FROM
THE AIRPORT.
THANK YOU, I'M LEAVING FOR
AFRICA.
>> THANK YOU FOR YOUR
FLEXIBILITY.
>> NEXT SLIDE.
NEXT WE HAVE DR. CREANGA.
>> GOOD MORNING, GOOD AFTERNOON,
GOOD EVEN, EVERYONE.
I'M GOING TO TALK ABOUT OUR
LEARNINGS FROM SEVERE MORBIDITY
SURVEILLANCE IN THE STATE OF
MARYLAND.
NEXT SLIDE.
THIS WORK IS PART OF THE
MARYLAND MATERNAL HEALTH
INNOVATION PROGRAM THAT WE
STARTED IN 2019, FUNDED BY HRSA.
NEXT SLIDE.
SO WE ARE IMPLEMENTING
SURVEILLANCE IN THE STATE OF
MARYLAND, PART OF SERIES OF
INITIATIVES AND PROGRAMS THAT
WE'RE IMPLEMENTING AT THE SAME
TIME.
SO IN CONJUNCTION, WE WORKED ON
INEQUITY INITIATIVES IN
HOSPITALS TRYING TO PROVIDE
TRAINING TO PROVIDERS, AWARENESS
OF IMPLICIT BIAS, STARTED
TELEHEALTH INITIATIVE FOR SEVERE
HYPERTENSION DISTRIBUTING FREE
BLOOD PRESSURE CUFFS PREGNANT
WHOM WOULD NEED THEM, THROUGH
HOSPITALS.
RESOURCE MAP, 2500 RESOURCES
MET, AND GENERAL PUBLIC
PROVIDERS TO USE.
IMPLEMENTING MOTHERS AND BABIES
PROGRAM TO ALSO ADDRESS
PREVENTION OF POSTPARTUM
DEPRESSION, ALSO TRAINING FOR
PROVIDERS TO SUPPORT AFTER THEIR
EXPERIENCED SEVERE MATERNAL
EVENTS.
NEXT SLIDE I'M SHOWING
DEFINITION CURRENTLY BEING USED
FOR SEVERE MATERNAL MORBIDITY,
CDC DEFINITION ENDORSED BY
MANIERS IS, INCLUDING INSPECTED
OUTCOMES OF LABOR AND DELIVERY
RESULTS IN SIGNIFICANT SHORT OR
LONG-TERM CONSEQUENCES TO A
WOMAN'S HELD.
AS YOU KNOW THERE IS A WIDE
VARIETY OF MATERNAL MORBIDITY
AND SEVERITY, MAKING MEASURE.
DIVERSITY -- MEASUREMENT
DIFFICULT.
WE USE THE ALGORITHM USING 21
INDICATORS OF ORGAN SYSTEM
DYSFUNCTION, USING THIS DEAF,
NEXT SLIDE, SHOWING BOTH IN
MARYLAND AND NATIONALLY WE HAVE
SEEN SMM INCREASING STEADILY
OVER THE PAST I WOULD SAY TWO
DECADES, DATA SHOWN HERE FROM
2010 AND AFTER.
SO, GIVEN THE LIMITATIONS FOR
THIS ICD ALGORITHM THAT IS
CURRENTLY BEING USED THROUGHOUT
THROUGH THE
UNITED STATES, I'M SHOWING
FACILITY-BASED IDENTIFICATION OF
REVIEW OF SEVERE MATERNITY
MORBIDITY, PROPOSING TWO-FACTOR
DEFINITION INCLUDING ICU
ADMISSION, AND/OR RECEIVED 4 OR
MORE UNITS OF BLOOD PRODUCT.
THE PERIOD FOR SURVEILLANCE IS
BETWEEN ONE SESSION AND 42 DAYS
POSTPARTUM.
THE OBJECTIVE IS TO LEARN CLOSE
TO REAL TIME AS POSSIBLE HOW TO
PREVENT FUTURE SMM EVENTS FROM
OCCURRING.
NEXT SLIDE.
THIS IS THE SMM SURVEILLANCE
CYCLE FOR MARYLAND, FOR OUR
PROJECT.
WE HAVE HOSPITAL DATA
ABSTRACTOR, ABSTRACTING CASE
INFORMATION INTO A COMMON
DATABASE AT OUR UNIVERSITY.
HOSPITAL REVIEW COMMITTEES
REVIEW THIS INFORMATION.
OUR TEAM AT HOPKINS DEDICATING
TIME TO ANALYZE DATA AND
DISSEMINATING FINDINGS,
INFORMATION THAT GOES TO THE
HOSPITALS CONTRIBUTING TO THE
PROJECT, DATA BRIEFS FOR THE
STATE SHOWING INFORMATION OF
COMMON INTEREST ACROSS THE
HOSPITALS, ALSO PUBLICATIONS.
NEXT SLIDE.
THIS IS THE INFORMATION THAT
WE'RE COLLECTING ON ALL THE
SEVERE MORBIDITIES IN HOSPITAL
ON OUR DATABASE, LOOKING AT
TIMING OF MORBIDITY, INFORMATION
ON DEMOGRAPHICS, PRENATAL CARE,
DELIVERY INFORMATION, ICU OR CCU
ADMISSION, MAJOR SURGERY AS WEL
AS COVID-19 DATA.
WE'RE COLLECTING INFORMATION ON
COVID VACCINATION, THIS WAS
STARTED IN 2020, SO THIS IS WHAT
WE CONTINUE TO DO.
WE DO HAVE A CASE NARRATIVE FOR
EACH CASE, THE TIME OF KEY
EVENTS, ALL THIS INFORMATION IS
COMPLETED AFTER REVIEW COMMITTEE
MEETING BY DATA ABSTRACTORS.
DURING THE HOSPITAL REVIEWS, WE
HAVE COMMITTEES,
MULTI-DISCIPLINARY COMMITTEES IN
MOST HOSPITALS, ASSIGNING CAUSES
OF MORTALITY, THAT YOU MAY BE
MORE FAMILIAR WITH, WE HAVE
REVIEW COMMITTEE TALK ABOUT
SEQUENCE OF CLINICAL EVENTS AND
CAUSES OF MORBIDITY AND THEY
HAVE A FINAL ANALYSIS WHERE BY
THEY ARE LOOKING AT
OPPORTUNITIES TO ALTER OUTCOMES,
PRACTICES DONE WELL, SHOULD BE
READY TO REPORT, OVERALL
RECOMMENDATIONS FOR IMPROVEMENT.
NEXT SLIDE.
SO IN TERMS OF ASSESSING
OPPORTUNITIES TO ALTER OUTCOME,
PREVENT MORBIDITY, WE PROVIDE A
STANDARDIZED DEFINITION SHOWN
HERE AND A GUIDE TO HAVE
COMMUNITIES TRY DETERMINATION OR
ASSESSMENT WHETHER THE SMM EVENT
WAS PREVENTIBLE OR NOT.
SHOWING DATA FROM -- TELLING YOU
FIRST WE HAVE 27 OF 32 BIRTHING
HOSPITALS IN THE STATE CURRENTLY
PARTICIPATING IN OUR
SURVEILLANCE COVERING 80% OF THE
BIRTHS IN MARYLAND, WE STARTED
IN 2020 WITH PILOT PROGRAM, WITH
ONLY SIX HOSPITALS, WE'RE NOW
WORKING WITH 27 OF THE 32.
HERE I'M SHOWING DATA FROM 279
SMM EVENTS IDENTIFIED AND
REVIEWED IN 2023.
AS YOU SEE, ABOUT 43% ICU
ADMISSIONS, 37% BLOOD
TRANSFUSIONS, 22% OF THE CASES
MET BOTH CRITERIA IN OUR
DEFINITION, ICU ADMISSION AND
BLOOD TRANSFUSION WITH MORE THAN
FOUR UNITS.
WE SEE 40 TO 45% OF THESE EVENTS
OCCUR IN WOMEN 35 TO 39 YEARS,
ANOTHER 40, 45% IN WOMEN OVER 40
YEARS OF AGE.
AND OVERALL, THE SMM RATE IN
2023 WAS 97 FOR 10,000
DELIVERIES, NON-HISPANIC BLACK
WOMEN HAVE TWICE THE RATE OF
MAJORITY GROUP OF NON-HISPANIC
WHITE WOMEN.
NEXT SLIDE IS SHOWING MEDICAL
HISTORY INFORMATION.
SO, IT'S IMPORTANT TO NOTE THE
FIRST FIGURE IN THE TABLE OF THE
279 CASES REVIEWED, 80% HAD
SIGNIFICANT MEDICAL HISTORY.
SO WE HAD 39% OF THE PATIENTS
WITH OBESITY.
WE HAD 19% OF PATIENTS WITH
CHRONIC HYPERTENSION, ALSO 9% OF
THE PATIENTS WITH PREGNANCY
CARDIOVASCULAR CONDITION.
COMPLICATIONS IN PRIOR
PREGNANCY, 43% OF ALL OUR
POPULATION HAVING EXPERIENCED
PREGNANCY LOSS, AND 19 OR 20%,
SO ONE IN FIVE HAVING HAD
HYPERTENSIVE DISORDER IN A PRIOR
PREGNANCY.
AND THEN ALSO OF NOTE, 30% OF
WOMEN IN 2023 WHO WERE IN OUR
DATABASE HAVE HAD DIAGNOSIS OF
HYPERTENSIVE DISORDER OF
PREGNANCY WITH A SPECIFIC
PROGRAM FOR THESE POPULATIONS.
IN TERMS OF DELIVERY
CHARACTERISTICS IN THIS SERIES
WE HAVE ALMOST 4 IN 5 SMM EVENTS
DURING THE DELIVERY
HOSPITALIZATION, SO MORE THAN
20% OCCURRED OUTSIDE OF THE
DELIVERY HOSPITALIZATION.
THESE PATIENTS, 74% HAD CASAREAN
DELIVERY, HALF OF THE
DELIVERIES WERE EMERGENCY
DIFFERENCES.
STILL BIRTH OR FETAL DEATH IN
10% OF THE CASES IN THIS SERIES.
THE PRIMARY CAUSE OF SEVERE
MATERNAL MORBIDITY, ALSO
HEMORRHAGE CONTRIBUTED MORE THAN
HALF, 55% OF THE CASES, AND THEN
OF INTEREST FOR THE WORKSHOP
TODAY 12% WERE CONTRIBUTED BY
HYPERTENSIVE DISORDERS OF
PREGNANCY, 5% CARDIOVASCULAR
CONDITIONS, AND WILL 3% BY
STROKE.
NEXT SLIDE.
IN THE PREVENTABILITY OVERALL
ABOUT A THIRD OF CASES WERE
DEEMED PREVENTIBLE BY HOSPITAL
REVIEW COMMITTEES.
IN TERMS OF HYPERTENSIVE
DISORDERS OF PREGNANCY 2 IN 5
PREVENTIBLE, IN TERMS OF
CARDIOVASCULAR, 1 IN 5 EVENTS
WERE PREVENTIBLE.
I'M HERE SHOWING DATA FROM
ACROSS THE PERIOD 2020 TO 2024,
THE FULL SAMPLE, 724 EVENTS, I'M
COMPARING PATIENTS WHO HAD BE ON
OBSTETRIC HEMORRHAGE.
THE IN THE SECOND COLUMN 55% OF
THESE CASES OF WOMEN WITH
HYPERTENSIVE IN PREGNANCY
NON-HISPANIC BLACK, 25%
NON-HISPANIC WHITES, CHRONIC
HYPERTENSION ACCOMPANIED 38% OF
THESE CASES.
42% POSTPARTUM, 36 ANTE-PARTUM.
OF THESE CASES, 40% IN WOMEN
AGED 35+.
AND WE SEE THAT CHRONIC
HYPERTENSION ACCOMPANIED ABOUT
20% OF THE CASES IN THE SERIES,
56% OF THESE WOMEN WERE OBESE.
AND THEN IMPORTANTLY TO NOTE
HERE, THEY EVENTS WERE ANTE
PARTUM IN 50% OF THE CASES.
NEXT SLIDE.
SO, OUTSIDE OF DATA COLLECTION
PROCESS, WE'RE SOLICITING
INFORMATION ABOUT HOSPITAL LEVEL
POLICY CHANGES AND HAPPY TO SHOW
EXAMPLES.
RESULT OF PARTICIPATION, WE'VE
SEEN HOSPITALS CHANGING THEIR
POLICIES, CHANGING THEIR -- THE
WAY THEY EDUCATE THEIR
TECHNICIANS AND THEIR STAFF,
THEIR PROVIDERS, WE SEE THAT
THEY ARE INCLUDING
ANESTHESIOLOGISTS TO UNDERSTAND
SOME -- WHAT WERE KEY CONCERNS
AND THE LAST QUOTE ON THE STAGE
FROM ONE, WE'VE NOT HAD ANYTHING
LIKE THIS BEFORE IN TERMS OF
ENGAGEMENT ACROSS DISCIPLINES.
LAST SLIDE.
SO I WANT TO END BY HIGHLIGHTING
IMPORTANCE OF ADVOCACY AND
TALKING TO LEGISLATORS AND
MAKING A CASE FOR LEGISLATION IN
SUPPORT OF OUR PROGRAMMING IN
MATERNAL HEALTH.
WE'VE DONE THIS IN THE PATH WITH
THE SURVEILLANCE PROJECT, ABLE
TO START THE PROJECT IN MARYLAND
IN 2020, THROUGH LEGISLATION,
AND AS OF MAY OF THIS YEAR
THROUGH THE MARYLAND MATERNAL
HEALTH ACT OF 2024 THIS
PARTICULAR PIECE OF LEGISLATION
MANDATES ALL HOSPITALS IN THE
STATES TO PARTICIPATE IN OUR
SURVEILLANCE PROGRAM.
SO WE'RE GOING TO GO FROM 27
HOSPITALS WE WORK WITH CURRENTLY
TO COVER ALL 32.
NEXT SLIDE.
I'M GOING ACTUALLY END BY
TELLING YOU THAT WE'RE ALWAYS
ADDING ADDITIONAL PIECES TO THE
PROGRAM, SO WE'LL HAVE ALL
HOSPITALS IN THE STATE
PARTICIPATE STARTING IN OCTOBER
OF THIS YEAR.
WE'RE GOING TO ADD OPTIONAL
EQUITY REVIEW MODEL FOR HOSPITAL
REVIEWS COMMITTEES TO USE TO
UNDERSTAND CONTRIBUTION OF
RACISM, BIASES, AND TRY TO DO A
RE-REVIEW OF RANDOM SAMPLE OF
10% OF CASES AS PART OF A
STATEWIDE COMMITTEE.
THIS IS ALL.
THANK YOU SO MUCH.
I WELCOME YOUR QUESTIONS.
THANK YOU.
>> WE'RE GOING TO DO ALL THE
QUESTIONS AT THE END IF
EVERYBODY COULD HOLD THE
QUESTIONS TO THE Q&A SECTION.
THANK YOU SO MUCH FOR YOU TALK
OF A HEALTH SYSTEM BASED
INTERVENTION AND IMPLICATIONS
NATIONALLY.
DEFINITELY STATEWIDE ALREADY.
I'LL HAPPENED IT OVER TO DR.
MONDEL.
I THINK YOU'RE ON MUTE.
NOW WE CAN HEAR YOU.
>> THANK YOU FOR BEING PART OF
THIS IMPORTANT PANEL.
TODAY I'M GOING TO SPEAK OF
CHALLENGES AND INNOVATIONS IN
CARDIOVASCULAR HEALTH IN
PREGNANCY.
CARDIOVASCULAR DISEASE IS
IMPORTANT, EXISTING DISEASE
REQUIRES CAREFUL MANAGEMENT
DURING PREGNANCY.
YOU KNOW THE CHALLENGES.
INCREASED RISK OF COMPLICATIONS
SUCH AS HEART FAILURE,
ARRHYTHMIA, AND MANAGING
PREEXISTING DISEASE IS IMPORTANT
IN CONTEXT OF PREGNANCY
INCREASED PLASMA VOLUME, CARDIAC
OUTPUT, CAN CHANGE OUTCOME OF
PREGNANCY, ALSO A PROBLEM FOR
MANAGING PREEXISTING DISEASE.
NEXT SLIDE PLEASE.
SO, WHAT ARE THE INNOVATIONS WE
CAN HAVE IN IMPLEMENTING THESE
INTEGRATED APPROACH?
WE COULD HAVE BETTER DIAGNOSTIC
APPROACHES FOR DELINEATING
CARDIAC DISEASES AND CARDIAC
LESIONS, WE COULD HAVE
CERTIFICATION TOOLS LOCALLY
USEFUL.
MULTI-DISCIPLINARY APPROACH AND
NATIONAL GLOBAL REGISTRY OF
CARDIOVASCULAR DISEASES TO SEE
WHAT IS THE PREVALENCE OR RISK
FACTORS.
NEXT SLIDE PLEASE.
SO, LET'S TALK ABOUT THE STAGES
OF OBSTETRIC TRANSITION WHERE WE
ARE DIRECTLY RELATED TO CAUSES
OF DEATH TO STAGE 4, WHERE
MOSTLY MATERNAL MORTALITIES
RELATED TO INDIRECT CAUSES MAY
BE CARDIAC, RENAL, LIVER HEPATC
DISORDERS.
NEXT SLIDE PLEASE.
WE HAVE INCREASED MATERNITY
CARE, AGING MATERNAL POPULATION,
INCREASED INTERVENTION,
C-SECTION RATE IS HIGH, A
CHALLENGE FOR THE
ADMINISTRATION.
MOST OF THE STATES ESPECIALLY
NORTHERN PART OF THE COUNTRY
STILL IN A STAGE 3 WHERE THE
MATERNAL MORTALITY IS HIGH YET
WE HAVE STATES IN THE SOUTHERN
PART WHERE WE ARE IN A STATE OF
TRANSITION THE INDIRECT CAUSES
PLAY ROLE.
HEART DISEASE COMPLICATES, AND
INDIA AND SOUTH ASIA.
THE CHALLENGES IN INDIA, LACK OF
AWARENESS, PAUCITY OF HIGH
QUALITY INDIAN DATA, ABSENCE OF
INDIGENOUS RISK STRATIFICATION
TOOLS, LACK OF WELL-DEFINED
MANAGEMENT PROTOCOL,
INSUFFICIENT COORDINATION
BETWEEN HEALTH FACILITIES,
SUBOPTIMAL ADMINISTRATIVE
SUPPORT, LACK OF MANAGEMENT OF
THESE DISORDERS.
NEXT SLIDE PLEASE.
SO THIS STUDY INCLUDED 26
STUDIES.
NEXT.
META-ANALYSIS, WHAT ARE THE
CAUSES OF HEART DISEASE IN
PREGNANCY FOR WOMEN IN SOUTH
ASIA.
NEXT.
WE SHOWED THAT DRAMATIC HEART
DISEASE CONTRIBUTES
SIGNIFICANTLY VALVE HEART
DISEASE, A PROBLEM OF LOW
SOCIOECONOMIC COUNTRIES.
CARDIOVASCULAR DISEASE IS
UPCOMING 18% OF THE CASES OF
HEART DISEASE ARE RELATED TO
CARDIAC DISEASE.
MATERNAL MORTALITY IN THESE
CASES IS HIGH, AS HIGH AS 26,
PRE-TERM MORTALITY AS HIGH AS
50%.
THERE ARE CERTAIN TOOLS THAT CAN
ASSESS RISK OF MORTALITY,
BECAUSE OF HEART DISEASE.
THESE SCORES SPEAK ABOUT
CLASSIFICATION, WE HAVE THE
ZAHARA SCORE RELATED TO CON
CONGENITAL HEART DISEASE.
DO WE HAVE SOMETHING THAT SCORES
WHAT'S PREVALENT IN THE LOCAL
HEART DISEASE, VALVULAR HEART
DISEASE, THIS STUDY WAS DONE IN
A SINGLE CENTER WHERE PREDICTION
OF ADVERSE CARDIAC EVENTS DONE
ON THE BASIS OF FACTORS THAT
WERE INDIGENOUS ESPECIALLY IN
THE WOMEN WITH VALVULAR HEART
DISEASE, EVALUATED AGAINST THE
SCORE, SHOWED IT HAS A GOOD
PREDICTION OF ADVERSE OUTCOME
WHEN THIS WAS USED, ESPECIALLY
IN THE WOMEN WITH VALVULAR HEART
DISEASE.
NEXT SLIDE PLEASE.
ANOTHER IMPORTANT STUDY THAT WAS
UNDERTAKEN IN THE COUNTRY WAS
PREGNANCY OUTCOMES IN WOMEN WITH
HEART DISEASE DONE AT MADRAS
MEDICAL COLLEGE.
NEXT.
THIS WAS THE STUDY THAT WAS THE
LARGEST SINGLE-CENTER STUDY,
PREGNANT WOMEN WITH HEART
DISEASE WERE INCLUDED.
THERE WAS ABOUT 1005 WOMEN, 1029
PREGNANCIES, VALVULAR HEART
DISEASE WAS THE COMMONEST THAT
WE SEE, HEART FAILURE WAS THE
MOST COMMON ADVERSE CARDIAC
EVENT SEEN IN THE STUDY.
NEXT.
SURPRISINGLY, THE STUDY, IT WAS
DONE IN THE SOUTHERN INDIA, DID
SHOW 60% OF WOMEN RECEIVED
FIRST-EVER HEART DISEASE IN
PREGNANCY, 26 TO 69% DIAGNOSED
FOR HEART DISEASE DURING
PREGNANCY SHOWING THAT A LACK OF
AWARENESS ABOUT CARDIAC DISEASES
IN WOMEN IN GENERAL AND LACK OF
ANTE NATAL OR PROPER CARE FOR
WOMEN WITH HEART DISEASE OUTSIDE
OF PREGNANCY.
SO WITH THIS STUDY, THE BASIS OF
THE NATIONAL PREGNANCY REGISTRY,
NEXT SLIDE, THIS IS A STUDY
SUPPORTED BY THE INDIAN COUNCIL
OF MEDICAL RESEARCH ACROSS THE
COUNTRY WHEREABOUT MORE THAN 50
MAJOR INSTITUTIONS IN THE
COUNTRY, PRIVATE AND PUBLIC,
WILL BE PARTICIPATING FOR
GIVING -- FOR COLLECTING DATA
WHICH WILL BE DEVELOPING
PROTOCOL FOR MANAGING PREGNANCY
IN WOMEN WITH HEART DISEASE,
BASED ON SYSTEMATICALLY
COLLECTED DATA ACROSS THE
NATION, DEVELOPING INDIGENOUS
STRATIFICATION TOOLS,
IMPLEMENTING THEM IN THE
DAY-TO-DAY MANAGEMENT.
THE OUTCOME MIGHT BE A CHANGE IN
PRACTICE PATTERNS, CARE OF WOMEN
FOR HEART DISEASE, MIGHT EVEN
IMPROVE THE MATERNAL-FETAL
OUTCOME, THE HYPOTHESIS, IT'S
GOING TO BE A LONG-TERM STUDY,
SEE WHAT WE GET OUT OF THE
STUDY.
NEXT SLIDE.
SO, SORRY, CAN WE MOVE BACK.
THIS COLLABORATIVE RESEARCH
WILL -- THIS NATIONAL DATA WILL
GIVE US PREVALENCE AND OUTCOME
AND MANAGEMENT, IT WILL ALSO
PROVIDE VALUABLE INSIGHT INTO
REGIONAL VARIATIONS THAT HAD
HEALTH STRATEGIES ACCORDINGLY.
WE WOULD BE TAKING HEALTH CARE,
CARE OF ELECTRONIC HEALTH
RECORDS, STREAMLINING DATA
COLLECTION, FACILITATE
MONITORING AND ALSO FORMULATED
RISK SCORES AND STANDARDIZED
PROTOCOLS.
NEXT SLIDE.
THIS IS AN EXAMPLE OF
COLLABORATION BETWEEN ACADEMIC
INSTITUTIONS, AND HAVING
INNOVATION HUBS.
NEXT SLIDE.
YES, THAT WILL STANDARDIZE THE
CARE AND HAVE LOCAL CLINICAL
GUIDELINES.
NEXT SLIDE.
SPECIALIZED TRAINING PROGRAMS
WILL BE PART OF THIS PROGRAM
WHICH ALSO WILL HAVE
MULTI-DISCIPLINARY APPROACH
WHERE OBSTETRICIANS AND
CARDIOLOGISTS WILL WORK TOGETHER
TO GIVE COMPREHENSIVE CARE TO
WOMEN WITH HEART DISEASE.
WE'RE TALKING ABOUT
POINT-OF-CAREDIAGNOSIS,
ESPECIALLY THOSE WITH VALVULAR
HEART DISEASE, DIAGNOSTIC TESTS
USEFUL IN DIAGNOSIS
POINT-OF-CARE TESTS WHICH WILL
DIAGNOSE CARDIAC DISEASE, ALSO
RISK FACTORS FOR PREECLAMPSIA
AND HYPERTENSION DISORDERS.
NEXT SLIDES.
NEXT SLIDE PLEASE.
WE HAVE ANOTHER INNOVATION,
mHEALTH, THIS IS A STRATEGY,
NEXT SLIDE, WHICH HAS BEEN USED
IN THE NORTHERN PART OF THE
COUNTRY WHICH IS HELPING TO
IMPROVE ANTENATAL CARE,
MONITORING PREGNANCY, MONITORING
BIRTH AND POST-NATAL EVENTS IN A
PATIENT'S LIFE.
THIS IS A TOOL THAT IS GIVEN IN
THE HANDS OF THE COMMUNITY
HEALTH WORKERS WHICH TRACKS
PREGNANCY AND THIS HAS
IMPROVED -- THIS HAS SHOWN
SIGNIFICANT IMPROVEMENT IN
ACCESS TO HEALTHCARE, SOMETHING
THAT COULD ALSO BE USED FOR
TRACKING CARDIOVASCULAR DISEASE
IN PREGNANCY.
NEXT SLIDE.
SO MOBILE HEALTH IS THE
SOLUTIONS WITH HELP OF TELEMED
MEDICINE AND TELECONSULTATIONS,
USEFUL ESPECIALLY IN CARDIAC
HEALTH.
NEXT SLIDE.
WE WOULD NEED SOME INNOVATIONS
IN SURGERY, MEDICATION, DEVICES,
BECAUSE WE KNOW WE HAVE TO HAVE
SOME INNOVATIONS IN
PROSPECTIVELY TO GIVE THE
PATIENT BETTER CHANCE OF
PREGNANCY OUTCOME.
NEXT.
NEXT SLIDE PLEASE.
AFFORDABLE MEDICATIONS THAT ARE
AVAILABLE AND ACCESSIBLE TO
WOMEN WOULD GO A LONG WAY IN
WOMEN ESPECIALLY WITH PROSTHETIC
HEART VALVES.
NEXT SLIDE.
WE NEED COMMUNITY-BASED
INTERVENTION, COMMUNITY
PARTICIPATION, AND IMPROVING THE
CARDIOVASCULAR HEALTH, WHERE THE
COMMUNITY HAS WORKERS IDENTIFY
EARLY SIGNS OF CARDIOVASCULAR
PROBLEMS, AND REFER APPROPRIATE
HEALTHCARE FACILITIES.
NEXT SLIDE.
SO, INTEGRATION OF
CARDIOVASCULAR HEALTH, NATIONAL
HEALTH PROGRAMS IS IMPORTANT
BECAUSE ADVOCACY FOR MATERNAL
HEALTH AND FUNDING IS IMPORTANT
TO CARRY ON THESE AMBITIOUS
PROGRAMS OF NATIONAL HEALTHCARE
DATA AND BRINGING ALL
MULTI-DISCIPLINARY APPROACH INTO
MANAGEMENT OF CARDIOVASCULAR
DISEASES.
NEXT SLIDE.
IN SUMMARIZING TO IMPROVE
MATERNAL CARDIOVASCULAR DISEASE
WE NEED AWARENESS REGARDING OPT
OPTIMAL STRATEGIES, RISK
STRATIFICATION IF TOOLS AND
GUIDELINES, INTERDISCIPLINARY
COORDINATION, ADMINISTRATIVE
SUPPORT, AWARENESS OF MEDICAL
AND SOCIAL ISSUES AT ALL LEVELS
OF HEALTHCARE.
THANK YOU SO MUCH.
>> THANK YOU FORETHAT EXCELLENT
PRESENTATION OF THE OVERVIEW OF
CARDIOVASCULAR HEALTH IN
MATERNAL HEALTH IN INDIA AND
IMPLEMENTATION APPROACHES.
NEXT DR. GYAMFI-BANNERMAN.
>> THANKS FOR HAVING ME AT THIS
VERY IMPORTANT MEETING.
NEXT SLIDE PLEASE.
SO, I THINK WE'RE ALL FAMILIAR
WITH PREECLAMPSIA LEADING TO
LONG-TERM CARDIOVASCULAR
IMPLEMENTATIONS BUT I WAS ASKED
TO SPEAK ABOUT PRE-TERM BIRTH.
WE KNOW OBSTETRIC HISTORY IS A
WINDOW INTO FUTURE HEALTH.
THERE'S PREVENTION OF CHRONIC
DISEASES IN ADULT IT'S AND
CHILDREN, A PRIORITY, AND SIGNS
AND SYMPTOMS DIFFER BETWEEN MEN
AND WOMEN, WITH WOMEN OFTEN
BEING UNDERDIAGNOSED.
NEXT.
IN GENERAL WOMEN HAVE THREE
ENTRY POINTS TO CARE.
FIRST WHEN THEY THEMSELVES ARE
AN INFANT.
SECOND AT THE DEVELOPMENT OF
CHRONIC DISEASE.
THIRD, DURING PREGNANCY AND IN
THE POSTPARTUM PERIOD.
NEXT SLIDE PLEASE.
SO, THERE'S VERY IMPORTANT
COMPONENTS IN THE PRIOR
PREGNANCY HISTORY THAT ARE
IMPORTANT FOR THE
NON-OBSTETRICIAN TO KEEP IN MIND
AS YOU'RE SEEING THESE PATIENTS.
ONE WOULD BE THE NUMBER OF
PREGNANCIES AND PREGNANCY
LOSSES.
ANOTHER WOULD BE GESTATION AGE,
GESTATIONAL WEIGHT, AND
IMPORTANTLY WHAT WERE THE
PREGNANCIES COMPLICATIONS,
PREECLAMPSIA OR GESTATIONAL
HYPERTENSION, IF A PATIENT
DOESN'T REMEMBER THOSE SPECIFICS
YOU CAN ASK DID YOU SEE
MAGNESIUM SULFATE, THAT USUALLY
WILL REMEMBER THAT PIECE.
DID THEY HAVE GESTATIONAL
DIABETES OR DID THEY HAVE A
PRE-TERM DELIVERY, WHETHER IT'S
RESPONSIBLE -- SPONTANEOUS.
LOOK LOOK AT THE OVERVIEW OF
PRE-TERM DELIVERY, SPEAKING
ABOUT SPONTANEOUS PRE-TERM
DELIVERY.
AND THIS IS FROM TIME
IMMEMORIAL, INDICATED PRE-TERM
BIRTH OR IATROGENIC IS A THIRD,
30 TO 35%, SPONTANEOUS IS 65 TO
70%, WITHIN SPONTANEOUS ABOUT
2/3 PRE-TERM LABOR WITH INTACT
MEMBRANES, 1/3 RUPTURE OF INTACT
MEMBRANES.
WHEN YOU THINK ABOUT
PATHOGENESIS THERE'S SO MANY
FACTORS THAT GO INTO WHAT MIGHT
CAUSE A PREGNANCY TO DELIVER
PRE-TERM.
NEXT.
SO, WHEN WE'RE THINKING ABOUT
SPONTANEOUS, YOU SEE WHAT'S
COMMON WITH TWINS, EXPWROAS
REASON ACTION, CERVICAL DISEASE,
STRESS HAS BEEN A WELL DESCRIBED
CAUSE OF PRE-TERM DELIVERY,
INKNOWN AND INFECTIOUS
ETIOLOGIES.
NEXT.
WHEN YOU LOOK AT PRE-TERM BIRTH
THAT'S DUE TO PREECLAMPSIA WE
FOCUS ON VASCULAR DISORDERS AS
THE MAIN CAUSE FOR THAT TYPE OF
PRE-TERM BIRTH.
NEXT.
YOU CAN SEE THERE'S OVERLAP
BETWEEN SPONTANEOUS AND
INDICATED WHERE YOU CAN HAVE
BREAKDOWN OF MATERNAL TOLERANCE,
STRESS, UNKNOWN.
NEXT.
AND SO AS I'VE MENTIONED, I
THINK WE'RE ALL AWARE
PREECLAMPSIA HERALDS FUTURE
CARDIOVASCULAR DISEASE, SO THIS
SLIDE SUMS THAT LITERATURE.
THERE ARE META-ANALYSES,
ASSESSING 6-POINT MILLION
PREGNANCY, 258,000 WOMEN WITH
PREECLAMPSIA.
CORONARY HEART DISEASE 2 1/2
INCREASE OVER NOT HAVING AGAIN
HISTORY OF PREECLAMPSIA.
DEATH FROM CARDIOVASCULAR
DISEASE WAS INCREASED, STROKE
INCREASED, 80%.
AND THESE ASSOCIATIONS WERE
PERSISTING AFTER ADJUSTING FOR
AGE, BMI, AND STATUS OF
DIABETES.
NEXT SLIDE PLEASE.
ONE OF THE FIRST IN FACT STUDIES
THAT LOOKED AT SPONTANEOUS
PRE-TERM BIRTH IN FUTURE HEALTH,
THEY WERE LOOKING AT LONG-TERM
MORTALITY OF MOTHERS AND FATHERS
AFTER PREECLAMPSIA, POPULATION
BASED COHORT STUDY, RISK OF
MORTALITY IN MOTHERS AND FATHERS
AFTER PREGNANCY WITH
PREECLAMPSIA, OVER 600,000
BIRTHS IN NORWAY, FOUND THE
MOTHERS HAD INCREASED MORTALITY
BUT FATHERS DID NOT.
THIS IS TRYING TO GET INTO SOME
OF THE GENETIC LINKS THERE.
NEXT PLEASE.
YOU CAN SEE WHEN YOU LOOK AT
COMPARISON GROUPS THEY LOOK AT
PREGNANCY WITH PREECLAMPSIA TERM
VEERS US PRE-TERM, AND WITHOUT
PREECLAMPSIA.
FOCUSING ON OUTCOMES WE'LL GO TO
THE FINDINGS IN THE NEXT SLIDE.
SO WHEN THEY LOOKED AT PRE-TERM
BIRTH WITHOUT PREECLAMPSIA,
HAVING THE REFERENCE GROUP BE
TERM BIRTH WITHOUT PREECLAMPSIA
YOU'LL SEE THERE WAS INCREASE IN
THE RELATIVE RISK OF DEATH,
HAZARD RATIO 1.56, AND
CARDIOVASCULAR DEATH, INCREASED
THREE-FOLD.
ALL OF A SUDDEN WE START TO SEE
THAT EVEN WHEN PREECLAMPSIA WAS
OUT OF THE PICTURE, THERE WAS
SEEMINGLY INCREASED RISK FOR
PRE-TERM BIRTH IN AND OF ITSELF
AND CARDIOVASCULAR DISEASE.
THIS STUDY STARTED TO GET TO THE
QUESTION OF PRE-TERM BIRTH
LOOKING AT EFFECT ON GESTATIONAL
AGE AND FETAL GROWTH ON
LONG-TERM CARDIOVASCULAR
DISEASE.
THIS IS A POPULATION BASED STUDY
FROM A SWEDISH REGISTRY LOOKING
AT WHETHER GESTATIONAL AGE OR
SMALL FOR GESTATIONAL AGE
INDEPENDENTLY CORRELATED WITH
FUTURE CARDIOVASCULAR DISEASE.
923,000 WOMEN, WITH ONE PRIOR
DELIVERY, AND WITHOUT
PRE-EXISTING CARDIOVASCULAR, NO
PREVIOUS HEART DISEASE, HEART
FAILURE, STROKE OR DEATH.
ADJUSTED FOR MATERNAL AGE,
INCOME AND EDUCATION, AND
CHRONIC HYPERTENSION,
PRE-GESTATIONAL DIABETES,
GESTATIONAL DIABETES,
GESTATIONAL HYPERTENSION,
PREECLAMPSIA, IMPORTANTLY
ADJUSTED HERE FOR PREECLAMPSIA
AND LOOKING AT THE BIRTH
OUTCOMES BY GESTATIONAL AGE.
NEXT SLIDE PLEASE.
HERE IS WHAT THEY FOUND.
TERM AGAIN BEING REFERENCE
GROUP, GREATER THAN 27 WEEKS.
BUT IF YOU DELIVERED MODERATELY
PRE-TERM FROM 32 TO 36 WEEKS
INCREASED RISK OF CARDIOVASCULAR
DISEASE, ADJUSTED BY AGE,
ADJUSTED BY OTHER VARIABLES,
EXTREMELY PRE-TERM BIRTH SIMILAR
FINDINGS, INCREASED IN
CARDIOVASCULAR DISEASE BY
GESTATIONAL AGE AT WHICH YOU
DELIVERED.
NEXT SLIDE.
THIS GROUP DID LOOK AT FETAL
GROWTH, AND SO IF THE CHILD WAS
LESS THAN TWO STANDARD
DEVIATIONS OF THE MEAN AT BIRTH
THERE WAS INCREASE IN MATERNAL
CARDIOVASCULAR DISEASE.
AND THEN MODERATELY SMALL EVEN A
SMALLER CHANGE IN THE FETAL SIZE
WAS ASSOCIATED WITH INCREASED
CARDIOVASCULAR DISEASE.
SO INTERESTINGLY THINGS YOU CAN
FIND OUT AND RISK STRATIFY A
PERSON YOU SEE IN FRONT OF YOU
TO SAY, WELL, YOUR PREGNANCY
HISTORY ACTUALLY PUTS YOU IN
HIGHER RISK CATEGORY FOR ADVERSE
CARDIOVASCULAR DISEASE.
NEXT SLIDE PLEASE.
HERE IS ANOTHER STUDY WHERE THEY
LOOKED AT RISK OF ISCHEMIC HEART
DISEASE, SPONTANEOUS PRE-TERM
DELIVERY, ELECTIVE MEANT
IATROGENIC OR INDICATED PRE-TERM
BIRTH, A STUDY OF 750
PREGNANCIES, 750,000.
AGAIN, FIRST MORTALITY AND THEN
ISCHEMIC HEART DISEASE EVENTS,
BUT YOU CAN SEE AGAIN FOR ALL
PRE-TERM AND THEY BROKE OUT
SPONTANEOUS AND INDICATED AND
NOW REALLY HONING IN, NOT
RELATED TO PREECLAMPSIA OR
CHRONIC HYPERTENSION, INCREASED
RISK OF CARDIOVASCULAR DISEASE
AND THEN CARDIOVASCULAR EVENTS,
VERY SIMILAR.
YOU CAN SEE THAT FOR BOTH
GROUPS.
AND THIS PAPER CAME OUT THIS
YEAR, AND VERY SIMILAR FINDINGS.
THEY TOOK ALL OF THE MORE COMMON
ADVERSE PREGNANCY OUTCOMES,
PRE-TERM BIRTH, PREECLAMPSIA,
REALLY ALL OF THEM, AND LINKED
THAT WITH WHAT WAS THE LONG-TERM
RISK OF MORTALITY IN WOMEN.
SO, AGAIN, FOR THIS TALK WE'LL
FOCUS ON PRE-TERM DELIVERY, AND
TO SHOW YOU, I DON'T KNOW IF YOU
CAN SEE MY MOUSE HERE, BUT THIS
IS THE NUMBER OF YEARS AFTER THE
EVENT.
PRE-TERM DELIVERY LESS THAN 10
YEARS, 10-19, 20-29, 30-46,
LOOKING AT RISK OF MORTALITY
THERE'S INCREASE IN MORTALITY,
ALL OF THE TIME PERIODS IF YOU
HAD PRE-TERM DELIVERY.
NEXT SLIDE PLEASE.
SO WHAT ARE THE MECHANISMS,
BECAUSE WE'RE SEEING THIS OVER
AND OVER AGAIN IN OUR
EPIDEMIOLOGIC STUDIES.
ONE GROUP HYPOTHESIZED MAYBE
C-REACTIVE PROTEIN MIGHT BE
IMPORTANT HERE.
BECAUSE IT'S INFLAMMATORY
MARKER, LEADING TO PRE-TERM
BIRTH, ASSOCIATED WITH
CARDIOVASCULAR DISEASE.
SO THIS PARTICULAR GROUP LOOKED
AT CRP, CHOLESTEROL, ASSOCIATION
WITH SPONTANEOUS PRE-TERM
DELIVERY.
AND BASICALLY FOUND THERE WAS
INCREASE OF THE ODDS RATIO 6.4
IF YOU HAVE BOTH CRP AND
ELEVATED CHOLESTEROL PRESENCE.
SO REALLY INTERESTING FINDINGS
THAT START TO GET TO THE
MECHANISM.
NEXT SLIDE PLEASE.
ANOTHER GROUP ALSO TRIED TO TAKE
A NICE DEEP DIVE TO SEE, WELL,
WHAT COULD BE THE POSSIBLE
CAUSE, THEY LOOKED AT PULSE WAVE
VELOCITY MEASURES MEASURING
ARTERIAL STIFFNESS, THAT CAN
PRECEDE ONSET OF CARDIOVASCULAR
DISEASE.
THE GROUP THOUGHT WHAT ABOUT
LOOKING AT ASSESSING PREGNANCY
RISK IN FIRST TRIMESTER LOOKING
AT WOMEN WITH SPONTANEOUS
PRE-TERM BIRTH AND COMPARED TO
THOSE WHO DELIVERED AT TERM.
THEY FOUND DIFFERENCE IN
STIFFNESS ONLY IN THE INDICATED
OR IATROGENIC BUT NOT
SPONTANEOUS PRE-TERM BIRTH, NOT
THE MECHANISM BUT INTERESTING
WAY TO LOOK TO SEE WHAT WAS
POTENTIALLY CAUSING THIS.
NEXT SLIDE PLEASE.
WHAT ARE GAPS IN KNOWLEDGE?
SHOULD THERE BE AN EARLIER
CARDIOVASCULAR RISK ASSESSMENT
IN WOMEN WITH PRIOR SPONTANEOUS
PRE-TERM BIRTH, WHAT IS THE
MECHANISM.
WE DON'T KNOW THE ANSWER.
IS THERE AN IMPLEMENT STRATEGY?
LIFESTYLE MODIFICATION WITH
KNOWLEDGE OF HISTORY THAT PUTS
YOU AT RISK, DOES THAT MITIGATE
THE RISK FOR CARDIOVASCULAR
DISEASE FOR WOMEN WITH PRE-TERM
DELIVERY AND WOULD THIS
MODIFICATION CHANGE THE RISK FOR
PRE-TERM BIRTH.
IS THERE A BEST PRACTICE THAT
CAN MITIGATE THESE ASSOCIATIONS.
WHEN YOU SEE THIS, ASCERTAIN
THAT HISTORY.
IF YOU'RE THE OBSTETRIC
PROVIDER, INFORM THE PATIENT
THAT SHE HAS INCREASED RISK AND
REFER HER BACK TO PRIMARY CARE
PROVIDER FOR ROUTINE CARE.
IF YOU'RE THE PRIMARY CARE
PROVIDER, OBTAIN THOROUGH
OBSTETRIC HISTORY INCLUDING
PRIOR PRE-TERM BIRTH,
PREECLAMPSIA, SMALL GESTATIONAL
AGE, ALL IMPORTANT ELEMENTS
WHICH WE'VE SHOWN LINK TO
INCREASED CARDIOVASCULAR
DISEASE.
AND THEN ENCOURAGE ANNUAL
FOLLOW-UP AND EVIDENCE-BASED
PREVENTIVE STRATEGIES.
PRE-TERM BIRTHS ARE ASSOCIATED
WITH FUTURE CARDIOVASCULAR
DISEASE, OBSTETRIC HISTORY IS
IMPORTANT AND HELPFUL AT RISK
STRATIFICATION, COMMUNICATION
WITH PATIENT AND PROVIDER ARE
IMPORTANT.
AND WE NEED MORE PROSPECTIVE
STUDIES TO MITIGATE RISKS ONCE
WE IDENTIFY THEM.
THANK YOU FOR YOUR ATTENTION.
I GUESS WE'LL GO INTO THE PANEL
NEXT.
>> THANK YOU SO MUCH.
WE'LL NOW START TO KICK OFF THE
Q&A, AND TO START OFF WE'LL HAVE
QUESTIONS FOR ALL PANELISTS.
TO START WE'LL TAKE QUESTIONS
FROM THE AUDIENCE EVENTUALLY BUT
I WANTED TO START WITH A
QUESTION FOR EVERYBODY, THAT IN
YOUR VIEW WHAT INNOVATIVE
EVIDENCE-BASED APPROACHES HAVE
THE POTENTIAL TO DRIVE DOWN HIGH
PREVALENCE OF CARDIOVASCULAR
SEVERE MATERNAL OUTCOMES, FOR
EXAMPLE YOU MAY WANT TO TALK
ABOUT INTEGRATED OR
INTERSECTIONAL APPROACHES, WHAT
MOONSHOT TRIALS COULD BE
IMPLEMENTED, AND YOUR RESPONSES
COULD YOU PLEASE COMMENT ON
RESEARCH GAPS FROM
IMPLEMENTATION PERSPECTIVE,
CHALLENGES AND BARRIERS FOR
EVIDENCE-BASED, AND FOR -- WHAT
IS SCOPE FOR ADAPTATION OF
SUCCESSFUL EVENTS-BASED
INTERVENTIONS IN OTHER SETTINGS
GLOBALLY AND DOMESTICALLY.
FEEL FREE TO UNMUTE YOURSELF IF
YOU'D LIKE TO ANSWER THAT.
>> YES, THE MOST IMPORTANT WOULD
BE WE NEED TO HAVE RISK CODES,
GOOD DATA TO BE USED FOR THE
LOCAL POPULATION, AND
UNDERSTANDING WHICH OF THEM AT
RISK FOR INCREASE THE MORBIDITY
AND MORTALITY, BECAUSE OF THE
HEART DISEASE THEY ARE HAVING.
MAKING AVAILABLE RESOURCES FOR
MANAGING THESE HEART DISEASES,
ESPECIALLY INNOVATIONS
ANTICOAGULANTS, POINT OF CARE
DIAGNOSIS WHERE WOMEN ARE
SCREENED DURING NORMAL PREGNANCY
FOR EVIDENCE OF UNDERLYING
DISORDER, WHEN OFFERED MEDICINES
OR MAYBE OFFERED CORRECTIVE
SURGERIES TO CORRECT CONGENITAL
HEART DEFECTS, THIS COULD BE --
WE KNOWS THESE ARE PRESENT BUT
HAVE TO BE VERY GENERALIZABLE,
SHOULD BE AVAILABLE TO
MARGINALIZED SECTION, RURAL AND
TRIBAL WOMEN, AND NEED TO HAVE
THE HEALTH MULTI-DISCIPLINARY
APPROACH, ALL THE PERSONNEL
ATTUNED TO HAVE BASIC UNIFORM
PROTOCOL FOR MANAGEMENT OF THESE
DISORDERS.
I THINK THE APPLICATION OF
MOBILE TECHNOLOGY WHERE BASIC
GROUND LEVEL COMMUNITY HAS A
LEVEL WORKER, PICKS UP THESE
DISORDERS, MAYBE HAS THEM ENROLL
AND GIVES THEIR DATA TO
SPECIALISTS AT THE HIGH LEVEL SO
THEY KNOW THERE'S SOMETHING
WRONG WITH WOMEN WHO HAVE A
DIAGNOSED HEART DISEASE TOO
NEEDS TO BE HELPED, COME INTO
TERTIARY HEALTH CARE CENTER FOR
MANAGEMENT.
THESE ARE THINGS WE KNOW THEY
ARE OPPORTUNITIES, A QUESTION OF
IMPLEMENTING ALL THESE
ESPECIALLY IN THE CONTEXT OF
CARDIOVASCULAR DISEASE.
THANK YOU.
>> DEVELOPING AND TESTING
POINT-OF-CARE SPECIFICALLY.
SPECIFIC CONTEXTS, YES.
>> YEAH, I WOULD ADD AND SAY
THAT FOR ME THE MOONSHOT STUDY
WOULD BE TO BE ABLE TO LOOK AT
INDIVIDUAL WHO HAD FIRST
PREGNANCY, ADVERSE OUTCOME
WHETHER PRE-TERM BIRTH,
PREECLAMPSIA, ANYTHING THAT
INCREASED THEIR RISK, AND THEN
FOLLOW THEM PROSPECTIVELY, AN
INTERVENTION THAT MIGHT SHOW WE
CAN MITIGATE THESE RISKS AND
FOLLOW THEM DOWNSTREAM.
IT SEEMS VERY CHALLENGING IN
WHAT WE DO TO HAVE LONGITUDINAL
TYPE STUDIES WHERE WE ARE
FOLLOWING A COHORT MAYBE WITH AN
INTERVENTION BUT FOLLOWING THEM
TO SEE IF WE CAN HAVE EFFECT ON
THAT OUTCOME, TO ME WOULD BE
WONDERFUL.
THE OTHER THING THAT I THINK
JUST REALLY COMES OUT LOUD AND
CLEAR IN THESE TYPES OF STUDIES
BUT ALSO IN THE CONVERSATION
BEFORE ABOUT THE MORTALITY,
THERE ARE POINTS WHICH
DIFFERENCE TYPES OF PROVIDERS
ARE WITH PATIENT AND ON THE
OBSTETRICS SIDE YOU HAVE YOUR
MFNs, MID WIVES, OBs, BUT WE
HAND THEM OFF TO PRIMARY CARE
PROVIDER AT SOME POINT WHO MIGHT
MISS THAT HISTORY OR NOT
UNDERSTAND OR THEY MIGHT
UNDERSTAND ONE PIECE AND NOT
ANOTHER PIECE.
WE PROBABLY IN THE LAST FIVE TO
TEN YEARS HAVE DONE I THINK A
LOT OF GOOD WORK IN EDUCATING
EMERGENCY ROOM DOCTORS BECAUSE A
LOT OF POSTPARTUM PATIENTS SHOW
UP IN THE EMERGENCY ROOM, THAT
HISTORY OF RECENT PREGNANCY OR
PREGNANCY THAT WAS SEVERAL
MONTHS AGO IS MISSED.
SO I THINK WE CAN DO A BETTER
JOB OF HAVING OUTSIDE
COMMUNICATION WITH PRIMARY CARE
PROVIDERS AND INTERNAL AND
FAMILY MEDICINE DOCS SO EVERYONE
IS LOOKING AT THE SAME
PARAMETERS FOR EACH PATIENT.
>> I COULD BUILD ON THE POINT.
>> SORRY, PLEASE GO ON.
>> BUILD ON THE POINT EARLIER,
THERE'S A LOT OF DATA AVAILABLE
TO US, THE HOSPITAL LEVEL,
DEFINITELY, ALSO AT THE STATE
AND NATIONAL LEVEL THAT WE'RE
NOT ACTUALLY LEARNING ENOUGH
FROM.
SO I THINK THERE'S ROOM FOR
ADDITIONAL LEARNING FROM STATES,
COMMITTEES, REPORTS, EFFORTS TO
REVIEW MORBIDITY IN HOSPITALS
LIKE WE DO IN MARYLAND.
THIS HAPPENS MAYBE NOT STATEWIDE
BUT MANY HOSPITALS AROUND THE
COUNTRY.
THERE ARE MANY PROJECTS FUNDED
BY THE GOVERNMENT OVER THE PAST
COUPLE OF I WOULD SAY ALMOST A
DECADE NOW, ALL OF THESE LARGE
SCALE QUALITY IMPROVEMENT
EFFORTS THAT COULD BE, YOU KNOW,
BETTER EVALUATED, AND MAYBE
RESULTS BETTER DISSEMINATED.
NUMBER TWO, I AGREE WE NEED
DATA, NEED TO UNDERSTAND
PATTERNS AND PATHWAYS TO SEVERE
OUTCOMES AND ADVERSE OUTCOMES
FOR MOTHERS.
AND INFANTS AS WELL.
SO USING LINKED DATA SOURCES
THAT'S A POSSIBILITY, SOME
STATES ARE ALREADY LINKING DATA
ACROSS MULTIPLE PROJECTS,
STARTING WITH VITAL STATISTICS,
MEDICAID, CLAIMS DATA, AN
EXAMPLE, THE PELL PROGRAM IN
MASSACHUSETTS.
ALSO STARTING TO MAKE BETTER USE
OF THE EHR DATA THAT WE HAVE.
SO MAYBE USING DEAF DEFINITELYN
DATA ELEMENTS, EFFORTS TO
STANDARDIZE IN MATERNAL HEALTH,
ALSO USING COMMON DATA MODELS
LIKE OMOP, TRYING TO STANDARDIZE
MEDICAL TERMINOLOGY WE LOOK AT,
ACROSS NOT ONLY THE U.S. AND
STATES WITHIN BUT ALSO GLOBALLY.
SO INVOLVING COUNTRIES LIKE
INDIA, PAKISTAN, AFRICAN
COLLEAGUES AS WELL, THERE ARE
SOME COUNTRIES USING -- OR SOME
HOSPITALS EVEN IN THESE
COUNTRIES USING EHR DATA.
JUST A FEW IDEAS.
>> THAT'S AN IMPORTANT POINT,
HIGHLIGHTING METRICS AND ALL THE
DATA THAT WE HAVE, PILES AN
PILES OF IT AT OUR FINGERTIPS
BUT NOT USING IT AND LINKING IT
EFFECTIVELY IS AN EXCELLENT
POINT.
DR. BHUTT HAS JOINED US
REMOTELY.
I ASKED THE PANEL A KICKOFF
QUESTION, WHAT IN YOUR VIEW ARE
INNOVATIVE AND EVIDENCE-BASED
APPROACHES WHICH HAVE POTENTIAL
TO DRIVE DOWN HIGH PREVALENCE OF
CARDIOVASCULAR SEVERE MATERNAL
OUTCOMES AND I ASKED THE PANEL
TO COMMENT ON INTEGRATED OR
INTERSECTIONAL APPROACHES WHERE
THE GAPS ARE, CHALLENGES,
BARRIERS, WHAT IS THE SCOPE FOR
ADAPTATION OF SUCCESSFUL
INTERVENTIONS AND DIFFERENT
SETTINGS.
YOU'RE ON MUTE.
>> SO THANK YOU.
APOLOGIES FOR THE BACKGROUND
NOISE.
I'M IN A NOISY AIRPORT.
LET ME START WITH OF THE POINT
THAT WAS MADE ON INFORMATION AND
DATA.
I COULDN'T AGREE MORE.
I THINK WHAT WE NEED START WITH
IN MANY HEALTH SYSTEMS, I'M
LARGELY TALKING ABOUT DISTRICT
HEALTH SYSTEMS, IS WAYS AND
MEANS OF NOT ONLY MONITORING
WHAT PEOPLE COLLECT AND DON'T
USE, AND A LOT OF DHIS, DISTRICT
HEALTH INFORMATION SYSTEMS, THE
COMMUNITY HAS WORKER MANAGEMENT
INFORMATION SYSTEMS, THOSE DATA
ARE REALLY NOT USED EFFECTIVELY.
TOOLS AND TECHNOLOGIES THESE
DAYS, PARTICULARLY USE OF A.I.,
FOR COLLATING AND SYNTHESIZING
IN REAL TIME IS A STARTING
POINT.
IT'S A STARTING POINT TO
RECOGNITION OF WHAT ARE
IMPORTANT CAUSES OF MORBIDITY,
IMPORTANT CAUSES OF COMORBIDITY
IN MANY INSTANCES, AND WHAT WE
BELIEVE ARE THE MAIN DRIVERS FOR
MORTALITY IN MANY OF THESE
SETTINGS.
THE OTHER IS EFFECTIVE USE OF
TECHNOLOGY AND TOOLS.
I DO BELIEVE FOR MANY
CARDIOVASCULAR DISEASES THAT WE
SEE IN COMMUNITY SETTINGS, LARGE
SCALE POPULATION SETTINGS,
RELATED TO HYPERTENSION, RISK OF
CARDIOVASCULAR DISEASE, EVEN
ADVERSITIES ONE ENCOUNTERS IN
PREGNANCY RECOGNIZABLE BY
ULTRASOUND AND DOPPLERS, USE OF
MANY TOOLS AND TECHNOLOGIES NOW
OFFERS A VERY EXCITING
OPPORTUNITY FOR DEMOCRATIZATION
OF APPROPRIATE HELP, USE OF,
LET'S SAY, SMALL HANDHELD
DEVICES LIKE ULTRASOUND
MACHINES, AND USE OF DEVICES
SUCH AS ONES WE PILOTED IN OUR
TRIAL OF ADEQUATE MEASUREMENT OF
BLOOD PRESSURE AND PERHAPS
ADDITIONAL MEASURES SUCH AS
HEART RATE AND OXYGEN SATURATION
ARE TOOLS THAT WOULD HELP TRIAGE
THOSE WHO ARE AT GREATER RISK OF
ADVERSE OUTCOMES FOR EFFECTIVE
REFERRAL AND PERHAPS
STABILIZATION.
BUT AS I SAID, THESE THINGS CAN
ONLY WORK IF YOU IMPLEMENT THEM
ACROSS THE HEALTH SYSTEM.
THEY CAN'T JUST WORK AT ONE
TIER.
FOR EXAMPLE PROVISION OF THESE
SERVICES AT FACILITIES WHEN YOU
DON'T HAVE TRANSPORT DOES NOT
VENT.
WE NEED TO LINK TO EXISTING
ACCOUNTABILITY AND OVERSIGHT
MECHANISMS THAT EXIST IN MANY
PLACES BUT ARE NOT UTILIZED IN
REASONABLE ENOUGH OR NEAR, YOU
KNOW, REAL TIME OVERSIGHT.
I THINK THOSE ARE JUST SOME
STARTING POINTS.
THERE'S A LOT THAT CAN BE DONE.
THERE'S A LOT THAT CAN BE
PILOTED AT REASONABLE LEVEL
BEFORE YOU SCALE UP.
THANK YOU.
>> GREAT, THANK YOU.
I WILL NOW OPEN IT UP TO THE
QUESTIONS FROM THE AUDIENCE.
WE HAVE ONE QUESTION, TO WHAT
EXTENT DOES PRE-PREGNANCY
HYPERTENSION, OBESITY AND
DIABETES CONTRIBUTE TO PRE-TERM
BIRTH AND SHOULD PRE-PREGNANCY
HEALTH STATUS BE ASSESSED BY
OB/GYN?
>> DEFINITELY THESE ARE RISK
FACTORS, EVEN OBESITY IS A RISK
FACTOR FOR VERY EARLY PRE-TERM
BIRTH, AGAIN BECAUSE OF THE
INFLAMMATION THAT'S BEEN SEEN IN
MANY EPIDEMIOLOGIC STUDIES.
YOU KNOW, I THINK IATROGENIC.
WE WOULD LOVE TO SEE A PATIENT
BEFORE SHE COMES TO OUR FLOOR OR
CLINICS WITH ALL THESE RISK
FACTORS, AND NOW WE HAVE TO --
WE DON'T NEED A SCREENING TEST,
OBVIOUSLY THIS PERSON IS AT HIGH
RISK.
WE DO PRE-CONCEPTION CONSULTS,
WE TRY TO DO ALL THE TIME, BUT A
LOT OF PATIENTS PARTICULARLY
MOST NEEDY WON'T COME INTO CARE
BEFORE THEY ARE PREGNANT.
AND THIS IS EXACTLY WHY THE
ABILITY TO HAVE FAMILY PLANNING
IS DIRECTLY RELATED TO MATERNAL
MORTALITY.
BECAUSE IF SOMEONE CAN'T PLAN
THEIR FAMILY APPROPRIATELY
YOU'LL SEE MATERNAL DEATHS WHEN
THEY COME IN, WE WOULD HAVE SAD
YOU SHOULD NOT BE PREGNANT AND
THEY ARE.
YES, I AGREE OB/GYN AND MATERNAL
MATERNAL-FETAL MEDICINE WOULD
LIKE TO SEE THEM BEFORE HAND,
BUT THIS IS NOT WHAT HAPPENS IN
REALITY.
>> I WOULD PARTICULARLY ADD TO
THIS WHAT HAS BEEN JUST SAID,
CYNTHIA, WE WOULD PARTICULARLY
LIKE TO SEE PATIENTS WHO HAVE A
CARDIAC DISORDER BEFORE SHE EVEN
THINKS ABOUT PREGNANCY BECAUSE
THEN GETTING INTO PREGNANCY AND
ASKING HER THIS IS SOMETHING
THAT'S GOING TO ADVERSELY AFFECT
HER WHOLE LIFE IS SOMETHING WE
WOULD NEVER WANT TO DO.
SO IT WOULD ALWAYS BE BETTER TO
HAVE THEM IN BEFORE.
IT COULD BE THE PHYSICIAN,
TREATING PHYSICIAN'S CONNECTION
WITH OBSTETRICIAN TO REFER THEM
BEFORE PREGNANCY, SO GOOD
CONNECTIONS BETWEEN PHYSICIAN
AND OBSTETRICIAN IS IMPORTANT
EVEN BEFORE THE ADVENT OF A
PREGNANCY.
>> SO I WANTED TO ADD IS SOME OF
MY COLLEAGUES HAVE RECENTLY
DOCUMENTED AND ABSOLUTELY
UNRECORDED AND UNRECOGNIZED HIGH
BURDEN OF RHEUMATIC HEART
DISEASE IN YOUNG ADOLESCENT
GIRLS, PARTICULARLY IN RURAL
PAKISTAN, AND THOSE ARE THINGS
THAT OBVIOUSLY CAN BE RECOGNIZED
EARLY, CAN BE AMENABLE TO
EARLIER MANAGEMENT, OBVIOUSLY
OPEN THE DOOR TO PROPHYLAXIS AND
PREVENTION IN EARLY CHILDHOOD.
ALSO WE'RE RECOGNIZING QUITE A
SIGNIFICANT BURDEN OF SEVERE
ANEMIA, WITH ASSOCIATED
CARDIOVASCULAR COMPLICATIONS
THAT HAPPEN IN PREGNANCY, AND
THOSE THINGS DO REQUIRE THAT WE
DO HAVE PREVENTIVE STRATEGIES
PUT IN HEALTH SYSTEMS IN TERMS
OF PICKING UP SOME OF THOSE HIGH
RISK SUBGROUPS.
THANK YOU.
>> NOT JUST VALVULAR, WE COULD
TALK ABOUT CONGENITAL EFFECTS,
WE NEED TO MAKE IT AVAILABLE AT
AN AFFORDABLE COST FOR GIRLS,
EVEN IN THE PEDIATRIC AGE GROUP
TO UNDERGO SURGERIES TO CORRECT
THESE DISORDERS BEFORE THEY HAVE
SOMETHING THAT CANNOT BE
AMENABLE TO ANY SORT OF
TREATMENT ALONG THE
CONSEQUENCES.
SO AVAILABILITY OF AFFORDABILITY
OF SURGERIES, FOR CONGENITAL
DEFECTS IS VERY IMPORTANT ACROSS
ALL SECTIONS OF SOCIETY.
>> GLOBALLY A NEED IN THE UNITED
STATES AND LOW- AND
MIDDLE-INCOME COUNTRIES FOR
BETTER PRE-CONCEPTION ACCESS TO
CARE AND MANAGEMENT AND FAMILY
PLANNING IS A BIG PART OF THAT,
OF COURSE, BUT ALSO JUST ACCESS
TO HEALTH CARE AND COMMUNICATION
BETWEEN DIFFERENT LEVELS OF THE
HEALTH SYSTEM AND DIFFERENT
TYPES OF PROVIDERS.
>> I WOULD ADD, YOU KNOW, THAT
DETERMINANTS OF HEALTH, WE CAN
CAPTURE, A COMMITTEE FROM ACOG
BACK IN 2017, 2018 TO HIGHLIGHT
IMPORTANCE OF SOCIAL
DETERMINANTS OF HEALTH, HEALTH
LITERACY FOR OUR PATIENTS.
THAT WOULD BE IMPORTANT TO
CAPTURE AND THIS IS GOING ABOVE
AND BEYOND, KNOWING PREGNANCY
HEALTH DATA, KNOWING COMORBID
CONDITION THE PATIENT ENTERS
PREGNANCY WITH.
STARTING TO HIGHLIGHT THESE
ISSUES, TRYING TO BRING THEM TO
LIGHT, THEY ARE VERY IMPORTANT
AND I THINK THIS CAME OUT
ALREADY IN THE KEYNOTE
PRESENTATIONS AND FROM EVERYONE
ON THIS PANEL.
THANK YOU.
>> I HAD ANOTHER QUESTION WHICH
POINTS TO LARGER SYSTEMIC THINGS
WE'VE BEEN TALKING ABOUT, HOW DO
WE BEST PROMOTE COLLABORATION
BETWEEN CLINICIAN-SCIENTISTS
THAT IS IMPLEMENTATION
RESEARCHERS LIKE YOURSELVES,
HEALTHCARE SYSTEMS, HEALTH
POLICY, GOVERNMENTS, COMMUNITY
ORGANIZATIONS, BIRTHING PEOPLE?
WHAT ARE SOME COLLABORATIVE
STRATEGIES?
>> THE BEST EXAMPLE COULD BE
ABOUT THE REGISTRY THAT IS
ONGOING IN THE COUNTRY.
THE CARDIAC DISEASES PREGNANCY
REGISTRY, WHICH IS ACROSS ALMOST
50 SITES, ALL OVER THE COUNTRY,
ACROSS A WIDE AREA.
WHETHER IT'S A PARTICIPATION
ALSO OF THE ADMINISTRATION,
POLICYMAKERS ARE PART OF IT,
UNIFORM STRATEGIES, UNIFORM
PROTOCOLS.
THERE'S AN OWN GOING TRAINING
EVEN FOR DATA COLLECTION WHERE
ALL HEALTH RESEARCHERS ALONG
WITH THEIR COLLABORATORS ARE
BEING TRAINED TO HAVE SYSTEMATIC
COLLECTION OF DATA, HAVING
REGISTERED ALL THE PATIENTS
THROUGHOUT THE PREGNANCY, EVEN
FOR THE NEXT PREGNANCY, SOME
NATIONAL REGISTRIES, SOMETHING
WHERE YOU COULD HAVE
COLLABORATION ACROSS ALL SITES,
ALL INSTITUTIONS IN THE COUNTRY.
>> SO I THINK WE NEED TO
ENCOURAGE NON-TRADITIONAL
PARTNERSHIPS, WHAT WE HEARD FROM
ONE OF THE KEYNOTE SPEAK ABOUT
TRADITIONAL PARTNERSHIPS, HOW
WE'RE SWITCHING GEARS AND
CHANGING THE LANDSCAPE FOR
COLLABORATION BLOABLLY. --
GLOBALLY, TO BRING PATIENT
VOICE, VOICES OF WOMEN WHO HAVE
LIVED THROUGH MULTI-MORBIDITY,
ADVERSE EVENTS, WOMEN WITH
SPECIAL NEEDS, DISABILITY AND SO
ON, NEED TO BE BROUGHT TO THE
TABLE.
THIS IS HELPING TO SOME EXTENT
IN THE PAST COUPLE OF YEARS BY
THE GOVERNMENT, BY -- WITH
EXPANDING OPPORTUNITIES AT
HELPING OVER THE PAST DECADE AS
I SAID BEFORE SO I REALLY THINK
THAT THE WAY THAT WE HAVE TRIED
TO DO IT AND HAVE SUCCESSFULLY
DONE IT IN THE PAST COUPLE YEARS
WE DECIDED GRANT OPPORTUNITIES
AND FUNDING I THINK THIS IS THE
WAY TO GO AND MOVE FORWARD.
>> I HAVE A QUESTION FROM THE
AUDIENCE, CAN YOU OFFER ADVICE
FOR EARLY INVESTIGATORS NEW TO
COMMUNITY ENGAGED RESEARCH, HOW
TO INVOLVE COMMUNITY PARTNERS
WHILE TRYING TO PLAN RESEARCH?
>> WELL, I MEAN, THERE'S NO
SHORTCUT.
FOR EARLY CAREER RESEARCH, ONE
BIT OF ADVICE TO JOIN HANDS WITH
PEOPLE WHO ARE ALREADY DOING
THIS IN THE COMMUNITY SETTINGS.
ESTABLISH PARTNERSHIPS.
AND PERHAPS SPEND A LITTLE BIT
OF TIME JUST LEARNING THE ROPES
AS TO HOW COMMUNITY LIAISON,
RELATIONSHIPS, AND
CO-DEVELOPMENT OF MANY RESEARCH
PROTOCOLS TAKES PLACE.
IN MANY OF THESE COMMUNITIES,
PARTICULARLY TRADITIONAL
COMMUNITIES, THERE'S NOTHING
THAT YOU CAN DO THAT'S IMPORTANT
WITHOUT ENGAGEMENT, ASSENT, PART
OF COMMUNITY MEMBERS LEADING TO
SOMETHING MEANINGFUL AND
SUSTAINED.
SINCE I DO A LOT OF WORK WITH
PUBLIC SECTOR PROGRAMS, BRING ON
PUBLIC SECTOR PARTNERS AS
CO-DEVELOPERS OR
CO-INVESTIGATORS IN PROJECTS
BECAUSE IF YOU HAVE FINDINGS,
POSITIVE OR NEGATIVE, FROM LARGE
SCALE EVALUATIONS OR TRIALS,
THEN IT IS THEY WHO ARE
GENERALLY GOING TO BE RECIPIENTS
AND PERHAPS PROPPANTS HOW TO
TAKE THING FORWARD.
WE'VE LEARNED MORE FROM POSITIVE
THAN NEGATIVE INSTANCE IN MANY
INSTANCES.
BUT IT ALSO OFFERS A PLATFORM IN
MANY OF THESE SETTINGS FOR
BRINGING THE PRIVATE SECTOR.
I FIND IF YOU HAVE A SUCCESSFUL
PROGRAM IN A COMMUNITY RURAL
DISTRICT, ONE OF THE FIRST WHO
WANT TO JUMP ON BOARD AND LEARN
AND ENGAGE PRIVATE SECTORS, NOW
A GROWING BODY, LAST BUT NOT
LEAST TO LOOK AT TECHNOLOGY AND
INNOVATIONS WHICH ARE COST
EFFECTS.
WITH THE POLY CRISIS AND
ECONOMIC LIMITATIONS, IT IS
PERHAPS IMPORTANT FROM THE VERY
OUTSET TO LOOK AT INTERVENTIONS
THAT WILL BRING COST
EFFECTIVENESS WITHIN BUDGETS,
THAT ALWAYS REQUIRES ENGAGING
WITH MINISTRIES OR FINANCE,
DEPARTMENTS OF FINANCE, SO IT IS
A PARTNERSHIP THAT YOU DEVELOP
FROM THE GET-GO, WITH RELEVANT
AUTHORITIES AND TO YOUNG
INVESTIGATORS THERE'S NO
SHORTCUT.
JOINING HANDS WITH GROUPS DOING
THIS IS A GOOD START, A SAFE
START.
IF YOU DON'T HAVE PEOPLE IN YOUR
REGION DOING THIS PERHAPS
LEARNING FROM OTHERS DOING ITS
NEARBY OR IN NEIGHBORING
COUNTRIES IS ALSO A REASONABLE
START.
THANK YOU.
>> I COULD ADD TO THAT LIKE
YOUNGER RESEARCHERS WOULD
COLLABORATE WITH COMMUNITY
MEDICINE AND DEPARTMENTS,
TALKING ABOUT PUBLIC HOSPITAL,
GOING FOR PREVENTIVE PROGRAMS,
NO THE -- NOT HOSPITAL BASED BUT
COMMUNITY BASED, INVOLVING
COMMUNITY WORKERS, HEALTH
RESEARCHERS WORKING OVER THERE,
AND THE PRIMARY AND SECONDARY
LEVEL CARE OF RESEARCHERS OR
DOCTORS AT THEIR PROGRAMS, THEY
ARE THE PEOPLE WHO ARE GOING TO
IMPLEMENT YOUR POLICIES,
WHATEVER YOU HAVE.
SO THAT'S THE BEST WAY OF
UNDERSTANDING THE PROBLEMS IN
THE COMMUNITY.
IF YOU HAVE TO DO SOME RESEARCH,
TO START RIGHT FROM THE GRASS
ROOTS THROUGH THE COMMUNITY, AND
THEN COME UP, YOU CANNOT DO
HOSPITAL-BASED RESEARCH AND GET
TO KNOW THE PROBLEM.
SO, ONCE THEY GO INTO THE
COMMUNITY THAT'S THE ONLY WAY
YOUNG RESEARCHERS ARE GOING TO
UNDERSTAND THE PROBLEMS, THEY
ARE GOING TO UNDERSTAND WE HAVE
A LOT OF PROGRAMS, ASKING THEM
TO IMPLEMENT.
WE HAVE PROTOCOLS, CHECKLISTS,
BUT THERE'S SOME ISSUES THAT MAY
PREVENT THEM AND UNDERSTANDING
OF THAT ONLY COMES WITHIN THE
COMMUNITY FROM THE HEALTH
WORKERS THAT ARE WORKING AT THE
COMMUNITY LEVELS, THE PROBLEMS
OF THE PEOPLE WHO ARE COMING IN
FROM THE -- THEY ARE PROBLEMS OF
ACCESS TO HEALTH CARE, PROBLEMS
OF AFFORDABILITY, THEY ARE
ENGAGEMENTS IN POPULATION, HOW
THEY REACH THE HEALTH, THEY NEED
TO UNDERSTAND WHAT ARE THE
LIMITATIONS SHE HAS TO GO
THROUGH.
THESE ARE SOMETHING THAT YOUNG
RESEARCHERS IF THEY UNDERSTAND
ARE THE GRASS ROOT LEVELS IT'S
GOING TO GO A LONG WAY
IMPLEMENTING WHATEVER
STRATEGIES, WHATEVER PROTOCOLS
WE HAVE, IMPROVING THE HEALTH
CARE.
>> GREAT POINTS ABOUT MAKING
SURE THAT IF YOU'RE INTERESTED
IN COMMUNITY RESEARCH AND THE
YOUNG INVESTIGATORS TO START AT
THE COMMUNITY LEVEL TO MAKE SURE
THAT YOU HAVE SOME UNDERSTANDING
OF THE GRASS ROOTS.
DR. BANNERMAN?
>> I HAVE TO SAY THAT, YOU KNOW,
BEING A CHAIR OF A DEPARTMENT, I
THINK THAT IT'S VERY IMPORTANT
FOR US HERE IN SAN DIEGO, WE
INVOLVE OUR COMMUNITY IN JUST
ABOUT EVERYTHING THAT WE DO.
WE HAVE A COMMUNITY BOARD WHERE
WE PRESENT, YOU KNOW, OUR --
JUST ON A REGULAR BASIS THE
FINDINGS OF THE THINGS GOING ON
IN OUR DEPARTMENTS.
WE ENGAGE WITH THEM IN RESEARCH.
IT HAS TO BE LIKE I THINK OTHERS
ARE SAYING FROM THE VERY
BEGINNING BECAUSE THEN ONCE YOU
WANT TO TRY TO FIND SOLUTIONS, I
THINK IT'S TOO LATE TO ENGAGE
THE COMMUNITY WHEN YOU'RE
PROBLEM SOLVING.
YOU JUST WANT A COLLEGIAL GROUP
THAT CELEBRATES EVERYTHING,
THINKS THROUGH THINGS, YOU HAVE
A MORE CAPTIVE AUDIENCE TO HELP
US ALL WORK TOGETHER TO FIND
RESEARCH QUESTIONS WE NEED TO
ANSWER AND HOW DO WE ANSWER THEM
BEST.
>> WE HAVE ANOTHER QUESTION IN
THE AUDIENCE FOR DR. CREANGA,
STRUCK BY THE HIGH NUMBER OF
THOSE ARE SMM IN MARYLAND.
YOU MENTIONED AT THE END YOU
WILL NOW INCLUDE RACISM IN THE
DATA.
CAN YOU EXPLAIN HOW YOU WOULD
ASSESS RACISM, STRUCTURAL
RACISM, ARE THERE COMPONENTS OF
SOCIAL DETERMINANTS OF HEALTH
INCLUDED?
>> YES, THANK YOU FOR THAT
QUESTION.
YES, WE'RE NOW STARTING DOING
INTERVIEWS WITH PATIENTS WHO
HAVE EXPERIENCED SMM AND WE'RE
DOING IN-DEPTH INTERVIEWS WITH
ABOUT 35, 35 TO 40, THAT'S THE
PLAN.
WE WANT TO UNDERSTAND THE THE
ROLE OF SOCIAL DETERMINANTS OF
HEALTH IN HEALTH PREDISPOSING
INDIVIDUALS TO DEVELOP AND
EXPERIENCE SMM, TRYING TO
UNDERSTAND THE EXPERIENCE ON
PATHWAYS TO SMM AND TO
UNDERSTAND OVERALL EXPERIENCE
GIVING BIRTH.
SO THAT INCLUDES, YOU KNOW,
EFFECTS OF THEIR INTERACTION
WITH THE HEALTHCARE SYSTEM,
THEIR NEEDS, NEEDS THAT WERE
MET, NEEDS NOT MET, AND
IMPLICATION OF RACISM ON THE
CARE THEY RECEIVE.
SO WE'RE RESTRICTING OUR
INTERVIEWS TO PATIENTS WHO HAVE
EXPERIENCED SMM IN THE PAST
THREE YEARS, AND WE'RE NOT
LINKING DATA FROM INTERVIEWS TO
OUR SMM SURVEILLANCE, TRYING TO
MAKE SURE THERE'S NO POTENTIAL
BIAS AFFECTING THE DATA THEY ARE
GOING TO COLLECT, WORKING WITH
THE BALTIMORE HEALTH COHORT, A
COMMUNITY ORGANIZATION, HOME
VISITING PROGRAM AND LARGE SET
OF INTERVENTIONS AND PROGRAMS
FOR PREGNANT AND POSTPARTUM
PATIENTS.
>> YES, WE'RE LOOKING
SPECIFICALLY, USING A
QUESTIONNAIRE TO ASSESS HEALTH
AND ADAPT FROM ONE OF THE ACOG
COMMUNITY OPINIONS THAT I
MENTIONED BEFORE.
>> WE'RE ACTUALLY NEARING THE
END OF OUR TIME TODAY BUT I DID
WANT TO END WITH ONE QUESTION
SPECIFICALLY FOR THE ENTIRE
PANEL RATHER.
WHAT CHALLENGES, SOLUTIONS, AND
LESSONS, SINCE WE'VE LEARNED
ABOUT, YOU KNOW, SIGNIFICANT
CHALLENGES IN BOTH THE UNITED
STATES AND GLOBALLY, WITH --
ACROSS INCOME SETTINGS, WHAT
CHALLENGES, SOLUTIONS, AND
LESSONS COULD APPLY THE TWO
SETTINGS, THE USA AND GLOBALLY,
WHERE WE HAVE DIFFERENT TYPES OF
MATERNAL HEALTH CRISES
OCCURRING, CARDIOVASCULAR
HEALTH, BUT EQUALLY IN BOTH
PLACES.
WHAT RESEARCH OPPORTUNITIES DO
YOU FORESEE FOR GLOBAL
CORROBORATION IN LOW-RESOURCE
SETTINGS IN THE UNITED STATES OR
IN THE WEST, BUT SPECIFICALLY
THE USA AND INTERNATIONALLY.
>> MAYBE I CAN HAVE THE FIRST GO
HERE.
SO AS IN SO MANY THINGS IN
GLOBAL HEALTH, AISHA, I THINK
BUILDING A COMMUNITY OF
PRACTICE, PARTICULARLY AMONGST
PEOPLE WHO ARE WILLING TO
UNDERTAKE A DEEP DIVE IN THESE
ISSUES, NOT JUST FOR ADVOCACY
BUT ALSO FOR MEANINGFUL RESEARCH
PARTICULARLY AROUND PRIORITY
GAPS IS ONE OF THE MOST
IMPORTANT INITIAL STEPS.
AND I HOPE ONE OF MIGHT HAVE
REASONS FOR BEING INTERESTED IN
THIS PARTICULAR WORKSHOP WAS
THAT WE DESPERATELY NEEDED
COMMUNITY OF PRACTICE AROUND
SOME OF THESE ISSUES RELATED TO
MATERNAL HEALTH, WOMEN'S HEALTH
GLOBALLY, AROUND THE BASIC
MECHANISMS, UNDERSTANDING OF
SOME OF THE BIOLOGY, PHYSIOLOGY,
WHAT NEEDS TO BE DONE WITHIN
HEALTH SYSTEM FOR ADDRESSING THE
BURDEN OF NON-COMMUNICABLES, AND
FINDING AN OPPORTUNITY TO BUILD
A MORE HOLISTIC RESEARCH AND
INTERVENTION AGENDA THAT BRINGS
IN ELEMENTS BEYOND THE NARROW
DISCIPLINARY INTERESTS THAT WE
HAVE.
FOR EXAMPLE, IN REAL LIFE,
CARDIOVASCULAR DISEASES,
METABOLIC DISEASES, SOME OF
THESE ADVERSE ISSUES THAT WOMEN
FACE, ARE NOT DEALING FROM WHAT
MY COLLEAGUE WAS TALKING ABOUT,
THE SOCIAL DETERMINANTS OF
HEALTH, ISSUES WITH GENDER-BASED
VIOLENCE, THAT HAVE TO DO WITH
MARGINALIZATION, ISSUES THAT
HAVE TO DO WITH MENTAL HEALTH
AND THE POLY CRISIS MANY WOMEN
FACE.
IN SOUTH ASIA TODAY, INDIA AND
PAKISTAN, SOME OF THE MOST
IMPORTANT EMERGING AGENDA FOR
RESEARCH IN WOMEN DURING
PREGNANCY ARE EXPOSURES TO
EXTREME HEAT AND IMPACT THAT IT
HAS ON THEIR METABOLISM,
PHYSIOLOGY, IMPORTANTLY BIRTH
OUTCOMES, NOT JUST FOR THE FETUS
BUT ALSO FOR THE WOMAN HERSELF.
SO THOSE KIND OF INTERPOLATED
RESEARCH AGENDAS CANNOT BE MET
BY ONE RESEARCH GROUP ALONE.
ONE THING I'VE LEARNED IN 40
YEARS IN GLOBAL HEALTH STARTING
WITH MDGs IS THAT WE COULD NOT
ACHIEVE ANYTHING AROUND MATERNAL
AND CHILD MORTALITY REDUCTION IN
THE MDG PERIOD, FOCUS ON
MORTALITY REDUCTION, WITHOUT
PARTNERSHIPS.
COLLABORATIONS AROUND BRIDGING
GAPS.
WE DIDN'T BRIDGE EVERY GAP BUT
BRIDGED A LOT OF GAPS IN TERMS
OF EFFECTIVE INTERVENTIONS,
INTERVENTIONS AT SCALE,
MONITORING EVALUATION,
ACCOUNTABILITY.
AS WE MOVE INTO SBGs, GRANULAR
AGENDA, NOWHERE NEAR MEETING
TARGETS, THAT CANNOT BE MET
WITHOUT DEVELOPING A COMMUNITY
OF PRACTICE.
AND A COMMUNITY OF RESEARCH
COLLABORATION.
WITH LINKS TO POLICYMAKERS, TO
COMMUNITIES, AND OTHERS, TO
CREATE MOMENTUM THAT WILL TAKE
US FORWARD AND THAT IS WHAT IS
REQUIRED AT THIS POINT IN TIME
GLOBALLY.
THANK YOU.
>> I COULDN'T AGREE WITH MORE
WITH WHAT DR. BHUTTT WAS SAYING.
I DON'T CALL IT COMMUNITY OF
PRACTICE BECAUSE I THINK MORE
ABOUT QUALITY IMPROVEMENT AND
WHAT WE DO, HERE IN MARYLAND.
GLOBAL WORLD, I KIND OF TALK
ABOUT RESEARCH NETWORKS,
COLLABORATIONS ACROSS COUNTRIES
AND BORDERS.
SO I FULLY AGREE WE NEED TO
UNDERSTAND STILLBIRTHS, NOT ONLY
IN THE U.S., THERE'S AN
OPPORTUNITY TO UNDERSTAND
STILLBIRTH BY WORKING TOGETHER
WITH COLLEAGUES AT THE LONDON
SCHOOL, PAKISTAN, INDIA AND
OTHERS ALREADY DOING FANTASTIC
RESEARCH.
THERE'S SO MUCH TO LEARN ONLY IN
THIS SPACE.
THEN OF COURSE MATERNAL
MORBIDITY AND MORTALITY, EVEN
FURTHER INFANT HEALTH AS WELL.
RESEARCH COLLABORATIONS ARE VERY
MUCH NEEDED.
ESPECIALLY IF WE ARE TO USE THE
SAME DATA ELEMENT, SAME
METHODOLOGIES, HR SYSTEMS WHERE
THEY EXIST, RICH DATA SOURCES
THAT CAN BE USED ACROSS BORDERS
AND GLOBALLY.
>> DR. BANNERMAN?
>> I WANT TO SAY FIRST OF ALL I
AGREE WITH THE PRIOR TWO
SPEAKERS WHOLEHEARTEDLY,
PARTICULARLY IN THE CONTEXT OF
HAVING COMMON DATA ELEMENTS TO
HELP US UNDERSTAND WHAT'S GOING
WITH OUR PATIENTS.
WE HERE IN SAN DIEGO HAVE
COLLABORATIONS AROUND THE WORLD,
EVEN WITH SOME SPEAKERS WHO ARE
PARTICIPATING IN THE NEXT COUPLE
DAYS.
BUT I DO HAVE TO SAY THAT AS
LARGE AS THE WORLD APPEARS, EVEN
SMALLER THAN IT SEEMS LIVING IN
A BORDER STATE IN A BORDER CITY
WHERE WE SEE PATIENTS THAT COME
FROM ALL OVER THE WORLD, JUST
INTO SAN DIEGO, HAVE INCREDIBLE
CARDIOVASCULAR DISEASE UP FRONT
FROM REALLY PLACES YOU WOULDN'T
IMAGINE AROUND THE WORLD.
AND SO WE'RE TAKING CARE OF
THESE PATIENTS AND THINKING
ABOUT POLICIES AND RESEARCH,
THINKING ABOUT ALL THAT
TOGETHER, BUT WE DO NEED I THINK
BETTER WAYS TO WORK TOGETHER, TO
REALLY TAKE CARE OF SOME
PATIENTS THAT ARE VERY
ACTIONABLE BECAUSE WE ARE SEEING
THIS COME ACROSS OUR HOSPITALS
ALL THE TIME.
>> IF I CAN COME BACK ON ONE
POINT, AS I CLOSE, IN SOME
RECENT WORK THAT WE'VE BEEN
DOING MY GROUP'S BEEN DOING WITH
THE GATES FOUNDATION AND GATES
VENTURES ON WOMEN'S HEALTH AND
WELL-BEING ACROSS THE LIFE
COURSE, WHAT IS VERY CLEAR IS
THE INTERCONNECTEDNESS OF WHAT
HAPPENS IN EARLY LIFE, WHAT
HAPPENS IN THE MOST PRODUCTIVE
REPRODUCTIVE PERIOD OF WOMEN AND
WHAT HAPPENS LATER ON.
I THINK THERE'S AN OPPORTUNITY
IN ANY SCIENCE AGENDA RELATED TO
WOMENS HEALTH EVEN THE
REPRODUCTIVE PERIOD, HOW DOES
AFFECT WELL-BEING ACROSS THE
LIFE COWS PEOPLE ARE BEGINNING
TO LOOK AT WOMEN'S HEALTH NOT
THROUGH THE LENS OF REPRODUCTION
BEER INTERGENERATIONAL TRANSFER
OF HUMAN CAPITAL.
SORRY TO HAVE INTERJECTED.
>> I THINK mHEALTH IS
SOMETHING THAT COULD BE USED, IN
POPULATING, KNOWING WHICH WOMAN
IS GOING THROUGH WHAT EVENT.
WOMEN SHOULD HAVE THE HEALTH IN
THEIR OWN HANDS.
WE HAVE DIGITIZATION OF DATA,
WOMEN HAVE A MOBILE IN THEIR
HANDS, THAT SHOULD BE ONE WAY OF
REACHING OUT TO WOMEN, TO IMPART
EDUCATION ABOUT HEALTH, AND
WHERE THEY COULD BE -- WE SEE
COMPLETE INDIGENOUSIZATION ALL
OVER THE COUNTRY, ESPECIALLY IN
THE CONTEXT OF INDIA, WHERE ALL
THE INFORMATION IS THERE AT THE
FINGERTIPS.
WHY COULDN'T WE ADD HEALTH,
IMPORTANT HEALTH PARAMETERS TO
THIS DATA?
WE COULD JUST START WITH EARLY
CHILDHOOD, RIGHT FROM CHILDHOOD,
GOING TO THE REPRODUCTIVE YEARS,
THERE'S SOMETHING WHICH COULD BE
ADDED AND WHICH COULD BE DONE IF
THE GOVERNMENTS ARE TRACKING
CERTAIN THINGS, WHY DO NOT THEY
TRACK THE HEALTH OF OUR NATIONS,
AND THAT IS IMPORTANT IF YOU'RE
TRACKING THE REPRODUCTIVE CAREER
FOR WOMEN IF SHE HAS UNDERLYING
DISORDERS, IMPORTANT DATA THE
WOMAN CAN FEED HERSELF, LINK TO
HER OWN ID, THAT COULD BE
SOMETHING WITH RED FLAGS USED TO
OFFER HER SERVICES.
SO THAT'S ONE TECHNOLOGY THAT
COULD BE USED FOR THE
IMPROVEMENT OF HEALTH ACROSS THE
SOCIETY.
>> THANK YOU SO MUCH.
WELL, WE'RE AT THE END OF OUR
TIME.
AND WE STILL HAVE A FEW
QUESTIONS BUT HOPEFULLY I CAN
SEND THEM LATER ON TO SOME OF
YOU.
I WANT TO THANK EVERYBODY SO
MUCH FOR YOUR TIME AND FOR YOUR
INTERESTING THOUGHT-PROVOKING
COMMENTS AND PRESENTATIONS.
WE WILL BREAK FOR LUNCH AND SEE
EVERYBODY BACK AT 1:35 EASTERN
TIME. THANK YOU.
>> HI, EVERYONE.
WELCOME BACK TO OUR LUNCH BREAK.
I'M HONORED TO INTRODUCE THE
NEXT PANEL ON HEMATOLOGY AND
BLOOD TRANSFUSION, FAX YACHTER
IN MATERNAL MORBIDITY AND
MORTALITY, EXPLORING ADVANCING
IMPLEMENTATION RESEARCH,
TRAINING, CAPACITY BUILDING AS
RELATES TO MANAGING BLOOD
DISEASES AND MATERNAL HEALTH
THROUGH THE GLOBAL PERSPECTIVE.
WE HAVE AN EXCEPTIONAL LINEUP OF
SPEAKERS, IN THE INTEREST OF
TIME I'LL NOT GO THROUGH FULL
CREDENTIALS AND BACKGROUND BUT
LOOK AT THE PROGRAM BOOKLET FOR
INFORMATION.
THE FIRST SPEAKER IS DR. MAKANI,
POLICY AND PARTNERSHIPS,
IMPROVING MATERNAL HEALTH
OUTCOMES THROUGH HEMATOLOGY AND
PLOD TRANSFUSION.
SECONDS IS DR. PECKER,
DISCUSSING TRANSFORMING
PREGNANCY OUTCOMES FOR PEOPLE
WITH SICKLE CELL DISEASE.
DR. OPPONG AND DR. ASARE WILL
GIVE A JOINT PRESENTATION
ADDRESSING DISPROPORTIONATELY
HIGH MATERNAL AND PERINATAL
ASSOCIATED WITH SICKLE CELL
DISEASE IN A LOW AND MIDDLE
INCOME COUNTRY, ROLE OF
MULTI-DISCIPLINARY CARE.
FINALLY DR. PEPRA HAD ADDRESS
STRUCTURAL RACISM IN THE
SUCCESS, SUCCESS AND CHALLENGES
OF INTERVENTION AND
IMPLEMENTATION.
WITH THAT, I WILL NOW TURN IT
OVER TO DR. MAKANI.
>> HELLO.
THANK YOU VERY MUCH, DR.
GOLDBERG.
HELLO, EVERYONE.
I'M PROFESSOR JULIE MAKANI,
CALLING FROM TANZANIA, IT'S AN
HONOR TO PARTICIPATE IN THIS
SESSION.
I APOLOGIZE BUT I'M GOING TO
SWITCH MY VIDEO OFF AND SPEAK
FOR TEN MINUTES WITHOUT MY VIDEO
O THANK YOU FOR INVITING ME.
THANK YOU.
WHAT I'LL DO IS TALK ABOUT
POLICY AND PARTNERSHIPS, AND THE
IMPORTANCE OF POLICY AND
PARTNERSHIPS WHEN IT COMES TO
IMPROVING MATERNAL HEALTH
OUTCOMES THROUGH HEM TOLLING AND
BLOOD TRANSFUSION.
I WOULD LIKE TO ACKNOWLEDGE THAT
THIS IS WORK THAT'S BEEN DONE BY
MANY PEOPLE OVER MANY YEARS, AND
FROM MANY COUNTRIES AND PLACES.
SECONDLY TO RANCH PATIENT'S
COMMUNITY AS WELL AS FUNDERS.
I WILL TALK ABOUT THREE MAIN
AREAS.
POLICY AND PARTNERSHIPS,
MATERNAL HEALTH, AND HEMATOLOGY
AND BLOOD TRANSFUSION.
SO WHEN IT COMES TO POLICY AND
PARTNERSHIPS, WHAT I WILL DO IS
TALK ABOUT POLICY IN THE CONTEXT
OF FOUR MAIN SECTORS OR AREAS OR
MINISTERS WHEN WE THINK ABOUT
THE PERSPECTIVE OF GOVERNMENT
MINISTRIES IN AFRICA OR
DEPARTMENTS OF -- IN OTHER
COUNTRIES.
THERE'S FOUR POLICIES I'LL BE
REFERRING TO, ONE IS POLICY IN
HEALTH.
SECOND IS POLICY IN EDUCATION
FOCUSING ON HIGHER EDUCATION.
THIRD AREA IS RESEARCH.
SO WHAT ARE THE POLICY PLATFORMS
THAT ARE IN PLACE THAT WILL
SUPPORT HEMATOLOGY AND BLOOD
TRANSFUSION TO IMPROVE MATERNAL
HEALTH OUT, SO SCIENCE,
TECHNOLOGY, INNOVATION.
FOURTH AREA IS FOREIGN.
MAINLY BECAUSE AS A GLOBAL
COMMUNITY WE WANT TO LOOK HOW WE
CAN WORK WITH OTHER COUNTRIES,
HOW WE CAN WORK WITH
INSTITUTIONS IN OTHER AREAS, AND
SO BEING ABLE TO UNDERSTAND
FOREIGN POLICY PLATFORMS IN
PLACE IS QUITE IMPORTANT.
THE SECOND AREA IS PARTNERSHIPS.
THIS IS PARTNERSHIP FROM CONTEXT
OF MULTI-DISCIPLINARY, TWO
DISCIPLINES HERE ARE HEMATOLOGY
AND BLOOD TRANSFUSION, AND
MATERNAL AND CHILD HEALTH.
BUT THEN THE OTHER AREAS IN
TERMS OF PARTNERSHIPS
MULTI-SECTORIAL, GEOGRAPHIC.
WHEN WE TALK ABOUT IMPROVING
MATERNAL HEALTH OUTCOMES WE'RE
TALKING ABOUT MATERNAL HEALTH,
HEALTH OF THE WOMAN, PREGNANT
WOMAN, BEFORE, DURING, AFTER
DELIVERY.
AND WE'RE ALSO TALKING ABOUT
MATERNAL HEALTH FROM PERSPECTIVE
OF WELL WOMAN BECAUSE WE WANT TO
BE ABLE TO UNDERSTAND WHAT ARE
THE INTERVENTIONS THAT NEED TO
BE PUT IN PLACE BEFORE A WOMAN
STARTS HER REPRODUCTIVE CAREER.
THE SECOND ASPECT IS REALLY
IMPORTANT TO THINK ABOUT HEALTH
OUTCOME, NOT JUST OF THE MOTHER
BUT OF THE CHILD AS WELL.
AND SO WHEN WE'RE TALKING ABOUT
POLICY AND PARTNERSHIPS, WE HAVE
TO CONTEXTUALIZE MATERNAL HEALTH
AS WELL AS CHILD HEALTH ASPECT
OF THINGS.
WHEN WE TALK ABOUT HEMATOLOGY
AND BLOOD TRANSFUSION, WE REALLY
WANT TO LOOK AT OBSTETRIC
HEMATOLOGY AND HEMATOLOGY IN
GYNECOLOGY OR HEMATOLOGY IN
WOMEN BEFORE THEY EVEN COME TO A
HEALTH FACILITY, AND THREE MAIN
AREAS IN THIS SECTOR THAT ARE
IMPORTANT IS PERIPARTUM
HEMORRHAGE, PROBABLY IN THE TOP
THREE CAUSES OF MATERNAL
MORBIDITY AND MORTALITY, IN MANY
COUNTRIES IN AFRICA.
ANEMIA, AND THIS IS PERTINENT
PRE-PREGNANCY.
AND IT HAS A BIG BEARING BECAUSE
IF WOMEN GO INTO PREGNANCY WITH
A SEVERE ANEMIA OR LOW LEVEL OF
HEMOGLOBIN THIS WILL HAVE A HUGE
IMPACT WITH REGARDS TO MORBIDITY
AND MORTALITY AND THE OTHER
HEMATOLOGICAL CONDITIONS JUST AS
IMPORTANT.
CLOTTING, BLEEDING, OTHER
COMPLICATIONS THAT MAY RESULT.
WHEN WE TALK ABOUT TRANSFUSION
THIS IS PERTINENT.
WHEN YOU THINK, IF ANYONE GOES
TO A TRANSFUSION CENTER, EITHER
WITHIN THE HOSPITAL OR WITHIN A
BLOOD TRANSFUSION SERVICE, THEY
WILL TELL YOU THAT THE TOP TWO
USERS OF BLOOD TRANSFUSION ARE
PREGNANT WOMEN OR OBSTETRIC
WARD, AND SECOND IS ANEMIA -- OR
PEDIATRICS.
PEDIATRIC, THE DEMAND IS IN
TERMS OF NUMBERS, WHERE FOR
PREGNANT WOMEN THE DEMAND IS IN
TERMS OF VOLUME.
SO BLOOD BANKS AND BLOOD
TRANSFUSION CENTERS REALLY
APPRECIATE THE INTERLING WITH
TRANSFORM AND HEMATOLOGY AND
MATERNAL AND CHILD HEALTH
OUTCOMES.
WITH POLICIES ONE OF THE THINGS
I WANT TO SAY IS THAT WE ARE
VERY FORTUNATE.
WHEN I SAY WE, IT'S REFERRING TO
COUNTRIES IN AFRICA.
WE'RE VERY FORTUNATE BECAUSE
THERE HAVE BEEN POLICIES THAT
HAVE BEEN PUT IN PLACE THAT HAVE
RESULTED IN QUITE AN EXTENSIVE
IMPROVEMENT IN HEALTH FACILITIES
AS PRIMARY, SECONDARY, TERTIARY
LEVELS.
WHEN YOU LOOK AT MOST AFRICAN
COUNTRIES, THEY HAVE ADOPTED AND
HAVE BEEN WORKING STEADILY OVER
THE PAST FIVE TO TEN YEARS ON
UNIVERSAL HEALTH CARE, REALLY
FOCUSING ON COMMUNITY AND
POPULATION LEVEL HEALTH
FACILITIES.
WHICH MEANS THAT THERE ARE
PLATFORM THAT HAVE OPINION PUT
IN PLACE TO IMPROVE MATERNAL
HEALTH OUTINCLUDING HEMATOLOGY
AND BLOOD TRANSFUSION.
SECOND ASPECT, THIS WAS REALLY
ACCELERATED BY THE COVID-19
PANDEMIC WHEN THERE WAS GLOBAL
SHUTDOWNS, THERE WAS LIMITED
MOVEMENTS BETWEEN COUNTRIES, AND
THIS RESULTED IN ACCELERATION OF
IMPROVEMENT OF TERTIARY
HEALTHCARE FACILITIES, THESE ARE
TREATMENT CENTERS, CENTERS OF
EXCELLENCE, TERTIARY HOSPITALS,
AND REALLY FORCED COUNTRIES TO
LOOK AT REFERRAL PATHWAYS.
WHEN WE TALK ABOUT HEALTH POLICY
AND THE CONTEXT OF IMPROVING
MATERNAL HEALTH OUTCOMES,
HEMATOLOGY AND BLOOD
TRANSFUSION, PLATFORMS ARE IN
PLACE.
NOW WHAT WE CAN DO AS MEMBER
STATES OR COUNTRIES IN AFRICA,
PART OF THIS GLOBAL COMMUNITY,
IS WE NOW HAVE THE
INFRASTRUCTURE, WE HAVE THE
INFRASTRUCTURE IN PLACE AT
PRIMARY, SECONDARY AND TERTIARY
LEVEL; WE HAVE THE PEOPLE IN
PLACE AT THESE THREE LEVELS; AND
WE HAVE THE SYSTEMS IN PLACE
BECAUSE WHEN YOU LOOK AT BLOOD
TRANSFUSION SYSTEMS AND CHILD
AND MATERNAL HEALTH SYSTEMS
THESE HAVE BEEN STRENGTHENED
ACROSS.
THE GAP THAT I THINK IS THERE
WILL BE MET BY IMPLEMENTATION
SCIENCE BECAUSE IT'S REALLY
SAYING HOW CAN WE CONDUCT
IMPLEMENTATION SCIENCE AND
TRANSLATIONAL RESEARCH USING
THESE PLATFORMS THAT HAVE BEEN
PUT IN PLACE AND UNDERSTANDING
AND REVISING THE APPROACH THAT
WE HAVE.
WITHIN HEALTH POLICY, THE OTHER
THING THAT WE TALK ABOUT AND
YOU'LL HEAR A BIT MORE ABOUT
WITH MY OTHER COLLEAGUES IS
REALLY TRYING TO ADDRESS ACCESS
TO HEALTH CARE FROM AN EQUITY
PERSPECTIVE, QUALITY
PERSPECTIVE, FROM MAKING SURE
THAT ANY PREGNANT WOMAN DOES NOT
HAVE DIFFICULTY ACCESSING GOOD
QUALITY HEALTH CARE WHEN THEY
NEED IT, WHETHER NEAR THEIR
HOMES OR WHEN THEY NEED IT WHEN
THEY ARE REFERRED TO ANOTHER
HEALTH FACILITY.
SO IN TERMS OF POLICIES, THE
OTHER POLICIES THAT WE NEED TO
TAKE INTO ACCOUNT, POLICIES IN
EDUCATION, SCIENCE, AND
TECHNOLOGY.
AND, AGAIN, THIS IS IMPORTANT
BECAUSE WE NEED TO BE ABLE TO
CONVINCE THE POLICYMAKERS IN
EDUCATION, IN SCIENCE AND
TECHNOLOGY, THE ROLE AND THE
VALUE OF IMPLEMENTATION SCIENCE,
THE ROLE AND VALUE OF
TRANSLATIONAL RESEARCH, SO IT'S
NOT LOOKED AT AS A SEPARATE
THING BUT IT'S LOOKED AT AS PART
AND PARCEL OF HEALTH POLICIES.
THERE'S A TENDENCY OF LOOKING AT
THESE EITHER SEQUENTIALLY OR AS
TWO SEPARATE AREAS, AND IT'S
REALLY A ROLE, THIS IS WHERE,
AGAIN, IMPLEMENTATION SCIENCE
COMES IN TO IT, CREATING A
BRIDGE BETWEEN HEALTH POLICY,
EDUCATION POLICY, HEALTH
RESEARCH POLICY.
I THINK THE FINAL SECTION WITH
REGARDS TO POLICY, WHAT WE
MENTIONED BEFORE, WHEN WE TALK
ABOUT PUBLIC POLICY WE NEED TO
THINK ABOUT THIS IN THE CONTEXT
OF FOREIGN POLICY.
WE NEED TO ENGAGE OUR
GOVERNMENTS, ENGAGE OUR
POLICYMAKERS SO WE CAN EXPLAIN
TO THEM WHY IT'S IMPORTANT FOR
US IN TANZANIA TO WORK WITH
COLLEAGUES IN UGANDA, IN GHANA,
AS WELL AS COLLEAGUES IN THE
U.S., IN THE U.K., IN INDIA
BECAUSE WE NEED TO BE ABLE TO
LOOK AND WORK TOGETHER AT
BILATERAL LEVEL AND MOMENT
LATERAL LEVEL TO EXCHANGE
KNOWLEDGE AND LEARN FROM EACH
OTHER.
THE OTHER SECTOR IS INVESTMENT
FROM PLANNING, FROM FINANCE,
FROM TRADE AND INDUSTRY BECAUSE
WE KNOW THAT THERE'S BEEN QUITE
A LOT OF INVESTMENT IN BUILDING
OF PLATFORMS, INFRASTRUCTURE,
FACILITIES TRAINING PEOPLE, BUT
WE NEED TO DO MORE.
THERE ARE PLACES WITH GAPS, NOT
ENOUGH HUMAN RESOURCES IN
HEALTH, AND THEREFORE WE NEED TO
CONVINCE MINISTRY OF FINANCE,
MINISTRIES OF TRAINING, THEY
NEED TO INVEST IN THIS SECTOR
AND IT WILL HAVE A GOOD RETURN.
IN TERMS OF POLICY, IT'S REALLY
MAKING SURE THE POLICIES ARE IN
PLACE FOR THE PRIVATE SECTOR,
CIVIL SOCIETY ORGANIZATIONS,
PATIENT AND COMMUNITY-BASED
ORGANIZATIONS AND NON-STATE
ORGANIZATIONS.
THAT'S WHY I STARTED WITH
POLICY, TRYING TO EMPHASIZE THE
ROLE OF POLICY IN THIS SPACE AND
IN FACILITATING IMPLEMENTATION
SCIENCE IN THIS SPACE.
NOW I'LL SPEND THE NEXT THREE OR
FIVE MINUTES TALKING ABOUT
PARTNERSHIPS.
FIRST AS I MENTIONED IN TERMS OF
LOOKING AT PARTNERSHIP THERE'S
BEEN QUITE A LOT, I'M ENVIOUS
LOOKING AT COLLEAGUES IN
OBSTETRICS AND GYNECOLOGY, HOW
THEY HAVE REALLY PUT IN ROBUST
SYSTEMS TO IMPROVE ANTENATAL
CARE, PERIPARTUM CARE, TO REALLY
ADDRESS THE WELL WOMAN BEFORE
SHE STARTS HER REPRODUCTIVE
JOURNEY.
WHEN YOU LOOK AT CHILD HEALTH,
THERE ARE INCREDIBLY SUCCESSFUL
IN TERMS OF HUMANIZATION
PROGRAMS, MANY COUNTRIES WILL BE
ABLE TO TELL YOU THAT
IMMUNIZATION IS PROBABLY BETWEEN
80 TO 100%, WITH REGARDS TO
GETTING THE BABIES WHO NEED OR
WHO ARE PART OF THEIR PROGRAMS
OF IMMUNIZATION.
I THINK THERE ARE PLATFORMS IN
PLACE WITH REGARDS TO HIV IN
CHILD HEALTHS, PREVENTING
MOTHER-TO-CHILD TRANSMISSION,
PROGRAMS FOR EARLY INFANT
DIAGNOSIS, FANTASTIC PLATFORMS
FOR NEWBORN SCREENINGS FOR
SICKLE CELL DISEASE OR NEWBORN
SCREENING FOR OTHER HEMATOLOGIC
CONDITIONS.
THIS SEGUES IN QUITE WELL INTO
PROGRAMS FOR CHILD HEALTH, AN
EXAMPLE IS THE INTEGRATED
MANAGEMENT OF ILLNESSES.
THE PARTNERSHIPS, IT'S REALLY
LOOKING AT HEALTH, YOU'RE HEAR
ABOUT THAT BUT I WANTED TO
MENTION A FEW PARTNERSHIPS IN
HEALTH.
SICKLE CELL DISEASE AT CENTER
LEVEL, REGIONAL LEVEL WHERE,
EAST AFRICA, WEST AFRICA,
AFRICAN LEVEL WITH EXAMPLES LIKE
SICKLE IN AFRICA.
THIS AND OTHER HEMATOLOGIC
CONDITIONS ARE PART OF
NON-COMMUNICABLE DISEASE
NETWORK, W.H.O. AFRO COUNTRIES,
AFRICA AND REGION OFFICES IN
W.H.O., HAVE ADOPTED THE
STRATEGY FOR TYPE 1 DIABETES,
SICKLE CELL DISEASE, AND HEART
DISEASE.
BLOOD TRANSFUSION HAS BEEN
STRENGTHENED, PLATFORMS FOR
IMPLEMENTATION SCIENCE RESEARCH.
I WANTED TO MENTION ABOUT
SCIENCE AND TECHNOLOGY, HERE THE
NIH WORKING WITH PARTNERS
FUNDING HEALTH RESEARCH HAVE,
AGAIN, OVER THE PAST TEN,
FIFTEEN YEARS, STRENGTHED
GENOMIC RESEARCH THROUGH
H3AFRICA DATA SCIENCE RESEARCH
AS WELL AS SICK UNTIL AFRICA,
THESE ARE NETWORKS THAT CAN THEN
NOW BE USED FOR IMPLEMENTATION
SCIENCE AND TRANSLATIONAL
RESEARCH.
BLOOD TRANSFUSION EXAMPLES OF
PLATFORMS ARE RED, BLOOD SAFE
GENE AND CELL THERAPY IS PART OF
THE CELL INITIATIVE.
THE OTHER IS FINANCING
PARTNERSHIPS.
NO ONE FUNDER, NO ONE ENTITY
WILL BE ABLE TO ADDRESS THE
NEEDS SO WE NEED TO THINK ABOUT
FUNDING PARTNERSHIPS, AND BEING
ABLE TO LOOK AND INTEGRATE AND
LOOK FOR AREAS OF CONVERGENCE.
FINALLY, THIS IS MY LAST
COMMENT, IN CLOSING TO EMPHASIZE
THREE THINGS.
THE FIRST IS WE NEED TO BE ABLE
TO ADDRESS AND HAVE AN IMPACT ON
THE PATIENTS.
AT THE SAME TIME WE NEED TO HAVE
AN IMPACT ON THE POPULATION,
THIS IS WHERE I WHERE THE IMPLN
SCIENCE IS ABLE TO BRIDGE.
WE START DOING IT NOW, CHANGE,
REVISE AND MODIFY, AND
IMPLEMENTATION SCIENCE PROVIDES
THAT FRAMEWORK TO DO THAT.
IT'S REALLY EMPHASIZING WE
CANNOT DO THIS ALONE.
WE HAVE TO PARTNER WITH EACH
OTHER AND HAVE THE RIGHT
POLICIES IN PLACE TO MAKE AN
IMPACT IN IMPROVING THE HEALTH
OF PREGNANT WOMEN OR IMPROVING
THE MATERNAL HEALTH OUTTHROUGH
THE LENS OF HEMATOLOGY AND BLOOD
TRANSFUSION.
THANK YOU FOR LISTENING.
OVER TO YOU.
>> GOOD AFTERNOON FROM
BALTIMORE.
IT'S A PLEASURE TO TALK TO YOU
ABOUT PREGNANCY OUTCOMES FOR
PEOPLE WITH SICKLE CELL.
MY FOCUS WILL BE ON THE U.S.,
CONTEXT, HOWEVER, OUTCOMES ARE
SUFFICIENTLY POOR IN THE UNITED
STATES, THIS IS AN AREA WE HAVE
TO KEEP LEARNING AND
COLLABORATING INTERNATIONALLY
AND PARTNERSHIPS WITH FOLKS
ACROSS DIVERSE RESOURCED
SETTINGS.
NEXT SLIDE PLEASE.
THESE ARE MY DISCLOSURES, LUCKY
TO HAVE RESEARCH FUNDING AND DO
CONSULTING WORK, CO-FOUNDER OF
SICKLE CELL REPRODUCTIVE HEALTH
EDUCATION DIRECTIVE AND SERVE ON
THE ADVISORY COMMITTEE FOR
FOUNDATION FOR WOMEN AND GIRLS
WITH BLOOD DISEASE. DISEASE.
THIS IS A BRIEF OVERVIEW FOR
PEOPLE WITH SICKLE CELL DISEASE
PARTICULARLY PEOPLE WITH OVARIES
IN CONTEMPORARY SICKLE CELL
DISEASE CARE.
AND THESE CONCERNS NOW BEGIN
WITH REALLY QUITE MOMENTOUS
TREATMENT CHOICES LIKE BONE
NARROW TRANSPLANT, GENE THERAPY,
BOTH GONADOTOXIC AT THE MOMENT,
REQUIRED PRESSURE FOR
POLICYMAKERS TO IMPROVE ACCESS
TO FERTILITY RESERVATION AND
CARE.
ANOTHER STEP FOR PEOPLE WERE
SICKLE CELL DISEASE IS MAKING
COMPLEX PRE-CONCEPTION
REPRODUCTIVE HEALTH DECISIONS.
I WANTED TO POINT FOLKS'
ATTENTION TO THE FACT THAT THE
CENTER FOR DISEASE CONTROL AND
PREVENTION RELEASED THEIR NEW
MEDICAL ELIGIBILITY CRITERIA FOR
CONTRACEPTION WITH CHANGED
RECOMMENDATIONS FOR FIRST LINE
CONTRACEPTION FOR INDIVIDUALS
WITH SICKLE CELL DISEASE, THESE
RECOMMENDATIONS IN BRIEF MAKE
PROGESTERONE ONLY CONTRACEPTION
FIRST LINE FOR SICKLE CELL
DISEASE, AND PUT MORE TIGHTER
RESTRICTIONS ON RECOMMENDATIONS
FOR ESTROGEN-CONTAINING
CONTRACEPTIVE USE BECAUSE OF
THROMBOTIC RISKS ASSOCIATED WITH
ESTROGEN BALANCING AGAINST
THROMBOTIC RISK OF PREGNANCY AND
HIGH RISK PREGNANCY, AN ABIDING
CONCERN FOR YOUR COMMUNITIES.
NEXT SLIDE PLEASE.
SO JUST A BACKGROUND, IN JAMAICA
AND THE UNITED STATES AND MANY,
I SUSPECT, OTHER PLACES,
MORBIDITY AND MORTALITY FOR
PREGNANT PEOPLE WITH SICKLE CELL
DISEASE IS STAGNANT.
HOWEVER, AS WE'LL HEAR FROM MY
AMAZING COLLEAGUES, EXISTING
TREATMENT AND MULTI-DISCIPLINARY
CARE MODELS HAVE THE POTENTIAL
TO TRANSFORM OUTCOMES.
AND TODAY I'M GOING TO TALK
BRIEFLY ABOUT WHY THE DATA
POINTS OF THE FACT THAT IN
SETTINGS WHERE THERE ARE SAFE
ACCESS TO RED BLOOD CELLS FOR
INDIVIDUALS WITH SICKLE CELL
DISEASE, EACH PREGNANT PERSON
WITH SICKLE NEEDS TO BE
EVALUATED FOR INDICATION FOR
PROPHYLACTIC RED CELL
TRANSFUSION DURING PREGNANCY.
MY SUMMARY OF THIS SLIDE WHY
WOULD THE PLACENTA BE NORMAL.
PATHOPHYSIOLOGIES ARE COMPLEX,
MULTI-FACTORIAL, AFFECTING MANY
ORGANS OF THE BODY.
WE INCREASINGLY APPRECIATE AND
ACKNOWLEDGE THAT AMONG THOSE
ORGANS ARE THE OVARIES,
PLACENTA, FOR A BRIEF TIME THE
FETUS.
AND SO JUST TO REVIEW THOSE
PATHOPHYSIOLOGIES, THIS INCLUDES
THE CLASSIC DEFECTS, HEMOGLOBIN
POLYMERIZATION WHICH CAUSES RED
CELL HOMOLYSIS, NASTY SCREECHING
ON ENDOTHELIAL CAUSING INCREASED
ADHESION AND INFLAMMATION.
THERE ARE MANY REASONS TO BE
INTERESTED IN MULTI-FACTORIAL
PATHWAYS, WE HAVE A GROWING
NUMBER OF THERAPEUTICS THAT
TARGET DIFFERENT PLACES IN THIS
PATHWAY.
AND THIS SLIDE IS INTENDED TO
PROVIDE OVERVIEW OF THOSE
PATHOPHYSIOLOGIES ANDS THINK
ABOUT IMPLICATION OF THOSE
PATHOPHYSIOLOGIES FOR PREGNANT
PEOPLE IN A DISEASES THAT CAUSES
ANEMIA, WE SEE MATERNAL ANEMIA,
IN A DISEASE THAT CAUSES VASAL
OCCLUSION WE SEE PLACEBO SEVEN
-- PLACENTAL DAMAGE, WE
SEE EXPANDING BLOOD VOLUME,
NORMAL RESPONSE TO PREGNANCY
THAT CAUSES CARDIO PULMONARY
STRESS, INCREASES IN
PROGESTERONE, VASCULAR
RESISTANCE CHANGES STRESS SIS
SYSTEMS.
HYPERESTROGENEMIA, AND EXPANDING
UTERUS INCREASES RISK FOR PAIN,
UNCOMFORTABLE, AT FETUSES GROW,
COMPRESSING LUNG SPACE LEADING
TO RISK OF ACUTE CHEST SYNDROME.
THESE ARE THE MOST REASONS DATA
FROM NATIONAL INPATIENT SAMPLE
IN THE UNITED STATES.
THIS IS THE CDC'S SEVERE
MATERNAL MORTALITY INDEX.
WE DID THIS STUDY TO COMPARE
OUTCOMES OF PREGNANT PEOPLE WITH
SICKLE CELL TO OTHER
POPULATIONS, RESTRICTED TO BLACK
FOLKS WITH SICKLE CELL DISEASE
AND -- I'M SORRY, BLACK FOLKS
WITH SICKLE IN ORANGE AND YELLOW
PLOTS, WITHOUT SICKLE CELL
DISEASE WHO ARE PREGNANT IN
PURPLE AND BLUE SLOTS.
THE ONE IS PEOPLE IDENTIFIED AS
WHITE WITHOUT SICKLE CELL
DISEASE.
I HOPE YOU CAN SEE MOST OF THE
MARKERS OF THE RISK IN SICKLE
CELL DISEASE IS SIGNIFICANTLY
GREATER THAN RACIAL MATERNAL
MORTALITY STATISTICS, AND
CERTAINLY THAN WHITE FOLKS
WITHOUT SICKLE CELL DISEASE.
WHERE EVENTS ARE RARE LIKE
CEREBROVASCULAR THE RISK OF
SICKLE IS HIGHER THAN THE
GENERAL POPULATION.
OUR PAPER DOESN'T STAND ALONE,
OTHER PEOPLE FIND THE SAME
THING, IT'S NOT NICE BUT DOES
CONFIRM WE HAVE A REAL PROBLEM
AND WE NEED TO ACT TO DO
SOMETHING DIFFERENTLY.
NEXT SLIDE PLEASE.
THIS IS TO FURTHER SHOW FETUSES
ARE ALSO ADVERSELY AFFECTED IN
ADDITION TO FETAL DEMISE,
PRE-TERM DELIVERY, BABIES ARE
SMALL FOR GESTATIONAL AGE,
INCREASED RISK OF DEATH.
AS A POINT OF INFORMATION
SHARING SEVERE MORBIDITY AND
MORTALITY INDEX BY CDC CARS
VASOOCCLUSIVE A MARKER, PAINFUL
IN 50% OF PREGNANT PEOPLE WITH
SICKLE CELL DISEASE.
WE DIDN'T REPORT THEM BECAUSE WE
HOPED THE NUMBER OF
VASOOCCLUSIVE CRISIS WOULD BE
NEAR ZERO.
HERE ARE CONCLUSIONS FROM MY
COLLEAGUE IN CALIFORNIA, LARGE
CALIFORNIA DATABASE.
HERE IS OUR CONCLUSION FROM
NATIONAL INPATIENT SAMPLE,
COMPLICATIONS DID NOT CHANGE
OVER THREE DECADES IN THIS STUDY
FROM CALIFORNIA, AND FROM THE
NATIONAL INPATIENT SAMPLE
PREGNANCY MORBIDITY AND
MORTALITY WAS UNCHANGED OVER 15
TO 25 YEARS.
NEXT SLIDE PLEASE.
THESE ARE THREE MAPS FROM THE
UNITED STATES.
ONE IN UPPER LEFT-HAND CORNER
SHOWING DISTRIBUTION OF
INDIVIDUALS LIVING WITH SICKLE
CELL DISEASE IN THE UNITED
STATES.
BENEATH THAT IS CARE.
YOU CAN SEE THERE'S A PROBLEM,
NOT ENOUGH PEOPLE TO CARE FOR
INDIVIDUALS WITH SICKLE CELL
DISEASE IN THE UNITED STATES.
AND IF YOU SUPERIMPOSE IN YOUR
MIND'S EYE THE GRAPH, PICTORIAL
REPRESENTATION ON THE RIGHT, A
MAP OF MATERNITY CARE DESERTS IN
THE UNITED STATES IT'S EASY TO
SAY SIGNIFICANT OVERLAP BETWEEN
WHERE THERE ARE MATERNITY CARE
DESERTS, SICKLE CELL CARE
DESERTS AND WHERE THERE ARE
SICKLE CELL PATIENTS.
OVER TURNING PROTECTION OF
APPORTION WILL COMPROMISE THE
REPRODUCTIVE HEALTH CARE OF
MILLIONS OF AMERICANS.
WHAT WE'VE BEEN LEARNING AND
WHAT WILL BE ILLUSTRATED, THIS
IS MULTI-DISCIPLINARY CARE.
THIS IS A FAMOUS SICKLE CELL
STAMP ISSUED TO COMMEMORATE
NEWBORN SCREENING IN THE UNITED
STATES.
BUT WHEN I LOOKED AT THIS WITH
MATERNAL-FETAL HEALTH EXPERT SHE
SAID IT NEVER OCCURRED TO ME IT
WAS THE BABY WHO HAD SICKLE CELL
DISEASE.
I THOUGHT IT WAS THE MOM.
I LOVE THAT BECAUSE I THINK IT'S
REALLY IMPORTANT THAT WE KNOW
WHEN HEMATOLOGISTS AND
OBSTETRICIANS SEE THINGS
DIFFERENTLY, IT CAN BE OUR
STRENGTH IN WORKING TOGETHER.
NEXT SLIDE PLEASE.
SO WHAT DO WE KNOW ABOUT
TRANSFUSIONS IN SICKLE CELL
DISEASE PREGNANCY?
WE HAVE A BEAUTIFUL
META-ANALYSIS BY OUR COLLEAGUES
IN TORONTO IN 2015.
AMONG THE COMPLICATIONS THAT
THEY STUDIED WERE MORTALITY,
PAINFUL CRISES, DIMENSIONS OF
PULMONARY COMPLICATIONS,
PERINATAL MORTALITY, NEONATAL
DEATH AND PRE-TERM BIRTH.
ON THE FAR RIGHT CHRONIC
TRANSFUSION, THOUSANDS OF --
THOUSANDS WERE COMPILED,
COMPLICATIONS SIGNIFICANT
REREDUCED.
TRANSFUSION IS LOW RISK IN HIGH
RESOURCE SETTINGS.
THE FIRST BULLET POINT IS
INCOMPLETE.
SHOULD SAY IN THE U.S. CONTEXT
WE HAVE ACCESS TO SAFE BLOOD
SUPPLY.
OUR CONCERNS INCLUDE TRANSFUSION
REACTIONS, IN SECTIONS, IT'S OUR
PRIVILEGE TO WORRY LESS THAN IN
OTHER PLACES.
IRON OVERLOAD IS A LONG-TERM
COMPLICATION, NOT A SHORT-TERM.
WE WORRY ABOUT ALLOIMMUNIZATION
BUT AT THE MOMENT WE DON'T HAVE
DATA TO SUGGEST PEOPLE GIVEN
PROPHYLACTIC TRANSFUSIONS VERSUS
ON-DEMANDS ARE AT DIFFERENT RISK
FOR ALLOIMMUNIZATION.
CAN BEING CAN BE REDUCED WITH
PROPHYLACTIC MEDICATIONS, WE
DON'T HAVE ANY GOOD DATA ON
HEMOLYTIC DISEASE OF THE
NEWBORN.
MOST CAN BE PREVENTED OR
REDUCED, RISKS ARE LOW COMPARED
TO POTENTIAL BENEFITS FOR
INDIVIDUALS WITH SICKLE CELL.
NEXT SLIDE PLEASE.
DOWNSTREAM BENEFITS OF
PREVENTING PAIN WITH
PROPHYLACTIC TRANSFUSION IN
PREGNANCY SHOULD BE UNDERSTOOD
TO BE SIGNIFICANT.
WHEN YOU KEEP PEOPLE OUT OF PAIN
THEY ARE OUT OF EMERGENCY CARE
SETTINGS, REDUCING FETAL
EXPOSURE TO OPIOIDS, .
AN PAIN CRISIS IS ACCEPTED
INDICATION FOR DISEASE MODIFYING
THERAPY, EVERY TREMENDOUS FOR
SICKLE CELL EXCEPT ONE IS FDA
APPROVED BECAUSE IT PREVENTS
PAIN AND TRANSFUSIONS PREVENT
PAIN FOR PEOPLE PREGNANT BUT DO
NOT HAVE A WIDE AND ACCEPTED
INDICATION.
IT CAN REDUCE NEED FOR EMERGENCY
TRANSFUSION AND HOSPITALIZATION
AND BLOOD EXPOSURE AND CRISIS
AND HELP IMPROVE INFANT
SURVIVAL, GROWTH, EXPOSURE TO
SORT OF TOXIC MATERNAL
CONDITIONS LIKE PREECLAMPSIA AND
OPIOID EXPOSURE.
IN CONCLUSION, SICKLE PREGNANCY
OUTCOMES IN THE U.S. ARE
STAGNANT AND POOR.
CHRONIC TRANSFUSIONS ARE DEEMED
LOW RISK BY AMERICAN SOCIETY OF
HEMATOLOGY AND POTENTIALLY
BENEFICIAL.
WE SHOULD OFFER TREATMENT MORE
AGGRESSIVELY.
WE NEED RESEARCH, GUIDELINES AND
INCENTIVES TO BUILD
MULTI-DISCIPLINARY CARE TEAMS.
THANKS FOR HAVING ME.
IT'S A PLEASURE TO SPEAK WITH
YOU TODAY.
>> EVENING FROM ACCRA.
>> PLEASE GO AHEAD.
>> GOOD EVENING, I'M DOING THIS
PRESENTATION WITH DR. ASARE.
I'M AN OBJECTS VISION
GYNECOLOGIST, LEADINGS A CLINIC
IN AKKRA, AND DR. ASARE IS A
HEMATOLOGIST WHO WORKS AT THE
SAME CLINIC WITH ME.
NEXT SLIDE PLEASE.
SO, WE DON'T HAVE ANY CONFLICTS,
ANY DISCLOSURES.
NEXT.
SO THIS WILL BE OUR LEARNING
OBJECTIVES.
WE HOPE BY THE END OF THIS
PRESENTATION OR DEMONSTRATES
PREVALENCE OF SICKLE CELL
DISEASE IN GHANA, HIGHLIGHT
INCREASE OF MATERNAL AND
PERINATAL MORBIDITY AND
MORTALITY, ASSOCIATED WITH
SICKLE CELL DISEASE, ALSO LOOK
AT THE VALUE OF
MULTI-DISCIPLINARY SICKLE CELL
OBSTETRIC TEAM APPROACH TO CARE.
THIS DEMONSTRATES HIGH BURDEN OF
SICKLE CELL DISEASE IN AFRICA,
SUGGESTING BY THE YEAR 2030
300,000 WILL BE BORN WITH THIS.
IN GHANA IT'S A COMMON
CONDITION.
IT'S SO BECAUSE THERE'S HIGH
PREVALENCE OF HEMOGLOBIN S GENE,
30% OF INDIVIDUALS WITH SG.
NEAR BI2% OF ALL NEWBORNS HAVE
SICKLE CELL, TRANSLATES TO
18,000 NEWBORNS EVERY YEAR, A
HUGE NUMBER WHEN COMPARED TO THE
U.S., 2400 PER YEAR, AND 300 IN
THE U.K.
NEXT SLIDE.
NOW, WHERE I WORK, WE SEE ABOUT
1400 INDIVIDUALS WITH SICKLE
CELL DISEASE, OR WOMEN WITH
SICKLE CELL WITHIN THAT AGE
GROUP.
OBSTETRIC UNIT, 1 ^50 WOMEN ARE
DELIVERED THERE EACH YEAR.
SICKLE CELL DISEASE DURING
PREGNANCY IS LIFE-THREATENING
COMPLICATION.
NOW, THIS STEPS FROM HIGH --
STEMS FROM COMPLICATIONS
ASSOCIATED WITH SICKLE CELL
DISEASE.
NEXT SLIDE.
NOW, THE COMMON PERINATAL
COMPLICATIONS INCLUDE FETAL
GROUP RESTRICTION, PRE-TERM
DEATH, LOW BIRTH WEIGHT, AND
PERINATAL MORTALITY COMPARED TO
WOMEN WITHOUT SICKLE CELL
DISEASE.
NEXT SLIDE.
WHEN IT COMES TO MATERNAL
COMPLICATION, PREECLAMPSIA,
ECLAMPSIAS ARE COMMON, MOST
IMPORTANTLY MATERNAL MORTALITY
RATIO IS OVER TEN-FOLD INCREASE
IN WOMEN WITH SICKLE CELL
DISEASE COMPARED TO
COUNTERPARTS.
THIS IS TRUE ALL AROUND THE
WORLD.
NEXT SLIDE.
AGAIN, COMPLICATIONS ARE
COMPLICATION, FREQUENT AND NEED
HOSPITALIZATION, NEARLY 35 TO
50% DURING THE PREGNANCY PERIOD.
EPISODE IS CLOSELY RELATED TO
ACUTE TEST SYNDROME.
PULMONARY EVENTS ARE COMMON
DURING PREGNANCY.
NEXT SLIDE.
THIS SLIDE SHOWS US THE RELATIVE
DISTRIBUTION OF MATERNAL
MORTALITY RATIO FROM THE
HIGH-INCOME COUNTRIES AROUND THE
WORLD.
IF YOU LOOK AT THE FIGURE FOR
THE U.S. OF A, PUBLISHED IN THE
YEAR 2020, WAS 21 PER 100,000
LIVE BIRTHS, RELATIVELY HIGH
COMPARED TO WESTERN COUNTRIES.
NEXT SLIDE.
NOW IN AFRICA, MATERNAL
MORTALITY RATIO IN WOMEN WITH
AND WITHOUT SICKLE CELL DISEASE
IS 551 DEATHS PER 100,000 LIVE
BIRTHS.
IF I IS ASTRO NOMICALLY HIGH
WHEN WE CONCENTRATION ON SICKLE
CELL POPULATION ALONE.
IN SUB-SAHARAN AFRICA THE RATIO
IS ALMOST 4,400 PER 100,000 LIVE
BIRTHS, WITHOUT INTERVENTION.
NEXT SLIDE.
NOW WHAT ARE THE KEY ISSUES TO
BE ADDRESSED?
WE THINK THERE'S A GLOBAL HEALTH
INEQUITY IN SERVICE DELIVERY TO
PREGNANT WOMEN WITH SICKLE CELL
DISEASE.
AGAIN, THE OPTIMAL APPROACH TO
REDUCE MATERNAL MORBIDITY AND
MORTALITY HAS NOT BEEN
ADEQUATELY ADDRESSED.
NEXT SLIDE.
THE QUESTION THEN, DOES
MULTI-DISCIPLINARY CARE REDUCE
MORBIDITY AND MORTALITY IN WOMEN
WITH SICKLE CELL.
NEXT SLIDE.
NOW, BETWEEN 2011 AND 2014 WHEN
THERE WAS NO CLINIC ACCRA, THE
RATIO WAS MORE THAN 10,000
DEATHS PER 100,000 LIVE BIRTHS.
NEXT SLIDE.
SO IN 2014, OUR TEAM STARTED A
MULTI-DISCIPLINARY CARE SYSTEM
IN ACCRA, COMPRISED OF
OBSERVATIONS, HEMATOLOGISTS.
NEXT SLIDE.
NOW, DURING THAT PERIOD WE DID
REVIEW OF DATA OF THE MORTALITY
DATA AT OUR FACILITY.
WHICH TO HIGHLIGHT THE MAIN
CAUSES OF THE MATERNAL MORTALITY
AMONG WOMEN WITH SICKLE CELL
DISEASE.
NEXT SLIDE.
WE ALSO FOUND OUT ACUTE PAINED
SEWED IS LEADING CAUSE, AND THE
LEADING CAUSE OF DEATH IN
PREGNANCY.
NEXT SLIDE.
WE REALIZED SYNDROME CONTRIBUTED
TO 86% OF ALL MATERNAL DEATHS.
WHAT WAS CRITICAL ABOUT THAT
REVIEW WAS THAT IT HIGHLIGHTED
SERVICE DELIVERY FAILURES AND
SOME CHALLENGES WITHIN THE
HEALTH CARE DELIVERY SYSTEM
PARTICULARLY FOR WOMEN WITH
SICKLE CELL DISEASE.
AGAIN GIVES US AN OPPORTUNITY
FOR PROVIDERS TO DEVELOP NEW
ACCEPTABLE AND FEES ABLE
SOLUTIONS TO ADDRESS THE
PROBLEM.
NEXT SLIDE.
NOW BEFORE WE COULD IMPLEMENT
OUR APPROACH TO CARE WE NEEDED
TO GET BACKGROUND DEFINITION,
ONE IS DEFINITION OF ACUTE CHEST
SYNDROME, AN ACUTE PAIN WHICH
CAN BE DISTINGUISHED FROM LABOR
PAIN, BASED ON ABSENCE OF
UTERINE CONTRACTION, EVIDENCE OF
LABOR PROGRESSION AND DELIVERY.
IF IT'S A PATIENT SELF-REPORTED
SICKLE CELL, WE CONSIDER IT
ACUTE PAIN EPISODE.
NEXT SLIDE.
AGAIN, IT WAS IMPORTANT TO
REDEFINE ACUTE CHEST SYNDROME
BECAUSE WE REALIZED THERE WAS NO
STANDARD DEFINITION FOR ACUTE
CHEST SYNDROME ESPECIALLY AS
RELATED TO PREGNANCY.
WE CAME OUT WITH THIS
DEFINITION, A PARAMETER, BE A
NORMAL CLINICAL FIND ON LUNG
EXAMINATION AND PRESENCE OF AT
LEAST TWO OF THE FOLLOWING
CRITERIA.
THAT'S A FEVER OF MORE THAN 38
DEGREES CELSIUS, INCREASED
RESPIRATORY GREAT GREATER THAN
90th PERCENTILE, POSITIVE
CHEST PAIN, INCREASED OXYGEN
RETIREMENT, DROP IN BASELINE
GREATER THAN 3%, OR NEW
RADIODENSITY ON CHEST X-RAY.
NEXT SLIDE.
NOW, OUR WORK HYPOTHESIS WAS
IMPLEMENTING A
MULTI-DISCIPLINARY TEAM IN
LOW-RESOURCE SETTING WOULD
REDUCE MATERNAL AND PERINATAL
MORTALITY RATES IN BEFORE AND
AFTER STUDY DESIGN.
NEXT SLIDE.
SOME OF THE THINGS WE DID WAS TO
IMPLEMENT SIMPLE PROTOCOLS FOR
MATERNAL AND PERINATAL CARE.
SO, WE ENSURED THAT THERE WAS
CLOSE MONITORING OF MOTHERS AND
BABIES DURING THEIR PREGNANCY
PERIOD.
FOR THE BABIES SERIAL ULTRASOUND
IN THE THIRD TRIMESTER TO
MONITOR FETAL GROWTH.
WHERE THERE WAS SUSPECTED GROWTH
RESTRICTION.
NEXT SLIDE.
WE IMPLEMENTED MULTI-DISCIPLINE
CARE APPROACH, USED SPIROMETRY,
AND WHERE PATIENTS COULD NOT, WE
USED LATEX-FREE BALLOONS.
NEXT SLIDE.
AGAIN, DURING ACUTE PAIN
EPISODES, ROUTINE MONITORING OF
OXYGEN SATURATION, USE OF PULSE
OXY METERS, IMPLEMENTED BLOOD
TRANSFUSION, PREGNANT WOMEN THAT
WAY ADMITTED AND REQUIRED
INPATIENT CARE WERE DESIGNATED
TO WARDS WHERE THEY WERE
MANAGED.
NEXT SLIDE.
NOW, AFTER IMPLEMENTING THIS
APPROACH TO CARE FOR 13 MONTHS,
THE MATERNAL MORTALITY RATIO
REDUCED FROM OVER 10,000.
NEXT SLIDE PLEASE.
AGAIN, THE PERINATAL MORTALITY
RATE REDUCED FROM ABOUT 60 PER
THOUSAND LIVE BIRTHS TO 23,
62.2% RELATIVE RISK REDUCTION IN
MORTALITY RATES.
NEXT SLIDE.
FIRST, THIS RESULT WAS PRESENTED
AT ONE OF THE CONFERENCES, LATER
PUBLISHED IN THE "NEW YORK
TIMES."
NEXT SLIDE.
NOW, HOW HAS THE LOW MATERNAL
MORTALITY RATE IN WOMEN WITH
SICKLE CELL DISEASE BEEN ATTEND
OVER THE YEARS, NEXT SLIDE.
SO, AFTER ABOUT THREE YEARS OF
PUBLISHING THIS DATA WE WENT
BACK TO SEE WHETHER THIS WAS
ACHIEVED WITH WOMEN WITH SICKLE
CELL WAS SUSTAINABLE.
REVIEW DEMONSTRATED YES, WE HAVE
SUSTAINED LOW MATERNAL MORTALITY
AND PERINATAL RATE AT THE
HOSPITALS, STILL USING
MULTI-DISCIPLINARY CARE
APPROACH.
NEXT SLIDE.
SO WHAT ARE IMPLEMENTATION
STRATEGIES FOR
MULTI-DISCIPLINARY SICKLE CELL
OBSTETRICS APPROACH IN GHANA?
NEXT SLIDE.
NOW, THE CURRENT SITUATION IS
THAT WE HAVE DEMONSTRATED
POSITIVE IMPACT OF
MULTI-DISCIPLINARY TEAM AT THE
HOSPITAL, WHICH IS THE LEADING
TEACHING HOSPITAL IN ACCRA, WE
RESTRICTED TO OUR HOSPITAL BUT
THEREFORE SEVERAL OTHERS ACROSS
THE COUNTRY.
OUR WORK IS AT A LOW REACH,
THEREFORE THE CURRENT REACH WE
CAN'T SAY IT MAKES MAKES MUCH C
HEALTH IMPACT BECAUSE THERE ARE
MANY MORE WOMEN WITH SICKLE CELL
DISEASE ALL OVER THE COUNTRY.
NEXT SLIDE.
SO WHAT ARE OUR PLANS?
OUR PLAN IS TO SCALE UP, TO AT
LEAST EVERY REGION IN GHANA,
GHANA CURRENTLY HAS ABOUT 16
POLITICAL REGIONS, MOST HAVE
SECONDARY LEVEL HOSPITALS BUT
THEY DON'T HAVE
MULTI-DISCIPLINARY OBSTETRIC
CARE PROGRAM AT ANY FACILITIES
HERE.
WE'RE THEREFORE ABOUT FOUR OR
FIVE SITES EARMARKED TO MOVE TO
THE NEXT COUPLE OF YEARS.
AND COLLECTIVELY THESE FOUR
SITES COMBINE OVER 600 PREGNANT
WOMAN WITH SICKLE CELL DISEASE
THAT DELIVER EACH YEAR.
THIS IS BETWEEN 5,000 TO
THOUSAND MATERNAL DEATHS PER
100,000 LIVE BIRTHS.
IF WE CAN REDUCE ACROSS FOUR
SITES BY 50%, WE'LL HAVE MADE
SOME IMPACT.
NEXT SLIDE.
WHAT IS UNIQUE ABOUT
MULTI-DISCIPLINARY TEAM IN
ACCRA?
WE HAVE A VIBRANT TEAM OF
WILLING PEOPLE EAGER AND READY
TO WORK TOGETHER.
WE ALSO HAVE THE BENEFIT OF A
GLOBAL MENTOR WHOSE ADVICE HAS
BEEN SUPPORTING THIS WORK IN
MANY -- AT MANY LEVELS.
THE TEAM HAS REGULAR MEETINGS AT
WHICH WE DISCUSS NEARLY EVERY
CASE OF ACUTE PAIN EPISODE OR
ACUTE CHEST SYNDROME.
THE TEAM HAS AGREED TO REVIEW
AND EDUCATE EVERY CASE OF
MATERNAL MORTALITY TO FIND A
CAUSE AND FIND MEANS OF
PREVENTING SUCH EVENT FROM
OCCURRING AGAIN.
NEXT SLIDE.
THIS PROGRAM IS NOT WITHOUT
CHALLENGES.
WE WORK CURRENTLY, ONE OF THE
BIGGEST PROBLEMS IS ISSUES WITH
SPACE.
A LOCATION OF STAFF, THIS IS AN
ENTIRELY NEW CONCEPT.
SO WHEN PEOPLE HAVE TO MOVE FROM
THE DIFFERENT ROOMS TO A AGREE
TO COME TOGETHER, TO HAVE THIS
JOINT TEAM, IT DOESN'T COME
EASILY.
BUT WHEN YOU HAVE WILLING PEOPLE
READY TO WORK TO MAKE AN IMPACT,
WE'RE ABLE TO MAKE SOME INROADS.
AGAIN, WE NEED DEDICATED STAFF.
OF COURSE, FUNDING SUPPORT TO DO
SOME OF THE BUSY THINGS FOR
PREGNANT WOMEN WHEN THEY COME TO
THE CLINIC.
A LOT OF SICKLE CELL DISEASE
PATIENTS ALSO HAVE A LOW
SOCIOECONOMIC STATUS, SOME
BECAUSE OF THEIR DISEASE STATUS
ARE NOT IN MEANINGFUL EMPLOYMENT
SO AFFORDING BASIC HEALTHCARE IS
CHALLENGE, A MEANS OF SUPPORTING
THIS CLINIC, SUSTAIN INTEREST IN
THE CLINIC WILL BE USEFUL TO
MAKE SURE WE ENSURE PROGRESS.
THE QUESTION IS, IS IT EVERY
SECTOR?
EVERY COMMUNITY, OR EVERY
HOSPITAL THAT WILL ACCEPT THIS
SORT OF PROGRAM?
PEOPLE ARE USED TO RUNNING
ANTENATAL CLINICS SEPARATE,
HEMATOLOGY CLINICS RUN
SEPARATELY, PULMONOLOGY CLINICS
RUN SEPARATELY.
BRINGING THESE TOGETHER IN ONE
CLINTON TO DISCUSS CASES IS THE
OLD SYSTEM OF REFERRING,
SOMETIMES CHALLENGING.
AGAIN, WE NEED TO CONSIDER
BRINGING PATIENT PARTNERS, TO
ALSO SUPPORT SCREENING.
NEXT SLIDE.
NEXT SLIDE PLEASE.
HOW DO WE OVERCOME CHALLENGES OF
CREATING A GOOD
MULTI-DISCIPLINARY OBSTETRIC
CARE?
WE NEED WORK WITH OTHER MEMBERS
OF THIS TRIANGLE, WITH THE
HEALTH FACILITIES AND RECOGNIZE
THE ROLE OF THE PREGNANT WOMEN
AS IMPORTANT STAKEHOLDERS IN
EVERYTHING THAT WE'RE DOING.
WE CAN'T WORK FOR THESE PREGNANT
WOMEN AND SEEK BETTER OUTCOME
FOR PREGNANCY WITHOUT INVOLVING
THEM.
WE NEED TO ENGAGE THEM IN
EVERYTHING THAT WE DO RIGHT FROM
THE BEGINNING.
NEXT SLIDE.
NOW, MULTI-DISCIPLINARY APPROACH
SHOULD BE THE GOLD STANDARD
BECAUSE WE'RE SEEING IT SEEMS TO
HAVE HIGHEST IMPACT ON REDUCING
MORBIDITY AND MORTALITY RATES AS
DEMONSTRATED IN LOW RESOURCE
ENVIRONMENT.
IMPLEMENTING MULTI-DISCIPLINARY
APPROACH INCLUDING HEMATOLOGIST
CAN REDUCE MATERNAL MORBIDITY
AND MORTALITY IN THIS COHORT.
NEXT SLIDE.
WE JUST TALKED ABOUT THIS.
NEXT SLIDE.
SO IN CONCLUSION WE SAY PREGNANT
WOMEN WITH SICKLE CELL DISEASE
HAVE ONE OF THE HIGHEST
MORTALITY RATES OF ANY
PREEXISTING CONDITIONS IN BOTH
RESOURCE LOW AND RESOURCE RICH
ENVIRONMENT.
ACUTE PAIN AND ACUTE CHEST
SYNDROME ARE LEADING CAUSES,
THIS YEAR LEADING CAUSE OF
MATERNAL DEATH ACCOUNTING FOR
80% OF ALL DEATHS IN PREGNANCY
WOMEN.
MOST ACUTE PAIN, ACUTE CHEST
SYNDROME AND PULMONARY THROMBO
THROMBOEMBOLISM INCLUDE IN THIRD
TRIMESTER.
THIS SHOULD BE THE GOLD STANDARD
OF CARE.
NEXT SLIDE.
THANK YOU VERY MUCH.
THANK YOU.
>> I HOPE EVERYBODY CAN HEAR ME.
IT'S A PLEASURE TO BE HERE.
I THANK THE ORGANIZERS FOR
ALLOWING ME TO TALK ABOUT SOME
OF THE WORK WE'RE DOING.
NEXT SLIDE.
SO I HAVE NO CONFLICTS OF
INTEREST TO DISCLOSE.
OF COURSE, THESE ARE MY NIH
GRANTS.
I WANT TO HIGHLIGHT THAT WHAT
I'M GOING TO PRESENT HAS BEEN
REALLY A TEAM EFFORT, SO FIRST I
WANT TO HIGHLIGHT THAT THIS
SCOPE AND REVIEW WITH US DONE BY
INDIVIDUALS IN MY LAB,
SPECIFICALLY THE PROFESSOR ON
THE RIGHT, THE MEDICAL LIBRARIAN
WHO OVERSAW THIS, AND ON THE FAR
LEFT IS DR. RYAN, WHO WAS A
POSTDOCTORAL FELLOW, NOW AT THE
CDC.
WE HAVE SOME PHENOMENAL STUDENTS
WHO ARE NOW GRADUATES OF THE
SCHOOL OF GLOBAL PUBLIC HEALTH,
AND THIS DATA I'M PRESENTING WAS
DISCUSSED AT THE PUBLIC HEALTH
PARTNERSHIP CONFERENCE IN 2021
AND WE ARE IN THE PROCESS OF
REVISING IT FOR SUBMISSION.
BUT THANK YOU SO MUCH.
NEXT SLIDE.
SO THIS IS AN OVERVIEW OF MY
TALK, TALKING ABOUT THE
BACKGROUND A LITTLE BIT, OUR
OBJECTIVES, OUR RESULTS AND
CONCLUSIONS AND FINAL THOUGHTS.
NEXT SLIDE.
SO I DON'T THINK I NEED REALLY
SPEND TOO MUCH ON THIS, BUT JUST
TO PULL OUT SOME INTERESTING
FACTS.
IN 2022, 817 WOMEN DIED IN THE
UNITED STATES, RELATED
COMPLICATIONS FROM PREGNANCY,
DELIVERY, POSTPARTUM -- DURING
FIRST YEAR POSTPARTUM.
WE KNOW BASED ON EVIDENCE 60% OF
THESE DEATHS ARE PREVENTIBLE.
OF COURSE, MANY OF MY COLLEAGUES
HAVE TALKED ABOUT THE
SIGNIFICANT DISPARITY THAT WOMEN
OF COLOR FACE IN TERMS OF BLACK
WOMEN, IN TERMS OF AMERICAN
INDIAN, ALASKA NATIVE SO I'M NOT
GOING TO DISCUSS THAT TOO MUCH.
THE ISSUE IS THAT THE RATES IN
TERMS OF MATERNAL MORTALITY ARE
COMPARABLE IN THE UNITED STATES
TO RESOURCE CONSTRAINED
SETTINGS, ASTONISHING AND ALMOST
UNFORGIVABLE IN THIS CONTEXT.
WHAT ARE THE CONTRIBUTORS TO
THIS?
WE KNOW THAT THE CONTRIBUTORS TO
THIS DISPARITY OF WOMEN OF COLOR
IS CHRONIC EXPOSURE TO RACISM
WHICH HAS BEEN DISCUSSED.
WE KNOW WOMEN OF COLOR ARE
EXPOSED TO VARIOUS
MANIFESTATIONS OF RACISM WHICH
LEADS TO WEATHERING, AND OUR
COLLEAGUES TALKED ABOUT THAT.
THIS ALSO NEEDS TO INCREASED
SUSCEPTIBILITY TO HYPERTENSION,
CARDIOVASCULAR DISEASE,
DIABETES, OTHER CHRONIC
CONDITIONS.
ANOTHER MAIN CONTRIBUTOR, WOMEN
OF COLOR FIND IT MORE
CHALLENGING TO ACCESS PROPER AND
COMPETENT QUALITY OF MATERNAL
CARE DUE TO RACISM.
NEXT SLIDE.
SO WE CAN THINK ABOUT RACISM AS
BEING STRATIFIED IN THESE
LAYERS.
FOR INDIVIDUAL ASPECT, WHICH IS
BASICALLY BELIEFS AND ATTITUDES,
INTERPERSONAL ASPECTS WHICH IS
BASICALLY PUBLIC EXPRESSIONS OF
RACISM BETWEEN INDIVIDUALS, AND
THEN ALSO THE INSTITUTIONAL
ASPECT IN TERMS OF INSTITUTIONAL
RACISM.
AND WE KNOW THAT INSTITUTIONAL
RACISM IS IMPORTANT BECAUSE IT
TAKES THE FORM OF DISCRIMINATORY
TREATMENT ON FAIR PRACTICES,
BIASES BASED ON RACE, INEQUITY
E
QUITABLE OUTCOMES.
A WOMAN OF COLOR COULD
EXPERIENCE IMPLICIT BIAS WHEN
DELIVERIES PERCEIVE FALSELY SHE
HAS A HIGHER PAIN TOLERANCE,
PRESCRIBED LESS MEDICATION,
LOWER QUALITY OF CARE.
THERE'S STRUCTURAL RACISM
ELEMENT, RACIAL BIAS ACROSS BOTH
INSTITUTIONS AND SOCIETY.
STRUCTURAL RACISM CAN BE
DESCRIBED AS MUTUALLY
REINFORCING FORMS OF
DISCRIMINATION THAT INCLUDE
NEIGHBORHOOD DEPRIVATION,
ECONOMIC INEQUALITY, EDUCATIONAL
DISPARITIES, DIFFERENTIAL ACCESS
TO HEALTH CARE.
THESE FACTORS ALSO INCLUDE
SOCIAL DETERMINANTS OF HEALTH,
WHICH ARE OF COURSE DEFINED AS
CONDITIONS IN WHICH PEOPLE ARE
BORN, GROW, WORK, LIVE, AND AGE.
SO, THIS WAS AN IMPORTANT
ELEMENT IN TERMS OF THINKING
THROUGH THE ISSUES AROUND
MATERNAL HEALTH.
NEXT SLIDE.
SO, THERE HAVE BEEN MANY EFFORTS
TO REDUCE MATERNAL MORTALITY
WHICH HAVE GIVEN RISE TO
IMPROVEMENTS IN MATERNAL HEALTH
BUT WE'VE NOT SEE THE CHANGE
AT
THE POPULATION LEVEL.
WE WANTED TO UNDERTAKE THIS
SCOPING REVIEW.
SO, OUR OBJECTIVES WERE
BASICALLY TO UNDERSTAND FIRST
STRUGGLE FOR MATERNAL HEALTH AND
MOTHERHOOD INCLUDES OF COURSE
DAILY RESISTANCE TO RACISM,
CLASSISM, SEXISM, OTHER FORMS OF
VIOLENCE.
WE CAN SEE THIS IN TERMS OF
EXAMPLE OF SERENA WILLIAMS, WHO
HAD A SIGNIFICANT POOR MATERNAL
OUTCOMES.
IF SHE CAN EXPERIENCE THESE
SIGNIFICANT DISPARITIES, WITH
RESOURCES, WE KNOW THEY EXIST.
THROUGH THIS PRESENTATION WE
WANTED TO ASSESS INTERVENTIONS
AND IMPLEMENTATION STRATEGIES
THAT ADDRESS MATERNAL HEALTH
RISK FACTORS RELATED TO
STRUCTURAL RACISM, IN THE U.S.,
OR DISCRIMINATION IN HEALTH CARE
DURING PREGNANCY AT DELIVERY OR
UP TO THE YEAR POSTPARTUM
AMONGST WOMEN OF COLOR.
NEXT SLIDE.
THIS IS AN OVERVIEW.
WE CONDUCTED A SCOPING REVIEW TO
SORT OF UNDERSTAND LITERATURE ON
THIS IN TERMS OF LANDSCAPE.
NEXT SLIDE.
SO WE SEARCHED ABOUT SIX
DATABASES USING THE PRISMA
GUIDELINES, WITH OVER 3,000
STUDIES IMPORTED FROM VARIOUS
DATABASES.
AFTER SCREENING, THOSE STUDIES
WE, 38 WERE ELIGIBLE, AND WE DID
FURTHER SCREENING.
WE HAD TO OMIT EIGHT STUDIES
BECAUSE THOSE EIGHT STUDIES DID
NOT INCLUDE INTERVENTION OR
IMPLEMENTATION ASSESSMENT, DID
NOT ADDRESS MATERNAL HEALTH RISK
FACTORS RELATED TO STRUCTURAL
RACISM, DID NOT ADDRESS
STRUCTURAL RACEISM, MATERNAL
HEALTH CARE, AND POPULATION THAT
WAS STUDY WAS NOT WOMEN OF COLOR
BETWEEN THE REPRODUCTIVE AGE AND
IN THE U.S.
WHICH LEFT US WITH 30 STUDIES.
NEXT SLIDE.
SO WE NOTED THERE ARE EIGHT
PATHWAYS.
THE FIRST ONE WAS THAT DURING
OUR REVIEW WE FOUND
INTERVENTIONS THAT ADDRESS
SOCIAL ECONOMIC DISADVANTAGE
WHICH ARE THESE THAT AIM TO
ADDRESS THE SOCIAL DETERMINANTS
OF HEALTH UNDERLYING INEQUALITY,
WE ALSO LOOKED AT INTERVENTION
TO ADDRESS MATERNAL HEALTH RISK
FACTORS, TO PRENATAL CARE, TO
HELP IDENTIFY THOSE AT INCREASED
RISK OF COMORBIDITIES.
AND THEN WE ALSO LOOKED AT THE
IMPORTANCE OF ADDRESSING QUALITY
OF CARE BECAUSE WE KNOW THAT
ACCESS TO HEALTH CARE IS NOT
ONLY IMPORTANT BUT ACCESS TO
QUALITY HEALTH CARE IS VERY,
VERY IMPORTANT AND IT HAS TO BE
ADDRESSED.
NEXT SLIDE.
THESE ARE SOME THINGS WE FOUND
LOOKING AT PATHWAYS THAT WE
MAPPED PREVIOUSLY, EXAMPLES OF
STUDIES WITHIN THE LITERATURE
THAT TRIED TO ADDRESS
DISPARITIES DUE TO RACISM.
ONE STUDY WAS FOCUSED ON RURAL
OREGON, THE PRENATAL PROGRAM,
WHICH BLENDED CARE WITH OUTREACH
BY USING BILINGUAL AND
BICULTURAL WORKERS WITH LINKS TO
AMERICAN HERITAGE COMMUNITY.
FACILITATING ACCESS TO ANTENATAL
CARE.
OTHER PROGRAMS FOR EXAMPLE TO
ADDRESS SOCIAL DISADVANTAGE,
THIS WAS A COLLABORATION BETWEEN
BOSTON HOUSING AUTHORITY AND
BOSTON PUBLIC HEALTH COMMISSION
TO DEVELOP THE PROGRAM CALLED
HEALTHY START, PROVIDED PRIORITY
ACCESS TO HOUSING IN THE CITY'S
TRADITIONAL HOUSING DEVELOPMENTS
TO HOMELESS AND HOUSING INSECURE
PREGNANT WOMEN WHO HAD EXISTING
OR EXPERIENCING MEDICAL RISK
ASSOCIATED WITH WITH POOR HEALTH
OUTCOMES AND FOUND SEVERAL
STUDIES THAT DOCUMENTED.
NEXT SLIDE.
SO, QUALITY CARE CAUSAL PATHWAY
ELUCIDATED CHALLENGES AS WELL.
FOR EXAMPLE, WE INCLUDED OR
LOOKED AT OBSTETRIC HEMORRHAGE
SAFETY BUNDLE TO REDUCE
DISPARITIES.
THE INTERVENTION CONSISTED OF 17
EVIDENCE-BASED RECOMMENDATIONS
TO PREVENT AND IMPROVE OUTCOMES
FOR MATERNAL HEMORRHAGE.
THE ISSUE WE FOUND ALTHOUGH
INTERVENTION IMPROVED OUTCOMES,
ESPECIALLY AMONG BLACK MOTHERS,
PRIMARY SOURCE OF RACIAL AND
ETHNIC DISPARITIES SUCH AS
SOCIAL DETERMINANTS OF HEALTH
UNDERLYING RISK FACTORS AND
STRUCTURAL RACISM MEDICAL
MISTRUST AND CARE OF CARE WERE
NOT ADDRESSED WHICH WILL
CONSIDERABLY IMPACT LONG-TERM
SUSTAINABILITY.
NEXT SLIDE.
SO WHEN WE THINK ABOUT
IMPLEMENTATION CHALLENGES, WE
FOUND DURING THE SCOPING REVIEW
FOR EXAMPLE IN THE LITERATURE
REPORTING ON IMPLEMENTATIONAL
PROGRAMS AND POLICIES TO
INTERVENING AT VARIOUS POINTS
ALONG THE PATHWAY, CRITICAL
EXAMINATION OF MULTIPLE FACTORS
SHAPING SUCCESSFUL
IMPLEMENTATION OF THESE
INTERVENTIONS HAS NOT BEEN
PRIORITIZED THROUGH THE
LITERATURE.
FOR EXAMPLE, PERINATAL CARE
PARTICIPATION REMAINS A
CHALLENGE, MOST NOTABLY WITH
MULTIPLE PROBLEMS, AND LIVING IN
DIFFICULT CIRCUMSTANCES.
WE DID FIND SUCCESSES, FOR
EXAMPLE APPROPRIATENESS OF
INTERVENTION, ACCEPTABILITY OF
THE INTERVENTION.
NEXT SLIDE.
SO IN CONCLUSION THERE REMAINS A
GREAT NEED TO REDUCE MATERNAL
HEALTH DISPARITIES IN THE U.S.,
AS WE HAVE NOTED.
STRUCTURAL RACISM IS A
CONTRIBUTING FACTOR TO THESE
DISPARITIES AND INTERVENTIONS TO
ADDRESS STRUCTURAL RACISM
DESPERATELY NEEDED.
SPECIFICALLY DURING OUR REVIEW
WE FOUND EVIDENCE-BASED
INTERVENTIONS TO REDUCE BY
ADDRESSING STRUCTURAL RACISM.
FIRST INTERVENTIONS ADDRESSING
INCREASED RISK OF POOR HEALTH
OUTCOMES, SECOND THAT ADDRESS
LOW QUALITY OF CARE AND THIRD,
INTERVENTIONS, EVIDENCE-BASED
INTERVENTIONS THAT ADDRESS
SOCIAL ECONOMIC DISADVANTAGES.
SO SUCCESS OF THESE
INTERVENTIONS EXTENDING SUPPORT
BEYOND PROXIMAL HEALTH CARE
NEEDS TO INCLUDE SOCIAL AND
ECONOMIC FACTORS ASSOCIATED WITH
IMPROVED MATERNAL HEALTH
OUTCOMES SHOULD BE AN
IMPORTANT -- SHOULD BE
IMPLEMENTED IN FUTURE OR
EXISTING STUDIES.
INTERVENTION CHALLENGES EXIST IN
TERMS OF IN OUR CONTEXT, BUT WE
ALSO NOTE AS MENTIONED BY OTHER
COLLEAGUES IMPLEMENTATION
SCIENCE RESEARCH WITHIN MATERNAL
HEALTH CAN ELUCIDATE BARRIERS TO
EFFECTIVE ADOPTION UPTAKE OF
EVIDENCE-BASED INTERVENTIONS.
THANK YOU SO MUCH..
>> THANK YOU TO ALL OF OUR PANEL
SPEAKERS.
NOW WE'RE GOING TO GO INTO A Q&A
FOR THE PANEL.
WE HAVE HAD SOME QUESTIONS COME
UP IN THE CHAT SO I WILL START
WITH THAT.
THIS IS FOR THE GHANA TEAM.
NUTRITION ASSESSMENT IS ONE OF
THE COMPONENTS OF THE
MULTI-DISCIPLINARY TEAM IN KBTH.
CAN YOU COMMENT ON NUTRITION
CARE MANAGEMENT THAT SICKLE CELL
DISEASE PATIENTS RECEIVE?
>> WE RECOGNIZE THIS IS HIGH
METABOLIC STATE, NUTRITIONAL
CARE AND SUPPORT ACTUALLY
SIGNIFICANT AND WILL ACTUALLY
MAKE IMPACT, IF WE ARE TO
IMPROVE THE OUTCOME.
UNFORTUNATELY, WE DON'T HAVE A
SYSTEMATIC NUTRITIONAL SUPPORT
FOR PREGNANT WOMEN HERE IN
GHANA, APART FROM THE USUAL
ANTENATAL EDUCATION ABOUT
IMPROVEMENT IN NUTRITION DURING
PREGNANCY.
ONE OF OUR RECENT STUDIES
ONGOING IS ASSESSING IMPACT OF
MATERNAL NUTRITION ON PREGNANCY
OUTCOMES IN WOMEN.
OUR HOPE IS THAT THE NEXT FEW
MONTHS OR BY NEXT YEAR THE
RESULT WILL COME OUT.
AND THEN WILL PROBABLY SEE MORE
LIGHT.
IF IT BECOMES NECESSARY WE'LL
PROBABLY HAVE TO CONSIDER
PRIORITIZING NUTRITIONAL
INTERVENTION.
YES, IT IS AN IMPORTANT SUBJECT
MATTER THAT NEEDS TO BE LOOKED
AT.
WE DON'T KNOW WHAT IMPACT IT
MAKES ON PREGNANCY OUTCOME FOR
THIS PARTICULAR POPULATION IN
PARTICULAR BUT HOPEFULLY VERY
SOON WE'LL GET TO KNOW.
THANK YOU.
>> ANOTHER QUESTION ABOUT
STRATEGIES THAT COULD OVERCOME
POTENTIAL CHALLENGES IN CARE
COORDINATION IN RURAL OR
DISPERSED POPULATIONS OF
INDIVIDUALS LIVING WITH SICKLE
CELL DISEASE.
I DON'T KNOW IF YOU HAVE
THOUGHTS ON THERE FOR THE U.S.
POPULATION, DR. PECKER?
>> THIS IS A REAL HUMDINGER FOR
OUR PATIENTS.
AND WE KNOW THERE IS
INFRASTRUCTURE DEVELOPED,
DEVELOPING ALL OVER THE COUNTRY,
WITH MODEL OF CLINICIAN
EDUCATION, ECHO OR TELEECHO.
WE INVITE YOU TO JOIN US AT
JOHNS HOPKINS AND AROUND THE
WORLD, AND INDIVIDUALS WITH
SICKLE CELL DISEASE ARE COMPLEX.
WE'RE HAPPY TO EXTEND CARE.
ANOTHER THING THAT NEEDS TO
HAPPEN FOR RURAL COMMUNITIES IS
TO HAVE A HUB AND SPOKE SO THESE
INDIVIDUALS ARE BEING SEEN AT
LEAST A FEW TIMES DURING THE
PREGNANCY BY HIGH RISK
OBSTETRICS AND HEMATOLOGISTS
THAT CAN PROVIDE GUIDANCE BUT WE
CAN WORK TOGETHER.
DR. ASARE AND DR. OPPONG ARE
DOING THIS ACROSS GHANA, SURELY
WE CAN FIGURE OUT HOW TO DO THIS
ACROSS THE UNITED STATES.
THERE IS TELEHEALTH
INFRASTRUCTURE TO SUPPORT
CLINICIAN WHO IS ARE INTERESTED
IN PROVIDING THIS CARE.
>> THANKS.
ANY THOUGHTS FROM THE GHANA TEAM
ON HOW YOU'RE DOING IT AND
LESSONS LEARNED?
>> DEFINITELY GHANA HAS A LOT OF
RURAL COMMUNITIES, PROBABLY MORE
THAN THE U.S.
THE CHALLENGES IN YOU U.S. YOU
CAN IMAGINE GHANA WILL HAVE
MULTIPLE ON THAT.
SOMETIMES ASSETS, GEOGRAPHIC
ASSETS IS A BIG PROBLEM.
BEYOND THAT FINANCIAL ASSETS
BECOMES A BIGGER CHALLENGE.
MORE IMPORTANTLY, ACCESS TO
HEALTHCARE SERVICE, IN GHANA AS
WE MOVE FURTHER AWAY FROM URBAN
AREAS, DISTRIBUTION OF
HEALTHCARE PROVIDERS BECOMES
ACUTE.
IF YOU'RE THINKING OF SCALING UP
THIS MULTI-DISCIPLINARY CARE, WE
UNDERSTAND THERE'S GOING TO BE A
LOT OF CHALLENGES.
SO, ONE STRATEGY WE THINK ON
WORK WOULD BE -- - FOR INSTANCE
IN HEMATOLOGY, CAN GENERAL
PHYSICIANS BE TRAINED TO TAKE UP
THE PATH OF HEMATOLOGY, THAT WAY
THEY MAY NOT BE HEMATOLOGIST IN
THAT PART OF THE COUNTRY
PATIENTS WOULD STILL BE
RECEIVING SOME FORM OF
HEMATOLOGY CARE, THAT WAY STILL
BE ABLE TO CREATE THE SITE
SPECIFIC OR FACILITY SPECIFIC
MULTI-DISCIPLINARY CARE SYSTEM
FOR THE NEED OF THE PEOPLE.
AGAIN, STRENGTHENING THE NETWORK
AMONG THE CARE PROVIDERS IS ONE
WAY OUT.
CURRENTLY, WE ARE ABLE TO
RECEIVE PHONE CALLS FROM OUR
COLLEAGUES FROM THE OTHER SIDE,
PLANNING, WHAT WE'RE PLANNING TO
IMPLEMENT THIS PROGRAM.
WE ALSO INVITE THEM TO JOIN THE
MEETINGS, SHARE IDEAS AND
COMMUNICATE.
WHERE IT BECOMES NECESSARY FOR
THEM TO REFER, CONTACTS HAVE
BEEN ESTABLISHED, SO THE SYSTEM
CAN TAKE CARE OF THE REST OF IT.
WE NEED TO WORK WITH WHAT IS
AVAILABLE, AND DESIGN SOMETHING
WITHIN THE CONTEXT OF WHAT'S
AVAILABLE AND TRY AND IMPLEMENT
IT THAT WAY.
THANK YOU.
>> WE HAVE A COUPLE QUESTIONS
ASKING HOW THE FOUR ADDITIONAL
SITES WERE SELECTED, AND WITH
THE SELECTING OF THESE
ADDITIONAL SITES WHAT ARE THE
SCALING OF THE INTERVENTIONS AND
STRATEGIES, CAN YOU TOUCH ON
VARIATIONS THAT MAY INFLUENCE
THE STUDY DESIGN IN THE NORTHERN
TERRITORY AS COMPARED TO ACCRA
TERRITORY?
>> MAYBE DR. ASRAE CAN TAKE THAT
ONE.
>> YES, THEY SITES WERE SELECTED
BASE ON THE FACT WE ALREADY
WORKED WITH OBSTETRICIANS, THEY
KNEW THE PROTOCOL, WERE
COMMITTED TO CARE FOR THE MEN
WITH SICKLE CELL DISEASE AND
RECOGNIZED THE NEED, RECOGNIZING
THE HIGH RATES AMONG THIS
POPULATION.
THEY SITES DO NOT HAVE
HEMATOLOGISTS, SO WE TEST SHIP,
CONSTANTLY ENGAGING THEM BY
PHONE CALLS, IF THEY HAVE
DIFFICULT CASE WE DISCUSS WITH
THEM, WE SENT THEM REFERRAL
SITES, THE REFERRAL PATHWAYS, SO
THEY CAN EASILY REACH US IF THEY
NEED ADVICE.
SOMETIMES WE HAVE AN MDT, WITH
AN MDT.
THAT'S IMPROVED CARE.
YES, WITH STRUCTURAL VARIATIONS
WE RECOGNIZE MOST PEOPLE IN THE
NORTH ARE MUSLIM, IT'S A MUSLIM
COMMUNITY.
SOMETIMES THEY DO -- WOMEN DO
REQUIRE PERMISSION FROM THEIR
HUSBANDS OR PARTNERS BEFORE THEY
SEEK HEALTHCARE SO WHAT WE'RE
DOING IS OBSTETRICIAN, TRAINING
TO ADVOCATING FOR THEIR OWN
CARE, TO SEEK HEALTH CARE
PROPERLY WHEN THEY HAVE
PROBLEMS.
THE OTHER THING WE'RE DOING WE
HELP THEM BUILD THEIR OWN
CAPACITY, BUILD THEIR HEALTH
CARE NEEDS, FACILITY SPECIFICS,
AND DOING CONTINUOUS TRAINING
FOR THEM AS WELL, AND THEN OF
COURSE WE'RE GETTING HOSPITAL TO
BE PART OF THE
MULTI-DISCIPLINARY TEAM SUCH
THAT OTHER PEOPLE WHO HAVE BEEN
TRAINED TO MANAGE THESE COHORTS
WOULD BE MANAGING THE CLINIC,
NOT SHIFTED AS USUALLY HAPPENS,
LOW AND MIDDLE INCOME, SOMETIMES
THEY SHIFT DOCTORS AND NURSE AS
BIT.
THOSE ARE SOME STRATEGIES WE'RE
EMPLOYING HERE TO HELP REDUCE
MORTALITY AMONG THIS POPULATION.
>> I LOVE HOW WE LEARN GLOBALLY
FROM ACROSS DIFFERENT
STRUCTURES, AS WE FIGURE OUT
SOLUTIONS.
I'M GOING TO CHANGE GEARS
BECAUSE WE'VE HAD A COUPLE
QUESTIONS COME UP IN THE CHAT.
HOW CAN TRAINING FOR HEALTH CARE
PROFESSIONALS BE IMPROVED TO
ADDRESS IMPLICIT BIAS AND RACISM
IN MATERNAL HEALTHCARE?
>> THANK YOU FOR THAT QUESTION.
>> PEPPER NOT PECKER, SORRY.
>> LYDIA, PLEASE GO AHEAD.
I THINK YOU HAVE SOME
EXPERIENCE.
IVE
>> DEFER TO YOU.
I JUST WANTED TO SAY ONE THING
ABOUT SICKLE CELL DISEASE, WE
TALK ABOUT RACISM BECAUSE YOU
CANNOT SEPARATE SICKLE CELL
DISEASE FROM RACISM.
RACISM IS THE WATER WE SWIM IN
IN THE UNITED STATES, SO LIKE
NOBODY'S GETTING OUT OF THE
POOL, RIGHT?
WE'RE ALL HERE TOGETHER.
BUT I THINK THE THING ABOUT
SICKLE, HOW WE CREATE SICKLE
CELL ANTI-RACIST CARE
STRUCTURES, WE CREATE SYSTEMS
THAT PROVIDE EXPERT CARE FOR THE
PEOPLE.
WE TALK ABOUT THIS DISEASE AND
WHAT IT REQUIRES.
YES, IT'S IMPOSSIBLE TO
DISAMBIGUATE FROM THE FACT THE
FACE OF SICKLE CELL DISEASE IN
THE UNITED STATES IS THAT OF A
PERSON THAT IN THIS COUNTRY WE
CALL BLACK.
BUT I REALLY THINK WE NEED TO BE
SURE THIS IS ABOUT MEETING,
MEETING PEOPLE AND PROVIDING
EXPERT CARE TO PEOPLE.
DR. PEP PEPRAH, TEACH US ABOUT
THE STRUCTURES.
>> THAT'S A FANTASTIC ANSWER,
NUMBER ONE.
NUMBER TWO, IN TERMS OF THINKING
HOW WE REALLY SORT OF
DISENTANGLE AND BREAK DOWN THESE
BARRIERS, I THINK WE HAVE TO
LOOK AT THE STRIATA.
OVERT AND COVERT RACISM,
INTERPERSONAL WE CAN ADDRESS IN
TERMS OF INSTITUTIONAL POLICIES,
WE CAN CHANGE THOSE TO MAKE SURE
THAT THERE IS LESS RACIAL BIAS
IN TERMS OF IT.
AND THEN ALSO LOOK AT THOSE
ISSUES AROUND SORT OF THE
STRUCTURES.
NOW WE CANNOT DIVORCE MATERNAL
HEALTH OUTCOMES FROM HOUSING,
FROM ECONOMIC DISADVANTAGE, IN
TERMS OF ALL OF THESE.
SO ALL OF THESE SORT OF IMPINGE
UPON THIS.
I LOVE WHAT WHAT WAS SET ABOUT
INCORPORATING POLICY, ULTIMATELY
HEALTHCARE PRACTITIONERS WE CAN
TRY OUR BEST TO PROVIDE CARE FOR
INDIVIDUALS, EVEN PROVIDE
SPECIFIC OPPORTUNITIES TO HELP
PATIENTS GET TO THOSE OTHER
AREAS IN TERMS OF ACCESS, BEYOND
THE HEALTHCARE FACILITY, BUT
ULTIMATELY IT'S POLICY IN TERMS
OF MAKING SURE THESE STRUCTURES
THAT HAVE EXISTED NEED TO CHANGE
SO POLICIES HAVE TO CHANGE THAT
EMBOLDEN THESE UNEQUAL TREATMENT
IN TERMS OF IT.
I THINK IT'S IMPORTANT THAT WE
DISCUSS THAT.
BACK TO DR. PECKER'S POINT WE
HAVE TO TREAT THE INDIVIDUAL,
TREAT PEOPLE, HAVE SYSTEMS THAT
TREAT INDIVIDUALS.
AT THIS POINT WE DON'T BECAUSE
OF DISPARITIES THAT EXIST.
THANK YOU.
>> AND, DR. PEPRAH, I THINK
ABOUT MY COLLEAGUES, AMAZING
SICKLE CELL DOCTORS THAT LOOK
DIFFERENT, BUT HAVE PHYSICIANS,
EDUCATED LIKE ME, HAVE FAMILIES
LIKE ME, WHEN THEY UNLIKE ME GO
INTO A HOSPITAL PREGNANT FOR
CARE THEIR RISK OF ADVERSE
OUTCOMES IS DIFFERENT BECAUSE OF
THE COLOR OF THEIR SKIN, A
SOBERING REALITY FOR PHYSICIANS,
SHOULDN'T BE TRUE FOR ANYBODY
BUT TO PUT A NAME ON HOW RACISM
WORKS.
AND SO I THINK ALSO ONE OF THE
PRINCIPLES OF TREATING
INDIVIDUALS WITH SICKLE CELL
DISEASE IS TO BELIEVE THEM WHEN
PEOPLE SAY THEY ARE IN PAIN, YOU
BELIEVE THEM.
SO MUCH OF WHEN I THINK ABOUT
WHAT -- ANECDOTES OF WHAT'S GONE
TERRIBLY WRONG IN CARING FOR
BLACK WOMEN THAT ARE PREGNANT IN
THIS COUNTRY, THEY COME INTO THE
HOSPITAL, THEY ARE NOT BELIEVED.
THEY ARE TOLD COME BACK
TOMORROW, WHAT WOULD IT MEAN TO
HAVE A HEALTHCARE SYSTEM WHEN
EVERYBODY IS TREATED WITH THE
DIGNITY OF BEING BELIEVED,
RIGHT?
AND HOW IF WE STARTED THERE,
WHAT WOULD CARE LOOK LIKE?
>> WELL SAID.
NO OTHER COMMENTS.
>> VERY POWERFUL.
THANK YOU BOTH.
GOING INTO SOME OF THE GLOBAL
PERSPECTIVES HERE, MAYBE DR.
MAKANI CAN WEIGH IN ON THIS ONE.
BUT, YOU KNOW, WE KNOW THE
MATERNAL MORTALITY IS QUITE HIGH
IN AFRICA.
WHAT SUGGESTIONS DO YOU HAVE TO
TRANSLATE WHAT WE'RE LEARNING IN
GHANA AND OTHER PLACES TO OTHER
AFRICAN COUNTRIES AND LOW- AND
MIDDLE-INCOME COUNTRIES WITH
HIGH MORBIDITY AND MORTALITY?
>> THANK YOU VERY MUCH.
THAT'S A REALLY GREAT QUESTION.
AND I THINK ONE OF THE SOLUTIONS
IS PARTNERSHIPS.
WHAT WE FOUND WHEN WE WERE
SETTING UP THE SICKLE IN AFRICA
NETWORK IS THAT THERE WERE
INDIVIDUAL POCKETS OF EXCELLENCE
WITHIN COUNTRIES LIKE YOU SAY,
YOU FIND WITHIN A COUNTRY
THERE'S QUITE A LOT OF VARIATION
BUT THERE WERE POCKETS OFES
EXCELLENCE.
WOULD YOU HAVE EXCELLENCE MAYBE
IN ACCRA OR MARSI, ALSO SICKLE
CELL EXCELLENCE, ALSO OBSTETRIC
EXCELLENCE.
THAT'S THE SAME THING AT AFRICA
LEVEL.
YOU'D FIND AS EXAMPLE GHANA
WOULD HAVE EXPERIENCE WITH
NEWBORN SCREENING, MAYBE SOUTH
AFRICA WOULD HAVE EXPERIENCE AND
EXPERTISE IN MANAGING DATA, ET
CETERA, ET CETERA, ET CETERA.
AND THE WAY THAT WE'VE BEEN
WORKING FOR THE PAST OVER TEN
YEARS IS REALLY JUST COMING
TOGETHER AS CENTERS, AS
COUNTRIES, AND SAYING WHAT CAN
WE LEARN FROM EACH OTHER, WHO IS
THE BEST PERSON TO LEAD IN THIS
PARTICULAR AREA?
BECAUSE THE EXPECTATION AND
SITUATION IS VERY DIFFERENT.
NOW, THIS KIND OF BIDIRECTIONAL
LEARNING AND CIRCULATION OF
KNOWLEDGE APPLIES IN BOTH DR.
PECKER AND DR. PEPRAR,
EMPHASIZING LEARNING NOT JUST
GLOBAL SOUTH AND GLOBAL NORTH,
SOUTH-SOUTH AND BIDIRECTIONAL.
WHEN YOU LOOK AT EXPERIENCE
AVAILABLE, MATERNAL HEALTH OR
SICKLE CELL DISEASE ASKING
IRONICALLY THAT NOW LESSONS CAN
BE LEARNED THE OTHER WAY AROUND
WHERE THE U.S. CAN COME AND
LEARN FROM YOUR UGANDA OR GHAND
THIS DOES ENCOURAGE HEALTHCARE
PRACTITIONERS, PATIENTS, TO
REALLY HAVE THAT HUMILITY AND
LEARN FROM EACH OTHER.
I THINK ONE OF THE OTHER POINTS,
ONE, THAT WHOLE THING WITH
PARTNERSHIPS, NETWORKS,
ENCOURAGING PEOPLE TO TALK TO
EACH OTHER ACROSS DISCIPLINES,
ET CETERA.
THE OTHER ASPECT I WANTED TO
TOUCH ON ABOUT IS REALLY
APPROACHING IT AS A TEAM.
THIS NOTION THAT THIS CAN ONLY
BE DEALT WITH BY SPECIALISTS IN
OBSTETRICS AND GYNECOLOGY OR IN
HEMATOLOGY, I THINK THAT DOESN'T
WORK AT ALL.
IRRESPECTIVE HOW MANY
HEMATOLOGISTS YOU HAVE OR HOW
FEW YOU HAVE, YOU'VE GOT TO BE
MULTI-DISCIPLINARY ACROSS ALL
THE CADRES OF HEALTH CARE
PRACTITIONERS.
THIS IS IMPORTANT.
WE'VE SEEN HOW BY USING THESE
TRAINED NURSES, MORE EFFECT
EFFECTIVE,
MORE EFFECTIVE TO TRAIN NURSES,
COMMUNITY HEALTH WORKERS WHO
WILL GIVE MORE ROBUST CARE
ESPECIALLY WITH PREGNANCY,
DELIVERY, COMPLICATIONS AROUND
THAT.
I THINK THOSE WOULD BE THE TWO
THINGS.
ONE IS THE PARTNERSHIP.
LEARNING FROM EACH OTHER WITHIN
AFRICA AND OUTSIDE AFRICA AT
GLOBAL LEVEL, THE OTHER THING IS
REALLY JUST BROADENING THE
PERSONNEL PROVIDING CARE SO IT
GOES BEYOND TRADITIONAL APPROACH
OF ONLY RELYING ON ONE TWO
MEDICAL DOCTORS, A HUGE CADRE
HAVE BEEN TRAINED, THAT KNOW HOW
TO DO THINGS THAT WILL BE
UTILIZED.
>> THANK YOU.
IT'S BEEN A POWERFUL PANEL WITH
POWERFUL RESPONSES.
ONE LAST QUESTION TO STAY ON
TIME.
I WILL LEAVE MY E-MAIL IN THE
CHAT AFTERWARDS AND IF PEOPLE
HAVE FOLLOW-ON QUESTIONS PLEASE
LET ME KNOW AND I WILL MAKE SURE
TO GET THEM TO THE PANELISTS AND
GET YOU RESPONSES.
WE'VE HAD SO MUCH DISCUSSION, SO
MANY GOOD TALKS, I'M GOING TO
ADDRESS TO THE WHOLE PANEL.
WHAT GENERAL AD VICE DO YOU HAVE
FOR PATIENTS WITH SICKLE CELL,
BLOOD DISORDERS, THAT ARE
PREGNANT OR THINKING OF GETTING
PREGNANT, HOW SHOULD THEY PLAN
FOR THIS AND HOW SHOULD YOU
REALLY THINK ABOUT INTERACTING
WITH, AS DR. PECKER SAID, THE
INDIVIDUAL PATIENT.
WE'VE HAD PEOPLE FROM ALL
CULTURES, ALL BACKGROUNDS, ALL
COUNTRIES, AND WHAT SHOULD WE
KEEP IN MIND WHEN WE'RE TREATING
THESE PATIENTS SO THEY GET THE
BEST POSSIBLE CARE?
>> I'M HAPPY TO JUMP IN.
I THINK AT INDIVIDUAL LEVEL IT'S
REALLY FOR PATIENTS TO BE THEIR
OWN ADVOCATES AND THEREFORE IF
THEY CAN'T TO RELY ON OTHER
PATIENTS, TO DEMAND, ASK FOR
MORE.
AND BY DOING THIS, IF THEY GO
AND SEE A HEALTHCARE
PRACTITIONERS TO TRY AND SEE IF
-- ENCOURAGE THEM, IT'S
COMPLICATED, BUT ENCOURAGE THEM
TO HAVE A MULTI-DISCIPLINARY
APPROACH TO THINGS AND SAY HAVE
YOU SPOKEN TO THE OBSTETRICIAN,
PEOPLE IN HEMATOLOGY.
AND SOMETIMES IT'S MORE
EFFECTIVE.
CERTAINLY IN MY PRACTICE, WITHIN
THE NETWORK, THIS IS WHAT WE END
UP DOING.
IF WE SAY IT'S EASIER FOR YOU AS
A PATIENT TO ASK YOUR DOCTOR FOR
ONE, TWO, THREE, WHEREAS IF YOU
AS A DOCTOR SAY TO ANOTHER
DOCTOR OR HEALTH CARE PROVIDER,
YOU NEED TO DO XYZ, THAT CAN
CAUSE POTENTIAL CONFLICT IF YOU
DON'T KNOW EACH OTHER.
IF THE PATIENTS AND MOST HEALTH
FACILITIES, NOT JUST IN AFRICA
BUT EVERY WHERE IN THE WORLD ARE
STARTING TO APPRECIATE VALUE AND
IMPORTANCE OF PATIENT ADVOCACY
AND LISTENING TO PATIENTS.
SO THAT'S ONE WAY OF DOING THAT.
THANK YOU.
>> THANK YOU ALL SO MUCH.
THE TIMING, WE'RE OUT OF TIME.
I DID SEE DR. PECKER PUT A
RESPONSE IN THE CHAT.
PRE-CONCEPTION CARE, PRENATAL
CARE, POSTPARTUM CARE,
ESPECIALLY IN THE U.S.,
TRANSLATED INTO SPANISH, REALLY
EMPOWERING PATIENTS TO BRING
EDUCATION TOOLS TO THE DOCS.
ONCE AGAIN, THANK YOU ALL SO
MUCH FOR AN EXCELLENT PANEL.
THERE WERE MORE QUESTIONS, I
WILL LEAVE MY E-MAIL IN THE
CHAT, AND GET BACK TO EVERYONE.
NOW I WILL PASS WORKSHOP TO DR.
PRICE TO START OUR NEXT PANEL.
>> GOOD AFTERNOON.
WELCOME TO THE LAST PANEL OF DAY
1.
I'M DR. PRICE, PROGRAM DIRECTOR
FROM THE DIVISION OF
CARDIOVASCULAR SCIENCE AT NHLBI.
AND CO-SIGN ACTIVIC PROGRAM LEAD
FOR NHLBI MATERNAL HEALTH
COMMUNITY IMPLEMENTATION
PROGRAM, IMPLEMENTING MATERNAL
HEALTH OUTCOMES FOR EVERYONE,
THESE EMPOWER COMMUNITIES TO
ENGAGE FULLY IN RESEARCH, TO
REDUCE MATERNAL MORBIDITY AND
MORTALITY.
THIS NEXT PANEL WILL SPOTLIGHT
THE RESEARCH TEAMS.
REFER TO THE PROGRAM BOOKLET AS
YOU'VE BEEN DOING THROUGHOUT THE
WORKSHOP FOR A FULL DESCRIPTION
OF THE SPEAKERS, BRIEFLY PART
PATING DR. NATALIE HERNANDEZ,
CENTER FOR MATERNAL HEALTH
EQUITY MOREHOUSE SCHOOL OF
MEDICINE.
HER COMMUNITY PARTNER JOINING
HER TODAY IS MARY NICHOLSON
JACKSON, CO-PRESIDENT OF THE
GEORGIA BREASTFEEDING COALITION,
CO-FOUNDER AND COMMUNITY
ENGAGEMENT DIRECTOR OF REACHING
OUR SISTERS FOR EVERYONE
INCORPORATED.
KNOWN AS ROSE.
FOLLOWING THAT WE'LL HEAR FROM
DR. WILLIAMS, ASSOCIATE
PROFESSOR AT NEW YORK
UNIVERSITY, AND HER COMMUNITY
PARTNER DAMALIA JACKSON.
TEXAS TECH, DR. CHRISTINE
GARNER, ASSOCIATE PROFESSOR OF
OBSTETRICS AND GYNECOLOGY,
RESEARCHER IN THE INFANT RISK
CENTER, ASSISTANT VICE PRESIDENT
OF RESEARCH AT TEXAS TECH
UNIVERSITIES HEALTH SCIENCES
CENTER.
REPRESENTING HER COMMUNITY
PARTNER CASIE STOUGHTON,
AMARILLO PUBLIC HEALTH.
WE'RE HEAR FROM DR. MENARD,
UNIVERSITY OF NORTH CAROLINA
SCHOOL OF MEDICINE.
JOINED BY HER COMMUNITY PARTNER
KAMARA BARNETT, COMMUNITY
COLLABORATOR FOR THE ACHIEVE
STUDY.
YOU'LL HEAR MORE THAT DURING THE
PRESENTATION.
LAST BUT NOT LEAST WE'LL BE
JOINED BY DR. KIRSTEN DORANS,
TULANE UNIVERSITY SCHOOL OF
PUBLIC HEALTH AND TROPICAL
MEDICINE, COMMUNITY PARTNER MARY
SCHULTHEIS, PRESIDENT AND CEO OF
CRESCENT CITY FAMILY SERVICES.
I ENCOURAGE YOU AS YOU LISTEN TO
OUR PANELISTS SPEAK TODAY FEEL
FREE TO ENTER YOUR QUESTIONS IN
THE CHAT AND WE WILL GET TO
THOSE QUESTIONS DURING OUR Q&A
FOLLOWING THE CONCLUSION OF THE
PRESENTATIONS.
WITH THAT I WILL TURN IT OVER TO
THE FIRST SPEAKER, DR. HERNANDEZ
AND MS. JACKSON, IMPROVING
PRE-CONCEPTION ACTION IN AND
CHOICES FOR TOMORROW.
>> THANK YOU.
GOOD AFTERNOON.
NATALIE HERNANDEZ GREEN, I'M AN
SOCIAL PROFESSOR, EXCITED TO
CO-PRESENT WITH ONE OF OUR MAJOR
COMMUNITY PARTNERS, I'M WEARING
A SHIRT REPRESENTING THE
ORGANIZATION REACHING OUR SISTER
EVERYWHERE WITH MARY NICHOLSON
JACKSON.
NEXT SLIDE.
JUST FOR SOME BACKGROUND
INFORMATION, OUR TOPIC AND
EVIDENCE-BASED INTERVENTION THAT
WE CHOSE BECAUSE WE'VE GATHERED
A LOT OF FORMATIVE WORK WITH
COMMUNITIES FOR OVER THE LAST
SIX YEARS WAS PRE-CONCEPTION
COUNSELING, PRE-CONCEPTION CARE.
IMPROVING HEALTH BEFORE, DURING,
AFTER PREGNANCY REMAINS A
STRATEGIC OBJECTIVE OF HEALTHY
PEOPLE 2030.
IT PROVIDES PLATFORM FOR EARLY
DETECTION AND MANAGEMENT OF
HEALTH RISKS, ENSURES THAT
INDIVIDUALS OF REPRODUCTIVE AGE
BEGIN PREGNANCY IN A STATE OF
OPTIMAL HEALTH.
WE KNOW CARDIOVASCULAR DISEASE
PARTICULARLY FOR BLACK WOMEN IS
ONE OF THE LEADING CAUSES OF
PREGNANCY-RELATED DEATH.
AND MORBIDITY.
CLINICAL RELEVANCE OF A CONCEPT
TARGETING IN PRE-CONCEPTION
COUNSELING WAS HIGH LIGHTED IN A
JOINT PRESIDENTIAL ADVISORY FROM
THE AMERICAN HEART ASSOCIATION
AND AMERICAN COLLEGE OF
OBSTETRICS AND GYNECOLOGISTS TO
HIGHLIGHT THE ROLE
PRE-CONCEPTION HEALTH PLAYS IN
OPTIMIZING CARDIOVASCULAR
DISEASE OF PREGNANCY CAPABLE
INDIVIDUALS.
MOSTLY CONDUCTED IN CLINICAL
SETTINGS AND THROUGH THE
IMPLEMENTATION PROJECTS A UNIQUE
OPPORTUNITY TO MEET A LOT OF
INDIVIDUALS IN THE SOUTHEAST
WHERE 30% DO NOT HAVE ACCESS TO
HEALTH CARE TO MEET THEM IN
COMMUNITY SETTINGS.
HOW DO WE THINK ABOUT
IMPLEMENTING PRE-CONCEPTION
COUNSELING WITH COMMUNITY
MEMBERS IN COMMUNITY-BASED
SETTINGS.
THE PROJECT HAD TWO PHASES.
PHASE 1 WE CONDUCTED A PILOT
TEST OF PRE-CONCEPTION
COUNSELING, THINKING ABOUT HOW
DO WE DO THIS, HOW DO YOU EVEN
BEGIN TO TAKE SOMETHING THAT
SEEMS FAIRLY COMPLICATED, THAT
CLINICIANS ARE USED TO DOING,
HAVING PERSONS LIKE YOU AND ME
IN COMMUNITY SETTINGS BEING ABLE
TO IMPLEMENT SOMETHING LIKE
THIS.
PEOPLE TEND TO FOCUS ON NEEDS
BUT WE WANTED TO AMPLIFY ASSETS
IN THE COMMUNITIES.
WE DID A PRE-CONCEPTION HEALTH
SURVEY, FATHER FRIENDLINESS
SURVEY, WE WERE INTERESTED IN
HOW TWO PEOPLE PARTICULARLY
PARTNERS, FATHERS, ARE INVOLVED
IN PRE-CONCEPTION HEALTH AND
HOLDING SOME FOCUS GROUPS TO GET
AT WHAT IS THE COMMUNITY
PRIORITIZING AS NEED.
WE DID A PILOT INTERVENTION AND
IMPLEMENTATION, USING EXPERT
MODEL TO DELIVER PRE-CONCEPTION
COUNSELING, THAT WAS SOMETHING
THAT WE HEARD FROM
COMMUNITY-BASED ORGANIZATIONS
THAT THEY WERE FAMILIAR WITH,
HOW DO WE UTILIZE MODEL IN THAT
WAY TO PRESENT PRE-CONCEPTION
COUNSELING AND THEN DID A POST
IMPLEMENTATION ASSESSMENT USING
FOLLOW-UP INTERVIEWS WITH OUR
COMMUNITY MEMBERS AND PARTNERS
PHASE 2, HYBRID EFFECTIVENESS
IMPLEMENT AGO TRIAL WITH SITES
WITH LOW INCOME AFRICAN AMERICAN
WOMEN IN GEORGIA, NORTH
CAROLINA, SOUTH CAROLINA,
WORKING ON PARTNERSHIPS IN
TENNESSEE.
SO WITH THIS HYBRID TO
EFFECTIVENESS IMPLEMENTATION,
RCT, INDIVIDUALS WILL BE
RANDOMIZED INTO TWO ARMS, ONE
LOOKING AT STRUCTURE FOLLOW-UP,
SO WE'RE STILL WORKING WITH
COMMUNITIES TO SEE WHAT THAT
LOOKS LIKE BUT RIGHT NOW WE KNOW
MOST PEOPLE DO MAILED
INFORMATIONAL FLYERS AND
ENHANCED STRUCTURED FOLLOW-UP.
HOW DO WE UTILIZE TECHNOLOGY OR
TOOLS THAT COMMUNITY SITES ARE
ALREADY USING AS WELL AS
ADDITIONAL INFORMATION SO THAT
IT'S ENHANCED AND NOT YOUR
STANDARD WAY OF DELIVERING
INFORMATION.
THE FRAMEWORKS ARE EXPLORATION,
PREPARATION, IMPLEMENTATION,
SUSTAINMENT FRAMEWORK, AND PRISM
MODEL.
TWO KEY COMPONENTS OF THE MODELS
IS THAT LASTING OF
SUSTAINABILITY.
MAIN GOAL IS LOOKING AT
IMPLEMENTATION OUTCOME.
ONCE THIS PROJECT LEAVES, HOW
ARE THESE COMMUNITY-BASED
ORGANIZATIONS ABLE TO SUSTAIN
AND CONTINUE THIS PROGRAM AT
SCALE AND FOR YEARS TO COME.
THIS PROJECT IS A FIVE-YEAR
PROJECT, THOSE TWO LAST YEARS
WILL BE WORKING ON
SUSTAINABILITY WITH OUR
COMMUNITIES.
NEXT SLIDE.
THIS IS JUST THE -- THESE ARE
COMMUNITY PARTNERSHIPS THAT I
MENTIONED WITHIN THE STATES.
OF GEORGIA, NORTH CAROLINA,
SOUTH CAROLINA.
A LOT ARE SIMILAR IN THE TYPE OF
POPULATION THEY SERVE, THE TYPES
OF PROGRAMS AND SO YOU'LL SEE
WE'RE WORKING WITH FIRST STEPS
PROGRAMS, HEALTHY START
PROGRAMS, AND THAT WAS IMPORTANT
BECAUSE WE WANTED THESE BRICK
AND MORTAR PROGRAMS THAT WERE
SIMILAR AND WOULD HAVE SIMILAR
WAYS OF HOW THEY ARE
IMPLEMENTING.
AND THEN I'LL HAND OVER TO MISS
MARY.
>> GOOD AFTERNOON.
NEXT SLIDE.
AS A COMMUNITY-BASED
ORGANIZATION AND SITE WE HAD
REGIONAL ADVISORY BOARD, RAB, WE
HAD 20 MEMBERS, WE ALSO THROUGH
THOSE MEMBERSHIPS AND SITES WERE
ABLE TO GAIN COLLABORATION, ALSO
ABLE TO PROVIDE INFORMATION TO
EACH OF US, BUT ALSO SHARE
INFORMATION TO OUR OTHER -- TO
OUR SITES AND PARTICIPANTS.
NEXT SLIDE.
WE HAD A MEETING IN MARCH, WITH
ALL OF THE TEN SITES, AND WE
DISCUSSED THERE AT THE STRATEGY
MEETING ON THE NEXT PHASE, WHICH
IS OUR YEAR 2.
WE WERE ABLE TO PROVIDE SOME
INFORMATION AND FEEDBACK TO THE
PROJECT MANAGERS AND COME UP
WITH OUR NEXT 2 TO 5 YEAR
STRATEGY ON WHICH WAY TO GO, HOW
WE WOULD IMPLEMENT THE
INFORMATION.
NEXT SLIDE.
>> THE WAY WE WORK WITH OUR
COMMUNITY-BASED SITES,
CONTINUING SITE ORIENTATION AND
TRAININGS, THESE WERE HELD IN
PERSON.
A WHOLE DAY WHERE WE DISCUSSED A
PROJECT BACKGROUND, PHASE 1
FINDINGS, PROGRAM DELIVERY.
WE ALSO MADE SURE WE HAD SITE
LIAISONS, PRIMARY PROJECT
CORRESPONDENCE FOR TWO TO THREE
PARTNER SITES EACH, HAVE OUR
SITE LIAISONS FROM OUR TEAM HAVE
BIMONTHLY AND MONTHLY MEETING
CHECK-INS WITH SITES ABOUT
RECRUITMENT AND IMPLEMENTATION,
WE ALSO DO MONTHLY NEWSLETTERS
WITH PROJECT IMPACT REMINDERS,
MATERNAL HEALTH RELATED
INFORMATION, EVENTS HAPPENING IN
THE COMMUNITIES, WE DO A LOT OF
CAPACITY BUILDING OPPORTUNITIES
WITH OUR SITES.
WE ALSO SEND HOLIDAY CARDS,
CONDOLENCE MESSAGES, JUST TO
MAKE IT MORE PERSONABLE SO WE'RE
BUILDING TRUST AND RAPPORT WITH
EACH OF THE COMMUNITY SITES.
AND LASTLY WE CREATED A RESOURCE
HUB WHICH WAS TO HOUSE ALL
RESOURCES COMPILED FOR
PARTICIPANTS AND REFERRAL LISTS
FROM PARTNER SITES.
AND THESE ARE TO BE AVAILABLE
FOR YOU UTILIZATION DURING YEARS
2 TO 4 THROUGHOUT THE
PRE-CONCEPTION COUNSELINGS,
THROUGH THE EIGHT SESSIONS,
SOCIAL DETERMINANTS OF HEALTH,
NUTRITION, PHYSICAL ACTIVITY, AS
WELL AS DIABETES, GENETIC
HISTORY, FAMILY PLANNING,
CONTRACEPTION.
THAT'S IT.
IT'S A REALLY QUICK LIGHTNING
TALK.
AND NEXT SLIDE, WE JUST THANK
YOU, HERE'S SOME MORE
INFORMATION ABOUT OUR
ORGANIZATION WHICH INCLUDES
PARTNER ORGS AND WEBSITE.
THANK YOU FOR YOUR TIME.
>> WE'LL HAVE OUR NEXT PANELIST,
DR. NATASHA WILLIAMS AND
COMMUNITY PARTNER, MS. JACKSON,
TO TALK ABOUT THE JUST MOST
PROJECT.
>> THANK YOU.
GOOD AFTERNOON, EVERYONE.
I'M DR. WILLIAMS, THE CONTACT
PRINCIPAL INVESTIGATOR FOR THIS
INITIATIVE.
WE LOOK FORWARD TO PRESENTING
WITH MY COLLEAGUE DAMALIA
JACKSON.
WE DO NOT HAVE CONFLICTS OF
INTEREST.
I WANT TO ACKNOWLEDGE THE NIH
AGREEMENT THAT WE HAVE FOR THIS
INITIATIVE.
NEXT SLIDE.
SO IT TAKES A VILLAGE.
I WANT TO ACKNOWLEDGE ALL OF THE
AMAZING COLLABORATORS.
THIS IS A PARTNERSHIP WITH NEW
YORK CITY HEALTH AND HOSPITALS
CORPORATION, THE LARGEST PUBLIC
HEALTH SYSTEM IN THE COUNTRY,
FAMILY HEALTH CENTERS AT NYU
LANGONE, AND SEVERAL OTHER STAFF
MEMBERS, RESEARCH SUPPORT
STUDENTS, ADMIN, STUDY
PARTICIPANTS.
NEXT SLIDE.
SO ALSO AS DR. HERNANDEZ SHARED
IN HER TALK THIS WAS A
MULTI-PHASE STUDY, SO PHASE 1
THESE ARE SOME OF THE COMMUNITY
PARTNERS THAT WE'VE WORKED WITH,
AS WELL AS OUR PHASE 2
INITIATIVE AS WELL.
BUT I WANT TO ACKNOWLEDGE ALL OF
THE AMAZING WORK THAT THEY HAVE
ALL CONTRIBUTED TO THROUGHOUT
THIS INITIATIVE.
NEXT SLIDE.
SO IN OUR PHASE 1 INITIATIVE FOR
THE -- THE JUST MOTHERS PROGRAM,
WE ALSO CONDUCTED A COMMUNITY
NEEDS ASSESSMENT.
WE LOOKED SPECIFICALLY AT THE
DATA THAT'S AVAILABLE IN NEW
YORK CITY, WHICH IS WHERE OUR
PROGRAM IS LOCATED.
AND WE ARE WORKING WITH BOTH
BLACK AND LATINA BIRTHING
PEOPLE, WHO HAVE
DISPROPORTIONATE MATERNAL
MORBIDITY AND MORTALITY.
BASED ON DATA AT OUR LEVEL AT
NEW YORK CITY AND STATE AS WELL
AS NATIONALLY, MANY OF THE
PREGNANCY-RELATED DEATHS ARE
PREVENTIBLE.
WE'RE FOCUSED ON OUR INITIATIVE
TO ADDRESS SOCIAL DETERMINANTS
OF HEALTH AND LIFESTYLE,
NUTRITION, AND OTHER FACTORS
RELATED TO MATERNAL MORBIDITY
AND MORTALITY.
NEXT SLIDE.
OUR PHASE 2 INITIATIVE INCLUDES
CLUSTER RANDOMIZED STEPPED WEDGE
TRIAL.
IT IS A TYPE 3 HYBRID
IMPLEMENTATION TRIAL.
WE ARE ADOPTING THE ORIGINAL
EVIDENCE-BASED PROGRAM WHICH IS
THE STARTING EARLY PROGRAM, ALSO
KNOWN AS STEP.
IT IS A LIFESTYLE PRENATAL
COUNSELING AND NUTRITION PROGRAM
THAT'S TRADITIONALLY DELIVERED
BY REGISTERED DIETITIANS, IT IS
DONE IN PERSON, AND IS REALLY A
FAMILY APPROACH THAT FOCUSES ON
NUTRITION, PHYSICAL ACTIVITY,
AND STRESS REDUCTION, AND SOCIAL
SUPPORT FOR A HEALTHY PREGNANCY
WE'RE WORKING WITH TWO NEW YORK
CITY PRENATAL CLINICS AND
INDIVIDUALS RECEIVING THEIR CARE
ARE ELIGIBLE AS LONG AS THEY ARE
18 OR OLDER, ENGLISH OR SPANISH
SPEAKING.
THE MAJORITY OF INDIVIDUALS
IDENTIFY AS BLACK AND/OR LATINA
PATIENTS.
NEXT SLIDE.
FOR ADAPTATION WE'RE GUIDED BY
CFIR, AS WELL AS PRINCIPLES OF
COMMUNITY BASED PARTICIPATORY
RESEARCH.
SO ALL FACETS OF THIS INITIATIVE
INCLUDES OUR COMMUNITY PARTNERS.
THE ADAPTATION INCLUDES A
TECHNOLOGY BASED PROGRAM,
mHEALTH, AND THAT'S REALLY
DESIGNED TO IMPROVE THE
ACCESSIBILITY OF THE PROGRAM
WHICH WAS TRADITIONAL DELIVERED
BY REGISTERED DIETITIANS, IN
PERSON, SO THE ADAPTATION IS A
VIRTUAL PROGRAM.
WE'VE DEVELOPED A MOBILE HEALTH
WEB-BASED PLATFORM THAT'S
AVAILABLE TO OFFER ASYNCHRONOUS
AND SYNCHRONOUS LEARNING.
WE EMPLOY AND TRAIN COMMUNITY
HEALTH WORKERS, OR MATERNAL
COMMUNITY HEALTH WORKERS, TWO
SCREEN FOR SOCIAL DETERMINANTS
OF HEALTH AND OTHER
HEALTH-RELATED SOCIAL NEEDS.
AND WE HAVE STRIVED TO ENSURE
THAT THE PROGRAM IS CULTURALLY
RESPONSIVE, TAKING INTO DEEP
CONSIDERATION THE HISTORICAL AND
SOCIAL CONTEXT OF THE POPULATION
THAT WE'RE WORKING WITH FOR THE
PROGRAM, UNDERSTANDING LITERACY
AND HEALTH LITERACY, AS WELL AS
LANGUAGE ISSUES AS WELL.
NEXT SLIDE.
THESE ARE PRIMARY AND SECONDARY
AIMS.
I JUST INCLUDE OUR LOGO HERE
WHICH IS A LINK TO THE STUDY
SITE BUT IT IS NOT PUBLICLY
FACING.
IT IS FOR STUDY PARTICIPANTS.
NEXT SLIDE.
OUR IMPLEMENTATION STRATEGIES
FOCUS ON TECHNOLOGY THAT WE'VE
DEVELOPED INCLUDING SCRIPTS FOR
VIDEOS, CONTENT FROM THE
ORIGINAL PROGRAM, TEXT MESSAGES
AS WELL THAT ARE DELIVERED TO
PARTICIPANTS, AND THEN THE ROLE
OF OUR COMMUNITY HEALTH WORKER
THAT WILL PROVIDE LIVE
COUNSELING SESSIONS VIRTUALLY
AND THROUGH THE WEB-BASED
PLATFORM.
NEXT SLIDE.
WE HAVE CONVENED A COMMUNITY
OVERSIGHT GROUP, JUST TO BRIEFLY
SHARE THE STRUCTURE OF THAT
GROUP, IT'S CO-CHAIRED BY TWO OF
OUR COMMUNITY PARTNERS, WE
PARTICIPATE IN MONTHLY VIRTUAL
MEETINGS, AND ALL OF OUR
MEETINGS ARE OPEN TO COMMUNITY
PARTNERS TO ATTEND.
SO IT IS NOT UNCOMMON TO FIND
THAT COMMUNITY PARTNERS ARE
ATTENDING MEETINGS AROUND THE
RESEARCH STRATEGY AND
IMPLEMENTATION, AS WELL AS OUR
PRINCIPAL AND CO-PRINCIPAL
INVESTIGATORS ATTEND AS WELL,
INTEGRATED INTO THE STUDY
DESIGN.
NEXT SLIDE.
AND THEN JUST TO SHARE BRIEFLY
SOME OF THE FUNCTIONS THAT WE
THINK ABOUT ALONG THE CONTINUUM
OF ENGAGEMENT, INCLUDING
COLLABORATION, INVOLVEMENT,
CONSULTATION AND OUTREACH, WITH
OUR PARTNERS, WITH REALLY
THINKING ABOUT THE GOAL TO HAVE
RESPECTFUL CULTURALLY RESPONSIVE
UNDERSTANDING
UNDERSTANDING COMPASSION, SO
THERE'S DIVERSE PEP SPEER PERS.
DAMALIA IS GOING TO SHARE
EXAMPLES.
OVER TO YOU.
>> NEXT SLIDE.
OKAY.
SO, THIS IS ONE EXAMPLE OF HOW
THE COMMUNITY OVERSIGHT GROUP IS
INVOLVED IN THE PROJECT.
SO, THIS INVOLVED US LOOKING AT
VIDEOS THAT WOULD BE PART OF THE
INTERVENTION, THAT'S HOSTED ON
THE NYU LH SITE.
WE GOT A CHANCE TO LOOK AT THIS
VIDEO BEFORE THEY WERE MADE
AVAILABLE TO THE PARTICIPANTS.
THESE WERE SOME OF THE FEEDBACK
THAT MYSELF AND SOME OF THE
OTHER COMMUNITY OVERSIGHT GROUP
PROVIDED.
SO INCLUSIVE IMAGES, ADD MORE
PICTURES OF WOMEN BREASTFEEDING,
THOUGHT IMAGES WERE APPROPRIATE
FOR TARGET AUDIENCE.
NEXT SLIDE.
ONCE THIS FEEDBACK WAS RECEIVED,
THIS FEEDBACK WAS INCORPORATED
INTO THE VIDEOS, AND THESE ARE A
FEW EXAMPLES OF THE INCORPORATED
FEEDBACK, INCLUSION OF MORE
ETHNIC FOODS, REALISTIC HEALTH
FOOD SUBSTITUTIONS BECAUSE NOT
EVERYBODY HAS ACCESS TO
VEGETABLES ALL THE TIME.
INSTEAD OF REPLACING ENTIRE FAST
FOOD MEAL, FRIES WERE REPLACED
WITH VEGETABLES.
THE PARTICIPANTS IN THE GROUP
NOT ONLY INVOLVED FEEDBACK ON
INTERVENTION AND RESEARCH STUDY
BUT PROVIDED WITH MINI GRANTS,
TWO EXAMPLES OF WHAT THE MEMBERS
USED THEIR MINI GRANTS FOR.
FIRST IS A STAFF TEAM BUILDING
EVENT, THESE ARE STAFF WHO WILL
AS COMMUNITY HEALTH WORKERS WITH
MOTHERS AND CHILDREN, THE OTHER
EXAMPLE WAS ANOTHER PARTNER DID
A COMMUNITY CAR SEAT SAFETY
WORKSHOP.
NEXT SLIDE.
AND THESE ARE -- THIS IS ANOTHER
EXAMPLE, SO WE'VE HAD MANY
OPPORTUNITIES TO SHARE OUR
STORIES AND OUR EXPERIENCE
WORKING IN THE COMMUNITY WITH
THOSE WHO ARE IMPACTED BY THIS
ISSUE AND ARE PART OF THE
RESEARCH STUDY.
SO THESE ARE JUST THREE
EXAMPLES, THERE WAS A MATERNAL
HEALTH ROUNDTABLE THAT THE
MEMBERS HAD, SAY, IN DECIDING
WHAT WOULD BE THE TOPIC OF THE
ROUNDTABLE.
AND HERE YOU SEE ONE OF THE
MEMBERS SPEAKING TO THE
ATTENDEES.
MEMBERS HAVE ALSO BEEN ABLE TO
DIRECTLY ADDRESS POLICYMAKERS AT
THE STATE LEVEL.
AND OUR CO-CHAIR, MISS HELENA
GRANT, PRESENTED AS A KEYNOTE
SPEAKER AT THE ANNUAL FORUM.
THIS IS A PICTURE OF THE LOVELY
MEMBERS OF THE COMMUNITY
OVERSIGHT GROUP.
AS YOU CAN SEE, IT'S
REPRESENTATIVE OF MANY GROUPS
WHO WORK WITH MOTHERS AND
CHILDREN, PROGRAM MANAGERS,
DOULAS, MOST IMPORTANTLY
MOTHERS.
NEXT SLIDE.
THAT'S IT.
THANK YOU.
>> WONDERFUL.
THANK YOU SO MUCH.
NOW WE'LL MOVE ON TO DR. GARNER
AND COMMUNITY PARTNER.
>> GOOD AFTERNOON.
I'M THE DIRECTOR OF PUBLIC
HEALTH FOR PUBLIC HEALTH
DEPARTMENT IN AMARILLO TEXAS,
JOINED BY DR. CHRISTINE GARNER,
PRINCIPAL INVESTIGATOR FOR
VIBRANT MOMS PROJECT.
NEXT SLIDE.
WE DO NOT HAVE ANY CONFLICTS OF
INTEREST TO DISCLOSE.
NEXT SLIDE.
THE TEAM AT VIBRANT MOMS IS
WORKING HARD TO IDENTIFY
MATERNAL HEALTH PRIORITIES AND
ADDRESS DISPARITIES THROUGH
COMMUNITY ENGAGEMENT IN THE
TEXAS PANHANDLE.
WE HAVE A ROBUST AND ENGAGED
COALITION, SUPPORTING VIBRANT
MOMS PROJECT.
THE ACADEMIC LEADS FOR THE
PROJECT ARE FROM TEXAS TECH
HEALTH SCIENCES CENTER,
AMARILLO, TEXAS.
COMMUNITY LEADS ARE FROM
AMARILLO PUBLIC HEALTH AND
WESLEY COMMUNITY CENTER.
WE HAVE DYNAMIC CHAIRS FROM WIC
AND CATHOLIC CHARITIES JOSEPHS
PROJECT.
WE HAVE SUPPORT AND EXPERTISE
FROM A WIDE RANGE OF COMMUNITY
MEMBERS.
NEXT SLIDE.
TEXAS HAS HIGH MATERNAL AND
MORBIDITY RATES.
90% OF MATERNAL DEATHS WERE
DEEMED TO HAVE BEEN PREVENTIBLE.
ACROSS TEXAS, MORE THAN 20% OF
PREGNANT INDIVIDUALS RECEIVED
INADEQUATE PREGNANCY RELATED
CARE.
PREECLAMPSIA RATES ACROSS THE
STATE HAVE INCREASED OVER 37% IN
RECENT YEARS.
IN TEXAS, 46% OF COUNTIES ARE
CONSIDERED MATERNITY CARE
DESERTS.
AND THESE ARE PARTICULARLY
CONCENTRATED IN THE TEXAS
PANHANDLE RENAL.
THIS IS A MAP OF COUNTIES WHICH
CARE DESERTS WITH INDICATED IN
RED, AND COUNTIES WITH LOW
ACCESS ARE IN ORANGE.
OF THE SIX COUNTIES REACHED BY
OUR PROJECT, THREE OF THEM ARE
CONSIDERED DESERTS.
AND ONE IS CONSIDERED A LOW
ACCESS COUNTY.
AMONG SIX COUNTIES ENGAGED
BETWEEN 22 AND 42% HAVE RECEIVED
NO PRENATAL CARE IN THE FIRST
TRIMESTER OF PREGNANCY.
AND UP TO 48% ENTER PREGNANCY
WITH A CHRONIC HEALTH CONDITION.
FINALLY, THE MATERNAL
VULNERABILITY SCORE IS HIGH WITH
AVERAGE MATERNAL VULNERABILITY
SCORE OF 72%.
NEXT SLIDE.
THE TEXAS PANHANDLE IS A
WONDERFUL PLACE WITH AMAZING
PEOPLE.
AS YOU CAN SEE, THE MIX OF URBAN
AND RURAL IS ABSOLUTELY
STUNNING.
WHILE WE HAVE CHALLENGES,
DISPARITIES, AND INEQUITIES, WE
ALSO HAVE HARD-WORKING PARTNERS
WHO COME TO THE TABLE READY TO
TAKE ON ANY CHALLENGE.
I'M EXCITED TO HAND THE
PRESENTATION OVER TO DR. GARNER
TO TALK MORE ABOUT THE VIBRANT
MOMS PROJECT.
>> THANK YOU.
NEXT SLIDE.
SO, THE PREVIOUS SPEAKERS WHO
PRECEDED US ARE CURRENTLY IN
PHASE 2 PROJECTS, WE'RE STILL IN
A PHASE 1 PROJECT, WE'RE A YEAR
INTO A TWO-YEAR PROJECT.
VIBRANT MOMS IS A
COMMUNITY-DRIVEP PROJECT THAT
INVOLVES NEEDS ASSESSMENT AND
PLANNING FOR PHASE 2
IMPLEMENTATION TRIAL.
WE HAVE THREE MAIN OBJECTIVES.
THOSE ARE TO IDENTIFY COMMUNITY
PRIORITIES AND MATERNAL HEALTH
NEEDS IN OUR SIX COUNTIES, TO
IDENTIFY BARRIERS TO AND
FACILITATORS FOR IMPLEMENTATION
OF EVIDENCE-BASED INTERVENTIONS,
AND, THIRD, DEVELOP
IMPLEMENTATION STRATEGIES TO
BRING EVIDENCE-BASED
INTERVENTIONS TO THE PEOPLE WHO
NEED THEM.
OUR OVER ARCHING GOAL IS IMPROVE
CARE COORDINATION AND ACCESS TO
ENHANCE PREECLAMPSIA AND
MITIGATE HEALTH DISPARITIES.
WE'RE USING CONSOLIDATED
FRAMEWORK 2.0, USING A MIXED
METHODS APPROACH, FIVE TIMES OF
DATA.
THE SURVEY IS LED BY THE
AMARILLO PUBLIC HEALTH DISTRICT
DIRECTED BY CASEY, WHO WE JUST
HEARD FROM.
INPATIENT HOSPITAL DATA OBTAINED
FROM THE STATE, REVIEWS TO
DETERMINE PREVALENCE OF MATERNAL
MORBIDITIES IN SIX COUNTIES
WE'RE REACHING.
ASSET MAPPING AND FOCUS GROUPS
BEING CONDUCTED AMONG PREGNANT
AND POSTPARTUM INDIVIDUALS, AND
INTERVIEWS AMONG STAKEHOLDERS.
PARTNERS ASSISTED IN IDENTIFYING
PARTICIPANTS, RECRUITING AND
FOCUS GROUPS.
WE'VE TRAINED A COUPLE COMMUNITY
MEMBERS WHO HAVE DIRECTLY BEEN
INVOLVED WITH DATA COLLECTION.
NEXT SLIDE PLEASE.
COMMUNITY ENGAGEMENT HAS BEEN
CENTRAL TO OUR COALITION, AS WE
DISCUSS AND ENSURE THAT OUR
COALITION IS MUTUALLY BENEFICIAL
BETWEEN AND AND COMMUNITY
PARTNERS.
FULL COALITION MEETS QUARTERLY
WHERE THE BIGGEST DECISIONS ARE
MADE INCLUDING TIMES OF
QUESTIONS THAT WE INCLUDED IN
OUR DATA COLLECTION TOOLS, AND
MOST RECENTLY COALITION DECIDED
ON THE MATERNAL HEALTH PRIORITY
OR CONCERN THAT WE'LL FOCUS ON
FOR PHASE 2, PREECLAMPSIA.
WE ALSO HAVE MONTHLY MEETINGS
WITH CORE TEAM WHOM CASEY
MENTIONED PREVIOUSLY AND WE HAVE
SOMETHING CASUAL, COFFEE AND
CONVERSATIONS, VIRTUAL MONTHLY
MEET-UPS WHERE PEOPLE CAN POP IN
AND OUT FOR OVER THE COURSE OF A
COUPLE HOURS, BRING NEEDS TO THE
TABLE, SUCH AS WE NEED DATA FOR
GRANT APPLICATIONS, AND
DISCUSSED DIFFERENT IDEAS.
WE'VE ASSEMBLED WORKING GROUPS
ON AS-NEEDED BASES TO DIRECT
DIFFERENT PIECES OF THE PROJECT
AND PARTICIPATE IN COMMUNITY
EVENTS WHERE WE BUILD
RELATIONSHIPS AND JUST CONNECT
WITH COMMUNITY MEMBERS.
NEXT SLIDE PLEASE.
WE'RE NOW IN THE PLANNING PHASE
FOR -- TO PRAISE FOR -- TO
PREPARE FOR PHASE 2, PRESENTING
DATA AT COALITION MEETINGS
GUIDING NEXT STEPS.
WE DETERMINED OUR PRIOR WE'LL BE
ADDRESSING WILL BE PREECLAMPSI.
IN NOVEMBER WE'LL IDENTIFY AND
STRATEGIES FOR SCREENING AND
INTERVENTION FOR PREECLAMPSIA.
GIVEN THE SHORTENED TIMELINE WE
DECIDED TO CREATE AND DISTRIBUTE
VIDEOS FOR OUR STAKEHOLDERS
ABOUT OUR PHASE 2 PLAN.
AND TO SOLICIT FEEDBACK IN THAT
WAY.
AND THEN THAT WILL BE LATER
FOLLOWED UP BY IN-PERSON TOWN
HALL MEETINGS AND THROUGHOUT OUR
SIX COUNTIES THAT WE'RE
REACHING.
NEXT SLIDE PLEASE.
LAST BUT NOT LEAST, THESE ARE
OUR 30 PARTNERING ORGANIZATIONS
MEMBERS OF OUR COALITION.
AS YOU CAN SEE OUR PARTNERS
RANGE FROM ACADEMIC INSTITUTIONS
AND HEALTHCARE FACILITIES TO DAY
CARES, LOCAL NON-PROFITS,
GOVERNMENT AND SOCIAL SERVICE
ORGANIZATIONS, AND TOGETHER THIS
GROUP IS DEFINING THE NEXT STEPS
FOR IMPROVING MATERNAL HEALTH IN
THE TEXAS PANHANDLE.
THANK YOU SO MUCH FOR INVITING
US TO SPEAK WITH YOU ALL TODAY.
NEXT DR. MENARD AND HER
COMMUNITY PARTNER.
>> THANK YOU.
THANK YOU FOR THE OPPORTUNITY TO
SHARE OUR WORK.
I'M THE PRINCIPAL INVESTIGATOR
FOR THE ACHIEVE STUDY,
CO-PRESENTING WITH MISS BARNETT,
COMMUNITY COLLABORATOR AND LEAD
OF PATIENT ACTION GROUP, NEXT
SLIDE PLEASE.
PRESENTING ON A LARGE UNIVERSITY
OF NORTH CAROLINA ACADEMIC AND
REGIONAL COMMUNITY PARTNERS,
SHARED PURPOSE TO REDUCE
MATERNAL MATERNITY BY ACHIEVING
AND IMPROVE RECOGNITION
PREGNANCY HYPERTENSION.
WE'LL DESCRIBE PRESSING NEED FOR
IMPROVEMENT IN PREGNANCY RELATED
HYPERTENSION, TREATMENT, ORIGIN
OF THE STUDY CONCEPT, AND THEN
OUR STUDY GOALS.
FOCUS TODAY IS ON ENGAGEMENT
PROCESSES WITHIN THE CONTEXT OF
IMPLEMENTATION SCIENCE STUDY,
THERE ARE TWO PHASES TO THE
PROJECT AS YOU'VE SEEN IN
PREVIOUS PRESENTATIONS.
PHASE 1 WAS FORMATIVE WORK IN
OUR COMMUNITY.
WE APPLIED LESSONS LEARNED TO
CURRENT PHASE 2 STUDY, COMMUNITY
ENGAGED TYPE 3 STUDY.
NEXT SLIDE PLEASE.
SO LET'S START WITH WHY.
HYPERTENSION DISORDERS IN
PREGNANCY ARE A MAJOR
CONTRIBUTOR TO MATERNAL
MORBIDITY AND MORTALITY AND
INCREASE LIFETIME RISK.
BLACK BIRTHING PEOPLE, RURAL
AREAS AND LOWER INCOME HAVE
HIGHER RATES.
DELIVERING RESPECTFUL QUALITY
CARE CAN PREVENT HYPERTENSION
AND RELATED MORBIDITY AND
PREGNANCY RELATED DEATH.
NEXT SLIDE.
AS PART OF A STATEWIDE PUBLIC
HEALTH INITIATIVE TO ADDRESS
DISPARITIES IN MATERNAL HEALTH
IN NORTH CAROLINA, WE ASK
PROVIDERS IN PERINATAL REGION 4
WHAT CAN WE DO TO PREVENT
MATERNAL MORBIDITY AND
MORTALITY.
COMMUNITY BASED PROVIDERS WERE
CLEAR.
WE NEED TO DO A BETTER JOB
IDENTIFYING AND RESPONDING TO
PREGNANCY-RELATED HYPERTENSION.
NEXT PLEASE.
THE ALLIANCE OF -- YOU CAN GO TO
THE NEXT SLIDE PLEASE.
THE ALLIANCE FOR INNOVATION ON
MATERNAL HEALTH, WE CALL THAT
THE HYPERTENSION BUNDLE, AND THE
AIM PROVIDES HOSPITALS WITH SET
OF PROCESSES THAT THEY CAN USE
TO IMPLEMENT EVIDENCE-BASED
GUIDELINES FOR TIMELY
RECOGNITION AND RESPONSE TO
SEVERE HYPERTENSION DURING
PREGNANCY.
MULTIPLE STUDIES DEMONSTRATED
THIS HYPERTENSION BUNDLE'S
EFFECTIVENESS, IMPROVING TIME TO
TREATMENT AND REDUCING MATERNAL
MORBIDITY IN INPATIENT SETTING
BUT MOST OFTEN PRESENT IN
OUTPATIENT SETTING.
WE BIRTHED THIS EVERYDAY TO
RESPOND TO COMMUNITY ASK AND
ADDRESSED SEVERE HYPERTENSION BY
ADAPTING AIM HYPERTENSION BUNDLE
TO THE OUTPATIENT SETTING.
NEXT SLIDE PLEASE.
DURING PHASE 1, WE CONDUCTED
FORMATIVE ASSESSMENT AND WHILE
ENGAGING COMMUNITY PROVIDERS IN
THREE RURAL COMMUNITY HEALTH
CENTERS ADAPTED HYPERTENSION
BUNDLE TO THE OUTPATIENT
SETTING.
IN PHASE 2 WE'RE FOCUSING ON
OUTPATIENT CLINICS THAT SERVE
BLACK IDENTIFYING, RURAL, LOW
INCOME PEOPLE, WE CHOSE A
MULTIPLE BASELINE DESIGN WITH
THREE COHORTS OF UP TO 20
CLINICS IN OUR PERINATAL REGION.
COHORT 1 IN ACTIVE
IMPLEMENTATION PHASE, WE HOPE TO
DEMONSTRATE IMPACT OF
MULTI-COMPONENT STRATEGY ON HIGH
QUALITY IMPLEMENTATION OF
OUTPATIENT BUNDLE IN SETTINGS
THAT REACH THOSE AT GREATEST
RISK.
A PICTURE OF THE TIMELINE, THE
GOAL BEING THE BASELINE DATA
DIRECTION, BUT BEING LIVE
IMPLEMENTATION, GRAY SUSTAINMENT
PHASE.
NEXT SLIDE.
AT THE CORE IS INTEGRATION OF
COMMUNITY ENGAGEMENT AND
IMPLEMENTATION SCIENCE.
I'LL TURN IT OVER TO KAMARA TO
DESCRIBE THE APPROACH.
>> FROM CONCEPTION ACHIEVES WORK
HAS BEEN COMMUNITY WORK AND
EQUITY INFORMED, SOON AFTER WE
LAUNCHED PHASE 2 THE NATIONAL
ACADEMY OF MEDICINE CAME OUT
WITH A FRAMEWORK ASSESSING
MEANINGFUL COMMUNITY ENGAGEMENT,
CONCEPTUAL MODEL TO ADVANCE
HEALTH EQUALITY THROUGH
TRANSFORMED SYSTEMS FOR HEALTH.
ON THE PETALS REPRESENTING THE
FRAMEWORK FOUR DOMAINS,
STRENGTHENED PARTNERSHIPS,
ALLIANCES, EXPANDED KNOWLEDGE,
IMPROVED HEALTH, HEALTH CARE
PROGRAMS WITH THE GOAL OF
CONTRIBUTING TO THRIVING
COMMUNITIES.
TO STRENGTHEN PARTNERSHIPS WE
BUILT A COALITION, THREE LEVELS,
PATIENT, CLINIC PROVIDERS AND
STAFF, THE BROADER COMMUNITY.
WE USE A RANGE OF STRATEGIES TO
INVOLVE THEM IN PROVIDING
GUIDANCE, INSIGHT, FROM EACH
LEVEL, EARLY ON OUR GOAL WAS TO
BUILD RELATIONSHIPS, TRUST,
SENSE OF PARTNERSHIP.
AS WORK EVOLVED THE COALITION
TOOK ON A MORE ENGAGED ROLE
CONTRIBUTING TO CO-CREATION AND
PROCESSES AND PRODUCTS.
NEXT SLIDE PLEASE.
IN TERMS OF THE SECOND PETAL,
PRIORITIZING LIMITS OF
COMPONENTS OF THE BUNDLE AND
TRAILER STRATEGIES TO ADDRESS
DETERMINANTS.
FOCUSING ON THREE COMPONENTS,
TAILORED FOR OUTPATIENT SETTING.
FIRST PROPER BLOOD PRESSURE
MEASUREMENT.
SECOND RECOGNITION OF SEVERE
HYPERTENSION AND EARLY WARNING
SIGNS.
AND THIRD TIMELY EVALUATION,
TREATMENT, ESCALATION OF CARE
FOR PATIENTS EXPERIENCING SEVERE
HYPERTENSION.
FORMATIVE WORK HIGHLIGHTED
IMPORTANCE OF RESPECTFUL CARE,
ENHANCED COMMUNICATION,
BIDIRECTIONAL COMMUNICATION.
NEXT SLIDE PLEASE.
>> A KEY FINDING FROM PHASE 1 TO
PHASE 2 WAS IMPORTANCE OF
MOVING
AT THE SPEED OF TRUST,
BOLSTERING OUR ENGAGEMENT AS WE
EXPAND OUR WORK IN PHASE 2
PROVIDING NEW OPPORTUNITIES, NEW
CHALLENGES.
HOW TO EXPAND MEANINGFUL
ENGAGEMENT ACROSS COUNTIES,
COMMUNITIES, CLINICS.
NEXT SLIDE PLEASE.
>> BASED ON LEARNING FROM PHASE
1 WE EXPANDED, INTEGRATING TWO
CATEGORIES THAT ALIGN WITH THE
COMPENDIUM.
STRATEGIES TO ENGAGE COMMUNITY
PARTNERS, COALITION AND PATIENT
ACTION GROUPS.
AND SECOND, STRATEGIES TO
SUPPORT CLINIC-LEVEL INTEGRATION
OF ADAPTED BUNDLE, BEING
FACILITATION, TRAINING,
SIMULATION, AND EDUCATION
MATERIALS.
THE GOAL OF THE WORK TO ACHIEVE
THAT THIRD DOMAIN, PETAL OF
IMPROVED HEALTH CARE.
NEXT SLIDE PLEASE.
>> WE'RE ALSO INSPIRED BY THE
FOURTH PETAL DOMAIN, THRIVING
COMMUNITIES, IN PHASE PHASE 2
EXPANDING COALITION, PRIOR TO
ACTIVE IMPLEMENTATION IN EACH
COHORT.
WE'VE ALSO CREATED WORK GROUPS,
PATIENT ACTION GROUPS, TO ENSURE
THE VOICE AND PERSPECTIVE OF
PEOPLE WITH LIVED EXPERIENCE ARE
FULLY INVOLVED.
I LEADED PEG FOR BLACK
IDENTIFYING BIRTHING PERSONS.
WE HAVE ALSO LINKED EFFORTS WITH
SPANISH SPEAKING GROUPS WHICH
SERVE AS A PEG, PROVIDING
INSIGHT AND PERSPECTIVE FROM 9
LATINO AND HISPANIC POPULATIONS.
WE HAVE IDENTIFIED PATHWAYS TO
BRING PATIENT AND COMMUNITY
CENTERED PERSPECTIVES AND
APPROACHES TO CLINIC PHASE TO
CHANGE HOW THINGS ARE DONE, BOTH
PEGS ARE CENTRALLY INVOLVED IN
TRANSLATING FINDINGS INTO USEFUL
EDUCATIONAL MATERIALS, TO
PROVIDE CLINICAL PRACTICE.
NEXT SLIDE PLEASE.
AS ONE EXAMPLE WE CREATED A
VIDEO INCORPORATING THE KEY
MESSAGES WE GAINED FROM PATIENT
PARTNERS ABOUT WHAT RESPECTFUL
CARE MEANS AND HOW PROVIDERS AND
STAFFER CAN COMMUNICATE TO MEET
PATIENT NEEDS.
THIS VIDEO IS USED IN TRAINING
AND COACHING TO UNDERLINE THE
KEY ELEMENTS OF RESPECTFUL CARE.
WITH THE HELP OF WONDERFUL
PARTNERS WE'RE TO HAVE A GREAT
START AND LOOK FORWARD TO
SHARING RESULTS IN THE FUTURE
AND HOPE THIS MULTI-COMPONENT
STRATEGY WILL PROVE TO BE A
WIDELY REPLICABLE IN SETTINGS
THAT REACH THOSE AT GREATEST
RISK FOR HYPERTENSION-RELATED
MATERNAL MORBIDITY AND
MORTALITY.
THANK YOU ALL.
>> WONDERFUL.
THANK YOU.
AS WE COME UPON THE LAST
PANELIST PREPARE TO PUT YOUR
QUESTIONS IN THE CHAT.
50EU8
50EU8 I WILL TURN IT OVER TO
KIRSTEN DORANS AND HER PARTNER.
>> I'M HAVING RESIDUAL INTERNET
PROBLEMS, SO I'M JOINING BY
PHONE.
LET ME KNOW IF YOU HAVE TROUBLE
HEARING ME.
SO, THANK YOU FOR THIS
OPPORTUNITY.
I'M AN ASSISTANT PROFESSOR IN
EPIDEMIOLOGY AT TULANE,
CO-LEADING THIS PROJECT ALONG
WITH WITH DR. JIANG HE AND MARY
SCHULTHEI, FROM CRESCENT CITY
FAMILY SERVICES WHICH PROVIDES
WIC AND RELATED SERVICES TO MOMS
AND FAMILIES IN GRETNA,
LOUISIANA, AND NEW ORLEANS AREA.
NEXT SLIDE PLEASE.
WE HAVE NO DISCLOSURES, NO
CONFLICTS INTEREST TO DISCLOSE.
NEXT SLIDE PLEASE.
SO WITHIN THE PROJECT WE'RE
FOCUSING ON DIABETES PREVENTION
IN WIC CLINICS.
THE DPP IS A YEAR-LONG PROGRAM
WHICH FOLKS USES US -- FOCUSESN
HEALTHY EATING, PHYSICAL
ACTIVITY, WEIGHT LOSS, SHOWN TO
REDUCE RISK OF DEVELOPING TYPE 2
DIABETES AMONG THOSE AT HIGH
RISK.
WITHIN THIS PARTICULAR PROJECT
WE FORMED A COMMUNITY ACADEMIC
PARTNERSHIP, TESTING DIFFERENT
STRATEGIES FOR IMPLEMENTING DPP
IN WIC IN LOUISIANA FOR
POSTPARTUM WOMEN AT HIGHER RISK
OF DEVELOPING TYPE 2 DIABETES IN
THE FUTURE.
THOSE WITH A HISTORY OF
GESTATIONAL DIABETES OR A BODY
MASS INDEX GREATER THAN 30.
NEXT SLIDE PLEASE.
SO WITHIN THIS PROJECT WE'VE
FORMED A STRONG PARTNERSHIP
BETWEEN LOUISIANA WIC AT THE
STATE, REGIONAL, CLINIC LEVEL,
WITH TULANE AND OTHER ACADEMIC
PARTNERS.
MARY WILL TOUCH MORE ON THIS IN
A FEW SLIDES.
BUT WE SPECIFICALLY DECIDED TO
FOCUS ON WIC BECAUSE THE
DIABETES PREVENTION PROGRAM
GENERALLY HAS LOW UPTAKE IN MOMS
DURING THE POSTPARTUM PERIOD.
IT'S A CHALLENGING TIME PERIOD.
BUT THE WIC HAS A HIGH REACH,
REACHES NEARLY 7 MILLION PEOPLE,
40% OF INFANTS ACROSS 12,000
COMMUNITIES, EMBEDDED WITHIN
COMMUNITIES FOR MORE THAN 50
YEARS, SO THAT LONGSTANDING
INTEGRATION WITHIN COMMUNITIES
HAS LED TO A LOT OF TRUST.
AND SO THIS IS REALLY INTEGRAL
AND CRITICAL FOR
COMMUNITY-ENGAGED IMPLEMENTATION
RESEARCH.
SO WE DECIDED TO FOCUS ON WIC TO
MEET MOMS WHERE THEY ARE ALREADY
RECEIVING NUTRITIONAL-RELATED
SERVICES.
IT'S EFFECTIVE, ACCESSIBLE,
FEASIBLE.
DELIVERY COULD BE SUSTAINABLE
AND SCALABLE.
NEXT SLIDE PLEASE.
SO, AS THE EARLIER PRESENTATION
ALSO IN THIS PANEL, WE ALSO HAVE
A TWO-PHASE PROJECT.
OUR FIRST PHASE WE SPENT A YEAR
DOING FORMATIVE WORK,
IDENTIFYING INTERESTS IN THE DPP
PROGRAM WITHIN WIC, BARRIERS AND
FACILITATORS TO IMPLEMENTATION
WITHIN WIC.
IN ORDER TO DO THIS WE USED THE
EPIS FRAMEWORK AS OUR FOURTH
DOWN DAYS, WE BUILT OFF THE
COMMUNITY PARTNERSHIPS, WHICH
WAS LED BY MARY.
WORKING DOING FOCUS GROUPS AND
INTERVIEWS WITH MOMS, WIC STAFF,
AND OTHER KEY COMMUNITY PARTNERS
IN RELATED AREAS.
ONE MAJOR BARRIER WAS COMING IN
PERSON TO AS MANY SESSIONS AS IS
TYPICALLY REQUIRED WITHIN THE
DPP.
SO WE'RE NOW TESTING, NEXT SLIDE
PLEASE, IN PHASE 2, TWO
DIFFERENT STRATEGIES FOR
IMPLEMENTING DPP.
FIRST IS AN IN-PERSON STANDARD,
DPP, 24 SESSION WHERE IS MOMS
COME AND MEET WITH HEALTH COACH
IN PERCH AT A WIC CLINIC FOR 24
SESSIONS OVER A ONE-YEAR PERIOD.
OUR COMPARISON IS A STRATEGY IN
WHICH THE MOMS ARE COMING IN FOR
IN-PERSON GROUP SESSIONS 12
TIMES IN THE YEAR BUT THEN ALSO
RECEIVING SUPPLEMENTAL
ASYNCHRONOUS SUPPORT, RECEIVING
SESSION MATERIAL,
ASYNCHRONOUSLY, CHATTING WITH
OTHER MOMS IN THE GROUP AND
THEIR COACHES, AND ALSO BEING
ABLE TO RECEIVE FEEDBACK ON
PROGRESS FROM COACHES REMOTELY
AS WELL.
WE HAVE HYPOTHESIZED THIS
STRATEGY MIGHT BE MORE FEASIBLE
FOR BOTH MOMS AND CLINICS, MAYBE
MORE SUSTAINABLE AND MORE
ACCESSIBLE, WON'T BE WORSE FOR
MORE HEALTH-RELATED OR
CLINICALLY RELATED OUTCOMES SUH
AS WEIGHT LOSS.
NOW OVER TO MISS MARY.
THANK YOU.
NEXT SLIDE PLEASE.
>> GOOD EVENING, EVERYONE.
THANK YOU.
I'M SO HONORED TO BE ON THIS
CALL TODAY NOT ONLY AS A
COMMUNITY PARTNER BUT ALSO AS
BEING GIVEN THE OPPORTUNITY TO
BE A CO-P.I., SO DR. DORANS, I
THANK YOU FOR THIS OPPORTUNITY.
ON THIS SLIDE I THINK THE
BEAUTIFUL THING ABOUT THIS
PARTNERSHIP, I'LL USE THE WORD
PARTNERSHIP, THE COMMUNITY
ENGAGEMENT ECHOED OVER TODAY AND
TODAY IN EVERYONE'S
PRESENTATION.
I WANT TO GIVE A SHOUT OUT TO
DR. CREAR-PERRY, STARTING POST
KATRINA, I'M GRATEFUL FOR THAT.
IN THIS PICTURE IT WAS THAT LONG
LASTING RELATIONSHIP THAT WAS
ALREADY TRUSTED IN PLACE WITH
STATE LOUISIANA AS A WIC SERVICE
PROVIDER, I HAD THAT
RELATIONSHIP, SO IT WAS SO GOOD
WHEN DR. DARANS CAME IN EARLY OF
THE APPLICATION BEING PUT
TOGETHER FOR THIS GRANT SHE
ENGAGED US AND WIC WAS AT THE
TABLE IN THE BEGINNING.
WE HAVE JENNIFER NICKLAS, THE
DIRECTOR OF OUR WIC SERVICE, AND
JENNIFER IS REPRESENTING
LOUISIANA WELL, SHE'S AT A
NATIONAL LEVEL, SHE'S ACTUALLY
THE PRESIDENT-ELECT FOR NATIONAL
WIC, SHE'S ABLE TO LIFT OUR
VOICES AT A HIGHER LEVEL.
LEASELY LEWIS AND CELIA
BRIDGEFORTH, GREAT HAVING THIS
TRUSTED RELATIONSHIP ALREADY
BUILT AND BEING ABLE TO MOVE
FORWARD, OUR INITIATIVE WITH
COMMUNITY ACTION NETWORK THAT
WAS ALREADY IN PLACE, ALREADY
HAD STAKEHOLDERS AT THE TABLE,
ALL WE HAD TO DO WAS BRING OUR
ACADEMIC PARTNER IN AND BRIDGE
THE GAP.
NEXT SLIDE PLEASE.
YOU CAN SEE A LIST OF ALL
STAKEHOLDERS.
YOU CAN SEE FAITH BASED, WIC
SERVICE HEALTH DEPARTMENTS,
FQHCs, INSURANCE PROVIDERS,
NON-PROFITS, WE HAVE A LARGE
GROUP OF COMMUNITY ADVISORY
COMMITTEE MEMBERS, THIS IS
GREAT.
NEXT SLIDE PLEASE.
AND ONE THING THAT HAS BEEN
GREAT, STUDY STEERING COMMITTEE,
YOU CAN SEE WE DO REPRESENT THE
LOCAL, THE STATE, THE NATIONAL
LEVEL.
BEING ABLE TO HAVE ALL OF OUR
WIC SERVICE PROVIDERS, STATE
REPRESENTATION, AND THEN BEING
ABLE TO TAKE OUR INITIATIVE AND
DO SOME NATIONAL CONFERENCES, BE
ABLE TO PRESENT AT NATIONAL WIC
ASSOCIATION CONFERENCE, BEING
ABLE TO SEE THAT GREAT
ENGAGEMENT AT ALL LEVELS HAS
BEEN REALLY GOOD.
HAVING QUARTERLY MEETINGS, MEET
THANKSGIVING
-- MEETINGS THAT ARE
REGULAR.
I GIVE CREDIT TO THE COALITION,
AMAZING GROUPS PUT TOGETHER,
HIGHLIGHTING THE MOMS ADVISORY
GROUP WHICH WAS LED BY COURTNEY
MARTIN, WHO DID AN AMAZING JOB
LEADING THE GROUP.
THE WOMEN SHARED BARRIERS,
ANYTHING TO MOVE IT FORWARD.
THEY PRESENTED GREAT
INFORMATION, EVEN DESIGNED A
LOGO FOR THE PROJECT SO HAVING
THE VOICES OF OUR MOMS LIFTED
HAS BEEN AN AMAZING OPPORTUNITY
AND THEN EXPANDING OUR COALITION
AND ADVISORY GROUP LATER ON
BRING IN MORE MEMBERS AT ALL
LEVELS.
THAT'S BEEN GREAT.
NEXT SLIDE.
EXPANDING THE PARTNERSHIP HAS
BEEN GREAT.
WE'RE IN REGIONS 1-6, ALSO
REGION 9.
AS WE WENT OUT TO MEET SERVICE
PROVIDERS EVERYONE KNOWS WIC HAS
BEEN AROUND FOR OVER 50 YEARS.
WE HAD A CHANCE TO JUST MAKEUP
LIFTING -- UPLIFT THE WIC STAFF,
WHETHER IN WIC ONE DAY, THE
LONGEST EMPLOYEE WAS THERE FOR
49 YEARS DOING THIS GREAT WORK.
WE NEED TO GET OUT, GO TO THE
CLINIC, MEET THEM IN PERSON
APPRECIATE THEM.
WE'VE BEEN ABLE TO IDENTIFY IN
THE REGION OTHER CLINICS THAT
WANT TO PARTICIPATE.
SO THAT'S BEEN REALLY GOOD.
NEXT SLIDE.
I WANT TO GIVE A LOT OF
ACKNOWLEDGMENTS TO LOUISIANA WIC
AT THE STATE LEVEL.
IT'S BEEN AMAZING, AT THE
REGIONAL LEVEL, MOMS ADVISORY
GROUP, COMMUNITY ADVISORY
COMMITTEE.
WE COULD NOT DO THIS WITHOUT
EACH OTHER.
SOMEONE MENTIONED EARLY ON ABOUT
HAVING THE TEAM, BEING ABLE TO
WORK AS A TEAM.
YOU HAVE THE -- I TELL PEOPLE
THE QUARTERBACK, WIDE RECEIVERS,
RUNNING BACKS, WE WANT TO MAKE A
TOUCHDOWN IN THIS.
I GUARANTEE WE'LL DO IT.
I CAN SEE EPIS STUDY, THE WORD
FOR ME IS SUSTAINABILITY, AND I
COULDN'T THINK OF A BETTER
PARTNER THAN WIC BECAUSE WIC IS
PUBLIC HEALTH AT ITS FINEST.
EVERYONE WHO KNOWS IT, IT'S THE
LAST PROGRAM THAT EXISTS THAT WE
STILL HAVE A GREAT ENGAGEMENT
WITH OUR MOMS, OUR FAMILIES, OUR
BABIES AND INFANTS.
JUST BEING ABLE TO SUPPORT THEM
AND KNOW WE'RE HERE FOR THEM.,
WE'VE BEEN HERE 50 YEARS AND
WANT TO BE HERE ANOTHER 50
YEARS.
HERE IS THIS LIST OF OUR
COMMUNITY PARTNERS.
TOGETHER WE CAN DO IT.
THAT'S WHAT WE'VE BEEN ABLE TO
DO.
I KNOW THAT BEING ABLE TO
CONTINUE TO WORK WITH OUR
COMMUNITY PARTNERS AND VALUE
THEM, VALUE CLIENTS, CONSUMERS,
CUSTOMERS WHO RECEIVE THE
SERVICES FROM US, I WANT TO
THANK DR. DARANS AND HER TEAM
OUT IN THE COMMUNITY, GETTING
FACE TO FACE WITH FAMILIES, AND
JUST THIS PAST WEEKEND WE WERE
ALL TOGETHER SEEING HOW WE CAN
INTEGRATE OUR PROGRAMS INTO THE
COMMUNITY.
I CAN ASSURE YOU THAT THIS
INTERVENTION WILL BE SUSTAINED
IN WIC.
NEXT SLIDE.
I THANK EVERYONE.
THAT MIGHT BE MY LAST SLIDE.
STUDY TEAM MEMBERS, STUDY TEAMS
WORKING HARD IN THE CLINIC TO
DELIVER THE INTERVENTION, VERY
GRATEFUL FOR EACH AND EVERY ONE
OF THEM.
EVERYBODY WHO SUPPORTED AT
TULANE UNIVERSITY, BRINGING
GREAT INITIATIVES IN
MATERNAL/CHILD HEALTH, TOGETHER
WE'LL IMPROVE MATERNAL/CHILD
HEALTH AND BIRTH OUTCOMES AND
ADDRESS THOSE MATERNAL MORBIDITY
AND MORTALITY AND CONCERNS IN
THE COMMUNITY AND STATE OF
LOUISIANA.
THANK YOU.
DAY 1 HAS BEEN GREAT.
Y'ALL ARE LOOKING FORWARD TO DAY
2.
I LEARNED A LOT AND HEARD GREAT
MESSAGES AND I'M THE PROUD
MOTHER TODAY OF MY TWINS, I WAS
A HIGH RISK PREGNANCY BUT MY
TWINS MADE 36 AND I'M SO PROUD
TO SAY HAPPY BIRTHDAY TO THEM
AND DR. DORAN, ALSO A VIRGO.
>> THANK YOU TO ALL PANELISTS.
HAPPY BIRTHDAY TO YOUR TWINS,
MARY.
WE HAVE TIME MAYBE FOR ONE
QUESTION FROM, MAYBE TWO
QUESTIONS IF ANYONE HAS ANY
IMMEDIATE QUESTIONS.
I DON'T SEE ANYTHING JUST YET IN
THE CHAT.
THANK YOU FOR MENTIONING HOW YOU
ESTABLISHED HUER PARTNERSHIP --
YOUR PARTNERSHIPS.
IF YOU COULD LIMIT YOUR RESPONSE
TO ONE MINUTE, TALK ABOUT
FORMATIVE WORK THAT WENT INTO
ESTABLISHING YOUR COMMUNITY
PARTNERSHIPS, WHETHER NIECE WERE
ESTABLISHED BEFORE PHASE 1 BEGAN
OR THROUGHOUT THE COURSE OF
PHASE 1.
>> REAL QUICKLY MANY
PARTNERSHIPS FORMED FOR OTHER
INITIATIVES BEFORE WE GOT
STARTED.
SO THEY WERE ALREADY EXISTING.
HOWEVER, OVER TIME DIFFERENT
ORGANIZATIONS HAVE GONE ON TO
TAKE ON DIFFERENT INITIATIVES.
SO WE OFTEN RELY ON EXISTING
PARTNERS AS WELL TO SAY WHO ELSE
IS DOING THIS WORK IN THE
COMMUNITY THAT YOU THINK WOULD
BE A GOOD FIT.
>> I ECHO.
WE HAD PREVIOUS PARTNERSHIPS,
ALSO HAVE A GREAT AMBASSADOR,
DANET, WHO RECOMMENDED PARTNERS
THROUGH THE NATIONAL HEALTHY
START COALITION AS WELL AS OTHER
COALITIONS THAT SHE HAS BEEN A
PART OF.
SO SHE WAS INSTRUMENTAL HELPING
US ACHIEVE THAT AND OTHER STATES
WE NORMALLY HAVE NOT WORKED IN.
>> SPEAKING FOR THE NORTH
CAROLINA UNC WE STARTED IN PHASE
3, WITH CLINICAL PARTNERS.
I AS A SPECIALIST HAVE SUPPORTED
THESE FQHCs IN THE CARE OF
COMPLEX PATIENTS, PROVIDING
PRENATAL CARE IN THE LOCAL
AREAS.
DISTANT FROM FROM THE MAIN
HOSPITAL.
IT STARTED THERE.
THERE WAS A TRUSTING
RELATIONSHIP THAT STARTED.
GOSH, KAMARA, DO YOU WANT TO
CHIME IN WHEN YOU GOT INVOLVED?
I DON'T WANT TO PUT ON YOU THE
SPOT.
>> IT'S BEEN GREAT WORKING WITH
THE TEAM.
ADDING A LIVED EXPERIENCE,
ADDING MY PERSPECTIVE TO THE
GROUP, A VERY HOPE AND GREAT
GROUP TO WORK WITH.
>> SHE'S JUST BEEN ONE OF THE
PEOPLE THAT'S BEEN VERY
INSTRUMENTAL HELPING OUR PATIENT
ACTION GROUP, THE REPRESENTATION
OF VARIETY OF INDIVIDUALS FROM
DIFFERENT COUNTIES, THAT COME TO
YOUS WITH LIVED EXPERIENCE AND
INFORM OUR WORK.
>> THANK YOU.
>> MARY?
>>> MOREHOUSE REACHED OUT TO US,
WE'RE NOT AT THE CLINICAL
SETTING.
[AUDIO DISTORTION]
SO THAT WAS CLINICAL VERSUS THE
COMMUNITY SETTING, THAT'S BEEN
VERY, VERYING THERE.
>> THANK YOU ALL.
ONE MORE QUESTION, I DON'T SEE
ANY OTHERS SO I'LL ASK ANOTHER
ONE OF MY QUESTIONS.
TODAY WE HEARD A LOT ABOUT POWER
OF PARTNERSHIPS AND POSITIVE
IMPACT, IN YOUR PRESENTATIONS
TODAY EXEMPLIFYING BENEFITS OF
THESE COOPERATIONS.
ONE OF THE IMPORTANT PARTS,
ASPECT OF PROGRAMS IS TESTING OF
EVIDENCE-BASED INTERVENTION,
THAT HAVE ALREADY BEEN
EMPIRICALLY SHOWN TO BE
SUCCESSFUL IN IMPROVING HEALTH
OUTCOMES, SPEAKING OF BEING AN
INTEGRAL PART OF THE RESEARCH
TEAM.
>> I'LL START.
I THINK --
>> GO AHEAD.
>> WITH OUR REACHING OUT TO
DIFFERENT COMMUNITIES AND
FINDING PEOPLE ON THE STREET AND
ASKING THEM IF THEY WANT TO BE
PART AND GETTING THEIR FEEDBACK
OF THEIR OVERWHELMING
EXCITEMENT, AND JUST AWARENESS
ABOUT PRE-CONCEPTION AND
ESPECIALLY THE MEN, THAT THEY
ARE NOT UNDERSTANDING THE
NUTRITION, EXERCISE, ALL OF
THAT, HOW THAT PLAYS AN IMPACT
IN ORGANIZATION AND SO FORTH,
AND THEN THE WOMEN, AGAIN, FROM
WHAT WE HAD, PARTICIPANTS WE HAD
PROBABLY 80% SHOWED
HYPERTENSION, SO REFERRING THEM
TO THE DOCTOR FOR ONE THING THAT
WAS VERY INTERESTING TO ME, THEY
DON'T REALLY REACH OUT TO THE
DOCTORS, AS MUCH.
THEY GO TO TIKTOK, I WAS VERY
SHOCKED BY THAT INFORMATION WHEN
WE TALKED ABOUT PRE-CONCEPTION
BUT ABLE TO PROVIDE THEM AND
REFER THEM TO THEIR PHYSICIANS
AND TALKING ABOUT WHY IT'S VERY
IMPORTANT.
>> IN THE INTEREST OF TIME I'M
GOING TO TURN IT OVER TO DR.
KAREN PLEVOCK-HAASE TO CLOSE OUT
DAY 1.
>> THANK YOU SO MUCH, CANDACE.
I'LL KEEP THIS BRIEF AS WE WRAP
UP.
WE WANT TO SAY HUGE THANK YOU TO
ALL OF OUR KEYNOTES AND
PANELISTS FOR SHARING TIME,
EXPERTISE, INSIGHTS.
THESE SESSIONS HAVE BEEN
INSPIRING AND HIGHLIGHT
IMPORTANT CONSIDERATIONS AS WE
SEEK TO IMPROVE MATERNAL HEALTH
OUTCOMES IN THE U.S. AND
GLOBALLY.
WE LOOK FORWARD TO REVISITING
THE TAKEHOMES TODAY IN THE
WRAP-UP AT THE END OF TOMORROW.
WE THANK THOSE ATTENDING ON ZOOM
AND VIDEOCAST FOR ACTIVELY
ENGAGING AND BEING PART OF THE
IMPORTANT DISCUSSIONS.
WE'RE VERY APPRECIATIVE OF YOUR
TIME AND THOUGHTFUL DISCUSSION
POINTS BROUGHT FORTH.
WE LOOK FORWARD TO CONTINUING ON
TOMORROW.
WE'LL HAVE A MORNING KEYNOTE
PRESENTATION AND THREE MORE
ENGAGING PANELS INCLUDING
IMPLEMENTATION SCIENCE, MATERNAL
LUNG HELD, SLEEP HEALTH,
INNOVATIVE CARE DELIVERY.
WE'RE EXCITED FOR CONTINUED
ENGAGEMENT AND VALUABLE
LEARNINGS AS WE MOVE INTO DAY 2.
WE'LL START AT 10 A.M. EASTERN
STANDARD TIME TOMORROW AND
YOU'LL USE THE SAME ZOOM LINK
YOU USED TO ATTEND TODAY.
THAT CONCLUDES OUR DAY 1.
I HOPE EVERYONE HAS A WONDERFUL
EVENING.
THANK YOU.