GLOBAL HEALTH INITIATIVE - Key Persons
Job Titles:
- GHI Research Director, Comprehensive Sickle Cell Program
Andrew Campbell, MD, is the Director of the Comprehensive Sickle Cell Program at Children's National Health System in Washington DC. Before his move to Washington, he directed the University of Michigan Comprehensive Pediatric Hemoglobinopathies Program and was the Co-Director of the Minority Health International Research Training Program at the University of Michigan Medical School, Center for Human Growth and Development. He also directed a Fogarty Grant Training Program focusing on health disparities affecting Child Health. He is a Faculty Member and Mentor of the Northern Pacific Global Health Research Fellows Training Consortium, Ghana Site. His projects include Translational Research (Vascular Biology) in Ghanaian Sickle Cell Patients with the Department of Physiology at the University of Ghana Medical School and Health Outcomes research in the Sickle Cell Clinic in Accra, Ghana. For the past several years he has focused his research on understanding the varied phenotypic expression of sickle cell disease in different populations through the multinational Consortium for the Advancement of Sickle Cell Disease Research (CASiRe) which he directs. Dr. Campbell is a graduate of Case Western Reserve School of Medicine and completed his residency training at Harvard Affiliated Massachusetts General Hospital in Boston followed by his Pediatric Hematology/Oncology Fellowship at Northwestern University.
Dr. Campbell's interest in global health goes hand in hand with his professional focus: Sickle Cell Disease (SCD). "I started to realize a lot of the burden of SCD is in countries outside of the US," he says, adding "the sickle cell gene has a much higher rate in sub-Saharan Africa than here in the US. 75% of the SCD cases in the world are in sub-Saharan Africa, and no more than 1% of the world's SCD population is in the US." In addition, most medical centers in sub-Saharan Africa are dramatically lacking in the resources necessary to care for this disease. "So," recalls Dr. Campbell, "I started to partner with SCD centers and students in Ghana to have a better understanding of SCD and the SC phenotype within the Ghanaian population."
The partnership grew to become more substantial overtime, and Dr. Campbell became a Faculty Member and Mentor at the Northern Pacific Global Health Research Fellows Training Consortium in Ghana. In this position he was able to provide training for medical students and researchers, as well as further his research interests into SC phenotype and expand access to SCD treatment in the surrounding area. He also collaborated with local blood bank specialists in Ghana in order to more thoroughly understand alloimmunization rates in SCD patients who have received multiple transfusions.
Through this work and his partnership with the Sickle Cell Clinic in Accra, Ghana, the incidence of kidney disease in SCD patients became an increasingly apparent trend. "We have an inherent interest in looking at the incidence of kidney disease in pediatric and adult patients in Ghana," says Dr. Campbell, as well as "the possible correlation between retinopathy and kidney disease." With one study underway at the clinic, there have been rates as high as 60 to 70 percent of patients with "some sort or sickle renal disease." These findings led the SCD clinic to develop a nephrology clinic to manage patients when they are there for SCD.
There are definitely challenges, especially due to insufficient monetary and personnel resources. "Many of our collaborative partners have many responsibilities that results in their inability to commit (to a project)," says Dr. Campbell. However, he adds, "they are very eager to collaborate in order to not only understand SCD and other chronic diseases within their population but also to allow them to (conduct research)." Understanding the underlying factors of SCD and its treatment is a priority for this community, especially given the current impact on and genetic probability of this disease within this population.
Dr. Campbell also serves as a mentor to young physicians and researchers in Ghana. He has worked closely with several students, assisting them to conduct research and develop publications. One of his previous mentees, a PhD candidate in physiology, is now the Chair of Physiology at the University of Ghana Medical School. At the moment, he is on the thesis advisory panel for a masters student studying sickle cell disease. A previous PhD mentee's project studying sickle cell disease was recognized as "one of the best projects in that class," recalls Dr. Campbell. Educational outreach is really about "capacity building" he adds. By enabling these clinicians and researchers to be their best, Dr. Campbell is fueling sustainable development, and helping the Ghanaian system to advance from the top-down. The partnership, and their joint, sustained research efforts, informs Dr. Campbell's understanding of sickle cell disease and his treatment for patients at Children's.
In addition to providing critical insights into SCD, doing fieldwork "allows you to see a realistic view of the healthcare system and the challenges of research that you encounter," describes Dr. Campbell. There are many unforeseen challenges, which being on the ground helps researchers to identify. For example, recalls Dr. Campbell, "many countries that you might collaborate with might be English speaking but you really don't appreciate the importance of the country's dialect or tribal language, which is substantial." These details can have a serious impact on the comfort of families involved in the research studies as well as their ability to participate. "Local partners really help you understand and navigate the underlying culture and languages," says Dr. Campbell, adding that "there are cultural considerations we night not consider here in the US." This insight from local providers is very important for understanding how to design a study as well as developing "competent health care strategies," for research and treatment.
Dr. Campbell also leads a multinational research group, the Consortium for the Advancement of Sickle Cell Disease Research (CASiRe), focused on understanding the varied phenotypic expression of sickle cell disease. The consortium collects information about pain rate and use of health care facilities during severe pain crises. This research both helps to "bridge the gap in care between developing countries and those with resources," and helps Dr. Campbell to "improve the care of SCD patients here in the US, of which at least a third are first generation."
Another international project Dr. Campbell is focused on is called SC Ontology, funded by Atria Africa. Dr. Campbell and his colleagues are working to develop "the first international ontology database for chronic illness." The project involves researchers and providers from the US, Europe, sub-Saharan Africa, and Brazil. The expected result of the project is a "web based resource," which "defines various SCD terms and phenotypes." Dr. Campbell hopes it will become "a resource for international providers," giving them information on "SCD phenotype, management, and treatment." It has been developed over the last three years and is expected to launch over the next few months.
From his many research projects and partnerships, Dr. Campbell has identified the clear need for international teamwork to address the global burden of pediatric disease. Moving forward here at Children's, Dr. Campbell thinks it is very important to "increase our network of operations" as well as to "include more trainees, residents, and fellows to be part of global health projects." In addition, he would like to see Children's partner with a sister hospital overseas in order to facilitate sustainable growth and mutual education opportunities for medical trainees.
Job Titles:
- GHI Founding Director / Associate Chief, Cardiology / Director, Echocardiography
Dr. Craig Sable has a strong commitment to global health that includes extensive clinical outreach, multiple research publications in rheumatic heart disease (RHD), world wide telemedicine experience, leveraging his long standing role as echocardiography director, educational portfolio mentoring over 75 fellows and other trainees and leadership roles in national and international committees and writing groups. Dr. Craig Sable has collaborated with the medical team at the Uganda Heart Institute (UHI) at Mulago Hospital in Kampala Uganda, the largest public teaching hospital in Uganda, to improve the care of children with heart disease in Uganda. Dr. Sable has personally led over 20 medical/surgical missions to Mulago Hospital since 2003; the last eleven have focused on performing open-heart surgeries at the Uganda Heart Institute. He has also coordinated nine other surgical trips by teams from North America, Europe, India, and Asia. Nearly 1,000 children have received life-saving care, dozens of nurses and physicians have received training, and the foundation for a self-sustainable tertiary cardiac care program in East Africa has been established. This collaboration serves as the foundation for a very productive research partnership as well.
Dr. Sable provides senior mentorship for the most productive team of active RHD investigators in the United States, focusing their research on using echocardiography, task-shifting, highly portable technology and telemedicine to develop novel approaches to secondary prevention of RHD. RHD remains the most common cause of cardiovascular morbidity and mortality in children and young adults in the world today despite being preventable. He currently serves as one of four Center Directors in the American Heart Association Strategically Focused Children's Research Network; this center is focused on prevention of RHD.
His 100+ peer reviewed publications include 25 publications in RHD, 9 as senior author. Dr. Sable has 7 additional publications in other global health topics including a 2017 manuscript on building a sustainable cardiac surgery and catheterization program in Uganda. He played a key role in the 2015 AHA scientific statement, Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever (ARF) in the Era of Doppler Echocardiography. Dr. Sable's primary contribution to this paper, developing guidelines that redefined the role of echocardiography in subclinical carditis, was one of the two significant changes from the 1992 Jones Criteria (and is reflected in the title).
Dr. Sable has established a vast telemedicine network for interpretation of echocardiograms from over 100 locations around the world, including Uganda, Morocco, and Brazil. The advanced infrastructure of the telemedicine program and echocardiography laboratory has allowed for seamless interpretation of RHD echocardiograms, ensuring that a large volume of de-identified data can be translated into timely and meaningful scientific presentations and publications. Dr. Sable has significant collaborations in the global RHD community. He served on the World Heart Federation RHD Working Group from 2011 - 2015 that developed critical RHD research priorities. Dr. Sable is the RHD program chair for the 2017 World Congress of Pediatric Cardiology and Cardiac Surgery. His fundraising efforts have contributed to bringing in nearly $3 million of funding for global health activities to CNHS over the last 15 years.
Dr. Sable's interest in global health and RHD traces back to his very first global health trips to Africa and Latin America, starting in 1991. While his main interest at the time was improving treatment and diagnosis for congenital heart disease (CHD), it became increasingly apparent that for every CHD patient, there was a patient with RHD. Despite this ratio, "there was a huge gap in the ability to diagnose and treat RHD in sub-Saharan Africa and Latin America," he recalls. Even though it was a very similar disease burden, RHD is frequently ignored, and gets "thousands of times less funding than other global health concerns," adds Dr. Sable. His interest also has a personal motivation. As a child growing up, Dr. Sable's grandmother was always very sick. In 1969, she had two heart valves replaced as a result of having had rheumatic fever as a child and later developing RHD. Motivated by the clear international need and his personal history, Dr. Sable has made it his life's work to expand access to resources for screening and treatment of RHD for children around the world.
Job Titles:
- Physician in the Pediatric Hospitalist Division and the Special Immunology Section of the Infectious Disease Department
Dr. Ferrer is an attending physician in the Pediatric Hospitalist Division and the Special Immunology Section of the Infectious Disease Department at CNHS. Currently, she is the Education lead for the newly launched Children's National Global Health Initiative. She serves as a clinician for the Children's National Special Immunology clinic caring for children with perinatally- and horizontally-acquired HIV and as a consultant physician for the adolescent Burgess clinic. She is a Global Health Faculty Mentor for CNHS residents and co-director of the Global Child Health Curriculum at CNHS.
Previously, she served as the Medical Director of the Baylor College of Medicine Bristol-Myers Squibb Children's Clinical Centre of Excellence in Maseru, Lesotho from 2005-2009 where she assisted with a scale-up of pediatric HIV care and treatment for the country. She has lectured frequently on pediatric HIV, malnutrition, tuberculosis and global health topics in sub-Saharan Africa, Romania, Kyrgyzstan, China and the United States.
Dr. Ferrer's interest in global health began while in her internship program at Baylor University Medical Center, doing short service trips to Guatemala and Ghana. In her residency at Baylor College of Medicine, Dr. Ferrer traveled to Botswana, helping communities struggling with HIV. Following these experiences, she was recruited to go to Sub-Saharan Africa to address the HIV epidemic, bringing US training and education to rural locations to improve outcomes. Dr. Ferrer's focus then shifted to Lesotho, and the implementation and improvement of a pediatric HIV program, collaborating with on the ground foundations to get reliable drug supply to the country and establish a system of patient testing, diagnosis, and treatment.
"Physically seeing kids, and then teaching-how to diagnose, start treatment, and remain on treatment," says Dr. Ferrer, "that is what has fueled my passion for teaching. It is the mentorship of local providers that is going to make the project sustainable."
Following her four years in Lesotho, Dr. Ferrer became involved in pediatric HIV projects in Romania, Kyrgyzstan, and China. Here, she encountered many of the same challenges as she faced in Lesotho, the largest being accessibility and affordability of antiviral drugs. As Dr. Ferrer readily points out, the majority of the burden of pediatric disease is abroad and is caused by readily treatable illnesses. "The chances of dying before age five are 1/12 in Africa, 1/19 in South Asia, and 1/147 in the US, and most of the deaths abroad are from pneumonia and diarrhea, with malnutrition contributing to about 50%" cites Dr. Ferrer.
However, identifying the solution is the easy part. "What is appealing to me, is that it is not just about the medicine, we know what to do, but about the actual implementation-that is the difficult part," says Dr. Ferrer. "We know the theoretical, but the practical situation is different. The logistics are what is hard. We need to figure out, how can this be both low cost and effective?"
To address these issues, Dr. Ferrer is focused on training local providers and improving the way healthcare is administered. "Introducing task-shifting, innovating ways to deliver services, and building partnerships and collaborations are so successful to implementation and delivery of care. Having the local partner identify what they need is the most effective, and the best, part."
In her positions as Education lead for Children's Global Health Initiatives, Global Health Faculty Mentor for CNHS residents, and co-director of the Global Child Health Curriculum at CNHS, Dr. Ferrer is actively contributing to training the next generation of global health providers while building CNMC's global health presence. Utilizing her own on the ground experience as well as the knowledge and advice of fellow CNMC providers involved globally, Dr. Ferrer is helping to inform the next generation of global health leaders and educators, for "transforming lives and impacting child and infant mortality globally."
The biggest objective right now for global health is leveling the playing field, "the reason children are dying of malnutrition and diarrhea is because of their zip code," says Dr. Ferrer, "everyone identifies this as heartbreaking and quite unfair, but it's entirely a reality." This is why education is so critical, to raise awareness and encourage contribution.
Job Titles:
- Children 's National As a Nurse
Kristi Myers, MSN, RN, CPN, began her work in global health before she was even a nurse. At age 18, she had the opportunity to assist on a hospital ship with Mercy Ships in Sierra Leone for two weeks. At 21, she volunteered again on a ship in Ghana. Experiences that instilled her passion for global health and confirmed her decision to become a nurse, Kristi's interests have increasingly become intertwined.
After receiving her undergraduate degree in nursing from Liberty University in 2007, Kristi first joined Children's National as a nurse intern on the Heart and Kidney Unit, where she worked as a registered nurse until 2011. From 2011-2014, she transferred to the satellite emergency department at United Medical Center in SE, D.C., while simultaneously pursuing her Masters in Nursing Education at Marymount University. In 2014, she returned to Children's National as a Professional Development Specialist, where she currently works as a nurse educator to train and prepare new nurses through the Transition to Practice and Preceptor programs.
Throughout, Kristi has maintained her interest in global health. From 2008-2012, she volunteered as a nurse with several medical organizations in Haiti, making the trip with surgical and clinical teams several times. In fact, it was her experience during Haiti's earthquake in 2010 that directed her focus to nursing education. Kristi had been working with a surgical team in Ouanaminthe when the earthquake struck, forcing many Haitian nursing students studying at the university in Leogane back to her site. In joint efforts at earthquake relief, Kristi worked closely with the nursing students, where she realized the benefit of training others as a more long term and sustainable approach to strengthening global health efforts.
Searching for a way to apply her expertise in nursing education to global health while at Children's, in 2017, Kristi was introduced to the Global Health Initiative (GHI) while working on a research study with Dr. Lineo Thahane to develop e-learning programs for nurses in Lesotho. In 2018, she joined GHI nurse Lynda Dattilio to start the Global Health Workshop, and in 2019, launched the Nursing Special Interest Group for GHI, which she currently leads. The Group works to introduce, engage, and prepare nurses for global health work.
As its official mission and in Kristi's words, the Nursing Special Interest group envisions "To bring together nurses to share education, training, research and knowledge in a way that promotes cultural competency and is mutually beneficial. We believe the core of global knowledge is respect for each other and the shared desire to both learn and teach in diverse settings with the goal of sustainability.
" She is glad to be able to combine her work as a nurse educator with a global focus, as the two started together for her. As she works today to train nurses for global work, she's still in touch with the nursing students she met at Ouanaminthe, always serving as a reminder to her why she got involved in the first place.
Job Titles:
- Professional Development Specialist