Community Spotlight
Working Across Borders
Stanford faculty members are deeply committed to international health care, providing treatments, training and support to developing countries around the world. Here are just a few of their stories.
Tracking a Killer
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Like detectives in search of a suspect, Peter Small, MD, and his team meticulously comb over evidence looking for clues. But instead of a person, Dr. Small, an associate professor of medicine (infectious diseases and geographic medicine), is on the trail of Mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB).
This deadly organism has evolved into different strains, each with slight variations in its DNA sequence. Some of these variations cause the bacterium to become resistant to drug therapy, but they also allow Dr. Small and his colleagues to use molecular analysis to identify individual strains by their unique genetic code.
By applying this technology to tuberculosis cases in San Francisco , the investigators were able to match specific strains to infected patients and to trace the progress of the disease from person to person. Dr. Small then collaborated with health care professionals in Mexico to track the disease in an area with a high level of drug-resistant tuberculosis.
“In countries with many cases of TB, people tend to think it’s like the flu: It just happens,” says Dr. Small. “By using molecular techniques we were able to demonstrate that, no, this isn’t ‘just happening’—there is a particular situation that is accounting for much of the transmission of the disease.”
In fact, in one community in Mexico up to one-third of the tuberculosis cases could be traced back to a single individual. This work helped encourage Mexican health care workers to treat tuberculosis with a more advanced regimen than was previously standard.
To Dr. Small, this project is an example of a partnership that has existed for decades. “Because of the long-standing collaboration that Stanford has with Mexico , we were able to identify their best researchers and transfer this technology,” he says. “These types of projects provide the opportunity for Stanford faculty and students to get a better appreciation of where we fit in the world.”
Changing Lives
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The women come from all over the country, some traveling for days on foot and by bus, to the hospital in the city of Massawa, in the African nation of Eritrea. Most of them are teenagers, and they all suffer from a complication of prolonged childbirth, called a fistula, that a group of surgeons from Stanford attempt to repair.
During an obstructed labor that can last up to 40 hours, damage to the birth canal can result in a fistula, an opening between the vagina and the bladder or rectum that leads to leakage of urine and feces. In most cases the baby does not survive, and the woman must live with the humiliating effects of the leak, as well as frequent infections.
“These women are often ostracized and thrown out of their homes. They are childless, and they cannot work,” says Mary Lake Polan, MD, PhD, chair of the Department of Obstetrics and Gynecology, who organized a two-week trip in February, 2004. “This surgery allows them to participate in the lives of their families and their culture. It is extraordinarily important.”
This was the second trip to Eritrea for members of the department, and Dr. Polan hopes to make it an annual event. “This is a wonderful educational experience for students, residents and faculty to practice medicine in ways that are different than in the United States ,” she says. “It makes them better doctors to work in other countries and see things they would otherwise only read about in a textbook.”
Unfortunately, because of malnutrition, the young age of mothers, and limited health care, fistulas are a common problem in many developing countries. In future visits, Dr. Polan and her group hope to teach Eritrean doctors surgical procedures and to start prevention programs.
“We are lucky to be able to help educating physicians and formulating solutions to this problem,” says Bertha Chen, MD, an assistant professor of obstetrics and gynecology, another member of the team. “We are working with the Eritrean public health department to create education strategies for preventing these complications.”
More information on the Eritrean Women's Health Project is available through the OBGYN site.
A New Beginning
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It can take 20 years for a vaccine on the market in the United States to become easily accessible in the developing world. With the goal of removing that frustrating time lag, Stanford researchers are working with health officials in India to create a new approach to vaccine development: an Indian pharmaceutical company that can produce a vaccine on its own.
The collaboration is the culmination of research by Harry Greenberg, MD, the Joseph D. Grant Professor in the School of Medicine and senior associate dean for research, who has developed a vaccine for rotavirus, a disease that causes severe diarrhea and kills hundreds of thousands of children each year. The vaccine contains a strain of rotavirus isolated from Indian newborns that did not get sick from the infection.
“Occasionally, there are naturally occurring strains of rotavirus that infect newborns but do not cause disease,” Dr. Greenberg explains. “But these strains do appear to immunize these infants against future infection.”
Dr. Greenberg’s vaccine is part of a clinical trial in India that also includes a vaccine developed by the Center for Disease Control. Both vaccines will be produced by the newly formed pharmaceutical company in the hopes that one of them will be effective in protecting against rotavirus.
“The idea is to take these two candidate vaccines and use this start-up company to actually make commercial lots and test them to see if we can give birth to a company in India that can produce a vaccine for the Indian market,” explains Dr. Greenberg. “This would be a new paradigm for pharmaceutical development.”
-Courtesy of Center Focus, a publication of the Office of Medical Development
Related sites:
Profile of Mary Lake Polan, MD, PhD
Profile of Harry Greenberg, MD
Posted: 12/02/2004
