[00:00:00] Dr. Rob Murphy: Welcome to the Explore Global Health Podcast. I'm Dr. Rob Murphy, Executive Director of the Havey Institute for Global Health here at Northwestern University Feinberg School of Medicine. Today we are speaking with two incredible leaders in the field of global pediatric health, Dr. Colleen Fant and Dr. Sahera Fargo. They're co-directors of the new Center for Global Pediatrics Health here at the Havey Institute for Global Health, their center is a joint effort between Northwestern University Feinberg School of Medicine, and the Ann and Robert H. Lurie Children's Hospital of Chicago. We are going to discuss their journeys in pediatric global health and the vision that they have for the center now and in the future. Welcome to the show, Colleen and Sahera.
[00:00:51] Dr. Sahera Fargo: Thank you for having us.
[00:00:52] Dr. Colleen Fant: Yeah, thanks for having us.
[00:00:54] Dr. Rob Murphy: Can you share what you hope to accomplish in these positions and the vision that you have for the Center's impact on global pediatric health? I'm gonna start with you, Colleen.
[00:01:02] Dr. Colleen Fant: We're super excited for this new center. There's been lots of great activities around pediatric global health and research and education and advocacy at the hospital and kind of throughout the Northwestern system. And based on all this great work, now we have the center to support everything and hopefully we'll really grow a lot of our partnerships, really deepen our international relationships and really support trainees and faculty who wanna engage in the field.
[00:01:24] Dr. Sahera Fargo: Yeah. You know, as pediatricians we focus on the most underserved and vulnerable populations, so it's important for our audience to know children and young adults make up more than one third of the world's population but they're the ones facing most of the health disparities. So we're really hoping to improve the health of children worldwide. To add as to what Colleen said, really foster partnership and to really leverage the expertise that's already existent here
[00:01:50] Dr. Rob Murphy: Now a center is a university structure that sets it apart from departments and programs. I would like you to tell me what you started with and when, and how it kind of merged into this center. Can you just tell me a little bit about the progress from how you started to being the center?
[00:02:10] Dr. Colleen Fant: Probably the backbone of global health at Lurie Children's is really this educational partnership we have with Bugando Medical Center, which is a hospital in Mwanza, Tanzania. And that probably started over a decade ago as this really cool bi-directional educational exchange where the Tanzanian pediatric residents would come to Lurie, our residents would go there. And that just was ongoing every year just always in existence. And then kind of in addition to that, we had all these other activities really happening in silos. So there's a lot of really fantastic research happening in the department of adolescent medicine and infectious disease. There was a lot of difficulty kind of connecting interested trainees and learners with all the cool stuff happening. So based on this educational partnership, the research that was happening we started to create a network of folks who were just interested in building a team, building a community trying to grow from what we have. You know, now years later and a couple of knocking on some doors we kind of got our team together and now we've got a lot of good programmatic work and we're excited for the next step.
[00:03:08] Dr. Rob Murphy: That's exactly what a center is supposed to do. Sahera, how did you fit into all this?
[00:03:12] Dr. Sahera Fargo: Yeah. Similarly, I mean, I'm pretty new to the Northwestern family. I've only been here for about a year and a half. I've had experience mostly in global health research and was co-director of a center at my previous institution and really linked up with Colleen when I first arrived to figure out what was the global health landscape and as Colleen mentioned it was just a lot of in silo work. So we started talking, started realizing our expertise were really complimentary, and we had a lot of similar ideas for how to create the center, and that's kind of how it came about. I think Colleen did a lot of the groundwork.
[00:03:48] Dr. Colleen Fant: Yeah, but having Sahera come on was fantastic 'cause she had all that background experience of doing it so we could really learn and kind of model on some of the best practices.
[00:03:56] Dr. Rob Murphy: Both of you have extensive experience in global health, Can you tell me about any experience or something from your past that made you interested in global pediatric health?
[00:04:07] Dr. Sahera Fargo: I'm French. Originally I was born, and raised in France. And of parents who are immigrants and Indian. So I have this like French Indian. So I think when you're born an immigrant in a country, you already kind of have the mix of cultures. I grew up traveling to where we came from and as a resident I really wanted that even as a medical student. But not to date ourselves, but at the time of when we were trainees, there really wasn't a formal global health curriculum. You kind of had to create your own path. So for me, that happened with rotations as a student and resident in Sub-Saharan Africa at a time when HIV was just really rampant. It was the number one cause of mortality. You couldn't come to Subsaharan Africa and not see, you know, funerals and lots of deaths. And I realized so many of these deaths were actually in infants and young under five. I already had an interest in pediatrics, but to me that was really kind of the spark in the late nineties, early 2000. And I was fortunate enough that right out of residency I worked with the Baylor Pediatric AIDS initiative in different Sub-Saharan African countries, and that was it. That was like the path for the rest of my career really, that was the spark.
[00:05:16] Dr. Rob Murphy: Well, considering what's going on these days you may be called back to duty. If you're reading the recent WHO reports and the analysis that have come out about stopping PEPFAR so quickly. The number of new cases that are projected, are really, I mean, it's astronomical that between 770,000 and 4.3 million people are gonna get infected with HIV now.
[00:05:38] Dr. Sahera Fargo: It's really disheartening because it was always such a pride, I think, for most investigators and practitioners in this field to really realize how far we had come in such a short time. I'm not that old. And , to really remember, just even when I give lectures to the local students. They've never seen any infant really born with HIV. They don't know what PJP pneumonia is, or those opportunistic infections that we talk about. It's really a foreign concept to them, fortunately. And so it's disheartening to think how far we've come, but we've done it before and the infrastructure is on the ground, and so I'm gonna try to remain optimistic.
[00:06:17] Dr. Rob Murphy: I agree with you. I mean, we did it once. We can do it again. We're gonna have to do it in a very different way. And, it's, it is just so tragic the way it's being done. Colleen, what was the kicker for you?
[00:06:26] Dr. Colleen Fant: My journey was a little bit different. I went to college at Northwestern and was kind of one of the first participants in their minor in Global Health. So very early on I got that academic background in global health and we were all reading all the Paul Farmer books and getting really excited about equity in global health social justice. So that was really kind of what sparked things. And then I actually lived in Ghana for about a year between college and med school, working on some adolescent medicine work. And I just loved the challenge of navigating between all the different entities and interests and understanding how different people think and do things and how similar we all are. So then when I did pediatrics, I sort of figured out how I wanted to get global health there and I have interestingly decided to never do clinical medicine. I've always felt that I'd be a better doctor here in the US and I'm probably not the person you want taking care of some of the diseases I don't see very frequently when I'm abroad. In residency, I got the experience to help design a modular curriculum for pediatric emergencies for a residency in Kenya, and I really enjoyed that ability to bring in a little bit of subspecialty training and some expertise that a lot of my colleagues on the ground taking care of children don't have access to. So most kids around the world get care from providers who don't have any pediatric training or advanced or specialty pediatric training. And we have so much of that here at Lurie and in the US. I really get inspired with sharing skills and tips and tricks for kind of helping take care of the acutely ill kids and support my colleagues on the ground.
[00:07:50] Dr. Rob Murphy: You worked extensively on increasing the accessibility of simulation-based medical education. Could you explain how this approach is transforming healthcare delivery and resource limited settings?
[00:08:01] Dr. Colleen Fant: Yeah, I think simulation is this really cool educational tool that's ubiquitous in most western medical education or health professional education systems, but hasn't quite permeated the global health professions education sphere. As I mentioned, most kids are cared for by folks who don't have access to advanced pediatric training or the opportunities to kind of get trained in special pediatric skills, acute resuscitation, or specific procedures. My thought of what I can bring to the game is really some advanced training in pediatric emergencies. So simulation is this really cool tool where around the world most folks learn how to practice medicine from the classroom, reading textbooks, and then directly going to the bedside and kind of practicing things on patients. Simulation is this bridge where learners are allowed to kind of practice clinical scenarios, procedures and get feedback and become really masters at what they're trying to do. And then they get that before taking care of kids. There's pretty good data from other simulation programs like Helping Babies Breathe and the ETAP Plus program that using simulation for pediatric acute care does improve pediatric outcomes. And one super cool experience. I just wanted to share. I was working with the pediatric program in Kenya and we were training the faculty there on simulation, and they had 50 graduating medical students who we trained on neonatal resuscitation with simulation, and all 50 medical students were about to enter practice and graduate and had actually never had a hands-on experience resuscitating a baby. They had seen some, they learned about it, but they hadn't actually had the experience. So now this kind of cohort of 50 is going out into the field, having successfully resuscitated an infant, at least in simulation. So hopefully saving kids lives out in the community.
[00:09:39] Dr. Rob Murphy: Oh, that's incredible. Dr. Fargo your research focuses on complications of HIV in children and youth, both in the US and Sub-Saharan Africa. How does your work in infectious diseases intersect with the broader goals of global pediatric health at the center?
[00:09:54] Dr. Sahera Fargo: Yeah, so I think Colleen and I are really examples of different trajectories that you can take in global health. 'Cause the work we do is so different. So our work and our research really focuses at the intersection of infectious disease and non-communicable disease. So as you and I were talking rob, like we've made such great strides in HIV and in pediatric HIV in that now it's becoming a chronic disease for those youth and children with perinatally acquired HIV and that they're you know, surviving and thriving, but really having a lot of non-communicable disease much earlier on than their adult counterpart. And a lot of the precursors of, you know, for example, cardiovascular disease really emerged during childhood and adolescence at a time that's really important for prevention and intervention. So that's really what our research focuses on. This is especially important in areas of the world like Subsaharan Africa because we know there is this youth bulge that's coming up. So for those of you who may not know, the youth bulge is this demographic trend where, really those between 15 to 24 will be the majority of the demographic in that part of the world, and it's tremendous opportunities for growth, but also challenges, especially in healthcare. So what I'm hoping is that expertise and what we've done will help kind of push forward global health research and help support junior and senior investigators to really create innovative solutions when we think about the intersection of all of these issues in global health.
[00:11:21] Dr. Rob Murphy: The Center for Global Pediatric Health is committed to equity, a very hot term at the present time. Can you discuss how your programs are working toward achieving global pediatric health equity and what changes you face in this effort?
[00:11:36] Dr. Sahera Fargo: Um, lots of challenges. So let's talk about maybe what we're hoping to do right? I mean, I think Colleen really laid it out by building multilateral ism and really trying to have local capacity on the ground is important. I work on non-communicable disease, but also in infectious disease like social determinants of health and healthcare disparities are really paramount in resource limited settings. And then, how do we prioritize research to improve equity so we have our work cut out for us. I think both Colleen and I can share some successes that we've had on the ground, and I think the long term collaborations that we've had with certain countries really speak to that, and we can talk about how we wanna tackle these challenges.
[00:12:22] Dr. Colleen Fant: Yeah, I think it's always a challenge. I mean, you know, in this day and age it's a little bit of a hot button word, but if you just go back to what we mean when we talk about equity, it's not equality like the same for everyone. It's really trying to kind of raise ourselves all up to kind of a similar standard. And from the education sphere some of the work we've been doing, we really focus on equitable, bi-directional educational exchanges. So from the get go it's been important at Lurie Children's that not only do our residents get this experience in Western Tanzania. But we've been offering it to all of their graduating pediatric residents every year and kind of funding it for over the last decade. Now their residency's actually grown fantastically, so we can't unfortunately afford everyone now but we're really committed to that. So even this year we have seven folks rotating here at Lurie Children's from Tanzania, and we actually don't have any Lurie Children's residence going to Tanzania, but we still believe strongly in making an equitable exchange. And I think the other thing we really strive for, and hopefully we're really gonna push for with the center is again, talking about equity and not equality. When we look at funding, when we look at program development, really making sure that the bulk of the funding is spent locally and a lot of the support for the program really focuses on spending money on the ground and bringing resources in with us rather than kind of extracting stuff.
[00:13:37] Dr. Rob Murphy: Globally, on the American side, we've seen a significant downturn in people, trainees interested in going abroad and spending some time, applying for longer term research, training grants for a year or five years. So we have different mechanisms. It's not just here at Northwestern, it's really nationwide that, for some reason people are a little gun shy right now. Any thoughts, from the field that you have about why this is happening and if you think this will be a permanent thing or you think it's temporary.
[00:14:12] Dr. Sahera Fargo: I think it comes in waves, right. Because like, maybe Rob you can even speak to that, but during The AIDS epidemic it was the same, right? Like nobody really wanted to travel. Everybody was afraid of HIV and AIDS. We saw a similar kind of sentiment during the COVID pandemic while everything was shut down. And so we're picking back up after that. But you know, I'll give you an example because I work in Uganda. It's tricky now, A) you know, there was an Ebola outbreak in the fall and we had a couple students on the ground. So it always adds some complexity when you're trying to make sure that your trainees, et cetera are safe. But I will also say USAID really helped with a lot of logistics for that on the ground, and so I wonder, you know, it's difficult to be in this situation and to make sure that our colleagues understand that we wanna continue to strengthen the relationship with the current stakeholders and funding agencies that wanna fund that work. But I think that sentiment kind of trickles down. And it's just a lot of anxiety to, for us, how do we continue doing that work? And it's hard for our trainees not to also see us having that anxiety. I'm hopeful, again, I'm being the optimist, but I'm hoping that the balance will sway. And I think now more than ever, it's tremendously important to show our colleagues that we're in this for the long haul. No matter what happens in terms of funding or administration, what we strive for as you know, clinicians, physicians, researchers hasn't changed.
[00:15:43] Dr. Rob Murphy: Let's talk about your big partnership with Bugando Medical Center in Tanzania. This has been going on for a long time, and it's a key part of your work. Can you tell me a little bit more about that? Share any success stories or challenges from this collaboration that highlight the importance of relationships like the one with this center?
[00:16:01] Dr. Colleen Fant: Yeah, I was pretty lucky that I did my fellowship training here at Lurie Children's and learned about this partnership kind of just even coming into training and was incredibly impressed by the commitment of the institution here to this relationship and really building it out. If you look at the numbers we've taken dozens of the Tanzanian residents and they've rotated here at Lurie Children's over the last couple years. We have a much bigger residency at Lurie Children's than they do. So our numbers are significantly higher for folks who have rotated over in Bugando and Tanzania, but incredibly high numbers. Just for the last, you know, decade, 12 years or so. What's really neat about it, is it really just was educational. Our residents go there for a month. They are observers. They will do a couple educational sessions. Their residents come here for a month, they're observers. Similarly, do some educational sessions. And then about five or six years ago, things kind of shifted and we said, we are committed to each other. We are a partnership. What are some other key priorities? So we started to actually expand our relationship. We went from just the pediatric residency to now the emergency room as well. We've got a lot of programmatic work. We're doing the ped simulation on both the pediatric side and the emergency medicine about us inside. We've gotten some grant funding to do point of care ultrasound training not just in pediatrics, but in the field of emergency medicine. We've done some trauma work now with some database creation based on some priorities set by the ER. And probably the most impressive thing that's happened outta this relationship is our pediatric cardiology program. So when the head of peds at Bugando said one of their priorities is improving their ability to take care of children with heart disease and improve their ability to diagnose and appropriately refer out. We said, okay, we have some resources that we can compliment that and do it. So for the last couple years we've been doing echocardiogram or heart ultrasound training with the pediatric residents and faculty there. We actually were able to rope in one of our residents here at Lurie Children's to help design some programmatic work. But we've donated ultrasound machines per their request, and the partnership just continues to grow. So we'll be there in September for the third annual workshop session.
[00:18:03] Dr. Rob Murphy: Yeah, no, it's just really fun to see how transferring that technology, especially with the drop in prices with these portable ultrasounds and, you know, really making them available. We did the same thing with the fiber scan, the elastography, a machine that measures fibrosis in the liver. We bought one for a group in Nigeria. They were doing every HIV infected patient, they were doing fiber scans. And like, you know, we weren't even doing them here in Chicago, and they're doing it there. They had the numbers on everybody. It was really quite incredible. Can, either of you or both of you, tell me What are the emerging trends and challenges in pediatric care worldwide?
[00:18:38] Dr. Sahera Fargo: Yeah. I will say one of the ones that we've tried to tackle, and again it's become harder, is we've actually found that climate change has had a huge impact on the outcomes that we've been interested in. So a lot of our work is focused in Kampala, and a lot of the research in general in Sub-Saharan Africa focuses on these really large urban capital cities. And air pollution is really awful. So what we've tried to do is kind of measure the air quality both through questionnaires and then also kind of fitting in personal air monitors to some of our participants. And what we found, not surprisingly, is that the particular matter, the fine particulate matter that we know is associated with, you know, issues from a cardiovascular and lung health standpoint are really sky high. And are associated with a lot of the outcomes that we're interested in measuring, which isn't so novel in that we've had that data, you know, from China and larger cities. But what's really unique is that these kids are only 12 and we're already seeing an impact on their cardiovascular health. So for me, that's gonna be a really big thing to tackle for our center is how climate change is jeopardizing children's future and how that's catalyzed by changes. You know, access to clean water, electricity, all the social determinants of health that we're measuring and that are typically lacking in the groups that we're focused on. And then I'll just say one more and I'll hand it to Colleen is that we actually have also found that there's just a lot more internally displaced children worldwide. Even in zones that are not conflict ridden. So Uganda is right on the border with South Sudan and we're just seeing a ton of refugees coming in. So I think how do we continue to protect these children and that number will continue to grow. So I think those two are the ones that are really gonna be big emerging trends and things that we'll have to tackle.
[00:20:33] Dr. Colleen Fant: I think from the academic side many, many countries around the world have really elevated their national hospitals and the amount of subspecialty care they can provide for kids, procedural support they can provide for kids. And really the national hospitals in a lot of countries are just fantastic, you know, training environments. But I think a lot of the kids still being taken care of at the regional and district level hospitals don't have the access to that kind of very high level of care. So I think really kind of bridging that gap is key. And I think that's a great role for academic global health to have. And it's not a unique problem in developing countries that exist here in the US too. So even in the US most kids in the ER get their care at a general ER from a non pediatric ER doc. So we similarly have that issue in the US that we try to address like outreach kind of training.
[00:21:15] Dr. Rob Murphy: One final question. I asked this of everybody on this podcast. What advice do you have for young people who are just now embarking or wanting to embark or thinking to embark on a career in global health?
[00:21:29] Dr. Sahera Fargo: Yeah, so I have a couple of mentees that are medical students and residents, and it's obviously right, like the elephant in the room, it's becoming harder. And so what I am trying to communicate to them is that despite current difficulties and funding, et cetera, kind of cultivating a global mindset and like trying to understand health inequities which exist here, right in the US. Being open-minded to learning different perspectives, trying to stay informed and adaptable. And then I think just ensuring that as a trainee, you can have the best skillset possible, whether that's clinical, analytical research, because that's what we'll need to solve these bigger problems. And then lastly, I think Colleen and I really highlighted there's different entry points into global health and pediatric global health and that mentorship, at least for me personally, was really key. So identifying a mentor that has a great track record that you like working with, that you know, you gel with is really paramount to developing that career.
[00:22:32] Dr. Colleen Fant: As cheesy as it sounds, I would say like, you know, find your joy in medicine, like the field of medicine in general and pediatric medicine is an incredibly joyful and rewarding field. And global health is incredibly joyful and rewarding. Be open to opportunities and be persistent. I always tell folks, I've had plenty of grants get rejected. I've had plenty of projects fail again and again over time. And it can feel really disheartening in the moment. But if you really care about it and you have the kind of joy and passion behind it, you will find the right thing to stick to you. And then what I always advise trainees is kind of, figure out the niche you may want to create for yourself. You don't have to know exactly. And then be open to maybe atypical opportunities to support it. So if you wanna get better at global health research, maybe actually doing a research project with a data set in the US will help flex those muscles and build those skills. Like Sahera said, have that really deep skill set that you can then bring to global health. You know, engage with different projects. But be open to them and stick with it. It's worth it.
[00:23:27] Dr. Rob Murphy: Well, it's great advice from the both of you and I thank you very much. Thank you, Dr. Sahera Fargo and, Dr. Colleen Fant for joining me today and sharing your remarkable stories with us. Thank you so much.
[00:23:40] Dr. Sahera Fargo: Thanks for having us.
[00:23:41] Dr. Colleen Fant: Thank you for having us.
[00:23:42] Dr. Rob Murphy: Follow us on Apple Podcasts or wherever you listen to podcasts, to hear the latest episodes and join our community that is dedicated to making a lasting positive impact on global health.
