Students participate in inaugural global health research program​​

Second-year medical student Laura Bliss holds a slide containing cells from a patient treated for a bladder problem. As a participant in the Global Health Center's inaugural summer research program, Bliss studied bladder conditions commonly seen in women.
Second-year medical student Laura Bliss holds a slide containing cells from a patient treated for a bladder problem. As a participant in the Global Health Center’s inaugural summer research program, Bliss studied bladder conditions commonly seen in women. Photo: Robert Boston

As a second-year medical student, Laura Bliss has yet to treat a patient or even decide on a specialty, but she already has conducted research to help women diagnosed with serious bladder problems.

This summer, Bliss spent eight weeks poring over slides from St. Louis-area patients suffering from urinary tract infections, overactive bladders and painful bladder syndrome. Her goal ​was to identify urinary biomarkers that potentially could help distinguish among the conditions rapidly and inexpensively.

The three bladder conditions have similar symptoms, which can make it difficult for doctors to establish a diagnosis. As a result, patients sometimes are told to wait it out or are prescribed an antibiotic that may not relieve the pain and other symptoms.

Bliss’ project was part of Washington University’s inaugural Global Health Center summer research program. Eight students were selected for the program from nearly 100 applicants. The other Washington University students who participated were Caila Brander, Nneka Molokwu, Gina Phillips and Maria Ruiz.

The students worked in lab and field settings to address medical issues with global impact, such as maternal health, childhood malnutrition and access to health care.

William G. Powderly, MD, director of the Institute for Public Health, explained that the program and the Global Health Center, both part of the institute, operate from a multidisciplinary viewpoint.

“Addressing one component will not address the entire picture,” Powderly said of global health issues. “Things are not simple – they are intertwined.”

He pointed out that universities are an excellent place to explore such complex issues since they bring together experts from diverse backgrounds and students who are eager to learn. The new summer research program paired faculty experts with students who “can make a definite impact on global health, even from the middle of the United States,” said Powderly, who is also the J. William Campbell Professor of Medicine and co-director of the Division of Infectious Diseases at the School of Medicine.

“We can provide leadership on global health issues right here in our own communities,” he said. “There is a local health dimension to global health problems. Poverty is not unique to sub-Saharan Africa.”

Here are details about the five Washington University students who participated:

Bliss, the medical student who researched bladder conditions, worked with Emily Ma, a May 2014 graduate of the College of Arts & Sciences, in the lab of Indira Mysorekar, PhD, assistant professor of obstetrics and gynecology.

Caila Brander, a junior in the College of Arts & Sciences, worked with Sarah Brown, PhD, assistant professor of pediatrics. Brander went to Haiti to collect data assessing the nutritional status of residents in a rural village. She measured the heights and weights of residents and also gauged food and water availability, diversity of diets and how often residents obtained health care. Brander said she learned that U.S. data collection standards aren’t always feasible, depending on environmental or other factors at a research site. For example, when she needed to measure the heights of residents, Brander had to account for uneven floors and sloping walls in her data.

Nneka Molokwu, a candidate for a master’s degree in public health from the Brown School, worked with Mark Manary, MD, the Helene B. Roberson Professor of Pediatrics. Working on the Medical Campus, Molokwu analyzed data from moderately and severely malnourished Sierra Leonean children who received therapeutic food. Under standard protocol, a child is treated based on his or her level of malnutrition, with severely malnourished children treated separately from those found to be moderately malnourished.

One issue with this protocol is that parents don’t know the degree of a child’s malnutrition until he or she is diagnosed at a clinic. If a child has moderate malnutrition but is taken to a clinic that only treats severely malnourished children, the family is redirected to a different clinic. With an integrated protocol – pioneered by Manary’s group – all children are treated in the same place, with the same food and same staff.

Early results indicate that this integrated approach is more effective than the standard protocol in treating children with malnutrition. The approach is also more centralized, making it more convenient for families and more cost-effective for volunteers, researchers and governments.

Gina Phillips, a senior in the College of Arts & Sciences, performed community-based research in north St. Louis to explore barriers that contribute to higher mortality rates for breast cancer among African-American women.

After having met some breast cancer survivors with lymphedema – which is marked by painful swelling in the arm, breast or chest after lymph node removal or radiation – Phillips plans to do her senior thesis project on barriers to treatment for the condition, including problems with insurance coverage. Sarah Gehlert, PhD, the E. Desmond Lee Professor of Racial and Ethnic Diversity, and Lailea Noel, a doctoral candidate at the Brown School, served as Phillips’ mentors.

Maria Ruiz, a sophomore in the College of Arts & Sciences, focused on maternal health and childhood mortality for her project. Ruiz analyzed bacteria from women with bacterial vaginosis, a condition linked to preterm birth and other complications.

She and her colleagues isolated strains of bacteria that now can be used to study and understand the condition. She also identified what appear to be several new species of vaginal bacteria. Ruiz plans to continue her research with faculty mentors Amanda Lewis, PhD, assistant professor of molecular microbiology, and Warren Lewis, PhD, instructor in medicine, to determine how the bacteria contribute to the condition.

The researchers plan to give the new strains to the Human Microbiome Project​ for whole-genome sequencing. Future studies using these strains may help reveal new strategies for treatment and prevention.

Other students who participated in the program include Sarah Bridge, from the University of Utah, who worked with Thomas Cox, MD, associate professor of anesthesiology, Anshuman Sharma, MD, professor of anesthesiology, and Arbi Ben Abdallah, PhD, instructor of anesthesiology; Yaneve Fonge, from the University of Rochester, who worked with Shanti Parikh, PhD, associate professor of anthropology; and Michael Scolarici, from Saint Louis University, who worked with Jacco Boon, PhD, assistant professor of medicine.

Student researchers stand with Global Health Center Manager Jacaranda Van Rheenen, PhD (lower left). To her right are Maria Ruiz, Laura Bliss and Nneka Molokwu in the front row. In the top row (from left) are Gina Phillips, Caila Brander, Yaneve Fonge, Sarah Bridge and Michael Scolarici. (Photo: Kimberly Singer )

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