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Global Health Ecuador.JPG

Anna Munsey, right, a veterinary medical student at UW-Madison, and Keith Poulsen, a campus veterinarian, help Ecuadorian farmer Dario Francisco test one of his dairy cows for brucellosis.

Chase McNulty

In Ecuador’s dairy hub, some cows produce little milk. Many people get mysterious flulike illnesses and joint pain.

UW-Madison researchers helped pinpoint the problem: brucellosis, a disease once widespread in Wisconsin.

Students and faculty from Madison are testing Ecuadorian cows for the disease and hope to set up a vaccination program for cows that also could keep people and the dairy economy healthy.

“It’s something we can do to collaborate with the people there to improve animal and human health,” said Keith Poulsen, a UW-Madison veterinarian.

Madison is home to a wide range of programs aimed at improving health conditions around the world, and the university is the engine driving most of them. The Ecuador project illustrates an expanding concept of global health on campus, where a Global Health Institute was established this year.

Global health isn’t about only building clinics, providing medications and performing surgeries in distant lands, said Jonathan Patz, institute director; it’s about studying links between health problems and the environment, the economy, infrastructure and even politics.

“We want to explore questions like when does food aid do more harm than good?” said Patz, an environmental studies professor who shared a Nobel Peace Prize four years ago for work on the health impacts of climate change.

The institute is broadening the university’s focus on global health beyond the education and service programs of the UW School of Medicine and Public Health’s Center for Global Health, which started in 2005.

Someday, the institute could attract funding from organizations such as the Bill and Melinda Gates Foundation, said Dr. Jim Conway, an associate director of the institute. That might help UW-Madison become a global health powerhouse like Johns Hopkins, Harvard and Tulane universities, he said.

“We could and should be able to take this to the next level,” Conway said.

Helping our sisters

In Madison, global health is an everyday topic.

The city has 10 sister cities in foreign countries — including Managua, the capital of Nicaragua, where plastic surgeons from Eduplast, a Madison-based nonprofit, have traveled for 20 years.

The surgeons repair cleft lips, cleft palates, burns and other deformities while exchanging lessons with doctors in Nicaragua.

Throughout Madison, clinics, hospitals and groups such as the Wisconsin Medical Project regularly donate medical supplies to developing countries.

Edgewood College sends nursing students to Guatemala for training and to assist midwives.

Religious organizations also are involved in global health. Blackhawk Church, for example, sends teams to Kenya to help women affected by HIV, and to Honduras to volunteer at medical and dental clinics.

But most global health efforts here are associated with the university.

Some get considerable attention, such as the Combat Blindness Foundation, founded in 1984 by Dr. Suresh Chandra, a UW-Madison ophthalmologist. The group performs cataract surgeries in India and other countries.

Many aren’t as well known, such as the Kibale EcoHealth Project in Uganda. Led by Tony Goldberg, a UW-Madison veterinarian and epidemiologist, the project studies the transmission of infectious diseases between animals and people in a region of Uganda marked by deforestation, a high rate of HIV infection, and the recent emergence of Ebola virus and yellow fever.

Goldberg and his colleagues test monkeys, apes, livestock and people for a variety of microbes. They also interview people about their beliefs and behaviors.

“In order to solve any of these problems, you have to understand the root social drivers in people,” said Goldberg, another associate director of the Global Health Institute.

All of the programs share a common theme: mutual benefit. “It’s not just about us saving them. It’s about us working with them to enrich each others’ lives,” said Dr. Cindy Haq, until recently director of the Center for Global Health.

Haq now heads up the medical school’s urban training program in Milwaukee, a shift that illustrates another theme of campus global health programs: Lessons learned overseas can be applied at home.

“Where your patients are coming from is related to their health,” she said. “Context and history matter, whether it’s in another country, in rural Wisconsin or in inner-city Milwaukee.”

Joel Charles got a crash course in cultural relevancy during one of the university’s global health field courses in Mexico.

He and other UW-Madison students were trying to get rural families to come to a nutrition class, with little success — until they helped rebuild a volleyball court. Crowds started turning up for volleyball and staying for class.

“The relationships have to come first,” said Charles, now a medical student on campus who hopes to work with Latinos in the U.S. in his medical practice.

Program has room to grow

Ten field courses now are available in foreign countries as part of an undergraduate certificate in global health that started this year.

Two years ago, a campus reaccreditation process identified global health as a strength with room to grow, Patz said. That led to a series of “incubator” talks at the Wisconsin Institutes for Discovery on topics from infant mortality in developing countries to crop wilt in bananas, a food staple in much of the world.

In September, the institute awarded grants to eight projects that bring people from a variety of departments together to tackle global health challenges.

One of the winners was the dairy farm project in Ecuador.

During field course trips to the country, Poulsen said, veterinarians asked him about the vaccine to prevent brucellosis, which has made some cows there unable to sustain a pregnancy and thus unable to provide a normal amount of milk.

Many people in the area also routinely fall ill with brucellosis symptoms, which are similar to flu symptoms but can last much longer, Poulsen said. Few cows or people are tested or treated for the disease.

During some initial testing this year by Poulsen and UW-Madison students, 20 percent of cows in large dairies were positive — enough to potentially cause significant harm to the dairy industry.

More testing is planned, with the goal of eventually vaccinating cows in areas most affected.

The immediate benefit may be thousands of miles away, but the lessons could prove useful in Wisconsin.

Pasteurized milk and vaccination of cows mostly wiped out brucellosis here decades ago, Poulsen said. But the raw milk movement, along with declining immunization, could bring it back, he said.

“It’s good for us to keep up our knowledge about it,” he said. “We could see more here.”