McGill Global Health Programs is thrilled to announce the selection of the third cohort of Steinberg Global Health Postdoctoral Fellows. Established in 2015 by The Blema and Arnold Steinberg Family Foundation, the award is for entering or current postdoctoral fellows at McGill University who are pursuing research related to global health in low or middle income countries or among Aboriginal populations in Canada. The Fellowship is awarded by the Faculty of Medicine, upon recommendation of Global Health Programs, to one or more postdoctoral fellows on the basis of academic merit. The Fellowship stipend is $45,000, plus an annual travel stipend of $5,000 and may be renewable once.
2017 Steinberg Global Health Postdoctoral Fellows: Shaun Cleaver | Wenhua Wang
Shaun Cleaver is a physiotherapist with over 15 years’ experience in global health. Shaun conducted his doctoral dissertation research through the University of Toronto, exploring ‘meanings of disability, and what to do about it’ together with persons with disabilities in Zambia’s Western Province. Shaun became inspired to do this research from his work as a rehabilitation clinician, educator, researcher, and program manager working in various locations in “the global South.” These experiences in resource limited environments with diverse cultural norms caused him to question the idea that biomedically trained health professionals were well-placed to understand, and therefore respond to, the challenges faced by persons with disabilities. In-turn, this led him to engage in qualitative research using critical and participatory approaches.
Shaun sees the Steinberg postdoctoral fellowship at McGill University’s School of Physical and Occupational Therapy as an opportunity to deepen, broaden, and strengthen as a scholar. In his postdoctoral work, Shaun will deepen his methodological skillset with a focus on participatory ethnography, broaden his substantive competency by engaging in policy research, and strengthen his collaboration with groups of persons with disabilities.
Summary of Dr. Cleaver’s project: Persons with disabilities face systematic disadvantage the world over. This disadvantage can lead to fewer opportunities, a lower quality of life, and poorer health outcomes for persons with disabilities. In Shaun’s PhD research in Western Zambia, poverty was the primary concern of the participants with disabilities. The identification of poverty as a primary concern coincided with the development of a new social welfare policy that is being rolled out in 2017, the Social Cash Transfer Scheme (SCTS). Households eligible to receive the SCTS will receive small bi-monthly payments. This is not a disability-specific program; instead, it targets households living in extreme poverty, with a provision that households with a person with a disability receive extra consideration as compared to those who do not have a person with a disability. The impending roll out of the SCTS has been greeted with much interest from Zambians with disabilities: it has the promise to lead to important improvements in standards of living, but will it live up to this promise? With such an important policy rolling out, persons with disabilities will undoubtedly have opinions of it; but what are the ways that they will respond to this policy process?
For his postdoctoral research project, Dr. Cleaver will conduct a participatory ethnography to investigate well-being, inclusion, and policy involvement among persons in the context of the roll out of the SCTS. Shaun will interview members of 30 households with persons with disabilities – including beneficiaries and non-beneficiaries of the SCTS – in two specific communities in Mongu and Kalabo districts of Western Province. In these semi-structured interviews, Shaun will learn about the household members’ perceptions of their situations and how this has changed (or not) with the SCTS roll out. Simultaneously, Shaun will describe the disabilities of participants using the International Classification of Function, Disability and Health (ICF) as a base of comparison to the participants’ self-perceptions. Through the interviews and participant observation in the communities, Shaun will learn about the ways in which persons with disabilities respond to, and try to shape, the SCTS and its implementation. In parallel, Shaun will interact with policymakers at the Ministry of Community Development (which is responsible for the SCTS) to explore opportunities for the increased involvement of persons with disabilities in the policy process.
Dr. Cleaver is supervised by Matthew Hunt at McGill and Virginia Bond at the Zambart Project.
Wenhua Wang is a postdoctoral fellow in the Department of Family Medicine at McGill University and newly recipient of a Steinberg Global Health Postdoctoral Fellowship. He holds a Bachelor of Medicine and Ph.D. in Social Medicine and Health Management from the Shandong University in China. He spent two years in Tibet undertaking his doctoral research on primary health care performance assessment while working with the AusAID-funded Tibet Health Capacity Building Program as Chinese Long Term Advisor in Health Management. Four publications and two conference presentations have grown out of his dissertation research. He also worked as consultant for the China Medical Board in the first Tibet Household Health Survey in 2015. Before moving to McGill, he was a faculty lecturer at Wuhan University in China. His research interests include patient experience survey design and primary care policy analysis in a comparative perspective.
Summary of Dr. Wang's project: Over past decades, many countries have identified primary health care (PHC) as health reform priority. Evidence from both high-income and low- and middle-income countries found that a strong PHC system is linked to better equity and better population health at lower costs (Kringos DS et al. 2013; Macinko J et al. 2009). China now faces emerging challenges to meet the populations’ health care needs associated with a rapidly aging society and increasing burden of non-communicable diseases which are already China’s number one health threat, accounting for over 80 percent of the 10.3 million deaths annually (World Bank 2016). Strengthening the PHC system is central to addressing these challenges, and achieving sustainable development goals.
China initiated a national health reform to build a PHC based health system since 2009. While development of primary healthcare is on China’s political agenda, comprehensive performance information is an urgent need to guide the current health reform including assessment of the user experience. Instruments have been developed and validated to evaluate care from the user perspective in Western industrialized countries, but no work has been conducted to determine if the attributes and items measured by existing instruments are applicable in China or, if they reflect Asian values of health and healthcare. This project is designed to develop a consensus on the attributes to be evaluated in primary care delivery models through a Delphi process and to identify which attributes best assessed from the user perspective are addressed in existing primary care evaluation instruments through literature review. The findings will provide policy-evaluators and primary care researchers with information to guide the selection of instruments that evaluate primary care from the user perspective in China. The experience and expected products from China can be shared and be replicated in other countries in Asia.
Dr. Wang is supervised by Dr. Jeannie Haggerty.
José Ignacio Nazif-Muñoz is a Steinberg Global Health Postdoctoral Fellow in the Institute of Health and Social Policy at McGill University. He received his PhD in Sociology and a Masters of Arts from McGill University. His doctoral thesis Inequity on the roads: the interplay of global forces and road safety policy diffusion and traffic fatalities and injuries was awarded the 2016 Arts Insight Dissertation Award for the best dissertation of 2015 in the Social Sciences at McGill. His research has been published in journals such as International Journal of Comparative Sociology, Injury Prevention and Traffic Injury Prevention, cited in United Nations’ resolutions (i.e. General Assembly A/68/368), public policy reports and peer-reviewed journals. He received the John D. States Award for the top student paper at the 58th Association for the Advancement of Automotive Medicine Conference in Munich Germany in 2014. He has worked as consultant for the Pan-American Health Organization, the Economic Commission for Latin America and the Caribbean, and the Inter-American Development Bank. His research expertise includes global health, globalization, road safety, road users’ vulnerable populations, policy diffusion, and policy evaluation.
Summary of Dr. Nazif-Muñoz’s project: In recent years the world has seen a veritable epidemic of road fatalities. The most recent report of the World Health Organization (WHO 2015) on road safety indicates that traffic crashes cause 1.24 million fatalities yearly. Road traffic deaths disproportionately affect developing countries; indeed, although developing countries account for 48% of motorized vehicles worldwide, 91% of global road deaths occur in these countries. Road traffic deaths are one of the leading causes of death among younger people. Crashes resulted in more than 260 000 deaths in children and youth aged 0–19 years, with 93% of these deaths occurring in low-income and middle-income countries. Road traffic deaths are the ninth and second leading cause of death in children between ages 1 and 4 years and 5 and 9 years old, respectively (WHO 2008). This situation has triggered a strong global response led by international organizations providing aid and guidance to developing countries (Rosenberg et al. 2010).
The main objective of this post-doctoral research is to provide insight into differences and similarities in child traffic fatality rates between low income and high income countries in order to assess road safety measures to protect children. More specifically to assess the extent under which the global diffusion of child restraint laws has been effective in targeting child occupant mortality rates across the world. A comprehensive examination of the effectiveness of child restraint laws will be provided, since a much more detailed analysis of this phenomenon can be carried out with the unique dataset I assembled for my dissertation. In order to complement this global analysis, I will also examine the cases of Brazil and Chile to identify more closely the institutional mechanisms which inhibited and/or facilitated the implementation of child restraint legislation in these countries.
Dr. Nazif-Muñoz’s supervisors are Dr. Arijit Nandi and Dr. Mónica Ruiz-Casares
Toyin Togun is a clinician scientist with strong interest in implementation science focused on discovery and practical application of novel immunological tools to improve the diagnosis and management of tuberculosis (TB) in children. His professional background is in clinical medicine and he completed a Master of Science degree in Public Health in Developing Countries at the London School of Hygiene & Tropical Medicine. He also successfully completed a Medical Research Council (MRC)-funded PhD in Biomedical Sciences at The Open University, Milton Keynes, United Kingdom. His PhD research, carried out at the MRC Unit in The Gambia – West Africa, was an immuno-epidemiological project in childhood TB that centred on the interface between clinical assessment, diagnostic algorithms, advanced diagnostic biomarkers and the challenges of translating these insights from discovery to practice and policy on the field. Among the scientific outputs from his PhD research are the discovery of a novel multicytokine biosignature for diagnosis of childhood TB, four first-author publications including two book chapters, and several presentations at major international conferences. In a further recognition of his outstanding scientific outputs and his inspirational leadership potentials, Dr. Toyin Togun won the prestigious MRC Gambia Director’s Award for “Research Leader of Tomorrow” in December 2015.
Toyin believes that the Steinberg postdoctoral fellowship at McGill University, and the opportunity to work within Professor Madhukar Pai’s team at the famous McGill International TB Centre will give him an opportunity for a mentored research career development experience. The most important aspects of his Steinberg postdoctoral fellowship will include further training to gain new skills such as clinical validation of promising biomarkers, conduct of validation trials in diverse settings, and a better understanding of how to translate basic science research into potential diagnostic tools.
Summary of Dr. Togun's project: In 2014, there were an estimated 1 million incident cases of tuberculosis (TB) in children younger than 15 years of age, while as many as 140,000 children died of TB. About 75% of all childhood TB cases occur every year in the 22 high burden countries, most of which are in sub-Sahara Africa. Differentiating TB from other respiratory diseases (ODs) in children with suspected TB disease is difficult, especially if diagnosis relies on clinical and radiological features or microbiological assays (since children often cannot produce sputum).
In this project, we propose to validate a novel multi-cytokine diagnostic biosignature that was identified in unstimulated plasma supernatants from HIV-negative children previously, to distinguish TB disease from ODs among childhood populations with a different HIV and TB epidemiology in Africa and India. This multi-cytokine biosignature has potential to be developed into a non-sputum-based point-of-care test, which is a felt need in the field of TB. The project will also provide valuable information relating to the immunopathogenesis of TB in children.
Dr. Toyin's supervisor is Dr. Madhu Pai.
Vincent Duclos is a Steinberg Global Health Postdoctoral Fellow in the Department of Social Studies of Medicine at McGill University. He has held academic positions at Laboratoire d’anthropologie sociale (Collège de France) and the Collège d’études mondiales (FMSH) in Paris. He has completed his PhD in anthropology at Université de Montréal in 2013, and has been a visiting doctoral student at the Max Planck Institute for Social Anthropology in Halle (Germany). His research expertise includes global health, digital media, the reconfiguration of health-related practices, development theories, social studies of science and technology as well as relations between India and the African continent. He has conducted research in India, in West Africa (Senegal and Burkina Faso) and in Canada. Dr. Duclos has published articles in various scientific journals.
Summary of Dr. Duclos’ project: Over the last few years, interventions that rely on digital media to provide medical solutions have been proliferating on a global scale. Patients, medical practitioners, hospitals, and laypersons are increasingly connected, either through private networks, or the Internet. Under the impulsion of governmental agencies, international institutions, NGOs, and private sector players, mHealth is rapidly gaining importance on the global health agenda. Defined as medical and public health practice supported by mobile devices (WHO 2011), foreshadows critical changes in the management of individual patients and population health. All in all, it promises to transform global health by linking bodies, knowledge, and health practices in new spatial and temporal configurations. This research examines such configurations.
This research focuses on a mHealth initiative (MOS@N) currently being implemented in the district of Nouna, in rural Burkina Faso. In a context where loss to follow-up is a major public health challenge, MOS@N uses mobile technology to improve the medical monitoring of participating pregnant women and people living with HIV/AIDS. Currently implemented in 26 villages, the project involves the participation of primary health centres. Conducted in close collaboration with the Centre de Recherche en Santé de Nouna, this research contributes in documenting the impact of MOS@N on the monitoring of patients and, ultimately, on the utilization of utilization of healthcare services in low-resource settings. This research will make a significant anthropological contribution to the study of global health. Its primary aim is to understand how mHealth forges new relations between technology, knowledge, and healthcare on a global scale. It aims to examine how connected spaces of medical care transform the government of human life. More broadly, this research will contribute to interdisciplinary scholarly research on techniques and rationalities that shape global health as a field of knowledge and intervention.
Dr. Duclos’ supervisor is Dr. Tobias Rees.
Lena Shah received her PhD in Epidemiology from McGill University and a Master´s of Community Health from the University of Manitoba. She has spent the past three years in Lima, Peru undertaking her doctoral research on the role of household contact tracing in a tuberculosis (TB) endemic area. Prior to this, Lena was a Field Epidemiologist (2006-08, cohort 32) with the Canadian Field Epidemiology Program (CFEP) of the Public Health Agency of Canada and placed at the British Columbia Centre for Disease Control in Vancouver. Lena’s collaboration on the investigation of a TB outbreak on Vancouver Island as a field epidemiologist resulted in a co-authored publication in the New England Journal of Medicine (2011). Her areas of interest include working in marginalized populations, studying the transmission of TB, HIV and sexually transmitted infections, use of social network methods in outbreak investigations and applied public health research.
Summary of Dr. Shah’s project: This postdoctoral research builds upon a CIHR funded research project to estimate the effectiveness of an active case finding program for the evaluation of household contacts of tuberculosis (TB) cases in an endemic area. During my doctoral thesis work, I designed and implemented a pragmatic stepped-wedge cluster randomized trial in one of the largest and most densely populated districts of Lima, Peru. Through this study, I supervised the design, training, roll out, data collection and supervision of a contact screening intervention within a routine TB program operated through Ministry of Health clinics. This postdoctoral work will continue to strengthen this operational research program with collaborators from Canada, the United States and Peru.
The first phase of the postdoctoral work will complete analyses related to data collected from the pragmatic stepped wedge cluster randomized trial study. The study included a baseline period followed by the introduction of the intervention across 34 health centers in four groups over 20 months. The study includes data for 3,000 case patients of tuberculosis and approximately 12,000 household contacts identified by the routine public health program.
During the postdoctoral research program, a mixed methods study, including a qualitative research component, will be undertaken. This complementary study will examine the perspectives of frontline TB program staff in undertaking routine systematic active case finding of household contacts of TB cases and their experiences during the implementation phases of the study trial.
Dr. Shah’s supervisor is Dr. Jay Kaufman.