Capstone Projects - South America // Eck Institute for Global Health // University of Notre Dame

Eck Institute for Global Health

Capstone Projects - South America

Name: Molly Elston  MS '12
Degree and Year: Biology
Rockhurst University, 2011

Capstone Project:  How rural health promoters and participatory research models can help bridge healthcare barriers in the Napo Province in Ecuador


Abstract:  In 2000, the Ecuadorian Congress established a National Health Care System and passed health care reform measures. By 2007, however, access to healthcare services was still limited for many Ecuadorians, with nearly one-third of the population lacking regular access and two-thirds without health insurance or adequate resources to pay for health services. This lack of access to care is a serious issue that must be addressed if Ecuador is to continue to promote the development of its citizens. The goal of this research was to identify key health issues regarding health needs, practices, and access in three communities in Timmy Global Health's catchment areas in the Napo province of Ecuador in order to gauge how a rural health promoter program could address these key health issues and supplement Timmy's current medical brigade efforts in the area. First, a quantitative health survey was used to identify basic socio-demographics, sanitation practices, and the most commonly reported health concerns for Timmy’s adopted communities. Next, a more qualitative, participatory approach toward research in the form of individual interviews and focus groups was employed.  The surveys showed that the majority of questionnaire respondents have only completed up to primary school, make less than $50 per month, and do not have insurance. Information collected also displayed a great lack of basic health knowledge and problems with water sanitation in the communities. It is the hope of this project that findings of the this project and the recommendations created as a result of these findings can be utilized by Timmy Global Health in order to accomplish their goal of moving towards a Rural Health Promoter program empowers communities to take charge of their own health needs and promotes sustainable local knowledge in these same communities.

Name: Gabriela Moriel  MS '12
Degree and Year: Preprofessional Studies
University of Notre Dame, 2011

Capstone Project:  Empowering the Napo Province for a healthier future:  A partnership between Rural Health Promoters and Timmy Global Health


Abstract:  Timmy Global Health is an Indianapolis-based nonprofit organization with a hybrid mission: to expand access to healthcare both locally and internationally and to empower students and volunteers to tackle some of today’s most important global challenges. Over the past year Timmy has been working to increase access to healthcare in nine adopted communities in the Napo Province through primary care medical brigades that travel to each community every 2-3 months. Over the past year, August has been slowly developing the Rural Health Promoter program with 8 out of the 9 communities that Timmy currently resides. The research aims were to design training materials for the two rural health promoters in Napo. Surveys results showed the flu (83.02%), diarrhea (22.64%), and fever and body pains (15.09%) were most prevalent in the community. Each of these illnesses or symptoms are usually related to some underlying issue within the community and are rarely caused by more chronic infections such as HIV or TB. The goal was to use the rural health promoters as the key communication link between medical brigades and the community, by targeting health issues at their roots and preventing many of these preventable and commonly seen illnesses from occurring in the first place. Two resource cards were created to be distributed to rural health care providers in Napo Province. One card focused on hygiene and sanitation information and another on disease

Name: Melissa Baranay  MS '13
Degree and Year: Behavioral Neuroscience
Yale University, 2011

Capstone Project:  Polyandry and longevity in Aedes Aegypti: Implications for Dengue transmission and control


Abstract:  Dengue fever is currently the world’s most devastating arbovirus and it is rapidly becoming one of the most far-reaching and impacting diseases.  Its incidence has increased 30 fold in the last quarter century and continues to spread at an alarming rate.  The disease is spread primarily by Aedes aegypti mosquitoes and is a serious, endemic threat in more than 100 countries worldwide.  Due to the lack of effective vaccine protection against dengue viruses, the only available preventative measures lie in the vector realm, specifically control and/or elimination of the vector.  There are several ongoing efforts involving transgenic and sterilized males and females, however, these methods cannot be realized to their full potential until the vector itself is fully understood.  Chiefly among these unknowns are the mating behaviors of female Aedes aegypti and the lifespan of both males and females.  This paper examines the techniques available to analyze the presence or absence of polyandry, multiple mating, in both lab reared and field collected mosquitoes in addition to exploring the longevity of a lab reared strain believed to be longer living than average.  Both of these factors, polyandry and longevity, have the potential to greatly alter the perceived effectiveness of current control methods and may lead to the development of new and more advanced vector control programs.  Through longevity studies of birthing  “granny” mosquitos, DNA extractions, and spermathecae dissections, we showed that the lifespan of both male and female Ae. aegypti is considerable longer than anticipated. This information should greatly improve people’s study of dengue. My study also revealed several new techniques that can be used in the study of polyandry, including the lab methods I used in study. My research may improve the processes of people studying dengue throughout the research community.

“Overall, I had an amazing experience with my project as a whole and with my field placement. Going on field excursions to help on other projects were easily some of my favorite days during my field experience and I will always remember the crazy island roads, secret swimming streams, and critters I encountered along the way!”

Name: Michael Burton Jr.  MS '13
Degree and Year: Psychology and Preprofessional Study
University of Minnesota, 2012

Capstone Project:  Investigating the development and breadth of Quinolone resistance


Abstract:  Quinolones came into existence during the process of designing an antimalarial drug known as chloroquine (Andriole, 2005). A byproduct of this research was the discovery of nalidixic acid. The initial function of nalidixic acid was treatment of urinary tract infections (Dalhoff, 2012). Over time, however, a collection of quinolone antibiotics emerged from this drug. The reliance on the class of Quinolone antibiotics has contributed in part to an emerging trend of antibiotic resistance. The following literature review will explore the evolution of quinolone antibiotics, mechanisms of activity and the various classes of quinolones and derivatives. This launching point will inform a discussion on the rise of antibiotic resistance in quinolone drugs. Included in this discussion are the multiple pathways of resistance employed by numerous bacteria and the rates of resistance in various pathogenic bacterial species. A focal point of this review hinges on analyzing the emergence of quinolone resistance in Neisseria gonorrhoeae. This species, responsible for gonorrhea, has clinical relevance due to its insidious presentation in women, and long-term health consequences for millions of people. Additionally, in acknowledgment of the increasing globalization of the world, developing countries face a disproportionate burden of infection and resistance. Synthesizing the literature on quinolones, quinolone resistance, and Neisseria gonorrhoeae provides global health experts, researchers, physicians and laypeople an overview of a current crisis and its immediate implications. Furthermore, this body of literature heightens alarm over the possibility of an additional super bug in Neisseria gonorrheoe. Through this extensive literary review, I have found that further study of quinolone antibiotics could greatly advance the treatment of Neisseria gonorrheoe. At present though, as antibiotics are developed, communities must better their technology communication to inform the public and health care providers on sexually transmitted disease.

“My time in Ecuador challenged me to reflect on the systemic problems that lead to poor health. The culture enriched my life.”

Name: Stephanie Cripps  MS '13
Degree and Year: Preprofessional Studies
University of Notre Dame, 2012

Capstone Project:  An assessment of community health promoters in Ecuador’s Napo Province


Abstract:  The purpose of this study is to understand the role of TGH community health promoters in the Napo Province, in order to help TGH choose the best way to run their community health promoter program. TGH’s health promoter program in the Napo Province has never been evaluated before, and this exploratory study can act as a baseline to compare future evaluations of the health promoters and their impact on community health.  Because there is such wide variation in community health programs, there is no standardization or one-size fits all approach to evaluate community health worker programs. For the purposes of studying TGH’s Napo Province health promoters, qualification, outreach engagement, motivation, community recognition, and community perception of community health promoters were chosen as areas of interest by TGH to be examined in order to gain a thorough understanding of the role of a health promoter and possible areas for improvement. Surveys conducted found that while most people could recognize and liked their health promoter, they believed the promoter did not have an overly extensive or useful knowledge of healthcare. This could be solved through a promoter training program, one in which topics of community interest, like alcoholism and family planning, could be given greater attention. I believe this research will help TGH improve the efficiency of their community health promoter program and therefore better health in the Napo Province.

“Community health promoters are members of a community chosen to act as a bridge between the community and health care providers by giving basic health and medical promotion, education, and care to the community.”

Name: Colleen McKenna  MS '13
Degree and Year: Biochemistry
University of Notre Dame, 2012

Capstone Project:   Analysis of child feeding practices in Huancayo and Trujillo, Peru


Abstract:  Worldwide, over 2.6 million children die each year from malnutrition alone; it is a big global health concern.  Today in Peru about 18% of children suffer from chronic malnutrition.  The purpose of this study was to assess the feeding practices of caregivers in two communities in Peru and to evaluate the impact that Catholic Medical Mission Board has had on the communities.  On average, the children in the communities ate a variety of foods and were fed at least four times daily.  The mothers had a good understanding of nutrition and hand washing practices.  Further investigation is needed to evaluate the quantity of food and to account for confounding factors in the study.

During my time at Peru, I was always amazed by the generosity of all the people I met and touched by their loving and inviting spirits. The children’s smiles warmed my heart and I hope to return to Peru soon to continue to work with CMMB to combat child malnutrition.”

Name: Megan Finneran  MS '14
Degree and Year: Preprofessional Studies and Spanish
University of Notre Dame, 2013

Capstone Project:  An assessment of healthcare access and its limitations in Ecuador’s District 15D01


Abstract:  The Ministry of Health (MOH) in Ecuador and medical brigades conducted by the nonprofit Timmy Global Health (TGH) provide medical attention in district 15D01 of the Napo province. However, limited collective information exists about the services provided and the gaps that exist within the healthcare system. This study aims to explore the medical services available at various facilities and to compare patient demographics, health behaviors, obstacles in accessing medical attention, transportation details, and healthcare experience. A checklist was used to gather information about available services at three hospitals, fourteen MOH centers, two TGH brigade sites, and five miscellaneous providers. Patient interviews were conducted in Spanish with 28 patients in MOH facilities and 75 patients at brigade sites. The MOH facilities act as the permanent presence for healthcare but patient obstacles to seek care still exist. TGH brigades serve to overcome transportation-related obstacles by working directly in communities and allowing patients to walk and to travel less time to reach care. Medications were the number one patient motivator for choosing brigade care instead of an alternative facility. Collaboration between the MOH and TGH is essential to best attend to patient needs. Brigade focus should be put on rural communities distanced from an MOH facility that face the greatest obstacles in seeking care. The role of brigades as a medication dispenser calls for future work to better understand its effect on patients.

“I spent three weeks in Ministry of Health (MOH) centers, where I interviewed 28 patients to gather information about demographics, health behaviors, transportation methods, travel times, and level of satisfaction with the experience in the given facility.”

Name: Katherine Kralievits  MS '14
Degree and Year: Mathematics and Spanish
University of Notre Dame, 2013

Capstone Project:  Cost analysis and qualitative assessment of the Catholic Medical Mission Board’s “Taking Care in the First 1,000 Days” Program in Trujillo, Peru


Abstract:  Iron deficiency anemia is a severe public health problem that affects over 50% of children under 5 years of age and nearly half of pregnant women and adolescents in Peru. Iron supplementation has been identified as an efficient public health intervention; however, implementing anemia reduction programs that include both micronutrient supplementation and education components will yield more sustainable results.  The goal of this study was to perform an assessment of Catholic Medical Mission Board’s “Taking Care in the First 1,000 Days” program.  The objectives were to 1) evaluate the reduction in anemia prevalence among a sample population of those enrolled in the “Taking Care in the First 1,000 Days” program, 2) determine the number of children and pregnant women recovered from anemia among this sample population, and 3) estimate the total cost required to reduce anemia among this population of children 6-35 months and pregnant women in Trujillo, Peru.  Using the estimated total cost and health outcome data, the cost per participant recovered from anemia was calculated. When excluding costs for the participants who withdrew from the program, the cost per participant recovered from anemia was S/. 521 PEN ($186.54 USD) per child between 6 and 35 months and S/. 311 PEN ($111.35 USD) per pregnant woman.  The cost analysis was supplemented with in-depth interviews with participating mothers and pregnant women to better understand their perceptions, challenges, and barriers while enrolled in the program. Using the data collected, several recommendations for future program improvements were made.

“This rewarding field research experience through the University of Notre Dame and the Catholic Medical Mission Board in Peru allowed me to develop a specialized skillset that I will able to use in my future career in global health.”

Name: Marcos Marugan-Wyatt  MS '14
Degree and Year: Biology and Anthropology
University of Notre Dame, 2013

Capstone Project:  Assessment of clinical infrastructure and resource availability for antibiotic resistance testing, treatment, and prevention in Quito, Ecuador


Abstract:  In the last few decades, antibiotic resistance in bacteria has increased at an alarming rate. The situation has quickly escalated from bacteria resistant to one or two treatment options to those that are resistant to all known forms of antibiotics. This is not merely a problem localized to a specific country; instead it is quickly becoming a global crisis. No one is more likely to be feeling the burden of this issue than the underdeveloped nations in which resources and clinical infrastructure necessary for early detection and treatment are not on par with those of the more developed countries. This research aimed to specifically study antibiotic use and resistance in southern Quito, Ecuador. The goal was to do an initial assessment of the current state of antibiotic resistance in the area, followed by the administering of surveys to better understand the public’s awareness and knowledge with regards to this growing problem. The findings of this research indicated a strong need for the implementation of educational programs aimed at teaching correct antibiotic use, regulations directed at controlling the over the counter administration of antibiotics by pharmacies, and campaigns against self-medication.

“My results were interesting, indicating that antibiotic resistance is a large, ongoing, and growing problem in southern Quito, Ecuador, that lack of antibiotic distribution control, a medical culture of self-medication, and deficient public awareness of antibiotic use and antibiotic resistance are among the main factors at fault.”

Name: Andrew Taniguchi  MS '14
Degree and Year: Preprofessional Studies
University of Notre Dame, 2013

Capstone Project:  Recovery of leishmania promastigotes from infected sandflies: A study in phlebotomine artificial blood feeding


Abstract:  Leishmaniasis is a disease caused by the trypanosomatid parasite Leishmania and manifests itself in a variety of symptoms from cutaneous ulcers to degradation of mucosal areas, and is fatal in certain cases when left untreated. It is a neglected tropical disease that continues to be a burden for many countries because of the limited amount of diagnostic tools and complex treatments with severe side effects. The parasite causing the disease features a digenic lifecycle and requires the sand fly as an essential intermediary host and vector to continue propagating. This project explores the methods used for infecting Phlebotomus papatasi, Lutzomyia verrucarum, and Lutzomyia peruensis sandflies with Leishmania promastigotes. The sand fly infections with Leishmania major and Leishmania peruviana were accomplished via artificial membrane feeding procedures using a variety of animal skin membranes, and both human and mouse blood to mimic conditions in which natural infections are transmitted.  Detailed instructions on how to prepare membranes, blood meals, and dissections are outlined for successful recovery of motile promastigotes from infected sandflies and their subsequent re-culture for future molecular assays of Leishmania promastigotes. These protozoa contain a sophisticated signaling cascade system of phosphorylated proteins to transduce environmental signals. It is because of these signaling transductions that Leishmania are able to respond to stress and adapt to their environments in order to survive. Future experiments aimed at extracting these phosphorylated proteins, and identifying the associated kinases, phosphatases, and their downstream targets represent new avenues for the discovery of novel drug targets and therapies designed to mitigate the signaling pathways of Leishmania, effectively haling the lifecycle of Leishmania and/or preventing clinical disease from manifesting itself in treated hosts or vectors.

“This was a phenomenal opportunity to establish collaboration between the University of Notre Dame and NAMRU-6 and an immersion into a wonderful culture and group of people.”