Speaking at the International School on One Health

The School of Public Health and Zoonoses, GADVASU, Ludhiana, in collaboration with the University of Saskatchewan, Saskatoon, Canada, organized the International School on One Health, on the theme of “A Team Science Approach for Protection of Animal, Human and Environmental Health”. This event was organized under the Integrated Training Program in Infectious Diseases, Food Safety and Public Policy (ITraP) funded by NSERC, Canada, and GADVASU and the Freie University, (FU) Germany were partners in this program. I was invited to deliver a lecture on “Systematic Research Prioritization in One Health: A Strategy to Meet Global, National and Sub-National Challenges”.

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In this hour-long session, I gave a brief introduction to the systematic research priority setting exercise and discussed the experience of deploying the methodology in the International context (through the SNNDZ network), at the National Level (through PeriMilk, the PHFI-RCZI project) and at the sub-national level (at Odisha, through a collaborative approach with KKIT School of Public Health).

Workshop on Data Acquisition and Quality Assurance for Setting Research Priorities in Zoonoses in Odisha

I spoke at a two-day, interactive, hands-on workshop on “Data Acquisition and Quality Assurance for Setting Research Priorities in Zoones in Odisha”, which was conducted on 27th and 28th January by the Roadmap to Combat Zoonoses in India Initiative (RCZI), Public Health Foundation of India (PHFI), in collaboration with the KIIT School of Public Health (KSPH), Bhubaneswar.

At this event, the data collection teams were trained in the process of research priority setting, which followed the modified CHNRI method adopted by the RCZI for the initial priority setting exercise in 2010. (1,2) On the first day of the hands on workshop, the theoretical basis of priority setting was elucidated. The second day was dedicated to field piloting of the data collection tool.

The data collection processes were observed by the trainers of the workshop and in the second half of the day, detailed feedback was provided, along with measures to ensure course correction. Another pilot interview was conducted in the second half to demonstrate principles of data collection, and all concerns regarding the process were resolved.

The data collection teams will undergo a further round of pilot testing of the tools and the interview process under the guidance of the field advisers before the data collection process is initiated.

The data collection process is expected to take up to eight weeks and initial results should be available for analysis by April, 2016. It is expected that the research prioritization process would lead to important, policy-relevant findings from the state of Odisha, which has a significant burden of zoonoses and neglected tropical diseases.

The leader of the herd (Wild Buffalo, Kruger National Park)

The leader of the herd (Wild Buffalo, Kruger National Park)

References

  1. Sekar, N., Shah, N. K., Abbas, S. S. & Kakkar, M. Research options for controlling zoonotic disease in India, 2010-2015. PLoS One 6, e17120 (2011).
  2. Child Health and Nutrition Research Initiative. A new approach for systematic priority setting in child health research investment. (Child Health and Nutrition Research Initiative, 2006).

Training Program on Research Priority Setting in Zoonoses

I have come to Bhubaneshwar, which is one of the project research sites under the India Research Initiative to provide training to the research team at the local site on the research priority setting exercise which we had taken global in August through a workshop held by the Public Health Foundation of India in collaboration with the Institute of Tropical Medicine, Antwerp, Belgium and the Hans Hoheisen Wildlife Research Station, University of Pretoria, South Africa. I had written about the event in a previous update.

The research priority setting in the context of the state of Odisha, in eastern India is quite distinct from the context we discussed in the global stage. On one hand this exercise, through multiple training workshops, such as this one, enhances the research capacity in the public health cadres at all the research sites; and on the other, it helps to create local, context-specific, customized priorities that can then be investigated by the interested agencies.

One particular aspect of interest in Odisha is the presence of forest fringes in the peri-urban areas. These forest-fringes create a unique interface for interaction between human-domestic animal-wildlife, creating a unique ecosystem for disease or pathogen emergence. The focus of the training workshop here is to provide the researchers at my host institution, the KIIT School of Public Health, Bhubaneshwar, with the skills needed to independently conduct the exercise.

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The program was initially scheduled to be for two days, but has spilled over for a couple of hours into the third day as well. Tomorrow I shall conclude the training workshop and establish timelines for the future outcomes of the prioritization process per se.

In addition, in the three days I have been here in Odisha, I have also conducted a stakeholder analysis in which I am trying to locate micro-level  and meso-level stakeholders who can give me a value map for their personal perceptions regarding the role they can play in a policy-environment. This stakeholder analysis will let us understand the power dynamic at different levels: the macro level (national level stakeholders), the meso level (state level stakeholders) and the micro level (policy-target level stakeholders). This, in turn, will form the basis of understanding the gaps in capacity and levels of policy absorption that can happen at the different levels.

The stakeholder mapping and analysis processes have typically been used in industrial and economic settings. To the best of my knowledge, no other agency has conducted a stakeholder mapping and analysis for zoonoses and emerging infectious diseases, especially in the Indian context. From the initial brush I have had with the data, it appears that the outcomes are going to be of great interest, both from the policy-maker and target-stakeholder perspectives.

Evidence-based medicine meets person centred care: a collaborative perspective on the relationship.

This short commentary was published in the Journal of Evaluation in Clinical Practice and it was propelled by a discussion which took place on a private email list serve regarding the role EBM might play in the emerging fields of person centred medicine and precision medicine. Unfortunately, the article is behind a pay wall!

Price AI, Djulbegovic B, Biswas R, Chatterjee P. Evidence-based medicine meets person centred care: a collaborative perspective on the relationship. J Eval Clin Pract. 2015 Sep 10. doi: 10.1111/jep.12434. [Epub ahead of print] PubMed PMID: 26358758.

Abstract:

In a recent list-serve, the way forward for evidence-based medicine was discussed. The purpose of this paper was to share the reflections and multiple perspectives discussed in this peer-to-peer encounter and to invite the reader to think with a mind for positive change in the practice of health care. Let us begin with a simple question. What if we dared to look at evidence-based medicine (EBM) and informed shared decision making like two wheels on a bike? They both need to be full of substance, well connected, lubricated and working in balance, propelled and guided by a competent driver, with good vision to get the bike where we want it to go. We need all the tools in the toolkit for the bike to stay operational and to meet the needs of the driver. By the same rationale, evidence alone is necessary but not sufficient for decision making; values are necessary and if neglected, may default to feelings based on social pressures and peer influence. Medical decisions, even shared ones, lack focus without evidence and application. Just as a bike may need a tune up from time to time to maintain optimal performance, EBM may benefit from a tune up where we challenge ourselves to move away from general assumptions and traditions and instead think clearly about the issues we face and how to ask well-formed, specific questions to get the answers to meet the needs we face in health care.

 

© 2015 John Wiley & Sons, Ltd.

KEYWORDS: evidence-based medicine; person-centred medicine; philosophy of medicine

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Research Prioritization for Zoonoses Prevention and Control, South Africa

I recently spoke at a workshop on understanding how to go about doing research prioritization for prevention and control of zoonotic diseases at the Hans Hoheisen Wildlife Research Station, which is affiliated to the University of Pretoria, South Africa.

The event was organized by Institute of Tropical Medicine, Belgium and Public Health Foundation of India, in collaboration with the University of Pretoria who played host for us. Set in the heart of the Kruger National Park, the HHWRS was the most idyllic, “One Health” environment in which such a workshop could have been hosted. The workshop was attended by country investigators from selected partners, who are a part of the Strategic Network on Neglected Tropical Diseases and Zoonoses (SNNDZ). This image shows most of the participants who were a part of the event:

Country Investigators at the Workshop on Research Prioritization in South Africa

Country Investigators at the Workshop on Research Prioritization in South Africa

In the image: From left to right: Wayan Tunas Artama (Ecohealth/One Health Resource Center, Indonesia), Greg Simpson (Hans Hoheisen Wildlife Research Station, University of Pretoria, South Africa), Vivek Kattel (BP Koirala Institute of Health Sciences, Nepal), Mekonnen Yitagele (Haramaya University, Ethiopia), Lai Jiang (Institute of Tropical Medicine, Belgium), Evelien Paessens (Institute of Tropical Medicine, Belgium), Richard Akuffo (University of Ghana, Ghana), Pranab Chatterjee (Public Health Foundation of India, India), Manish Kakkar (Public Health Foundation of India, India).
Not in Image: Fabiola Quesada (University of Pretoria, South Africa)

In course of the two-day event, we trained the participants in the methodology that had been adopted by the Roadmap for the Control of Zoonoses in India (RCZI) Initiative to define the research priorities in the Indian setting. In the days ahead, each of the country investigators shall initiate a research prioritization exercise in their own country and hopefully we shall come together by the middle of 2016 to publish the findings from these endeavors. Such a multi-country approach to understanding the knowledge gaps and knowledge needs with respect to zoonotic disease control and prevention is unprecedented and we hope to present the consolidated findings at the One Health Conference in Melbourne in December 2016 to a larger audience to bring about more intense discussion on the matter.

The results are likely to result in a better understanding of the research and informational needs landscape with respect to zoonotic diseases and emerging infectious diseases. Armed with this systematic understanding of research needs within a local context, we can then proceed to make informed policy and funding decisions to fuel the most critically needed issues towards their solution.

Eyes on the Future

Eyes on the Future

Melodies and Maladies: Reflections on Shakespeare and his Portrayal of Disease and Death

This short article was published in RHiME (Research and Humanities in Medical Education), which is the flagship journal of the University College of Medical Sciences, New Delhi, and is run by the Medical Humanities Group and Medical Education Unit. I wrote this article in honour of William Shakespeare’s 450th birth anniversary in 2014.

Chatterjee P., Seth B.Melodies and maladies: reflections on Shakespeare and his portrayal of disease and death.RHiME [serial online] 2014[cited 2014 Jul 6];1:. Available here.

Abstract:

Shakespeare has long been acknowledged to be a pioneer in understanding the functions and dysfunctions of the human mind. However, very little discussion has centered on his knowledge of the physical science of medicine. In this article the authors reflect on Shakespeare’s portrayal of diseases and death in his work and conclude that he had significant knowledge of the contemporary medical sciences.

Keywords: Humanities, Literature, William Shakespeare

Learning Points:

The reviewer was a keen student of the Bard’s work and wanted us to focus on his depiction of the various fluids and their impact on health or disease as portrayed in his work; and of course, the vagaries of the mental faculties of man, one of the most widely used dramatic elements.

Co-Author:

Dr. Bhavna Seth, Lady Hardinge Medical College, New Delhi. Dr. Seth helped search the Bard’s work for medical references and in the drafting of the article as well.

Governments are legally obliged to ensure adequate access to health information

This article was inspired by the work being done by the Health Information for All by 2015 group in bringing information to both care seekers and care givers.

Bhaumik S, Pakenham-Walsh N, Chatterjee P, Biswas T. Governments are legally obliged to ensure adequate access to health information. Lancet Glob Health. 2013 Sep;1(3):e129-30. doi: 10.1016/S2214-109X(13)70043-3. Epub 2013 Aug 2. PubMed PMID: 25104255.

Abstract

Access to reliable, relevant, and implementable health-care information has been identified as one of the key determinants for reaching the Millennium Development Goals (MDGs).1 In 2006, Pang and coworkers2 noted that the challenge is to “ensure that everyone in the world can have access to clean, clear knowledge—a basic human right, and a public health need as important as access to clean, clear water, and much more easily achievable.” However, this challenge has repeatedly been put on the sidelines.

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