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Drs. Martin Richer, BSc’96, and Selena Sagan, BSc’04, are making their mark as part of the worldwide effort to end the Zika virus. (Photo: Joanne Hui)

Joanne Liu, MDCM’91, M MGMT, DSc, received a call on a Friday night. Could she address the United Nations General Assembly on the Monday morning? It was September 2014 and the Ebola crisis in West Africa, which would eventually claim more than 11,000 lives, was reaching its peak. Liu, International President, Médecins Sans Frontières (MSF), had been to Monrovia, Liberia, earlier that summer, where her logistician had told her the morgues were full.

For the 48 hours after the phone call, MSF agonized over the speech, Liu shared at her Medicine class’ 25th anniversary CME seminar last Homecoming. They would need to choose their words carefully. For help, Liu called her people in the field. She said, “What do you want me to tell the world?” and her team told her, “Tell them that we’re overwhelmed. Tell them that we’re at the breaking point and if they don’t show up we’re going to leave. Tell them that we’ve been losing the battle for the last six months, but if they show up we might win it over the next three months.”

Liu did speak at the UN that Monday. And the world did respond, although not before the disease had made its appearance outside Africa, with two cases, one each, in the U.S. and Western Europe.

Many factors had delayed the process: leaders loath to admit the extent of the devastation, lest their countries lose vital economic ties; militaries that refused to cooperate; and an unfortunate message issued early in the crisis.

“The message MSF had back then was: There is a deadly disease that you have a 50% change of dying from, and we have no treatment. Come to our centre with people wearing space suits,” said Joanne Liu, MDCM’91, M MGMT, DSc, in an address to her Medicine class at Homecoming 2016. (Photo: ManLi Que)

“The message MSF had back then was: There is a deadly disease that you have a 50% chance of dying from, and we have no treatment. Come to our centre and die with people wearing space suits,” said Liu. “Nobody wants to die away from their loved ones.”

Liu is one of many clinicians, researchers and educators in the wider Faculty community who embrace an additional role, that of changemaker. Here are just some examples of the forms that calling can take.

Zika detectives*

Drs. Martin Richer, BSc’96, and Selena Sagan, BSc’04, both assistant professors in the Department of Microbiology and Immunology, are making their mark in another way, as part of the worldwide effort to end the Zika virus.

They have developed a new mouse model with a working immune system that could be used in laboratory research to improve understanding of Zika and aid development of new treatments.

The ongoing Zika pandemic has caused infection in millions of people in the Americas and spurred new research using laboratory animals to study the virus. However, most of this research has been performed on mice with defective immune systems, resulting in limited understanding of the immune response to the virus and slowing efforts to develop potential vaccines and antiviral treatments.

In their study, published in PLOS Pathogens, Richer and Sagan’s team provoked a Zika infection in adult mice with healthy immune systems and studied the immune response to infection. The new mouse model could be used in further research to investigate the immune response to Zika virus. In particular, the newly identified Zika virus epitope could point the way to specific molecular strategies for studying T-cell responses to infection and could lead to the development of a vaccine.

Green crusader

As President of the Canadian Association of Physicians for the Environment, Jean Zigby, BSc, MDCM’97, advocates on a number of issues including a neonicotinoid ban, the end of coal-fired plants, and a full environmental accounting for oil and gas projects. His organization, which brings together hundreds of doctors across the country “to protect human health by protecting the planet,” also shares information on how the health sector itself can reduce its climate footprint.

The palliative care physician, who works at the Jewish General Hospital and the CLSC de Côte-des-Neiges – CSSS de la Montagne, says it’s important for doctors to keep in mind that cleaner air and water, safer streets and more green spaces make for a healthier Canadian populace. He says that as professionals who care for the health of their patients, it behooves doctors to speak up when the environment is threatened.

According to Zigby, doctors are in a unique and privileged position to effect change: “Their reach extends to individuals’ core experiences at an intimate level.” With the respect doctors experience in society, they also “have the ear of the politicians.” It can take very few doctors to make a difference, he says.

Disease predictor

A sense of accessibility is at the heart of a project led by Marina Klein, MDCM’91, MSc’01, implementing a mobile treatment and diagnosis unit to try to eliminate Hepatitis C from a Saskatchewan Indigenous community with particularly high rates of the disease, as well as HIV. The Professor of Medicine at the McGill University Health Centre (MUHC), and Research Director, Division of Infectious Diseases, says the Prairie province has seen an upward trajectory since 2002 in new HIV infections in Indigenous people, most of whom have also contracted Hepatitis C. Klein, who is also National Co-director, CIHR Canadian HIV Trials Network, says the infection rates are equal to those in Sub-Saharan Africa.

A principal investigator at the Canadian Co-Infection Cohort, which studies clinical outcomes of a large number of the dual infections, she helped set up the 18-month project in the Big River First Nation in Northern Saskatchewan.

The worldwide rates of these co-infections among the marginalized is trending up, which puts a damper on the accomplishments achieved in HIV/AIDS.

Klein remembers working at the Royal Victoria Hospital of the MUHC in 1994. “Virtually every room on 6 Medicine and 10 Medicine were filled with young men dying from AIDS. Men came from all walks of life. They were artists and dancers and were exceptional people, who were often dying alone in those rooms because their families had ostracized them, their partners, their lovers, had died before them and the staff were afraid to enter those rooms,” she recounted at the same Faculty of Medicine Homecoming event as classmate Liu.

But just two years later something revolutionary happened. Highly potent antiretroviral therapy, which suppressed HIV below detectability, would bring the number of deaths into sharp decline. In 1995, nearly 1500 Canadians died from AIDS. By 2002, the number of AIDS deaths totalled 89, a 94% reduction.

Now, though, the dual infection rates are causing what she calls an epidemic of end-stage liver disease because those who are spreading the infection at higher rates, namely through shared needles and unprotected sex, are too often the ones not receiving care.

Klein sees a reluctance by politicians and public health authorities to support proper medical interventions to injection drug users and other marginalized people. She says that unless care is stepped up and the enormous mark-ups pharmaceutical companies earn on some medications are lowered, high rates of cures seen with new treatments won’t do anything to bring down the number of liver disease cases and the ensuing burden on the health care system.

Truthteller

Another area where McGill-trained or -based clinicians and researchers play a frontline role: countering misinformation in the media.

Laurence Kirmayer, BSc, MDCM’78, James McGill Professor and Director, Division of Social and Transcultural Psychiatry, sees it as a responsibility to challenge certain ideas put forward by journalists. He does this if he notices new research being presented in a way that’s reductionist. When the goal is to be concise, “there’s a risk of oversimplification,” he says, giving the example of a reporter who contacted him for comment on a theory linking lead poisoning from addictive gas sniffing a generation ago with today’s Indigenous youth suicide crisis. “We’re always struggling to find some simple explanation for complex, multifactorial things,” he said in the article and, tells Medicine Focus now: “Part of my task is to push back against overly simple accounts.”

Plain speaker

While Kirmayer fights oversimplification, Abbey Mahon, MSc(A)’15, a nurse in pediatric care at the Montreal Children’s Hospital of the McGill University Health Centre (MUHC), steers clear from the overtly complex when talking to her patients and their parents. This means no medical jargon.

“As a nurse, part of my mandate is to ensure they understand what’s going on.”

Communicating in accessible language was a lesson Mahon learned at Research to Policy Dragon’s Den, an annual three-day workshop organized by the McGill Institute for Health and Social Policy. Tasked with developing proposals that would make children more active, Mahon pitched the idea of spurring new playground construction through subsidies—an experience that underscored the importance of using language that is accessible to people outside one’s own profession, especially when acting in an advocacy role.

Global Health Scholar

Developing children are particularly vulnerable to chemical exposure, explains Clare Fogarty, BSc’17.

Just as it is hard to celebrate advances in HIV/AIDS treatment with liver disease on the rise in the co-infected, anti-malarial programs in place in more than 80 countries around the world may have unintended side effects.

Venda Health Examination of Mothers, Babies, and their Environment (VHEMBE) is a birth cohort study designed to examine the effects in South Africa on birth outcomes of indoor residual spraying (IRS)—a practice that has been effective in protecting populations from infectious mosquitoes.

Clare Fogarty, BSc’17, an undergraduate student in the Department of Microbiology and Immunology received a Cavazzoni Family Undergraduate Global Health Award enabling her to intern with the VHEMBE study.

Results from the study suggest that pregnant women who lived in homes where spraying had occurred had elevated blood levels of DDT, which would make it to their children’s bloodstream.

Developing children are particularly vulnerable to chemical exposure.

“This underscores the importance of studying the potential health impact of exposure to insecticides used for IRS,” Fogarty said at her poster presentation for Global Health Night 2016–2017, held at McGill’s New Residence Ballroom.

Observant fellow

Like Fogarty, Dr. Maxime Cormier shares an interest in global health. He studies the social determinants of risk factors for tuberculosis (TB) in Indigenous populations worldwide.

A fellow in Pulmonary Medicine, Cormier recently carried out a large review of interventions for the various social factors that play a role in TB, such as smoking, diabetes, drug use, crowding and housing conditions. He looked for risk factors that stood out among the 400 studies on which he did a systematic review. He ended up making an interesting observation concerning diabetes.

A 40% rate of diabetes was seen in the general Indigenous populations in the Southern U.S., while he saw less than a 1% rate among the general Indigenous populations of Brazil, Russia and Malaysia. “One thing I can conclude is that the Indigenous populations from high-income countries have a disproportionate burden of diabetes compared to low-income countries. And the opposite is true: Indigenous populations in low-income countries are less at risk of diabetes than the general population,” he said at Global Health Night 2016–2017.

Compelled to speak their mind

Students and alumni who discover social inequities or impending harm to a group or the public at large often take the next step and speak out, just as Liu did on that fateful Monday morning in front of the UN. For Zigby, it’s about “taking a stand for what you think is right, based on evidence.” Kirmayer echoes this point, saying that it’s impossible for an academic who knows that a policy is hurting the public to stay neutral.

“If it’s clear that certain circumstances are harming people, it would be irresponsible as an academic, irresponsible as a clinician and irresponsible as a citizen not to say something.”

Philip Fine is a longtime Montreal writer. He is the former Canadian correspondent for Times Higher Education and University World News and was a frequent contributor to the Globe and Mail. Now working mostly in digital marketing, he currently writes for technology company Robotiq and Luxury Retreats Magazine. 

*Adapted with permission from a release issued by PLOS Pathogens. With thanks to Jose Mendez.

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