First published on October 20, 2014 in observance of the COPH’s 30^th anniversary celebration.

October is Domestic Violence Awareness Month.

Like many entities directed at the greater public good, the USF College of Public Health’s Harrell Center was the product of a private philanthropist’s gift. James Harrell and his family wanted to do something to help eliminate family violence, and they acted on that desire. The result was a 1997 endowment that set the stage for what has become an international force.

“The intent of the Harrell family was to provide a center that would focus on family violence,” affirmed Dr. Martha Coulter, the center’s founding director, “but they were particularly interested in looking at the prevention of family violence, as well as research that would be directly applicable to prevention and intervention.

“So the mission of the Harrell Center, really, is to be an intermediary between research and practice, to do research that is focused on family violence intervention and prevention across the lifespan.

“The grant was an endowment, so the funding is very limited, because it’s just the interest on the endowment. Now, most of the income is from other grants and contracts,” Coulter said, “but what the Harrell endowment did was provide the base for doing that kind of research.”

Brick sponsored by the Harrell Center in remembrance of James Harrell after his death in 2007.

One of three faculty members at the center full-time, Coulter, whose doctorate is in maternal and child health, teaches three courses: Family and Community Violence, Child Maltreatment, and Child Health, in addition to coordinating the maternal and child health academic concentration at COPH.

“In the very beginning, there was only the grant and the establishment of the center conceptually,” she said. “Over the years, we’ve developed.”

That development recently necessitated alignment into three divisions.

“The specific divisions – the redesigning of the organizational chart – has really been something that I’ve done this year,” Coulter said. “Before that, over the years, we’ve just developed these different projects and all worked together, but it looked like now we were at a place where we really needed to have a little bit more separate organization and to develop some strategic goals and objectives in each of those content areas.”

The result is a children’s services division directed by Dr. Lianne Estefan, an intimate partner violence division directed by Coulter, and an elder mistreatment division directed by Dr. Carla Vandeweerd. Dr. Karen Liller recently joined the center as a regular collaborator focusing her attention on the overlap between child maltreatment and unintentional injury, Coulter said, and “usually about 10” graduate students round out her staff. A community advisory board is among the center’s numerous external extensions.

“The children’s section has been very involved in looking at issues regarding the prevention of violence in the community,” Coulter explained, “and the center has developed a virtual research institute with one of the community agencies, Champions for Children, which is a multi-program unit, so that we can do research that is truly collaborative. We’ve worked very consistently with them over the years.”

Graphic that Harrell Center graduate assistant Natasha Hojati created for the Center’s Facebook page.

Coulter said that much of what her intimate partner violence section does involves the courts, so much so that she has become a regular consultant for the courts and has undertaken the task of evaluating the effectiveness of their intervention programs for batterers. Developing and continually improving guidelines for batterer intervention and responses to the needs of victims have been major off-shoot projects.

Among the section’s more significant research findings is that female batterers are falling through the cracks. While the county’s intervention for male batterers has been “very effective,” Coulter said, it has largely failed to successfully intervene with female batterers, who comprise about 15 percent of all convicted batterers in Hillsborough County.

“The clinical providers of these programs,” she said, “have been saying for a long time that they didn’t think the state-mandated curriculum for men was really the right curriculum to use for women.”

Among many leaders and dignitaries who have visited the Harrell Center over the years was then-Attorney General Janet Reno, who attended an elder abuse conference sponsored by the Center in 2001. The attorney general is pictured above with students Seraphine Pitt (left) and Carol Williams, and below with Dr. Coulter.

The elder mistreatment division concentrates on elders with dementia and the kinds of violence against them, which is, Coulter said, “fairly common, unfortunately, from both spousal caretakers and children taking care of elderly parents. The dynamics of this are very different from other sorts of domestic violence and really have a lot to do with people not understanding how to help people who have dementia.”

Coulter said she considers a new project in the division to be particularly tantalizing and potentially groundbreaking.

Called the Senior Surfers Project, Coulter said it looks at the rapidly expanding but little-known phenomenon of women over 50 seeking relationships online and getting responses from people who wind up physically, emotionally or financially harming them.

All previous research on Internet connections leading to violent encounters has been on adolescents, she said, so Senior Surfers is another project aiming to keep potentially overlooked victims out of the cracks – in this case, the cracks that open at the nexus of society and technology.

Dr. Coulter chats with Judge Dennis Alvarez (left) and James Harrell at a 1997 function.

With so much involvement in the local community, including working closely with the Spring and, until its recent demise thanks to funding shortfalls, the Family Justice Center, the Harrell Center’s global impact might be surprising to some, but global involvement has proven beneficial on numerous fronts.

Dr. Pnina S. Klein, a clinical and developmental psychologist and professor of education at Bar-Ilan University in Israel, recently led a Mediational Intervention for Sensitizing Caregivers workshop on campus to promote cognitive functioning and attachment by improving parent-caregiver interactions with infants and young children.

Attendees included community professionals, physicians and COPH students, faculty and staff.  Dr. Robert Nelson, a joint professor in COPH and the Morsani College of Medicine, sponsored attendance by a visiting group of physicians and clinicians from Ecuador.

“It’s been used all over the world,” Coulter said of MISC. “The outcomes internationally of this program have shown that it’s very effective in strengthening attachment and reducing child maltreatment, so we brought Dr. Klein here from Israel this year to do a training for community people and staff here, as well as faculty and students.”

Dr. Martha Coulter, Harrell Center founding director (right in both photos), in Ecuador in 2007.

Elsewhere on the international front, Coulter is working with the medical school in Panama to begin collecting information and developing guidelines for Panamanian health providers to improve their responses to intimate partner violence. She’s also working in Quito, Ecuador, to develop a program that will provide fundamental intervention services for indigenous populations.

Children in a remote Himalayan village in India read books sent to them by the Harrell Center.

Coulter went to India in 2012 with a group that collected data on maternal/child health and family violence among the 26 indigenous tribes in the Himalayas as a response to one tribal leader’s interest in addressing those issues. Progress has been slow, she said, because the tribes are not formally centralized in any way, and the terrain is difficult and isolating. The center recently collected books to send to children there. A librarian navigates dirt paths on a bicycle to deliver them.

Not surprisingly, Coulter’s five-year vision for the Harrell Center is about more expansion, mostly ideological, and lots of it.

“I would like to expand our depth in looking at female offenders and the way the courts respond to them,” she said.

“We’ve applied for some grants to look with a lot more depth at issues related to fathers. This is an area that has been somewhat neglected and needs a lot of attention. What are the ways that we can help fathers from the very beginning develop the kinds of skills that will be more nurturing and less likely to produce problems?

“As far as the center itself,” she said, “I think the area that we really need to expand the most is our capacity for doing community training and education and technical assistance.”

“I’d also like to see us focus on more primary intervention in a public health direction.   A lot of what we’ve done has been secondary response intervention, but I would like to see us working with primary situations – families, parent-child relationships.”

Coulter said an example of the center’s involvement in this area is its participation in the Hillsborough County Violence Prevention Collaborative, a plan for reducing violence throughout the county.

Community events also make Coulter’s expansion list. Recent ones have included fundraisers with artists and bands, and even a biker run.

“I would like to see us expand these community events, because they have been very helpful. The center doesn’t have much funding,” she said, “and the funding that we get is almost always research funding, so if we want to do things that are outside the research arena, we have to raise the money ourselves.”

Story by David Brothers, College of Public Health. Photos courtesy of Dr. Martha Coulter, Eric Younghans, Dr. Robert Nelson, USF Health and the Harrell Center.

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The USF College of Public Health’s (COPH) Dr. Ricardo Izurieta, professor, and Dr. Benjamin Jacob, associate professor, aim to identify hot spots for COVID-19 in Ecuador using cutting-edge epidemiological methods combining data with technology.

The “COVID-Zero: Minga for the Health and Work” project began in Quito, Ecuador, in March of 2020, according to Izurieta, and has now extended to the whole Ecuadorian territory.

“Ecuador was the Latin American country with the highest COVID-19 incidence and mortality rates in the region,” Izurieta said. “Despite more than 70 days of national isolation, in the city of Quito the transmission of the disease increased in the last two weeks of March-April 2021. Notwithstanding, due to pressures from business people and the underemployed population, the city went from a red light (total quarantine) to a yellow light (partial quarantine) with the imminent risk of explosive outbreaks.”

Izurieta said even though the number of COVID-19 beds were increased to 762 beds in Quito, there were only 5 percent of available beds in June 2021.

“The Ecuadorian health care system, as well as the government institutions by themselves, did not have the capacity to control the pandemic. Therefore, it was necessary to bring in the community through their Parish Health Committees (PAHCOs) and Community Control and Surveillance Posts (C-POSTs) in the prevention and control of this pandemic,” he said.

Izurieta said the aim of COVID-Zero is to implement a multidisciplinary and integrated COVID-19 community control program to reduce severe morbidity and mortality in the most affected areas of Ecuador.

They plan to combine three sources to combat COVID-19: information provided by trained community epidemiologists, information from the Ministry of Health’s surveillance system and in the third phase—to be implemented in 2022—information provided by geographical information systems (GIS), satellite images (SI) and drones or unmanned aerial vehicles (UAVs).

“This technology has already been validated and applied with malaria control in Africa by Dr. Jacob,” said Izurieta. “The information collected by the community epidemiologists provides a unique insight on thoughts and perspectives of the pandemic in Ecuador. Through this strategy, we are getting an understanding of potential confounders or future variables that may affect COVID-19 transmission and relief efforts as well as active surveillance information from the ground.”

According to Jacob, using this method to identify COVID-19 hotspots will allow for better outreach in the community, allowing public health practitioners to conduct targeted outreach in areas where people are gathering.

“There’s nothing more enjoyable than watching a disease fall. I’m taking down malaria and I’m going to take down COVID,” Jacob said. “I’m able to use the GPS technology and artificial intelligence ArcGIS to determine unknown locations where we can do interventions.”

Jacob said his job will be to find where aggregation centers, both known and unknown, are located so that Izurieta can then come in and create a protocol to address education in those areas on preventing the spread of COVID-19.

According to Jacob, drones will help gather data on possible centers of aggregation and gather what he calls “signatures” using GPS coordinates of that area. Drones gather data on where it finds hot spots of individuals gathering.

“Combining the role of the drone technology, satellite data, which is where we run systems with GIS, and artificial intelligence infused into a cell app, we’re able to now control the drone and see real time live stream data on a handheld,” Jacob said. “At the same time, we’re taking signatures of these aggregation centers and utilizing them to find unknown locations using satellite data systems of ArcGIS. So, it’s a combination where you use the artificial intelligence within ArcGIS and cell phone technology to infuse in one database.”

According to Jacob, this is what will make this a powerful mechanism in identifying where these clusters are, a vital piece of information in COVID-19 prevention efforts in Ecuador.  

Izurieta says the efforts of the project are supported by Ecuador’s Ministry of Health, which will plan to incorporate the epidemiological advances into their primary health care networks.

“Minga is an Inca tradition of community work/voluntary collective labor for purposes of social utility and community infrastructure projects,” Izurieta said. “In this specific community solution, our ‘Minga’ is for the health and work of the people. Since the ‘Minga’ is voluntary community work, no salaries are expected. All members of the community contribute with what they have, for example, scientists are contributing with their intellectual work, community leaders with their administrative work, community epidemiologists with their field work.”

While the researchers look to secure funding for this project, Izurieta said they have been able to partner with the Universidad Central del Ecuador, Ministry of Public Health of Ecuador, City of Quito Municipality and VECIS–Neighbors for the Health of our Communities–a grassroots organization of the popular neighborhoods of Quito.

“As immediate impacts, we have already seen a reduction in severe morbidity and mortality caused by SARS-CoV-2. Many COVID-19 intensive care units have been closed in the country because of the successful immunization and control program. Since Oct. 28, 2021, the whole country has been reporting zero COVID-19 deaths until today. In the short term, we expect the elimination of the community transmission of SARS-CoV-2 and a dramatic decrease in the burden of post COVID-19 disease among priority parishes in Ecuador,” Izurieta said.

In addition, the community epidemiologists of the project have actively participated in the National COVID-19 Immunization Program.

Izurieta was one of the professionals who developed the National Immunization Plan 9 Million Immunized in 100 Days program, implemented by Minister of Health Dr. Ximena Garzon, a COPH alumna.

“Currently, Ecuador is third in the Latin American region after Chile and Uruguay in terms of total population with complete COVID-19 immunization,” he said.

Izurieta is hopeful for the work of this project.

“This interventionist epidemiology project has the potential of affecting future SARS-CoV-2 outbreak protocols worldwide, as well as contributing to the efforts of controlling the pandemic and other pandemics. By conducting a spatial analysis, we can create predictive models used to mitigate future outbreaks of emerging infectious diseases,” he said.

Story by Anna Mayor, USF College of Public Health

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Choosing the path of public health

USF College of Public Health (COPH) alumna Dr. Ximena Garzon-Villalba, who earned her PhD from the college in 2016, has been appointed the public health minister of Ecuador.

Garzon-Villalba, who is also originally from Ecuador, joined the USF COPH as a doctoral student in 2012. Prior to that she was an occupational health physician for 16 years.

“I thought, well, it’s time for me to study something will allow me to help more people at once.”

“One day I was in my office and I was thinking, ‘OK, right now I am helping one patient at a time, but why am I not helping more people?’ So I thought, well, it’s time for me to study something will allow me to help more people at once,” she said.

Thus began her journey into public health and earning her PhD with a concentration in occupational health.

“That was one of my dreams that I made for myself,” she said. “One of my goals in studying at USF was to come back to Ecuador and develop that program here.”

She also developed their master’s in public health online program.

Garzon-Villalba said that being a graduate of a U.S. university added much value to her CV.

“People here appreciate a degree from the U.S. and, of course, USF is known as a very prestigious university because it has so many programs that also collaborate with universities in Ecuador,” she said.

Leading the charge during a pandemic

She was approached by the health ministry to fill the spot of public health minister.

“I felt that this could be a very good opportunity to help change the concept of public health here in Ecuador, which is very limited. I learned so much at USF, and I thought that I could make the concept of public health wider and apply all this knowledge that I got at USF in Ecuador,” she said.

“I learned so much at USF, and I thought that I could make the concept of public health wider and apply all this knowledge that I got at USF in Ecuador.”

Ecuador is going through a very bad epidemiological situation, according to Garzon-Villalba, who says the country now ranks second in Latin America for COVID mortality rates.

She said that Ecuador’s president and vice president have been in contact with her frequently to help develop an intervention to vaccinate at least 9 million Ecuadorians in 100 days, which is about 71 percent of the population.

“Right now, we are applying the intervention with the population, but that goal is not enough to acquire herd immunity, so now we are planning to vaccinate 12 to 15 million people before the end of the year to achieve immunity,” she said.

Building a public health foundation

Garzon-Villalba said she is very thankful for her team.

“I call them the A-team of public health,” she said. “They are professionals with a lot of knowledge and experience in public health. Our goal is to develop and implement ways to control the pandemic and develop the National Public Health Program for Ecuador.”

She said the pandemic has also greatly impacted the health system in Ecuador, which she said is on the brink of collapsing.

“We are developing a program to help the health system become freer and provide more group health to the population,” she said. “We are focused on providing integral health care to the population and enough medicine and equipment. Also, improving the health care in the whole system is vital because of the pandemic.”

A tool to change the future

“Being in this role is a tool to change public health in my country and to help it get away from the pandemic,” she said. “I had an integral education at USF that allowed me to guide a very strong team to help my country to try and rise from the pandemic—socially and economically. I am very proud of what I am doing and what I can do in the future. I am capable of doing it because of my strong education. This new role is a tool to help people.”

“I am very proud of what I am doing and what I can do in the future. I am capable of doing it because of my strong education.”

Garzon-Villalba said she also could not do her job without the support of her family, which includes her husband and son, who is currently a USF student earning his master’s degree in architecture.

“This is not easy at all. I am working very hard, and I appreciate the support of my family, husband and son,” she said. “I am also very grateful for my advisors Dr. Thomas Bernard and Dr. Aurora Sanchez- Anguiano and many others who played an important part in my learning. I couldn’t be what I am right now without their support.”

Related media:

View a recording of Dr. Garzon-Villalba’s official presentation by Ecuador’s president-elect Mr. Guillermo Lasso here.

Story by Anna Mayor, USF College of Public Health

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The American Society of Tropical Medicine and Hygiene (ASTMH) held its annual meeting recently and USF College of Public Health’s (COPH) Dr. Miguel Reina Ortiz took full part in it.

The ASTMH is the largest international scientific organization of experts that, according to its website, “is dedicated to reducing the worldwide burden of tropical infectious diseases and improving global health.”

Reina Ortiz, a COPH alum and an assistant professor of global health practice and global communicable disease, participated in a variety of events at the meeting, held virtually in November. Some of the events included:

• Presenting research. Reina Ortiz presented a poster aimed at understanding the effect of Hurricane Irma on arboviral transmission in Florida. (Arboviruses are viruses transmitted by mosquitoes, ticks, fleas and other vectors.) “In that research, we observed a spatial and temporal association between meteorological variables associated with Hurricane Irma and transmission of West Nile virus,” Reina Ortiz said. The research was conducted with support of the COPH, including Drs. Ismael Hoare and Ricardo Izurieta and students Daniel Chacreton, Desiree Lara, Sarah Bradley and Astha Kakkad.
• Co-chairing the ASTMH’s Committee on Global Health (ACGH) symposium dealing with pathogens in metagenomics. Metagenomics is the study of genetic material recovered from environmental samples.
• Speaking at a pre-course on modeling for disease outbreaks. Reina Ortiz specifically spoke on modeling COVID-19 in Ecuador and the impact of reversing social distancing measures.

During the meeting, Reina Ortiz was also appointed president of the ASTMH’s ACGH. The ACGH is the largest sub-group of the society, with over 800 members from 63 countries. Its mission is to lead the society in global health thought leadership and engagement. His appointment will run until November 2021.

“Serving the ACGH and ASTMH is a great opportunity to contribute to the development of the global health field and to support the activities of a professional organization I call home,” said Reina Ortiz. “The opportunity to connect with students, fellow researchers and global health practitioners who are equally passionate about addressing pressing global health issues and reducing health-related disparities is fulfilling and encouraging. By promoting a platform for the exchange of state-of-the-art research in global health, tropical medicine and public health, both the ASTMH and ACGH significantly contribute to the advancement of science and to the scientific dialogue in these areas. I am honored and humbled to represent the COPH in my service with the ACGH and ASTMH.”

Story by Donna Campisano, USF College of Public Health

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To reduce the risk of COVID-19 transmission for health care workers and those living in areas of intense transmission, public health practitioners have developed educational flyers outlining COVID-19 biosafety-at-home protocols to reduce the threat of contamination at home.   

“Communication is an important aspect of our work in public health,” said Dr. Miguel Reina Ortiz, assistant professor specializing in global communicable diseases at the USF College of Public Health. “During rapidly evolving situations like COVID-19, the amount of unproven, scientifically inaccurate information that is shared over social media seems to outpace the amount and rate at which scientifically-sound information is shared. In such situations, it is important to convey public health messages in a clear and timely manner to guide the general population.”

Reina, also an alumnus of the COPH earning his PhD in 2015, was part of a team of 12 experts from the U.S. and Latin America consisting of epidemiologists, virologists, infection disease preventionists, and public health practitioners who developed a protocol over 11 iterations. Their final protocol was used to create a biosafety-at-home flyer that was distributed in Ecuador in May, which at the time was Latin America’s COVID-19 hot spot. Since then, the protocol has been distributed in other countries, reaching upwards of 7,000 individuals through social media, websites and email. 

Their manuscript titled “Biosafety at Home: How to Translate Biomedical Laboratory Safety Precautions for Everyday Use in the Context of COVID-19,” has been published in the journal of The American Society of Tropical Medicine and Hygiene. Their goal was to use research laboratory biosafety measures and translate them into something that could be applied within people’s homes to prevent the spread of SARS-CoV-2.

“We assessed what would be the best mechanism to translate biosafety measures that are usually implemented at a research laboratory facility to home or other every-day environments,” Reina Ortiz said. “The focus was on people with high levels of exposure such as those working in certain hospital areas or those living in areas with very high transmission rates.”

Reina Ortiz said this work was important because it provided support to a population who at the time of publication was being devasted by COVID-19.

“COVID-19 has severely impacted the life of millions of people around the world. At the time that this work was done, Ecuador had become a COVID-19 epicenter in Latin America with traumatic scenes such as corpses lying out on the streets of Guayaquil, arguably Ecuador’s largest city and the economic capital of the country,” he said.

The flyer was originally developed in English and translated to Spanish by Spanish-speaking experts in order to address the urgent needs of Ecuador, according to Reina Ortiz.

“This communication product has the potential to help people with high COVID-19 exposure to focus on proven strategies to avoid contamination and spread of SARS-CoV-2,” Reina Ortiz said. “As a result, the impact can be at an individual level (decreasing personal risk) and, potentially, at the population level (decreasing transmission levels from the persons who use the information).”

Reina Ortiz also said that immediately after working on this project, similar needs were reported from colleagues leaving in Portuguese- and French-speaking countries, such as Brazil and France, and that the product is currently being translated to Portuguese and the French edition is being explored.

“Our work shows a way forward to convene experts to develop communication products that were previously non-existent, in a timely fashion during pandemic or emergency events,” Reina Ortiz said.

Story by Anna Mayor, USF College of Public Health

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Dr. Miguel Reina Ortiz, an alumnus and assistant professor in the USF College of Public Health has long held an interest in working to solve the HIV epidemic around the world and specifically in Ecuador, where most of his schooling and education took place. Reina Ortiz continuously conducts various research studies focused on health determinants and health behaviors associated with HIV in minority and vulnerable populations.

In addition to this research, he has a passion for community engagement in the form of education and instructional talks. Recently, he was invited by the Pontificia Universidad Católica del Ecuador-Sede Esmeraldas (PUCESE) as a speaker to discuss the current global, national, and local status of the HIV epidemic in an effort to continue to raise local awareness and knowledge in the fight against HIV.  

Over 150 people attended the presentation, and most of the audience was made up of university students and members of the general public. Reina Ortiz wanted to educate them on the current state of HIV/AIDS in the region to engage on a discussion about effective prevention strategies that adjust to the local realities, where new cases have started to slow in recent years.

“The goal was to provide an overview of global and national characteristics of the HIV epidemic and to create awareness about the current status of HIV in Ecuador and in the Esmeraldas region,” said Reina Ortiz.

Reina Ortiz was also pleasantly surprised by how receptive the audience was to his message and how eager they were to learn about and discuss the topic among their peers.

“The presentation was very well received,” said Reina Ortiz. “An interesting exchange followed, which was not limited to questions to myself, as speaker, but rather a conversation between members of the audience and myself, discussing the current status and reasons behind it.”

It most likely won’t be long before Reina Ortiz is back on a stage presenting on topics related to HIV/AIDS again, as he currently has ongoing research dedicated to the topic. Two of his research projects have been developed in collaboration with Dr. Ricardo Izurieta, professor in COPH, as well as colleagues from Johns Hopkins University and Universidad San Francisco de Quito. These studies focus on how impactful behavioral nudges and financial incentives are increasing HIV testing in Ecuador, and he even hopes to study some of these same topics in the local Tampa Bay area one day.

“In the future, I would like to focus my research on how to improve HIV testing rates and related HIV care activities in Tampa Bay,” said Reina Ortiz. “I am particularly interested in comparing African descendant populations in Ecuador, Latin America and the United States with respect to HIV prevention strategies.”

Story by Cody Brown, USF College of Public Health

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Dr. Miguel Reina Ortiz, an alumnus and assistant professor in the USF College of Public Health (COPH), is following his passion for global health by conducting research on HIV along the Ecuadorian coast.

Along with Dr. Ricardo Izurieta, an associate professor of global health who completed his medical degree in Ecuador, Reina has undertaken a research study focused on HIV in the Esmeraldas region of Ecuador, where nearly half the population is made up of African descendants.

“African descendants are an important but sometimes neglected population subgroup, and local leaders, like Dr. Diogenes Cuero Caicedo [a lawyer], have made significant efforts to rescue the cultural identity and improve life among them,” noted Reina.

The region is thought to have such a high proportion of people with African heritage because of a Spanish shipwreck that occurred around the area during the time of the slave trade. Through the chaos of the event, the slaves were able to free themselves and ended up inhabiting Ecuador.

“Interestingly, the slaves seemed to have developed relationships with local indigenous populations and established La República de los Zambos, probably the first group in the Americas to operate as an entity independent of the Spanish crown,” said Reina.

The scope of his research in the region involves working with other teams to discover important determinants of HIV and HIV-related behaviors within the population.

“[We have found] that the determinants vary according to different sub-populations,” said Reina. “For instance, among men who have sex with men, we found that HIV/syphilis co-infection and syphilis mono-infection were more common among participants who were older, those who had multiple partners, or those who had been forced to have sex in the 30 days prior to the survey.”

With these determinants in mind, Reina works to ensure that his research helps to contribute to the HIV knowledge base of certain leaders and officials within Ecuador, with hopes that they can help solve the epidemic in this region.

“Depending on the specific needs and scale [of the epidemic], either the local district or zone representatives will be involved. But if a national scale-up is required, then the Ministry of Health will be involved,” said Reina.

He hopes this type of research will help develop relationships with officials and lay the foundation for future decisions that benefit those at risk for HIV infection.

“At the moment, our dissemination efforts are focused on publishing papers and providing results at national and international conferences where there is the potential to network with decision makers,” said Reina.

Story by Cody Brown, USF College of Public Health

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USF researchers explore explosion of Zika after the 2016 Ecuadorean earthquake and what it tells us about emergency preparedness

Homes in Ecuador destroyed by the 2016 earthquake. The damage left tens-of-thousands displaced across the country.

On April 16, 2016, a 7.8 magnitude earthquake rocked the South American country of Ecuador. It was the most severe seismic event in nearly 40 years – killing roughly 700 people and displacing more than 70,000.

In the weeks and months that followed, tens-of-thousands of survivors sought access to shelter, food and clean water, with thousands of emergency personnel assisting in rescue and relief efforts across the country. But along with the visible devastation facing those throughout the affected region, another big, but not so obvious problem was quickly spreading.

A new study from researchers at the University of South Florida (USF) College of Public Health shows an alarming connection between this natural disaster and the number of Zika cases in Ecuador. The article, “Post-earthquake Zika virus surge: Disaster and public health threat amid climatic conduciveness,” published last month in Scientific Reports, outlines the explosion of Zika and provides insight into how these disasters can have hidden costs.

“There was clearly a significant increase in the number of Zika cases after the earthquake,” said Miguel Reina Ortiz, PhD, assistant professor in the Department of Global Health. “We also saw that the areas that were most severely affected by the earthquake had the biggest increase in the number of cases of Zika.”

From left, College of Public Health Assistant Professor Miguel Reina Ortiz, PhD, and Assistant Professor Ismael Hoare, PhD, analyze data collected from Ecuador’s Ministry of Public Health.

Reina, along with co-principal investigators Associate Professor Ricardo Izurieta, MD, PhD, and Assistant Professor Ismael Hoare, PhD, collected and analyzed data from Ecuador’s Ministry of Public Health 18 weeks before and after the earthquake. The researchers also incorporated data from numerous sources encompassing earthquake impact, climatic variability and socio-economic factors. They found that the number of Zika cases were 34 times higher after the quake in the most severely impacted regions. In comparison, those areas that were mildly impacted saw their rates of disease nearly double.

“When we see any natural disasters hit, we become intensely focused on helping those affected by the physical impact, such as rescuing people in damaged buildings. That is the priority,” said Hoare. “But, other ancillary programs, like vector control, may not receive similar attention. This data shows the need for those programs is also very important.”

Researchers say while they did not specifically look at the physical conditions that led to the rise in Zika, they are able to make informed hypotheses as to why the explosion occurred. The team points identified structural damage and disruption in water services leading to an accumulation of standing water that favors the breeding of mosquitoes that spread the disease. They also say damage to homes, which might force people to spend more time outdoors, leaves people at a higher risk of exposure to the vectors.

Mosquitoes being studied in a laboratory. (Photo by Eric Younghans, USF Health Communications)

“When there is a disruption in the ecology and infrastructure, these diseases that may not be seen as endemic can suddenly arise,” Izurieta said. “It’s important that we use this data to inform our decision making before and after disasters occur.”

While the study did directly examine the events in Ecuador, researchers believe it can also shed light on the potential risk other regions around the world face, including Florida. Hurricanes, for example, can create similar environmental conditions to what was seen after the earthquake. And, because of Florida’s tropical climate and weather conditions, experts say the emergence of viruses here is possible.

In fact, this year, the Centers for Disease Control and Prevention reported nearly 100 new cases of Zika in Florida. USF researchers say the state’s vector control system, which is one of the best the country, has been successful in keeping the spread of the disease to a minimum. They warn, however, that in the event of a severe natural disaster, an increase in cases is possible, especially if locally transmitted cases are reported right before the disaster.

“For that reason, the message is that a disaster like an earthquake or hurricane can disrupt, not only the environmental and infrastructure conditions, but also place populations at higher risk to acquire all sorts of diseases,” said Izurieta.

Through this research, the USF team has developed a statistical model they hope to apply to other areas experiencing a variety of disasters. The hope is to build a diverse understanding of the issue to be able to better inform policy makers of the importance of maintaining vector control initiatives when disasters strike.

This study was conducted in collaboration with researchers at the USF College of Public Health, the USF Morsani College of Medicine, the Ministry of Public Health of Ecuador, the Universidad San Francisco de Quito in Ecuador, the James A. Haley Veterans’ Hospital and the Baylor College of Medicine.

Story by Aaron Hilf. Photos by Ryan Noon. Reposted from USF Health News

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The intersection of social justice and global health has always been a calling for USF College of Public Health alumna Dr. Erika Arteaga-Cruz.

In her role as the health projects officer for the Belgium Socialist Party Cooperation for Development-NGO in Quito, Ecuador, she fulfills her public health passion of working with indigenous groups and women organizations to advocate for health rights.

“It is a job that gives freedom to pursue social justice and not just a technical position [behind] a desk,” she said.

USF COPH alumna Dr. Erika Arteaga-Cruz. (Photo courtesy of Arteaga-Cruz)

Fos, the Belgium Socialist Party for solidarity NGO, promotes the right to social protection in health for the population of Ecuador through dialogue, debate and community engagement, according to Arteaga-Cruz.

As the health projects officer, Arteaga-Cruz designs, monitors and evaluates programs in Ecuador regarding the right to health, gender and citizenship partnership.

She also analyzes and drafts proposals regarding the social determinants of health—skills she said she started acquiring while earning her MPH from the COPH’s Department of Global Health in 2007 as a Fulbright Scholar and while pursuing her doctoral degree at the Universidad Andina Simón Bolívar with Jaime Breilh.

Arteaga-Cruz said working with social movements and the ability to work closely with the indigenous movement in Ecuador is what attracted her most to this position.

“During my med school years, community health was a favorite subject and activities in rural communities were important,” she said. “Growing up with a dentist father involved in medical campaigns and brigades to indigenous or rural areas of the country, I developed a social sensitivity toward unfair distribution of resources made public health—collective health—a better choice for later development of the medical career.”

Working among the community is something that has always been close to Arteaga-Cruz, who also holds a medical degree from Ecuador’s Universidad San Francisco de Quito.

Her position frequently sends her across Central America and the Andean region to push for social medicine across Latin America.

Arteaga is frequently invited as a guest speaker advocating for health rights in Latin America. (Photo courtesy of Arteaga-Cruz)

Next month she’s traveling to Chiapas, Mexico to conduct a presentation on her research regarding the indigenous health practices of ‘parteras,’ midwives, in the Cotacachi and Imbabura regions of Ecuador.

“Health is a different practice [in Cotacachi and Imbabura] that includes the sacred connection with the territories,” she said.

Arteaga-Cruz said her time at the COPH and with the applied anthropology department at USF equipped her with the project management, focus group methodology skills and qualitative data collection abilities she uses daily with the indigenous groups she interacts among.

“Living in the U.S. gave me another perspective of how social justice could be achieved also in wealthy countries where injustice also exists and people who do not have anything at all are being exploited by those who accumulate capital,” Arteaga-Cruz said.

Arteaga-Cruz has also served with Aliméntate Ecuador Program (Feed Ecuador Program), European Union in Ecuador, Health Secretary of the Quito metropolitan district, and Social Medicine Latin-American Association (ALAMES). She’s an active board member of the Center for Economic and Social Rights.

Her article, “Good Living (Sumak Kawsay): definitions, critique and implications for development planning in Ecuador,” is on press in the Brazilian Center of Health Studies (CEBES) journal examining the health development model and progressive governmental roles.

She credits the COPH for giving her some of her first glimpses to better understanding the health needs of the community and also acknowledges that one of the main challenges of being a student was also being a mom and a student simultaneously.

Arteaga-Cruz said part of her MPH completion was done due to the support of the father of her children and that she greatly admires Dr. Melody Schiaffino, an alumna of USF, who went ahead and created ‘PhD Moms’ as a support mechanism for single moms to study advanced degrees in Florida.

“My passion is understanding other health views,” she said. “As Virchow said: ‘Medicine is a social science and politics nothing but medicine at a larger scale.’ Thus, ill health and its root causes lies in the unequal distribution of resources worldwide.”

***

COPH Alumni Fast Five:

What did you dream of becoming when you were young?

Artist / painter.

Where would we find you on the weekend?

Yoga / walking around water to recharge – connect / Full Moon- women’s circles celebration.

What is the last book you read? 

“Dos veces única” by Elena Poniatowska  (Latinamerican novel about the first wife of Diego Rivera and the cultural ambience of Mexico back then).

“Change the World Without Taking Power” by John Holloway.

What superpower would you like to have?

Compassion (inspired by the Dalai Lama).

What’s your all-time favorite movie?

“Star Wars” (IV- V- VI).

Story by Anna Mayor, USF College of Public Health

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Researchers at the USF College of Public Health have begun exploratory research examining HIV/AIDS in indigenous populations in Ecuador, Panama and Belize.

Using syndemic theory as their lens, they are investigating factors impacting the spread of HIV/AIDS in each community, according to principle investigator Dr. Dinorah Martinez-Tyson, assistant professor in the Department of Community and Family Health (CFH).

“It’s looking at the interaction or the synergy between multiple factors, such as poverty, food insecurity, drug and alcohol use, all these things, and how they sort of influence each other to possibly create the perfect storm for the spread of HIV,” Martinez-Tyson said.

Dr. Martinez-Tyson (seated at the head of the table) sits with a focus group among a Kichwa community in Ecuador. (Photo courtesy of Dina Martinez-Tyson)

The research, funded by an internal COPH grant, is a multidisciplinary research effort involving faculty from the Departments of CFH and Global Health. Dr. Julie Baldwin, affiliate professor in CFH, served as the original visionary and principle investigator for the project, according to Martinez-Tyson.

Dr. Arlene Calvo, assistant professor in CFH, has been examining the Ngäbe-Buglé in Panama.

She said this population, living in extreme poverty, has seen a dramatic increase in the number of patients going to receive HIV care.

“It has been all over the news here in Panama,” Calvo said. “They have been identifying new cases in the past two years. At the antiretroviral clinic they went from having 30 patients to over 500 patients in less than a year. These are the cases that are identified. We know that there are more cases, we just don’t know how many.”

Members of the Ngäbe-Buglé community advisory committee in Panama with doctoral student and research team member, Dr. Arturo Rebollon (second row) and Dr. Arlene Calvo (third row, far right). (Photo courtesy of Arlene Calvo)

Drs. Miguel Reina and Ricardo Izurieta, from Global Health, and Drs. Dina Martinez Tyson and Dr. Lauri Wright, from Community and Family Health, worked with a Kichwa community in Ecuador.

“The way the communities received us was very positive,” Reina said. “They were very happy to have us there and were very collaborative.”

Through focus groups and key informant interviews with community stakeholders, researchers spoke to both men and women of varying age groups, asking them a variety of questions on topics such as domestic violence, nutrition, and drug and alcohol use.

A poster from a focus group discussion with the Kichwa population in Ecuador. (Photo courtesy of Shirley Bejarano)

“They were so open,” Martinez-Tyson said. “A couple of focus groups were thanking us because they told us no one has ever asked them these questions and that they were able to communicate issues about things they really didn’t think were issues but they realized now that they should do something about.”

Dr. Ismael Hoare, assistant professor in Global Health, and Dr. Martha Coulter, professor in Community and Family Health, focused on multiple indigenous groups in Belize, including the Maya, both Quetchi and Mopan communities, and the Garifuna and Kriol populations.

They concentrated their efforts in Belize on establishing contact with a community that had no prior established relationships.

“We had to do the ground work in organizing and setting up a network of individuals who would inform our research and who would be able to assist us,” Hoare said.

Hoare and Coulter worked together to establish the community advisory board, planning interviews and key informant interviews with stakeholders in the Mayan community. Their next step will be focus groups with the community.

An event on World AIDS Day in Belize with a focus on both AIDS and violence. (Photo courtesy of Martha Coulter)

“They were extremely receptive,” Coulter said. “This is a very small rural southern town in Belize and the concerns of the people there, particularly the political structure there, is that the government in Belize has given more resources to the more populated areas. So, they were very enthusiastic about the possibility of getting more data to support the need for more resources in this more rural population.”

Coulter said having Hoare’s presence made establishing connections smoother, given his prior faculty experience at the University of Belize.

“It’s a really small community, so people need to trust you and make sure they know exactly what you’re doing and why and that there will be outcomes that will be helpful to them,” Coulter said. “We were fortunate in that the mayor and some of the other people in the community really feel like it’s important to get the word to the central government in Belize that they need more resources.”

Izurieta said a unique aspect of this research was its integrative approach.

“There were four key pillars in this multidisciplinary approach,” he said. “The integration of academia with the community, integration between COPH departments, integration between USF and international institutions, and the integration of faculty and students.”

Dr. Martinez-Tyson (second on left), Dr. Miguel Reina (fourth on right) and Dr. Ricardo Izurieta (first on right) also met with key leaders and academic partners in each country as part of the research process. Also in the picture: Vanessa Chee (doctoral student, CFH; first left), Isabel Hernández (Ecuador’s research team; third left), Shirley Bejarano (MPH student, HPM; third right), and Dr. Enrique Terán (Ecuador’s research team; second right). (Photo courtesy of Dinorah Martinez-Tyson).

As an epidemiologist, Izurieta said it put him front and center with new ways of collecting data and brought to his attention the impact the research was having on the community.

“These indigenous communities have been neglected in terms of their access to healthcare services,” he said. “One of the indicators that caught my attention was we observed that there was more cases of AIDS in relation to the cases of HIV reported. For me, as an infectious disease epidemiologist, that was alarming. Indigenous people infected with HIV were arriving at the last stages of the disease and when we tried to see what was going on with these communities, I tried to find information, and we didn’t have any. So, that was our intention, to see what was going on with these populations.”

Shirley Bejarano, a COPH graduate student in the Department of Health Policy and Management who assisted in the research, said one of her top priorities when enrolling in the master’s program was to learn to conduct qualitative research, a skill she honed while assisting with the research in Ecuador.

Researchers traveled through small towns to reach the indigenous communities in more rural areas. This is a photo taken in Ecuador. (Photo courtesy of Shirley Bejarano)

“Every aspect of my involvement with the research captivated me. It was incredible to learn about conducting qualitative research first hand, simultaneously learning and putting it into action,” she said. “Secondly, spending time with individuals from the indigenous community, learning about their culture, and creating rapport with them was a remarkable experience. Third, I had a wonderful time working with the entire Ecuador research team. My research experience in Ecuador was phenomenal, it encompassed everything I wanted to learn and practice.”

Martinez -Tyson said she was thankful to the College for providing this opportunity, as it allowed her to work cross-departmentally on an issue that is experienced worldwide.

“HIV knows no boundaries, it crosses state lines, country lines,” she said. “I would not have had the opportunity to work with colleagues outside of my department if it was not for this grant. From an academic, career development perspective that has been invaluable for me.”

The year-long research is close to wrapping up and researchers aim to start data analysis in the next phase.

Following data analysis, researchers said they hope to move forward with developing interventions.

Agricultural fields in Ecuador. (Photo courtesy of Shirley Bejarano)

“The results we are going to get from this will enable the different countries with developing interventions for HIV prevention, nutrition and intimate partner violence that are respectful to the culture and the society’s we’re working with and that are relevant to them,” Calvo said.

Reina said while it was a challenge to coordinate working in three different locations with three different researchers and IRB approvals, they managed to coordinate and balance it all.

“Overall, it was a very successful and positive experience. We have achieved what we set out to do. I think that’s an important value of this research,” Reina said. “We have communities from these different countries. They are all indigenous; they are similar but are also different. So, it’s going to be interesting to see the results and see how much geographic location will impact the similarities or differences.”

The researchers would also like to extend thanks to the following collaborators who assisted with their research endeavors:

Belize

Community Advisory Group:
Dr. Phillip Morgan, University of Belize
Mr. Roy Polonio, University of Belize
Pastor Lorna Sampson, Community Activist
Mrs. Pulcheria Teul, Women’s Issues Consultant
Mrs. Lorraine Johnson, Women’s Department, Punta Gorda
Mayor Fern Gutierrez, Punta Gorda Town Board
Ms. Christina Coc, Maya Alliance
Mrs. Celia Mahung, TIDE
Mrs. Froyla Tzalam, SATIIM
Ms. Mavis Ogaldez, Community member

Ecuador

Enrique Teran
Isabel Hernandez
Mercedes Flores
Nestor Yamberla
All the community members from Iluman and Cotacachi

Panama

Community Advisory Board:
Vielka Amador
Alejandrina Acosta
Victoriano Amador
Bernardo Pascacio
Valentín Gallardo
Marquelin Gallardo
Mario Caballero
Maribel Caballero
Marino Gallardo

Community Liaison:
Rosmery Pascacio

Research Team:
Dr. Arlene Calvo
Dr. Arturo Rebollón
Natalia Vega

Story by Anna Mayor, USF College of Public Health.

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