We need to view ourselves as citizens of a planet
The growing emphasis on global health is a boon not only to the developing world. It also can benefit the richest nation on Earth.
Collaborative studies in Colombia, for example, are yielding insights that may improve the care of premature infants in the United States, says Mario Rojas, M.D., assistant professor of Pediatrics at Vanderbilt University Medical Center.
Two years later, with the help of the International Clinical Epidemiology Network and private industry, they launched their first study, a comparison of different technologies for ventilating infants with respiratory failure. It was the first randomized, controlled, multi-center trial in neonatology conducted in the country.
Colombia’s infant mortality rate is about 20 deaths per 1,000 live births—three times the rate in the United States. Lack of services to support premature babies is a major reason.
Rojas and Lozano decided to evaluate high-frequency oscillatory ventilation (HFOV), an expensive technology that some studies had concluded was superior to conventional ventilation. Was it worth the investment of Colombia’s already limited healthcare resources?
To find out, they had to ensure that ventilation was performed in precisely the same way in each of the five participating intensive care nurseries.
“They all had different protocols for management (of respiratory failure) and outcomes varied significantly between them,” Rojas says. “So the great challenge was trying to get all of these medical centers and physicians to sit down together and… agree to do the same thing.”
Lack of standardization also plagues multi-center trials in the United States, but Rojas, who at the time was on the faculty at the University of North Carolina at Chapel Hill, says he and Lozano weren’t discouraged by the enormity of their task.
“We felt if we were able to put everything together,” he says, “we would be able to do many other studies.”
And so they did. Results from the four-year-long study, published last year, showed that when conventional therapy is standardized, outcomes are just as good as those obtained from HFOV. This was good news for financially-strapped countries.
Since then, the researchers have studied the use of prophylactic surfactant and nasal continuous positive airway pressure as a way to decrease the need for intubation and mechanical ventilation, and hospital-acquired infections in seriously ill newborns. They’re currently seeking funding to study whether probiotics, “friendly” bacteria that colonize the gut, can prevent such infections.
These studies “may have a significant impact on health care in the United States,” Rojas maintains. That’s why, he says, “We need to work together…
“We need to view ourselves not only as citizens of a country… (but) as citizens of a planet.”
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