Africa State Partnership Program Highlights Global Health Advancements and Reciprocal Learning

The UNC Institute for Global Health and Infectious Diseases welcomed the N.C. National Guard, with Malawian and Zambian military delegates and civilians to UNC-Chapel Hill on July 23 for a global health program, recognizing long-standing country partnerships that have advanced vital research and improved the health and wellbeing of African citizens. The visit was part a week-long event known as “Operation Tar Heel Welcome,” to celebrate newly signed Africa State Partnerships with the North Carolina National Guard (NCNG) and N.C. State Government. The NCNG was awarded two of the state partnerships based on UNC’s extensive global health research, training and service, in Malawi (30+ years) and Zambia (15+ years). Video recordings of the program can be found here: Part 1 – Africa State Partnerships and Part 2 – Africa State Partnerships. 

Welcome from Dr. Myron Cohen

“We’ve never had an opportunity to work with the N.C. National Guard and certainly never had so many dignitaries from Malawi, Zambia and Botswana with us. And we are thrilled about this opportunity to expand relationships. The Institute is important because we’re a state organization. Like a province, we are concerned about the global implications of our work which appeals and applies to the state as well. Our work is just as important for the people of North Carolina as the people of Lilongwe, Malawi.”

Telepathology Using Digital Microscopy

“The first person you’ll hear from today is Dr. Amy Brownlee with an entirely unique pathology program in Malawi that I think will please and surprise you. It started with very few physicians and no pathologists. And as you know, if you have a tumor or something seriously wrong, the tissue becomes critical.

“UNC built a pathology building on the grounds of the Kamuzu Central Hospital, and after developing with the help of the hospital and Director Dr. Jonathan Ngoma, the country decided to build their National Cancer Center right next to this building. Then, in 2019, UNC pathologists began reading slides. And so what happened was we bought a microscope that you’re going to see, called an imperial microscope, and our faculty and students here read the slides in Malawi with the now pathologists in Malawi. This is an entirely unique program in the world of global pathology and we’re very proud of it.

“Instead of just studying blood cancers, we’re now studying breast cancer, pediatric cancer, esophageal cancer and cervical cancer, and have expanded services to surgery and palliative care, and we’re even building radiation oncology facilities. Malawian pathologists, who were trained in South Africa, came back to Malawi to practice because there was infrastructure for them to have a job. And now, because of these pathology services, Dr. Tamiwe Tomoka is developing her own training program for pathologists in Malawi, and a collaboration between Malawi and UNC provides reciprocal learning.”

With a colleague who was in Malawi, Dr. Amy Brownlee demonstrated a real-time telepathology reading for a cancer patient.

“It’s amazing what having just one pathology laboratory can do for cancer care in this part of the world,” Dr. Bownlee said. “This kind of collaboration is entirely unique and would be impossible without the leadership of the Malawi government.” 

Technology To Improve Obstetrical Outcomes 

Dr. Cohen then introduced Dr. Jeff Stringer, “the director of our Global Women’s Health program, one of the largest in the US, if not the largest. He lived in Lusaka, Zambia, between 2001 and 2012, co-founding the Centre for Infectious Disease Research in Zambia (CIDRZ).”

“This image (right) depicts the central interaction that we’re really concerned with—the pregnant patient and the provider,” Dr. Stringer said. “What you see is a midwife, who will determine gestation. She has lots of tools, which work fine unless there are complications, like placenta previa or twins, at which time an ultrasound is needed.”

But there are not enough ultrasound machines, not enough trained sonographers, and not enough expert interpreters. Dr. Stringer has been working for the last decade on a revolutionary point-of-care handheld ultrasound device that can be used anywhere in the world. During the program, he demonstrated how a deep-learning AI model can estimate gestational age. He also emphasized that the device would not replace a diagnosis, but could be used as a screening tool to identify high-risk pregnancies. 

“Our research shows that in all cases, the diagnoses can be determined just as well as human beings. Dr. Margaret Kasaro has received a grant from Helmesley Foundation to build a team that will train midwives at four to five sites in Lusaka. The idea is to develop a policy environment that can facilitate a country-wide roll out.”

“We see this absolutely universal to the United States and other countries. In North Carolina, we have patients who have to travel hours to get a scan, depending on where they live.”

Vector-Borne Disease

“Ticks are sort of the new frontier in vector-borne diseases, increasingly recognized as a threat to human and animal health,” said Dr. Ross Boyce.

“When a tick attaches, it uses a local anesthesia and an immune suppressant at the bite so that you don’t know you’ve been bitten. This allows it to stay attached for up to 10 days, which makes ticks really good at transmitting disease because we don’t realize when one is attached.

“Some tick diseases we might have in common include Spotted Fever Rickettsioses, like Rocky Mountain Spotted Fever, which is deadly. Others are less fatal including African Tick-Bite Fever, and Rickettsia Parkeri, which leaves a scab, causes a mild fever and headache. The Crimean-Congo haemorrhagic fever has the largest distribution of any vector-borne except for Dengue Fever. And then there’s the Alpha-Gal Syndrome, an allergy caused by a tick bite that results in intolerance related to red meat, with a variety of symptoms. Some are mild symptoms that are harder to recognize, like fatigue, joint aches, and the inability to think clearly. From a military standpoint, this is something we’re concerned about.”

We have military bases in our state, we have ticks, and we know from studies in Johnston County that out of 400 people tested, 60 had exposures to alpha-gal, and we estimate that 15-20% of the population has been exposed to this from tick bites. But if 15-20% of your soldiers can’t eat red meat, and are fatigued, with nausea or diarrhea, this can certainly impact their readiness.”

Emerging Pathogens and Regional Expertise in Civilian Biodefense

Dr. William Fischer led the final part of the program, acknowledging the need for preparedness as the outbreaks of severe emerging infectious diseases increase.

“We have a responsibility to build global partnerships to enhance preparedness. With UNC Project-Liberia, we’re shifting our model from crisis response to integrated cycles of preparedness,” Dr. Fischer explained.

“A diagnostic laboratory will help us improve both diagnostics and surveillance, but it will also help us provide better clinical chemistries in hematology to support clinical care of patients. We’re using this infrastructure to better understand pathogens like Ebola. As Dr. Cohen says, it’s about understanding the rules of the virus, understanding not only how high and fast it can replicate, but also what compartments it can replicate in. This is really important when we talk about Ebola and semen and the potential for sexual transmission and how we think about therapeutics that can not only clear the virus from the blood, but also clear it from other compartments in the body. 

“We often think viruses emerge in tropical regions, but the reality is that they emerge and circulate everywhere. H5N1 is a really important example of how we’re seeing unprecedented circulation across the U.S. right now, both in domestic fowl as well as mammals, with the first ever documented transmission from bovine to humans, which really represents, I think, an important threat.

“Our expertise recently led to UNC Hospitals becoming a designated treatment center for patients with highly infectious diseases. UNC and Emory University are the only two Regional Emerging Special Pathogen Treatment Centers in the Southeast, serving as hubs of a larger umbrella of the National Special Pathogen Response System.”

Watch the recorded program here: Part 1 – Africa State Partnerships and Part 2 – Africa State Partnerships.

The U.S. National Guard’s State Partnership Program (SPP) fosters enduring relationships between states, both domestically and internationally. These programs involve the pairing of a U.S. state’s National Guard with the military forces of a partner nation. Through joint training exercises, exchanges of personnel, and collaborative initiatives, state partnership programs facilitate the sharing of knowledge, expertise, and resources. 

About the UNC Institute for Global Health and Infectious Diseases

The UNC Institute for Global Health and Infectious Diseases (IGHID) at the UNC School of Medicine is an engine for global health research and pan-university collaboration, transforming health in North Carolina and around the world. Our work started over 30 years ago with infectious disease physician-researchers studying HIV in China and Malawi, and soon expanded to nearly 50 countries, operating as the UNC Center for Infectious Diseases. In 2007, the Institute for Global Health and Infectious Diseases was officially established to strengthen UNC’s interdisciplinary research and build on historic strengths in medicine and public health. Through the years, our work has saved millions of lives and shaped policy through evidence-based research around the world, particularly in the areas of HIV and Malaria. Today, the Institute facilitates research excellence and nurtures emerging scientists to advance patient care and practice, to address the most important global health issues of our time–through research, training and service.