Dr. Keith Fowke and Dr. Mario Pinto with patient cohort at Nairobi research clinic.

Today, UM research in Kenya includes two major inter-related Rady Faculty of Health Sciences programs led by Keith Fowke, Department Head of Medical Microbiology and Infectious Diseases and James Blanchard, Executive Director of the Institute for Global Public Health. Responding to a need for public health advocacy from UM research partners in Kenya, Global Public Health programs expanded to Kenya in 2008 as an extension of successful projects originally started in India.

“Our programs in Kenya are a unique example of how laboratory-based researchers interested in molecules and cells are collaborating with researchers studying issues of stigmatization and together they make meaningful impacts for marginalized people,” said Keith Fowke.

As researchers began working with marginalized patient cohorts, increased need for community-based supports emerged, informing new programs developed by UM researchers Dr. Souradet Shaw Canada Research Chair (CRC) in Program Sciences & Global Public Health, Dr. Marissa Becker, Dr. Lisa Lazarus, Dr. Lisa Avery, Dr. Joshua Kimani, Dr. Larry Gelmon, Dr. Lyle McKinnon, Dr. Julie Lajoie, Dr. Leigh McClarty, Dr. Jason Kindrachuk CRC in Molecular Pathogenesis of Emerging and Re-Emerging Viruses and Dr. Rob Lorway, CRC in Global Intervention Politics and Social Transformation,. 

“When I first came to Kenya in 2009 there was a group of young men who were starting to attend clinics established for female sex workers, many of whom identified as gay and bisexual, which is criminalized in Kenya,” said Rob Lorway. “Some were young students, and some were older or married, but what was important is that they had a high HIV prevalence. They came to us because we provided safe spaces from Kenya’s public healthcare system that can be, at times, quite judgmental.”

A legacy of evidence-based support & patient directed research

Four decades ago in the early 1980s, after eradicating an outbreak of the sexually transmitted infection Chancroid in Manitoba, Dr. Allan Ronald was recruited to lead a similar program with the Department of Medical Microbiology at the University of Nairobi, Kenya. Dr. Francis Plummer, then an infectious disease fellow on Ronald’s team studying with a group of sex-workers, would gain global renown for the discovery of a link between the spread of sexually transmitted diseases and the emerging HIV/AIDS epidemic.

Among the patient cohort exposed to HIV/AIDS, Plummer and his team identified a group of women with a natural immunity to HIV-1, the virus that leads to AIDS. Over the following 17 years UM researchers, including Fowke, studied the immune system of these women leading to new approaches to HIV prevention. The women participating in the study had contributed to saving and improving the lives of tens of millions of people living with HIV around the world but continued to live a criminalized lifestyle at the fringes of society.

Dr Elizabeth Ngugi, a local public health nurse working with Plummer in managing the patient cohort in the 1980s and ‘90s, recognized the adversity these women and others like them endured each day. Through advocacy, a new patient-directed research model was developed to foreground the needs and voices of patients as fully recognized research partners, rather than research subjects.

Keith Fowke, who was a graduate student at UM labs in Kenya at that time, recalls of Dr. Ngugi, “she was a very direct and clear-thinking woman. Beginning in 1984, Dr. Ngugi developed a peer educator model to train sex workers and support them as informed and educated leaders within the community. Dr. Ngugi’s influence has been global and has resulted in a deep 40-year relationship with this community which has now evolved into the Sex Worker Outreach Program (SWOP) which has been adopted as a best-practice model by the World Health Organization, UN AIDS and countless others.”

Dr. Julie Lajoie (second from left), Dr. Mario Pinto, Joyce Adhiambo (pictured in SWOP t-shirt) and Dr. Keith Fowke pictured here.

Now in 2024, UM infectious disease research in Nairobi encompasses 10 SWOP clinics providing HIV prevention and care services to more than 30,000 female sex workers, about 9000 men who have sex with men and close to 1500 transgender individuals. Supported by Joshua Kimani and Larry Gelman who follows in the legacy left by Dr. Ngugi, some patient partners are now respected community organizers like Joyce Odhiambo with SWOP Ambassadors, who presented to EU Parliament in Brussels in 2018.

Current clinical programs funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) deliver HIV care and prevention services. However, due to the criminal status of sex work and homosexuality in Kenya, the mere presence of HIV medications or even condoms could provoke harassment or police response.

Members of the patient cohort meet at a Nairobi health clinic.

“In Kenya 4% of the general population is infected with HIV, and in sex workers it’s about 28%,” said Fowke. “Despite these high risks, many women in our cohort choose not to take anti-HIV drugs to prevent infection because of the stigma resulting from their association with being used to treat HIV infection. We are working on providing new approaches to HIV prevention that would be acceptable to these women, including the anti-inflammatory drug, aspirin, which may prevent the immune cell HIV infects from entering the vaginal mucosal environment thereby preventing infection.”

Community empowerment through global public health research

Members of the male patient cohort meet with Dr. Keith Fowke and Dr. Mario Pinto.

“We’re talking about marginalized and stigmatized people, whose lives and livelihoods are criminalized,” said Lorway. “Within the first year of our program 12% of men who have sex with men who originally tested negative for HIV were testing positive. So, despite clinicians doing everything they could at the time – providing risk reduction counseling, supplying condoms and lubricant – HIV infection was growing among these men in our cohort.”

Tourism in Kenya has influenced hotspots where gay and bisexual men can congregate and celebrate themselves. By mapping these hotspots, the Global Public Health team have provided local clinicians and community organizations the ability to establish program catchments and generate their own accurate community health data to inform program coverage targets that guide the funding priorities of donors and the Government of Kenya. Furthermore, by providing training to community leaders so that they can cultivate their own research agenda, now community leaders are coming to Lorway and the team for support with their own investigations.

These expanding partnerships have paved the way for organizations like SWOP Ambassadors, who provides legal aid training and support to sex workers and engages with police to ensure that the right to access healthcare services is respected. The internationally-funded community based organization, HOYMAS (Health Options for Young Men on HIV, AIDS, and Sexually transmitted infections) has now established a clinic in Nairobi which guarantees non-discriminatory care and runs anti-stigma campaigns focused on sexual health and human rights advocacy.

“The shifting scope of Global Public Health research in Kenya is a strong sign of transformational success,” said Mario Pinto, Vice-President (Research and International). “The work of these dedicated researchers and clinicians to advance health as a human right has empowered these underserved communities, not just in self-advocacy, but as entrepreneurs and leaders in their field on the international stage. We know that when people of sexual minorities live free of harassment and stigmatization, they are more likely to access life-saving medical care and be their authentic selves.”

CFI-Funded laboratory provides much-needed sex worker outreach programs

Dr. Keith Fowke and Dr. Mario Pinto pictured with Dr. Julius Oyugi, Director of the University of Nairobi Institute for Tropical and Infectious Diseases

In Kenya, UM has partnered with the University of Nairobi to build a Canada Foundation for Innovation funded lab on their campus and has now developed 10 different SWOP clinics across the city as part of ongoing sex worker outreach programs. “When we first started this program, there wasn’t much medical research infrastructure in Kenya, now I’m supervising Kenyan PhD students doing cutting edge research projects without having to leave their country and we are able to hire all staff locally through with grants available to African institutions,” said Keith Fowke.

Decades of results in overcoming epidemics and securing international funding from partners including Bill & Melinda Gates Foundation and the Global Fund to Fight AIDS has helped to foster good relationships with government. health officials have signaled a willingness to collaborate on efforts to prevent an emerging epidemic of anal cancer among men who have sex with other men resulting from the sexually transmitted infection HPV.

“We have begun addressing an epidemic of cervical cancer resulting from HPV among female sex workers, but a different approach is needed to provide care for men who have sex with men,” said Lorway. “Hate speech almost constantly enters the political theatre during times of economic disruption like the COVID-19 pandemic, so it’s often about quiet negotiations with health official — which can be frustrating because of the urgent need for care. Working with our local partners we’ve established new provisions for anal health care for men who have sex with men. Although working in such a prohibitive political climate can be challenging, these partnerships provide the room we need to discretely develop programs without provoking a negative public reaction.”

Research impacts at home in Manitoba

Joyce Adhiambo (left) and Victoria Were (right)

“There is a presumption that access to care and sex worker support programs are less advanced in the global south. However, in Canada, by criminalizing the clients, we push sex works even further underground,” said Lorway. “Criminalizing sex work makes it extremely difficult to deliver health services. In this case we have something to learn from our work in Kenya about how to provide services to those who are hardest to reach.”

Leading the way in sex work advocacy in Manitoba is the Sex Workers of Winnipeg Action Coalition (SWWAC)  who are partnering with UM infectious disease expert Julie Lajoie, to facilitate an ongoing information exchange between the sex worker communities in Nairobi and Winnipeg. Two community leaders came to Winnipeg in 2022 to discuss their role as grant co-applicants and to share strategies on getting organized in the face of criminalization and public stigma.

“In Canada, we have a parallel issue of Missing and Murdered Indigenous Women, and tragically, there are commonalities in the experiences of marginalized people on both sides of the ocean,” said Keith Fowke. “In Manitoba we’re at least a decade behind African programs in HIV prevention approaches. There are more new cases of HIV in Manitoba this year than in epidemic of the 1980s and ‘90s, and it’s mainly among women in indigenous communities.  We need to adapt global best-practices to prevent infections in Manitoba.”

The Winnipeg-based community resource center Sunshine House is leading the way in Manitoba by offering HIV and sexually transmitted disease testing services and have held a Science + Supper, often featuring presentations from UM Faculty members.

“Programs like those offered at Sunshine House, SWWAC and SWOP Ambassadors are foundational,” said Lorway. “Something we as researchers can always work toward is the de-monopolization of science, to put the power to make change into the hands of those who most urgently need it.”

McClarty didn’t always know exactly what she wanted to do, but she has always had an interest in public health and health care. When she finished her undergraduate degree in microbiology, she began looking for opportunities at the Rady Faculty of Health Sciences’ Institute for Global Public Health. After completing her master’s and PhD, she is now a postdoctoral fellow.

What has been the most interesting finding in your research to date? What are you most proud of?

In my PhD, I was working on understanding equity and HIV care in Manitoba. We found all sorts of inequities in care. My work was some of the first to explore that stuff in Manitoba. It’s really set a foundation for continuing to do work around HIV in Manitoba, not only care but also prevention. The community of researchers focusing on HIV and other STIs in Winnipeg is really growing and it’s exciting for me to see.

A lot of your research focuses on HIV. What is it about HIV that makes you want to study it?

HIV and STIs are interesting because they’re social. I like to focus, not only on the virus, but thinking about people and how they interact with the pathogen and each other. For example, HIV has been well studied for 40 years and we are still struggling with people experiencing stigma around it. I think that is a really important reason to study it.

What has been most rewarding during your postdoctoral fellowship? How has COVID affected it?

We have funding from the Bill and Melinda Gates Foundation to bring together leading experts in global health policy and research programming to discuss and advance Program Science, which is essentially an approach that uses embedded research and learning to optimize public health programming to improve health outcomes and equity. Our work is specifically focused on HIV and other STIs but can be applied to other areas.

Because of COVID, we’ve only met online. There’s some intangible aspect to Zoom meetings that is not conducive to the same kind of brainstorming and collective thinking as in-person meetings. We are really hoping to meet in person in the spring.

You’ve done your undergrad, masters and now PhD at UM. What is it about UM that has made you want to stay?

A few things. I really love Winnipeg. I think it’s just the best city ever and most of my family is here.

The other reason is I really believe in the approach we take to research at the Institute for Global Public Health. The research is very much grounded in public health programming and making sure the research we are doing is able to be applied in important programmatic contexts. Once I realized I wanted to stay in global health and work in HIV and STI research, the Institute for Global Health just felt like the right place to do that because I felt like the values really aligned with mine.

Do you have any mentors and if so what role did they play in your studies and career path?

Dr Marissa Becker has been a significant mentor for me. I’ve been with her since my master’s. It’s too hard to leave her, she’s wonderful. She has provided a safe and supportive learning environment but still challenges me at all the right moments.

Dr Sharon Bruce, head of community health sciences, has been incredibly important to me in terms of how I think as a researcher. She has really taught me how to think critically and how to question and challenge things in my research.

I’m really lucky that they both happen to be women!

Once you complete your postdoctoral fellowship, what are your plans?

I don’t know! The only solid thing I can say is I want to continue doing applied research that works towards equity in health. I think it’s better to make sure I’m working in nice supportive places that push me to learn and grow as a researcher and person.

Two additional professors had their Canada Research Chairs renewed by the Government of Canada: Distinguished Professor David Barber (environment and geography) and Debbie Kelly (psychology).

“I congratulate these three researchers on their success in receiving these funds,” says Digvir S. Jayas, Vice-President (Research and International) and Distinguished Professor at the University of Manitoba. “They are all recognized leaders in their fields, having an impact on our understanding of factors affecting how we age, how we address global health challenges, and our changing climate.”

These CRCs will receive a total of $3.3 million in funding over the next seven years. Blanchard is the recipient of a new Tier 1 chair ($1.4 million over seven years). He previously held a Tier 2 chair which expired in December 2014.

Barber holds a Tier 1 CRC in Arctic System Science ($1.4 million over seven years). Barber’s research has defined the principal causes of Arctic climate change [the loss of an average of 70,000 km2 of multiyear sea ice per year over the past three decades; over 80 per cent of the pre-1970 total], with regional interrogation of the inherent spatial and temporal scales of change. His research has also elaborated numerous consequences of this change on the Arctic marine system in terms of ecology, biogeochemical impacts, industrial development, Inuit Traditional lifestyles and teleconnected impacts to temperate parts of our planet.

Kelly holds a Tier 2 CRC in Comparative Cognition ($500,000 over five years). Her research focuses on the age-related decline in our cognitive abilities, particularly the ability to remember important locations. We know that all parts of the brain do not age at a constant rate, which results in some abilities showing earlier age-related degeneration compared to others. Animal models of aging permit us to examine the aging process under controlled conditions, allowing us to clearly differentiate between healthy aging and diseased aging – such as Alzheimer’s disease. Kelly uses an avian model, which presents a unique opportunity to study the two brain hemispheres independently, to better understand cognitive aging.

There are currently 37 CRCs at the University of Manitoba.

President and Vice-Chancellor David Barnard addressed the group, introduced everyone to Front and Centre: the Campaign for the University of Manitoba, and invited a number of distinguished guests to share their stories.

“I could provide countless examples of U of M trailblazers who are changing the world of business, contributing to our country’s artistic and cultural identity, and advancing international research priorities,” said Barnard, “but I think it’s much more effective to hear it from the experts themselves.”

Dr. Jamie Blanchard [MD/86, BSc(Med)/86], professor of Community Health Sciences and Medical Microbiology, and a renowned epidemiologist and public health specialist focusing on global health and the control of HIV/AIDS, discussed how his important research is helping to improve access to health services around the world, and how the U of M is uniquely positioned to lead in the field of Global Public Health.

Chris Couture [BComm/83, CA/86], an Asper School of Business grad, member of the Front and Centre President’s Campaign Team, and co-host for the evening shared what it meant for her and her husband Gerry Couture [BES/81, MCP/86] to take a leadership role in the campaign.

The big announcement of the evening came from Bryce Douglas. A pioneer in finance, the former deputy chairman and managing director of RBC Dominion Securities Inc., and one of the country’s foremost philanthropic leaders, Douglas discussed what inspired him and his wife Nicki to give $2 million to transform the existing Bryce Douglas Professorship in Finance (which they established in 2002 with a $1 million gift) into an endowed research chair.

“I saw this as an opportunity to invest in tomorrow’s business leaders,” Douglas said. “It is my hope that this chair will attract the best researchers to join the University of Manitoba’s community of innovators, which will enhance the scope and quality of teaching in the Asper School’s finance program, and provide students with more opportunities to excel in the corporate world.”

“It really has been an incredible couple of months, and I feel privileged to have met and worked with many of the notable donors and community leaders who’ve taken their place front and centre,” Barnard said of the campaign, “donors like Bryce Douglas and his wife Nicki.”

Marcel Desautels and Edmund Dawe at the alumni event held in Toronto on November 19, 2015

To conclude the evening’s events, guests were treated to a performance by the accomplished Dr. Marcel Desautels [B.A.(Lat.Ph.)/55, LL.B./59, LL.M./65, LL.D./99], accompanied by Dr. Edmund Dawe, dean of the Desautels Faculty of Music, on piano. A distinguished U of M graduate, national business leader, and the visionary who singlehandedly transformed the Faculty of Music with a $20 million gift, Dr. Desautels also happens to be a passionate and gifted opera singer.

Alumni receptions similar to this one will be held in Calgary on November 26, in Victoria on November 28, and Vancouver on December 7. To learn more about these upcoming events, visit umanitoba.ca/alumni.

It sounds esoteric, but it is elegant in its simplicity and effective when applied, and best illustrated by example. A decade ago, India was experiencing a substantial HIV epidemic. It was clear that the solution would require effective programs to reduce HIV risk among sex workers. But how? Dr. Blanchard and his colleagues started by involving sex workers in a social mapping process to identify where best to focus resources and efforts, and then moved on to the action phase, which included evolving better ways to implement peer education and community outreach and mobilization efforts. Condom use jumped from less than 50 per cent to almost 90 per cent and the epidemic was reversed. The community mobilization processes were also associated with declines in violence against sex workers.

The program was so successful that it is being expanded in India and adopted by countries in Africa, albeit in customized ways in order to accommodate financial, social, political and cultural barriers. “Kenya had seen it work and said it wanted the program as well,” says Dr. Blanchard.

The beauty of the methodology is that it can be used to combat a broad range of health and social issues; a program is under way to address maternal, newborn and child health. “The solutions may be different but the approach is the same,” says Dr. Blanchard, adding that the program science methodology is also cost effective “because you implement these processes by leveraging already existing resources, introducing efficiencies and then working with government to fill them.”

According to Dr. Stephen Moses, a professor in the University of Manitoba’s departments of Medical Microbiology, Community Health Sciences and Medicine, Dr. Blanchard has addressed the problem of taking small pilot projects and scaling them up, sometimes exponentially. “Dr. Blanchard’s contribution shows that it is possible to design health programs and services that can be implemented on a very large scale, and that it can be done in a systematic and scientific way.”

Dr. Blanchard and his team have received numerous funding awards, including a $21.1-million (U.S.) grant from the Bill and Melinda Gates Foundation (2014) to establish a technical support unit in Uttar Pradesh, India providing “technical assistance to the government of Uttar Pradesh to improve health, nutrition and development coverage and outcomes” for the state’s 210 million inhabitants.

“When it comes to improving global health, it’s not so much a matter of knowing what to do, but how to implement the technologies and innovations we already have,” says Dr. Blanchard. “The program science approach gives us the tools we need to do just that.”

This story originally appeared in the Excellence in Research and Innovation special feature, published in the November 17 Globe and Mail, produced by Randall Anthony Communications Inc. in co-operation with The Globe and Mail’s Custom Content Group. Reprinted with permission. All rights reserved.

Living in this impoverished resettlement colony are groups of people who come from other cities, a large number hailing from Bangladesh or its surrounding borders. They earn a living by gathering bits of cloth; some gather plastic bottles and bags to repurpose into other items — a bit like an up-cycling system, explains Blanchard, director of the Centre for Global Public Health (CGPH) in the Faculty of Health Sciences.

James Blanchard, director of the Centre for Global Public Health (CGPH) in the Faculty of Health Sciences.

“In these villages you have women who are trying to have healthy lives and healthy babies, but quite often are facing various barriers in terms of accessing care, [barriers that] can vary from knowledge to finances or gender roles and lack of power in making decisions related to their own health,” says Blanchard, who is also a professor in the departments of community health sciences and medical microbiology and a Canada Research Chair in Epidemiology and Global Public Health.

In June, the CGPH announced it had received funding from the Bill & Melinda Gates Foundation to establish a Technical Support Unit (TSU) led by a team of global public health experts from the university’s College of Medicine. Blanchard is principal investigator on the project, which includes co-principal investigators: Lisa Avery, an assistant professor in the departments of community health sciences, obstetrics, gynecology & reproductive sciences, and medical microbiology; Maryanne Crockett, an associate professor, in the departments of pediatrics & child health and medical microbiology; and Stephen Moses, a professor in the departments of medical microbiology and community health sciences, where he also serves as head of the department.

Local women, children and goats in Gudur, India

Through the five-year $21.1-million project called “Technical assistance to the Government of Uttar Pradesh to improve health, nutrition and development coverage and outcomes,” the TSU’s goal is to support the government and to increase the efficiency, effectiveness and equity of the delivery of key reproductive, maternal, new born and child health services and outcomes.

At 210 million, Uttar Pradesh is the country’s most populous state: close to 78 per cent live in rural areas across nearly 100,000 villages. According to the Census of India’s 2012-13 Annual Health Survey, it also continues to report the highest maternal mortality ratio, of 258 per 100,000 live births, and an infant mortality rate of 72 deaths per 1,000 live births.

“The reason we were selected, we believe, and we’ve been told by the Gates Foundation, is because we have the capacity, capability and track-record of incorporating learning and data into the development and design of programs,” explains Blanchard. “The ‘program science’ approach [a newly evolving approach to prevention science] is really a unique thing for the U of M.”

One facet of program science is incorporating research into the development and implementation of evidence-based interventions. This approach also provides information on how interventions can be adapted to specific situations or communities.

Avery focuses her research on inequities in health care access and outcomes, particularly the determinants of health and their impact on sexual and reproductive health (including maternal, neonatal and child health) of low and middle income societies.

Lisa Avery and Maryanne Crockett. Photo by Daniel Gwozdz

“The old way of doing things were you would get funding, you would do a program and you would try to get the government to be involved, or like what you’ve done, and roll it into something,” she says. “We’ve found through experience, especially our previous India projects, by directly linking to and partnering with the government from the start, they became involved with all decision-making steps from the beginning and it was much easier to take something to scale and make it sustainable.”

Avery adds that in order to enable sustainable change, experts are embedded in the government system to provide technical support. “Our innovation is working at the community, health facility, and policy-making level, with data, monitoring and evaluation at each tier.”

At the outset of the project, the TSU completed a rapid assessment of the potential critical needs or gaps. With this particular project, this involved mapping health care facilities and services and qualitative research within the community in order to fully understand the issues and impact on utilization or behaviors at the community level, Avery explains.

One approach is to utilize frontline health workers, such as India’s accredited social health activists (ASHAs). Instituted by the Government of India’s Ministry of Health and Family Welfare as part of the National Rural Health Mission, these women are trained to act as health educators and promoters within their communities.

“They have learned to track women and their children across the continuum of care in a continuous manner. We use that information to micro-plan,” says Avery. “They are then able to actually identify who potentially isn’t accessing care or … not getting appropriate nutritional services. The ASHA then puts that all together to try and problem solve with the woman and the community.”

The ASHAs relay back issues related to social, cultural, gender and resource constraints. Once the TSU establishes the constraints within a specific village, they work with the frontline workers towards finding solutions.

Mother and child in a village of India.

“That’s our mandate. We want to be able to give them the tools on how to problem-solve around the issues that are facing them as individuals or as a community,” Avery explains. “We know that communities often have their own solutions, but having them come together and brainstorm informs our programs. We incorporate the issues they are problem-solving around and the solutions they come up with into broad program content.”

Avery says she sees similarities to her clinical and program work in Winnipeg. “It isn’t just women overseas who potentially lack power or who have limited education. Sometimes some of the work we’re actually doing overseas is based on learning from here.”

She thinks people often forget that in Canada, especially in Manitoba, there are a large number of vulnerable, marginalized populations living in remote communities, similar to the ones in Uttar Pradesh.

“We’ve developed innovation models to try and better serve the health-care needs of Manitoba,” says Avery, pointing to the College of Medicine’s J.A. Hildes Northern Medical Unit, which provides medical services for northern and remote residents who are temporarily in Winnipeg, and helps to train medical residents to become family physicians who will work in northern and remote locations.

“I think that’s actually influenced a lot of the type of thinking we do with our global health programs and vice-versa. Many of these issues are far reaching and impact all of us in some way or another. The world is a small place; what happens locally also impacts things globally and the other way around.”

Avery hopes that by the end of the five-year funding, the TSU has worked itself out of a job and that the women and children in Utter Pradesh will be doing much better than they are today.

Blanchard visited the ragpickers colony just days before he got on a plane back to Winnipeg to speak at the formal Gates Foundation funding announcement. Looking back, he remembers thinking, as he stood in the impoverished community: “It was really something, the fact that this project, which at one level is an academic institution in Winnipeg, Canada, is able to actually project its skills. Our experts in obstetrics, gynecology, and our trainees — we’re able to basically take the resources, experience and expertise that we have and develop programs.

“It really struck me that a project like this really does have an impact within the village, within these homes.”

Story originally appeared in the Winter 2015 issue of Research Life.

This will be an occasional feature that brings our remarkable grad students to the fore. Enjoy!

PhD Student: Claudyne Chevrier
Studying in: Community Health Sciences
Advisor: Rob Lorway

UMT: Where are you from?

CC: I’m from Montreal. I moved here three years ago for my PhD so I feel like I have my “Winnipegger” card. I was here last year, so after that, I was like, ‘You guys, I’m in.’

UMT: Do you miss anything about Montreal?

CC: I miss everything about Montreal.

UMT: Did anything strike you as weird about Winnipeg?

CC: Yeah, there are a lot of things about Winnipeg that are weird. Maybe the weirdest thing is how it grows on you in the weirdest way. Now I love Winnipeg and I get angry when people make jokes about Winnipeg. I’m like, ‘What!? You can’t. You don’t even know.’ It’s funny.

UMT: What brought you here?

CC: I moved here because I wanted to work with Rob Lorway, who is one of my advisors. My other advisory is Jamie [Blanchard].

My background is in anthropology — social and cultural anthropology. I moved into public health somehow for my master’s and then the person who was my master’s advisor was Rob’s post-doc advisor — so I kind of just stayed in … the academic family, and moved here.

UMT: In a nutshell, what do you study?

CC: I do a lot of things in global health. But for my project, I am doing an ethnography of sex workers in Winnipeg; so I work on access to social services and health services for sex workers in this city. That’s the short answer. But then there’s always questions when I say this to people.

Image: Katie Chalmers-Brooks

UMT: You have a tattoo of a circle on your wrist. Can you tell us about that?

CC: I actually got it in Winnipeg. Two years ago now, maybe. It’s stick and poke, so it’s imperfect.

UMT: What is ‘stick and poke’?

CC: It’s done just with a needle. The reason it’s stick and poke is that I wanted it to be imperfect. That’s the significance for me. Imperfection is perfect. And I needed it on my wrist so I see it everyday.

UMT: What did you want to be when you were a kid?

CC: I wanted to be writer. Very clearly. I also wanted to be a veterinarian. But I wanted to be a writer; I love reading and writing. And I get to still read and write in academia but it’s not the same thing. I still read and write most days.

UMT: Are you reading anything for pleasure right now?

CC: I did start a book for pleasure about a year ago. I’m still working on that. It’s Isabel Allende’s The House of the Spirits. It’s about the revolution in Chile; it’s very bloody and mysterious and ridiculous. And I’m reading it in Spanish because I’m trying to improve my Spanish, which is maybe why it’s taking me so long.

Image: Katie Chalmers-Brooks

UMT: So you speak French, English and Spanish. Any other languages you speak or wish to speak?

CC: If they could pay me to learn languages, that’s what I would do. That would be my favourite. I love languages.

UMT: Considering your work with this research group, Hindi would be good to know.

CC: I would love learn Hindi! I’m trying to learn Hindi. I suck at it. I have some books I open once in a while.

UMT: What is the best part of your job?

CC: My research project. I changed it maybe a year and half ago so it would better reflect my values and the work that I do; I’m also an activist. I do a lot outside of academia. I changed my project so it would relate to that, so that’s been really really good.

UMT: What sort of activism are you involved with?

CC: Well, right now, it is mostly in relation to my project because there is only so much you can do. I’m a sex workers rights activist. I work with the Winnipeg working group; we’re working to fight against Bill C-36. We have been working against it, as part of the Canadian Alliance for Sex Workers Law Reform…. In Manitoba, our humble goal is to challenge the ideas of the sex trade, especially the idea that it’s only sexual exploitation and that it is inherently violent, which is normally the only thing you hear. It’s more complicated than that.

I definitely believe in a harm-reduction perspective. Let’s give sex workers the resources they need without judging them. If they want out, they should have access to all the resources in the world, but if they want to stay in, let’s not judge them. Let’s say, ‘Hey, what do you need?’

UMT: So it sounds like you enjoy the qualitative research?

CC: Oh yeah. I’m a qualitative person all the way.

UMT: Do you listening to music or anything while studying?

CC: I listen to a lot of really embarrassing pop.

UMT: Like Justin Bieber-embarrassing?

CC: Oh no. Like Beyoncé.

“I’m in a 90s moment, like I re-discovered Counting Crows. They are so whiney. I love them.”

UMT: That’s not embarrassing.

CC: Thank you. I also think so.

Or I listen to Songza, like anything from the 90s. I’m in a 90s moment: like I re-discovered Counting Crows. They are so whiney. I love them. Or I listen to a lot of folksie French music from Quebec.

UMT: Are you a Habs fan? A hockey fan?

CC: No. But yes. Don’t say anything against them because I will have to get angry, but I don’t really care. (But I do.)

UMT: Why sex workers? Why this population?

CC: I always wanted to work with things related to gender because that’s sort of my thing. I’m a pro-choice feminist, which for me means that women can do whatever they want with their bodies, including selling sex if they want to. Or anyone, not just women.

I was going to work on fertility in India because that is something that really really matters to so many women I know there. And then I was offered to go and do a project for a sex workers organization in Southern India. I ended up changing everything since it was community-based research. It mattered more to them that I focus on something different so I changed my topic. And then from there I just started to open up a space around me where I started to talk about sex work differently and I met new people who were sex workers. And I learned that people I knew had all sorts of experiences in the sex industry. And eventually it became a thing where a lot of people I love are sex workers.

I constantly hear horrible things being said about sex workers or see people treating them like victims or like they are disposable or it doesn’t matter what happens to them. It becomes very different when you start thinking about those things being said about people that you know and love. You shouldn’t have to go through that to care, but I guess that’s the world we live in, and that’s what comes with having as much privilege as I have.

Image: Katie Chalmers-Brooks

UMT: What do you parents do? Are they scientists?

CC: My dad was a helicopter pilot. Well, he’s alive, but he retired from that and eventually he started selling helicopters, which sounds like a lie. But it’s a thing. And my mom is a nurse. So the health part comes from that a little bit.

My parents are very adventurous people. They are awesome. They are much cooler than I will ever be. It’s very hard to live with. My parents, for their retirement … were in Vancouver for 10 years and they bought a sailboat and they sailed a boat down to Mexico. And that’s what they do for six months a year. How do you compete with that? They are winning.

UMT: How old are you?

CC: I’m 31.

UMT: Do you have any hobbies?

CC: Not really any more. I work too much.

I guess a journal. How sad is that? I liked biking and may start biking again. I have a winter bike; it’s just so cold. And one of my plans for this winter if I don’t hate winter is to get into cross-country skiing.

Image: Katie Chalmers-Brooks

UMT: Have you received any good advice from your advisors?

CC: Yes, I receive all sort of good advice, although I don’t think I take all of it. What I like about Jamie [Blanchard] … [is that he’s] very pragmatic. He understands complex ideas and I’m an over-thinker. It’s kind of my superpower, for better and for worse; it’s what I do. And he’s very good at seeing how that makes sense in the real world. And I love that.

My other advisor, Rob [Lorway], helped me out a lot when I was doing my master’s — and one of the things he told me that I repeat constantly to people who are writing is, ‘This is not the work of your life. It’s just words on paper. Just do it. Just do it.’

I love that. It’s true. Because you get stuck. Just do it. Just write words on paper. You will re-work it a million times but just do it.

“Go Team Feminism. Je t’aime. Je t’aime.”

UMT: Do you have any strange mementoes on your desk?

CC: I do, and I’m so glad your not seeing my desk right now. It’s a good reflection of who I am; it’s a mess of books and art.

I shouldn’t say this, but I really don’t like Justin Trudeau, at all. And I always make jokes about that because everyone loves him. And my colleague, another PhD student, printed out a photo of him — he does this regularly— but this one I kept because it’s a photo of Justin that’s just impossible to not laugh at. He has this overly intense look. It’s just too much. And he wrote on it, “Go team Feminism. Je t’aime. J.T.” And now everyone thinks I love Justin Trudeau.

‘Go team feminism.’ I love it so much.

UMT: What’s your favourite country of the ones you’ve visited?

CC: India.

UMT: Thanks for your time.

UM Today looks back at one of the first trailblazers in this field, Dr. Allan Ronald.

Dr. Allan Ronald

Ronald, a renowned infectious disease researcher who has come to the aid of some of society’s most vulnerable populations, was inducted into the Canadian Medical Hall of Fame in 2010.

The Portage la Prairie-born doctor pioneered the U of M’s world-renowned infectious disease research program. Not only did Ronald help change the landscape of this research field but he has helped steer its future as a mentor to academics across Canada and globally.

He has spent the better part of the last three decades studying infectious diseases in hard-hit Africa. His early work to control an outbreak of the sexually transmitted disease chancroid in Winnipeg in the mid-1970s provided a strategy that proved important later in the prevention and control of HIV infection.

In 1980, he established one of the first clinical investigation units exploring sexually transmitted infections in Africa. The program started small but eventually would put the University of Manitoba on the map as a leader in the field of HIV epidemiology and immunology, as well as improve disease prevention and care. Lessons learned have been used widely throughout Kenya and around the world. The Manitoba/University of Nairobi group has made major discoveries, including recognizing the importance of breast milk in the transmission of HIV from mothers to infants, the role of male circumcision in reducing the risk of HIV infection among men, and the role of the immune system in protecting some individuals from acquiring HIV infection.

Ronald officially retired in 2000 after a 32-year career as a professor and researcher with the University of Manitoba but since then has kept busy fostering the comprehensive HIV/AIDS Care and Prevention Program in Uganda. His expertise is still sought-after by governments and international agencies.

“Africa is a vast and complex continent, and very few outsiders have been able to leave a lasting mark. Allan is one of those rare individuals who has truly done so,” said colleague Stephen Moses, professor of medical microbiology, internal medicine, and community health sciences at the University of Manitoba.

Picking up the torch

In 2008 the department of community health sciences established the Centre for Global Public Health to tackle public health issues on a global scale. It does this through directly deterring the spread of HIV/AIDS and by educating communities about disease prevention.

The Centre has been enhancing the University of Manitoba’s contribution to the improvement of public health systems, programs and activities in diverse global settings.

A cornerstone of the CGPH is the design and implementation of international health and development projects in several countries including India, China, Kenya and Pakistan, primarily in the areas of HIV and STI prevention.  Its partners include the West China School of Public Health at Sichuan University in Sichuan, China; and the Karnataka Health Promotion Trust in Bangalore, India.

Another group that charges forth on this front is the Manitoba Resistance and Susceptibility to Infection Research Group.

For 25 years the group has been publishing influential scientific papers and attracting experts from around the globe to help it address extremely important questions on the biology of sexually transmitted infections. The group is led by U of M scientists including  Francis A. Plummer, group leader (epidemiology and immunobiology of infectious diseases), Stephen Moses (epidemiology and control of infectious diseases), Keith Fowke (cellular immunology and genetics) and Xiao Jian Yao (molecular virology and viral pathogenesis).

This group’s research aims to identify genetic correlates of resistance and susceptibility to HIV-1 infection; to understand host and viral factors in HIV infection and disease progression; and to study host and viral interactions. Much of this work is made possible through their collaborations with, and support of, the National Microbiology Laboratory in Winnipeg.

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WHAT: Much of their work focuses on saving the lives of women and babies in rural regions of Kenya and India where barriers to accessing care are significant and the quality of care, variable. With on-location teams, these doctors aim to solve problems on two levels—in facilities (hospitals, clinics and pharmacies) and in the community. In India, this has included identifying gaps in care and offering life-saving solutions for hospital staff to employ (for example, cleaning and drying an unresponsive newborn to stimulate breathing). They outline can’t-be-missed services that need to be offered to women and children and detail at what stage to do so. In Kenya, their work includes partnering with the government to train community health workers who travel by bike around remote areas and educate women about health issues—like the danger signs to watch for during pregnancy.

THE INSPIRATION: In Kenya, 480 women die for every 100,000 births. In rural areas, that number can more than double to roughly 1,000 women. In the regions of Kenya and India where Crockett and Avery have projects, data from their initial assessments found less than 15 per cent of women stay in a hospital or clinic—or receive care from a midwife or community health worker—during the 48 hours after delivery, yet this is when you see the most maternal deaths. More than 40 per cent of deaths among children under five happen within the first month with three quarters occurring in the first week of life and more than half of those in the first day.

IN THEIR OWN WORDS: “Most of the things that kill women and children don’t require the degree of technology that we have here,” says Crockett, who specializes in infectious diseases and treats some of Manitoba’s sickest kids: those with meningitis, lung infections and sepsis. “That’s what’s frustrating, that it’s simple. It’s simple if you break it down to: ‘You just need this.’ But it’s how you get that zinc lozenge in the mouth of the child that has diarrhea.”

“Perhaps the most disturbing thing about maternal, neonatal and child health is that the causes of death for both women and babies are very well known, easily treatable, easily preventable (conditions),” says Avery. “Globally, post-partum care remains this huge gap even though it’s a crucial time to acutally be able to save lives.”

FUNDERS: the Bill and Melinda Gates Foundation and the Canadian Department of Foreign Affairs, Trade and Development

LEARN MORE

• In the winter 2014 issue of ResearchLIFE magazine

The five-year funding will support a strategy led by the Government of Uttar Pradesh, the largest state in India with a population of almost 210 million, and over 5 million births each year. The U of M project, aligned with the Gates maternal, newborn and child health strategy, seeks to reduce the number of mothers and infants who die during and immediately after birth, and the number of children under five who die from common illnesses through effective interventions and services in communities and at health facilities.

Uttar Pradesh in India

Interventions will include easy-to-use tools to address the major causes of maternal and newborn and child deaths, and the underlying role of malnutrition in these deaths. The project will also support the Government of Uttar Pradesh by strengthening the use of research and monitoring systems to improve the availability and quality of services, particularly for the most underserved populations in the state.

“The University’s significant commitment to helping populations in need, whether here at home or around the globe, is one that is a source of great pride to our University. The dedication and commitment of our research teams who are making transformational and sustainable changes to peoples’ lives, is humbling,” said President Barnard.

The CGPH led project, titled: “Technical assistance to the Government of Uttar Pradesh to improve health, nutrition and development coverage and outcomes,” will provide technical and managerial support to Uttar Pradesh’s National Health Mission by establishing a Technical Support Unit (TSU), implemented by CGPH’s partner, the India Health Action Trust (IHAT). IHAT is a longstanding partner of CGPH, specializing in providing comprehensive technical assistance and training in program planning and management.

According to James Blanchard, Director of CGPH and one of the project’s leaders, the establishment of a TSU will improve the efficiency, effectiveness and equity of its execution capabilities across three platforms:  provision of public health programs and services; stewardship of service delivery; and partnership with the private sector and communities.

“Our team at CGPH feels privileged to be able to partner with the Government of Uttar Pradesh and the Bill & Melinda Gates Foundation on this initiative,” said the Canada Research Chair in Epidemiology and Global Public Health.

“We have a very dedicated and talented team in India and Canada that sees this as both an important responsibility and a challenge that will demand all of our best skills, effort and teamwork to make the project a success. It is a rare opportunity for us to participate in work that can affect the lives of so many women, children and their families and communities.”

The CGPH was established within the College of Medicine’s department of community health sciences in 2008 in collaboration with the department of medical microbiology.  The CGPH enhances the contribution of the University of Manitoba to the improvement of public health systems, programs and activities in diverse global settings.  A cornerstone of the Centre is the design and implementation of international health and development projects in several countries including: India, Nigeria, Kenya, Pakistan, China and Ukraine.