And the University of Manitoba is there.

Dr. Marissa Becker [MD/99] is an associate professor in the department of community health sciences and the department of medical microbiology and infectious diseases within the Rady Faculty of Health Sciences. She is also director of technical collaboration for the Institute for Global Public Health (IGPH).

In Delhi, her role with IGPH supports UM projects in India.

Dr. Marissa Becker

UM has been working in India since the early 2000s, beginning with work on HIV prevention and care led by Drs. James Blanchard and Stephen Moses. Since then, the work has expanded to maternal and child health, nutrition, family planning, and health systems strengthening, as well as work on infectious disease surveillance and tuberculosis.

Becker notes: “We currently work in Delhi, Madhya Pradesh, Karnataka, and Uttar Pradesh. Our biggest program is in Uttar Pradesh in partnership with India Health Action Trust, where we work with the local government to run a Technical Support Unit (TSU) on maternal and child health. We support the government in achieving its health goals in the areas of maternal, newborn and child health, nutrition, family planning and health system strengthening.”

The UM TSU team, funded by the Bill and Melinda Gates Foundation, is large, with about 1,200 people, mostly local residents, providing technical support for programs at the state level and local community level. They work with frontline workers, health care providers, health systems, data, and they design and implement surveys.

Becker explains: “The TSU team is headed by Dr. Vasanth Kumar who has an appointment with UM community health sciences, as do many of our senior core team members from India.

In addition to the team in India, we have a number of UM faculty who support the work, including Drs. Stephen Moses, Maryanne Crockett, Rob Lorway, Shiva Halli, Lisa Avery, Ties Boerma, and BM Ramesh. Dr. James Blanchard is lead of the TSU team in Uttar Pradesh. A number of our postdoctoral students and other graduate students are also engaged.”

When the pandemic hit India a year ago, UM researchers were asked by the government of Uttar Pradesh to help provide support in dealing with the pandemic. They created and implemented a multi-pronged strategy using data for decision making and helped establish a very comprehensive COVID-19 surveillance system for the state. In addition, they provided training and support to front line workers in the community around prevention measures and community surveillance. Further, they supported forecasting for strategic planning of equipment and supplies and helped in conducting COVID seroprevalence studies.

With the tidal wave of COVID cases today, the UM team is working with the government to help address the very serious and very dire oxygen shortages.

Becker says: “The situation here is very difficult- and the health system in many areas across the country is overwhelmed- the impact is immense. The health care facilities are full and many have insufficient equipment and supplies. Families are really struggling. On top of their trying to cope with loved ones that are sick, many are incurring significant financial costs — catastrophic out of pocket expenses.”

She explains that the vaccination program in India started out strong but unfortunately the total proportion of the population immunized was still very low when this latest wave hit.

“I fear that the country will have a difficult time in catching up quickly enough to address this current wave,” she says. “In the meantime, other prevention measures have been put back in place with lockdowns in many states across the country. We are also now seeing many countries step up with support now, but I’m worried about the shift to more cases in the rural areas and also to neighbouring countries in the region in which we are seeing increases in cases — and these countries are also facing shortages of vaccines.”

Becker admits that the pandemic is affecting her personally to some extent.

“Many of our team members and their families have been affected,” she says sadly. “Many friends and colleagues are trying desperately to help their loved ones find a bed, find medicines, to provide care to them. You can hear people’s frustrations, grief and exhaustion when you speak with them.”

Becker believes that the UM community should be proud of the UM response in India. “Not only has our team played an active role in addressing the pandemic, but it has also tried to help the state of Uttar Pradesh ensure that many of the consequences of the pandemic, such as interrupted health care services, have been mitigated. We have worked very hard to ensure the quick and safe return of full services for ensuring maternal and child health.”

Finally, Becker appeals to all of us in taking the situation seriously.

“Sitting here in Delhi now, I want to convey that this is a global emergency and we need to treat it as such — with upmost speed in rolling out vaccination programs, and ensure access to all- within our own country, but also globally,” she explains. “We must learn from this pandemic in effort to prevent and better address future epidemics, and mitigate their very significant consequences, including the tremendous health,  social and financial impacts.”

She adds: “As academics, we need to keep making sure we are using science and appropriate data to inform our response to the pandemic. It’s so critical right now. I think our projects here demonstrate the use of data for decision making.”

As a Rady Faculty of Health Sciences graduate student who started a charity to help desperately poor children in Uganda, she lives as frugally as possible. But she is enriched by making a difference, one child at a time.

“It’s incredibly rewarding,” says Aboud, who is about to receive her PhD in medical microbiology, having completed her thesis on HIV transmission in Kenya. “Not many people get the chance to feel like they actually change someone’s life, and see that change.”

Aboud, 32, co-founded the charity Bridging Villages with her husband Zaid, 31. He holds a master’s degree in pharmacology from the U of M. Since making their first volunteer aid trip to Uganda in 2014, the couple has raised about $30,000 for the project, including their own contributions.

“Our eyes were opened to the need, and there was no way we could walk away from it,” Aboud says.

They have held Manitoba events such as a trivia night and a social to benefit Bridging Villages. The organization recently obtained official charitable status.

Now living in Uganda and working with partner organizations in the village of Namavundu, the Abouds have renovated a school for 120 children who are orphaned or can’t afford education, established a child sponsorship program so Canadians can support individual kids in the school, helped villagers to obtain medical care, and supported a women’s vocational training program.

Their next project is a shelter for street kids. The couple is also making plans to adopt two orphaned Ugandan toddlers who have special needs.

Aboud says it is deeply gratifying to see lives transformed by education. “In February, we’re sending 12 children to high school who never would have gotten there without the Bridging Villages sponsorship program,” she says.

The charity also provides life-changing medical help. One little girl suddenly couldn’t walk and had to stop going to school. Her family, who couldn’t afford medical care, assumed she had become permanently disabled. Aboud helped get her into a hospital, where a benign tumour was found on her spine and removed. The girl is expected to make a full recovery.

Aboud, who grew up in Pinawa, met her future husband in an undergraduate microbiology class. Born in Iraq, he came to Canada as a refugee at age 16. Zaid plans to return to U of M next fall, either to earn another master’s degree as a physician assistant or a PhD in community health sciences.

Aboud will soon start post-doctoral work with a University of British Columbia team on a study in northern Uganda of how conflict affects HIV transmission. So the couple foresees a great deal of separation and travel between Canada and Uganda for the next few years.

The microbiologist has faced her own medical challenges. She lives with Crohn’s disease and on her first trip to Uganda became seriously ill with malaria. Nonetheless, she says, “I have a heart for Africa.”

She credits U of M mentors with fuelling her passion for both science and service. “Dr. Marissa Becker and Dr. Lisa Avery (faculty affiliated with the U of M’s Centre for Global Public Health) are two of my role models. I love the impact they have in communities.

“Dr. Blake Ball (assistant professor of medical microbiology), my PhD supervisor, has also played a huge role in who I am. He knows that life is not just the lab. He saw in me something beyond basic science, and he helped foster that.”

To learn more about Bridging Villages, visit bridgingvillages.org.

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.