In The Global Know

As the program promised, the AAN Annual Meeting in Vancouver was teeming with internationally oriented activities and programs. In addition to the Global Heath Session (which admittedly, you needed a compass and breadcrumbs to find), there were presentations on work outside of the US interspersed at many of the other Sessions, HeadTalks addressing issues in Global Neurology, an INS on Practical Approaches to Narrowing the Epilepsy Treatment Gap and an excellent presentation by Rufus O. Akinyemi, MD of Ibadan, Nigeria with his acceptance of the Bruce S. Schoenberg International Award in Neuroepidemiology. Drs. Omar Siddiqi (from Harvard’s BIDMC and the University of Zambia) and Kiran Thakur (Columbia University) took up the leadership gauntlet within the AAN’s Global Health Section. Check out Synapse for more details on the program they are envisioning and planning for the coming 2 years.

Remarkable events that didn’t happen? The plenary presentationThe World Health Organization Atlas 2015: Country Resources for Neurological Disorders was inexplicably cancelled at the last minute. Dr. DeAngelis indicated this was requested by the WHO. Dr. Walter Koroshetz, who gallantly provided an alternative talk addressing the Global Burden of Disease, attributed the withdrawal to the World Federation of Neurology, an organization that partnered with WHO on the endeavor. Whatever the political underpinnings of the very untimely decision to pull the talk, its cancellation was a disappointment to the many people who attended the session specifically for that presentation. As the Zika epidemic continues to rage on and the previously restrained CDC concluded that indeed we can consider Zika causative of microcephaly and GBS, an updated report on the country-level neurologic expertise and infrastructure available to battle the consequences of the infection, even if a work-in-progress, would have been incredibly valuable from a public health and a medical education perspective. Sadly, it is unlikely this publication will garner anything approaching the attention it would have gained at an AAN plenary in any other available venue.

USAID announced a $30 million dollar commitment to Combating Zika and Future Threats: Grand Challenge for Development. “The Challenge seeks to spur innovation for interventions like vector control, personal protection, surveillance, sample transport, and community engagement”. A submission for funding, at least the initial step, requires 3-pages of text in 12 point font, mercifully short. Kudos to USAID, the US NIH, and the NSF for providing funding mechanisms to advance our understanding of the virus so we can address the Zika catastrophe. But as a clinical researcher who has written a lot of grant proposals, I can’t help but be struck by the inherent ‘crisis-research paradox’–that anyone deep in the clinical trenches battling this epidemic is hardly in the right state of mind or being to develop a thoughtful, well-constructed research proposalOf course, basic scientists in effected regions may have more capacity to re-direct their efforts—see this week’s Science for the fascinating Zika work conducted by a group of Brazilian researchers . But from a clinical research perspective, no one decides to do their grant writing in the midst of heavy clinical responsibilities. The NEJM’s call for “Partnerships, not parachutes” is a critical and long-overdue message. But developing meaningful collaborative partnerships takes time—time to build trust, time to assure there is a common understanding of the goals and shared perspective on priorities. This can’t happen overnight and is even less likely to occur when at least one side of the partnership is mired in crisis. There can be no stronger argument for encouraging, funding and facilitating the development of cross national academic collaborations than this paradox.

Relevant partnerships at high levels seem increasingly evident. The World Stroke Congress to be held in Hyderabad, India in October will include a Joint World Stroke Organization-World Health Organization Session: Global Stroke Policies . The African Mental Health Foundation has recently put out a call looking for additional partners specifically indicating an interest in collaborations to address co-morbid neurologic conditions. Opportunities for neurologists to identify people to work with in research endeavors, provision of clinical services and educational exchange are out there, but can be hard to find in the chaos of today with so much available internet-based information.

Gretchen L. Birbeck, MD, MPH

Gretchen L. Birbeck, MD, MPH

Gretchen Birbeck is a neurologist who divides her time between the US and Africa. Her US academic home is the University of Rochester where she is the Rykenboer Professor of Neurology and Research Director for the Strong Epilepsy Center with adjunct appointments in the Center for Human Experimental Therapeutics and the Department of Public Health. Her additional skills in epidemiology, health services research, and tropical medicine are brought to bear during the 6-months annually she spends in Africa where she serves as Director for the Chikankata Epilepsy Care Team in rural Mazabuka, Zambia, an Honorary Lecturer at the University of Zambia and a consultant for the Paediatric Research Ward at Queen Elizabeth Central Hospital in Blantyre, Malawi. Gretchen’s research programs are aimed at identifying opportunities to prevent or ameliorate the medical and social morbidities of common neurologic conditions in low-income, tropical settings with the ultimate goal of developing successful interventions feasible for scale up and broad implementation. She has been recognized as an Ambassador for Epilepsy by the International League against Epilepsy, a Global Health Research Ambassador by the US Paul Rogers Society, a National Outreach Scholar by the WK Kellogg Foundation and a Leader in Medicine by the American Medical Students Association.

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