Crossing the country to promote global health

A 1997 alumna bicycles through 13 states to raise awareness of the links between poverty and disease.

Karen Kiang, M.D. ’97, approached the podium at the public library in Telluride, Colo., with an enthusiasm and none of the weariness you might expect from someone who had pedaled her bike 77 miles over a 10,000-foot mountain pass the previous day. Slim, with a luminous smile that dominates her round face, Kiang came to Telluride with a single goal—to awaken others to the urgency of world health issues she has seen firsthand.

Kiang has no desire to lecture—she designed her presentation, dubbed Global Health 101, as a conversation starter. “What do you know about malaria?” she asked a high school student in the audience. When he replied that it’s a blood disease, she nodded her head. Like so many other diseases facing the developing world, malaria is largely preventable with low-cost interventions, she told the audience. Kiang has seen malaria’s damage with her own eyes, and it’s the senselessness of it that bothers her most. “These are treatable diseases, but it takes money to get things done,” she said.

Just 18 days earlier, she had left San Francisco with 20 other bicyclists to begin the Ride for World Health, a 3,700-mile journey across the United States to raise awareness and money for global health issues. Along the way, Kiang and the other riders, most of them medical students, slept in school gyms, in churches and in the homes of gracious local hosts. In the evenings the riders led lectures and discussions about issues like malaria, HIV, tuberculosis and the poverty that drives these diseases in the developing world. Kiang and her companions sought to raise $250,000 for Partners in Health, a nonprofit global health program aimed at providing basic health care to underserved people in Haiti, Rwanda, Guatemala, Mexico, Russia, the United States and other parts of the world. “Just $50 can provide testing and treatment for seven tuberculosis patients,” said Kiang. “You also prevent each patient from spreading it to 10 to 15 other people.”

Kiang signed up for the ride after receiving a notice about it via e-mail. “I couldn’t resist,” she said. Already an avid bicyclist, she owns no car and bikes about 10 miles each day to her job at The Northern Hospital in Melbourne, Australia. “I loved the idea that such a humble vehicle could carry such an important message,” she said. The ride also appealed to her sense of adventure.

But Kiang is not just on a ride—she’s on a mission. “I grew up in a safe, well-to-do suburb of Minneapolis. I never worried about whether I could eat or not,” she said. Her parents, both physicians, fled China to escape Communism and never allowed her to take prosperity for granted. “My father lived for years on rice porridge,” said Kiang. “I understood from an early age how fortunate I was, and I felt I should pay something back.”

During medical school she teamed up with renowned medical parasitologist Peter J. Hotez, M.D., Ph.D., to study chronic hookworm in China and Thailand. She noticed that one village had fewer cases of parasitic disease than the others. “It was the richest village, and that realization was part of my public health awakening,” said Kiang. “Poverty is the root of disease.” She saw it on American Indian reservations and in the villages of China and Thailand—poverty leads to malnutrition, which boosts the probability of infection, in turn increasing the risk of early death.

Kiang has spent her career trying to stop the cycle. As a resident at Duke, she traveled to Tanzania to work with HIV patients. While there, she met her partner, Tim Fricke, M.Sc., a pediatric optometrist. After two years as an Epidemic Intelligence Service Officer at the Centers for Disease Control and Prevention in Atlanta, Kiang moved to Australia, where she is now the equivalent of a fellow in the emergency room at The Northern Hospital.

In November, she will embark on her next project, a stint with Doctors Without Borders, which will likely take her back to Africa. But in April she still had a ride to finish. By the time she reached Washington, on May 21, Kiang had crossed 11 states and given her Global Health 101 presentation to hundreds of people. “Once people realize these problems exist, they open themselves to doing something about it,” she said.

—Christie Aschwanden

When numbers matter: an epidemiologist improves health care for the homeless

Can statistics help the health of New York City’s homeless? Bonnie Kerker, Ph.D. ’01, is convinced that they can. Over the last two years, Kerker, the city’s assistant commissioner for epidemiology services, and her colleagues have analyzed data from more than 100,000 clients of the city’s vast shelter system.

Her research—based on data from everyone who spent a night in the shelter system from 2001 through 2003 that were matched to Health Department registries—has created a picture of the health of this population. Now this information underpins a plan to augment health care resources available to shelter residents.

Among her findings—single adults who use New York’s shelter system are diagnosed with HIV infection 16 times more often than the city’s general population. And the death rate among the homeless is twice as high. These facts helped influence the new plan, scheduled to be fully operational by December 2006.

The new plan enhances both medical screenings and treatment options. Expanded services will range from shelter-based ambulatory detox services to greater assistance for pregnant women. Progress will be monitored against new performance indicators that will track the implementation of each step. Deaths due to exposure to natural elements or extreme weather will also be analyzed.

Lead author of a report, “The Health of Homeless Adults in New York City,” which was released in January 2006, Kerker is particularly pleased that the plan will “expand rapid HIV testing and increase the identification and treatment of alcohol and drug abuse at shelters—all of which the city said it would do in response to the findings. It’s the bright side of some dark data.”

Participation in the new health programs is voluntary, and eligible candidates will receive information to explain what’s being offered and how they can benefit. The city’s ultimate goal is to find homes for as many shelter users as possible. “We think that improving people’s health can improve their chances to acquire and maintain adequate housing,” Kerker said. “But the big elephant in the room is really homelessness.”

Kerker’s concern for underserved populations began at age 10, when she imagined herself as a Peace Corps volunteer helping malnourished African kids. She and her two sisters grew up in New City, a suburb north of New York City, where their father was a lawyer and their mother a former teacher. Kerker, now 37, did join the Peace Corps after graduating from Tufts in 1990 with a degree in American studies. During two years in the Dominican Republic, she developed community health and education programs in Sabana Alta, a small town of 8,000 people.

Hired as an epidemiologist and data analyst for the New York City Department of Health and Mental Hygiene in 1995, Kerker left in 1997 to pursue a doctorate at Yale. “I was always interested in the translation of data into action. My two amazing advisors—Mark Schlesinger and Sally Horwitz—gave me much hands-on opportunity to see how data can actually be used in real life. Dr. Horwitz was evaluating the health effects of Connecticut’s new Welfare to Work program. Being involved in that process helped me understand how to analyze and present data in a way that makes them useful to policy-makers.”

Her doctoral program yielded an unexpected professional reward. After 18 months at a child welfare agency in Connecticut, Kerker heard through a classmate about a new Department of Health bureau in New York established by another Yale alumnus, Farzad Mostashari, M.D. ’96. He hired her in late 2003. When Mostashari left in 2005 to head another project, Kerker was promoted to his former position.

Today, she runs a department with 25 employees and clearly loves her work. “Everybody really relies on data in the Bloomberg administration. So you feel like you’re needed, and that the work you do is actually being used in policy decisions,” Kerker reflected. “That’s why I went into this field in the first place.”

—Carol Milano


			Originally published in Yale Medicine, Autumn 2006. Copyright © 2006 Yale University School of Medicine. All rights reserved.