Q&A: A conversation with Hilton Foundation CEO, Dhaka-awardee on health solutions

NEW YORK — Cholera has long been a common part of life in Bangladesh. The international health research institute icddr,b annually treats about 40,000 cholera patients at their free-of-charge hospital, and sees more than 220,000 people each year, says John Clemens, executive director of the organization. Yet while the highly contagious, bacterial disease has caused public health crises in Haiti, Yemen and other countries, Clemens sees cholera, like many other illnesses, as manageable. In one of its latest innovations, icddr,b developed the first oral cholera vaccine that the World Health Organization now stockpiles.

“It is easily, easily treatable if you know how to treat it,” said Clemens, a medical doctor with a background in infectious diseases. “The problem is that in many places where cholera occurs, the local health care providers and physicians don’t have the experience.”

The pioneering public health organization, which also developed oral rehydration solutions, just received a $2 million boost. They are this year’s recipient of the Conrad N. Hilton Foundation's humanitarian prize, the organization announced today.

Devex sat down for a conversation with Hilton Foundation CEO Peter Laugharn and Clemens to discuss their collaboration and what it takes to scale public health solutions in Bangladesh to countries across the world. Here is the conversation, edited for length and clarity.

Icddr,b takes a very practical approach in implementing its research in Bangladesh. Peter, is this what drew the Hilton Foundation to want to work with and award them for their efforts?

Peter Laugharn: We have been doing the prize since 1996 and it has been about our intention to shine a light on an organization that has done great things in alleviating human suffering, and to make things possible we did not think were possible before. In icddr,b’s case, the very simple idea of oral rehydration solution had not occurred to people before. But it combines a number of things for us. There is scientific rigor in a place like Bangladesh, which in an alternate universe, might be just a place of victims, but has found solutions that have been useful — not only in Bangladesh, but all over the world. There’s also the fact that the interventions are all practical, and they are mostly very low cost. That makes them very easy to spread on their own.

Bangladesh is one of the most vulnerable countries to the effects of climate change. How are you able to keep up with the health challenges that this continues to present? What else drives your work?

John Clemens: Our strategic priorities are really focused on major global public health problems that are also public health problems in Bangladesh. In addition to emerging infections and respiratory infections, we have programs on reduction of maternal and neonatal mortality and control, malnutrition, universal health coverage and health systems research. And now we are starting work on health adaptation to climate change and control of noncommunicable diseases. As we do research in these different areas we try to foster the development of a continued pipeline of inexpensive products and interventions that might have a major impact of public health.

One example is the problem of maternal mortality. In many countries the major cause of death is bleeding to death, and 70 percent of the births are occurring in the home [in Bangladesh], so it is very difficult to subjectively assess the amount of blood loss just by looking, by people who are not medically trained. So we created a birthing mat that mom sits on after the baby crowns. When that becomes saturated with blood, at about 500 cc, the mat begins to ooze blood, providing a clear visual que to the family to transfer mom to a facility for transfusion. We have tested this out in 100,000 home childbirths.

And the idea is to then scale this outside of the country?

JC: And even inside. It is not a standard part of care yet in the country. So, for births that are occurring in the homes, it represents something that may mitigate death due to hemorrhage. We have also developed much cheaper, ready-to-use, therapeutic food for the treatment of kids that have experienced severe acute malnutrition. We see hundreds of these children at our hospital every year. They come in very sick with diarrhea, pneumonia, tuberculosis, meningitis, etc. Once you get the kids over those immediate health problems you still are left with the challenge of reconstituting them. You have to have a very caloric and nutrient-dense material. However the international product [of ready-to-use food] is very expensive and is based on peanuts, which is an African diet. So we have developed an identical preparation — same number of calories, same distribution of nutrients, but based on lentils and chickpeas, which is the local diet, and can be produced for about 30 to 40 percent of the price of Plumpy’nut, the other product. And we tested it, head to head, in our nutrition unit, to rehabilitate malnourished children. The results of the trial had absolutely identical, critical outcomes.

Another innovation we have in the pipeline is an approach that deals with the problem of tuberculosis that occurs in urban slums. We have set up basically a public-private partnership, a very credible diagnostic center called GeneXpert to genetically diagnose tuberculosis and immediately distinguish multidrug resistant tuberculosis, together with digital chest radiography. We then assure those that test positive are channeled into appropriate anti-TB programs. The private partners are formal and informal providers in the slum community, of which there are many. This has been so successful in Dhaka, where we started this, that the Global Fund and other donors have now supported us to roll this out in other cities in Bangladesh and we are talking with other countries as well.

What are the conversations like when you two come together?

PL: As Dr. Clemens said, climate change is going to exacerbate a lot of migration and health and disease issues. We are fortunate to have a framework like the SDGs, but we don’t have a clue, globally, about how to finance this. We were talking earlier today about how you sometimes need to take a justice approach and say the world knows how to do this — it just needs to provide the finance so it can be done equitably. Beyond that, we say it is pretty amazing that this comes from the South. This is different model than we normally see; the organization is based in the South, the vast majority of their staff are from there. One thing we would like to do is encourage the building up of more local solutions. We are pretty confident that as the population and expertise in the South grows, more and more of the solutions will be coming from the South.

Dr. Clemens, do you have an idea of how are you planning on using the award money to scale icddr,b’s work?

JC: We would like to leverage our ongoing work in further developing and evaluating this pipeline of innovations in realistic public health programs, so we can provide a suitable evidence base for the roll-out of these interventions in Bangladesh and elsewhere. Traditionally icddr,b is an organization that has done a tremendous amount of work of global relevance, but the work itself has been done in Bangladesh. We will continue to do a lot of work in Bangladesh. We believe we can be much more effective as a partner to other developing countries by directly working with other countries, in other countries, to evaluate these innovations and help generate the needed evidence for policy decisions.  

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