As Jim Curran, dean of the Rollins School of Public Health, is fond of pointing out, health challenges today exist in a world without boundaries. To succeed in meeting the health needs of all people around the world, including those close to home, Emory has to keep an international focus. And because of the special challenges that face many developing nations, it's also the right thing to do. In an increasingly international Emory University, the Woodruff Health Sciences Center works hard to serve distant parts of the world, both on a human-to-human basis and through programs that will enable these communities to better meet their own health needs.

The busy road between the Georgias
As in previous years, numerous faculty and students from the schools of medicine, nursing, and public health traveled between Atlanta and Tbilisi, the capital of that "other Georgia" in Eastern Europe. They have established bonds with their counterparts, provided much help, and learned even more. For example, a medical student traveled to Tbilisi to collect 500 cord blood samples, which were then analyzed by Dr. Glen Maberly in the Rollins School of Public Health, who found that six of every 10 infants showed thyroid deficiency. This information has major implications for development and health and was relayed to international authorities for corrective efforts. Other medical residents worked in tuberculosis testing in the area.

Georgia on our minds
The Atlanta-Tbilisi Healthcare Partnership was founded 17 years ago to improve education and health systems in Atlanta's sister city. Under the leadership of Emory medical professor Ken Walker, the partnership has become one of the largest and most effective international commitments at Emory, involving Emory's schools of medicine, nursing, and public health, as well as many physicians working at Grady Memorial Hospital and faculty at Morehouse School of Medicine, Georgia State University, and the Georgia Institute of Technology. The impact has been huge, in areas ranging from Tbilisi's medical and nursing education to women's health. This year, Walker was presented an outstanding global citizen award by the U.S. Agency for International Development for his work in establishing a modern pediatric hospital emergency room in Tbilisi, the first of its kind in a post-Soviet nation.

Another first for that other Georgia
The other Georgia got its first university-level nursing school this past year, thanks to efforts of Emory's own school of nursing. Nursing faculty led by Helen O'Shea worked in conjunction with clinicians in Tbilisi to develop a four-year curriculum that represents an enormous change in a country where nurses traditionally have received only limited classroom education, with no clinical exposure. The process began in 2003, when several Tbilisi physicians attended a summer institute headed by O'Shea and were amazed to learn about clinical instruction at sites like Grady Hospital or the geriatrics center at Wesley Woods. They and O'Shea developed 27 course syllabi. This fall, the first class of 20 students entered the nursing program at Tbilisi State University.

Global vaccines, benefiting India and the developing world
India now has the largest number of people living with HIV/AIDS of any country in the world. Almost half of new cases are women, with a subsequent rise in infected children. HIV infection increases susceptibility to TB, still the country's biggest communicable disease killer of adults. Most AIDS and TB patients are young adults. Their illnesses orphan their children and threaten India's promising economic development. This year, the Emory Vaccine Center is joining forces with another leader in vaccine science and technology, the International Center for Genetic Engineering and Biotechnology (ICGEB) in New Delhi. The goal of the collaboration is to enhance vaccine development for HIV/AIDS and other infectious diseases that disproportionately affect India and other parts of the developing world.

Facing down a major killer of children and young people
So many young South Africans die every year of respiratory infections that Keith Klugman, the first Foege Chair of Global Health, decided to make preventing and treating those infections his life's work. The former head of South Africa's equivalent of the U.S. CDC and the world's leading expert on antibiotic resistance in pneumonia, Klugman is well equipped to take the challenge. It could hardly be more urgent. Pneumonia has always been a threat at the extremes of life, in infancy and old age. Now the global AIDS epidemic is causing large numbers of people in the prime of their life to die of AIDS-related pneumonia. As a result, the average life expectancy in Klugman's native South Africa has dropped into the 30s.
     His landmark study of almost 40,000 South African children concluded overwhelmingly that inoculation with the pneumonia vaccine would save thousands of lives among children, including those infected with AIDS. He is now working on strategies to make affordable vaccines available and to increase surveillance capacity for microbiologists in this and other nations. Klugman chairs the international committee of the American Society for Microbiology (ASM), a group with more than 40,000 members and a full-time staff in Washington. He is also lending his expertise to the U.S. government, which recently gave funding to the ASM committee from the President's Emergency Plan for AIDS relief, a $15-billion initiative to combat HIV/AIDS worldwide. This work is all part of the synergy coalescing around global health in Atlanta and in the Rollins School of Public Health, all part of serving the greater world community.

New hope for Africa in its battle against AIDS
The Rwanda Zambia HIV Research Group (RZHRG), one of the most long-standing and successful in Africa, is headquartered at the Rollins School of Public Health, where founder and director Susan Allen continues to develop prevention strategies against AIDS in these two countries. In the early 1980s, when Allen was doing her pathology residency in San Francisco, she was puzzled, like other physicians, by the deaths she was seeing in young gay men. A Belgian physician told her that the same thing was happening in Africa—except there the deaths were occurring among heterosexuals.
     In short order, Allen set off to Rwanda to explore what she thought might be an emerging tropical disease. By the time the AIDS virus was discovered, she already had established Rwanda's first pathology laboratory. When an HIV test became available, she established a mobile HIV testing site there, the first of its kind on the African continent. When Allen found a high rate of infection among healthy women and a higher-than-expected discordance in married couples—one infected, the other not—she began developing couples' voluntary counseling and testing that not only appeared to lower the rate of infection between couples but also provided important information on heterosexual transmission of HIV.
     During the Rwandan genocide in 1994, many of her team on the ground were killed. Today, however, the RZHRG is going strong, even larger than before the genocide and holding numerous counseling sessions like that in the photo above. With funding from the World AIDS Foundation and the National Institutes of Health, Allen's group now works with the largest cohort of discordant heterosexual couples in the world (about 1,000), has developed a vaccine laboratory in Rwanda, and recently started the first HIV vaccine trial in the country.
     A similar program in Zambia maintains the world's second largest cohort of discordant heterosexual couples and promotes couples voluntary counseling and testing as an entry point into HIV clinical care, including antiretroviral therapy programs and prevention of mother-to-child transmission. In addition to the main site in its capital city, Zambia has three satellite clinics in surrounding districts and one mobile clinic.
     This year, 15 public health students from Emory interned in the programs in Africa, learning firsthand how non-ethnocentric program interventions can change and protect lives.