I. SUMMARY

The commitment to education, research and service in public health is emphasized in the following strategic plan priority areas: health and the environment, health policy and management, international public health, tropical medicine, and public health practice. The mission statement specifically identifies international programs, international health and tropical medicine as strategic plan priorities.

More than 25% of our students come from abroad; 57 different countries were represented in 1993-1994. More than half of the research grants and contracts in the SPHTM are located in international health and development and tropical medicine.

As new global health care concerns have emerged, we have shifted our focus to address these challenges. SPHTM is directly involved and/or responsible for major awards in the international areas of environmental health risks, HIV/AIDS, infectious diseases, population studies, nutrition, and early detection of famine. Basic laboratory and field research studies are also being carried out. By approaching education in innovative ways, we have been able develop new formats and reach new student markets. New courses are being developed that use new information technology that are offered closer to where the student lives and works (e.g., in-country, Washington, D.C., Senegal, South Africa, Taiwan, Zaire) and that are increasingly oriented towards providing mastery of defined skills and competencies.

The School of Public Health and Tropical Medicine is committed to the University's goals to enrich and strengthen Tulane's international programs. By definition, our international educational and research programs are multidisciplinary and applied; all necessary expertise is not represented by the SPHTM faculty. Increasingly, there is need to collaborate with other Tulane Schools and Colleges and other colleagues outside Tulane. A major budgetary need is the $150,000 annual project development costs.

II CURRENT STRENGTHS, GOALS AND STRATEGIES

The Department of Tropical Medicine has its roots in the founding of the Medical College of Louisiana which was established in 1834 in response to "tropical diseases". As the only Department of Tropical Medicine in the United States, it has made significant contributions to parasitology and tropical medicine and is extensively involved in the epidemiology and control of infectious diseases. The Henderson Chair of Tropical and Semi-Tropical Diseases is held by Dr. Donald J. Krogstad, Chair of the department. The department's programs include course work on specific diseases prevalent in the tropics and prepares health professionals to deal with public health problems of tropical developing nations. The Center for International Community-Based Studies, established in 1993 and located in the Tropical Medicine Department, provides a focal point and mechanism to creatively expand interdisciplinary research and training, with an emphasis on disease in communities in the developing world. The Center has been responsible for funded projects in Egypt, Cameroon and Malaysia. The department is working on the development of diploma courses in Tropical Medicine to be held in both English and Spanish.

III. PROGRESS TO DATE

IV. CURRENT INTERNATIONAL PROGRAMS, ACTIVITIES AND COURSES

Environmental Health Project (EHP) (1994-1999)

Donald J. Krogstad, M.D. is the Principal Investigator of this 5 year sub-contract to Camp, Dresser & McKee, which is one of USAID's two major contracts in health. In contrast to the other project (BASIC - which focuses on treatment), the EHP focuses on preventive and public health strategies. Tulane's role is to provide expertise in tropical and vector-borne diseases, which were formerly covered by the VBC Project (in which Tulane performed a similar function). This project (EHP) will permit Tulane to take a lead role in planning assessments and interventions with USAID, and should also provide a wide range of opportunities for Tulane faculty in the Schools of Public Health and Tropical Medicine and Medicine as well as other university schools and colleges. The contract amount is $10,000,000.

Social Mobilization Training and Research: A Global Perspective (1992-1994)

Professor Jack Ling, M.A. is the Principal Investigator of this project. Tulane, in collaboration with UNICEF and with support from UNDP, WHO, USAID and UNFPA is playing a lead role in a global social mobilization training and research initiative currently underway. This initiative seeks to develop Social Mobilization (SOCMOB) training and research capacities at institutions of higher learning in several regions of the world. Its aim is to transform development goals into societal action. Embracing the critical principle of community involvement, SOCMOB seeks to empower individuals for action. It is a broad scale development approach that calls for a continuum of activities, ranging from advocacy at the political level to information and education at the community level. It includes developing intersectoral support, bureaucratic and technocratic solidarity, and forming alliances with the non-governmental and private sectors. Tulane began offering a SOCMOB certificate course in the summer of 1993, an intensive 12 week course which will serve as a prototype for adaptation by the sponsoring agencies and participating institutions. Development of linkages for this program are currently underway with Nigerian State Universities in Ife and Zaria, Mahidol University in Thailand, the University of the Philippines and CIESPAL in Ecuador. Since 1992, Social Mobilization has drawn almost 50 participants from more than 25 countries to Tulane. The participants have represented the highest levels of the public health profession: university professors, deans and directors; directors of UNICEF for their countries and their regions; and representatives of ministries of health, population and welfare. The amount of funding is $235,000 per year.

Hubert H. Humphrey Fellowship Program (1979-present)

Tulane has participated in the Hubert H. Humphrey Fellowship Program since its inception in 1979. Since then Tulane has had 133 mid-career professionals from 58 countries participate in the Program taking training in many areas of Public Health. In continuing a tradition of administration of mid-career professional programs sponsored by the United States government, Tulane University is responding to the needs of the developing world. In addition to individual course work, research, and co-curricular activity, a series of seminars on topics of mutual interest to the participants are held in which Humphrey Fellows have the opportunity to share new perspectives with American colleagues and specialists in their disciplines. Tulane is the only school to have continuously had Humphrey Fellows. Many Humphrey Fellows remain at Tulane to pursue an advanced degree.

Peace Corps Internationalist Program

Elaine Boston, Dr.P.H. is the Director of this collaborative program between the Tulane School of Public Health and Tropical Medicine and the Peace Corps International. Through this collaboration Peace Corp Internationalists who are recruited to the program are recommended to register at Tulane School of Public Health and Tropical Medicine for 40 credit hours of course work prior to departure for the Peace Corps assignment. Upon completion of two-years of service with the Peace Corps, the students earn a degree of Master of Public Health (MPH) from Tulane University. There have been over 30 students enrolled in this Tulane/Peace Corps Program annually since 1993. Moreover, significant numbers of returned Peace Corps Volunteers have come to Tulane because of our international reputation and our project involvement in countries where they have served.

The PEW Charitable Trusts Grant: Ethnic Conflict (1993-1995)

S. W. R. de A. Samarasinghe, Ph.D. is the Principal Investigator of this grant from the Pew Charitable Trusts to support a comparative study of ethnic conflict and political and economic transition in South and Southeast Asia and Eastern and Central Europe over a two year period. The principal goal of the project is to share the comparative experience of countries in South and Southeast Asia who have experienced protracted ethnic conflict and conflict management with policy makers, scholars, and opinion makers in Central Europe to help them find answers to their current challenges. Tulane will provide and facilitate dialogue and publication in order to meet the project objectives. The project amount is $200,000.

UNICEF Video Clearinghouse (1992-1994)

Jack Ling, M.A. is the Principal Investigator of this UNICEF funded project on a Child Survival Video Clearinghouse. The Clearinghouse collects, reviews, and catalogs approximately 350 productions. The creative programs are produced by the UNICEF field offices; they can be useful for advocacy, education or training purposes. A summary of selected videos and their purpose, content and technical information is published by the clearinghouse twice annually as a newsletter to be sent to UNICEF country offices, national committees, and other professional organizations. The contract amount is $38,400 for two years.

Food and Nutrition Monitoring Support Project (1991-1995)

Nancy B. Mock, Dr. P.H. is representing Tulane as a subcontractor to the International Science and Technology Institute (ISTI) on this centrally funded AID project to provide support to food and nutrition monitoring activities of interested host country governments and USAID missions. This contract draws on Tulane's success in implementing food and nutrition surveillance programs. The core funding is supplemented by mission buy-ins to implement country level programs as the project progresses.

Public Health Schools Without Walls

William E. Bertrand, Ph.D., in conjunction with faculty from other major universities such as Johns Hopkins and Harvard, has been developing an initiative to develop high quality, sustainable training strategies for public health professionals in developing countries. The goal of this project is to train a continuing cadre of public health leaders and workers who can apply epidemiology, operational research, management analysis, communication skills and other public health techniques to assess and address public health challenges of the present and of the future. To accomplish this goal, the project supports the University's Master of Public Health Programme, a two-year program of classroom and on-the-job training and service in applied and field-oriented public health, leading to the degree of Master of Public Health. The Rockefeller Foundation has provided start-up support since 1992. Programs in South Africa, Uganda and Zimbabwe are underway.

Health and Human Resources Analysis for Africa (1992-1997)

William E. Bertrand, Ph.D. is the leading subcontractor at Tulane working with the Academy for Educational Development for this USAID funded activity. The purpose of this five year project (1992-97) is to increase the utilization of research, analysis, and information in support of improved health, nutrition, education and family planning strategies, policies and programs in sub-Saharan Africa. This USAID funded project provides $2.01 Million for Phase I and $995,941 for Phase II of the project.

The Evaluation of Family Planning Program Impact (1992-1997)

Jane T. Bertrand, Ph.D. is the leading Tulane subcontractor to the Carolina Population Center for this USAID funded five year initiative. The purpose of this project is to strengthen the capacity of USAID and host-country institutions to evaluate the impact of population programs on fertility. The objectives are to (1) develop consistently defined indicators of family planning impact for use across population projects and programs, (2) apply methodologies developed throughout this project in USAID's central and field population projects and programs and, (3) facilitate the inclusion of impact evaluation plans in new population projects at the design stage. This USAID funded project provides $2.1 Million for five years.

Mali: Malaria Research and Training Center in Bamako (1991-1998)

Donald J. Krogstad, M.D. is working with the Malaria Research and Training Center at the National School of Medicine and Pharmacy in Bamako, Mali. The MRTC has a wide range of basic and applied programs which range from molecular biology research to the testing and implementation of applied field strategies to decrease the morbidity and mortality of Plasmodium falciparum malaria. These activities began 3 years ago and now include the training of Malian scientists at Tulane and prospective studies of children who develop severe life-threatening malaria. Current funding includes World Health Organization Tropical Disease Research Program (WHO/TDR) support for Malian trainees at Tulane. Activities in Mali are supported by USAID, WHO/TDR, and by the National Institutes for Health.

Niger: Health Sector Support Grant

Nancy B. Mock, Dr. P.H. is Principal Investigator with USAID in a two-year project extension of this grant that has just ended. The goal of this project is to undertake major policy and institutional reforms in the health sector in order to increase the sustainability, efficacy, and coverage of basic health services. The project has five major objectives: to increase cost recovery of the health care system, to contain health care costs, to increase the equity of financial resource allocation, to increase the institutional capacity of the Government of Niger, especially the Ministry of Health, to develop and implement policies, to plan and manage health care services, and to improve resource management.

Senegal: Inter-Institutional Linkages Project III (1993-1997)

Robert R. Franklin, M.D. of Tulane, in collaboration with Charles F. Finch, M.D. of Morehouse School of Medicine, co-directed this project to assist in the development of an inter-institutional linkage between the Tulane School of Public Health and Tropical Medicine, Morehouse School of Medicine, and the Institute for Health and Development (IHD) at the University of Cheikh Anta Diop. The specific objectives of the program are 1) to further strengthen the educational capacity of the IHD by training faculty and staff and by assisting in the development of curricular materials for the Certificate d'Etude Specialisee (CES) at the IHD; 2) to begin to develop the capacity for applied research at the IHD by training key personnel in research methodology by undertaking one or two small pilot studies, and by identifying key areas for further projects; and 3) to further develop and define the inter-institutional linkage between the IHD, Tulane, and Morehouse for continued mutually beneficial institutional linkage activities. Project I took place in 1988-1989; Project II took place in 1989-1992.

Zambia: HIV Prevention Project (1993-1996)

William E. Bertrand, Ph.D, is the Principal Investigator of this USAID funded project for which Tulane is subcontractor to Morehouse School of Medicine. The purpose of this broadly-based three year project is to reduce the incidence of HIV transmission in Zambia. There are four main components to the project: Public Health Education, STD Control, HIV Testing and Counseling, Policy Development, and Small Grants. In an effort to maximize the best use of resources, a pilot program in three STD clinics will be funded. This pilot program will allow for training of clinic staff in clinical diagnosis and treatment; procurement of STD medications and diagnostics; and condom procurement. A clinic-based information system will also be developed to facilitate cost-effective functioning of clinic activities. All activities will involve the participation of local NGOs. Other collaborators on the Zambia HIV/AIDS Prevention Project include Johns Hopkins University and the Program for Appropriate Technology in Health. The project amount is $1.2 Million for three years.

Taiwan/Tulane Collaborative Program and Training Initiatives

Ted T. L. Chen, Ph.D. has taken a lead in developing new collaborative initiatives in Taiwan. Since 1991, Tulane has signed collaborative agreements with the National Department of Health in 1991, the National Defense Medical Center in 1992, the Taiwan Provincial Department of Health in 1993, and the National Taiwan University in 1994. Results of these collaborative initiatives produced a steady increase of Taiwan students enrolled at the Tulane University School of Public Health and Tropical Medicine. In the Fall of 1991, Taiwan students enrolled at the public health programs were less than five. The enrollment increased to approximately 10 in 1992, 25 in 1993, and currently there are over 40 Taiwan students enrolled for the Fall semester. Close to one-half of the Taiwan students who come to Tulane are supported with scholarships provided by various funding sources in Taiwan. These students study in all major fields of public health and should serve as the agents to link Tulane further with Taiwan in international health program development.

Bolivia: Community and Child Health Project (1993-1994)

Andrew Arata, Ph.D. is the Principal Investigator of this project that has contracted with the Community and Child Health Project in Bolivia to provide technical assistance in all phases of the CCH-Chagas project. Tulane has reviewed all documentary and training materials produced to date and, in conjunction with the CCH staff, developed a document that presented the objectives and accomplishments of the project over the last two and one half years. Technical assistance has been provided in the areas of planning, entomology, ecology, and health education. The project amount is $99,977.

Haiti: Synthetic Peptide-Based Diagnosis of Plasmodium Falciparum Infections (1991-1995)

Mark A. James, Ph.D. has support from the USAID's Program in Science and Technology Cooperation for collaborative research involving the Hospital Sainte Croix in Leogane, Haiti. The specific aim of this project is to develop synthetic peptide-based immunodiagnostic methods for rapid detection of Plasmodium falciparum infections. The project is funded for 4 years at $150,000.

Honduras: Biological Control of Aedes Aegypti Larvae in the Integrated Dengue Control Project, Progreso (1992-1994)

Gerald Marten, Ph.D. has support from the Rockefeller Foundation for research work focusing on the use of copepods (cyclops) for the biological control of Aedes aegypti mosquitoes in Honduras. The project is funded for 3 years at $152,784.

Honduran Street Children Project (1993-1995)

Donald C. Kaminsky, M.D. has support from the PEW Charitable Trust to conduct this project which focuses on street children in Tegucigalpa, Honduras. This comprehensive community-based integrated approach includes nutrition intervention; creative, innovative approaches to family planning activities, especially for adolescent market vending women; and an interest in and recognition of the importance of child care centers. The project amount is $263,000

Mexico: Longitudinal Surveillance Program of Enteric Pathogens in Children in Day Care Centers in Mexico

Richard A. Oberhelman, M.D. is involved with collaborative projects (1) to determine the etiology of diarrheal diseases in Mexican day care center populations and (2) to evaluate risk factors for neonatal salmonellosis in a cohort population. The project is funded locally in Mexico through UADY.

Nicaragua: Establishment of the "Center for Clinical Investigation of Childhood Diseases" (1994-1995)

Richard A. Oberhelman, M.D. is involved as a subcontractor for the Nicaraguan Ministry of Health for this project funded by Pan American Health Organization. The purpose is to promote collaboration on clinical and epidemiological problems in child health among Nicaraguan, U.S., and European medical institutions. Current activities focus on a community-based study of intestinal helminth infection and child development as an early marker of adverse nutritional status. Future work plans includes evaluation of rapid diagnostic tests for bacterial enteritis and studies of the impact of acute respiratory infections. The project amount is $39,814.

Peru: A Randomized Placebo-Controlled Trail of Lactobacillus GG for the Prevention of Diarrhea in Undernourished Peruvian Children (1994-1996)

Richard A. Oberhelman, M.D. is involved with a collaborative project to evaluate the use of Lactobacillus GG for prophylaxis of diarrhea in children from a Peruvian shanty town area in Lima. The project is funded in Peru by the Thrasher Foundation with an amount of $82,611.

Egypt: Schistosomiasis Research Project, (Epidemiology 1,2,3) (1990-1994)

Barnett L. Cline, M.D., Ph.D is the Principal Investigator of this USAID project subcontract to Medical Services Corporation International. In this project, Tulane served as U.S. collaborator which linked the Center for Field and Applied Research (CFAR) and the Egyptian Ministry of Health. Tulane's primary responsibility is quality control of parasitology data in a major, multilaboratory (8 laboratories throughout Egypt) epidemiology research project. The contract amount is $103,600.

Egypt: The Impact of S. Hematobium on Bladder Cancer in Egypt (1993-1996)

Barnett L. Cline, M.D., Ph.D. is the Principal Investigator of this subcontract on a USAID project to study the impact of schistosomiasis on bladder cancer. This is a collaborative epidemiologic research project with the National Cancer Institute in Cairo. The contract amount is $86,961.

Master of Philosophy, Birla Institute of Technology, Plani, India and Christian Medical College, Vellore, India

In cooperation with the Birtla Institute of Technology, Plani, India and Christian Medical College, Vellore, India, the department co-sponsors a program resulting in an M.Phil. degree awarded by the Birla Institute. The program was created to assist the Indian health professions' leaders develop greater expertise in the area of health systems management and, specifically, hospital administration. This program follows the curriculum of the Tulane HSM MHA program which is grounded in the quality standards of the Accreditation Commission on Education in Health Services Administration (ACEHSA). The program began in 1991 with the admission of twenty administrators who had at least five years of experience in the field of administration. A class of twenty-five has been admitted each year since that time. There are plans to open a second sight in Bombay in 1995 which will allow for the admission of twenty-five. Ultimately there are plans for the opening of four sights allowing for the training of one hundred administrators per year. The cost to the department for its participation has been $10,000 per year. Funding has been sought from USAID where the grant proposal was approved for funding but not funded in 1993. If the program received the funding at the level proposed to USAID, $1,000,000 over a five year period, it would become self supporting by the end of that period.

CURRENT INTERNATIONAL COURSES

HCED 604 EDUCATIONAL APPROACHES TO COMMUNITY DEVELOPMENT

An introduction to the work of community health educators. Focuses on strategies for identifying and involving community leaders, community needs assessment, small area analysis and planning, and community level development strategies.

HCED 606 TRAINING METHODOLOGIES FOR HEALTH PROFESSIONALS IN DEVELOPING COUNTRIES

An introductory course intended for health professionals who will be responsible for designing and carrying out short-term training courses for paramedical and village-level personnel in primary health care in developing countries. Such elements of training programs as trainee selection, needs assessment, selection of content, behavioral objectives, course design, training methodology and processes of evaluation will be reviewed. Emphasis will be given to the use of participatory training techniques which are especially important when trainees have limited educational backgrounds.

HCED 610 THEORETICAL FOUNDATIONS OF HEALTH EDUCATION AND HEALTH PROMOTION (3)

This course examines the social and behavioral theories and models for life-style and behavior change. It focuses on theoretical frameworks and behavioral strategies for improving health including such theories as needs theory, personality development theory, the health belief model, reasoned action, behavior modification, social-learning, social support, and social change theories. Emphasis is given to the application of these theories in health education practice both domestically and internationally.

HCED 611 HEALTH COMMUNICATION THEORY AND PRACTICE (2)

This course is designed to acquaint students with the role of communication in health and behavior change. It covers basic principles and practices in interpersonal, group, organizational and mass communication and their application to public health. Students will have the opportunity to put into practice some of the theories and techniques learned in group exercises.

HCED 612 INTERNATIONAL HEALTH COMMUNICATIONS/EDUCATION: PRACTICES AND ISSUES (2)

Reviews the health communication and education practices in the context of developing countries. Current topics, such as infant formula, immunization, family planning, essential drugs, diarrhea disease control, water and sanitation, tobacco and alcohol, and life-style illnesses will be analyzed in an effort to identify effective approaches, as well as the obstacles and constraints, which confront health communication/education practitioners today.

HCED 714 PLANNING AND EVALUATION OF HEALTH EDUCATION PROGRAMS (3)

Designed to provide skills in planning and developing health education interventions for behavior change at the individual, family or social network levels of practice. Emphasis is placed on applying program design and evaluation principles to the development of educational interventions. The course is structured in a lecture-discussion format. Given its skill development focus, the course includes weekly homework assignments and the development of a health education program plan.

HCED 631 CASE STUDIES IN HEALTH EDUCATION (3)

A study of the methods of planning, designing and implementing health education programs. Students examine actual interventions using the case study method.

Maternal and Child Health (MCHL)

MCHL 612 INTERNATIONAL ASPECTS OF MATERNAL AND CHILD HEALTH (2)

Oriented to students interested in international health, especially as it relates to developing countries. The purpose of the course is to acquaint the students with the characteristics of health care for mothers and children, the factors affecting their health and the problems of delivering services which seem to be inherent to developing countries. The course combines lectures and student presentations.

MCHL 710 DESIGNING AND OPERATING PRIMARY CARE SERVICES (3)

The course is directed toward the development or enhancement of the student's ability in designing and operating ambulatory-type health services. A set of service design steps and integrated into the presentation of service planning, implementation, and evaluation. Emphasis is on the utilization of empirical information in the development of health care programs.

Environmental Health Sciences (ENHS)

ENHS 604 COMPARATIVE HEALTH SYSTEMS (3)

Global environmental health topics are discussed with emphasis on water supplies and treatment, human waste disposal, solid waste disposal and vector control. Selected field trips will complement material covered in lectures.

Health Systems Management (HSMG)

HSMG 604 COMPARATIVE HEALTH SYSTEMS (3)

An overview of the determinants of health systems and the components of the system in developed and developing countries of the world. The course will examine in depth the health systems of a number of selected countries. For comparative analysis, different health systems of the work will be categorized into four groups. Both inter-group and inter-group differences in health care costs, delivery, and organization of health care and health status of the population will be examined. Recent proposals for health-sector reform will also be analyzed and evaluated.

HSMG 615 MANAGING HEALTH CARE IN DEVELOPING COUNTRIES (2)

The purpose of this course is to teach important concepts of management as they apply to managing health care in developing countries. The course will offer a management perspective specifically suitable for students who wish to work in the health sector of developing countries. It will offer solutions to the most prevalent management problems of health care systems in developing countries, namely lack of leadership, lack of planning and proper implementation of health plans, lack of decision-making skills, and lack of appropriate organization structure and methods. The importance of a trained manager in delivering health care as a significant part of a health team which presently consists of only physicians, nurses, and auxiliaries will be highlighted.

International Health and Development (INHL)

INHL 604 HEALTH AND ECONOMIC DEVELOPMENT (3)

This course provides an introduction to social and economic development issues. The political and economic characteristics of developing countries, the process of and obstacles to economic growth are also explored. The relationships among health, nutrition and development are analyzed to illustrate the need for an intersectoral approach in development and health planning. Other important development issues, including population problems, food production and distribution, and international flow of capital are also discussed.

INHL 605 CURRENT ISSUES IN INTERNATIONAL HEALTH (2)

The roles of different types of international health organizations are defined and examined, including financing institutions, implementing institutions, research entities, technical support entities, and coordinating bodies. Organizations such as AID, World Bank, UNICEF, WHO and typical private and non-governmental voluntary organizations are described and compared. State-of-the-art management tools such as health information and management systems, program evaluation, and operations research techniques are presented. Major issues in international health are discussed including: water and sanitation, oral rehydration in primary health care, to program implementation and sustainability are also reviewed.

INHL 606 PRIMARY HEALTH CARE (2)

This course covers the evolution of the concept of Primary Health Care (PHC) and current PHC practices in the developing countries. It analyzes and reviews the principles and eight essential elements of PHC, as defined by the 1978 Alma Ata Conference under the joint sponsorship of the World Health Organization and the U.N. Children's Fund (UNICEF). Management and logistical aspects of PHC are discussed, along with a number of country PHC profiles. Child survival, a global initiative begun by UNICEF and embraced by the United States Agency for International Development (AID) and many voluntary organizations dedicated to health and development, is reviewed in the context of PHC.

INHL 611 HEALTH ECONOMICS FOR DEVELOPING COUNTRIES (3)

This course starts with a review of possible impacts of macro-economic changes on health and policy options to reduce or reverse the negative consequences of macro-adjustment policies. The course concentrates on the methodology issues of estimating demand and supply of health services; pricing policy in the health sector, methods of financing health, how to increase productivity of health resources, problems and prospects of private health insurance schemes in developing countries, methods of estimating costs and benefits of health programs and projects, and cost-benefit and cost-effectiveness analyses. To illustrate the issues, case studies from different developing countries are used.

INHL 616 INTERNATIONAL ASPECTS OF COMPARATIVE HEALTH SYSTEMS (3)

Students will examine social, economic, and political determinants of health care systems and the evolution of various systems over the last few decades. Students will compare theories of health policy and priorities, models of government intervention in providing health care and compulsory insurance, systems of remuneration, financing, planning, manpower, education and training.

INHL 620 HEALTH ADVOCACY (3)

This course examines the various elements of health advocacy for policy change as well as for policy implementation. The course points out the various competitive development priorities decision-makers face. Political process in which the roles of bureaucracy, legislature, mass media and political and social action groups are analyzed. Different methods of advocacy are presented and case studies are undertaken. Students will be required to undertake advocacy exercises.

INHL 623 THEORETICAL BASIS FOR MONITORING AND EVALUATION IN INTERNATIONAL HEALTH (1)

normally taken in conjunction with INHL 624.

INHL 624 FIELD METHODS AND PROJECTS FOR MONITORING AND EVALUATION IN INTERNATIONAL HEALTH (2)

Provides the student with the basic concepts and methodologies needed to undertake evaluation research. Major applications of evaluation research are covered: program planning, monitoring, impact and efficiency assessment. Students will design an evaluation study based on intervention projects being undertaken by school of public health and tropical medicine faculty or projects of special interest to the students. This course is the equivalent of EPID 624.

INHL 625 CULTURAL ASPECTS OF INTERNATIONAL HEALTH (3)

This course is designed for both U.S. and non-U.S. students planning to work in developing countries or with international health agencies. Topics to be covered include: approaches to working in an unfamiliar culture, cultural factors influencing health care delivery in each of the major geographic areas, working within the specific culture of the international health care donors, and the application of selected principles of cultural anthropology to health care in overseas settings.

INHL 626 FORMAL QUALITATIVE METHODS (3)

This course will provide hands-on experience in qualitative methods useful for health research. Formal and non-formal ethnographic methods will be taught, including key informant interviewing, direct structured observation, free lists, pile sorts, ranking and management, and analysis of qualitative data. Students are required to use the software program ANTHROPAC.

INHL 627 DIETARY ASSESSMENT IN INTERNATIONAL SETTINGS (3)

This course examines the roles of dietary assessment in the evaluation of health and nutritional status in international settings. A variety of dietary intake methodologies are presented, compared, and contrasted, with special emphasis on methods currently employed in developing countries. Combined with a practicum, students will select a methodology for data collection, design and administer an appropriate questionnaire, enter and process data, and present findings at the end of the session.

INHL 628 EPIDEMIOLOGY OF PROTEIN ENERGY MALNUTRITION (3)

Designed for students planning to work in health programs that relate to malnutrition in less developed countries. The major epidemiologic correlates of malnutrition are presented as well as the measurement techniques (such as anthropometrics) needed to study the disease.

INHL 629 FOOD SECURITY AND NUTRITIONAL RISK ASSESSMENT (3)

The purpose of this course is to develop student conceptual and methodologic competencies in order to effectively design, manage, and evaluate food security intervention programs. The course emphasizes food security and nutritional risk assessment techniques as planning and management tools. Students are trained to use computer-assisted analytical tools developed through Tulane's Famine Early Warning System.

INHL 630 ORGANIZATIONAL CHANGE IN INTERNATIONAL SETTINGS: CONCEPTS AND APPLICATIONS (2)

This course introduces concepts of organizational change and provides students with the analytic and technical skills needed in promoting positive change and effectively dealing with negative changes that occur with organizations in developing countries.

INHL 631 ETHNIC CONFLICT AND CONFLICT RESOLUTION WITH APPLICATIONS TO HEALTH AND DEVELOPMENT (3)

Outside the industrialized west, ethnic conflict has shown a rising trend globally both in regard to the number of such conflicts as well as their intensity. In the post Cold War world, ethnic conflict has emerged as a major factor leading to political instability, violence and displacement of populations in almost every part of the world with serious implications for public health. The causes of these conflicts are many and are a mixture of historical, political, economic, sociological, cultural, and psychological factors. The consequences are equally multi-dimensional, ranging from human suffering due to physical violence, illness, malnutrition, and disease to economic, political and social dislocation and retardation. This in turn makes nation building, an essential precondition to sustainable health and development, difficult if not impossible. This course will address this major issue from an interdisciplinary, cross-cultural perspective. The primary goal will be to teach the students a better understanding of such conflicts and a deeper appreciation of strategies to assist in the nation-building projects of these societies. Such an understanding, it is hoped, will help the public health and development practitioner to factor in the "ethnic element" into health and development strategies, policies, and programs so that there can be truly optimal and sustainable solutions to problems of multi-ethnic societies.

INHL 635 DESIGN AND MANAGEMENT OF INFORMATION SYSTEMS WITH INTERNATIONAL APPLICATIONS (3)

A review of all aspects of developing a user-oriented quantitative data/information resource for the different stages of decision making in health and development programs. Decision and indicator model development, data quality control and registration, data reduction techniques, and a review of types of data needed for resource allocation are covered. Examples and case studies will come from primarily international settings.

INHL 639 PUBLIC HEALTH COMMUNICATION AND AIDS (3)

The course discusses AIDS communication campaigns in terms of basic principles of communication theory and practice. Using materials from AIDSCOM, AIDSTECH and other sources, participants will explore campaign strategy, research, and materials development. Two major theoretical frameworks will be introduced: Adoption, Diffusion and Hermeneutic Dialectic. Examples of applications of each model will be presented and implications for using each model will be presented and the implications for using each approach will be explored. The course will discuss the design and management of communications programs, including communication planning, formative research, materials development, dissemination, monitoring, and evaluation. Participants will demonstrate their command of course materials through written reviews of communication materials and presenting an outline for an original campaign.

INHL 640 DECENTRALIZED PLANNING AND MANAGEMENT OF PRIMARY HEALTH CARE SYSTEMS IN DEVELOPING COUNTRIES (3)

This course teaches how to plan and manage decentralized primary health care programs. It responds to the WHO emphasis on decentralization as the principle strategy to accelerate "Health For all" and to the reality that effective planning and management are crucial to making the best use of limited resources. Students will learn practical, creative management and planning tools for use in the decentralization of primary health care while drawing on real life and "what if" case studies.

INHL 642 EPIDEMIOLOGICAL APPROACHES TO DISASTER MITIGATION IN INTERNATIONAL SETTINGS (2)

In this course the student will develop analytical and technical skills needed to understand disaster relief and mitigation principles within an epidemiological and public health context, including evaluation and quality assurance of relief efforts. Temporal and chronic disasters and their impacts provide the context for this course. The course is designed for public health professionals who need training in the health dimension of disaster relief. Issues of regional cooperation to providing disaster relief will be addressed. The course includes treatment of "complex disasters" which involve humanitarian emergencies that include victims of political strife and civil war. Students will develop skills in health related aspects of disaster management, including the development of disaster mitigation plans and evaluation, and an understanding of the political framework through which disaster response must be filtered.

INHL 644 DESIGN AND EVALUATION OF HIV/AIDS PROGRAMS (2)

The student is provided with an overview of the current epidemiologic characteristics of HIV/AIDS and their impact and influence on the design and evaluation process of HIV/AIDS programs worldwide. Skills in the design of HIV/AIDS programs through multisectoral involvement and consensus building setting goals, objectives, and targets are developed in each student. The evaluation of HIV/AIDS programs will focus on process, outcome, and impact indicators and the utilization of evaluation data for reports.

INHL 645 SURVEY MEASUREMENT IN THE INTERNATIONAL HEALTH, POPULATION AND NUTRITION SECTORS

The use of sample surveys to satisfy program related information needs has become increasingly common in recent years in the international health, population, and nutrition sectors. In order to take full advantage of recent developments in survey methodologies, professionals working in these sectors need to have a solid understanding of the intended uses and limitations of various standard protocols, as well as the underlying principles of survey measurement. Accordingly, the purposes of this course are two fold: (1) to establish a solid understanding of the basic principles of survey measurement, and (2) to review the "state of the art" in survey measurement in the health, population and nutrition sectors, with primary attention to the methodological basis of the protocols considered and the strengths and weaknesses of the various approaches in actual practice.

INHL 654 INFORMATION BASED HUMAN RESOURCE PLANNING IN INTERNATIONAL SETTING (2)

This in-depth course is designed to familiarize students with the complexities of human resource development in various international settings. The course seeks to increase students' knowledge and skill level to enable them to plan, produce, and manage a human resources development program. The key components of this process and their respective activities, such as planning at the micro and macro levels, design of educational and training programs, applicant recruitment and selection, career development, supervision and counseling, and monitoring and evaluation of performance will be presented and discussed in order to achieve this objective.

INHL 715 ADVANCED EPIDEMIOLOGY OF PROTEIN ENERGY MALNUTRITION (3)

Presents more sophisticated treatments of certain topics covered in the introductory course. These include both methodology for field collection and analysis as well as in-depth study of relevant nutritional problems such as vitamin A deficiency, infant feeding practices, low birth weight, and consequences of malnutrition.

INHL 796 PREVENTIVE MEDICINE RESIDENCY (third year practicum) (0)

INHL 797 FIELD STUDIES AND SPONSORED PROJECTS (1-3)

Students design and conduct a specific project under the direction of the faculty. Written and oral presentations of the project are required.

INHL 798 PRACTICUM (0)

Field experiences are recommended for department majors lacking practical experience in particular areas of international health. This field practice offers an opportunity to integrate and apply the theories and concepts learned in the program to various settings and services the academic advisor.

INHL 799 SPECIAL STUDIES (1-3)

Topics of individual research and study to be conducted with the guidance of a faculty member are identified by the student and advisor and approved by the department chair. Groups of students together with faculty may also arrange special seminars on relevant topics not presented in other courses.

SPELL 643 POLICY DEVELOPMENT AND IMPLEMENTATION: LATIN AMERICA, AFRICA AND OTHER DEVELOPING COUNTRIES (3)

This course is presented in a seminar format which combines lectures and case studies on policies of development and management in Latin America, Africa and other developing areas. Comparative perspectives on development strategies for Latin America, Africa, and Asia are presented.

INHL 997 DISSERTATION (0)

INHL 999 DISSERTATION RESEARCH (-15)

Population Studies (POST)

POST 615 INTRODUCTION TO POPULATION STUDIES (3)

Designed as an introduction to world population growth and its implications at the individual, familial and societal levels. Readings and lectures will cover population theory, basic demographic methods, current patterns of population growth, and programs designed to influence demographic trends. This course will have a strong international focus. *Tulane undergraduate students may enroll with permission of their dean, faculty advisor and permission of the instructor in the school of public health and tropical medicine.

POST 616 METHODOLOGIES FOR EVALUATING FAMILY PLANNING PROGRAMS (2)

Reviews the state-of-the-art methods for evaluating family planning programs in the international context, based on a conceptual framework linking inputs, outputs, effects, and impact. Distinguishes between program-based and population-based measures and explores the appropriate use of both. In addition, students gain familiarity with widely used methodological tools, such as situation analysis, program effort index, quality of care studies, couple-years of protection index, cost-effectiveness analysis, contraceptive prevalence surveys, and methods to measure fertility impact.

POST 625 COMPUTER APPLICATIONS IN DEMOGRAPHY (2)

Designed as an introduction to demographic techniques. Computer software programs are used to illustrate demographic technical tools: measurement of population growth, age composition, standardization, mortality and the life table, nuptiality and fertility, population distribution and migration projections, stable models, and incomplete data analysis. Following a "hands-on" approach, the students use the software programs to learn how to calculate the basic demographic measures.

POST 635 POPULATION POLICY (2)

Familiarizes the student with the nature of population policy, the process by which it is formed, the variety of policies that exist, and a general idea of their effectiveness. Focuses on policy issues related to fertility and family planning in developing countries. Students should develop a good understanding of the major issues in the ongoing debate over the relationship between population growth and socio-economic development. They will also study the relationships between fertility patterns and maternal/child mortality and morbidity and review the major health concerns related to contraceptive use. Students will read about and discuss several of the critical policy issues related to family planning programs, including ethical issues and the problem of financing rapidly expanding family planning programs. Students are expected to leave the course with a thorough understanding of the policy context in which international family planning programs, including ethical issues and the problem of financing rapidly expanding family planning programs. Students are also expected to complete the course with a thorough understanding of the policy context in which international family planning programs operate at both the national and international levels.

POST 702 COMMUNICATIONS RESEARCH FOR FAMILY PLANNING AND HEALTH (3)

Constitutes a practical introduction to the research methodologies used in planning a communication program for promoting desirable health behavior, designing appropriate messages, pre-testing communications and evaluating program effectiveness. Most examples and data sets will involve international family planning, but will be applicable to other areas of public health. Lectures will be combined with exercises in which students carry out communication pretests, conduct and analyze the results of focus groups, and do secondary analysis of existing communication data sets by computer. These skills are basic to the systematic approach in designing, implementing, and evaluating a health communication program.

POST 725 INTERMEDIATE DEMOGRAPHIC METHODS (3)

This course introduces students to a set of techniques for evaluating the quality of basic demographic data and for developing plausible estimates of fertility levels and trends from data which suffer from defects typically encountered in developing countries. Students will also be introduced to computer software for use in applying many of the techniques considered.

Special Public Health Courses (SPHL)

SPHL 700 HUMPHREY FELLOWS SEMINAR (0) Faculty.

SPHL 797 HUMPHREY FELLOWS FIELD STUDIES (0-12)

Tropical Medicine (TRMD)

TRMD 605 MEDICAL HELMINTHOLOGY (3)

The study of parasitic worms with special reference to those causing human disease. In lecture and laboratory the student is acquainted with the different groups of helminths, their zoological classification, structural characteristics, life cycles, geographic distribution, methods of transmission, reservoir hosts, location and tissue damage produced in the human body, host's immunologic responses, laboratory diagnosis and methods of treatment and control.

*TRMD 606 MEDICAL ENTOMOLOGY (3)

Designed to provide the fundamental information necessary for understanding the role of arthropods in the transmission of human disease. Following a brief review of the general anatomy, physiology, and classification of arthropods, individual groups of medical importance are considered in detail in regard to the recognition of important species, the epidemiology and pathogenesis of associated diseases, and the principles and methods of vector control. Lectures, demonstrations, and laboratory exercises.

*TRMD 607 MEDICAL PROTOZOOLOGY (3)

The objective of this course is to enable the student to gain the skills, knowledge and biological perspective essential for the practical recognition, evaluation and management of problems in clinical or public health practice involving the protozoa that are parasitic in man. In lecture and laboratory diagnosis, immunologic transmission, reservoir hosts, pathogenicity, laboratory diagnosis, immunologic aspects and methods of control. Tulane undergraduate students may enroll with permission of their dean, faculty advisor, and permission of the instructor in the school of public health and tropical medicine.

TRMD 617 IMMUNOLOGY (3)

Designed for students of medicine and allied health fields with the aim of providing information necessary for understanding the immune system. Following a comprehensive consideration of both cellular and humoral immunity and the complement system, attention is given to the role of the immune system in resistance to infection and the maintenance of homeostasis.

TRMD 623 METHODS IN CELL BIOLOGY (3)

Provides students with introduction and broad overview to the basic biochemical, molecular and immunological techniques that are commonly used in biomedical research with a special emphasis in parasitology. The various topics to be covered will include centrifugation, analysis and isolation of proteins and nucleic acids, recombinant DNA and immunological methods. The theory behind the various techniques and the general procedures for carrying them out will be described.

TRMD 631 CLINICAL TROPICAL MEDICINE (4)

Clinical tropical medicine provides a substantial introduction to the major diseases of tropical and developing countries. Emphasis is placed on important parasitic diseases, gastroenteritis and vaccine preventable diseases. Course material focuses on the etiology, pathogenesis, symptomatology, diagnosis and treatment of these diseases; epidemiologic characteristics, control methods and current research directions are also described. Many lectures are presented by recognized authorities with firsthand experience in the tropics.

TRMD 632 PREVENTIVE TROPICAL MEDICINE (2)

Designed primarily for the physician to complement TRMD 631 Clinical Tropical Medicine. Presents the basic principles of preventive medicine in the context of the special environment (physical, biological and social) of tropical and developing countries. Emphasis is placed upon the prevention and control of infectious diseases of major public health importance. Vaccine preventable diseases are given special emphasis. In addition to presenting concepts and theoretical methods of disease control, detailed examples are provided of actual programs.

TRMD 702 DEPARTMENTAL SEMINAR (1,1)

TRMD 703 CAPSTONE COURSE (1)

This capstone course provides an opportunity for students to integrate knowledge from Tropical Medicine courses and other public health courses to design a proposal or national plan of action (NPA). Proposals to NPA will be developed in groups and will address a problem in Tropical Medicine or a disease control strategy for a particular region. Students work closely with faculty advisors and present their work at the end of the semester as a Capstone Seminar and a written report. The course provides practical experience in study design and presentation by simulating the steps necessary to present a successful project in either basic or applied tropical medicine.

TRMD 708 PARASITOLOGIC METHODS (2)

Provides the student with training in the diagnostic techniques and research methods of medical parasitology. In lectures, demonstrations and laboratory exercises, emphasis is given to the principles and detailed procedures employed in the routine examination of fecal, blood, tissue, and other specimens in a medical parasitology laboratory, in serodiagnosis, and in entomologic field studies.

TRMD 709 PARASITES OF LOWER VERTEBRATES (4)

The objective of this course is to enable the student to recognize the members of all major groups of parasites, primarily the helminths which occur in domestic animals and wildlife. Emphasis is given to those organisms which are known to be, or are potentially zoonotic. In lectures, the various groups of parasites, their identification, relationships to one another, and life histories are stressed. In the laboratory representatives of each major group are studied, and in addition, the students examine a variety of wild animals from which parasites are recovered and identified.

TRMD 710 COMPARATIVE MICROANATOMY OF HELMINTHS (2)

Designed for advanced students in parasitology, this course is based on the detailed study of the morphologic and special recognition features of all types of helminths that are known to occur, or are expected to occur in human tissues. In addition, certain groups of protozoa and common types of artifacts that may be confused with worms in tissues are covered. The characteristic features of lesions associated with parasites in tissues are examined in a general way.

*Tulane undergraduate students may enroll with permission of their dean, faculty advisor, and instructor in the school of public health and tropical medicine.

TRMD 718 IMMUNOPARASITOLOGY (2)

Designed to provide students of medicine, the basic sciences, and public health with an understanding of the role of immunity to parasitic infections. Special emphasis will be placed on current knowledge of mechanisms of immunity to protozoal and helminth infections that cause malaria, trypanosomiasis, leishmaniasis, schistosomiasis and filariasis, some of the most widespread and debilitating diseases still plaguing the world. Additional topics may be covered according to student needs and trends in the field.

TRMD 782 MALARIA (2)

An advanced course which provides a substantial introduction to the most important parasite diseases in the world at the present time. Essential information concerning the biology, immunology, biochemistry and genetics, the biology of the mosquito vector as well as clinical aspects, chemoprophylaxis and chemotherapy, epidemiology and control measures are presented in lectures and demonstrations. Included are laboratory sessions during which techniques for diagnosis and field surveys are covered from the theoretical and practical standpoint. Designed for health professionals who expect to work in malarious areas or who have a special interest in malaria.

*Tulane undergraduate students may enroll with permission of their dean, faculty advisor and instructor in the school of public health and tropical medicine.

TRMD FILARIASIS (1)

Designed for students in public health who have a basic background in medical parasitology. Coverage includes the natural filarial parasites of man, the zoonotic filariae, vector biology, and the immunological implications of infection.

TRMD 786 SCHISTOSOMIASIS (2)

Designed for students in public health and those in tropical medicine, the course addresses various aspects of this disease which is considered to be next to malaria in importance. The course covers in detail the geographic distribution of the parasites, the epidemiology, especially transmission dynamics and transmission foci; the human host-parasite balance, nutrition, immunity, clinicopathological manifestations, diagnosis and treatment; the snail hosts and the snail-schistosome relationship; medical malacology as it relates to schistosomiasis; strategies; and methods of control and zoonotic schistosomiasis.

TRMD 796 PREVENTIVE MEDICINE RESIDENCY (0)

(third year/practicum)

TRMD 799 SPECIAL STUDIES (1-5)

TRMD 996 THESIS (0)

TRMD 997 DISSERTATION (0)

TRMD 999 DISSERTATION RESEARCH (1-15)

V. FACULTY

Department of Applied Health Sciences

Ted Chen, Ph.D., Professor Judith McDivitt, Ph.D., Assistant Professor

Department of Biostatistics and Epidemiology

Harrison C. Spencer, MD, MPH, Professor and Dean

Department of Environmental Health Sciences

Assaf Assaf Abdelghani, ScD, Professor
William Toscano, PhD, Professor and Chair

Department of Health Systems Management

David Fine, MHA, Professor and Chair
Walter Burnett, PhD, Associate Professor
Mahmud Khan, PhD, Associate Professor
Vinod Thukral, PhD, Associate Professor
E. Gordon Whyte, PhD, Clinical Associate Professor

Department of International Health & Development

Andrew Arata, PhD, Clinical Professor
Jane Bertrand, Professor and Chair
William Bertrand, PhD, Professor
Robert Franklin, MD, Associate Professor
David Hotchkiss, PhD, Assistant Professor
Carl Kendall, PhD, Associate Professor
Mahmud Khan, PhD, Associate Professor
Jack Ling, MA, Clinical Professor
Robert Magnani, PhD, Assistant Professor
Scott McKeown, DrPH, Research Assistant Professor
Nancy Mock, DrPH, MPH, Associate Professor
Frank Reily, MA, Research Instructor
S.W. de A. Samarasinghe, PhD, Clinical Associate Professor
Jennifer Strickler, PhD, Assistant Professor

Department of Tropical Medicine

VI. PROPOSED INTERNATIONAL PROGRAMS

EXECUTIVE MPH in Health Systems Management (Taiwan)

Professors David Fine and Ted Chen are developing this executive level MPH program in collaboration with the Chinese Hospital Association in Taiwan. The goal of this project is to recruit and train executive level hospital administrators in Taiwan annually through the Tulane MPH program in Health Systems Management. Eighteen credit hours will be taught by Tulane faculty who will travel to Taiwan or by Tulane appointed adjunct faculty in Taiwan. Eighteen credit hours will be taught by Tulane faculty on the Tulane campus. The projected cost for this program is $260,000 per class.

Environmental Health Science Training Workshop (Taiwan)

Ted Chen, Ph.D., Assaf Assaf Abdelghani, D.Sc. and William Toscano, Ph.D. are collaborating on plans to work with the Environmental Health Administration of Taiwan to set up short-term training workshops in Taiwan. The collaborating institution in Taiwan is the College of Public Health, National Taiwan University. The funding agency is the Taiwan EPA.

Executive MBA/MPH (Taiwan)

David Fine, MHA, is developing an executive level MPH track in the Tulane/National Taiwan University Executive MBA program developed and administered by the Freeman School of Business. This is an interdisciplinary program that will provide an executive level training program for Taiwan business administrators. At the end of the course a joint MBA/MPH will be awarded.

Executive Master of Applied Development and Health

This program is designed for professionals with field experience working in the areas of social and economic development and/or health program interventions who require the theoretical, analytical and practical skills to be effective in their jobs. This is an interdisciplinary program, drawing on faculty and approaches from many disciplines, including the fields of economics, sociology, and public health. The program is modeled after the successful Development Studies Program already in existence in Washington, D. C. and the Social Mobilization Program which has been conducted at Tulane for the past two summers.

Build A School of Public Health in Collaboration with Davao Medical School Foundation

Ted Chen, Ph.D., with support from the Tulane University Administration, is taking a lead in developing this initiative to develop a new school of public health in the City of Davao, located in the Southern region of the Philippines. The President of Davao Medical School Foundation and his top associates have visited Tulane campus to express their strong interest in pursuing this collaboration. Initial contact has also been made with Philippines' DOH and USAID.

School of Public Health and Institute for Malariology, Parasitology and Entomology in Hanoi, Vietnam

Donald Krogstad, M.D. and Ted Chen, Ph.D. are developing an initiative in this Vietnam development. An initial step will be the overall assessment of health needs in North Vietnam. If USAID support becomes available in the near future, it may be possible to begin with an assessment supported through the EHP, which could then advise USAID of the needs and set the process in motion for support. Major perceived needs at the Hanoi School of Public Health are the education of young faculty outside Vietnam for 1-3 years to address the lingering effects of isolation until 1990, especially in HIV/AIDS, nutrition, health communication/education, epidemiology and malaria. Also being considered is a need for assistance to the Institute of Malariology, Parasitology and Entomology. Because malaria is viewed as the number one health problem in Vietnam, any health program must address malaria as an issue and in particular, drug resistance. This program is being developed in collaboration with the College of Public Health of the National Taiwan University.

CALI, COLOMBIA

The 30 year collaboration between Tulane and Cali has been reactivated during the past year. There are multiple levels of collaboration in this project, including visits by Tulane physicians to the new tertiary care facility at Fundacion del Valle (Dr. Antonio D'Alessandro), by Tulane academic faculty to the Universidad del Valle (Dr. Mark A. James), and scientific collaboration between investigators at Tulane and CIDEIM, which focus on relapse in Plasmodium vivax malaria (Drs. Jackie Alger and Donald Krogstad) and the vectors associated with transmission of leishmaniasis (Dr. Dawn M. Wesson). Short-term collaborations have been supported by a small fund created 10 years ago by Tulane. CIDEIM and FES (because Universidad del Valle could not contribute due to its status as a governmental institution). Likewise, short-term scientific visits have been supported by NIH Visiting Scientist funds available through CIDEIM or Tulane. Dr. Alger's work is now being supported by a WHO/TDR Fellowship for Doctoral Studies written by her in collaboration with Drs. Krogstad and Nancy Saravia (Adjunct Professor). Additional applications for support are now being written by Drs. Saravia and Krogstad.

Hospital Albert Schweitzer, Deschapelles, Haiti

Donald J. Krogstad, M.D. is developing this initiative. The close proximity of Haiti and its French tradition, together with the fact that Dr. Larry Mellon, the founder of the hospital, obtained his medical degree from Tulane are important factors. Unfortunately, the present political situation makes it difficult to travel either into or out of Haiti. When that situation has been resolved, we intend to travel to Deschapelles to honor a request to provide the rapid test for chloroquine resistance. During the last 3-4 years, there has been a three-fold increase in the frequency of P. Falciparum infection, which could be produced by chloroquine-resistant P. Falciparum parasites. Because the primary objective of the Schweitzer Hospital is not research, this connection has the potential to provide overseas clinical sites, but is not likely to provide major basic research opportunities in the short term.

Environmental Health Initiatives in San Pedro Sula, Honduras

Ann C. Anderson, Ph.D. is developing an initiative that led to the signing of a cooperative agreement between the Tulane School of Public Health and Tropical Medicine, the Universidad de San Pedro Sula, and an Advisory Committee of medical, business, industrial, and community leaders in San Pedro Sula to address environmental health issues of importance to the city. An environmental needs assessment has been done which outlines the major environmental problems in the area and prioritizes issues for action. The first international conference on environmental health issues was held in August, 1993. The second conference, planned for November, 1994, will focus on water resource and water quality. The ultimate goal of the initiative is to develop a school of public health in San Pedro Sula.

Immunopathogenesis of Chagas' Disease in Paraguay

Mark James, Ph.D., is involved in collaborative research at the Instituto de Investigaciones en Ciencias de la Salud (IICS), Asuncion, Paraguay to study the role of cytokines in the immunopathogennesis of Chagas' disease. Chagas' disease is endemic in Paraguay, thus providing an important site with local expertise for studies on the immunologic, epidemiologic and clinical aspects of the disease. The proposed budget is $50,000 per year for 3-to-5 years. The faculty of the Department of Tropical Medicine would be primarily responsible for the project. January 1966 is the target date for the implementation of this initiative.

Shanghai Medical Center, Chinese Institute for Health, Peoples Republic of China

VII. Time Frame for Proposed New Programs

VIII. CONCLUSION