Loren Galvao, MD, MPH [Preceptor]

What is your role in the WI Population Health Fellowship program?
Loren Galvao, MD, MPH, joined the preceptor ranks in August 2010. “I believe it is a very exciting role because I get to see people grow in their career plans. For me, it is very gratifying to be working with a Fellow and develop with them new initiatives, new research, and publications.”

What inspired you to become involved with the Fellowship program?
“I am involved in the Population Health Sciences Dept; I have had an appointment as an honorary Fellow since 2005 so I have been working with other investigators there. I am also one of the Associate Directors for the SHOW [Survey of the Health of Wisconsin] project— a statewide population health project since 2005. I was contacted by the Fellow also who is very interested in global health. I work globally and locally—this Fellow is also interested in working globally and locally so I think we have a lot in common; it was a good match.”

What are a few highlights of your background in public health?
“I’m a physician, my medical degree is from Brazil and I also did training in OB/GYN early in my career. After that, my work has been very focused in public health and global health. For the past 20 years I have been working mostly in the area of reproductive health, HIV prevention, family planning, maternal and child health. So my research has evolved into a wide range of areas.

Early in my career I thought I would be a gynecologist. But then I moved to the U.S. and became interested in public health. My plan was to go back to Brazil and practice OB/GYN…but after I completed my degree in public health at the University of Michigan, my views changed a bit. However, even when I was in Brazil working in obstetrics and gynecology wards in large hospitals, I saw girls 12 and 13 delivering babies or having abortions—some of them would die at a young age due to abortions and complications. I wanted to work more to prevent these sorts of things from happening. So, I already had view of public health. Also, in my training in Brazil as a medical student, I had the opportunity to do a lot in community health and public health. Our university was very strongly focused on social medicine. So I had an opportunity as a medical student to already see these kinds of broad approaches—public health, social medicine. We also looked at the broader determinants of health because it is a country that has major disparities—economic and healthcare access. I grew up in that environment where I felt I needed to address these broader issues that are associated with health. When I came to the U.S. to do a Master’s degree in public health, I felt that my clinical background was helpful, but I really wanted to focus more on the public health. Most of my career has been public health but the clinical background helps, especially in global health. It was something that grew—through Master’s in public health, working in international organizations and now being in academia, I feel I can connect these worlds—of international non-governmental organizations (NGOs) and academia.

I have worked with the Population Council in Brazil researching family planning and HIV; conducting national assessments, qualitative studies and a randomized trial comparing female and male condoms in Brazil and several other studies on the female condom. Before that, I worked with Save the Children where I was mostly involved in global health programs; my work focused a lot on maternal and child health. At that time I worked with several countries in Latin America, Asia and Africa providing support to programs that implemented child survival, maternal health and family planning. The main areas where I worked were southern Africa, Bangladesh, and Bolivia. To date I have worked in 19 countries.

Since 1996, my research interests have really focused more on HIV prevention. When I came to the U.S. in 2001, I still was doing consulting for international organizations. I spent two years doing consulting for WHO, Family Health International, and the Population Health Council, mostly in the areas of HIV prevention, providing support and advice for studies.

In 2003 I joined the UW-Milwaukee Center for Cultural Diversity and Global Health and started developing research in Africa. After that, I also joined the Center for Urban Population Health as the Associate Director for Community Partnerships. So my work is really balanced between the global and the local. I divide my time and it’s a real challenge sometimes to do both global and local public health research—but it is possible and very rewarding.”

What are you working on right now?

“My major project internationally is an NIH-funded project where I’m a co-Principal Investigator in a 5-year study entitled “Pathways.” In this study, we are examining the pathways between HIV, poverty, and food security. This is in collaboration with the Medical College of Wisconsin and CARE-Malawi. CARE is a large humanitarian organization working in about 72 countries globally. This project is a large evaluation of a development intervention; the major components are microfinance, sustainable agriculture, and health. We are evaluating the long-term effects of these interventions on health outcomes including HIV, nutrition, reproductive health, gender, empowerment, and community and individual behaviors. It’s a multi-level evaluation. It’s important because there are few studies doing such a controlled, quasi-experimental design. You have a lot of evaluations for international NGOs that are limited in study design or scientific rigor.  As we are reviewing the literature, we have found few evaluations using a quasi-experimental design.  So it’s a very exciting study—this is the one I’m really focusing on globally.

In Wisconsin I’m very involved in SHOW—a major population-based cross-sectional household study that will be done over many years. One important thing about this study is that it forms an infrastructure for ancillary studies so there are opportunities for other researchers to join and design, for instance, community-specific surveys (“mini-SHOWs”) or “before and after” community-based intervention studies. I’m very interested, either in U.S. or globally, in studies that have effects and impacts on the community. Studies such as SHOW and Pathways provide an opportunity for others to join—other researchers, Fellows, and graduate students, to come and really sustain these kinds of studies. I am very pleased to have a Fellow working with us. She is involved in a community advisory board to the SHOW—it’s a small pilot study where we are looking at how we can use SHOW findings to interest communities to use this data to develop community action. So, the Fellow is involved in global and local projects. Hopefully there will be more Fellows in the future who are interested in this connection with the local and global. The U.S. is part of the global…but sometimes there is a separation. I believe there has been more interest in global health in the past decade in the U.S.; many universities are starting to expand their programs in global health so hopefully the universities in Wisconsin will expand their work in global health. I believe Fellows, graduate students, and other researchers are the key for that. The young people who are coming who are excited about it—they are key for this, to really keep this going…We’re trying to build a global health research team in Milwaukee—very exciting!”

Do you have any advice for those interested in the Fellowship?

“It’s important to have some experience in the community. It’s very important to have that connection where you deal directly with people—otherwise it becomes very theoretical. If you’re interested in global health, go to another country and spend at least a few months working with an international organization. Or if your focus is local—do something in the U.S. working directly with people. Even if a Fellow is going to focus on biostatistics or epidemiology or areas such as those, the Fellow would then have the experience with people in the communities and face the problems that affect the people in those communities. I believe this is essential.”

Do you have a public health role model/hero?

“There are so many that are wonderful people! One person I admire a lot is Dr. Helene Gayle—she is the president of CARE-USA. Her career is really fantastic—she’s worked with the CDC, Gates Foundation, and now CARE. She’s doing a wonderful job there and has been a leader both in the organization but also globally—she has been supportive of our project in Malawi. She is a person who really has a strong passion for global health and has been doing wonderful work.

Dr. Paul Farmer also on the academic side is a wonderful role model with all his work in Haiti and globally and looking really broadly at HIV and other health issues.”

What is one public health-related activity in your community that you are proud about?

“I believe there are many large studies that are published in academic journals and they are kept as…almost a secret by academics—they don’t really get to the communities. The way academia is set up is that the researchers have to publish their findings in peer-reviewed journals and books, but many times it doesn’t get to the real people—the lay people in the community. So, in working with SHOW for all these years, I felt that I would really like to see the findings get to the communities.

Milwaukee is one of the cities with major disparities in the U.S.—poverty levels are very high compared with other cities—fourth in terms of poverty. I believe SHOW is an extraordinary study that has a lot to give. I wouldn’t like to wait until we publish all the findings—it doesn’t get to those communities in need. So, the idea of the SHOW Community Advisory Board (CAB) came about in discussions with the community organizations here including the Social Development Commission (SDC), which is an organization that is also interested in addressing poverty and health issues. So I think it was a good marriage of academia and a local social service organization to look at research in a different way—really trying to translate those findings of a large and very important population health study to the communities.

And the idea is very simple: to bring people together who are clients of the SDC who are interested in improving health in their communities to discuss these findings as they are available. The preliminary findings from SHOW are becoming available now, so the idea is that they look at these findings through their own eyes—we have about 12 members—in sessions throughout the year where we discuss health and the ethics of research—this is very important given the history of African Americans with ethical issues and research; many people in the community are afraid of research, many don’t trust research, they are tired of being “researched.” The idea is to bring people together who are affected by major health disparities and look at the data and then from there, interpret the findings through their own eyes—not through the eyes of researchers only—and see how they could use the findings either to affect policies or to use the data for simple interventions they could do in the community, like community action.

Also they (the CAB) are serving as an advisory group on how we can disseminate the data to the community in a way that is understandable and it makes sense—that really reaches the community. For example, most researchers believe that publishing is enough. So we ask how can we make the data “talk,” and be meaningful for those communities and really affect change? There are many levels of affecting change—obviously it is very important to publish in the peer-reviewed literature and books but there are other ways to reach the community. It could be through media, art, songs, local journals, or local newspapers. I also believe it is important to let the data “talk” and can bring the real histories of people through narratives. Sometimes if you just present numbers it is not attractive to communities. We are already hearing from our SHOWCAB that they would like to see more visual dissemination of data. We are in the process of getting their advice at this point. We’ll have more recommendations next year but I believe it will be very interesting to see the inputs of the African American community. Hopefully there will be other researchers interested in this and it can multiply to other communities in Wisconsin. Since SHOW is statewide, there could be other communities who are interested in getting data and replicating this model for community action and really contributing to effect change.”

What is one public health achievement you think will happen in the next 25 years? What is one you would like to see in the next 25 years?
“Well, since I work in the area of HIV/AIDS, I would like to see a vaccine for HIV…and hopefully in 25 years we will have one. Before that, given that I have been working in primary prevention research with female and male condom—I would like to see a microbicide that is user-friendly for women, safe and low cost. Before we have a vaccine, this could be a great technology. I’m very interested in user-friendly, safe, effective and low-cost technologies for reproductive health that could improve women’s lives.”
Any closing thoughts?

“The Fellowship is a very important program. I would really like to see more Fellows interested in the connection between the local and the global—that the local is part of the global. So hopefully we’ll have more Fellows in the future in Wisconsin who are interested in this kind of work. I believe this program has enormous potential in public health and global health by bringing the passion of young investigators and people who will be doing this kind of research to the field!”