Scatterlings

Dear readers,

Thank you so much for your support. I have initiated a couple of new projects. One of my next projects will be a second collection of poems with the preliminary title,”Scatterlings.” Here is a sneak preview meditating on recent events in Baltimore.

An ode to Baltimore

Riots

 A broken man, a broken back,

Mental ravens slowly torn apart on a torturer’s rack,

Frustrated guardians pushed to the brink,

Vigilante justice and mayhem replace invisible legal ink.

Neighborhoods straining under the weight of poverty,

Lash out against police doubling as social workers and soldiers against calamity,

Do we wall of thugs in casks of Amontillado?

Do we decree from afar morality’s credo?

Aftermath

An eerie calm has returned to the street,

Where businesses and rioters were poked to bleed,

Violence has been replaced by armed sentinels, rhythmic chants, and silence,

A tired single mother on her way to a second job,

Remonstrates with her errant son and equates his father with a fob.

Promises and vows are taken anew,

Pointing fingers temporarily lances the boil of inequality,

Repeated conversations provide society a measure of indemnity.

 Family

      What happens to society’s son or daughter lacking love’s path to identity,

      Who turns to gangs for family structure and solidarity,

      Who sells marijuana to the prosecutor that will become his jailer,

      Who graduates from prison to face scorn from those who wish to assail him or her,

      Who will wear this mark of Cain on every job application?

       What will become of human beings deemed by some to be flotsam or equivalent        to an infestation?

       In a burning city that inspired “The Star Spangled Banner,”

       Can we reclaim lost members of the societal family and implement our       forefathers’ vision with rigor and candor ?

Cancer immunotherapy (First appeared in The Norwalk Patch)

Effective immunotherapy i.e. enlisting the patient’s own immune system to fight disease may mark a milestone in the fight against certain cancers. Three lymphocytes – T cells, B cells and NK-cells – involved in specific immune responses against cancers and other diseases. T cells recognize specific antigens via a T-cell antigen-receptor. The two main types of T cells, CD4- and CD8 T-cells, are categorized according to their respective CD4 and CD8 surface markers. The latter group includes cytotoxic T cells, also known as killer T lymphocytes. These cells kill invading pathogens or other disease-causing agents. Scientists discovered that a type of protein receptor, cytotoxic T-Lymphocyte Antigen 4 (CTLA-4), prevented T cells from launching immune attacks [1]. In the early 1990s, another “brake” was discovered in dying T cells namely programmed death 1 or PD-1. The rationale underlying cancer immunotherapy is that exposing CTLA-4, PD-1 or using other appropriate immune-system-based therapies may enable the release of the immune system to destroy cancer.

Genetically engineering a patient’s T cells to target tumor cells marked one of the promising turning points in cancer immunotherapy. A research group from Memorial Sloan Kettering Cancer Center reported last year that T cell therapy ( chimeric antigen therapy [CAR]) in their studies put 45 of 75 adults and children with leukemia into complete remission, although some relapses were occurred at a later date [1]. Researchers from other institutions have reported promising results such as tumor regression with advanced melanoma. The hope, according to Dr. S. Rosenberg, is that CAR T cell therapy may eventually “become the standard of care for B-cell malignancies” like acute lymphoblastic leukemia and chronic lymphocytic leukemia.

For some patients with metastatic disease, cancer immunotherapy may offer a chance, although researchers have yet to figure out why the treatment works in some patients and not in others. In addition, there are side-effects such as the release of signaling proteins regulating interactions between immune cells, also known as cytokines. Cytokine-release syndrome can be mild and therefore treatable or the rapid and massive release of these molecules could lead to declines in blood pressure and debilitating fevers.

Nevertheless, buoyed by promising results, scientists are turning their attention to developing engineered T cells for other cancers, including pancreatic and brain tumors.

Source

1.            Couzin-Frankel, J., Breakthrough of the year 2013. Cancer immunotherapy.Science, 2013. 342(6165): p. 1432-3.

Parkinson’s disease

First appeared in The Norwalk Patch:

We are able to control muscle movement, in part, via the aid of a brain chemical called dopamine. One of the hallmarks of the movement disorder, Parkinson’s disease (PD), is the death of dopamine-producing nerve cells. The onset of this syndrome is insidious and include numerous motor (tremor, rigidity, bradykinesia, postural instability) and non-motor symptoms (e.g., sleep disorder). It is one of the most common neurological illnesses (as many as 1.5 million patients in the USA alone; mean age of onset = 65 years old) and treatment costs exceed $14.4 billion per year. According to the latest report from the Pharmaceutical Research and Manufacturers of America, nearly 40 medicines are currently being developed to treat and diagnose PD and related conditions. The investigational disease-modifying therapies include medicines focused on protecting brain cells in an attempt to halt disease progression or therapies aimed at generating new cells or repair damaged cells. The full 2014 report on the PD pipeline can be found here.

Direct and indirect approaches to fight cancer

Cancer– a group of at least 200 disease forms and many more subtypes – wreaks havoc in the human body through uncontrolled growth of cells. While debates about a suitable 21st-century-definition continue (to avoid over-management of these conditions), it is clear that genetic surveys inform the diagnosis and treatment of many cancers. Catalogs such as The Cancer Genome Atlas, funded by the National Cancer Institute and National Human Genome Research Institute, have informed the understanding of diverse tumor characteristics.

However, the atlas may only have revealed 1/10th of the needed genetic information e.g., researchers estimated that they would need 100,000 samples to find most genes involved in the 50 most common types of cancer. Structuralfeatures of each tumor may also hamper the search for effective cancer-fighting therapies. According to Dr. Rakesh K. Jain, director of the Steele Laboratory for Tumor Biology at Massachusetts General Hospital and author of a Scientific American article [1], blood vessels constricted by a tumor constituent or matrix could retard the dispersion of potentially lifesaving medications throughout the neoplasm. Preclinical studies from his laboratory showed that depleting the matrix with a blood pressure medication could improve the perfusion of anticancer drugs in a neoplasm and improve survival rates [1]. Researchers are currently investigating angiotensin inhibitors as matrix-depleting agents combined with chemotherapy in patients with pancreatic ductal adenocarninoma (the fourth leading cause of cancer deaths in the United States) [1, 2]. Should the results bear fruit in the future, Dr. Jain envisions that treatment may consist of targeted cancer cell-killers, vessel-normalizing drugs, and matrix-depleting agents. Patients unable to take anti-hypertensives may potentially also benefit from alternative agents attacking other abundant tumor constituents. Ultimately, laboratory tests could be employed to measure the response of the matrix to different test agents [1].

Cancer researchers are in the midst of exploiting genetic and physical information to understand the etiology of diseases that are increasingly affecting poor- and middle-income countries. Hopefully the global toll of 8.2. million deaths in 2012 could be slowed with these approaches.

References

1.  Jain, R.K., An indirect way to tame cancer. Scientific American, 2014. p. 48-53.

2.  Hezel, A.F., et al., Genetics and biology of pancreatic ductal adenocarcinoma.Genes & Development, 2006. 20(10): p. 1218-1249.

 

Entrepeneurs

My homage to entrepeneurs will begin with a piece a wrote a while back for the Norwalk Patch: http://patch.com/connecticut/norwalk/can-entrepreneurs-aid-the-south-african-economy.

Additional information is available through the South African Institute for Entrepeneurs.

I hope to continue this series by shining a spotlight on entrepeneurs across the globe.

Cheers.

Diabetes and infectious illness series on Amazon

Hi everyone,

Happy Friday and thanks to everyone who checked out my author pages on Amazon and Facebook. This is just a quick announcement that my two-part series is available in paperback and Kindle formats on Amazon. The first book, Perspectives on Type 2 diabetes, is available for immediate purchase and the second book, HIV/TB/Diabetes resource kit, should be available within 48 hours. Please discuss any information you wish to follow up on with a doctor.

I hope to return to blogging soon (Amazon author page).

Antidiabetic therapies (a sneak peek at my next book)

Here is a chapter of my next book, Perspectives on Type 2 diabetes, that will contain a lot of reader-friendly science and some stories. Enjoy!

What does the perennial herb, Galega officinalis, have in common with a venomous lizard, the Gila monster, and pancreatic extracts from collies? The answer is simple i.e., original sources for important antidiabetic therapies. A seminal paper, The Beneficial Influences of Certain Pancreatic Extracts on Pancreatic Diabetes, by Banting et al.1 that described results of experiments conducted on dogs laid the groundwork for the discovery of insulin, thereby forever changing treatment of the disease. A biguanidine derivative from the poisonous G. officinalis plant, metformin, is recommended by the American College of Physicians as monotherapy for the initial pharmacologic therapy of most Type 2 diabetics (except for pre-specified contraindications such as renal impairment; a complete list of contraindications is available).2 Saliva from the desert-dwelling Gila monster served as a source of incretin therapies—glucagon-like peptide-1 (GLP-1) agonists and dipeptidylpeptidase-4 (DPP-4) inhibitors. These compounds, hailed as breakthrough discoveries for the management of diabetes and possibly obesity, operate through switching on insulin and suppressing glucagon to control blood glucose. Based on evaluations performed in 2013, both the US Food and Drug Administration (FDA) agreed with the European Medicines Agency (EMA) concluded that available data did not corroborate published concerns regarding an increased risk for pancreatic side effects with GLP-1-based antidiabetic therapies.3

 

A multifactorial approach incorporating lifestyle changes and any one of several mainstay therapies is likely to form the basis of individualized algorithms designed by clinical teams for the treatment of each diabetic. It bears repeating that diabetics are more likely to be hospitalized with cardiovascular (CV) disease, have end-stage renal disease, go blind, and suffer non-traumatic lower limb amputations compared with non-diabetics.4 Intensifying case-finding in the general population to delay or prevent Type 2 diabetes therefore continues to be a national priority. Clinical symptoms (increased urination, increased thirst, unexplained weight loss, fatigue, blurred vision, increased hunger, and sores that do not heal) combined with any one of established blood tests (glycohemoglobin test [HbA1c], a fasting plasma glucose [FPG] test, an oral glucose tolerance test [OGTT], random plasma glucose [RPG] test) serve as diagnostic benchmarks.5 Following screening and diagnosis, patient-centered care and management usually includes individualizing an A1c target, establishing the frequency and pattern of self-monitoring blood glucose levels, reducing vascular risk, and tailoring pharmacotherapies taking comorbidities or downstream complications from diabetes into consideration. According to the 2013 clinical practice guidelines from the Canadian Diabetes Association, the desirable goal of vascular protection for all diabetics is potentially within reach by incorporating pharmacotherapies into an ABCDES-management algorithm. Simply put, A refers to A1c (optimal glycemic control, usually ≤7%), B = optimal blood pressure control (<130/80 mmHg), C = (LDL-C ≤2.0 mmol/L if decision made to treat), D refers to drugs to protect the heart, E refers to exercise and other behavioral changes (regular physical activity, healthy diet, achievement and maintenance of healthy body weight), and S = smoking cessation.4 In addition, a 2015 management algorithm from the American Association of Clinical Endocrinologists and American College of Endocrinology underscores the importance of tailoring treatments for obese or overweight diabetics in a milieu of clinical complications and attendant management risks. Moreover, pre-diabetes, glycemic-control, insulin addition or escalation-, and CV-risk-factor-modification algorithms have been summarized for the benefit of healthcare professionals.6,7

 

In the real world, a patient’s age, disease stage, body weight, comorbidities, work situation, income, level of health literacy, adherence, and personal priorities8 may all have to be taken into consideration in designing an appropriate management algorithm. Although the different algorithms may have to integrate clinical and socioeconomic factors, the long-term goals of each treatment plan remains the same: the prevention of micro-angiopathic complications—retinopathy, nephropathy, neuropathy; the prevention of macro-angiopathic complications—myocardial infarction, stroke, limb loss; restoration of quality of life; improvement in comorbidities; patient satisfaction and accompanying treatment adherence; the avoidance of hypoglycemia and weight gain. Anti-hyperglycemic pharmacotherapies to achieve individualized glycemic control include metformin, sulfonylureas, glinides, DPP-4 inhibitors, GLP-1 agonists, acarbose, pioglitazone, and insulin. Each medication may have independent associated risks such as hypoglycemia or weight fluctuations as well as other side effects. In addition, doses may need to be adjusted depending on a patient’s kidney function.8

 

The numerous approved pharmacotherapies for lowering blood glucose concentration have contributed to declining death rates due to diabetes in richer countries. However, the tripling of the number of diagnosed American diabetics since 1980, and similar trends worldwide have added to the impetus to develop more effective treatments with reduced side-effect risks. Currently, 100 of 180 antidiabetic therapies are undergoing clinical investigation for the management of Type 2 diabetes.9 One of the medications in the current pipeline improves glucose-dependent insulin secretion. Other medications with potentially longer therapeutic lives are also undergoing evaluation. Any therapeutic innovations in incretin-based therapies would be especially interesting because of additional beneficial effects on blood pressure, dyslipidemia, reduction in body weight, and potential cardioprotective, and neuroprotective effects. Although the jury is still out regarding the purported pancreatic risks associated with these agents, the multi-organ benefits of the drugs have given healthcare professionals cautious optimism for further use until large, randomized clinical trials can educate the community about the actual risks of pancreatitis and pancreatic cancer.10 Optimized trial paradigms geared towards improving the CV safety profiles of antidiabetics such as enrichment of higher CV-risk enrollees to ensure that an adequate number of endpoints is obtained to allow a meaningful estimate of risk, using both glycemic efficacy and cardiac safety as primary measures in a single trial, conducting meta-analyses based on appropriate statistical considerations of accrued, adjudicated CV events recorded during phase 2 and 3 trials, and monitoring defined groups or populations for interim analysis or non-inferiority or superiority comparisons are also currently under consideration.11

 

Given that more than $1 in $10 is spent directly on diabetes and associated complications in the USA, and $1 in $5 is spent on caring for people with diabetes, a continued commitment to therapeutic innovations with acceptable benefit/risk profiles bodes well for the delivery of affordable, optimal care.

 

References

 

  1. Nackerdien Z. The Story of Insulin. 2012; http://patch.com/connecticut/norwalk/bp–the-story-of-insulin-3febf556. Accessed April, 2015.
  2. Qaseem A, Humphrey LL, Sweet DE, Starkey M, Shekelle P. Oral pharmacologic treatment of type 2 diabetes mellitus: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2012;156(3):218-231.
  3. Brooks M. Medscape Medical News. FDA Sides With EMA on Incretin Diabetes Drugs. 2013.
  4. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes 2013;37(suppl 1):S1-S212.
  5. U.S. Department of Health and Human Services. National Diabetes Information Clearinghouse (NDIC). http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/#3. Accessed April, 2015.
  6. AACE/ACE comprehensive diabetes management algorithm 2015; https://www.aace.com/files/aace_algorithm.pdf. Accessed April, 2015.
  7. American Association of Clinical Endocrinologists and American College of Endocrinology – Clinical Practice Guidelines for developing a diabetes mellitus comprehensive care plan 2015. Accessed April, 2015.
  8. Pfeiffer AF, Klein HH. The treatment of type 2 diabetes. Dtsch Arztebl Int. 2014;111(5):69-81; quiz 82.
  9. Pharmaceutical Research and Manufacturing Association. Medicines in Development. Biopharmaceutical Research Companies Are Developing 180 Medicines to Treat Diabetes and Related Conditions 2014; http://www.phrma.org/sites/default/files/pdf/diabetes2014.pdf. Accessed April, 2015.
  10. Devaraj S, Maitra A. Pancreatic safety of newer incretin-based therapies: are the “-tides” finally turning? Diabetes. 2014;63(7):2219-2221.
  11. Geiger MJ, Mehta C, Turner JR, et al. Clinical Development Approaches and Statistical Methodologies to Prospectively Assess the Cardiovascular Risk of New Antidiabetic Therapies for Type 2 Diabetes. Therapeutic Innovation & Regulatory Science. 2015;49(1):50-64.

The Story of Insulin

This story that I published in 2012 for the Norwalk Patch is worth revisiting:

“Pharmaceutical company” and “doing the right thing” are words that do not belong in the same sentence, if critics are to be believed. Inflammatory rhetoric amplifies known examples justifying negative publicity. Therefore, one could have been forgiven for having viewed a past exhibit at the New-York Historical Society with a measure of skepticism. The title of the exhibit was: “Breakthrough–The Dramatic Story of the Discovery of Insulin and the Era of Hope,” co-sponsored by the pharmaceutical company, Eli Lilly. For a brief moment one was transported to an almost-forgotten success story, in which academia and industry collaborated positively towards conquering a hitherto incurable disease.

The narratives, photos, and videos focusing on the researchers involved in the prelude to, and actual discovery of, insulin drew immediate attention. Diabetes mellitus, the latter word derived from the Latin for “honey,” had affected sufferers for centuries, as evidenced by historical quotes (Aretaeus, the famed second century physician from Cappadocia, who practiced in Greece and Rome, referred to diabetes in terms of “the melting down effect on flesh and limbs”) and diagnoses, e.g. descriptions on an Egyptian papyrus of sweet-smelling urine characteristic of the disease. The anatomy and physiology homage to the boomerang-shaped pancreas and histological stains highlighting the islets of Langerhans provided insights into some of the methods used to study the disease.

Many people were also fascinated by the stories of the scientific pioneers. Dr. Elliott P. Joslin was acknowledged for making patient involvement and empowerment the key features of diabetes management. Dr. Frederick Allen, an alumnus of The Rockefeller University in New York City, showed that diets below 1000 calories could lower blood sugar levels. The shoulders of these and other research giants formed the platforms for the men who would eventually share the Nobel Prize in Physiology and Medicine in 1923 for the discovery of insulin, Drs. Frederick Banting and John Macleod. The two discoverers shared their cash awards with Best and Collip, two contributors to the work.

Their studies are further elaborated upon in a book, Breakthrough: Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle (St. Martin’s Press, New York, 2010 , written by Thea Cooper and Arthur Ainsberg. The image of Banting that coalesced from the book was one of a loner, with no sense of purpose when he first enrolled in freshman classes at the University of Toronto. Contrast Banting’s persona with that of Professor John Macleod, a Scottish recruit to the University of Toronto and an authority on carbohydrates and metabolism, and one begins to grasp why there was discord between the two men. At the start of his research, Dr. Banting was already aware of the elusive secretions from the pancreas that could normalize blood sugar levels. However, because of degradation caused by digestive enzymes, no one in the English-speaking world had been able to isolate this secretion. In 1916, the Romanian scientist, Nicolas Paulesco, was successful in normalizing the blood sugar levels of dogs by injecting them with an extract called “pancrein,” but this success was not yet widely known. So much of Dr. Banting’s early work was conducted in a vacuum, with only his assistant, Charles Best, serving as an immediate sounding board for his ideas. Endless months of labor by both of them finally paid off when dog 408, a collie, finally responded positively to injections of the pancreatic extract. Buoyed by ensuing successes, Dr. Banting drafted a seminal paper titled “The Beneficial Influences of Certain Pancreatic Extracts on Pancreatic Diabetes,” that would eclipse all prior discoveries in the field and change the field.

Enter Big Pharma in the form of Alec Clowes, the man charged with identifying medical projects with commercial potential for Eli Lilly. According to the book, Eli Lilly, the grandson of the company’s founder, was a man who thought that the future of the company hinged on patenting fundamentally new ideas, not improvements of old ideas. Basing his thoughts on the successful collaboration between inventors, George Westinghouse and Thomas Edison, he proposed that basic biological research could provide the source of information enabling pharmaceutical companies to develop and patent entirely new proprietary drugs. Risk was not new to the Lilly family. Colonel Lilly built the first plant in 1895 to manufacture gelatin capsules, in essence a more palatable delivery mechanism for unpalatable medications.

The transfer of production rights from Toronto to the Lilly plant in Indianapolis was by no means a straightforward exercise. It seemed as if every short-term victory was followed by failure, with batches of variable quality insulin being produced, and insulin shortages becoming a huge issue. Diabetes specialists were also faced with the ethical dilemma of whom to treat and whom to turn away. Through a large monetary investment by Lilly and further interactions between the Canadian group and Mr. Clowes, large-scale production of insulin was finally undertaken at the Indianapolis plant.

Celebrities often bring more attention to a cause, and this was the case with Elizabeth Hughes (daughter of the Supreme Court Justice Evans Charles Hughes), who went on to live a full and productive life after receiving insulin.

Fast forward to the present day, and the rising numbers of diabetes sufferers seem to overshadow the successes from this positive academic-industry collaboration. In 2006, the United Nations passed a resolution declaring diabetes as serious a health threat as infectious diseases such as HIV/AIDS. As if to reinforce that theme, the exhibit concluded with flickering images of children in the developing world walking long distances to a clinic to receive life-saving medications. The International Diabetes Federation’s Life for a Child Program supports the care of children in 26 countries worldwide; benefits from the sale of the book on the discovery of insulin will also go towards its activities.

YouTube videos and images covering more aspects relating to the insulin story can still be found on the New York Historical Society web site.

Revisiting food stamps

April 15, tax day in the USA, has come and gone. The government’s coffers are filled with dollars that will be divided into paying off the federal debt and spending devoted to mandatory and discretionary needs of Americans. According to the National Priorities Project, more than half of the 2015 discretionary spending is proposed to go to the military. Of the $2.6 trillion earmarked for mandatory spending, 50% is proposed to go to social security, unemployment, and labor and 39% is likely to be devoted to Medicare and health. Last year, about 11% of the federal budget went to non-health-related safety net assistance to individuals and families that have endured hard times. This category of individuals is likely to include minimum-wage employees and long-term unemployed people. Many of them may survive with the aid of food stamps, a topic I touched upon in a 2013 post in the Norwalk Patch. Although, the numbers below are out of date, the message of needing to address core societal issues in order to improve the economy remains the same:

Photo essays and YouTube videos paint portraits of the human condition and its endless possibilities. Bill Brandt’s visual exploration of landscape and literature enhance our understanding of life in Britain in the previous century. Akram Zaatari’s archiving of black-and-white photos and use of social media inform us of the lives of ordinary citizens in North Africa, the Middle East, and Arabic communities around the world. We view the world through their eyes and begin to appreciate the complexities of historical events and different societies. Similarly, Apple’s latest video promoting its mhealth tools opens our eyes to the possibilities of assisting communities worldwide.

Unfortunately, many Americans will not see or benefit from the gifts of these innovators. The ‘generational or situational poor’ continue to scrape by in the richest country in the world. Many American kids are also poor and therefore unlikely to have the energy to read, learn computing or become part of the information revolution that is capturing our imaginations today. They are simply going hungry or, if the long lines at fast food chains are any indication, consuming cheap food with knock-on health effects like obesity. According to the Child Trends report for 2013, 34 children out of a hypothetical class of 100 high school graduates are likely to be overweight and 22 are living in poverty (10 in deep poverty). If poor children are lucky enough to have parents or parental figures, these individuals are possibly unemployed, working in low-paying jobs, or receiving some form of government assistance. Families who have fallen on hard times depend on food stamps to make ends meet. This means that approximately   13 million US children and many more adults will have to find ways of making the $31.50 per week  (according to the Lowell Sun) they may receive from Supplemental Nutritional Assistance Program (SNAP or food stamps) stretch into nutritious meals that can fuel their bodies and energize their minds.

Congress has now voted to cut the SNAP budget by roughly $4.1 billion.  Regardless of one’s political point of view, the sad truth is that the 2008 economic crisis caused a dramatic increase in hunger in the United States. Add to this the fact that at least 40% of food is wasted annually (at a yearly disposal cost of $1 billion), and one begins to see the dilemma facing the poor and the charities that must now step in to fill the void left by the government. While Congress continues to debate the depth of the SNAP program cuts, one cannot help but wonder if there are alternative solutions? Could shoring up the program combined with targeted assistance to budding entrepreneurs in poorer neighborhoods provide “a way out” for some people? In her book, The Blue Sweater: Bridging the Gap between Rich and Poor in an Interconnected World, Jacqueline Novogratz, CEO of the Acumen Fund, illustrates the success of Acumen’s model of philanthropic investing in making people self-sufficient. Successful replication of this model or similar options in the US may revive the spirits of those who have fallen on hard times.

 

 

A Return Journey with Medicine and Hope for Sudan

A re-post of an article that appeared in a university newsletter and in the Norwalk Patch ( March 13, 2012):

Social media has amplified the message of atrocities suffered by Africans and others and helped to mobilize millions of people into action across the globe. The North/South Sudanese conflict is a specific example of war brought to the attention of millions of people through the efforts of the media and celebrities such as George Clooney. Flickering TV images of war-ravaged Sudan and the occasional New York Times article can also provide overworked Americans with some glimpses of what is happening in an African country that officially became two countries with the secession of South from North Sudan. While education of an increasingly inter-connected world is important in stopping violence, the truth is that sustainable development in any war-torn region can only be achieved through the active participation of its own citizens.

Who will help carry the developmental torch once the media spotlight has dimmed? In the case of the Republic of South Sudan, newly established in 2011, one of those people is Jacob Atem. After losing his parents (members of the Dinka tribe) during the Second Sudanese Civil War (1983-2005), a six-year-old Jacob accompanied by his 14-year-old cousin, Michael, walked for miles towards Ethiopia and the safe harbor offered  by President Magisto. They were two children lost in a sea of refugees, with the threats of wild animals, hunger, thirst and death constantly lurking over them. As he would later recall: “If four or five people went to sleep at night, chances were great that two people would not get up the following day.”

Jacob converted to Christianity in Ethiopia and stayed in the refugee camp for two years. President Magisto’s government was overthrown and the new regime forced the refugees back to their home country. Caught between warring factions and fearing retribution from the Sudanese government of President El Bashir, Jacob and others started walking again – this time towards Kenya where those that survived the treacherous journey, including drowning and crocodiles in the Gilo river, stayed for nine years. Thanks to the efforts of dedicated private citizens and the US government, Jacob was brought to the USA in 2001 and he became a foster child in Michigan. The complete story of Jacob and Michael can be found on the web site of the Southern Sudanese Health Care Organization (SSHCO).

TV specials at the time recapped stories of the “Sudanese lost boys” (a misleading moniker as both genders endured these hardships), culminating in adoption stories and images of them in leafy white suburbs. Jacob would later marvel about the amenities and shelter that Americans take for granted. He obtained his high school diploma in record time, followed by a Bachelor’s degree at Spring Arbor University in Michigan and a Masters degree in Public Health (MPH) from Michigan State University. Jacob is currently pursuing his PhD in Health Services Research, Management and Policy at the University of Florida. Along the way, he married a girl from his hometown. That is traditionally where the story would end with a young man finally being able to live the American dream.

However, Jacob has been inspired to be a conduit, i.e. a liaison between American and African cultures that applies knowledge gained in the USA for the benefit of his countrymen. Together with Lual Deng and the assistance of others, he formed the SSHCO, which aims to provide healthcare and a sense of hope to the people of South Sudan. Jacob and his colleagues have completed the first phase of their dream, namely the construction of a clinic in his hometown of Maar. The second phase involves the shipment of medical equipment and supplies to the clinic. Medical supplies are en route via Mombasa in Kenya, but more donations are needed for the perilous second leg of the trip through rough terrain to Maar. Since arrival of the supplies in good condition has to be carefully orchestrated with the rotation of qualified medical personnel through the clinic, the SSHCO and dedicated volunteers are reaching out to their real-world and online communities to raise the anticipated $13000 needed to achieve their immediate goals. If all goes well, the SSHCO will be opening the clinic at the end of April 2012. Donations are welcomed on their official web site.

The SSHCO has also been entered in the Dell Social Innovation Challenge. After registering on the Dell site and confirming his or her email address, a prospective supporter can type in “Maar Health” in the search box and vote for the organization. A People’s Choice Award from Dell, facilitated by numerous likes on Facebook and tweets, would go a long way to making the dream of Jacob and his countrymen become a reality.