May 15 2014
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Future of Public Health: Q&A with Margo Klar, PhD Candidate at the University of Florida

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Future of Public Health is an ongoing series focused on the emerging faces in the world of public health. We spoke with Margo Klar, MPH, a PhD candidate in the Department of Epidemiology at the University of Florida’s College of Public Health & Health Professions, about what helped lead her to the field, her Bill and Melinda Gates Foundation-funded work in maternal health, and where she hopes to go from here.

NewPublicHealth: What encouraged you to pursue a degree and career in public health?

Margo Klar: As an undergraduate at the University of California, Irvine (UCI) I majored in Chemical Engineering and worked in an environmental engineering lab. My undergraduate research focused on the effects of urban runoff on water quality, which we tracked from inland California to the ocean. During my last quarter at UCI, I took a biomedical engineering course. As a part of the class, we were asked to invent a new sleep apnea device. I really enjoyed that creative process and it opened my eyes to the fields of biomedical engineering and medicine.

After graduating, I began looking at applying to medical schools. I went back to school and took anatomy and biology prerequisites. My anatomy teacher once said, “In the United States we worry about problems with our feet, in other countries people don't have feet.” This really resonated with me. While researching medical school programs, I learned about Master of Public Health programs. I decided the MPH would be a great stepping-stone and improve my application to medical school. I was accepted into the Yale School of Public Health in the department of Environmental Health Science. Not only did I receive the training necessary to evaluate health and look for ways to improve global health, I was also able to direct my own thesis research project. I wrote my master’s thesis on an indoor cookstove improvement project for Proyecto Mirador, LLC in rural Honduras. I collected health data and examined indoor air quality improvement and reduction of firewood use as a result of cookstove replacement. This was a terrific learning experience.

NPH: You’ve received a Grand Challenges Explorations grant from the Bill and Melinda Gates Foundation to develop ceramic umbilical cord scissors. What drove you to pursue maternal and child health coming from an environmental background?

Klar: My mentor at Yale, Catherine Weikart Yeckel, PhD thought I should take a look at the Grand Challenges Explorations grant through the Gates Foundation. Essentially this funding mechanism releases a set of topics every six months to which they fund somewhere between 80 to 100 grants to the amount of $100,000 for two years of work. After the first proof of concept phase is complete, a second phase application can be submitted for up to $1 million.

Dr. Yeckel encouraged me to take a look at the maternal and child health topic. Essentially, I Googled top reasons for neonatal mortality in developing countries- neonatal tetanus and infection as a result of poor birthing hygiene and the way the umbilical cord is cut, was among the top causes. I really did not, at the time, have a strong interest in maternal and child health. I had an interest in problem solving, mainly because it’s been something, which has been a personal strength throughout my education. Thanks to my engineering background, I can look at a problem and come up with a solution to try to mitigate it. So, essentially I just applied my problem solving skills to the maternal and child health topic.

NPH: Tell us about the work that you’re doing with the Grand Challenges Grant and how it will affect people in developing countries?

Klar: I applied for the first phase of funding with an idea I called ceramic umbilical cord finger scissors, now named Ceramic Cord Cutting Device – C3D, which I thought would be ideal for cutting umbilical cords. At the time, I thought that as long as the material didn’t rust I could greatly reduce umbilical cord infection and neonatal tetanus. It’s not quite as simple as that, but a novel device with a special design made of ceramic has many advantages. Ceramic does not rust or degrade like metal and can easily be disinfected with bleach, heat, or ethanol without degradation to the surface over time. Bleach is a disinfectant that is available in many locations and cited by the World Health Organization as being a good substance to clean surgical instruments in low-resourced environments.

Clostridium tetani is the bacterium that causes tetanus and it reproduces by spores. Those spores are found in dirt, which settle in the porous microenvironment of metallic rust. When the umbilical cord is cut with rusted metal, those spores can come in contact with a freshly cut umbilical cord causing neonatal tetanus. Globally, 18% of babies are born without protection against neonatal tetanus. So, my first priority was making the device something that couldn’t rust and was easy to clean.

Because the ceramic blade does not degrade over time like metal, it also stays sharp longer than metal—somewhere between 1,000 to 10,000 times longer. This means that there is no waste stream requiring proper disposal and reduces reliance on a steady supply chain. One of the areas that we’re testing now is the medical life span of the device- we are quantifying how many times the device can cut an umbilical cord, be washed with soap and water, disinfected with bleach, and repeated.

Additionally, I am interested in designing a device that was safer to use than single and double-sided razor blades currently provided in clean birthing kits and distributed in economically low resource environments. As you might imagine, there are dangers to the health care worker—and potentially the baby and the mother—when you’re handing a razor blade, which is very sharp. I wanted to design a device so that it wouldn’t be easy for the health care workers to cut themselves or accidentally cut someone else. This is important not only for general health care worker safety, but also in an area where hepatitis or HIV is endemic, you wouldn’t want the health care workers cutting themselves while cutting the umbilical cord because it could transmit viruses.

Lastly, I wanted to create a device design that did not require putting the umbilical cord down on a potentially unclean surface to cut through it. Putting the cord down on an unclean surface potentially exposes a newly opened wound to pathogenic microorganisms that cause infection. My design is one where there is only one safe way to use it.

NPH: What are some of the surprising lessons that you’ve learned in your studies?

Klar: I wouldn’t say I’m surprised by it, but I’ve really learned the value of mentorship. I have a large group of mentors now, including a supervisory committee for my dissertation as well as personal mentors that are not on the project. Spending time with my mentors, regardless of their research or their passions, is very motivating for me. They help me look at current challenges and offer perspective, and always push me to be my best.

My current team includes a materials science engineer, biomedical engineer, pathologist, epidemiologist, nurse midwife and a global development specialist. I have my background in chemical engineering, business, and public health. It’s amazing the challenges that can be overcome by bringing so many people together. 

Lastly, something else surprising to me is how much I learn from being exposed to different environments. There are different ways of looking at problems and different research methods depending on which field you’re in. When I’m exposed to those different methods and listen to different perspectives on problem solving, I become more dynamic in my own problem solving abilities. I’m able to translate this into my own work. The greater the variety of environments I’m exposed to the better I can connect the dots to find new solutions. To ensure this learning environment, I have been lucky enough to be awarded the University of Florida’s Clinical and Translational Science Institute’s Pre-doctoral Training Fellowship to support my education and further enhance my research training and academic exposure.

Tags: Maternal and Infant Health, Technology