OK, I've got a lot to cover, so we're going to get started. Hi, my name is Diego. I work at CoreOS, and I'm here to talk to you about self-hosted Kubernetes. So CoreOS, we use self-hosted Kubernetes in our enterprise Kubernetes distribution, which is called Tectonic. We've been doing this for quite a while now in production with lots of customers doing this, and we think it's the best way to run Kubernetes. So this talk, I'm just going to kind of try to prove that to all of you. So who is this talk for? Well, a lot of different people. First would be cluster operators. If you're running a cluster or maintaining a cluster or multiple clusters, upgrading them, self-hosted Kubernetes is one approach you can take that we think is a good one that will make your life easier and a lot of dimensions I'll get into. Also, if you're a Kubernetes contributor or you're just interested in Kubernetes, self-hosted Kubernetes touches on a lot of interesting aspects of Kubernetes API surface and things like that. We hit a lot of corner cases we had to solve, so it's cool from a Kubernetes point of view just to see Kubernetes running itself. And lastly, people who enjoy clever hacks. So we had to come up with a couple of neat tricks in order to make self-hosted Kubernetes work that I'll get into during this talk, and so I think they're kind of cool and hopefully you do too. So first, to get everyone on the same page, I want to talk about what is self-hosted Kubernetes? Well, it's somewhat self-evident, but it's Kubernetes running on Kubernetes. Specifically, all of the Kubernetes control plane components are running as native Kubernetes objects, namely deployments, daemon sets, they're using things like secrets. And that's about it in terms of what it actually is, but of course the devil's in the details, right? So this talk is gonna come in three parts. First, I'm gonna talk about why you'd want to use self-hosted Kubernetes. I'm gonna make the case for why we think this is the best way to run Kubernetes. Then I'm gonna get into how it works and I'm actually gonna launch a self-hosted cluster and show you guys some of the ins and outs of it and some of these tricks I was talking about to make it work. And at the end of the talk, I wanna get into what's next for self-hosting. So we have self-hosting today, it's working great, but it also unlocks a lot of possibilities for what you can do once you have a self-hosted cluster in doing some pretty sophisticated stuff in terms of managing your cluster, scaling it up, that sort of thing. And so I'll touch on that in the end. So first, let's go over why you'd want to self-host a Kubernetes cluster. Well, first of all, you wanna leverage Kubernetes strengths. We have Kubernetes, it's great at running highly available resilient software, wouldn't be great if we could actually run Kubernetes taking advantage of all of that useful stuff that's encoded in Kubernetes. Secondly, it really simplifies your node management story. So it turns out once you're using self-hosted Kubernetes, your node requirements are very simple and I'll describe that a little bit. Lastly, it really makes your cluster lifecycle management a lot easier because you're managing using the same lifecycle management tools that you use when you're managing any application on Kubernetes, Kube, Cuddle, and friends like that. So if you're running a Kubernetes control plane, what might be some properties that you'd like this control plane to have? Well, for one thing, you might want it to scale it up and down automatically. Let's say your cluster is growing, you're getting more users, more people are hitting the Kubernetes API. You might want to scale up the number of API servers you're running or controller managers or so on. You also might want to handle node failures gracefully. So let's say one of your masters goes down. You want to quickly bring up another master to run the components that were running on that failed node so that you don't have any downtime, so that your workloads keep running. You also want to be able to safely roll out new versions of your software in a resilient manner. So you want to run, update your API servers, let's say, one at a time. You want to wait for them to roll out. You don't want to have any downtime. And then what if something goes wrong? What if you set a flag that, it turns out, breaks some part of your control plane? You want to be able to roll back to the last known good state that you had. While we're at it listing, making our wish list here, what about advanced networking? What if you want to run some sort of network policies that constrain how your control plane talks to each individual component into other parts of your cluster? What if you want to have role-based access control and auditing to control and keep track of your control plane, who is talking to, what it's allowed to do? What about health checking, monitoring? If you're deploying Prometheus in your cluster, if you're looking at liveness checks and health checks, you want your control plane to have that too to make sure that you know very quickly if there's a problem. Lastly, what about resource allocation and accounting? You don't want to waste compute by having snowflake masternodes that aren't optimally using the resources, and you also might want to know how much is my control plane costing to run? How many resources is it actually using? So if you think about it, what's really good at doing all this stuff? The obvious answer is Kubernetes itself, right? Wouldn't be great if we could just run our control plane this way. Something else that self-hosting unlocks is simplified node management. So if you think about Kubernetes worker, so forget about masters for a second, what do you really need to run a Kubernetes worker? Well, you need the kubelet, right? That's what's gonna talk to the API server and figure out which pod should be running. You need a container runtime, Docker, container D, rocket, et cetera, that is actually gonna run your pods, and you need some credentials to talk to the API server, let's say a kube config. And that's it, really. Most workers, that's what they run. It's a very minimal subset of things compared to a master where you might be running specific API server controller manager, et cetera, system D units, if you will, or whatever else. So in a self-hosted world, this is all you need because everything is running in Kubernetes. Everything is really a worker. There's no distinction between a master and a worker from a compute point of view. So in that case, how do you select a master node? Well, it's actually just as simple as applying a label. The only difference between master and non-master nodes is that they happen to have labels on them. And so again, using the Kubernetes built-in primitives, it's simpler, it's more uniform, and it's more flexible, and I'll get into that a little bit later as well. Lastly, what about lifecycle management? What about upgrading your cluster, changing flags in your cluster, adding new, rotating your certs, let's say, for your API server? Well, all you do is kubectl apply, kubectl edit, and you can go in and change anything, and then Kubernetes will roll out those changes in the way we all know and love. Now, realistically, your control plane is your most important part of your Kubernetes cluster from one point of view. So you don't really want to be using kubectl in production, I would assume. So ideally, you'd actually want to automate this. Maybe you want to write some software that is using Client Go to talk to the API server. You can encode a lot of logic and expertise into some program, maybe we call it an operator, that will manage your control plane, upgrade it, self-heal it, and so on, and I'll get into that a little bit as well later. So that hopefully makes the case for why you might want to self-host, what some of the benefits would be. Now let's actually get into how it works. So when you want to create a self-hosted cluster, there's just three main areas that you want to address in order to have something that's production ready, that is something you could actually use to run real workloads. The first is bootstrapping. How do you actually create a cluster? It's not, if you start to think about it, it's actually not that easy. And then what about upgrades? I touched on it a little bit, but in practice, how does it work? How do you actually upgrade your whole control plane? And then disaster recovery. Inevitably, some things can and will go wrong. How do you make sure that a self-hosted cluster is recoverable? So I'll go through each of these one by one and I'll actually jump over to the terminal and make a cluster and then break it for all of you and we can see how this works. So the first step that we need to figure out is bootstrapping. How do you actually create a cluster from scratch? If you think about it, the control plane, as I illustrated earlier, is running as daemon sets and deployments, right? But you need a control plane to create daemon sets and deployments, right? How can you say, could Cuddle create if there's no API server to talk to? So here we have clever hack number one, which is that we're gonna create a temporary static control plane to bootstrap a self-hosted cluster. In essence, we'll have a special ephemeral control plane that we can stand up, that we can point at our XED instance that will be used in our production cluster, create our assets and then tear down that cluster and we're off to the races. How do you actually do this in practice? There are a few projects that are doing this. The one I'm gonna talk to you today is called Bootcube. It's a Kubernetes incubator project that I work on and a few other people here. And the way it works is you give it temporary control plane manifest. So these are manifest that purely describe pods because they need to run on the Kubelet. There's no control plane yet. The Kubelet only really knows how to run pods. So these are gonna describe your API server controller and scheduler. You also need your self-hosted control plane manifest. So this is actually gonna describe your permanent self-hosted cluster once it gets running. And then lastly, you need an initial master node. And I put master here in parentheses because as I said, there's nothing really special about the master node. It's just the node that we so happen to choose to be our initial node that we're gonna bootstrap on. So Bootcube is gonna take these three inputs. They're just files on disk and your node. And it's gonna stand up a temporary control plane. And then it's gonna pivot that into the self-hosted control plane. So let's actually launch a cluster and take a look at that. So here, can everyone see this okay? Cool. I've got a few nodes sitting around here on my laptop. So let's look at the actual manifests we're gonna use for a sec. So Bootcube actually provides a nice little render tool that can create manifests that are good, they're kind of baseline to run a self-hosted cluster.  In practice, you really want to customize these assets to match the specific configuration you want. So if we look at what we've got. So we can see we've got a kube config up here. We've got these bootstrap manifests that I was talking about. So we've got an API server, controller manager, and scheduler, and those are just pods. Then we've got a bunch of other manifests. And this is actually our control plane that's gonna run. So we've got API server, controller manager, scheduler. We've also got kube DNS, which is an add-on we like. It's got kube flannels. We're actually deploying our network overlay as part of this self-hosted cluster. And then a few other things, RBAC rules, and so on. And then we've got all our PKI material that we're gonna need to have a secure cluster. So if I hop over to my master node, you can see here I've copied over the assets already and I have bootcube. So what I'm gonna do is I'm just gonna say, sudo bootcube start, and then I say use the assets in this directory. And what it's gonna do is actually, if I open another terminal here, what it's done is it's copied these bootstrap manifests over to the kubelet manifest directory. So it's starting them up as static pods. And once that's done, it's gonna use that temporary control plane to create the self-hosted assets. So since looking at text is not actually that enlightening, I'm gonna illustrate this with pictures. And thanks to my co-worker, Aaron, who originally made these really good slides. So here is just gonna reflect what's going on in my terminal right now. We've got the kubelet, we've got bootcube, and we've got at CD. The first thing bootcube does is it creates static pods. As I showed, it's just by copying these static manifests over to the kubelet directory. And so we have an API server, scheduler, controller manager. Once they get up and running, they talked at CD, you effectively have a functioning control plane. The kubelet is configured to look at this API server address, and so it actually joins the cluster. So we have this temporary control plane, and we have the kubelet, it's a one node cluster. Bootcube detects that this cluster is up and running, and then it creates the self-hosted components, effectively by calling kubectl create. And so the kubelet, since it's talking to the API server, sees that it should be running these pods. So it's gonna start up the actual self-hosted API server, scheduler, and controller manager, but really it's just functioning as a kubelet normally does, running a daemon set, deployment, et cetera. Once the self-hosted control plane is running, bootcube tears down the static pods. They're not needed anymore. It sees that the self-hosted cluster is running. And then bootcube itself exits, bootcube's done. We never use bootcube again in an ideal world. And the self-hosted cluster is now talking the same at CD instance, so that's the kind of trick that allowed us to use the temporary control plane and the final control plane and the pivot. And the kubelet now talks to this API server, and we have a one node cluster. From there, we can start joining other nodes and expand our cluster accordingly. So let's go back, look at our cluster. Okay, cool, it's all done. We have all self-hosted control plane is successfully start, so bootcube exited, we're done with it. So let's actually look at our cluster. So you can see we've got two nodes, we've got our master, and then I had a worker sitting around that was just waiting for an API server to appear. And then we actually have our control plane. So if we say kubesystem, get deployments, got our controller manager, scheduler, et cetera. Our daemon sets, we've got kubabiserver, flannel, kubproxy, et cetera. Right, cool. All right, so now we've got a cluster, but as we know in Kubernetes land, things are moving very fast, so we wanna upgrade it, right? How do we upgrade it? Well, this is probably the most boring slide of the talk. Actually, we just go and change the image in our daemon set, it's actually that easy. So I'm gonna say kubectl, edit. Might have to put that first. Daemon sets, kubeserver, cheat. And we're gonna say, well, when 185 came out, what, yesterday, two days ago, let's upgrade to that, we wanna be on the bleeding edge. Cool, now let's get daemon sets wide. So it's kinda hard to see when it's blown up, but you can see that kubeserver has been upgraded to 185. And thanks to daemon set rolling update strategy, it's gonna do this in a safe manner. And as I mentioned, we don't wanna really be using kubectl edit on our production clusters, possibly, but you can, in a pinch or in an emergency, you can go in and you can fix something this way. All right, the last piece I wanna cover here is disaster recovery. So things can and will go wrong with your cluster, either due to bugs, operator error, what have you. So what kind of failure modes might you see in a self-hosted cluster? First, you have partial control plane loss. Let's say that someone is editing their kubescheduler deployment, accidentally scales it down to zero. Well, you've got a problem now because you can scale it back up, but there's no scheduler there to decide which nodes it should be running on. So how do you deal with that? Well, in that case, you're gonna have to recover the scheduler itself. What about if you lose the whole control plane? Let's say I have a bare metal cluster in my basement, I accidentally go and trip the fuse and I start a backup. We need to restart things, right? So we'll have to recover the entire control plane. And lastly, you might lose the cluster completely. Let's say I accidentally delete my auto scaling group in AWS. Well, hopefully you have backups and you can recover from a backup. I'm gonna make a brief interlude to talk about a pod check pointer. It's another thing that we use in self-hosting. So if some of you were, I know I went kind of fast, but a keen observer might have noticed a trick during the upgrade demo. I said it was easy. It is not actually that easy. How do you upgrade an API server? How do you actually handle master node reboots? Your API server, when I updated it, I have a single master cluster here. It's not actually what you wanna do in the real world, but my little laptop, that's all it can handle. So when I updated the API server, you think about a daemon set. What it's gonna do is it's gonna terminate the old pod and once it's fully terminated, start up a new pod. Okay, we terminated the API server, then what? There's no API server. No one's telling us what to do next, right? So how did this work? Well, welcome to clever hack number two. We run a checkpoint or daemon, and this is actually running on all the masters. It's a pretty simple daemon, but what it does is for certain critical pods, it creates local checkpoints. It copies down the static manifest and in the case of a control plane outage, it will actually deploy that manifest. Wait for the cluster recover and then on we go. And so during an upgrade, this is actually a mini outage that we're creating on purpose and the checkpointer is what allows us to do that upgrade by temporarily running a local API server, waiting for the new API server to start back up and then decommissioning the checkpoint. So I can illustrate this in pictures. So let's say we have our Kubelet and our API server, the checkpointer is watching both and it's basically trying to reconcile. The API server says that pod one and two should be running. The Kubelet says that pod one and two are running. So we're good. This is our steady state. The checkpointer will create these inactive checkpoints that are just on standby. Let's say pod two disappears from the Kubelet. Let's say it's the API server. It's like this upgrade example you're just talking about. And it's not able to start a new one because there's no API server if you have this chicken and egg problem. The checkpointer will see this. It will activate the static manifest checkpoint. This pod will start. It's an API server, so now the Kubelet can talk to it and decide, oh, I should be running an API server. So it'll actually run the real API server pod. The checkpointer sees, okay, API server and Kubelet are matching again and it'll just retire the static pod. So pretty simple, but not obvious. And it helps us both in upgrades and in reboot situations. And then we're back to our steady state. The last piece here I wanna talk about is recovery. So the checkpointer helps us in some cases, but not from all outages. For example, in the example I gave about scaling your scheduler down to zero, you don't have a functional control plane anymore so you can't fix what's broken. You need a bigger tool. So if only there was a way to jump start a cluster. Jump start sounds kind of like bootstrap. So clever hack number three comes in, which is we actually use bootcube to extract manifest from the cluster and then run another temporary control plane. So just like when we started the cluster the first time, we can do the same trick to create a control plane that's pointing at our same at CD, fix whatever's broken and then on we go. So I'm gonna do a quick demo of this. We're going to purposely break our cluster. So let's say kube cuddle and kube system. I did this earlier, that's probably easier. So we're gonna scale our kube scheduler to zero replicas because why not? So if we say get pods, we see, we got two schedulers that are terminating. That's bad news, let's wait for them to go away. Okay, they're gone. Well, oops, I didn't really mean to schedule it to two. Maybe I meant 10 or something. Sorry, zero, I meant 10. So let's scale it back up. Okay, that worked, right? API server said sure, that's what you wanna do. But then it's gonna ask the scheduler to schedule those pods and uh-oh, we don't have a scheduler. All we have is pending pods, they're not gonna get scheduled, right? So what do we do? We can use boot kube recover. So let's hop to the server back to our master really quick. And so we can say boot kube recover and then we say recovery dur is home core recover and then kube config, because we need to talk to the API server. In this case, we still have an API server. Etsy, Kubernetes, kube config, all right. So let's talk to the API server and it recreated these bootstrap manifests because if you think about the ones we use to start the cluster, that's a one-time thing. This could be a year later, our cluster is very different. We can't reuse those assets, but this one is gonna create boot kube start friendly assets. So we boot kube start it. Boot kube start. And this time we say the asset dur is home, sorry, home cluster recover. Oh, sorry, core recover, thank you. All right, so it's the same process. It's gonna create a temporary control plane. As soon as that happens, we're gonna have a scheduler. It's gonna be able to schedule the missing schedule pods and we're good again. That's just gonna take a second for the kubelet to take care of this. So, while that's recovering and I'll check on it in a second, I wanna talk about what's next for self-hosting. Self-hosting is a good place. As I mentioned, Tectonic is core-west distribution. We're using self-hosting in production today, lots of clusters. It's stable and great and has all these nice properties I talked about, but it also unlocks a lot of interesting things we can do to kind of take our cluster management to the next level. So one is automated operations. There's a lot of things you can do now that these are Kubernetes objects that you can manage using the Kubernetes API. One is cluster upgrades. As I said before, you don't really wanna be using kubectl apply, right? You want to maybe use client go and code some logic and specifically you wanna have kind of fine-grained control over rollout ordering.  You also want to maybe handle some pre and post-upgrade operations, turning on a new flag, updating some credentials, things like that. You can encode this in an operator. Also, kubelet upgrades. So how do you actually upgrade a kubelet? Well, that's one thing that is running statically on each machine, but why don't we just deploy a daemon set that can actually run on every machine and make the necessary changes? It could RPM or DEB install. And lastly, configuration management. As we know, things change over time. We might wanna change our cluster. Ideally, we don't wanna have to tear down our cluster or make a new one. So one thing we can do is actually have our operator go in and change flags and do the right coordination. It might be a nuanced process, but it's something you can encode in software and it's much less error-prone that way. We can even do things like deploying a new network overlay or changing your network settings. This is something that we actually do at CoreOS. So actually a lot of these automated operations are things that Tectonic does, but there are other things that we're still kind of adding every day. Similarly, we talked about node management and how that's simpler, but it also, by having these unified nodes, it unlocks a lot of power as well. One is self-healing. So I just did a bootcube recover manually. That's also not ideal. I had to SSH to the machine. I had to run some commands. What if there were node agents that, if the operator senses that there's a control plane problem, could remotely invoke bootcube recover or something equivalent to heal your control plane? Or what about auto-scaling? You could increase the number of masters if you're experiencing higher load or if your requirements increase over time. Or what about if, since all nodes are the same, anytime your auto-scaler adds a new node, it talks to the operator and says, hey, I'm a new node. What should I be? Should I be a master? Should I be a worker? Should I have some other specialized role? Since all nodes are the same, they can be provisioned as anything. And lastly, node identity. So in recent communities versions, something called TLS bootstrapping was added, which allows every node to have a unique identity by performing a challenge and response with the API server when it joins the cluster. And so since our nodes are simple and have very little state, they can use this very nicely. And we're very close to actually merging this into bootcube. Should be in, hopefully, next week. So let's just check back at our cluster sec. Yeah, it's back. So let's look at our pods here. And yes, our scheduler is back. We're happy. Cool. So bootcube is a Kubernetes incubator project and Tectonic is CoreOS's specific distribution of Kubernetes. But we are trying to also get this support actually in upstream so that more Kubernetes users can access it. So kube-adm, which is the upstream tool for deploying clusters, is adding Kubernetes support, is self-hosted Kubernetes support. It's almost done. I think you can actually launch clusters now and upgrading is coming next. The checkpointer, instead of being a standalone pod, is actually being added to the kubelet itself. And that is already done for pods and we're just adding support for secrets, which is necessary for the API servers, the way we run them. But as always, we need help. If you're interested in this kind of stuff, if you're interested in coming up with more clever hacks, check out SIG Lifecycle. You can join, see us on Slack or our mailing list and come to our weekly meetings. So that's all I've got. We have a few minutes for questions if anyone has anything. And thank you so much for coming. Does this work? Yeah. Yes. In the beginning, where was your etcd cluster? Ah, good question. And how do you feel about self-hosting etcd itself? Right, so my etcd cluster is running on a separate node, just natively. Self-hosting etcd is something we've worked on. We've actually uncovered a lot of bugs in the API server as a result in terms of connections because when you're running the self-hosted etcd on the pod network and they're moving around a lot, it turns out the API server is not actually resilient at reconfiguring these connections. It was something that we never exposed before. So we're working on trying to fix HA for self-hosted etcd and then we'll re-evaluate whether that's something to do. I think it's something that makes a lot of people nervous because that's the baseline building block. But on the other hand, you can launch self-hosted etcd clusters for use, not for your control plane. And that works really nicely. So it's experimental. Actually, in Bukub, you can use it. But there are some known issues with it that we're trying to fix upstream in the API server. Sorry if you can pass it to someone. So what if we want to upgrade Kubernetes versions? So we need to down our whole cluster, right? If I want to update from 1.8 to 1.9. You don't have to do that. With Tectonic, we are able to upgrade from 1.6 to 1.7 and 1.7 to 1.8 with no downtime, just rolling update exactly as I showed. What are the bare requirements that you need? You might have done it, and I missed it. In order to get, you need to run the kubelet directly on the node, right? That's not obvious. You can't self-host the kubelet in the kubelet. We tried, but that one was a little too tricky. And adding new nodes to the kubelet, I guess it doesn't matter where the control pane runs or its daemon set. So I'm also confused about the proxy, because I thought that has to run on the node and the flannel also. Yes, so I kind of elided this for time. So we run the control plane on nodes that are labeled as master nodes, right? So we label the nodes. We set selectors on our control plane. And we set taints on those nodes so that other workloads don't run on them. And then for the API server and kubet proxy, yes, those need to have network connectivity. So that's why they run as daemon sets using host networking. But the controller manager and the scheduler were able to run as deployments since they don't have that. But does the flannel have to have access to the host devices? Sure, yeah. Well, it uses CNI, right? So it actually just talks to the kubelet and is able to deploy the plugins, and that's it. And then the proxy is the same way, I guess? Yep. Very cool. So the only binary that you need to run directly on the node is the kubelet itself. That's right. I think we might be out of time. One more question. Anyone? OK, let me. The clarification on the snapshotter, is it necessary in case of breakdown of communication with the control plane? Or if there is a breakdown and the node reboots and then the kubelet doesn't know what to start? So the checkpointer runs conservatively. It's basically trying to reconcile the state between the last time it talked to the API server and what it's seeing on the kubelet, which it can always see because it's running on the kubelet itself. So if the API server is down or if there is a network partition or something, it'll do the conservative thing. But in Kubernetes land, that's what you want, right? If you're running an extra pod, theoretically, that'd be OK. You don't want to run the kinds of workloads where you can only have exactly one pod. I mean, if I just lose my control plane, like the connectivity to the API server, then will I instantly lose my pods because the kubelet is going to be like, oh, I don't know what to do? No, that's not the way the kubelet works. The kubelet will keep running what it's running. But it's more, yes, if it reboots or something else happens. Thanks. Cool. All right, let's go. I want to ask between permanent control plane and temporary. Well, what do you mean the mix? Maybe you can hand in the mic really quick. Having a permanent control plane and what we're seeing right now, the best of both worlds, correct? Well, the temporary control plane is, as the name implies, temporary, right? It's only used when you are starting your cluster or recovering it. Right, but having a permanent control plane and self-hosted control plane, how about that? Well, but if you're maintaining a permanent control plane, then you lose, you have double the overhead, and you don't have the benefits of self-hosted control plane in terms of management and stuff, right? So if you're having to maintain both, it's almost as what's the point in that case, right? OK. Because part of the idea is this is simplifying the management of control plane. Right, thank you. Thanks very much.


going to do something different with some hot sauce today stick around I'll show you what we're going to do what we're going to do is so apparently hot sauce will freeze it'll freeze we're going to freeze it into a popsicle I'm gonna see if because like they say you know if you're sucking on an ice cube after eat something hot it will help right well what happens if we freeze it as it's still going to be just as hot we're gonna find out I got a level five here sriracha this is just leftover sauce as I've had from the hot sauce challenge that we did this is a level six this is mango this is the hottest I've got right now so I'm going to sacrifice these I love them they're good as you can see I've been using them one serving is one teaspoon is one serving so there's 18 yeah 18 teaspoons in these things so let's go ahead and only the screen not the video she's over here it's okay so we're going and I think she's going to put strawberries in here or something I'll do it after you're finished okay so I don't know how long it's gonna take to freeze but we're gonna go ahead let's get the hottest one first the level six let's pour it in here and see see if we'll have enough to make a sickle don't want to mix the two because I want the hottest but if I mix them they might be a little hotter let's go ahead and mix right or will the level five week in the six it doesn't matter because I'll be at the tip of that anyway so yeah but I don't want to like I want to have some to put like with my chicken wings and stuff oh yeah so I'm gonna fill this oh shit interesting so we're gonna put this in here I'm gonna put it in the freezer until it freezes and we'll be back with you and I'm gonna try that I don't think monkey's going to now you won't try a lick though right you first though yeah well I'm gonna eat it like a popsicle I'm not gonna bite it but I'm gonna you know put it my mouth like a popsicle so oops sorry so let's put this in the freezer okay you'll have to fill these up with water a little crack who said no if you don't anyway I do it'll be who told you that because leave it in the comments below if I put this in there without anything in these do you think they'll freeze and crack I don't think they will well find out if you don't do it I've had similar things to this before and I used to make my daughter popsicles and sometimes I would only make a couple and they didn't break so we'll find well what was this a buck they just want to make a strawberry yeah we're gonna find out okay okay we'll be back with you hang tight talking to them always answers me so we'll be back with this she goes okay we'll be right back okay guys we're back it's like the next day hot sauce sickle now I'm having trouble getting it out of here I was gonna go ahead and get it out for you but keeps pulling off the stem so we're gonna try get it out here on this plate and then I'll put it on the on the sickle stick a knife no stuff just don't freeze very well shit you smell that it's a hair and a nap oh I can smell it now all right I got me a water here cuz I can't drink milk you want to lick try a lick nope you're first cuz if you see my reaction you'll be like no no you do it first yeah just yeah make me be the chicken I forget what you this is like 200,000 scovilles a if I remember correct the number six was like 200,000 scoville unit nope nope not good for popsicle I'm just going to take a bite good luck you want to put water down I have to say me here we go I just took a lick I was hoping it wouldn't be so hot that you could have enjoyed it as a different flavor so popsicle if you freeze it it's hot it's still hot it's hot so it didn't change it in any way it didn't make it better no because I'm gonna do what more I think you should wait until those hiccups that it takes your hair away yeah quickly so you could not eat the whole thing I'm sure somebody could that's some good hot sauce it's good hot sauce but no way no thanks one more come on I did too bite nope one little egg that's enough for me she's got to take care I gotta take off don't buy monkey monkey so she's out for now when try it no thanks hi guys so there you go she's just sorry she had to take that cold so I'm gonna get off here and say shame bear the bed a legend she said don't try it I say try it it's fun oh one more for you ha it says it touches your tongue enjoy the rest of your week bye bye guys take care


Joining us, I'm Steve Morrison from CSIS, the Center for Strategic International Studies, the Center on Global Health Policy. We're thrilled to be here today for this event that's co-sponsored with the Global Health Caucus of the House of Representatives led by Representative Betty McCollum. We're delighted to be able to do this jointly also with the Consortium of Universities for Global Health. We'll be hearing more this morning about the progress made in organizing that consortium through two days of meetings at the National Institutes of Health today. This phenomenon of dramatically expanded interest on American campuses and global health is really the central subject of what we're here to talk about. And CSIS, which is a foreign policy think tank which has expanded its own interests in these areas and launched a commission on smart global health policy that involves Mike Merson and involves several members of Congress and a number of other prominent individuals, is putting a special emphasis in its work on the need to recognize what is happening within our society, and particularly among universities and campuses. And so we've reached out and tried to build these linkages with some of the key leaders on those universities, and we're delighted here today that we're able to hear directly from three of the students who are in these programs who will be introduced to you in a minute. Let me just turn now to Congresswoman Betty McCollum. She's from the state of Minnesota. She's a Democrat. Has worked with CSIS on the Smart Power Commission, which was an important effort in 2007 into 2008 to try and chart a course for the next administration that would leverage the full assets of American influence in rebuilding America's standing in the world. She's been a very strong voice for fuller engagement by the United States on global health, a very strong voice in Congress. Starting the Global Health Caucus, a very strong advocate of higher levels of engagement on global food security, which as you know is now front and center as a major new initiative of the Obama administration. She's a former teacher and champion of youth and education. Thank you so much, Betty, for hosting us today and agreeing to kick this event off. Thank you. Well, I'd like to welcome everybody here this morning. You're here to learn about this ever-growing interest in global health throughout the country. And I'm so proud that CSIS has asked the Global Health Caucus to be part of this, because we really look to their reports and their big thinking and brainstorming that they go through for our office. We find so many initiative and great ideas and really find them a great learning partner. So I'd like to thank CSIS for your interest in elevating global health. Congressman Vic Snyder is one of the original congressional Global Health Caucus founders and he might be joining you later. And if he does, I know if Vic Staff or Lena will make sure that who's with my office will make sure you get to meet Vic. He's just great on this issue. I founded the Global Health Caucus to provide a bipartisan forum among members of Congress to address global health challenges facing the U.S. and around the world. I had been getting my appointment to be on the Foreign Policy Committee, found that there were a lot of questions that people would have about HIV AIDS. You know, what's the CDC's role? What's the NIH's role? How do we work with all these global partners that we have? What's the World Bank's role in all of this? And so I thought what a great way for all of us to kind of get together and share information to do some brainstorming but more importantly to inform and educate House members as well as their staff. At the time the avian flu was kind of emerging as an issue and what we were going to do, both how it would affect public health here, public health around the world, how it would affect commerce. And if commerce stopped, what were the implications on the supply chain? There's just so many things when you start looking at global health that can take you down very many tracks. And universities have a huge role to play on this. And I say this not saying that it's anything new to universities, it's something very old to universities. And I can speak from this from firsthand experience literally. I fell in Japan two days before my son's wedding. Called the embassy and said, I'd like to know where the nearest US embassy list with American doctors are. No problem.  And I don't know where I'm gonna go if anything happens in Guatemala but we're figuring that out right now because I leave the end of this week. But I was pretty relaxed, I was in Japan, it was gonna be cool, it was gonna be fine. But I got talking to my doctor who didn't use his English a whole lot. And he had done some training at the University of Hong Kong. And who was doing the leadership role there when he was taking his training? It was British. And when I pulled out my little bottle of Advil and he's kinda lookin' at it going, well that I'm not too familiar with. He went and got one of the partners of the clinic who had been to Harvard. Who looked at me and said, well we can call Tokyo for that. And I said, I'm kind of in pain right now. And they said, well, we could get you some Japanese medicine. And I said, would you recommend it to your mother, your sister, your aunt, your wife? They all said yes. I said, well I'm in Japan and you are very highly trained physicians. Give it to me. So I came back and 19 pins later. But anyways, that's a different story. I treasure my Japanese X-rays with the Japanese kanji on it. So you have, the universities and medical students have had a long interaction. And in fact, when the avian flu was first kinda circulating around, I was talking to some faculty members at the University of Minnesota and they were telling me during ZARS, it was a relationship that young doctors and scientists had developed with Chinese counterparts of things we're getting out through the internet. So I'm very happy that you're here today. And I'm so glad that we have a panel here of our up and coming leaders. You're going to be making a difference. And it's our job to create the opportunity and the platform for you to really make the difference you want to. So I want to applaud the leadership shown by the universities and the creation of the consortium of the universities of global health to provide strategic planning for schools and career paths. And Minnesota, my home state who isn't here right now today is also involved in that. But the paper that CSIS has put forward has some recommendations and some ideas and some in which I think Congress could be involved in. And we look forward to working with the leaders and with some of the ideas if you want to move forward with them consider the global health caucus your first call for help. So I'm going to turn it back over to you. I'm going to be in and out of the room. Hopefully I'll be able to get back but schedules constantly change around here much like a doctor's day. So thank you very much. Thank you very much. Hi, I'm Mike Merson from Duke University. Representative McCollum, thank you very much. We wish you a quick healing and thank you for all the support that you give to global health and for being here today. You want to, we all want to get to the students so I just, I'll be brief. My students tell me that global health is hot. That's what they tell me. So we did a Google search and we found 120 million hits for global health last month. I guess that means global health is hot. But I think what was really clear to us from the consortium meeting we just had which you heard about, we had 300 participants from 60 North American universities that just finished a two day conference. And the enthusiasm for the field was just clearly palpable. Prior to the conference, our secretariat for the consortium undertook a survey of universities and we found that 60% had founded a global health program in the past three years and a third in the past year just showing how many universities are starting programs or global health. What's exciting, of course, is that the training of undergraduates, master students, doctoral students all have increased over 100% in the past three years. What is also interesting, we found in our survey that our universities are working with as many as 97 countries around the world. Institutions in 97 countries. Africa the most heavily represented probably wouldn't surprise you in Asia and the Americas. And many countries were working with many American universities. Probably wouldn't surprise you that 21 universities are working in India and 20 in China and 14 in South Africa. 12 in Uganda and 11 in Brazil. Just to give you a sense of the world we live in. And I think very important for this meeting that we're not just talking about medical schools or even just public health schools. We're talking about an organic student movement that's across U.S. campuses in the entire country. Public policy, business, law, environment, divinity, communication schools, departments in arts and sciences, economics, psychology, sociology, anthropology, I could go on. These are programs, these are centers, these are institutes, these are departments that encompass the entire university. Many people ask why. Why has this phenomenon occurred? And no one really knows the answer to that. It's a multiple of reasons. I think our current young generation has an unconsummated desire for sacrifice and service. That's the main reason. Our students are driving a lot of what is going on on campuses. I always tell the students if you want to get something done on the campus you can do it far faster than administrators or faculty because administrators listen to students. Now there are many other reasons, pandemics in the news, swine flu, SARS, AIDS, the information technology boom, the Gates Foundation and their billions of dollars that they put into global health. The rock stars like Bono, social justice movements, involvement of faculty in many disciplines. These are all the reasons why this takeoff has occurred. And I like to think that the parents of the students have played a role in this as well. CSIS commission recently undertook a survey with the help of the Kaiser Foundation. They found that 57% of Americans felt that we were not doing enough to improve the health of people in developing countries and that 50% of Americans had donated money to an organization that works to improve health for people in developing countries. So I'd like to think that the parents are also playing a role in this. At our conference, we had eight university presidents that signed a statement committing themselves and their universities firmly to global health. And our board, which highly debossed chairs, he'll say a word at the end, hopes that the presidents of all universities represented at the meeting are going to sign this document. Now, I think I should say that we get asked why global health now when we're faced with real challenges here at home, particularly with our economy. And there are many reasons for this, but just to mention briefly a few, diseases don't need passports, viruses don't need passports. We're a global world when it comes to disease. Just an example, maintaining surveillance for diseases like swine flu are critical for our nation. Another reason global health is important is because of what we call global health diplomacy. Where is the U.S. most popular in the world today via the surveys that have been done really in sub-Saharan Africa very much due to our PEPFAR program. Another reason why global health is important to our nation is what we call sustainable development. We know that health is central to economic development. We know that in the world, another 90 million people will go into poverty this year. Another 45 million children will become malnourished. These raised security concerns that I already mentioned. So because of sustainable development and again because of security, global health is important. Global health is also important to our nation because of commodities and trade. The global health care industry is worth about three and a half trillion dollars right now. And that's important for American business. And a fifth reason, of course, are issues like global public goods and human rights. The fact that everyone around the world deserves equal opportunity to be free of disease, to be able to get age drugs, and of course to have diseases like smallpox and hopefully soon polio are eradicated. We heard at our conference that we just finished from Zika Manual that there are 7.3 billion dollars available for global health in 2009 and the Obama Administration has pledged 61 billion over the next six years and three-quarters of this money is going to be dispersed through the State Department and USAID. And I think that raises probably the questions in your mind, well, what can universities do? How can we make a difference in global health? Well, obviously we're educating and training future leaders as you'll hear in a minute, our students. But also we can do unbiased policy analysis. We can do translational and operational research to evaluate the impact of interventions and improve their delivery. And that's very important to be sure we have programs that are sustainable. And then lastly, we can do independent monitoring and evaluation of programs that are on the ground and show impact. So there's a lot I think that universities can do and contribute, including our partnership with the U.S. government. Traditionally, the U.S. government has had its relationships mostly with Health and Human Services, Department of Defense and Department of Education. These can certainly be expanded. We heard from the NIH director at our conference that global health is one of his top, the new NIH director is one of his top five priorities. We heard from the Fogarty International Center, which has always been a good close partner with the academia, the Heart and Blood Institute and of course, an infectious disease institute that they welcome greater partnership with us. So one is we can continue our traditional relationships but also universities can develop new relationships, particularly with Department of State. We heard from Eric Goosby about how the PEPFAR program wants to have more capacity building to strengthen the governments and universities abroad to be able to deal with the problem of age, TB, malaria, maternal and child health and neglected tropical diseases. Well, that's a perfect place where universities can make a difference. And as I've already mentioned, we can certainly help partner with the government in the area of policy analysis. So we welcome the opportunity to be here and talk with you and let me now just introduce to you that our three students, and they can do two things. They can show you what universities can do in the field of global health. They also can display for you the enormous enthusiasm that today's students have and these are our future leaders of what is a very growing and a very exciting field. Now there's a booklet outside that I hope you all will pick up or we can get to you called Saving Lives which describes what many students are doing. I think that as you will hear, their contributions are enormous as are the faculty that are mentoring them. I'm going to introduce now our student from Duke University. Duke established a global health institute in 2006 as a result really more than anything else of student enthusiasm backed by support from top leadership of the university including its health system. We're an interdisciplinary institute that spans the campus and Duke Medicine. We're in line with our university's commitment to service to society, interdisciplinary scholarship and internationalization. I think our institute like many other global health programs are committed to reduction of health disparities internationally but also locally. Global health is health around the world and our experience in many other universities understand that and are working to improve the lives and reduce health disparities everywhere. On our campus and many other campuses there's been enormous enthusiasm among undergraduates. We have what's called a certificate or a minor that is now second enrollment on the campus in a short period of three years. Students all spend their summer on a project in an underserved population in this country or abroad and I want to introduce to you Greg Morrison who is one of our undergraduates. Greg was born in Columbia, South Carolina. He's a third year student, a junior. He's a double major in history and public policy. He's also enrolled in the global health certificate program that I mentioned. He spent his past summer in Uganda through something called the Duke Engage program which is a program which supports undergraduates who wanted, who wish to get engaged in a community project either overseas or at home. And in this case, Greg went to, as I mentioned, went to Uganda and was involved on a maternal health issue. Greg hopes to attend law school and we certainly hope he continues his work on health policy issues. And after Greg speaks, as you see on your program, Don Teya from Boston University will come up and introduce a student from Boston University. Jeff Copeland will come up and introduce a student from Emory University. Thank you, Dr. Morrison. Thank you all for being here today. My name is Gregory Morrison. As Dr. Morrison said, I'm a junior at Duke University. I spent this past summer in the southwestern corner of Uganda working in four separate rural villages in an attempt to improve maternal health which is one of the major millennium development goals by giving ultrasound scans to women who do not have access to hospitals which is where the ultrasounds are generally located and by distributing mosquito nets and psych-to-side-treated bed nets so that women would have a reduced risk of getting malaria during their pregnancies. My group of students was sponsored by the innovative Duke program, Duke Engage and we were able to see about 1,700 different women over the course of our two months in the country. While I was doing my field work, work that was deeply connected to earlier work that I'd been able to do in the classroom, I realized that the challenge posed by talking about health for everyone, that that health for everyone entails immense, immense challenges, that it's really difficult to get a grasp of without actually spending some time in the communities in which health disparities are serious and exist. Global health at Duke is an interdisciplinary and somewhat surprisingly is much, much, much more complex than merely looking at and analyzing health policy. In this global era, global health is not just a health concern for the United States. It's a national security concern. It is an economic concern for us with all that economics entails, trade policy, energy policy, financial policy. The women that we saw in Uganda were definitely helped by my group's two-month stay, but real solutions, long-term sustainable solutions, can only come if we work at all levels of the United States government, at all levels of the international system, and at all levels of the private sector, including and in particular at the university level. Working in Uganda allowed me to grow as a global health professional. And it's programs like this, the programs that are often run through universities that allow students to have field hands-on experiences. That are going to, in a very serious way, provide the next generation of global health workers. And it's my hope that this generation, that my generation of global health workers is going to be the generation that, as our previous generation conquered smallpox, that we will be able to conquer AIDS, that we will be able to conquer malaria, and that we will be able to control tobacco-related illness. It takes, first of all, an educated, second of all, prosperous, and third of all, a peaceful community to be a healthy community. In unique ways, the work that is done in universities across this country, in particular at Duke, where I'm a student, contributes to that goal of healthy communities all across the world. And that's because universities are a hotbed of innovation. We invent technologies, we invent programs. Students and professors are able to do studies. We're centers of research. We produce new knowledge. We add to the human knowledge base. And we are bastions of scholarship in the sense that universities have very rigorous methodology and are able to bring critical thinking to a lot of the problems that the world faces. And it's not only that this work has to be done abroad, as Dr. Merson alluded to. There are serious problems in our own country with health disparities. And just as the private sector and governments have important roles to play in solving and bridging those disparities, so do universities. And again, I just want to say that probably the biggest contribution of universities in the field of global health is the fact that it's universities that are producing the next generation of people that will work on these problems. And I think that it will be up to our generation here to, and many of y'all's generation out there, to solve and improve the problems of health disparities on the planet. So thank you very much for your time. My name is Donald Thea, and I am from the School of Public Health at Boston University. And what I would like to do is to introduce Nancy Scott, but first tell you a little bit about our program at Boston University. The Department of International Health, of which I'm a member, has been in existence since the mid-1990s. And I've been doing international, I've been doing international public health for about 25 years. And one of the things that I say to my students is that this really is a golden era for public health. I have never seen more interest among our students in public health, and it has really increased tremendously over the last couple of years. We have the largest entering class in the Department of International Health at Boston University, and we comprise the largest department of public health at Boston University. Our degree program is a master's program and a doctoral program, and it's focused very much on developing practitioners of public health, and that's a long tradition of that at Boston University with a dedication to serving underserved populations in the Boston area, and our program at Boston University and in global health serves that particular purpose also. In service to the education of the students, we have a Center for Global Health and Development which has approximately 56 projects across 23 countries currently, in which we place our students. One of our biggest programs is in Zambia, where we've been on the ground for 10 years doing malaria work, doing mother-to-child transmission of HIV work, doing policy analysis, and doing advocacy. Nancy Scott, who is a student in our doctoral program, has been involved in work in Zambia for approximately the last eight years and has had the opportunity to be involved in a whole array of different very practical issues on the ground in Zambia and has given her a really unique perspective in terms of being able to understand what the real-life problems are in Zambia over the span of several technical areas and several eras. During this period of time, PEPFAR was introduced in Zambia and it was a game-changing experience in terms of the lives of Zambians. Nancy was involved in a very large mother-to-child transmission project funded by the National Institutes of Health, of which I was the principal investigator and had a unique experience that she's going to tell you about following that research study to its conclusion and translating those findings into public health policy. So with that, I'd like to introduce Nancy Scott, who is a doctoral student in our program at Boston University. Thank you. Thank you, Don. And good morning to everyone. And thank you all for being here to show your commitment and interest in global health and its role in development. I'm very humbled and honored to be standing up here to share my experience with you and I hope that in the next few minutes my story will do some justice to the incredible opportunities and the quality education that Boston University has provided me over the course of the last eight years. So eight years ago I entered the MPH program, Masters of Public Health program, at Boston University. And I had a lot of passion, a lot of enthusiasm. I was really excited about this field, but I really didn't have a lot of direction or guidance and I really didn't know the breadth and depth of what the field had to offer. When I came out of my MPH program, I had a better understanding of that, a better understanding of the core competencies of public health, a better understanding of the breadth and scope of what global public health was. So about two weeks after I finished my MPH I took my new skills and I got on a plane to go to Zambia to work as an intern with a long-standing partnership that Boston University has with the government down there. And I was working with the National Malaria control program. And at the time, as my colleague mentioned there was insecticide-treated bed nets are a big malaria intervention. And at the time in Zambia my job was to somehow coordinate all the players that were involved in distribution of insecticide-treated nets and design a database that the government could then use to sort of track and monitor its progress and really figure out where they stood in this whole scheme of things. And it was there that I sort of got my first taste of what it felt like to really contribute to something meaningful and something important. And I later found out that that model was actually adopted and used by several other countries as well. So I got my first taste there and I was pretty excited. I returned to Zambia later, not long after, about six months later to run and wind down the randomized controlled trial that Don mentioned in my introduction. Looking that was evaluating or trying to find the best and safest way for HIV-positive women to breastfeed. And when I got on the plane back down to Zambia, I thought, this is great. I can still apply my public health skills. I'm where I want to be. I had absolutely no idea of the of the magnitude of policy and international events that it would sort of position me as this opportunity. And so I get down there and one example in particular is that Zebs was winding up the results of Zebs, the breastfeeding trial that I just mentioned. The results of Zebs actually informed WHO policy and in 2006 WHO changed their infant feeding guideline recommendations for HIV-positive women in part due to the results from Zebs. And that trickled down and suddenly Zambia was changing their policies and I found myself as a young 20-something woman in the halls of the Ministry of Health and in these rooms with big ministry officials sitting down and presenting these results to them and translating these scientific results into very policy-relevant terms for those officials for other audiences and I thought, wow, this is it. This is where I want to be. So I had been out there, seen the breadth and scope of the field and at that moment realized, okay, I want to be here in this room in policy and translating, working to translate that policy into practice. So how do you take these global WHO guidelines and make it work in the rural context of Zambia? But it was also in that same room that I realized and became acutely aware of my limitations and I needed to build this skill set and this skill base that I wasn't quite there. I was getting by but it just wasn't quite there and so I returned after four and a half years in Zambia. I got on a plane and returned to Boston University to pursue my Doctorate of Public Health so that I could strengthen skills like policy analysis. I could strengthen my leadership and management skills. I could strengthen my implementation science and research skills. So a Doctorate of Public Health is a very practice-based degree that aims at producing leaders in the field of public health and having just completed my coursework for that about a month ago, I can confidently stand here and say that the curriculum at the DRPH at Boston University and other institutions definitely filled those gaps that I saw in my personal career growth and my career effectiveness, my professional effectiveness and so I'm really looking forward to the opportunities to take this and move forward in public health and in my dissertation with early infant diagnosis of HIV and policy and I want to highlight specifically that Boston University over this sort of long path that I've been involved with them has really given me the opportunity through its classroom through its extensive field program and my experience was only in Zambia and as Don mentioned there's 23 other countries that BU is working in right now and so through this applied public health research field program and importantly through its community of mentors that is offered under this same roof all these incredible experts looking at these complex global health problems through a multitude of different lenses having that as a resource as a student has been invaluable in my professional growth so I want to say that through those three things academics has really allowed me to explore the field, narrow my focus and then identify what skills I need to build up to become a strong public health professional and contribute to solving some of these complex problems. Thank you very much. Hi I'm Jeff Copeland from Emory University Vice President for Global Health there I spend most of my career at CDC I started my own career in global health in smallpox eradication and I think and has said this is an exciting era as any era in public health and that excitement translates into our upcoming generation here of public health leaders and we've heard from two third is from Emory University's School of Public Health Rollins School of Public Health is a second year student in the master's program Christine Kossrepor is from Wisconsin from Madison Wisconsin graduated the University of Wisconsin where she excelled was a star student in microbiology and immunology came to us in public health and is going to share with you her experience this past summer. Thank you Dr. Copeland and thank all of you for being here today to show your interest in global health and also to allow the students to share their experiences as well. So this summer as part of my education and training at the Rollins School of Public Health at Emory University was a wonderful opportunity by Emory's Global Health Institute to travel to Ghana with three other Emory students to work on a critical albeit not glamorous public health problem, diarrhea. Well for most of us diarrhea is a rare occurrence excuse me a minor inconvenience and a rare occurrence each year diarrhea results in the deaths of 2.2 million individuals and in Ghana specifically the third leading cause of death in children under five years of age but the impact of diarrhea goes beyond the mortality statistics there's a significant effect of repeated or persistent diarrhea infections in children as they become malnourished due to the loss of nutrients leading to diminished growth and under development as well as the susceptibility to other infections such as malaria and measles because of the widespread and devastating impact of diarrhea diseases it is critical to evaluate ways in which to diminish this problem with this in mind our team of four students developed a project to research the potential risk factors of diarrhea by comparing the water sanitation and hygiene practices of rural communities in southern Ghana through the disciplines represented on our team including Global Health Epidemiology Microbiology Medicine Anthropology and Environmental Engineering we were able to use a variety of methods to research these risk factors we found that the diarrhea prevalence did not seem to be dependent on the drinking water or the sanitation services used instead our findings suggested that a lack of hygiene was a main contributor to diarrhea in rural communities as one third of community members did not own soap and results from our water quality testing revealed that over 60% of houses had dangerous levels of E. Coli present in the drinking water stored in their homes even though the water had been perfectly clean before it entered their houses this indicated to us that the water was not contaminated at the source but instead that individuals were in their homes now before I traveled to Ghana this summer and started this project I had assumed probably like many of you that if you simply install a piped water system or dig a well that the water is clean and the problem of diarrhea will not exist but from my experience I learned that the problem is much more complex the individuals in these communities had access to piped and treated water and yet there was no ingesting water that had the potential to make them ill because our team realized that the hygiene education was so lacking in these communities we decided that as a team we could use our varied backgrounds to offer advice and recommendations to the communities we talked with community members about the safest way to store their water educated mothers about the importance of washing after changing their children's diapers and discussed various methods available to treat drinking water for all of us on the team this experience afforded us a great opportunity to develop our leadership skills we learned to communicate our ideas effectively to be flexible and to deal with problems as they arose and to remain composed in difficult and often heart-wrenching situations like when we met Alice a woman who suspected that drinking water was making her children sick so she added kerosene to her water because she thought she was making it safer for them to drink but notably we all gained confidence as we were not only able to develop our ideas on paper together and then successfully execute them as a team but we also surprised ourselves and our ability to use what we have learned in our education at Emory as a place to community members like Alice on a personal level this was a great opportunity for me and I gained so much in just three months I not only learned practical skills like how to design and implement our own research project but I also learned how complex public health problems can be even when on the surface they appear to have easy solutions I quickly understood how essential it is to be able to work with people of different disciplines and different nationalities in order to create effective public health interventions but most importantly as an epidemiology student I work with the percentages and statistics of diseases so it is so easy for me to forget about the individuals who are affected with this experience I was able to put a face to the numbers and to understand the difficulties and hardships that people face at these diseases at the community level I now know that in my career as an epidemiologist I will not be satisfied working with the data and numbers alone and that in order to truly understand a problem or to create or to have effective solutions I need to make personal connections to the people behind the statistics since returning to classes at Emory this fall I have found myself thinking often of the Gnans and my teammates and I met this summer I know that their faces will stick with me as I continue down my career path and my experiences this summer will continue to shape the person that I am and the professional that I hope to become along with my teammates I also hope that through our research and through the research of all students who have the opportunity to work internationally that we will one day contribute as much to the global community as we do this summer thank you very much thank you all it's my pleasure now to introduce Hailey Debas who is chair of our consortium Hailey is from the University of California San Francisco has a long distinguished career in global health and is leading a very exciting initiative in California among universities in global health and then we'll have questions and answers and let me say that I've been instructed that those of you who would like to ask questions after Hailey speaks that I need you to since this is being filmed to line up at the microphone right Steve okay Hailey good morning thank you Michael just let me start by expressing the deep gratitude of the consortium of universities for global health to the congressional global health caucus and to CSIS and Steve Morrison who made this opportunity possible for us you just heard from three students and I hope you witnessed their enthusiasm their idealism they represent tens of thousands of students throughout universities in fact this is a time like no other where the desire to help people in need has never been greater we witnessed it after Katrina students gave up their summer holidays and went to New Orleans to help build houses and we're considering it now on a much larger scale with university students wanting to help the poor all over the world the US universities are a vital national asset in the implementation of US global health agenda not only do they provide unique competitive advantage with committed students and faculty as you saw with their skills in training in research and discovery with healthcare provision but they also form good ambassadors of ambassadors of goodwill that has made the US a beloved country in sub-Saharan Africa our 190 US universities have some sort of global health program and as Mike told you 60 of them have formed a consortium which met at the NIH over the past three days we were very pleased to have our speakers the director of the NIH Dr. Zekiel Emmanuel and Dr. Eric Goosby all of whom showed their commitment to global health and to actually making changes in the way global health is funded so that the basic services in global health are also emphasized not simply the vertical disease based issues in spite of the fact that the universities have this unique capacity in training research and service in healthcare so far they have not been used to their full potential in the US global health agenda the consortium of universities for global health is eager to be called upon to serve in global health to serve the country project its soft power and improve the lives and health of the poor people in developing countries I think there's a major opportunity here that US policy should use one of its important assets its universities to effect its global health strategy again I want to thank you for this opportunity and for your interest in global health so if anyone like to say any few words or ask questions the microphone is here Jerry Kirsch I think would speak first he's the chair of our advocacy committee from the consortium Jerry but others can please line up if you want to say something or ask a question thank you Mike I spent five years of my career from 1998 to 2004 as the director of the Torby International Center for Public Health so I know this building very well I have the privilege of testifying for the appropriations committee and a meeting with many members of the congress the essential issue is that the NIH could not do things in global health without having the resources to do that our universities represent a unique resource an absolutely unique resource global health is not just about health and the health professions it is the broadest range of activities as Mike presented only in our universities do you find the expertise ranging from economics, law, management and the health sciences in our university our College of Fine Arts is deeply engaged two years ago World AIDS Day our music drama and fine arts program ran activities for our students representing service and creating in the center of the student union an opportunity for our students to be tested and counseled we were worried that our students would not participate in so public that they would come up to do it we ran out of tests before the end of the day the engagement our expertise and our greatest asset for our students best way to move this agenda forward for our nation is to have our students out there peer relationships building trust is the future of global health for our nation as well as for the rest of the world thank you Mike well said introduce yourself maybe Judy Wasserheit I'm Judy Wasserheit I'm the vice chair of the department of global health and I'm one of the many members of the consortium of universities for global health and I too want to thank you for this chance to talk with you what you've just seen is how the world is changing this is what we at the University of Washington call the G generation or the global generation and you've seen three great examples you guys did a terrific job three great examples of the passion and the desire to make those better places which is a pretty cool thing they are demanding G universities that really provide interdisciplinary preparation to do the job they want to do and what they just issued to all of us in the room particularly the people on the hill is a demand for G or global non-partisan states people and policy makers to support what they want to do and I think this is pretty much what it is so the obvious question with something like this is okay where do we start there are in this brochure there are four I think very important ideas about where to start I want to highlight one of them and I can say something that Jerry can say because of his former directorship maybe he could say but didn't say about Fogarty and that is the National Institutes of Health has a secret weapon and a real hidden tool and that is Fogarty because right now if you look all around low and middle income countries in the developing world if you look at the leaders in education and training policy development the vast vast majority came out of programs at Fogarty which is currently funded at less than one quarter of one percent of the NIH budget if you talk about best buys and looking for hard outcomes Fogarty is an incredible best buy in terms of training both for our for this G generation here and around the world I'll be thinking about moving that to a minimum of one percent of the NIH budget so I would suggest that among the other recommendations in here we think that thank you thank you Jerry as we discussed three examples from Africa I'll probably base my comment on Africa because one of the things I've been seeing is that we have the the collaboration between US University and African University has focused more on the research area but we have not seen much on the teaching and the practice so I think as the consortium grows we need to look at the balance between the teaching, the research and the practice and for the students I wonder probably when you were in Uganda when you had the chance to interact with students from Macquarie University for the part of your team to participate Greg, speak about what you did there a little bit when we were in Uganda we partnered, the Duke group partners with a private hospital in Mbarara and we were then further, so it was our group of hospital health professionals and then we also brought in four students from the Mbarara University of Science and Technology and they were studying everything from essentially a history all the way to technology and we were able to train these students in some of social science research methods for conducting surveys and they also worked with us in the clinics and we would go to their houses we would go out to eat with them all the time and so, yes, we had a very solid interaction with students, we also had solid interaction with the teaching faculty at the University of Science and Technology there so that these faculty were meeting the faculty that we brought from Duke and we were meeting the students and there was a lot of exchange on at the knowledge level and also at a cultural level between those two groups and it was one of the more valuable parts of the experience. Please. Hi, I'm Sarah Dash with Congresswoman Doloro. Thank you all for being here with this wonderful work you're doing. I have a question about specifically women and children developing nations and I'm sure that many of you are familiar with the wonderful writing of Nicholas Kristoff and Cheryl Woodon on how this needs to be a major focus in our international outlook. I'm just curious the three examples that you all gave all really have to do with women and children's help and I'm wondering if anyone could comment on the role of the growth of University program and particularly partnerships and institution building in other countries on helping to advance this goal of investing in women and children's help. Sure. Anyone want to comment? I want to say Nicholas Kristoff is speaking at Duke tomorrow. Lucky you. Thank you very much. I think that's a very important question. I am convinced that global health the global health agenda could not be significantly moved forward without empowering women in developing countries and without attending to the disease of women and children. The University of California is just developing a 10 campus-wide center for women's health and empowerment because this is the most critical element in global health and I think most of our universities have programs on women's health and so I think that's very important and universities can make the most important contribution in that. I can echo that in fact. Dr. Copeland and I are with Emory and Duke are planning a project that will actually be Rwanda and Ethiopia looking at maternal and child health issues together very shortly so I want to echo what Hailey said I think all of us in the room couldn't agree with you more. We were delighted to hear from all our speakers on Monday's eco-manual and others that maternal health is going to be given a lot, well hopefully going to be given a lot more funding and priority and we would agree that the Millennium Development Goal that has really been least reached is the one around maternal health. Yes, Don, please. Yeah, maternal and child health really is a core competency in public health and I think that it really runs through much of what is done on a global stage and Boston University is establishing a strategic alliance with a new department at Aga Khan University in Pakistan which has sought to bring together the department of OBGYN the department of pediatrics to have one over arching program within the Aga Khan University so it's absolutely a very central focus of almost all global health programs. A word from Washington. You know another example is at the University of Washington Did you already use the microphone? I want it to be taped. Now that you can't hear me right? At the University of Washington we're working very closely not only at the University of Nairobi but also the Ministry of Health on precisely this issue because Kenyan has decided at their ministry level that this is one of their highest priorities and I think listening to our in-country partners is really important so we're working at the training, research and political level to re-evaluate their curriculum and also their policies I hope that reassures you next Good morning my name is Gene Koo and I'm with Blue State Digital and we are working with CSIS to help develop an online media strategy to engage people who are interested and excited about global health in helping to advance policy into the future and we saw with the Obama campaign which we had handed the incredible energy of students really making a huge difference we have a lot of great stories from that campaign but those stories really can't compare and we heard this morning in terms of what students are doing the energy that you have to make a difference and how much you're actually putting into it and our question right now in working with CSIS and the Commission on Smart Global Health is how do we help and pull students into be part of this movement to make global health something that matters not just to a relatively small country but something that the wider US population really starts to care about so what kinds of and I put this to the panel or to the audience what kinds of things can we do and especially from a new media perspective in terms of different kind of strategies to engage people in helping create this movement So students you're much more familiar with the new media than any of your faculty so any of you have thoughts on what the new media can do right exactly I just have a quick thought about making caring about global health a more mass phenomenon as opposed to a targeted phenomenon and part of what one of the major difficulties that we see in our country is unlike other places in the world we don't have a human rights based approach to health so we don't regard health as a human right we tend to regard it more as a commodity and so when you begin to change that mindset and target it so that your average American citizen starts to think about health as a something like freedom of speech then you're going to start to see a much much wider audience for messages about global health anyone else just go for it as far as using technology you probably know better than I do because I have Facebook all the time how to take advantage of the social networking sites and obviously Facebook was started as a social networking site for students but now it's becoming more age distributed and so my friends, grandparents are on Facebook now so I think using social networking sites is critical and doing things like target advertising as well as cell phone campaigns I think everyone has their iPhone and it's reachable at all times and so sending messages out that way is just a great way to get out the message of global health as an importance of global health even like facts or statistics like today 26,000 children died from a preventable illness things like that I think are really important because I think people just aren't aware of the issues you want to respond? just to mention this idea is at smartglobalhealth.org and there is a handout that was going around and so it would be great if you could sign up but also send us our ideas because you really want to figure out not just how to let people know about this but really get people involved the report that the commission is putting out that they really want the student and other folks who have on the ground the experience to put input into it and not just kind of the aroundable ideas so any idea that you might have please shoot them our way please good morning my name is Masere Kittaso and I work at the American Society for Microbiology I'm from the International Affairs Department and we work on a program to increase laboratory capacity building in a lot of the research-limited countries and one of the areas that have been really deficient in global health programs has been public health laboratory and I salute the consortium and I was really interested in understanding it's interested in seeing that there was a microbiology student here and we really are interested in knowing how with universities we can leak out better to support public health laboratories in resource-limited countries because that is one way forward I think Dr. Copeland might comment on that, Jeff maybe to tie in those of you who are working on other aspects of health with what we're talking about the global health in most of the places we work to have someone say we can't do health care reform because we can't afford it would make sense in some of the poorest places we've worked but even then people wouldn't be satisfied with that as an answer so I don't think it's a satisfying answer here either and for global health for us to have the credibility as we work around the world I think one thing I can't speak for everyone here but I suspect we're on an agreement whatever part you're in, whoever you work for we need health care reform legislation passed and we need it passed soon it is an unbelievable embarrassment to work around the world and have large parts of our population without health care here that's part of global health as well and so what you can get that legislation through with your members Republican, Democrat or whatever compromise here, compromise there the absence of that undermines U.S. strategic security and global health goals anyone want to come in on the lab question you're feeling about the role of laboratories in global health and how people interested in that area can help I'm sure I'd love to comment on that because it's a from working in some of the deep rural areas of San Diego fundamental problems of working in public health that and the human resource capacity and it's a big challenge trying to solve that and I think we've seen a lot of evidence of technologies that are simple and can be used in the field when being a rapid diagnostic test of malaria that can be done and administered very easily in the field and another is early infant diagnosis of HIV so trying to detect HIV in a child that's under 18 months one of the technologies that's recently become available in Zambia and a lot of other African countries for sure is the ability to take dried blood spot cards in these deep rural areas and transport those to the laboratories that do have capacity in the capital cities baby sometimes that's an 18 hour transport so trying to devise technologies that would be simple and affordable and implementable in the rural areas I think a lot of the laboratory response and investments have been in the central areas because that's where it's most that's the most congested areas so good Judy want to come in briefly and then we have one more question and then we adjourn it in three minutes so go ahead Judy I just want to highlight that what was just said is just as relevant to our rural populations here our Native Americans are many of our populations and so I think it's very important for us all to recognize that this global work comes back home to benefit our own populations in many ways my name is Jeannie and I'm with the Center for Victims Researcher I'm wondering if the panel or any of the other distinguished speakers today can comment about the relationship between mental health service provisions and global health provision and particularly of course my interest lies in trauma care well I mean anyone can comment Jerry I mean as he gets to the microphone I would simply say it's one of the top neglected areas in global health right now but I'm sure Jerry will add more to that there's a great understanding when you look at the burden of disease which is not just mortality but how disease morbidity ongoing problems impact on lives the leading cause of morbidity is mental illness and depression has huge impacts on work capacity in the family economics of the family so if the adult breadwinner who's oppressed happens the family is in deep trauma that's one side of it we have several epidemics going on none of which are infectious diseases there's an epidemic of trauma from a number of things war, domestic violence, violence against women and road traffic accidents huge burden and very little in the way of interventions to deal with we also have an epidemic of tobacco related illness and we haven't seen the worst of it yet because the smoking habits in the developing countries and where tobacco is being promoted takes years before the disease burden comes out so I think we're all aware of the agenda is not infectious disease the agenda is global health in all of its capacities universities are the repository of expertise to address that and I think one of the things the consortium wants to say is that we want to be partners with our friends in college in the congress you can do things to support the agenda and we can do things we are the best for anything in promoting global health and our own national interests thank you just to reinforce what Jerry just said two examples of ways in which universities are contributing exactly on this issue this coming April at the University of Washington there will be a student student led conference on war conflict and global health to look precisely at some of these issues you're talking about in this world in the past these conferences which are annual have attracted over a thousand students and faculty from around the country another example is that at the University of Washington we have a center on injury prevention which is now looking specifically at some of the intervention issues that Jerry just mentioned and how we actually do have interventions to offer for injury prevention and trauma prevention and trauma care so working with the world health organization and others how do we apply those in one of the countries as well as more widely in my country so let me thank all first a round of applause for our students thank you all for coming you were great and as Hailey said you represent thousands and thousands around the country and around the world that are drinking the Kool-Aid of global health Aaron Meacham a big thanks to all of you and others at CSIS for putting this together thank you all for coming let us know how we can help your cause here in the US government


When working with biohazard materials, you have to also exercise precaution when using the biohazard materials and when getting rid of them. So biohazard materials are basically any body fluid like blood, urine, or any biological materials such as cells or organisms like bacteria. Those are considered biohazard materials. So if you are in a lab where you're required to use a particular biohazard material, the important thing is to treat all these specimens as if they were infectious. Whether or not you know if they're infectious, you need to be careful. So treat all specimens as if they were infectious. So it is important to also wear your gloves. You need to wear your eye gear to protect yourself from any splashes that could occur because infectious materials can splash into the eyes and cause you to get an infection. So you have to also be careful. And when you have used your biohazard, you need to dispose of them so you can use a biohazard container as small as this. Let us say you are handling a very tiny amount of blood. You can discard the tube with the blood in it in this biohazard bag. And they have containers as big as this. So if you were working with large samples, for example, bacteria grown on certain plates and you're finished using the bacteria, you can dump them into a bin that has, if you notice, the symbol biohazard is located on these containers. And that will tell you that you're, that is the container for biohazard waste.