What is an Entomologist?

An entomologist is a scientist who studies insects. Most focus on a specific order or family of insects. For instance, coleopterists are entomologists who study beetles. Careers in entomology cover a multitude of fields from forensics to agriculture. Forensic entomologists study insects that infest decomposing bodies, e.g. blowflies, to help solve criminal cases.

Public health entomologists focus on the population biology of arthropod vector-borne infections. These arthropod vectors include mosquitoes, ticks, and flies, carrying certain pathogens which can cause illness in humans if bitten. Malaria, Dengue fever, Lyme disease, and Chikungunya, are just a few of the vector-borne infections causing morbidity and mortality across the globe. Public health entomologists study the vector’s behavior and pathology to develop methods for reducing the burden these insects impose on human health.

Career Highlight: In Academia

Dr. Dawn Wesson is a professor at the Tulane School of Public Health and Tropical Medicine. She has a background in medical and molecular entomology and vector biology. Dr. Wesson teaches graduate courses on ecology and vector biology, and is director of Tulane’s training and initiative program in vector-borne diseases. She has been the principal investigator on many research projects focusing on Dengue, Chagas and West Nile virus.

Currently Dr. Wesson and her research team are surveying local populations of Triatoma sanguisuga. This insect vector carries the parasite Trypanosoma cruzi, which causes Chagas disease. About 6 - 7 million people are estimated to be infected with Chagas globally, with Latin America having the highest burden. People with Chagas can develop an enlarged heart and arrhythmia, causing sudden death. This team’s surveillance data is used to develop mathematical models of mosquito species' distributions and the associated risks of disease to human transmission.

Dr. Wesson is also working on a project in deploying novel lethal ovitraps for container breeding Aedes mosquito species. The Aedes mosquito is a vector of Dengue, West Nile virus, Yellow fever, and Chikungunya. Ovitraps are devices used to trap mosquitoes and shorten their life, making it harder for them to pass along disease.

A Much Needed Presence of Doulas at East Jefferson Hospital

In the last 25 years, the United States maternal mortality rate has doubled, ranking the US 50th, compared to other world nations (Agency 2011). In addition, the US is ranked last for its high infant mortality rate (5.98 deaths per 1000 live births) amongst developed nations (Agency 2011). Most of these complications could have been prevented. Research indicates pre-term labor in women and low birth weights in newborns are higher in low-income women (Wilcox, Marks et al. 1994) . A mother’s lack of accessibility to pre-natal care which includes emotional and nutritional surveillance, and maintenance of current morbidities if present, also accounts for adverse birth outcomes (Alexander, Korenbrot 1995). The increased incidence of Caesarian sections and adolescent aged pregnancy has furthermore contributed to the prevalence of infant and maternal deaths and morbidities during child birth in the United States.

These statistics are deeply felt in the state of Louisiana. The maternal mortality rate in Louisiana is 17.9/100,000 deaths and an infant mortality rate of 9.4/1000 births. In Jefferson Parish, 7.8 per 1000 babies die yearly, 23% of mothers do not receive adequate pre-natal care, and 13% of all births were to teen mothers (Louisiana. Dept. of Health and Hospitals. 2003). Adolescent mothers are more likely to have adverse birth affects due to the compounded stressors of dependency on others, educational interruption, unemployment, and inaccessible resources. Caesarian sections, another risk factor in maternal and infant complications, can lead to infections in the mother, respiratory problems for the baby and mother, as well as increased blood loss and additional surgeries for mother and child (Young M.L., D'Alton M.E. 2008). In 2009, 39.6% of all births in Louisiana were via Caesarian section, resulting in the highest rate in the nation that year. At East Jefferson Hospital, at the end of 2009, 46% of the babies born were via caesarian section (Arnold 2012). High rates and the severity of complications for the mother and child seen across the nation and locally demands for neighboring hospitals such as East Jefferson Parish to implement an intervention.

There is a significant amount of data that affirms pregnant women who receive the support of a doula during their pregnancy (and post-partum) may prevent adverse birth outcomes, hence lowering morbidity and mortality rates of women and their infants. Doulas are trained individuals in pregnancy and childbirth who provide emotional and physical support to women during and after their pregnancy. The goal of a doula is to work with healthcare staff (nurses, midwives, physicians) ensuring that women feel safe and confident. Maternal safety and confidence is achieved with a doula’s continuous presence by the laboring mother’s side helping with responsibilities such as informing mothers and their families of each stage of labor, explaining medical terminology and providing hands on comfort to a mother (Klaus MH, Kennell JH 1997).

A meta-analysis highlighted in, The Doula: and Essential Ingredient of Child Births provides evidence of doulas enhancing birth outcomes of women. The study looked at eleven randomized control trials in primigravidas women that received care from a doula starting at the beginning of their pregnancy until a little after birth. Results showed techniques and exercises instructed by the doula reduced the duration of labor, instrument assisted birth, the need for pain relief medication during labor and the number of C-sections performed. This study also demonstrated the emotional benefits of a doula. The mothers with doula support developed a quicker relationship and higher confidence in caring for their babies, in addition these doula supported mothers reported having a higher self esteem and less depression compared to mothers without support. Mothers with doula support were also less likely to experience problems with implementing breast feeding (Klaus MH, Kennell JH 1997).

Similar studies after the one done by Klaus and colleagues focused on specific outcomes and adjusted for different variables. A hospital based doula support group in an urban multicultural setting further confirmed that doula support strongly improved breastfeeding outcomes in women (Mottl-Santiago, Walker et al. 2008). Another study in California paired low income women participants with doulas and they also experienced shorter labor and reduction in operational vaginal delivery. In addition, breastfeeding was increased (Nommsen-Rivers, Mastergeorge et al. 2009). In Georgia adverse outcomes in child birth and stress were reduced amongst teen mothers with doula support. Many of these doulas in this study went beyond their normal task; assisting in roles such as taking teen mothers to appointments, helping them attain financial benefits and being their advocates(Gentry Q.M., Nolte K.M. et al. 2010) . Over 10% of the women giving birth in Jefferson Parish are below the age of 19( Louisiana. Dept. of Health and Hospitals. 2003) , a doula program at East Jefferson would definitely service this population.

Doulas are present in all different medical settings. Community based doula programs incorporate many women from the neighborhood providing training for new doulas and functions as a hub, outsourcing jobs for those already working in the profession. They have been proven to reduce stress that causes pre-term labor (Kane Low L, Moffat A et al. 2006). Hospital- based doula programs, is an ideal structure for East Jefferson Hospital. Hospitalbased doula programs often recruit doula volunteers and also have paid doulas. These doulas are familiar with hospital policies, procedures and staff and averting any discrepancies in roles amongst the birthing team which is seen in community based doula programs.

Many of the hospital -based doula programs are funded by grants which saves the hospitals money (Ballen, Fulcher 2006). East Jefferson Parish Hospital can actually benefit financially from a hospital- based doula program. Under the Low Income and Needy Care Collaboration Agreement, private hospitals such as East Jefferson, receives government funding for covering the cost of providing care to low-income and needy families (Louisiana. Dept. of Health and Hospitals. 2010). Although majority of the people that reside in Jefferson Parish are middleclass residents, the low-income population is growing. Majority of the studies on doulas have targeted the birth outcomes of low-income mothers. A hospital based doula program that provides services to low-income families would match the need of the community and provide a financial incentive for the hospital.

Doulas are a relatively new health profession to the hospital setting resulting in limited research concerning their practices, and effects on birth outcomes. Nevertheless, there are strengths and weaknesses of this field. Much of the research linking doula care to improved health benefits are of mothers from disadvantaged and low-income populations. There is only one study which looked at the birth outcomes in middleclass women although the results were similar (McGrath, Kennell 2008). Therefore, there needs to be more research that compares birthing outcomes with doula support amongst women from different social classes. There also needs to be a study on the birth outcomes in comparing nulliparous women vs. primigravidas women with doula support. There may be different findings between the groups considering one has endured childbirth before and the other has not. Finally, more research is needed to identify the ways in which social support during labor aids in maternal outcomes (Klaus MH, Kennell JH 1997).

Research on doula programs have demonstrated consistent benefits for women and their newborns, therefore East Jefferson Hospital should consider implementing a hospital-l based doula program. Programs that combine health behavior in pregnant women, and better access to affordable healthcare along with the support of a doula may be the most effective intervention for healthy birth out-comes at Jefferson Parish hospital. Although a community based program, The Birthing Project of New Orleans, is a local example of a program that combines these elements of a successful program. Pregnant women at The Birthing Project have access to nutrition classes, and exercise classes along with the support of a doula. Another issue that should be taken into consideration when developing a program at East Jefferson is ensuring the cultural competency in the program. Health connections of Chicago were able to service the population of Spanish speaking mothers with doulas that were also fluent in Spanish. Cultural competency eases the bond between the mother and doula which increases the likelihood those mothers will adhere to doula support. This program will be a success if East Jefferson Hospital has doulas that are fluent in the languages of the groups represented in Jefferson Parish.

The presence of high birth complications amongst women , and specific populations such as teens, and low income individuals in the Jefferson Parish demands an intervention that can lower these numbers such as a doula program at East Jefferson hospital. Evidence does a great job in providing us with benefits. However more research needs to be done on the effects of doula care amongst different social classes, nulliparous women vs primigravidas women, in addition studies identifying the actual mechanisms of support that doulas provide. These findings also suggest that East Jefferson Hospital should implement a doula program consistent with cultural competent and well trained doula staff whom are educated on the latest advances in the field, along with a continual evaluation process for the program. In fact doula programs either community based or hospital based should be instituted all over the state of Louisiana as well as the US to reverse the burden of birth outcomes and mortality rates amongst women and infants all over.