WSU Global Health - Kenya Faculty 


Brooke Ramay

Brooke Ramay

Assistant Professor

  • Universidad del Valle de Guatemala
  • University of California San Francisco (Volunteer clinical faculty)

brooke.ramay@wsu.edu

 

Biography:

Dr. Brooke Ramay has a dual appointment as a clinical pharmacy professor and researcher at Universidad del Valle in Guatemala (UVG) and Washington State University respectively. She also serves as clinical volunteer faculty at UCSF. Dr. Ramay received a Distinguished Faculty Award from UVG in 2018 for her work with pharmacy students in Guatemala. She has worked on research related to access to medications and antibiotic use in the Center for Health Studies at UVG and antimicrobial resistance with WSU. She has worked on research related to medication use and antimicrobial resistance with a particular interest in defining community, household, animal and human-level risk factors for carriage of antimicrobial resistant Enterobacteriaciea in the community and hospital setting in Guatemala. 

Personal Statement:

When I was an undergraduate, I was fascinated by organic chemistry and as a student I worked on new paths for vancomycin synthesis (an important antibiotic used in hospital settings). When I was asked to deliver a talk about my work to our research group, I realized I was more interested in the drug’s effects on the human body than in the actual synthesis. Drawn to the idea of getting out of the lab and interacting with people, and excited to speak to patients about how drugs work, I opted to study Clinical Pharmacy. When I moved to Guatemala after obtaining my Pharm D., I serendipitously (and with a little persistence) began working in public health research; I began studying access to medication and antibiotic use, which led to more rigorous analysis of antimicrobial resistance. My professional journey has also included a short-stint teaching Quantum Mechanics and a more sustainable professorship teaching Clinical Pharmacology at Universidad del Valle in Guatemala.

Although our only current pet is a turtle, I am from a small town in northern California and, as a young girl, raised pigs and had horses, thus, I feel at home in the Allen School. I am an avid runner and enjoy listening to audiobooks and podcasts while getting my feet off the ground. 

Education &Training:

Dr. Ramay received her bachelor of science in Chemistry and a minor in Spanish from the college of creative studies at University of California Santa Barbara (2001). She was a regent scholar at the University of California San Francisco and received her Pharm D in 2006. She is a licensed pharmacist in California.

General Research / Expertise:

My expertise centers on the use of medications in the socio-cultural context of Guatemala in various clinical, outpatient and community settings.

  • Antibiotic use and Antimicrobial Resistance: Antibiotic use and it´s impact on community level antimicrobial resistance
  • Leishmaniasis : Describing Access to and the knowledge, attitude and practice of medications used to treat Cutaneous Leishmanaisis in endemic regions of Guatemala
  • Pediatric outpatients with HIV and End Stage Renal Disease: Measuring adherence to medications and treatment strategies in pediatric patients 

Research Contributions:

Dr. Ramay´s main research activities focus on the paradigms of antibiotic use as a potential risk factor driving antimicrobial resistance at the community level. While it is pretty clear that antibiotic consumption drives resistance, factors related to hygiene and sanitation may contribute more significantly to this global health problem. In a country where both antibiotic use and poor hygiene are a challenge, Dr. Ramay and collaborating partners in Guatemala are working to establish under what circumstances these factors play a role in the contribution to AMR. Through continual collaborative efforts with the Ministry of Health, findings from these studies may be used to develop health policy in Guatemala. 

Research Details:

Antibiotic use and Antimicrobial resistance

Antimicrobial resistance, when bacteria do not respond to the lethal effects of antibiotics,  happens when bacteria are exposed to elements that contribute to the survival or overall fitness of bacteria. Antibiotic use is one factor that drives resistance, but other elements such as sanitation and hygiene may be equally as important in the bacteria´s development of antimicrobial resistance. 

In our recently published community household based project in the Western Highlands and Lowlands of Guatemala, we found that the odds of detecting resistant bacteria significantly decreased for every unit of improvement in our “hygiene scale”. We concluded that poor hygiene has a greater impact on AMR E. coli in comparison to antibiotic use in households where hygiene is the poorest. This modification is not as significant of an issue when hygiene conditions are improved. These results emphasize the “transmission dynamics” of antimicrobial resistance genes between and among E. coli, and highlight the importance for interventions improving hygiene and sanitation as well as the rational use of antibiotics. Consequently, efforts to improve antibiotic stewardship should be coupled with improving hygiene conditions.

We have used previous findings to develop the current project where we are estimating the prevalence of more clinically relevant commensal extended-spectrum cephalosporin-resistant Enterobacteriaceae (ESCrE), carbapenem-resistant Enterobacteriaceae (CRE), and methicillin-resistant Staphylococcus aureus (MRSA) in the Highlands of Guatemala, both in the households in communities surrounding the hospital as well as in the hospital.  Ongoing findings from these studies are shared with the Ministry of Health in Guatemala as a surveillance platform to identify specific risk factors that contribute to community and hospital AMR in this region of the world.

Leishmaniasis

Neglected Tropical diseases of are particular concern in Guatemala where support for the Ministry of Health (MOH) program in Leishmaniasis varies greatly each year. Together, with the support of the CDC, we have worked to identify the prevalence of Cutaneous Leishmaniasis (CL) in Alta Verapaz, Guatemala and the key steps in the supply chain of meglumine antimoniate for the treatment of CL in this region. The prevalence estimate in this region of Guatemala was determined to be 3.8%. Although ministry of health posts have shown to be sufficiently stocked with meglumine antimoniate, major barriers in obtaining treatment for CL exist, including long distances to health posts, and the discomfort of intramuscular injection of medication. The Knowledge, Attitude and Practice (KAP) surrounding CL and CL treatment have been explored in two additional cross-sectional studies whose publication is pending. This group of studies has been used to create systems of support within the MOH and academic setting to provide diagnosis and treatment options for those infected with CL in Guatemala. 

Pediatric outpatients: HIV and End Stage Renal Disease

Treatment adherence, or the “extent to which a person´s behavior coincides with medical or health advice” is complex among chronically ill children and is a subject matter we have studied in two separate ministry of health clinics in Guatemala. Pediatric patients with Chronic Kidney (CKD) disease, and children with HIV face several barriers to medication adherence that, if addressed, contributes to improving clinical care outcomes.  In resource limited countries, access, and adherence to medication therapies are problematic.  We have carried out studies in adherence in pediatric patients with HIV and pediatric patients with ESRD in order to identify opportunities to improve adherence. Factors shown to all positively impact adherence are: higher educational level of patient´s mother, higher reported income, and living in metropolitan area.

Use of antibiotics and access to medications. We have found that self-medication practices with antibiotics are homogenous among groups belonging to different socioeconomic groups. Our research has documented a permissive attitude towards the over-the- counter availability of antibiotics from convenience stores, pharmacies and health care providers facilitated by a lack of effective regulation of prescription and dispensation. Finally, the lack of availability of antibiotics in public health facilities together with increased availability of antibiotics in private pharmacies and convenience stores is facilitated by the complex, and interwoven relationship between the pharmaceutical industry, the legislature, regulatory agencies and public health care providers.

Findings from these studies have been used to implement interventions to improve adherence. In ESRD, we have developed educational workshops for pediatric patients and their caregivers to address findings, and are currently testing the effectiveness. In the HIV clinic, we have carried out a randomized control trial to test the efficacy of text message reminders to improve adherence which hold promise to support antiretroviral adherence in pediatric patients living with HIV. 

Select Publications
  • Anson A, Ramay B, de Esparza AR, Bero L. (2012) Availability, prices and affordability of the World Health Organization's essential medicines for children in Guatemala. Global Health ;8:22. doi: 10.1186/1744-8603-8-22. PMID: 22747646 PMCID: PMC3503802
  • Ramay BM, Lambour P, Cerón A. (2015) Comparing antibiotic self-medication in two socio-economic groups in Guatemala City: a descriptive cross-sectional study. BMC Pharmacol Toxicol ;16:11. doi: 10.1186/s40360-015-0011-3. PMID: 25928897 PMCID: PMC4418049
  • Ramay BM, Caudell M, Cordon-Rosales C, Archila LD, Palmer GH, Jarquin C, Moreno MP, McCracken JP, Rozenkrantz L, Amram O, Omulo S, Call DR (2020) Antibiotic use and hygiene interact to influence the distribution of antibiotic-resistant bacteria in Guatemala Distinguished Oral Presentation at the 6th Decennial International Conference on Healthcare Associated Infections Manuscript in review PMID: PMCID:
  • Ramay BM, Cerón A, Méndez-Alburez LP, Lou-Meda R. (2017) Factors associated to acceptable treatment adherence among children with chronic kidney disease in Guatemala. PLoS One ;12(10):e0186644. doi: 10.1371/journal.pone.0186644. eCollection 2017. PMID: 29036228 PMCID: PMC5643062
  • Ramay B.M, Jara J, Purificación MP, Lupo P, Serrano C, Alvis JP, Arriola CS, Veguilla V, Kaydos-Daniels SC (2018) Self-medication and etiologies of individuals presenting at with influenza-like illness: Guatemala City, 2018 influenza season Poster Presentation, International Conference on Emerging Infectious Disease 2018 - manuscript in CDC clearance PMID: PMCID:

Awards:

2011 Featured faculty, Universidad del Valle de Guatemala, Guatemala
2018 Distinguished faculty, Universidad del Valle de Guatemala, Guatemala