Faculty Profile


Brooke Ramay

Brooke Ramay

Research Assistant Professor

  • Universidad del Valle de Guatemala
  • University of California San Francisco (WOS 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 is also part of the clinical volunteer faculty at UCSF. Dr. Ramay received a Distinguished Faculty Award in 2018 at UVG 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 is one of the lead investigators on the WSU, CDC-funded study: “Quantifying the Community Burden of Antimicrobial-Resistant Bacteria in Guatemala” currently being carried out in collaboration with the Paul G. Allen School of Global animal health at WSU and UVG.

Personal Statement:

I grew up in a small town in Northern California and moved to Guatemala City, Guatemala after graduating from pharmacy school in 2006. I was initially hired at Universidad del Valle de Guatemala (UVG) to teach Quantum Mechanics to Engineers and Chemistry majors, but after six months in the chemistry department, I transitioned into the department of pharmaceutical chemistry where I teach pharmacology and clinical pharmacy. I initially worked on public health projects as a student, and began a formal career as a researcher, collaborating with colleagues from the University of Denver and the Pan American Health Organization (PAHO) to describe barriers in the access to medications in Guatemala in 2012. In addition to projects in access to medications, I studied the paradigms of self-medication with antibiotics in Guatemala and the factors that influence this practice. In 2017, I partnered with colleagues at WSU and UVG to carry out a pilot study in community antimicrobial resistance. Even though we know that antibiotic consumption drives resistance, factors in hygiene and sanitation may contribute more significantly to antimicrobial resistance. In a country where both antibiotic use and poor hygiene are a problem, we are working to establish under what circumstances they play a role in their contribution to AMR.

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: Access to and use in the community and the 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
  • HIV: Measuring adherence to antiretroviral treatment and interventions to improve adherence in pediatric patients
  • End Stage Renal disease patients: Measuring adherence to medications and treatment strategies in pediatric patients

Research Contributions:

Prior to joining the faculty at WSU, Dr. Ramay worked on research related to access to medications in Guatemala and antibiotic use. Paradigms surrounding use may impact antimicrobial resistance, but other, more influential risk factors may be driving resistance at the community level as shown in current studies. Through continual collaborative efforts with the Ministry of Health findings from these studies may be used to develop health policy in Guatemala.

Research Details:

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.

Projects identifying community level antimicrobial resistance, specifically, commensal E. coli, have shown that poor hygiene conditions likely obscure effects of individual antibiotic use, presumably due to enhanced microbial transmission. Community members demonstrate higher prevalence of AMR E.coli in communities where sanitation and hygiene are poorer and antibiotic use is higher. Consequently, efforts to improve antibiotic stewardship should be coupled with improving hygiene conditions. Future studies will explore more robust and random sampling frames to calculate unbiased estimates of AMR in this region. Studies will be carried out in the community and hospital setting. These studies will identify community prevalence of CRE, ESCRE and MRSA, and will be 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%. And, although MOH posts have shown to be sufficiently stocked with meglumine antimoniate, major barriers in obtaining treatment for CL exist, included 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. 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. Text message interventions hold promise to support antiretroviral adherence in pediatric patients living with HIV. Studies designed to assess the impact of text messaging interventions must examine local context for cellular phone infrastructure and use and must account for potential loss to follow up when patients miss appointments and study assessments. Additionally, socio-demographic factors, environmental factors and factors related to patterns of cell-phone can be assessed to identify groups of patients where willingness to receive text messaging would support potential costs of implementing an intervention.

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