Julie Cliff

{{Short description|Australian physician and epidemiologist in Mozambique}} {{Use dmy dates|date=December 2023}} {{Infobox academic | honorific_prefix =  | name = Julie Cliff | honorific_suffix = {{Post-nominals|country=AUS|AO|size=100%}} | image = | image_size = | alt = | caption = | native_name = | native_name_lang = | birth_name =  | birth_date = {{birth year and age|1944}} | birth_place = Essendon, Victoria | death_date =  | death_place = | death_cause = | nationality =  | citizenship =  | other_names = | occupation = Epidemiologist, physician | period = | known_for = | title = | boards =  | spouse = | partner = | children = | parents = | relatives = | awards = Order of Australia (1996) | website = | education = | alma_mater = University of Melbourne | thesis_title = | thesis_url = | thesis_year = | school_tradition = | doctoral_advisor = | academic_advisors = | influences =  | era = | discipline =  | sub_discipline =  | workplaces = *Muhimbili Hospital *University of Dar es Salaam *Maputo Central Hospital *Eduardo Mondlane University *Centers for Disease Control and Prevention, Atlanta | doctoral_students =  | notable_students = | main_interests = | notable_works = | notable_ideas = | influenced =  | signature = | signature_alt = | signature_size = | footnotes = }} '''Julie Laraine Cliff''' {{Post-nominals|country=AUS|AO}} (born 1944) is an Australian physician and epidemiologist known for her work in the prevention and control of infectious diseases through investigating epidemics and health policy, particularly in Mozambique, where her career spanned around 40 years. There, her investigations revealed that the re-emergence of the paralytic disease konzo in poor rural communities was caused by high levels of cyanide in insufficiently processed cassava, as a result of changes in food preparation practices due to the economic effects of war and drought. In 1996, Cliff was appointed an Officer of the Order of Australia, and awarded an honorary degree of Doctor of Laws by Monash University. In 2013, she delivered the John Snow Society's Pumphandle Lecture, titled "From London to Mozambique, from cholera to konzo".

==Early life and education== thumb|London School of Hygiene and Tropical Medicine Julie Cliff was born in 1944 in Essendon, Victoria.<ref name=EOAS>{{cite web |last1=Centre for Transformative Innovation |first1=Swinburne University of Technology |title=Cliff, Julie Laraine – Person – Encyclopedia of Australian Science and Innovation |url=https://www.eoas.info/biogs/P004198b.htm |website=www.eoas.info |access-date=30 October 2023|archive-url=https://web.archive.org/web/20231105081524/https://www.eoas.info/biogs/P004198b.htm|archive-date=5 November 2023 |language=en-gb}}</ref> As a medical student she took up an elective in New Guinea, and in 1967 graduated MBBS from the University of Melbourne.<ref name=Fioritti>{{cite web |last1=Fioritti |first1=Nathan |title=Professor Julie Cliff AO |url=https://mdhs.unimelb.edu.au/engage/community/awards-and-honours/professor-julie-cliff-ao |website=Faculty of Medicine, Dentistry and Health Sciences |access-date=30 October 2023 |language=en |date=22 November 2016|archive-url=https://web.archive.org/web/20231105083235/https://mdhs.unimelb.edu.au/engage/community/awards-and-honours/professor-julie-cliff-ao|archive-date=5 November 2023}}</ref> She subsequently completed a diploma in tropical medicine at the London School of Hygiene and Tropical Medicine (LSHTM) and post-graduate medical training in London.<ref name=Fioritti/>

==Early career== thumb|Central Hospital Maputo In 1974 Cliff was appointed honorary medical specialist at Muhimbili Hospital and lecturer in medicine at the University of Dar es Salaam in Tanzania; spending two years in that country.<ref name=EOAS/><ref name=Fioritti/> From 1976 to 1979 she was medical specialist and director of the Infectious Diseases Unit at Maputo Central Hospital in Mozambique, joining there shortly after the country gained independence.<ref name=EOAS/><ref name=Fioritti/> She was part of a group of experts employed to rebuild a health service in Mozambique, a detailed account of which is given in her chapter "An orphan disease in Mozambique" in Julie Pearlman's ''The Practice of International Health'' (2009).<ref name=Pearlman2009>{{cite book |last1=Cliff |first1=Julie |editor1-last=Pearlman |editor1-first=Daniel |editor2-last=Roy |editor2-first=Ananya |title=The Practice of International Health |date=2009 |publisher=Oxford University Press |location=New York |isbn=978-0-19-531027-6 |pages=70–87 |chapter-url=https://books.google.com/books?id=R0TOWKJi16gC&pg=PA70 |language=en |chapter=4. An orphan disease in Mozambique}}</ref><ref name=Castle2018>{{cite journal |last1=Castle |first1=Matt |title=The curse of konzo |journal=Cassava Cyanide Diseases & Neurolathyrism Network News |date=June 2018 |issue=331 |pages=2–4 |url=https://biology.anu.edu.au/files/Konzo%20CCDNNews%2031%202018.pdf |issn=1838-8817}}</ref>{{efn|By independence in 1975, most doctors in Mozambique had emigrated, and of those that were left, most were concentrated in less needy areas. The country's over nine million population was at the time left served by around 50 physicians.<ref name=Wright1975>{{cite journal |last1=Wright |first1=Robin B. |title=Mozambique: Short Term Problems, Long Term Hope |journal=Africa Today |date=1975 |volume=22 |issue=3 |pages=15–19 |jstor=4185518 |issn=0001-9887}}</ref>}} In 1976 she was also appointed professor auxiliar Faculdade de Medicina at Maputo's Eduardo Mondlane University and remained so until 1998.<ref name=EOAS/> Her work there developed a close co-ordination with the University of Melbourne.<ref name=Dukes2014>{{cite news |last1=Dukes |first1=Kate |title=Celebrating collaboration for improved health in Mozambique |url=https://www.smh.com.au/education/celebrating-collaboration-for-improved-health-in-mozambique-20140415-36opk.html |access-date=5 November 2023 |work=The Sydney Morning Herald |date=15 April 2014 |language=en}}</ref>

From 1980 to 1984 Cliff was epidemiologist at Mozambique's National Directorate of Preventative Medicine.<ref name=EOAS/> She returned to the LSHTM to complete a master's degree in community health and then moved back to Mozambique.<ref name=Pearlman2009/> Subsequently, she spent four years as head of the Epidemiology Section of the National Directorate of Heath of the Ministry of Health in Maputo, and two years as acting head of the Department of Community Health in the Faculdade de Medicina Universidade Eduardo Mondlane.<ref name=EOAS/>

===Konzo=== Internationally, Cliff has become known for her role in revealing that the re-emergence of the paralytic disease konzo in poor rural communities in Mozambique was caused by high levels of cyanide in insufficiently processed cassava, as a result of changes in food preparation practices due to the economic effects of war and drought.<ref name=Harford2020>{{cite book |last1=Harford |first1=Tim |title=The Next Fifty Things that Made the Modern Economy |date=2020 |publisher=Little, Brown Book Group |location=London |isbn=978-1-4087-1264-1 |pages=112–114 |chapter-url=https://books.google.com/books?id=eSucDwAAQBAJ&pg=PT113 |language=en |chapter=32. Cassava processing}}</ref><ref name=Myers2016>{{cite web |last1=Myers |first1=Dayna Kerecman |title=Julie Cliff on Konzo, the Orphan Disease {{!}} Global Health NOW |url=https://globalhealthnow.org/2016-11/julie-cliff-konzo-orphan-disease |website=globalhealthnow.org |access-date=1 November 2023 |language=en |date=16 November 2016}}</ref> Her colleagues in this work included Howard Bradley and Hans Rosling.<ref name=Castle2018/> When she was first sent to investigate the outbreak in 1981, it was thought to be caused by polio.<ref name=Castle2018/> Then another infectious cause, or chemical or biological warfare was suspected.<ref name=Castle2018/> The eventual conclusion was what an elderly village man had told her at the onset; that "this disease has happened because the rain has not washed our cassava".<ref name=Castle2018/> Her study showing these findings was published in 2011, and highlighted that it particularly affected women and children, and spared breast fed babies.<ref name=Acton2013>{{cite book |last1=Acton |first1=Q. Ashton |title=Issues in Medical Chemistry: 2012 Edition |date=2013 |publisher=ScholarlyEditions |isbn=978-1-4816-4641-3 |page=52 |chapter-url=https://books.google.com/books?id=ugwWTGgDMiUC&pg=PA52 |language=en |chapter=3. Chemical Toxicology}}</ref> Her paper revealed how desperate times changed cooking practices.<ref name=Castle2018/> Instead of the usual three day soaking of peeled cassava roots followed by drying it out in the sun and then grinding it to a flour, poverty and drought had led to hunger and resulted in shortening the preparation process.<ref name=Harford2020/><ref name=Castle2018/> This, in addition to the direct effect of drought increasing the concentration of naturally occurring cynogens in raw cassava, caused higher amounts of cyanide in the processed cassava.<ref name=Castle2018/><ref name=Acton2013/> This led to the consumption of cassava before the cyanide was washed out.<ref name=Harford2020/><ref name=Acton2013/> Her team subsequently discovered further outbreaks of konzo in Africa.<ref name=Castle2018/>

==Later career== In 1988 she moved to the United States, where she became international epidemiologic fellow at the Centers for Disease Control and Prevention in Atlanta.<ref name=EOAS/> Cliff later held posts at the Centre for International Health at the Burnet Institute in Melbourne, and at the Department of Global Health, University of Washington.<ref name=Stanwell2013>{{cite news |last1=Stanwell-Smith |first1=Ros |title=Pumphandle Lecture 2013 "From London to Mozambique, from cholera to konzo": The newsletter of the John Snow Society |url=https://blogs.lshtm.ac.uk/johnsnowsociety/files/2020/07/broad-sheet-2013.pdf |access-date=3 November 2023 |work=Broad Sheet |publisher=Royal Society for Public Health |date=2013}}</ref>

In 2000, Cliff co-authored a chapter titled "Lovers, Hookers, and Wives: Unbraiding the Social Contradictions of Urban Mozambican Women's Sexual and Economic Lives" in Meredith Turshen's ''African Women's Health'' using real life stories to describe how many poor women in post-war Mozambique put themselves at risk of HIV through the exchange of sex for essentials needed to survive.<ref name=Turshen2000>{{cite book |last1=Turshen |first1=Meredeth |title=African Women's Health |date=2000 |publisher=Africa World Press |isbn=0-86543-819-6 |page=xiii |chapter-url=https://books.google.com/books?id=Sdx78njl-xYC&pg=PAxiii |language=en |chapter=Even strong backs need support: introductory notes}}</ref><ref name=Weinger2007>{{cite journal |last1=Weinger |first1=Susan |last2=Akuri |first2=John |title=Cameroonian Women's Perceptions of their Health Care Needs |journal=Nordic Journal of African Studies |date=31 March 2007 |volume=16 |issue=1 |doi=10.53228/njas.v16i1.50 |url=https://www.njas.fi/njas/article/view/50/44 |language=en |issn=1459-9465}}</ref>

==Honors and awards== In 1989 Cliff became visiting fellow at the National Centre for Epidemiology and Population Health in Canberra, Australia, and in 1993 SmithKline Beecham awarded her a fellowship.<ref name=EOAS/>

In 1996, Cliff was appointed an Officer of the Order of Australia, and awarded an honorary degree of Doctor of Laws by Monash University.<ref name=Fioritti/><ref name=Global>{{cite web |title=Julie Cliff {{!}} University of Washington – Department of Global Health |url=https://globalhealth.washington.edu/faculty/julie-cliff |website=globalhealth.washington.edu |access-date=30 October 2023}}</ref> She is a fellow of the Royal College of Physicians of London.<ref name=Fioritti/>

===Pumphandle Lecture 2013=== thumb|John Snow pub and pump as it was at the time of Cliff's lecture In 2013 she presented the John Snow Society's Pumphandle Lecture in London, two years after her colleague Rosling had delivered it.<ref name=Stanwell2013/><ref name=RSPH2013>{{cite web |title=John Snow Society Pumphandle lecture and AGM 2013 |url=https://www.rsph.org.uk/about-us/news/john-snow-society-pumphandle-lecture-and-agm-2013.html |website=www.rsph.org.uk |access-date=3 November 2023}}</ref> Titled "From London to Mozambique, from cholera to konzo", members would have proceeded to the John Snow pub afterwards.<ref name=Stanwell2013/><ref name=JSS2013>{{cite web |title=2013 Julie Cliff – From London to Mozambique, from cholera to konzo |url=https://johnsnowsociety.org/2013/09/05/2013-julie-cliff-from-london-to-mozambique-from-cholera-to-konzo/ |website=The John Snow Society |access-date=31 October 2023 |date=5 September 2013}}</ref>

==Selected publications== *{{cite journal |title=Thyroid function in a cassava-eating population affected by epidemic spastic paraparesis |journal=Acta Endocrinologica |date=1986 |volume=113 |issue=4 |doi=10.1530/acta.0.1130523 |pmid=3788422 |language=en |issn=0001-5598 |last1=Cliff |first1=Julie |last2=Lundquist |first2=Per |last3=Rosling |first3=Hans |last4=Sörbo |first4=Bo |last5=Wide |first5=Leif |pages=523–528 }} *{{cite journal |title=Konzo and continuing cyanide intoxication from cassava in Mozambique |journal=Food and Chemical Toxicology|date=March 2011 |volume=49 |issue=3 |pages=631–635 |doi=10.1016/j.fct.2010.06.056 |pmid=20654676 |issn=1873-6351 |last1=Cliff |first1=J. |last2=Muquingue |first2=H. |last3=Nhassico |first3=D. |last4=Nzwalo |first4=H. |last5=Bradbury |first5=J.H. }} *{{cite journal |last1=Taibo |first1=Cátia Luciana Abdulfattáhe |last2=Cliff |first2=Julie |last3=Rosling |first3=Hans |last4=Hall |first4=Casey Daniel |last5=Park |first5=Meeyoung Mattie |last6=Frimpong |first6=Joseph Asamoah |title=An epidemic of spastic paraparesis of unknown aetiology in Northern Mozambique |journal=The Pan African Medical Journal |date=2017 |volume=27 |issue=Suppl 1 |page=6 |doi=10.11604/pamj.supp.2017.27.1.12623|pmid=28721170 |pmc=5500942 |issn=1937-8688|s2cid=19262074 }} *{{cite journal |title=Epidemiology, clinical features and risk factors for human rabies and animal bites during an outbreak of rabies in Maputo and Matola cities, Mozambique, 2014: Implications for public health interventions for rabies control |journal=PLOS Neglected Tropical Diseases |date=July 2017 |volume=11 |issue=7 |article-number=e0005787 |doi=10.1371/journal.pntd.0005787 |pmid=28742094 |issn=1935-2735 |doi-access=free |last1=Salomão |first1=Cristolde |last2=Nacima |first2=Amílcar |last3=Cuamba |first3=Lutero |last4=Gujral |first4=Lorna |last5=Amiel |first5=Olga |last6=Baltazar |first6=Cynthia |last7=Cliff |first7=Julie |last8=Gudo |first8=Eduardo Samo |pmc=5542695 }} *{{cite book |series=Advances in Experimental Medicine and Biology |date=2018 |volume=1062 |pages=11–18 |doi=10.1007/978-981-10-8727-1_2 |pmid=29845522 |issn=0065-2598 |title=Dengue and Zika: Control and Antiviral Treatment Strategies |last1=Gudo |first1=Eduardo Samo |last2=Falk |first2=Kerstin |last3=Cliff |first3=Julie |chapter=Historical Perspective of Arboviruses in Mozambique and Its Implication for Current and Future Epidemics |isbn=978-981-10-8726-4 }}

==Notes== {{Notelist}}

==References== {{Reflist}}

==External links== *{{cite web |title=Julie Cliff: Pumphandle Lecture 2013 {{!}} John Snow Society | website=YouTube |url=https://www.youtube.com/watch?v=TVeYAQQwmT8 |language=en}}

{{DEFAULTSORT:Cliff, Julie}} Category:Living people Category:1944 births Category:People from Essendon, Victoria Category:Australian women epidemiologists Category:Australian epidemiologists Category:University of Melbourne alumni Category:Officers of the Order of Australia Category:Alumni of the London School of Hygiene and Tropical Medicine Category:20th-century Australian women medical doctors Category:20th-century Australian medical doctors