SEQUINS Hall of Fame: Edwin Trevathan, MD, MPH, on Community-Based Neurology and Global Health

The Society for Equity in Neuroscience (SEQUINS) continues to spotlight leaders whose careers have shaped efforts to improve access, representation, and outcomes across neurologic care and research. As part of its upcoming annual meeting, the organization recognized several individuals through its Hall of Fame initiative, honoring longstanding contributions to advancing equity in neuroscience globally.

Among this year’s honorees is Edwin Trevathan, MD, MPH, Amos Christie Chair in Global Health and Professor of Pediatrics and Neurology at the Vanderbilt Institute for Global Health. A pediatric neurologist and epidemiologist, Trevathan has spent decades leading research and public health initiatives focused on childhood neurologic disorders, epilepsy, and global health systems, particularly throughout sub-Saharan Africa. His work has included NIH-funded projects addressing epilepsy treatment gaps, neuroepidemiology, and workforce development in countries including Nigeria, Uganda, and South Africa. Prior to Vanderbilt, Trevathan also held leadership roles at the CDC, Saint Louis University, Baylor University, and Washington University in St. Louis.

In a recent Q&A with NeurologyLive^®, Trevathan discussed the significance of being named a SEQUINS Hall of Famer, the experiences that shaped his career in pediatric neurology and global health, and the broader challenges of improving neurologic care delivery in underserved populations. He also reflected on the importance of community partnerships, point-of-care diagnostics, and integrating equity more directly into neurologic training and healthcare systems.

NeurologyLive: What does being named a SEQUINS Hall of Famer mean to you?

Edwin Trevathan, MD, MPH: The existence of the Society for Equity in Neuroscience, and more specifically the Hall of Fame, draws attention to the needs of the world’s most vulnerable, their needs related to neuroscience and neurological disorders, and demonstrates that health inequity is not an inevitability. We can make a difference, and a sustained effort across generations can achieve health equity, elevating the health of all people.

What inspired your career in pediatric neurology and global health?

My father, a political science and history professor was active in the civil rights movement, and I saw from his work the inequities in the US and throughout the world. My mother was a special education teacher who brought her students to our home; she taught me as a child that people with disabilities could be, and should be, integrated into society where they can contribute and benefit themselves and all of us. I was initially attracted to epidemiology and global public health, which led me to the CDC in Atlanta, and then to Emory for medicine and public health. The great teaching of Drs. Laura Ment and Ben Shaywitz at Yale, and the encouragement of Dr. Andy Nahmias at Emory, helped me solidify my choice of child neurology. The people of the communities in Honduras, China, Nigeria, Uganda, the Democratic Republic of Congo, the US and elsewhere have brought me so much joy, I cannot imagine doing anything else.

How has your work shaped the understanding of neurologic care delivery in underserved populations?

Our work is in progress, and so I do not yet know the degree to which the work that I and my colleagues are doing will shape global public health. That said here are a few thoughts, not only from our work, but from the work that has influenced my current approach.

When pursuing health equity, a public health perspective is essential.We must think of people in communities as those whom we serve, not just people who travel to our clinics and hospitals, as many, perhaps most, of the people suffering from health inequities are not in the healthcare system as patients.We must move out of our hospitals and clinics and into underserved communities to screen, diagnose, and more effectively treat these people in need.

People from the underserved areas of the rural US to the underserved areas of northern Nigeria, have one thing in common.They do not trust, or feel comfortable in, the healthcare system.Developing partnerships with community-based organizations and training people who are trusted by their local underserved community is essential.

We clinicians in the brain sciences tend to work in our academic silos.Breaking down the barriers between medical disciplines is essential when working on a large scale to improve access to screening, diagnosis and treatment. For example, we have found in Nigeria that gaining support from the state and federal Ministries of Health to address the epilepsy diagnosis and treatment gaps requires integrating epilepsy screening and diagnosis with malnutrition screening and diagnosis in under-served communities.

Building systems of care to address health inequities also requires us to think outside of physical hospitals and physical clinics. For example, we have found that point-of-care EEG and mobile clinics reduces barriers to care among many people with epilepsy who are underserved.

More effective utilization of non-physicians, including community health workers trained for specific screening and diagnosis tasks, can often be effective, especially when the community health workers are trusted members of underserved communities.More work is needed in training and supervising community health workers.

What are the biggest challenges in improving neurologic care access for children worldwide?

Sustained and effective community and political engagement. The WHO and other organizations have made the improved screening, diagnosis and treatment of neurological disorders a global public health priority. Early engagement with leaders at the national, state, and community level, beginning with local leaders, is essential for successful community-based programs. In our experience engaging the local leaders early, such as during the study design phase, predicts success.

Although training more physicians, including primary care physicians, in neurological care is important, it is only one component of a strategy to reduce neurological disorders inequity.Eliminating health inequities in neurological disorders will require extensive use of non-physician providers, including community health workers and nurse practitioners.Physicians must be trained in supervision of these other healthcare workers, including remote supervision.

The Linguistic Challenge. Many neurological disorders, such as epilepsy, require a discussion with patients in their local language regarding complex topics, such as “alteration of awareness.” This diagnostic discussion in the over 2000 local languages in Africa, for example, is a major challenge. The development of questionnaires and AI tools in multiple languages that can mimic diagnostic evaluations is a major priority, and is one focus in our current research.

Point-of-care screening and diagnostics. Many people with poor access to neurological diagnosis and treatment do not know that their symptoms are neurological, or even medical. These people often have very limited resources for travel. The current systems of care expect people to find their way to specialists for diagnostic tests and treatment. We have developed point-of-care EEG and point-of-care clinical evaluations in communities without specialist care to supplement the primary care healthcare system. Waiting for people to make their way to clinics and hospitals doesn’t effectively reduce the diagnosis gaps and treatment gaps.

What opportunities exist today to better integrate equity into neurologic training and care delivery?

Because academic medical centers today are under increased pressure to generate funding, people with undiagnosed and untreated neurological disorders, who tend to be “unfunded” or “underfunded” are usually not sufficiently represented in our academic medical centers. Therefore, our students and residents often have limited experience with people who have poor access to healthcare. One method to better integrate equity into neurology training and care delivery in the US is to partner with Federally Qualified Health Centers (FQHCs) to provide continuing education for physicians and staff at FQHCs and staff neurology clinics at FQHCs with neurology trainees.