December 15, 2018

Dr. Justin Zaghi: An ounce of prevention

When Justin Zaghi learned as a senior in college that a type of birth defect was much more prevalent in Nicaragua than in the United States, he wanted to know why. He also wanted to know what he could do about it. 

Those questions led him on a journey that continues today, to help reduce the incidence of preventable birth defects in Nicaragua and beyond.

Zaghi’s mission originated in 2008 at UCLA, where he saw a poster advertising Project Nicaragua, an effort to deliver medical supplies for children who have spina bifida. This birth defect involves failure of the bones of the spine to form normally, which causes damage to the brain, spine or spinal cord. Severe cases can cause serious health problems, including fluid on the brain, bladder and bowel issues and lower body paralysis. 

“I was a neuroscience major and Spanish minor, so I thought this would be a good way to combine my interests,” said Zaghi, 29, who is finishing his third and final year of residency in internal medicine at UCLA (and whose sister, Sara, also made this year’s Mensch list).

After he learned that spina bifida is five times more common in Nicaragua than in the United States, he and a friend formed a research group of seven undergraduates who met weekly to investigate the issue. They discovered the problem resulted from a deficiency in B vitamin folic acid, which can reduce the incidence of neural tube defects by up to 80 percent when taken before and during pregnancy, 

Zaghi, who grew up in Tarzana and attends Valley Beth Shalom, realized that fortifying a staple food with folic acid — as is done in the U.S. with breads, cereals and other grain products — could provide a solution. He contacted Dr. Antonio Largaespada, the former director of nutrition for Nicaragua’s Ministry of Health, learned that rice was the third-most commonly consumed food in that country and proposed that rice be fortified with folic acid.

The director convened a meeting with Zaghi, the current minister of health and other health leaders in the summer of 2009. Within two months, the Ministry of Health issued a national resolution requiring fortification of rice with folic acid and other vitamins. 

“It was invigorating to think that our work could contribute to such an important public health intervention,” said Zaghi, who credits the Jewish concept of tikkun olam for motivating his activism. “Whenever you try to help other people, you gain more than you give.”

 He soon found that implementation of the resolution would take more effort and many more years. There were logistical and other challenges, including getting the required technology to the smaller rice mills and providing financial resources to develop and execute the program. 

While pursuing a joint MD/MBA at Harvard, Zaghi recruited fellow student Barbara Trejos to join the effort, and the two traveled to Nicaragua to learn how to accelerate the process. They also applied for and received two grants, one for $250,000 from Saving Lives at Birth and a similar amount from Grand Challenges Canada. The funds will be used to help the Ministry of Health implement the measure, work with vitamin providers and rice vendors, and create a social marketing campaign to promote purchasing and consuming fortified rice.

Zaghi hopes to expand the program throughout Central America and ultimately to Asia. He already has done some outreach in Vietnam. 

Zaghi — co-founder of the Born Well Project (, which advocates for the prevention of neural tube defects through food fortification — said his work in this area “is probably the most transformative experience” of his life. 

“I realized that while taking care of patients one-on-one is very rewarding … understanding the bigger picture around health and affecting change on a systems level can … help hundreds, thousands or even millions of people at a time.”