From supercomputers to village healers: Health research takes scientists far afield

David Hosansky | 27 April 2011 • Andrew Monaghan used to spend his time analyzing mathematical models of climate change in Antarctica, working on some of the world’s most powerful supercomputers. Now the NCAR scientist sits down with traditional healers in remote villages in Uganda, a world so far removed from supercomputers that there is often no electricity or piped water. During a recent visit, a local healer told Monaghan and other colleagues on a multidisciplinary project team studying bubonic plague that spirits had foretold their coming.

“It’s definitely culture shock,” Monaghan says.

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Sylvano Alipacum, a traditional Ugandan healer in the settlement of Gulaju near the village of Zeu. He often sees plague-like symptoms in other residents. (Photo by Andrew Monaghan, NCAR.)

Such is the life of a researcher trying to connect the often abstract realm of science with pressing human needs. To better understand the atmosphere, NCAR researchers work primarily with computer simulations and a host of observing tools ranging from radars to spectrometers. But to decipher how the atmosphere can affect human health—a growing area of interest—and to communicate those findings to societies at risk, they sometimes need to travel from village to village in some of the most remote areas of the world.

In Bangladesh, for example, NCAR researchers and their collaborators rely on a network of local organizations to distribute flood forecasts to far-flung villages that lack radios and televisions. In Ghana, they use portable ozone samplers to measure the pollutants that residents inhale as they cook over open fires. In Mexico, they survey backyards and alleys for open containers of water to track the likely spread of mosquito-borne dengue fever.

And in Uganda, Monaghan works with NCAR colleague Mary Hayden, a medical anthropologist who brings together researchers from several disciplines—including climate scientists, entomologists, medical professionals, and anthropologists—to study the impacts of climate and weather on disease. The team visited villages in the remote northwest part of the country earlier this year to help 10 traditional healers and witch doctors recognize the symptoms of bubonic plague. The Uganda project, funded by the U.S. Centers for Disease Control, aims to determine causes of plague outbreaks and reduce the disease’s toll.

The village healers rely on ancient treatments, such as herbs, animal parts, and incantations. But what plague victims need are antibiotics, and they need them fast. The disease turns deadly if left untreated for more than about 48 hours. On average, hundreds of Ugandans die from it each year.

The traditional healers are open to learning new methods and welcomed the team. They learned how to recognize telltale plague symptoms, including fever, chills, and buboes—enlarged lymph nodes in the neck, groin, and armpits.

Although the villages lack running water and reliable electricity, they generally have good cell phone coverage. So the scientists gave the healers cell phones that were preprogrammed with numbers for the nearest health clinics. (Most villages have portable generators that can be used to charge the cell phones.)

The researchers also delivered bicycles so villagers could ride the rough dirt roads to a clinic as quickly as possible and return with the antibiotics.

The healers then got certificates identifying them as graduates of the course about plague. “They were very excited,” Monaghan said. “They felt empowered and kind of legitimized.”

Connecting the dots: weather, climate, and disease

While it may seem unlikely for atmospheric scientists to be involved in efforts to fight plague, the Uganda program is part of a larger set of NCAR initiatives that seek to use weather and climate forecasting to better combat the spread of disease. Hayden spearheads the program.

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NCAR scientists Mary Hayden (left) and Andrew Monaghan (right) with Robert Okello, a clinician in the village of Zeu in Uganda. Okello is qualified to test for plague and treat patients with antibiotics. (Photo coutresy Andrew Monaghan, NCAR.)

Her team focuses on diseases that are linked to changes in weather and climate. In Ghana, for example, meningitis is most prevalent in the dry season, but the exact reason remains unclear. By using long-range weather forecasts, NCAR scientists working with the World Health Organization and other groups can try to better direct medical programs, concentrating immunization efforts in villages that are in the grip of dry and dusty weather.

In Mexico, as the climate warms, mosquitoes that carry dengue are expected to spread northward as well as to higher-altitude locations. This may place tens of millions of additional people in Mexico and the United States at risk for the disease.  Because the dengue-carrying mosquito only breeds in urban areas, a key challenge is understanding how human behavior and infrastructure influence mosquito populations in combination with climate.  Even if climate change eventually creates favorable conditions for the dengue mosquito's survival in new areas, societal factors—such as the amount of time people spend outdoors, whether they use screens in their homes, and whether they have reliable access to piped water and municipal trash collection—may hinder the mosquito's survival in new areas, or its ability to transmit dengue to humans.

Plague, which is carried by fleas on rats, tends to be associated with rainy weather. Monaghan is using computer models and observations to build a database of climate conditions in Uganda that may enable medical professionals to anticipate plague outbreaks in villages. His colleagues at the U.S. Centers for Disease Control and Prevention are using the climate database to model the extent of plague in Uganda and its year-to-year fluctuations. Early findings suggest that rainfall and temperature fluctuations that occur several months in advance of plague outbreaks are the key drivers. The researchers are now trying to understand why this happens, which may help them develop more effective intervention measures. 

The project has its share of challenges. Monaghan talks of meeting malnourished children with distended stomachs and walking into homes lacking any doors or windows to keep out rats.

“We have to keep building on the basic research, but we also need to focus on people,” he says. “The end point of this type of research is the benefit to society and helping to keep people healthy.”

 

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These simulations, created with the NCAR-based Weather Research and Forecasting Model, show the 10-year average of near-surface temperature and annual rainfall in plague-stricken areas. Such information can help researchers better anticipate when plague outbreaks are likely to occur. (Computer simulation images by Andrew Monaghan, NCAR.)