Re-engineering A River
The schistosomiasis parasite, according to Tufts' David Gute is "a corkscrew-shaped little beast” that afflicts a third of the children in the gold-mining community of Kwabeng, Ghana. For Gute and a group of students and colleagues, their mission over the past nearly two years has been to tame that beast. Their weapon of choice? Engineering. According to Gute, schistosomiasis needs three things to survive: water, humans and snails. Since you can't take the people out of the river ("It's 100 degrees in Ghana—kids are always going to swim in the river, and rivers have a very complex pattern of utility in African culture"), Gute and his team of faculty, graduate and undergraduate students are trying to take the snails out of the river. The problem-solving process, Gute says, is "a link to history." In the 1920s and 1930s, engineers "had concretely identified a relationship between the velocity of water and snail distribution." (Simply put, snails don't like fast-moving water.) So when a mining operation in Kwabeng diverted and slowed down the river, its snail population—and its schistosomiasis population—skyrocketed. The team’s goal, according to Gute, is to design a civil infrastructure that would speed up the water flow. Gute believes that this engineering-based, pre-infection intervention is more effective than post-infection drug treatments, which don't provide any immunity and allow for frequent re-infection. "It's a wonderful case example of where, if engineering reasserted itself as the source of primary prevention, we would see greater progress being made in the control of this disease." They began their work nearly three years ago when fellow Associate Professor of Civil and Environmental Engineering John Durant visited Kwabeng at the urging of a friend who thought the conditions there were ideal for studying the intersection of engineering and public health.
In February 2004, Durant and Gute took six undergraduates to Ghana to collect data and investigate the outbreak as part of the capstone course for civil and environmental engineering majors. "What we are attempting to do is have the engineers use their engineering skills in prevention-oriented interventions," says Gute. Finding A Solution Last summer, Charline Han—currently an engineering graduate student who had been part of the first capstone course—traveled back to Kwabeng to conduct an epidemiological survey on how the villagers interacted with the river, trying to find what Gute calls "hotspots of infection" along the main river, the Awusu, and surrounding streams. This past January, seven undergraduates and three graduate students—including a student from Tufts School of Medicine who studied engineering as an undergraduate—accompanied Gute, Durant and Associate Professor of Public Health and Family Medicine Jeffrey Griffiths on a return trip to the African nation to start working on a solution. "It's a very intense learning for them to be in a very new country and culture for two weeks," says Gute, whose work in Ghana is funded in part by a three-year International Project Fund grant from the University College of Citizenship and Public Service. "I think it's an environment in which this work can happen and in which both the professors and the students feel at ease." Nate Hudepohl, an MD/MPH student from Tufts School of Medicine who was one of the students who traveled to Ghana this January, coordinated the effort to survey Kwabeng's schoolchildren to identify those who were infected. He says that thanks to that effort, 60 children received treatment from Ghanaian health officials. "The main attraction to this type of project is the opportunity to work on an interesting problem with rewarding results," explains Hudepohl. "The effort of the principal investigators to involve students in the project provides easy access to international work that would be very difficult to find in most programs."  A child on a road in Ghana. Some of the possibilities for a solution in Kwabeng, according to Gute, are developing new optimal well designs to reduce reliance on infected streams, crafting more accurate maps of area structures, making infrastructure recommendations and creating an educational program for residents. Another, more significant change could be to change the rivers back to the way they were before the gold mining industry moved in. 'An Interdisciplinary Lens' Gute's group, known as The Kwabeng Project, is also coordinating with efforts led by Associate Professor of Political Science Pearl Robinson, director of the Africa and the New World program, who is studying the historical and economical importance of gold mining in Ghana. "The goal is to study gold through an interdisciplinary lens," says Gute, whose team wrote a letter of support for Robinson's project as she successfully sought university funding. "One of the outcomes that we would love to be able to see would be a triple win that would allow the mining company to operate in a way that would be environmentally friendly, for the central treasury in Ghana to still receive revenue and income from mining and to have local people employed by the mine, and," continues Gute, "then the third would be to have people no longer in an environment that is creating health problems."
The link between engineering and disease prevention wasn't always so buried. In fact, during the nineteenth century, he says, "engineering and public health were so intertwined that you could not separate one from the other. It largely has to do, I think, with the types of things that engineers were responsible for—clean, potable water; transportation systems; better housing; better means of communication." While advances in medicine have been a real boon to the realm of public health, Gute says that the value of engineering cannot be underestimated. "In the twentieth century, public health came more and more under the sway of medical approaches. Drug therapies replaced a real conviction about primary prevention," he contends. "A lot of what engineers are doing is saying, 'Let's not allow the pathogen in the water in the first place,' as opposed to treating the people who eventually drink the water and get sick." Despite the more difficult effort required in primary prevention, Gute says that attacking at the source is key. "The heavy lifting of public health really is about changing people's behavior and empowering them to wellness," he says. And Gute says that making more room for engineering within the "overmedicalized" realm of public health could make that heavy lifting easier—even on a global scale. "Some of what we see in global public health problems can be much more effectively addressed by bringing them together," he says. "Making that intersecting set between engineering and public health bigger and more complete is the way to go." Profile written by Patrice Taddonio, Class of 2006 Patrice Taddonio, a native of Holland, Pennsylvania, is an English major and a communications and media studies minor. Currently editor-in-chief of the Tufts Daily, she interned with the Improper Bostonian magazine during her sophomore year and worked as a temporary text editor with the Associated Press at the July 2004 Democratic National Convention. A songwriter, Taddonio has also performed on guitar and vocals at on-campus venues and at Boston-area benefits. Additional reporting by Georgiana Cohen Photo of Gute by Melody Ko, University Photographer. Ghana photos courtesy of the Kwabeng Project. This story originally ran on Mar. 27, 2006. |
Related Story
'Going Upstream to the Problem'By blending epidemiology and engineering, Tufts' David Gute is working to solve public health problems at home and around the world.
 "I think we're building a critical mass at Tufts such that we could really shine a light on understanding the role of water in general in health." — David Gute |
|
|
Applying engineering principles to primary disease prevention can help bolster public health efforts, says Tufts' David Gute.