When Tufts veterinarians Gretchen Kaufman (left) and Christine Jost went to Nepal to educate people about disease prevention, they learned a few lessons of their own.
On an ordinary day in the United States, rabies fails to enter most people's minds. With only one or two human deaths recorded due to rabies each year because of quick, effective and readily available treatment, the disease is thought of more as a condition afflicting only the occasional wild raccoon or bat.
For residents of Nepal, however, the threat of rabies is a daily concern. An extremely dense population of stray dogs serves as an active reservoir for the disease, which is transmitted to humans via animals. In a country less than a tenth the size of the U.S., more than 100 Nepalese lose their lives each year to rabies.
But two veterinarians from Tufts' Cummings School of Veterinary Medicine are working to change that, by teaming with community leaders and health organizations in Nepal to educate people about disease prevention and help fight the spread of rabies and other zoonotic diseases.
"Nepal is one of the many developing countries that are really challenged by rabies and have insufficient resources to really get a hold of it in the way that we have in the U.S.,” explains Gretchen Kaufman (A'76, V'86), who, along with Christine Jost (V'96, F'03), has spearheaded the efforts in Nepal's Chitwan District in conjunction with their colleagues at Nepal's veterinary school, the Institute of Agriculture and Animal Science (IAAS) at Tribhuvan University.
When they first met in 1994, Jost was a student in Kaufman's avian disease course. They didn’t begin working together until six years later, when Jost joined the international program at the Cummings School as a faculty member while pursuing a master’s degree in international environmental policy at The Fletcher School.
When Kaufman was contacted by the Humane Society International to assist with rabies control efforts near Nepal’s capital city of Kathmandu, she immediately thought of her former student.
“At that point, even though I was her senior as a faculty member, [Christine] was more experienced internationally, and so I went to her for help,” explains Kaufman.
For Kaufman, who has taught at Tufts since 1989, the attachment to Nepal is more than academic – she traveled there with her sister after receiving her undergraduate degree from Tufts in 1976, and the experience stuck with her.
"These things are serendipitous," she says. "I wanted to go back and be able to re-experience the country and do something meaningful there."
"Veterinary medicine is becoming more and more technical, and I worry that veterinarians are becoming less and less aware of their social power to transform communities," says Christine Jost.
Treating rabies poses unique challenges. Doctors have no simple test to determine whether or not a person has contracted the disease, and by the time a victim shows symptoms, it is usually too late for treatment. Providing preventative vaccination to exposed individuals creates a strain on resources that many cash-strapped countries are unable to withstand.
Seeking to address this resource imbalance, Jost and Kaufman traveled to Kathmandu in 2001 and organized a rabies workshop for public health officials. After teaming up with the Nepalese government and the IAAS (Nepal’s veterinary school), the two Tufts veterinarians began working in the Chitwan District, a sparsely populated region about a half-day’s drive from Kathmandu.
The region is home to the IAAS, which partnered with Jost and Kaufman to build a training program for Nepalese veterinary students in spaying and neutering procedures, increasing the school’s capacity to address rabies in the future in a way that would be acceptable to citizens of the world’s only official Hindu state.
“To control rabies, you have to control the dog population, and to control the dog population, you can't kill them in a Buddhist or Hindu society," says Jost. "You have to have other methods of control, and surgical sterilization is a very appropriate method, but if you don't know how to do it, you can't do it."
The Nepalese faculty and students travel to nearby farm communities in the foothills of the Himalayas, where they hold vaccination clinics, distribute information about spay and neuter options, and tap the local communities for feedback and assistance in the effort. Back at the school, they target stray dogs for the surgical training procedures and plan to earn money by performing the operations on owned dogs.
“The beauty of this project is the involvement of Tufts students with IAAS veterinary students and the exchange of their knowledge while working together in the community,” says Dr. Ishwari Dhakal, the campus chief at the IAAS.
Despite the promising collaboration, their work is far from finished. "This effort is still in its infancy," says Kaufman. "We would like to see ongoing participation by the community in identifying and transporting stray dogs, organizing vaccination clinics, record keeping and building awareness efforts.”
Food For Thought
As the rabies project unfolded, prospects for addressing other health issues in the area emerged. Jost jumped at the chance to get involved.
"We realized that there was a bigger opportunity to really have an impact, and it was a geographic area that many of us were interested in," she says. "Conservation and development, the future of wildlife, and the future of young people, and the [Nepalese] veterinary school -- it was all there."
The focus turned to the health of the community's livestock, which has broad implications for human health in terms of food-borne illnesses. Once again, Jost tackled the issue by harnessing the community’s organizational power. She connected with Heifer International, an NGO that boasted strong social mobilization capabilities and an established presence in the Chitwan District.
"The way [Heifer] works is to begin educational programs that bring women together in communities, and then it's the women that decide what they want to do, that begin their own self-help projects," Jost explains.
With help from the Nepalese veterinary school, Jost built on the Heifer infrastructure by organizing clinics at local farms, teaming Tufts and Nepalese veterinary students to screen livestock for tuberculosis, salmonella and brucellosis, talking to local women about livestock livelihoods, and spreading information about livestock management practices to limit the spread of food-borne illnesses. Lessons learned from this work were integrated into the social mobilization curriculum at the IAAS.
The key to that social mobilization is found in Nepal's women, who constitute the linchpins of subsistence farm families despite being subordinate by other measures of Nepalese culture.
“They grow, harvest and process, and they make most primary household decisions related to diet and nutrition,” Jost says. “So in terms of increasing the safety of livestock-derived food being produced and consumed in Chitwan, it was logical to start with women.”
Jost was impressed by the women’s capacity for organizing the community and spreading educational information. "I wish that I had the capacity for change that these women had," she remarks. "We had the benefit of linking a public health message to that process of social mobilization."
Firming Up The Future
The two Tufts veterinarians plan to continue their work in Nepal, establishing ties, where possible, between their projects in the hope that the groups involved will collaborate to address future problems.
“[We are] trying to get the community to own part of that control, and to accept some of the responsibility and participate in the program with [the IAAS],” says Kaufman. “We’re trying to link all these networks, all these things that we’re working on in various projects, so that it’s sort of one big community health program.”
They are embracing the residents of the Chitwan District as a valuable resource in their future plans. "Veterinary medicine is becoming more and more technical, and I worry that veterinarians are becoming less and less aware of their social power to transform communities as they focus on the sophistication of the medicine they can bring to bear in dealing with illness," remarks Jost.
And it’s a mutually beneficial relationship. As Jost and Kaufman work to share practical methods of disease prevention, they are enlightened by the persistence that people of Nepal exhibit on a day-to-day basis.
"The thing that always amazes me is that they're constantly plodding forward, despite the obstacles that are thrown in front of them," reflects Kaufman. "The government is overthrown, and they don't just throw everything down in despair and say 'Oh my God, we can't move forward.' They know they have to keep moving forward. This is what their life is about. That's always very profound for me—you just keep moving ahead, and things do eventually get done."
Profile written by Jessica McConnell, Class of 2006.
Jessica McConnell, a native of Hillsborough, NC, is a political science major and a communications and media studies minor. She wrote for the features section of The Tufts Daily throughout the spring of 2005, and worked last fall at the National Guardian Newspaper as an exchange student in Ghana, West Africa. This fall, Jessica played for the Tufts Women's Ultimate Frisbee team.
Kaufman photo by Melody Ko, University Photographer. Nepal photos courtesy of Gretchen Kaufman.
The story originally ran on Nov. 28, 2005.