For its inaugural event, the recently formed MIT Global Health and Medical Humanities Initiative presented “Examining Ebola,” a panel that probed the current global public health emergency from multiple disciplinary perspectives. The gathering, held at MIT on Oct. 28, also encapsulated the goals of the new initiative, which is based in the Anthropology section of the School of Humanities, Arts, and Social Sciences.
“We want to bring together scholars in different fields who don’t normally have a chance to talk to each other,” said Erica Caple James, associate professor of anthropology and director of the Global Health and Medical Humanities Initiative. “With this initiative, we hope to encourage more interdisciplinary collaboration on health matters — teaching together, researching together, and mobilizing the creativity of all five MIT schools, as the Institute continues to develop its future role in improving human health.”
Political, economic, and cultural determinants of health
In a series of planned panels and collaborative events, James says she aims to catalyze a “new kind of conversation” at MIT and beyond. “We want to look at illness and disease from a complex perspective, not simply as a matter of individual physiology,” she says. “This means also thinking through the political, economic, social, and cultural determinants of health.”
The six “Examining Ebola” panelists and moderator James provided a wide range of expertise and perspectives — from reports from the front lines of treatment in West Africa, to the latest laboratory advances in viral genetics and diagnostics, to analysis of the cultural and historical contexts for the current epidemic.
The impact of history
“The epidemic started at a crossroads where three countries meet in a forest region,” explained Adia Benton, assistant professor of anthropology at Brown University. “The history of war and transatlantic slave trade raiding in that region shaped movements of peoples across borders, and also explains some of the hostility that citizens there have toward health workers arriving in the region.”
Benton said such mistrust can grow in the face of “a military medicine intervention,” where there are forceful barriers to movement and when triage and treatment is prioritized according to established social hierarchies.
Referring to allegations that biological agents were used during the 1970s on members of the independence movement in what was then Rhodesia, Clapperton Chakanetsa Mavhunga, associate professor of Science, Technology and Society at MIT, noted that, given that history, it is not surprising that in his home country of Zimbabwe “people are hesitant and suspicious of well-meaning scientific initiatives.” Mavhunga called for “scientific innovation diplomacy” to “lay the proper groundwork” for medical advances that could help arrest the Ebola outbreak.
Biomedical engineer works toward a field test for diagnosis
One such medical innovation potentially headed to West Africa is a new paper diagnostic test for Ebola from the laboratory of Boston University biomedical engineer James J. Collins, who has recently accepted an appointment to the MIT faculty. Collins, a MacArthur Award winner and member of the three national academies, described an Ebola diagnostic technique that resembles a simple pregnancy test: a paper strip changes color in reaction to the presence of microscopic samples of Ebola pathogen. The test requires no refrigeration, and Collins hopes this test, along with an inexpensive device that can transmit results digitally, can move to field testing in the near future.
Questions about the virus
Accurate diagnostics and treatment also depend on gaining more intimate knowledge of the Ebola virus itself, observed Stephen Gire, a research scientist with the Sabeti Lab, affiliated with the Eli and Edyth Broad Institute. The virus replicates so fast that “you literally have billions of viral particles in your body, which take a while to clear out,” Gire said. Researchers have discovered RNA fragments in different bodily fluids months after Ebola is cleared from the system, he continued, and “it’s unknown whether this is actually infected virus.”
Gire’s lab is helping to show “how the virus is changing in real time, and where the mutations fall.” With 10,000 reported cases in West Africa — which, Gire says, might actually “be more likely in the 25,000 range” due to underreporting — many samples of this prolific Ebola virus are available for analysis, revealing to scientists the emergence of different strains in human populations.
The role of government policy and public education
Jeanne Guillemin, a senior advisor in the MIT SHASS Security Studies Program, and an authority on outbreaks of exotic disease said that resolving public health crises like the current Ebola outbreak requires the collaboration of researchers and experts from several realms. As critical as science is, she said, “Science alone rarely has all the answers.” For effective control of dangerous epidemics, she explained, the best medical science must be accompanied by astute government leadership and an informed public.
Guillemin also noted that limitations in political cooperation, legislation, and policy can damage our ability to respond well to health crises. For example, due to partisan politics the U.S. currently lacks a surgeon general to handle the Ebola crisis, including public education.
Although the past century saw dangerous anthrax and smallpox episodes, not enough lessons have been learned, Guillemin said. “We have been here before,” she said. “There is a litany of different outbreaks that more or less look like the one we’re having now.” Guillemin argues that large-scale public health emergencies can lead to policy changes that create long-term, meaningful structural solutions in the healthcare of developing nations, where outbreaks typically originate. “Deploying people to West Africa to help now is wonderful, but it’s a band aid,” she commented.
Transportation, media, and fear, unintended consequences
Yet given the scale of the current emergency, even such provisional aid is essential, said Jarrod Goentzel, the founder and director of the MIT Humanitarian Response Lab. Goentzel, who is engaged in helping move medical supplies to nations ravaged by Ebola, particularly Liberia, noted that “Africans are taking the lead on health care,” and he envisions that this crisis could eventually lead to strengthening health infrastructure in the affected African nations.
Today, however, only three counties in Liberia have diagnostic laboratories, and many hospitals and clinics are closed for lack of adequate protective gear, trained staff, and sanitation workers. Moreover, several factors are thwarting the distribution of vital equipment. Not only are African ports, airports, and roads blocked by the rainy season, but actions in the U.S. are complicating the supply chain as well.
With media coverage fanning fear at home, said Goentzel, “a lot of politicians are taking action, and, as just one example, the state of Ohio recently decided to stockpile protective personal equipment.” Actions like this lead to misallocation of resources, he said, and essential equipment “is not getting into the parts of the world where we have the most cases.”
Out of the silos
In the panelists’ conversation, Erica Caple James found confirmation that scholars from disparate fields have much to offer each other and the public on health issues. As the Global Health and Medical Humanities Initiative gears up, she intends to spark more productive interactions among scholars in the humanities, social sciences, science, and engineering fields.
“Conversations are happening all over MIT around different components of health and health care,” she says. “But they tend to take place in silos, with institutes and departments each focusing on their research specialties,” she said. “We would like to help generate more cross-school collaboration.”
As a medical anthropologist, James traces how illness unfolds in the specific contexts of family, social network, and community, and brings to light “the human experience of health.” She has focused on mental health, and in particular the struggles of Haitians in the face of a series of natural disasters, disease outbreaks, and government-sponsored violence.
Her field of medical and psychiatric anthropology is part of the larger, emerging discipline of “medical humanities,” a vein of study offered in medical schools that attempts, James said, to “provide greater insight into questions of human suffering, illness, and diseases, by situating them in historical and cultural contexts.”
Ethics, literature, the history of medicine, and the arts may all be featured in medical humanities programs. One goal is to give clinicians training in how “to think about a patient beyond being a constellation of symptoms on a checklist.”
James has seen that as medical schools “prepare clinicians of the future to encounter many different kinds of patients,” they are increasingly eager to add “cultural competency” to the portfolio of requirements for their graduates. With this in mind, James envisions an interdisciplinary Health Minor for MIT undergraduates who are pursuing medical and public health careers. In concert with the Institute of Medical Engineering and Science, she aims to help graduates and postdocs in the Harvard-MIT Health Sciences and Technology program who are seeking a global health course of study and research opportunities.
The “Examining Ebola” event was co-sponsored by the MIT Global Health and Medical Health Initiative, MIT SHASS Anthropology, and Prehealth Advising in the MIT Global Education & Career Development Office.
_____________________________________________________________________________Story prepared by MIT SHASS Communications
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Writer: Leda Zimmerman