Malaria Research Resources
Interview with KEMRI's Dr. Andrew Githeko
This is Dr. Andrew Githteko's story as told to Julia Royall, NLM project director, when she visited the site in January 2001.
Andrew Githeko, PhD, is a senior scientist at a remote Kenyan Medical Research Institute (KEMRI) research site. For 20 years, he has struggled with the isolation of working in the field along with his colleagues from KEMRI, WRAIR, and CDC, who has invested heavily in the site.
In July of 1999, the site, just outside of Kisumu in Kenya, received full Internet connectivity and 24-7 access to the Web as part of NLM's malaria research network created in partnership with the Multilateral Initiative on Malaria. Now Dr. Githeko and his colleagues at the site are now connected to the world. They can send and receive information from anywhere, but more importantly, they can now share their research.
The Kenya Medical Research Institute (KEMRI) was established in 1979 under the Science and Technology (Amendment) Act of that year to represent the national body responsible for carrying out health science research in Kenya. Prior to the establishment of KEMRI, health research in Kenya was conducted under the auspices of the East African Medical Research Council which had been established in 1957 to serve the countries of the East African Community. Following the break-up of the East African Community in 1977, the Kenyan Parliament passed the Science and Technology Act in 1977 and amended it in 1979 to provide for the establishment of research institutes. Under this act, the Kenya Medical Research Institute was charged with the responsibility of carrying out health research, and its mandates under the act.
Kisian, January 22, 2001
Revised to include Dr. Githeko's comments March 14, 2001
Julia Royall: That looks great. Do you want to talk about how all you used to do things before you had VSAT? I remember you had a computer in here that was really not connected to anything or anybody.
Andrew Githeko: Yes. My computer was connected because we had a network that goes to the main computer center. We had one computer to handle all the E-mail. This was an open system. We had to dial out hoping that the telephone wire was working and most of the time it did work. We couldn't send big documents, couldn't go into the Internet, use the library, the system was very slow, and anybody could read anybody's mail. It was a system that depended on honesty and integrity. But it worked, we appreciated it.
We didn't have a dream that we would have a direct satellite system at Kisian. We had seen these things in Europe and in the US, but we had no clue that it would ever, ever arrive at this site. When it finally arrived here it was pure magic. I mean I could log on to the National Library of Medicine in the US, I could log on to the World Bank, WHO sites and UNICEF. It was so fast, so reliable. We could download huge files, send huge files. I mean I was connected, totally connected.
JR: Tell me a little bit about your research. I remember you talking a lot about your interesting ideas about weather and malaria and also you spoke really well about malaria. Your knowing about malaria because you had malaria or your wife had it.
JR: And your feeling of isolation. Now I understand that you are the second person to call when the system goes down. Kevin DeCock the Director is first and you are second. What do you do on the Web?
AG: Well, let me tell you... My agenda has expanded tremendously. For one thing, people in Europe and the US discovered that they could get in touch with me. They are interested in people who are sitting in endemic areas. Their frustration was how to get in touch with us. They knew our quantity, they knew our quality, but how do you keep in touch? That was impossible. So finally the system was in place, they could talk to me any time and ask questions, ask opinions, ask me to write papers. Several times I am asked to write what is called position papers for various organizations. Now a position paper may require something in the order of sixty references, forty references. We had about 3-4 weeks to write it - very short time. I would have to get to the library very quickly and review all kinds of information very fast and shuttle the document up and down to different people to get it edited, and get it accepted. This can only happen with this system.
JR: Tell me about how you go about it.
AG: OK. For instance, I have a title now. I've just been appointed by WHO to become a temporary advisor for the climate and health meeting in Canada. They say we shall pay for expenses but you have to come and give us a presentation on this title. So immediately I need to know what has been written or what information is available about this issue. So I have my knowledge as an expert, but I need to know the latest information and who has done what and summarize that into a document. Then convert it to a presentation to present. What I'll do in the first place is visit the National Library of Medicine and check all the abstracts. For instance we picked a subject on climate and vector borne diseases. So I'll seek climate and vector borne diseases. And I'll get 100 references. I go through that, I filter what I want then I cut and paste some documents straight into my document, edit it and make the whole story. Within a week or so I have a draft, and I can assure you it is a draft of very very high standards, acceptable by their standards.
We use the same system to write books. For instance, this is a book we have just written. I was in charge of one of the sections. I never left my office. I got all the information from the Internet from WHO sites, NLM and UNICEF sites and the World Bank sites. I never left my office. The book is published. It is high quality work. It is being used by Governments to make policy. So this facility is fantastic. It has huge implications because we can utilize our expertise and our knowledge to the fullest. We are no longer handicapped. You come fully trained from the best universities in the world and if you don't have this tool, your knowledge is basically useless. Now you can disseminate your knowledge, you can take your knowledge and synthesize it and convert into a product that is useful for someone else. So it's just fantastic.
JR: Now tell me about some of your...I understand you also use NASA and NOAA databases a lot.
AG: Yes, very often I am made to. For instance last year I was invited to advise the Magreb States - this is north Africa, Tunisia, Algeria, Morocco and Libya. They needed to know what is the future, what is the risk of vector borne diseases in their region. So I went into the library and checked and there was very little published. The only work that focused on these areas was to go to the IRI Web site, the International Research Institute for Climate Prediction. I downloaded the data for the whole of Africa and checked where anomalies existed and these are anomalies that would be consistent with endemic diseases like malaria, like meningitis. We were able to just move around Africa , southern part, eastern part, west Africa and north Africa and check the temperatures and check the precipitation and say here we are likely to see an increase in malaria, here we are not likely to see an increase in meningitis or schistosomiasis simply by seeing if there are permissive climatic conditions. There's no way, there's no other way of doing this, it's only through the Internet and again I'm sitting right there playing with buttons, accessing this and that and doing the computations and then flying off to Tunisia and making the presentation. And they loved it.
JR: That's a great story. Andrew, if you could just...I'm going to put this down for a moment. (Gap) I'm so proud of what you are doing. It just really moves me a lot. You must be getting a lot of respect from people in other parts of the world.
AG: Yes, I recently talked to my ex-professor and he couldn't believe what I was doing. It was totally beyond his expectations. Because he trained many Africans who go back to their countries, good old traditional stories, mail gets lost, can't get a reprint, can't do this, can't do that. Now I am functioning as well as anyone in the US and Europe regarding communications.
We are a part. We manage projects, some set in Maryland, some set in UK. We forward mail to each other, we plan and agree and disagree. We run projects in Africa. We are a part. We can discuss plans. It is not one man writing a letter, giving instructions. There is a difference here. Sometimes they agree or disagree. It's a completely different way of communicating.
The beauty is in this system there is a new etiquette with how you communicate. You don't show anger, don't show aggression in E-mails because it is not polite. So people stick to this etiquette of professionalism and respect. It is a very good relationship.
JR: Tell me about how you relate to Europeans now. In the past you might have been someone who was trained who went back to Africa. They didn't know how you were doing. What is it like now?
AG: Oh, now? In two minutes they can find out how I am doing. It's so simple. They are very happy to know what's happening to me. They are very happy to know that I am doing well. Because these folks are very nice people. They go out of their way to train us Africans. It's rather sad that we normally vanish after all this investment but it is not going to happen. Because of this connectivity it's possible to bring more resources in. People know you are OK. People know you are connected. People know what facilities you have. If they find that you are connected they are quite comfortable to work with you.
If someone sitting in Tulane knows that he can talk to you every day using E-mail and then give you a feedback, then he feels more comfortable working with you. He is more likely to bring in more resources, grants, products.
JR: And you are more like colleagues, this is the collegial model.
AG: This is the best part of it. They no longer look at you as an inaccessible scientist. That gets finished the minute you start communicating at the same speed, at the same rate. They forget very fast.
JR: I forget where we stopped. Oh well, it doesn't matter.
AG: Yes it was. You know in life, basically to make a decision, you need information. The decision is as good as the quality of information you have. If one person has better access to information than you have, then they are more likely to dominate the decision making. This is a well known theory. So if you are underprivileged as far as information is concerned, then you'll always feel inferior to those whom you think or perceive to have better access to information. So formerly we always felt, you know, almost inferior to our foreign colleagues because we thought they were coming from where they are up to date with information, therefore we could not discuss with them. All we need now is common experiences. They tell us who has published work. This and this can happen. In fact they seemed to know more about what is happening in our countries than we did.
Now that is being sorted out by this system. Because I can access any library, I can access any data. I know who is doing what, the latest information, so I can make a decision based on scientific results. And when I discuss with my colleagues I'll say we are at par because I have the same access to information as they have. So we have the same situation. That brings about better respect, better relationships among ourselves. It's more respectful. They also respect us because they know that we are up to date. We are not left behind. So they feel more comfortable discussing science. It has really improved the relationship between ourselves and our colleagues in the west, in the US, Japan and Europe.
My only problem right now is that we are really not communicating among ourselves in Africa.
JR: OK, talk some about that.
AG: Traffic I can assure you is between Africa and the west, and one of the driving forces behind this is funding. One of the reasons we communicate with the US and Europe is that subject of funding. All the agencies are in the west. All our collaborators are in the west. So that tends to be the way we communicate. We never bounce ideas among our colleagues in Africa first because we are not in touch, this system is just coming up. And even more so we don't tend to know our colleagues very well in Africa. Then the question is what shall we discuss between ourselves? Is it science, is it funding, is it personal experiences? We have to find grounds for discussions. Shall we discuss common problems, joint research. This is an area that is very weak at the moment. We need to address the kinds of communications among Africans.
JR: A colleague of yours is going to come by this afternoon. He's at a site that is not connected yet. He's an African researcher, from west Africa. What kinds of things will you say to him, in fact if he comes, we'll even get you two talking. I know he's a colleague and a collaborator. When he's on the system, what will it be like?
AG: I will tell you about this colleague. Actually he is desperate to get on this kind of system. Because those folks down there quite often have to consult with us. We are older here, we've worked with vectors and parasites for much longer than they have. They know that we have some expertise. And actually they've been driving here over weekends to have discussions with us.
JR: Now Andrew, I've taken some video of that road. It's unbelievable.
AG: You can imagine. They drive here. We go to the town and sit the whole afternoon and discuss some different problems. Now we could have been talking on a daily basis through this system if they had one of their own.
I have another scientist, she was working down there, she needed some assistance. She tried E-mail, the server broke down, whatever happened. She again had to drive. Or wait until she got to Nairobi to send me a good E-mail, and they are just round the corner. Now that's a group we have been working very closely with. We are beginning to understand a basis for communication. It's a very funny system that I think is very new among Africans.
JR: Although I feel Africans have so many communications systems already. There is the textiles and the communication that's woven into textiles, there's the drums and the communicatons that that says. You have all these traditional methods of communication. What makes this one different, or how might you make it different?
AG: This is because you know culturally Africans have had some problems talking technically. We rarely talk technical matters ourselves.
JR: Because that wouldn't be polite in your culture.
AG: It's impolite it would be so alien to most people, so it doesn't happen. Now this allows professionals to talk very fast, very quietly, very silently without being seen to. You can reveal your most inner feelings, or your fears, inabilities, or whatever through a very private way.
JR: And it doesn't violate your culture of...
AG: Exactly, absolutely. I could still go out and start doing a traditional dance and throw myself around, like a true son of Africa. But when I get to my office, I am a professional. Asking questions about atoms, electrons, molecules and enzymes. Which is almost taboo outside of this office. It doesn't mean anything to anybody. But I can discuss that with my colleagues at Mbita and not feel guilty about it.
You see these are traditional values that are not very clear. You will talk to many people here and they will talk in a very convoluted way about science. You can go to the US and talk in technical jabber. There was a man from Colombia and he talked to me for hours until he discovered I probably knew more than he did, then he calmed down and started talking straight. In the US you have a scientific culture. It's not taboo to talk science. It is not taboo to talk science at lunch time or dinner time. In Africa we haven't reached there yet, not yet. Still very private and very personal communication.
JR. So E-mail to colleagues, whether they're here or in other places, is a way to maintain your traditional culture and still integrate the new tool. Tell me if you could meet with Luis and the other folks involved with that project. Someone in Tanzania, right? I'm trying to think, is Ethiopia involved?
JR: No, Tanzania, Kenya and Malawi.
AG: VSAT system?
JR: There are people at those other sites that you would want to talk to, right? What would you say if you wrote Yeya Toure?
AG: For instance, I want to write to Yeya and say Yeya what is your latest publication? A while back, I was talking to Yeya and he was working on vectors in a river system. We were very surprised that we were just beginning to observe that in a river system in Kenya. It's so different from what we see in our cases.
So I would like to write to Yeya and say, send me your paper about this and that. There are all kinds of other things.Yeya let me know what are your latest findings with regard to mosquitoes, parasites. Because we each have a couple of papers that aren't published yet. Then there are things like training, what is your training schedule? Have opportunities to talk to west Africa and see what they are doing. There are some things to discuss - the trouble is that we need funding, external funding to effect all these changes.
JR: Let's get to that. But first let's go back for just a minute to Luis. When you talk to Luis, could you tell me more about the project that you are working on, that you all collaborate together on?
AG: Luis is working on a NIH funded project, and he has run into some difficulties, technical problems. There was no-one in this country to discuss his problems. He went to many places. He even had some former experiences with this kind of project. So he approached me and said can I come and discuss this problem? I said sure, you can come up for a weekend and we can discuss this. After some discussions I proposed the source of his problem. I said that we need to do a little search and see if this is true. Actually I found 5 published papers.
AG: Already. Saying exactly what I said. So I said Luis, this is your problem. You see, he couldn't do this at Mbita. I can do it here. He has no Internet, or it is just so slow.
So within five minutes I was able to scan the library, get abstracts and we fixed the problem.Two things. One, using my former experience I was able to research these problems and propose a solution based on what I thought the problem was. Then I needed to confirm that this was the problem. The only way to confirm this was to go to the library and check. It takes 5 minutes. He went home a very, very happy man because he had spent a long time without results and he is an expert.
JR: Yes, he's a senior scientist out there.
AG: Yes, he's a senior scientist. He'd just missed something very small, he didn't think it mattered. It is very important to have these tools.
AG: With the E-mail system, first of all, you can cut out this bureaucracy and ways of controlling information flow. There are no filters you don't have to write letters through the Director or through some administrator, someone who will filter what you are trying to say. You can write to anyone straight up to White House, to Bill Gates, to director of NIH, to whoever you think is going to listen to you. In most cases if you keep your E-mail short and to the point I can assure you these people will respond, or their offices will respond.
So, it is fantastic because it removes those old barriers which were about controlling information, because information is power. Those who control information control the systems so if you break those barriers, you can access resources. More so you have much better access to information, which you can use for policy formulation or designing projects or gathering data, presenting findings, packaging it whether for policy makers in our country or somewhere else. It's so good.
JR: Andrew, can you give me an example of a specific piece of information that you've discovered because of this system that enabled you to do something differently? You've talked about it generally but something very specific like something about climate change that you saw in a database or whatever.
AG: OK, for instance perhaps, one of the discoveries I made started on the Internet. Just by going to the IRI databases and doing some very basic and straightforward analysis, I was able to observe that in some parts of Africa, we have very huge anomalies in maximum temperatures. In fact this was happening in east Africa where we have had malaria epidemics.
I wondered what the relationship was between these anomalies and malaria epidemics. Then I went to the local hospitals and looked for hospital data. I also approached the Meteorological Department and collected historical data. I then put it together and we discovered before any epidemics these epidemics are actually preceded by some huge anomalies in maximum temperatures. We can explain what those temperatures are doing to the mosquitoes and to the parasites so that it ends up being an epidemic.
Now, having worked that out, we were very able to construct a model to predict malaria epidemics. We can now predict an epidemic with this system four months before it happens. We are now trying to tell the Ministry of Health and use the system to plan logistics, drug delivery and vector interventions. We are no longer guessing. Now we have a system that uses scientific facts to predict the system. Before we were just guessing and we had no idea what was going to happen.
At times they took huge resources to areas where they expected to be an epidemic and for some bizarre reasons which we now understand, the epidemic didn't come. At other times they say well if it happened last year, might not happen this year and bang it would happen and we would be caught unaware. But now we have a system and we're trying to encouraging them to accept it. It takes a bit of time for them to believe us. We are still talking but it will happen. Again it all started by having access to a few databases to play around with and see what's going on. Then we were able to test that idea on the ground and fortunately we found it works and actually it has an application. This is a very very useful tool for us to have.
JR: If they know an epidemic is coming and when it is coming what kinds of...would they make sure people had more bed nets or try to treat some people with a prophylactic. How would that work?
AG: First you know the statistics are that 60-70% of all malaria cases are treated at home. So what we want to do is to go on the radio and describe the symptoms to people. Tell them if you have a headache, if you have joint ache, bad stomach, this and that, please go to your Doctor very quickly, do not delay. So the first thing is the information is broadcast through newspaper, radio, television telling people it's coming. Should you get these symptoms, do not delay, do not go to a witch doctor, do not take herbal medicine, go to your clinic and get treated.
Secondly we want to make sure that we have enough stocks of the right drugs in Government hospitals to treat severe cases. Because of course there are mild cases presenting mild symptoms and there are those who don't get to hospitals in time, who have severe malaria, who need to be admitted into hospitals, so we need huge stocks of medicines. So these cases they increase 10 fold in hospitals. Hospitals built for 300 people suddenly you will be having 1000 people per day. So we need these kinds of preparations.
Then we've also through our research shown that you don't have to spray everywhere. We are very specific where we spray in the highlands. This disease is very focal.
Next thing we want to do is large scale mapping, probably using satellites to show the kinds of places where this disease is focalized. So we can show when to preempt malaria by vector control.
If you live in such and such a place you must do certain things - you must sleep under a bed net. It's like you must wear trousers, you can't go around without trousers.
So these are the kinds of things we must do. Once we forecast the epidemic and know for sure it's going to happen, these are the steps that must be taken.
JR: OK it's on again.
AG: Hello, my name is Andrew Githeko. I am a scientist working for the Kenya Medical Research Institute at a station in western Kenya called the vector control and research station. I have worked here for the last 20 years on malaria and mosquitoes. Now we have programs on climate and human health. The center has grown over the years. We have increased our work capacities and more recently our communication and computing capacities and having access to the Internet.
Julia is here today to talk to me about this, I'm sure she will be telling you the rest of the story.
AG: Here look at this.
JR: Can you read that to me?
AG: This is coming from Adam.
JR: Glazer. Sure! He's a tip top reference librarian at the NLM.
AG: I believe it. I wrote to him Friday. I needed the full list of the authors of this article. And Monday morning, today, I got the full reference. Adam tells me Andrew, please try to visit your local library to see if you can get the full articles to see if this the sort of thing you want. Do you know what my reply was to him? I said, Adam, believe it or not, my nearest library is the National Library of Medicine.