By Erin M. Crews 09C 09G
Nikada (Vetta)Sunset in Rio de Janeiro
Evan GoldbergAn Emory delegation led by then-Provost Earl Lewis (second from left) met with Assero Rodrigues da Silva (fourth from left) of FASEH, including Uriel Kitron (center), Dabney Evans (fourth from right), and Juan Leon (third from right).
Courtesy of Parmi SuchdevLaura Doerr 10M (center) with pediatrician Flávio Capanema (far right), several medical students, and pediatric patients in one of Vespasiano’s public health clinics.
Parmi SuchdevEmory pediatrics resident Joanne Garde works alongside Brazilian medical students testing a child for anemia in Vespasiano, Brazil.
Lilian Perez 10PHA FASEH medical student walks with a community health worker to a household interview in Minas Gerais.
Amina Khawja 11PHFASEH medical students prepare to conduct household surveys to assess children’s nutritional status in Vespasiano.
Josafá Barreto has spent two years examining some 4,500 residents of Brazil’s Amazon region for signs of an ancient disease now unfamiliar to most of the world: leprosy. Though 15 million people worldwide have been cured in the last two decades, leprosy still plagues a handful of countries, hitting India and Brazil particularly hard.
Why does a disease that has been virtually eradicated in recent years persist in the Amazon?
“It’s not an easy question,” says Barreto, a doctoral student in the Federal University of Pará’s tropical diseases program. “Especially in these areas, people do not have access to health centers.”
Barreto intends to change that.
Beyond soccer and samba
Barreto is studying spatial analysis and disease ecology at Emory for six months through a grant from the Brazilian government, part of the country’s ambitious Science Without Borders program. During the next two years, Brazil will send 100,000 students and scholars around the world to conduct research in fields ranging from aerospace technology to biomedicine.
“Brazil is really doing a lot of stuff right,” says Uriel Kitron, chair of the Department of Environmental Studies and Barreto’s advisor at Emory. “They are investing a lot in infrastructure, in technology, in science, energy.”
Kitron was part of an Emory delegation led by former Provost Earl Lewis to Brazil last spring.
“We went on that trip to explore the possibilities for collaborations and interactions in Brazil,” says Dabney Evans, executive director of the Institute of Human Rights and a faculty member in the Hubert Department of Global Health. “We were thinking about that in terms of the university’s mission, in terms of research, teaching, and service.”
Participants in the Science Without Borders program, known as “sandwich students,” play a role in the collaborations that Evans envisions. But she and Kitron are co-chairing a series of faculty seminars this spring called “Brazil, a Growing Global Force: Beyond Soccer and Samba” that they hope will lead to deeper ties between Emory and institutions in Brazil. This Academic Learning Community, cosponsored by the Center for Faculty Development and Excellence and the Claus M. Halle Institute for Global Learning, grew out of the faculty members’ experiences on the provost’s delegation last year.
After visiting patients in eight cities in the state of Pará, collecting blood work, performing laboratory tests, and mapping residences, Barreto had mountains of data—and few tools to make sense of it. But he knew about Kitron’s work using geographical information systems (GIS) and spatial analysis to contain outbreaks of a number of diseases.
Kitron had never studied leprosy, however, and is wary of accepting students he has not met. Barreto cold-emailed Kitron to present his case.
“I didn’t realize how big a problem it [leprosy] still is,” Kitron says. “They had some ecological questions about the distribution of leprosy and they needed some tools they did not have. Usually I don’t accept students without meeting them, but all the Brazil projects happened together—I just felt like it was meant to be.”
Barreto arrived at Emory in August with a stipend from the Brazilian government, enrolling in a GIS course and studying informally under Kitron.
“The idea is to detect clusters of disease in the city, looking at past data, and then focus attention to that area, because it’s transmitted from person to person,” Barreto says. When he examined students in Brazilian schools, his team found that 4 percent of students had leprosy without their knowledge. “Sometimes they do not recognize a single lesion as an important disease. But without treatment, it can evolve to a class of deformity that you find histories of in the Bible.”
“Before coming here I had just a general idea of GIS and knew nothing about spatial analysis. And I found here a structure that was necessary to learn. I see him [Kitron] like a hub, a center of distribution who connects people. It makes a difference.”
Thanks to the sandwich studies program, Barreto expects to return to Pará with his data fully analyzed, at least one paper in the works, and a new wealth of international experience.
“I’m lucky to be in this stage in my life exactly at this moment,” he says.
The Science Without Borders program is certainly opening doors, but Brazilian students have been coming to Emory for years.
Land of immigrants
Jeff Lesser’s research methods are, shall we say, unconventional.
When he heard there was an open casting call for Gaijin 2, the sequel to the 1980 Brazilian film about Japanese immigration to Brazil—“gaijin” means “foreigner” in Japanese—he showed up to stake out his place in line. Never mind that the director was looking for 18-25-year-old Japanese Brazilians.
“Two really interesting things happened,” says Lesser, the Samuel Candler Dobbs Professor of History and chair of Emory’s history department. “Not surprisingly, nobody thought I was 18 to 25 years old”—he’s now 52—“and nobody thought I was Brazilian.”
“What made it worthwhile was that at some point when I finally fessed up that I wasn’t, many of them started saying, ‘Oh, I’m really relieved to hear that you’re not Japanese Brazilian. I’m not Japanese Brazilian either. I’m Korean,’ or ‘I’m Chinese.’ In the United States, the idea of a Korean American pretending to be a Chinese American often creates a lot of tension. It’s seen as a kind of betrayal. And in Brazil it’s being done in this very kind of normalized way.”
Lesser recounts this story in his office as he prepares to travel to Brazil for the fourth time in a semester, ahead of the publication of his new book about ethnicity, immigration, and national identity. He has made a career of studying the construction of national identity, and his work on immigration is well known in Brazil.
At the casting call, the producer eventually approached Lesser to let him know he would not be auditioning. “I didn’t even know what I would do, right, if I made it,” Lesser remembers, laughing. “But when I told him who I was, he said, ‘Oh, Jeffrey Lesser! We read your previous book in preparation for this movie. Why don’t you come and spend the day with us as we do the casting call?’ It ended up being this really amazing research experience.”
Lesser’s research experiences are often made possible by his strong personal network in Brazil, which he attributes to fluency in Portuguese—often an obstacle for American scholars.
“One of the terrific advantages of being so deeply linked to Brazil is incredible access,” says Lesser, who lived in Brazil as a young man and has 20-year-old Brazilian-American twins. Access could mean “chatting up the archivist to get them to show you things” or the ability to conduct oral histories. “That’s the only way you would even come to know that there’s a quiet casting call going on, and then going there and being able to work it out. That’s how we understand Brazil.”
Since Lesser arrived in 2000, Emory’s Latin American history program has attracted students from around the world. Oxford University’s master’s program in Latin American Studies regularly sends Brazilianists across the pond to study at Emory.
“We have students from England, Israel, Brazil,” Lesser says. “I have students from Brazil who come to work with me, to study Brazil.”
Food vs. fuel
The history department is still strengthening its Latin America focus, recently bringing labor and environmental historian Tom Rogers on board. Rogers, assistant professor of modern Latin American history, is studying what he calls the “stunning explosion in production” of ethanol in Brazil.
The story begins in the wake of the 1973 oil crisis, when the price of oil in Brazil quadrupled just as the Brazilian military government was attempting to industrialize the country rapidly. Sugarcane ethanol soon became an attractive alternative fuel. By 1986, a decade after the program began, three-quarters of cars sold in Brazil were powered only by ethanol.
Sugarcane agriculture was largely concentrated in Pernambuco, one of Brazil’s first sugar colonies. It was also the site of the two largest strikes of rural workers in Brazilian history.
“There were communist and church-related labor organizers out there talking to the workers and everything, and that is a big part of the story,” Rogers says. “But also the workers were reacting to processes of expansion and intensification of agriculture and the effects that had on them.”
Oil prices dropped in the 1980s, leading the government to shutter the ethanol program in 1990, though ethanol was still used in a mix with gasoline. It wasn’t until 2001, amidst fluctuations in the petroleum market and new government incentives, that ethanol production began surging again. Today, the heart of sugarcane production is in the state of São Paulo, and virtually all cars in Brazil are flex engine.
“How does a military government execute this program versus a sort of left-leaning but ultimately quite capitalist-oriented modern government in the 2000s?” Rogers asks. “But I’m also interested in the environmental angle. When you ramp up your production of ethanol from something quite low in the early ’70s to something that’s on the order of 3,000 percent more within a decade, that takes a lot of sugarcane!”
One of his major concerns is whether using agricultural land for biofuels supplants food, an issue shorthanded as the “food vs. fuel” debate.
“Sugarcane workers are among the most nutritionally underserved populations in the country. And it’s not a coincidence.” Rogers concedes that there are other factors at play, but says that biofuel production is also displacing food in a fairly straightforward way.
“At the same time that you’re replacing food crops, the expansion of sugarcane fields is also replacing a whole bunch of other stuff: forests, savannah lands, grasslands, which have a higher degree of biodiversity than a simple monocrop of cane stretching forever,” Rogers says.
What makes Rogers’ work unique is that he tackles these issues from a historical perspective. He worked for an environmental organization, the Southern Appalachian Forest Coalition, before attending graduate school, and had been a biology and history double-major in college. His current work is a marriage of his enduring interests in both labor and environmental history.
Rogers will return to Brazil next year to conduct interviews with sugarcane producers. “There’s so much connection in global agriculture and energy policy, and that’s what my project really is: both. And so both of these two things that lie at the center of my work—agriculture and energy—are deeply, profoundly global.”
Bridging two worlds
Five years ago, Juan Leon was looking for a project to study Brazil’s health care system when he met Jose Ferreira, a microbiology professor at Faculdade da Saúde e Ecologia Humana (FASEH) in Vespasiano, Brazil. Ferreira had approached Emory’s Rollins School of Public Health about a collaboration with FASEH’s medical school and the Vespasiano secretariat of health.
“FASEH is very connected to the city’s health system, and they have been one of the pioneers in the country of Brazil in starting its new health system,” says Leon, an assistant professor in the Hubert Department of Global Health.
Brazil’s health system has changed dramatically since 1996. “In the United States, when you get sick, you go to the doctor and they take care of you. In Brazil, you have teams of health professionals coming to your house every month to take care of you. So the focus is more on prevention rather than treatment,” explains Leon, a native Peruvian who spent several years living in Brazil in the 1980s. “We thought this would be a great model to learn from, not only for the United States but for other countries.”
Leon secured funding from Emory’s Global Health Institute to send two students to FASEH in the summer of 2009 to evaluate diarrhea treatment and satisfaction with Brazil’s health system. Ferreira would serve as their on-site mentor.
Lilian Perez 10PH was one of the first students to travel to FASEH. Perez worked in 11 clinics in Vespasiano and interviewed patients and health professionals over 10 weeks. She and Katie Mues 10PH were paired with two students each from FASEH’s medical school, who helped translate health surveys into Portuguese. They sampled households, collected data from mothers and children about their diarrhea status, and interviewed health professionals about their satisfaction with the health delivery model.
Perez was impressed with the health teams, but one of her major findings was that community health workers were not receiving adequate training. “This came not only from the health workers themselves, but also from the nurses,” Perez says.
Perez and Mues involved the secretariat of health when making recommendations about areas needing improvement. Since then, the secretariat has allocated more resources for training, set up transportation systems in difficult-to-access regions, and disseminated more health promotion materials to the wider community. FASEH has also begun sending medical students to Atlanta to complete rotations with Emory’s School of Medicine.
“Then Parmi’s story comes into the picture,” Leon says.
Parminder Suchdev, who splits his time between Emory’s School of Medicine and the Centers for Disease Control and Prevention (CDC), has been friends with Leon since the two met at Northwestern a decade ago while earning their MPH degrees. He arrived at Emory in 2007 as an assistant professor of pediatrics.
“It was surprising to me when I came to Emory that we didn’t even have a global health track in pediatrics. It seemed obvious,” Suchdev says. A year later, he had formed a curriculum series. By 2010 pediatrics had begun a formalized global health track.
Suchdev is driven in part by the conviction that working in low-income settings makes for better doctors. “You shouldn’t really leave [residency] as a doctor not knowing that a lot of kids still die of diarrhea in the world.”
The global health track in pediatrics established two domestic field sites—“We think local health is global health,” Suchdev says—at the International Community School in Clarkston and at a refugee screening clinic in DeKalb County. Residents could gain international field experience in Ethiopia. But Suchdev was hoping to establish another international field site in Brazil.
“Gaining experience in Minas Gerais”—the Brazilian state where FASEH is located—“would allow our residents to focus on public health implementation, assessing infant and child primary care, researching in the community, and practicing medicine in poor-resource settings, thereby honing their clinical skills,” Suchdev says. “There would also be opportunities to manage infectious disease pathology that we are not used to seeing, such as leishmaniasis and dengue.”
He was also drawn to FASEH because it offered an opportunity for the medical school to partner with public health faculty and students. “To me, it’s all about bridging the worlds of clinical medicine and public health,” he says.
The Department of Pediatrics will send its first resident to FASEH this summer, who will work directly with public health students on a nutritional supplement study. In the meantime, Laura Doerr 10M, who is completing her residency in pediatrics without formally participating in the global health track, recently spent four weeks in Brazil to pilot the program.
“For a country with a large income disparity, they are committed to finding novel yet inexpensive ways of improving the treatment of common medical conditions,” Doerr says.
“There’s pretty good evidence out there that having global health tracks or experiences in residency changes your career direction into dealing with underserved populations,” Suchdev says. “You’re more likely to get an MPH; you’re more likely to work in rural America; you’re more likely to work in an urban city.”
For those residents, and the university as a whole, Suchdev says, “I hope this will be a piece of a larger puzzle.”
Participants in the Academic Learning Community are working to piece together that puzzle. Rogers, the labor and environmental historian, hopes that faculty and graduate students will “come out of the spring having developed the kinds of relationships and having recognized the kinds of overlaps in intellectual interests that produce synergy.”
“Brazil has a really developed system of higher education, and there’s tons of energy,” he says. “They have enormous political will to make things better. They’re sending 100,000 PhD students around the world, and that kind of thing is just one register of what’s happening in higher education. If we want to be an internationalized institution with a global reach, then that’s a natural place to be.”
Evans, the human rights and global health specialist, would like to see the development of a network of scholars working in Brazil, both from Emory and other Atlanta institutions like the CDC and CARE.
“Brazil is a growing economy and is going to be a major player on the world scene,” she continues. “It seems like Emory should have a place in the conversation. The timing is right.”
Erin Crews 09C 09G is editor of Emory in the World.