Guerrant leads U.Va. effort for better worldwide health

By Fariss Samarrai

Stephanie Gross

Dr. Richard Guerrant (seated) with fellows in the Division of Geographic and International Medicine: Circle Alcantara of the Philippines (seated); and (standing, left to right) Gerly Annie de Brito of Brazil, Ping Chen from China, Kai Zu from China, and Patrick Ayeh-Kumi of Ghana.

Health threatened worldwide Tropical infectious diseases pose some of the greatest threats to the world's future, says Dr. Richard Guerrant, chief of the School of Medicine's Division of Geographic and International Medicine. "I call these threats the four Es." They are: • emerging infections, • exploding population without improved health, • economic impact of the diseases of poverty, and • probably most importantly, erosion of humanity and leadership, "if we turn our backs on the health threats facing the Third World."

When Dr. Richard L. Guerrant, a Roanoke native went to work at a mission hospital in the Congo as a U.Va. medical student in 1967, he had never been on an airplane. "What a big world it is," he thought to himself as he flew across the Atlantic. He didn't know that the experience would change his life forever.

"I never recovered from that first trip abroad," says Guerrant, who today is U.Va.'s Thomas H. Hunter Professor of International Medicine and chief of the School of Medicine's Division of Geographic and International Medicine.

"It was in Africa where I first learned that the most important word in medicine is empathy. I saw people living in conditions that humans don't deserve, and I realized that if circumstances were different, that could be me."

What some might regard as culture shock, Guerrant saw as an epiphany.

"I experienced reverse culture shock when I came home," he says. "It hit home for me that the vast majority of people in the world are poor, and that poverty is the greatest disease facing humanity."

Guerrant has since gone on to lead medical exchange programs in several countries in Africa, Asia and South America. He also directs U.Va.'s new Office of International Health, which is establishing international exchange programs in the health fields.

"Good health is an unassailable universal human value," Guerrant contends.

His specialty is tropical medicine -- the treatment of a huge variety of infectious diseases, including cholera, dengue, yellow fever, typhoid, diphtheria and others, that originated in the tropics but can now be found the world over as humans and resources travel fluidly across borders. His research is developing innovative approaches to diagnosing and treating gastrointestinal and parasitic illnesses.

For more than 20 years now, Guerrant and his staff and students have been working primarily in Brazil through a research and clinical collaboration with the Federal University of Ceara. Guerrant's group works in a public hospital for the residents of an impoverished district of Fortaleza, a city of 2 million in northeast Brazil.

One in four children in poor areas of Fortaleza may die before their fifth birthday because of diarrheal illnesses, and the survivors often suffer from numerous infections during their critical developmental years. This has long-term effects on their development and future productivity.

With funding from the National Institutes of Health and three foundations -- Rockefeller (which established the Division of Geographic and International Medicine in 1978), Kellogg and Clark -- U.Va. researchers and others are treating patients and investigating tropical disease processes. They are looking for new therapies, diagnostic tools and vaccines. They also are surveying the longer-term effects of infectious diseases on human development.

More than 100 U.Va. medical students, faculty and fellows have practiced medicine and conducted research in Brazil through Guerrant's program.

More than 60 international fellows and students also have participated in the exchange program. All have returned to their home countries to lead the development of new health programs and centers.

Since coming in contact with so many people in so many countries, Guerrant no longer thinks that the world is so big. It is a shrinking world, he says, because of a rapidly growing population in the Third World, and because of a globalized marketplace.

"Disease and poverty in the developing world are whole-world problems," he says. "Geographical borders cannot contain disease or poverty. We are not living in isolation. What affects our neighbors also affects us."

Guerrant says that because of increasing globalization through trade and travel, emerging diseases are crossing borders into developed nations. "Several diseases, such as malaria and tuberculosis, which had been brought under control, have re-emerged," he says. "This is due to greater exposure and an over-reliance on antibiotics."

The continuing population boom in developing countries is a direct result of poverty, Guerrant says.

"Infant and youth mortality is very high in poor countries. Families respond by having many more children than they can afford. Some of this is because of religious and cultural reasons. But we know that population growth rates drop when there is low infant mortality. That is one more reason for improving basic health in developing countries."

"If we, the citizens of the developed world, fail to respond to the poverty across our borders," he says, "then our loss of basic humanity will eventually endanger us as well. The new millennium will present many challenges to the future of humanity, and improved health worldwide is our best hope for our future."