Guerrant leads U.Va.
effort for better worldwide health
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.
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."
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."
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."
some might regard as culture shock, Guerrant saw as an epiphany.
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
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,"
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
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.
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
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
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.
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."
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
continuing population boom in developing countries is a direct
result of poverty, Guerrant says.
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
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."