good health of world’s poor
This is the ultimate goal of U.Va.’s Center
for Global Health
Photos by Fariss Samarrai
Because addresses are marked inconsistently in the poorest
areas of Fortaleza, Brazil, where Dr. Richard Guerrant
conducts much of his research on sick children, his research
team often uses satellite maps to find children’s
right: Guerrant and nurse Sayonara Sadio Bezerra de
visit the home of a child in their study.
left: These are some of the children and health care
in Guerrant’s study.
By Fariss Samarrai
Richard Guerrant, director of the Center
for Global Health,
can see a child
in Brazil and infer with little more than a glance whether
or not that child was repeatedly sick
with diarrhea as an infant and toddler.
can he tell?
Because chronic diarrhea can stunt growth, making a child
of seven years about 8 percent smaller than peers
who were not routinely sick as very young children.
He knows this because he has been treating and conducting research on sick
children in Brazil and other developing countries for more than 25 years.
long-term studies are showing that the debilitating
effects of childhood diarrhea are long
lasting. His recent findings show that
a person frequently
afflicted with diarrhea as a child may also wind up with an IQ deficiency
of up to 10 points. This is the equivalent of losing an
entire school year, and can have a lingering effect on overall productivity
for the individual as a citizen, and on the whole society.
work on solutions for the problems of poverty in
the Third World, the Center for Global
researchers and physicians from developing countries to U.Va., and sends
U.Va. students around the world for study and research on those problems.
Throughout the years, Guerrant has brought 65
fellows from developing countries in
South American, Africa and Asia to study
and conduct research in international
health programs at U.Va. All of these fellows have returned to their
countries to continue their work, reversing the “brain drain” that often typifies
such programs. More than 150 U.Va. students from across disciplines also have
traveled to Third World countries to work on health problems and issues under
This year, the Ellison Medical Foundation committed
$810,000 to the center to support these
international exchange projects and
research on the diseases of the poor. The grant also is funding interdisciplinary
courses and an annual symposium on international health. The University
is providing matching funds to the three-year grant.
show that three out of four children in the poorest
areas of Brazil suffer
repeating bouts of debilitating diarrhea during their first two years — the
same period when the children’s minds and bodies are undergoing
the most rapid and crucial development
period of their lives. Some of these children do not survive these “chronic,
smoldering, terrible gut infections,” but for the ones who do, they will
likely live with the negative effects throughout their lives, Guerrant said.
people in the developed world may not think this
matters very much. But when disease takes a slice
of life and intellect out of a segment of society,
it ultimately affects us all,” Guerrant said.
Many of the poor children in Brazil and throughout
the Third World will be sick up to half
of each month and will lose up to 10
A sick child can be orally rehydrated with a sugar-water-and-salt
concentration, but with each evacuation of the bowels, important
flushed away rather than absorbed into the body.
and his international team of colleagues, particularly
Dr. Aldo Lima, director
of the Institute for Biomedicine at the
have developed a host of new vitamin-enhanced medicines. They
are hoping to repair damage to the
intestines caused by diarrhea and improve absorption of essential
micro-nutrients with the new medicines. If the treatments succeed,
and clinical trials are promising, these children may grow
develop normally despite their repeated exposure to disease.
Timko, a U.Va. professor of biology and colleague
is looking for ways to genetically engineer essential
nutrients into widely consumed Third World foods, such as
bananas and cow peas. If this cutting-edge research succeeds,
vitamins simply by consuming their everyday foods.
Additional research is
being conducted by Reinaldo Oriá, a pharmacologist
who recently earned his Ph.D. at the Federal University of
Ceará while serving
a two-year fellowship at U.Va. Oriá is
putting together the puzzle that may someday explain which
micronutrients are most important for normal brain development,
and the best ways to deliver them.
He hopes his
answers will lead to new medicines that will put sick kids
on track for a healthier and more productive life.
In recent years, Brazil’s
poor neighborhoods have seen improvements. Just
over a decade ago, 70 percent of the people in the slums
of Fortaleza, the city where Guerrant conducts
much of his research, had no sewer systems or chlorinated
water. Today, 70 percent have sewers and
cleaner water. As a result, the infant mortality rate has
dropped from 8 percent to 2.5 percent – from 80 children dying at birth per 1,000 to 25. This
is still considerably higher than the 6.8 deaths per 1,000 live births in the
United States, but well below the 35 deaths per 1,000 for all of Brazil. These
improvements occurred under the leadership of Anastácio de Queiroz Sousa,
a former fellow at U.Va. who served as the secretary of health for Ceará,
the city where Fortaleza is.
Guerrant’s next dream is to form an international
network of global health centers modeled on the work done
at U.Va. This would link universities in the
United States with colleagues worldwide, sharing people
and resources, in an effort to make good the health of
To learn more about Richard Guerrant’s work in Brazil, see the Winter 2004
issue of the University of Virginia Alumni News magazine, to be published Nov.