Face to Face with Invisible Enemies

When a deadly contagion like Zika strikes, dedicated groups of doctors and scientists, including three from Sarah Lawrence, join forces to contain the spread of disease—on the ground, in the lab, against the clock, and out of public view.

Face to Face with Invisible Enemies

“There was a lot of fear, of course, and a lot of misunderstanding.”

In June 2015, Rick Berzon ’76 hopped on the helicopter in Guinea’s capital, Conakry, on his way to the remote city of Forécariah, a four-hour drive over often mud-choked roads, but just 45 minutes by air. Berzon was in the West African nation for three months last year, part of a team assembled by the US Centers for Disease Control and Prevention to confront a two-year-long Ebola epidemic. On the day of the helicopter trip, Berzon and other team members were responding to an outbreak that had killed six in Forécariah. Before the epidemic burned out, more than 11,000 people would die of Ebola in West Africa, the highest toll on record for an Ebola outbreak. At the start, half of all infected people died. Not until this January did the World Health Organization declare all of Africa Ebola free.

Berzon is one of several Sarah Lawrence graduates who have rallied when the world has confronted outbreaks of infectious disease. As a program director for the National Institute on Minority Health and Health Disparities, part of the National Institutes of Health, Berzon has extensive overseas experience, including his previous work as a technical adviser on HIV/AIDS for the US Agency for International Development, traveling regularly in East and South Africa.

Once in Forécariah, Berzon administered a survey he helped create to identify gaps in the public’s understanding of Ebola. “We would talk to people who were not infected just to make sure they knew what the symptoms were and knew exactly what they should do if they became infected, or if they suspected a neighbor or a family member was infected,” he says. It was something he did in several places around the nation, interviewing people in French or with the help of translators where French wasn’t spoken. He was also involved in field epidemiology. When a family member was infected, the task was to identify the sick person’s most recent contacts and then track those contacts.

“We wanted to pinpoint where the infection came from and who else was infected,” Berzon says. “There was a lot of fear, of course, and a lot of misunderstanding.” The farther he and his colleagues ventured from the capital, with its access to radio and television, Berzon says, that fear and misunderstanding grew stronger.

“People were skeptical and didn’t always trust us,” he says. “That’s to be expected. There was misinformation that we were perhaps even bringing the virus with us.”

Face to Face with Invisible EnemiesEbola outbreaks have been recorded in Africa since the 1970s, mostly in the center of the continent. Its initial symptoms—fever, chills, body aches, nausea, and vomiting—resemble malaria, which may have contributed to its rapid spread in West Africa, when people failed to take precautions against spreading infection. As Berzon’s chopper touched down in Forécariah, the city of 12,000 was already quarantined in an attempt to stem the epidemic. No one was permitted to leave or to enter.

For the 13 million citizens of Guinea, travel restrictions were common. In rural areas, military soldiers manned checkpoints where drivers and passengers would be made to wash their hands with bleach or strong soap and have their temperature taken, Berzon says, all part of the attempt to keep the infected from moving from place to place.

His long days going from house to house gave him an intimate look at human anguish. He recalls talking to a woman whose husband was very sick. She was holding their child while several other children stood nearby. “She was very frightened,” Berzon says, “and didn’t really know exactly what this illness was.”

“It ends up being a complete assault on who people are.”

Medical anthropologist Jacklyn Grace Lacey ’10 says the West African outbreak illustrates the political nature of disease and health. At the time the epidemic began, Ebola had been a neglected disease. “Neglect is not a politically neutral thing,” she says. In the more than two dozen Ebola outbreaks that have occurred in Africa since the 1970s, Lacey says, “Most of the people died invisibly and suffered invisibly. Aid was not provided. Accountability was not taken by former colonizing countries.” No one examined the health infrastructure, she says, to determine why countries were “completely underprepared to be able to heal their own people.”

In fact, Lacey says, the West had shaped Africa’s response to infectious outbreaks principally through its strong emphasis on disease containment. “African governments are pressured to construct their public health systems to focus more on surveillance than treatment,” she says. Health care infrastructure—things like physician training—received little attention from the West.

Lacey is a curatorial associate for African and Pacific Ethnology at the American Museum of Natural History in New York City. She oversees the African and Pacific research collections, and she conducts research, frequently looking at infectious disease from a biomedical anthropology standpoint. Her interest in health began in her all-girls Catholic high school, Academy of Notre Dame in Tyngsborough, Massachusetts, where she started a sex health education program in response to her school’s abstinence-only approach. Her interest intensified after high school, during an 18-month stay in Tanzania, where she worked as a health educator and interviewed traditional healers.

Face to Face with Invisible EnemiesWhen she enrolled in college at 20, she talked Drew Cressman (biology) into letting her attend a virology class designed for advanced students. “It is still the best class I ever took. I was completely hooked,” Lacey says. “I keep that textbook in my office. … I knew this was what I wanted to do with my life.”

During the recent Ebola outbreak, Lacey was part of a group that lobbied international aid agencies to include biomedical anthropologists on their field crews. By including professionals keenly attuned to culture, aid groups might ease reaction to an illness that is particularly terrifying to witness, Lacey says. Ebola is a hemorrhagic fever. Left untreated, it causes blood to seep out of the circulatory system and into the tissues, weeping through the skin, mouth, and eyes.

“You already have a heightened sense of fear and paranoia in the community just from witnessing the symptoms,” Lacey says. Then largely white international aid workers come in and introduce practices divorced from the local culture. “You’ve got these people who come in in full-body plastic suits,” Lacey explains, “and you take our sick people away from us, and then we don’t see them again, and you burn their bodies, which doesn’t help them transfer to the afterlife in a way that makes sense to us. And you tell us not to shake hands. Do not touch each other. And then you tell us that when our children are sick to not touch them because then we’ll get sick and die. You know it ends up being a complete assault on who people are.”

Medical anthropologists often can finesse the gap between medical and cultural demands. Because Ebola spreads through contact with blood or other bodily fluids of an infected person, the traditional practice of washing bodies before burial has been a frequent transmission route for the virus. Yet telling people not to wash bodies often induces them to hide the practice, thus increasing risk. In an outbreak in Uganda in 2000, Lacey says, a medical anthropologist brought a stop to new infections through ritual washing of the dead when he gave families protective garments so they could carry out the practice safely.

“We knew all the symptoms, but we didn’t know the cause.”

As essential as work on the ground is in fighting infectious disease, little happens without the work in the laboratory. W. Ian Lipkin ’74, MD, plays a critical role in identifying pathogens, consulting on a stunning variety of outbreaks, both human and animal.

The John Snow Professor of Epidemiology at the Columbia University Mailman School of Public Health, Lipkin consults with Saudi Arabia on MERS (Middle East Respiratory Syndrome). In 2003 the Chinese government flew him to China to manage its response to SARS (Severe Acute Respiratory Syndrome). He and his team identified West Nile Virus as the source of an epidemic that hit New York in 1999 and discovered or characterized more than 800 other infectious agents.

Whenever there’s a pathogen in the news, whether it’s Colony Collapse Disorder in honeybees or Zika virus in Brazil, Lipkin is very likely working behind the scenes in some capacity. His recent publications include characterization of the virus behind a mass die-off of tilapia, identification of the hepatitis virus in the blood supply, and novel bacteria in viruses and ticks in the Northeastern United States.

His interest in infectious disease began when he was a neurology resident at the University of California, San Francisco, at the beginning of the AIDS crisis in the early 1980s. At the time, little was known about the disease beyond the fact that it attacked gay men. “I was the only one who was willing to see these patients,” Lipkin says. “They were quite ill, and most neurologists don’t have a lot of experience taking care of infectious disease. I was concerned by the fact that nobody really knew why they were ill. We knew all the symptoms, but we didn’t know the cause.”

Face to Face with Invisible EnemiesIt would take two years for the human immunodeficiency virus (HIV) to be identified. “There was something wrong with the fact that it took so long to figure out why people were sick,” Lipkin says. “So I decided to go back into the basic science laboratory and learn how to develop methods by which one could rapidly figure out why people were sick.”

He succeeded, developing what he calls “a series of toolkits” that have changed the landscape of diagnosing infectious diseases. With these systems, human fluid and tissue samples can be tested against thousands of genetic fragments simultaneously, leading to the rapid identification of known pathogens or the characterization of new ones.

“It took two years to figure out why people were dying of what we later found to be HIV, and that process has been truncated to 48 hours,” Lipkin says. And today there are far more antiviral drugs available, although the overuse of antibiotics has eroded the power of antibacterials. “I think you can look at the glass as being half empty or half full,” he says. “We have more challenges because the world is a smaller place, and things that are located in the developing world are rapidly moving into the developed world. On the other hand, I think the science is delivering solutions more rapidly than it ever has.”