Upping the Orange

Sherry Tanumihardjo is a CALS professor of nutritional sciences and director of the Undergraduate Certificate in Global Health, a popular new program that draws participants from majors all across campus. She has almost three decades of experience working with vitamin A, and her research team has conducted studies in the United States, Indonesia, South Africa, Ghana, Burkina Faso and Zambia. Tanumihardjo has acted as a consultant to many studies throughout the world to assist with study design and appropriate standardization. She is a strong advocate for the promotion of nutritionally enhanced staple foods, vegetables and fruits to enhance overall health and well-being.

Describe your work with orange vegetables.
I have worked for a number of years on carrots of many colors as well as on orange-flesh sweet potato and, more recently, orange maize. Basically we are trying to improve the vitamin A status of individuals by having them consume more orange fruits and vegetables in general.

Can you give us an idea of how you go about doing that?
For many years I have worked with carrot breeder Phil Simon in the Department of Horticulture. He was breeding carrots for more orange color. We did a series of studies in both an animal model and in humans, trying to look at the uptake and distribution of the carotenoids that give the vegetables their orange color—and the vitamin A that is made from the carotenoids. Then we moved on to orange vegetables in humans in Africa. I have worked with orange-flesh sweet potato in South Africa and with orange maize in Zambia.

Can you describe the connection between the color and the nutritional value?
There are three well-known precursors of vitamin A that are called pro-vitamin A carotenoids. Those are beta-cryptoxanthin, alpha-carotene and beta-carotene. Many of you may have heard of beta-carotene because it is one of the compounds found in many over-the-counter supplements. But those are also the compounds that give carrots and orange maize their bright orange color.

What happens if there is not enough vitamin A in the diet?
The most drastic thing that can happen is death. So we go around trying to get people to improve their vitamin A intake not only to prevent death—there are many steps before that happens, and one of them is blindness. Vitamin A is extremely important in vision and it also helps us ward off disease, so it’s a very important vitamin.

How did you get started in Africa?
It actually started very slowly. I used to be a consultant and I would fly back and forth to different countries to help them look at study design. The sweet potato study was funded by the International Potato Center. I helped them design the study, they did the school implementation—a feeding study—and then I helped them get the work published. My work with orange maize started in 2004 in collaboration with HarvestPlus, a project managed by the International Food Policy Research Institute. We started working with animal models and then progressed to full-fledged feeding trials, the latest of which we finished in 2012.

What were some of the challenges in your work in Africa?
The challenge is that feeding trials, if they’re going to show what we call efficacy, have to be highly controlled. So that means you have to keep the children for long periods of time and feed them all of the foods—and the foods need to be the same across the group except your test food. So in South Africa we fed orange-flesh sweet potato to half the children and white-flesh sweet potato to the other half. And then when we moved on to orange maize we did two studies. One study was similar to the sweet potato study where we fed white maize and orange maize. And then we did a second study where we had three groups, which got a little more complicated. We had white maize, orange maize and then white maize with a vitamin A supplement.

Another challenge is that all of the human work that I do involves blood—so we have to take blood from these children. Vitamin A in the human body is stored in the liver, and we use indirect markers of liver reserves of vitamin A that you can pick up from the blood.

Looking down the road what kind of goals do you have for your research?
We would like for people to have optimal health by having a diet that has not only all the nutrients you need but also some of the potential compounds that gear us toward optimal health. So it’s not just about fighting blindness anymore, but to see if we can get people into a new nutritional state where they are actually able to ward off diseases such as cancer.

What kind of progress have you made?
We have had significant progress with sweet potato. Most people in Africa used to eat white sweet potato, not the orange sweet potato we eat here in the United States. Many countries in Africa have now adapted the vines to be orange-flesh sweet potatoes. We think that’s a success story. Regarding orange maize, there are three lines of orange maize that have been released by the Zambian government. Currently orange maize is available to consumers. Right now it’s at a premium price, but hopefully with time the price will come down to the level of white maize.

How did you get interested in this line of work?
It chose me. It wasn’t something that I was looking for, but I was working with vitamin A and if you’re working with vitamin A and status assessment, it’s going to draw you to the countries that may have a history of vitamin A deficiency.

Can you talk a little more about the international nutritional programming you’ve been involved in?
Most of the work that I’ve done is to support biochemical labs. We have not done a lot of nutrition education on the ground, although that is a goal of mine, especially in Zambia. We have discovered that Zambians actually have really good sources of vitamin A in their daily diets, so we want to help them continue to eat the fruits and vegetables that are good sources of those phytonutrients and vitamins and minerals.

The other thing that I work on is isotope methods, which sounds a little scary!

What are isotope methods and what do they do?
We work with a compound called 13C. Typical carbon in the human body is 12C and radioactive carbon is 14C. We are working with the form of carbon that constitutes 1 percent of the human body. It’s perfectly safe to use, but it also has allowed me to work with the International Atomic Energy Agency. That’s the same agency that oversees radioactive bombs in different countries, so it’s kind of interesting that they have something called Atoms for Peace. And they actually received the Nobel Peace Prize one year based on the safe use of isotopes in nutrition.

I have worked in several countries trying to help them understand isotope methods and to apply isotope methods at the population level to inform public health policy. It’s a very technical method, but it can answer questions of public health significance.

So it’s a research tool. And what kinds of questions does it answer?
It is the most sensitive marker of liver reserves of vitamin A. Basically what we do is we give a dose of vitamin A that has a slightly higher amount of 13C than what’s found naturally in the environment, and then we can follow the uptake and the clearance of that 13C in the human body. And from that we can calculate total body stores of vitamin A—how much is in the whole body.

To conclude here, there’s an interesting story about your office and a more recent career development of yours—serving as director of the Undergraduate Certificate in Global Health, a program you helped develop and launch in 2011.
Yes. The Nutritional Sciences Building was originally a children’s hospital, and this particular office that I sit in sat idle for many, many years, used only for small committee meetings and things like that. When we received funding for the Undergraduate Certificate in Global Health, I looked in this office again and realized that it now fits my purpose. Originally it was the viewing room for children who had died from a variety of diseases, and the parents would sit in this room and mourn their lost child. I decided that this room fit my new mantra at the university, which is to empower undergrads, to mobilize them, to try to change the world. And while I’m sure we won’t have 100 percent participation, we’ve already had about 1,000 students go through the program.

Field Notes: South Africa

In the fertile, rolling hills of the Eastern Cape province of South Africa, it’s hard to imagine a food shortage. But hunger is a serious threat there, espe- cially for children. The area also has high levels of poverty and HIV infection.

Researchers at the CALS-based Center for Integrated Agricultural Systems (CIAS) are teaming with local groups to try to improve those condi- tions. Together they have formed the Livelihood, Agroecology, Nutrition and Development project— LAND for short—to address the region’s complex, interrelated problems.

“Using a participatory approach, we have built strong ties with local villagers and their co-op, the Ncedisizwe Co-op, which means ‘helping the nation,’” says CIAS director Michael Bell, a professor of community and environmental sociology.  The Ncedisizwe Co-op encompasses 800 small- holder farmers in 26 villages.

Other local partners include the Indwe Trust, an NGO focusing on sustainable development, and Kidlinks World, a Madison-based charity dedicated to AIDS orphans and other vulnerable children.

The group’s goals are to provide sustainable livelihoods for smallholder farmers and their com- munities; to integrate health and nutrition with sus- tainable agricultural practices; to enhance ecosystem services such as crane habitat, erosion control and carbon sequestration; and to strengthen communi- ties through participatory decision-making.

Better use of grasslands will be key in those efforts, researchers say. “The people of this region are blessed with a wealth of grassland resources, but these resources are literally being eroded before their very eyes,” says agronomy professor Randy Jackson, who accompanied the LAND team on a recent visit. “Much of this is attributable to a governance system that treats most rangelands as unregulated commons, resulting in continuous grazing that promotes unde- sirable plants and exposure of bare ground.”

Rotational grazing, the group notes—which actually originated in Africa—will potentially double the level of animal production while also building soil quality, reducing erosion and promoting wildlife habitat. LAND has conducted workshops with farmers on rota- tional grazing and helped develop a supply chain connecting local grass-based meat to national and international markets.

Other activities have included helping form a women’s cooperative for vegetable production, working with community members on improving water supplies, and helping establish perennial home gardens to increase the quality and variety of local diets.

The LAND project has matured to the point where it can serve as the basis of a new global health certificate field course, “The Agroecology of Health,” that debuted this past winter. Bell and doctoral student Valerie Stull brought 10 undergraduate and two graduate students to the Eastern Cape for a 15-day visit that encompassed learning about agroecology and hydrology systems and working with community members to establish a one-acre vegetable garden at a school in the village of Kumanzimdaka.

The students planted herbs, tomatoes, onions, peppers, cabbage and radishes and plotted locations for future fruit trees.

“The experience left me feeling a tremendous amount of respect for the people in the community who continue to live off and use the land,” says Alexa Statz, a junior in life sciences communication. “I have high hopes that the garden we built together will be something that can stay with them for generations to come.”

Bell plans to continue having undergraduates participate. Learning about themselves and their place in the world, questioning and thinking critically were all objec- tives of the trip. “But the biggest objective was to provide students with the chance to discover what it means to lead a life of consequence,” Bell says. “Now that’s a pretty grand goal—and I think it happened in South Africa. It clicked.”

Creating a Healthier World

YOU CAN’T SPOT THEM RIGHT AWAY—they’re hidden in plain sight, often disguised as majors in the life sciences—but there are thousands of undergraduates on the University of Wisconsin–Madison campus who, in terms of their future careers, consider themselves “pre-health.”

What are their reasons? For some students, the motivation is acutely personal. As a child, Kevin Cleary BS’13 (biology) felt an urgent need to help as he watched his father deal with recurrent brain tumors. “By age 11, I knew I had a future in health care,” says Cleary. Many others aren’t yet sure what role they will play, but they are eager for guidance on how to use their majors to address an array of global problems including hunger, disease, poverty and environmental degradation. Says senior biochemistry major Yuli Chen, “I want to make an impact on people, and I believe that every person has the right to be provided basic necessities such as clean water, education and food.”

For much of the past century, young people seeking to address health-related suffering may have felt relatively limited in their options. Most considered medical school (still the gold standard to many), nursing school or other familiar allied health occupations that are largely oriented toward addressing disease after it occurs.

In recent years, however, health experts worldwide have placed an increasing emphasis on the importance of prevention in achieving health for the largest possible number of people. This was illustrated at UW–Madison in 2005, when the University of Wisconsin Medical School changed its name to the School of Medicine and Public Health, offering the following reason: “Public health focuses on health promotion and disease prevention at the level of populations, while medicine focuses on individual care, with an emphasis on the diagnosis and treatment of disease. Ideally these approaches should be seamlessly integrated in practice, education and research.”

The founding in 2011 of the interdisciplinary Global Health Institute (GHI), a partnership of schools, colleges and other units across campus, broadened the university’s approach to health still further:

“We view the health of individuals and populations through a holistic context of healthy places upon which public health depends—from neighborhoods and national policies to the state of the global environment. This approach requires collaboration from across the entire campus to address health care, food security and sustainable agriculture, water and sanitation, environmental sustainability, and ‘one health’ perspectives that integrate the health of humans, animals and the environment.”

Demand by UW students for educational options built around this broad concept of health had been growing for some time. Before the creation of the GHI, an Undergraduate Certificate in Global Health was introduced to offer students an understanding of public health in a global context. The certificate explores global health issues and possible solutions—and shows students how their own majors and intended professions might make those solutions reality. Although administered from CALS and directed by CALS nutritional sciences professor Sherry Tanumihardjo, the certificate accepts students from across campus and highlights ways in which teachers, engineers, farmers, social workers, journalists, nutritionists, policy makers, and most other professions can play a role in global health. Funding is provided through the Madison Initiative for Undergraduates, grants and private donations.

Earning the certificate requires completion of core courses focusing heavily on agriculture and nutrition, the importance of prevention and population-level approaches in public health, and the role of the environment in health. Students also complete relevant electives (examples: women’s health and human rights, environmental health, international development), and—most transformative for students—a field course, usually a one- to three-week trip either abroad or to a location in the United States where a particular global health issue is being addressed by one or more local partner organizations in ways specific to the place and the people who live there.

Expanding the Global Classroom

A LITTLE MORE than two years ago I started cold-calling CALS faculty and instructional staff requesting no more than 25 minutes of their time. The first thing I asked the dozens of respondents who agreed to my conversational survey was: “What do you already do to introduce your students to the international aspects of your field?” Then I asked: “What would you do?” And then: “What would you need to do it?”

Their answers were as varied as the sometimes spontaneous, often revisited and always generous conversations I enjoyed over the next few months. Some wanted technical support to connect their classrooms with equivalent courses in other countries. Many were eager to host their international colleagues as guest lecturers. Some envisioned podcasts and websites designed to share relevant teaching resources. Still others conjured up entirely new majors, or a renewed system for rewarding teaching engagement across campus more generally. All of them were eager to tackle the challenge.

In the end, three common needs stood out: more opportunities to collaborate with partners abroad; time to put new teaching projects together; and graduate student assistance to pull it off.

The CALS International Programs Office was prepared to meet those needs with a small awards program under the auspices of the campus-wide Madison Initiative for Undergraduates. International Programs director John Ferrick and undergraduate program development director Laura Van Toll conceived of the program to support science faculty interested in further introducing their students to the international aspects of their fields; I was brought on to help carry it out. We asked for “global learning outcomes” in the awards application so that we could learn the skills and perspectives instructors wanted their students to gain. And we gathered a group of faculty to evaluate and lend insight into the feasibility of their colleagues’ projects.

It Takes a Village

IT WAS A SHORT WALK FROM the village of Biwolobo, deep in the Ugandan countryside, to the pool where villagers got water for drinking, cooking and bathing. But the trip, a mere daily errand for locals, would have profound consequences for the CALS study abroad students who accompanied them.

After a few minutes they arrived at the narrow pool, which was set in a rock with steep walls on three sides. Slippery dirt stairs led down to the water’s edge. The water was brown and murky, with scum and bits of garbage floating on it. In a country where few people know how to swim, the pool invited tragedy. In the past month alone, two children had drowned while fetching water, then-student Jenna Klink BS’07 recalls learning.

Klink was shaken. “In spite of the drownings, kids were still fetching water from that pool.
It was the only source of water for their village,” she says. “And the water didn’t look at all safe
to drink. We later found out that it wasn’t.”

It was but one of many stories that would change the way Klink and 13 other UW students saw the world. Most of them came from small towns in Wisconsin and had never before left the country. They were part of a new CALS study abroad program in Uganda, in its third year when Klink’s group went in 2005. There they would spend three weeks over winter break experiencing things seldom seen by tourists.

Two nine-hour flights took them to steaming, bustling Kampala, the nation’s capital. There they attended lectures on such topics as AIDS and malnutrition at the Makerere University School of Public Health before heading out to rural villages to see how people dealt with those problems. In one village, Lyantonde, they observed and learned from a Ugandan nonprofit that was planting vegetable gardens, building rainwater collection tanks and getting mothers and infants off to a healthy start with nutritional education.

The entire time they soaked in the sights, the sounds, the smells—sometimes the aroma of foods they’d try for the first time, other times the stench of human waste and illness. They were delighted by people’s disarming friendliness—so different from the guarded stance of people at home—and by the children who would wave at their bus from the roadside. There were lush, rolling hills, the beauty of zebras and elephants in the wild.

And there were moments of despair. During a visit to Mulago Hospital—the nation’s referral hospital, meaning it offered the best treatment in Uganda—they were jarred by the dilapidated beds and equipment, the reek of urine, the open windows letting in dust and insects, the understaffing, and, above all, the suffering. The AIDS/HIV wards were full to bursting; children with extreme malnutrition and other conditions were waiting long hours to be seen.

Eric Monroe BS’05 was struck most by the malaria patients, many of them small children. They lay dying, a sense of futility engulfing patients and caregivers alike. “It made you sad but also angry because there are effective treatments out there,” says Monroe.

The weeks flew by, the students flew home. Small wonder that the world they returned to didn’t look quite the same. “We were shown all these things, then we came home to our beautiful Western lives, with our showers and toilets and sinks and washing machines,” says Kim Isely.

Around Madison, the students met up often and talked about their times in Kampala, in the villages. They reminisced about sitting around at the end of the day sipping Nile Specials, laughing at their mistakes and trying to make sense of it all.

And they started thinking of ways they could give back to Uganda, a country where people had much to offer but also needed many simple things. There must be something they could do. As they tried to resume their lives, they found that something had changed. They had left Uganda, but Uganda hadn’t left them.

That was exactly the kind of impact CALS had hoped for when starting the program in 2002. Biochemistry professor James Ntambi had been talking about undergrads in the life sciences with Ken Shapiro, then associate dean and director of CALS International Programs, and John Ferrick, then director of CALS Study Abroad. Sure, students were getting a top-notch education. They were learning all about cellular cycles and endocrine function and gene expression.

But the students needed more. They needed to know not just how biochemistry worked, but how the world worked. “It’s not just the biology of health,” says Ferrick. “There are many, many other factors that influence people’s decisions about health. Nutrition. Economics. Politics. Culture. All of those things are what we were trying to get at.”

Moreover, they wanted to respond to student demand. Students were eager to learn about conditions in the rest of the world. They wanted to get beyond their classrooms, beyond their borders.

Uganda seemed like a good way to get them there. Ntambi, a Ugandan native, had grown up in a small village and still had many connections at Makerere University, where he’d arrived to study science in 1971—the same year that dictator Idi Amin took power. Ntambi kept his head down and moved through the university system as Amin grew more outlandish in his rule, as people around town began to disappear.

By the time Amin was overthrown in 1979, Ntambi was finishing his master’s degree and working as a lecturer at Makerere. The following year, out of the blue, he got a Fulbright scholarship to do his Ph.D. at the Johns Hopkins University School of Medicine, an opportunity that brought him to the United States.

At one point he ran an exchange program with Uganda that he thought could serve as a model for CALS. As it happened, UW–Madison and Makerere University had recently renewed a Memorandum of Understanding for such partnerships. Shapiro, a CALS professor of agricultural and applied economics, had done research in East Africa and Ferrick had extensive experience in Africa as a Peace Corps volunteer in Lesotho.

The trio hammered out the program. A fall semester class about global health would be followed by a trip to Uganda over winter break. During the trip each student would work on a health-related research project. Ntambi and Ferrick would teach the class and accompany the group to Uganda.

Uganda study abroad was an immediate success—so much so that Makerere set up similar programs with other universities. In Madison, each year the program was improved upon—and each year it got more popular. By 2005, Ferrick was getting three and four times more inquiries than he could accept. Before long, he stopped publicizing the program. Word of mouth was more than enough.

After returning to Madison, the students from ’05 continued thinking of ways they could help the people who had opened their homes and lives to them.

And it was here that the local link provided by James Ntambi proved
crucial. Several of Ntambi’s former colleagues at Makerere University were committed to improving health and nutrition in Uganda’s rural communities. The students realized they could have the greatest impact by contributing to those efforts.

The most impressive was the work they had learned about in Lyantonde. The Community Based Integrated Nutrition program—CoBIN for short—was led by John Kakitahi, a physician and professor of community health at Makerere. CoBIN had trained 150 volunteer “family care workers” from various villages around Uganda to provide basic health services and education in their communities—an effective, low- cost way to address key public health challenges. Activities included health and nutrition counseling, garden planting and distribution of vegetable seeds, basic infant care and weight monitoring and building rainwater collection tanks.

The water tanks struck the students as especially important. Jenna Klink remembered the children drowning in Biwolobo. Eric Monroe recalled the many stagnant pools that were breeding grounds for mosquitoes carrying deadly malaria. The collection tanks being built by CoBIN often offered rural communities their only reliable source of clean water, especially during the dry season.

Even better, the tanks were conceived of and designed by a Ugandan. Engineer and Makerere University lecturer Moses Kizza Musaazi, through his company Technology for Tomorrow, specialized in simple inventions using local materials, all aimed at improving living conditions in rural Uganda.

In order to raise money, the students began selling necklaces made by Reach Out, a group promoting awareness about AIDS in Uganda. They gave some profits back to Reach Out and the rest to CoBIN to build more water tanks. It was a good start, but more was to come.

“We’d never talked about forming an organization,” says Klink. “Then we heard about the Wisconsin Idea Undergraduate Fellowship program, and we decided to apply.” Soon the group found themselves with $7,000 and a growing list of things they wanted to do. They formed a student organization and incorporated as a 501(c)3 nonprofit.

The fledgling Village Health Project (VHP) took on a life of its own. Fueled by passion, Klink, Monroe, Isely and the other founders applied for more grants and hit up friends and family. Their parents caught the fever and helped the group network in their own professional circles. Soon the students were visiting Rotary clubs and other service organizations and making their pitch.

With CoBIN as their boots on the ground, VHP started sending over funds. The projects they supported grew to include:
• Provision of natural water filters for use by village households. The filters use gravity to move water through layers of organic matter that absorb or kill many water-borne pathogens.
• Provision of “MakaPads,” affordable sanitary napkins made from papyrus—a simple innovation (also by Musaazi) that allows girls to attend school while menstruating, a barrier that impedes young women’s education throughout much of Africa.
• Building repairs and school supplies for Lweza Primary School in the village of Mukono, where Ntambi began his education.

The Village Health Project had an early opportunity to prove its mettle. In 2006 CoBIN’s funding from USAID dried up, and suddenly a group of undergrads in Madison became the organization’s sole source of revenue. Not surprisingly, CoBIN’s funding went from some $75,000 a year to around $15,000, which is roughly what it gets now, depending on donations. But CoBIN continues to thrive with its fleet of family care workers providing vital services in rural communities.

The Village Health Project, too, continues to grow and works in an easy exchange flow with Uganda study abroad. Study abroad students work on some VHP projects in Uganda, and many get involved with VHP after coming home, replacing students who graduate and move on in their lives. James Ntambi and John Ferrick sit on VHP’s board of directors to help make the flow even smoother. A half-dozen years after VHP’s founding, one thing seems clear—students returning from Uganda will continue feeling the need to do more.

Students who perform service abroad hope to make positive changes in that country. Less tangible, but just as real, are the ways in which the experience changes them.

Susan Mawemuko, a program officer with the Centers for Disease Control and Prevention at Makerere University, sees those changes in the waves of UW students who come in and out each year.

“When you meet them again at the end of the program, you think they have been living in Uganda for a very long time,” Mawemuko says with a smile. “It’s just three weeks, but it changes them forever—and you can see that on their faces.”

There is much evidence for the benefits of study abroad. Living in other countries helps students in everything from their general maturity to self-reliance and their ability to tolerate ambiguity, holds one study by the Institute for the International Education of Students. And spending time in another culture increases a person’s baseline creativity, found a study published in the Journal of Personality and Social Psychology (2009).

Employers increasingly recognize not just the value but the necessity of having a globally experienced workforce.

“A significant portion of our growth will come from international markets, whether through expanding the exporting of our products from the United States or establishing manufacturing bases overseas,” says Joel N. Krein, vice president–operations with Leprino Foods Company, Inc., a Colorado-based company that recruits CALS graduates. “The key to our success will be in recruiting and developing our future leaders with the skills and knowledge to excel in this international market.”

Certainly students are mindful of the job market when they opt to study abroad. “I recognize that to get the kinds of jobs I want, I need international experience and I need to know how to interact with other cultures. And I think that’s true of all students at this point,” says Rebecca Gilsdorf, who went to Uganda in 2009.

But what students experience runs much deeper. It’s a transformational experience that changes hearts as well as minds, and it’s not unusual for students to choke up when they talk about it. “Almost every single day I teared up,” says Liz Hill BS’09, recalling her trip to Uganda in 2009. “Just seeing how with so little they can give so much, and still be happy. I feel like they gave more to me than I gave to them.”

“It was one of the most pivotal experiences of my life,” says fellow ’09-er Douglas Stewart, who now works as a medical researcher and plans to go to med school. “You think you have a sense of what it will be like. But once you’re actually there, the visceral experience is much more powerful than simply reading about it.”

The experience has changed life plans for many students. “Before the trip, I was pre-med,” says Jenna Eun BS ’07, who now serves as president of the Village Health Project while earning her doctorate in biochemistry. “But afterward I realized I didn’t need to go into medicine, that a lot of what people need is not getting drugs or seeing a doctor. The issues there are usually more fundamental. It’s water and electricity. It’s public health issues. It’s civil engineering.”

Eric Monroe, from the 2005 group, had the opposite reaction. “I’d been kicking around the idea of medical school, but I wasn’t quite sure. I was thinking about maybe going into research or business,” he says. “But Uganda was one of the things that sealed the deal for me.” Monroe graduated from medical school in 2009 and is now a resident in radiology at the University of Washington.

Abby Stepaniak, also from 2005, was drawn to Africa for the long haul. After graduating she did the Peace Corps’ Master’s International program in South Africa and then shipped off to Sudan, where she works as a partnership coordinator with GOAL, an Ireland-based nonprofit. Study abroad continues to inspire volunteering for Peace Corps. Elizabeth Chadwick, who went to Uganda earlier this year, has signed up for a posting in West Africa after graduating this summer.

As for Jenna Klink, the Village Health Project’s first president, she took her community service gifts to post-Katrina New Orleans, where she earned a master’s degree in public health and serves as a program evaluator with the Louisiana Public Health Institute.

This year, Klink and Kim Isely returned to Uganda to assess impacts of the Village Health Project so far. They evaluated use of nine of the 13 VHP water tanks, and found that they are serving about 340 people, including 43 households and a school. Residents say the tanks save them up to four hours a day they would have spent fetching water, and that they are grateful to have water that tastes clean, gets their clothes clean and is free of water-borne diseases. This is an impressive achievement, especially considering it was the spare-time work of undergraduates.

But many of the group’s accomplishments defy quantification, Klink notes. “A lot of our impact can’t be measured. For example, the number of malnourished kids brought to the hospital and lives saved because of the family care workers’ presence in the villages.” Not to mention village children who have not drowned while fetching water.

Another thing that can’t fully be measured: the program’s impact on the students themselves. Because one thing no class can teach you is that when you set out to help others, the life that you change may be your own.

For more information, please visit dev.cals.wisc.edu/ip/ProgramTypes/Uganda and www.villagehealthproject.org.
Some material in this story comes from the documentary “Destination Uganda,” produced by the Big Ten Network in association with UW–Madison and CALS. The video is posted at www.youtube.com/watch?v=V5SQK29DtFU.

The Exterminator

The thing Que Lan remembers best about the summer of 1973 is the uncontrollable shaking. A stifling blanket of humid air had settled on top of Wuhan, the capital of Hubei province in central China, and it sat on the near 100-degree days like a deflated cloud. It was the time of year when a city collectively dreams of a sudden rain shower or a cool breeze—and yet 13-year-old Lan lay shivering underneath three blankets as her disease dragged her from profuse sweating into debilitating chills.

The diagnosis had surprised Lan. Malaria seemed like a far-off threat, the scourge of rural areas dotted with rice paddies and infested with mosquitoes. But even in the metropolitan climes of central China’s biggest city, where government trucks rolled down the avenues dousing neighborhoods with DDT, the threat of the disease was never too distant. As everywhere in the tropical and subtropical regions of Earth—where nearly 50 percent of the world’s population now lives—malaria lurks just one fateful bite away.

Lan’s illness was one of roughly one-half billion cases of malaria around the world in 1973. Because her family had easy access to medications, she avoided a far more somber statistic: More than a million people die from malaria every year, most of them children. Instead, Lan endured two weeks of shivering, fevers and aches and then recovered, well enough to return to school. Malaria was finished with her.

But Que Lan was not finished with malaria.

Now, nearly four decades after the bell first rung in her bout with the disease, Lan is halfway across the world, preparing to land her first solid blow. Malaria has not gone away and is as menacing as ever. While the disease has been pushed out of more temperate (and more prosperous) areas like Europe and the United States, malaria is still present in 108 of the world’s 195 countries. In most years, more than 250 million people will get sick with malaria and one million—most of them children—will die. Those statistics have led groups such as the Bill and Melinda Gates Foundation to declare all-out war on malaria, making eradication of the disease its number one medical goal. The World Health Organization and National Institutes of Health are equally engaged in the fight. But while these scientists and public-health officials struggle to control the disease and its devastating effects, Lan, a CALS associate professor of entomology, is attacking the source—the six-legged pest that malaria uses to get around. .

Entomology has come a long way from the days of peering through magnifying glasses at anthills. Today, entomologists like Lan peer at bugs from the inside out, scouring their genes for the drivers of their behavior. In her office on the 8th floor of Russell Labs, Lan hunches over her office computer and motions for a colleague to take a look at the bright bands of color on the screen. The bands are genetic code and, from that code, Lan has teased out a single gene essential to mosquito survival. A weakness. A genetic chink in the armor. In a multi-year study funded partly by the U.S. Department of Defense—which hopes to find better mosquito-control methods to protect troops in tropical regions—she’s also found a way to prevent that gene from doing its job. This is the target her lab is aiming for in a promising new approach in the fight against malaria.A target that, Lan hopes, can  debug the bug.

Humans have been swatting at mosquitoes for millennia. And mosquitoes have returned the favor, injecting us with all sorts of diseases, from dengue fever to lymphatic filariasis to West Nile virus. But malaria is king of them all, a harbinger of death and disease throughout the ages. Descriptions of malaria symptoms can be found in ancient Chinese medical writings dating back to 2700 B.C. and are scattered throughout Greek and Roman texts. The disease has claimed millions upon millions of lives, including those of several popes, the Italian poet, Dante, and, some scholars believe, Alexander the Great. Outbreaks of malaria have sent famous explorers far off course and swung the outcomes of wars by incapacitating entire armies.

As is to be expected with such a devastating disease, we’ve spent centuries battling back. In ancient China, a remedy for malaria’s intense fevers was made from dried wormwood leaves. In the 17th century, it was bark from the Cinchona calisaya tree that grew high in the Peruvian Andes. The active ingredients from both remedies are still used today in some malaria drugs. Other anti-malarial drugs were developed during both World War II and the Vietnam War as prosperous nations searched for ways to minimize the effects of malaria on their forces. Today, travelers to malaria-afflicted regions can take any of a half-dozen drugs to prevent infection and treat symptoms. But the development of new drugs has slowed dramatically, and the old ones are growing less effective as the disease gains resistance to them.

When a mosquito infects a person with malaria, they are actually injecting the plasmodium parasite into the bloodstream. Plasmodium heads for the liver where it begins to reproduce. It eventually builds an army of parasites that swarm into the bloodstream where they kill red blood cells and, sometimes, their host. During this stage of the disease, a single person can have millions upon millions of plasmodium parasites reproducing in their body. Multiply that single infection with hundreds of millions of people also carrying hundreds of millions of plasmodium parasites, and resistance to commonly used drugs is an inescapable result. To stay ahead of malaria means keeping it on its toes. Researchers know that the war will not be won with World War II-era weapons. It will take a modern, multifaceted arsenal to keep pace.

This is a lesson that the World Health Organization learned the hard way. In 1955, the WHO announced its Global Malaria Eradication Programme, aiming to rid the world of the disease with the help of newly developed weapons—including anti-malarial drugs developed during World War II and the insecticide DDT—and some it hoped were on the way. Medical science believed a vaccine to ward off malarial infection was close at hand, and buoyed by that optimism, the WHO boldly predicted the tropics could be soon free from the grip of the disease. But while the campaign did push malaria out of temperate regions of the United States and Europe, the disease proved intractable in other areas. A vaccine did not emerge, and the parasite quickly evolved resistance to many of the new drugs. But the WHO’s biggest shortcoming was underestimating the complexity of eradicating such a disease. That kind of bold aim necessitates more than good medicine.

“With malaria, we have pretty good drugs,” says Bruce Christensen, a parasitologist in the UW School of Veterinary Medicine.. “The problem is you don’t have very good infrastructure for health facilities (in developing nations). So it’s really hard for people to even get medical care. So even if you have good drugs, you probably don’t have them in the areas where you need them.”

At every turn, the WHO’s efforts were thwarted by the realities of human nature. People didn’t use the bed nets that were handed out in villages to prevent mosquito bites because the nets were stifling to sleep under and were handy as fishing nets. A campaign to spray the walls of houses with DDT met with a similarly unexpected failure. “One of the big problems they had with their workers was they would leave one wall unsprayed,” says Christensen. “And the reason they did that is because if they sprayed all the walls and killed all the mosquitoes, then they were out of a job and this was the best job they’d ever had.”

DDT presented other problems, as well. The insecticide had been the go-to weapon for mosquito control since 1948, when Paul Mueller won a Nobel Prize for demonstrating its lethal power over insects. By the 1960s, however, the pesticide once hailed as a miracle was looking more like an environmental monster, laying waste to birds, frogs and other animals. Facing mounting criticism from conservationists, the U.S. Environmental Protection Agency banned its use in 1972. With no U.S. market to serve, many companies stopped manufacturing DDT, making it scarcer and more expensive for widespread applications in the tropics. Plus, after three decades of near-exclusive use, it, too, was losing its potency.

In 1973—the same year that Que Lan was shivering under her blankets and unknowingly preparing for a career doing battle with malaria—the WHO threw in the towel. Malaria, the organization admitted, was hopelessly entrenched in certain parts of the globe.

The failure of eradication triggered a shift in thinking about malaria control. Many scientists and public-health officials realized that malaria and mosquitoes went hand in hand. You could never kill the disease, without also going after its carrier. In his 2010 letter to Gates Foundation supporters, Bill Gates even acknowledges that modern medicine isn’t ready to eliminate malaria. A vaccine, he says, is at least ten years away. We have to get better at killing mosquitoes.

The approach, called vector control, sounds hopeless at first. Places where malaria is endemic are home to multiple millions of mosquitoes that thrive year-round.No method of insect control could possibly eliminate that kind of population.Papua New Guinea is a perfect example, says Bruce Christensen. Mosquitoes there often lay their eggs in puddles of rainwater that collect in cattle hoof prints. Multiply a hundred eggs by a million hoofprints and the numbers quickly become incomprehensible. “What do you do?” Christensen asks. “Do you try to put [pesticide] everywhere? Because there are breeding sites everywhere.” The best that can be hoped for is to knock mosquito populations back, especially around areas more densely populated with people.

The authors of a new report on malaria control say such modest efforts may actually produce major results. . Published in the August issue of PLoS Medicine, the article points out that in parts of sub-Saharan Africa, a person can receive up to one thousand infectious bites from a malaria-carrying mosquito each year. Those mosquitoes aren’t just injecting that person with the disease, they are often also picking up a new batch of the parasite to carry to someone else. That means that, even if a massive campaign of drug delivery pushed the malaria to the brink of regional extinction, a single infected person moving in to the area could give rise to thousands of new infections and quickly re-establish the disease.

Controlling mosquitoes, on the other hand, makes it more difficult for the disease to rebound from successful anti-malaria campaigns. Reduce the number of mosquitoes in a malaria-infected environment by just half, and the instances of multiple infections and transmissions can drop by entire orders of magnitude. You simply can’t overestimate the role mosquitoes play the authors conclude. And that means that, to wage a truly effective campaign against malaria you need more than a doctor. You need an exterminator.

After her bout with malaria, Que Lan went on to study the sciences. She studied  microbiology at Wuhan University in China and earning a master’s degree at Brock College in St. Catharine’s, Ontario. But it took one intriguing offer—an invitation to complete her doctoral work at the University of Minnesota in noted entomologist Ann Fallon’s mosquito lab – for Lan to realize that the mosquito that bit her in 1973 was still buzzing around in the back of her head. It seemed like a crazy idea, the bravado of young ambition, but Que Lan wanted to bite back “I thought maybe someday I can do something about this,” says Lan, laughing at the audacity of her younger self. “It was just this kind of remote idea (that) maybe someday I can do something (to help).”

Under Fallon’s tutelage, Lan learned molecular biology, which she says “was really nothing to do with killing mosquitoes,” Her research had more to do with what makes them thrive. But after joining the UW-Madison faculty in 2000, she set out to turn that knowledge into better weapons for mosquito control.

“The key,” she says, “is to really understand the biology of your target insect and develop specific components that just target that.”

Lan knew from her Ph.D. work that mosquitoes, like all arthropods, don’t make their own steroids or cholesterols. Both substances are essential for survival, and insects must get them from their food sources. So when Lan discovered that a gene called sterol carrier protein-2 was activated in proteins in the gut during feeding, she knew she had found an essential link in a mosquito’s ability to live. “That’s the Achilles’ heel,” she says. “(I thought) if I can destroy this pathway, they may not survive.”

Her lab turned their focus exclusively on the gene. They mapped its proteins to decipher the chemical transactions that took place around the gene and studied when and where it was switched on. They studied the function of the gene during the mosquito’s various development stages, which led to a critical discovery: If the gene was not allowed to activate inside a mosquito egg, the developing larva would not get the cholesterol it needed and the egg would not hatch. In other words, silence the gene and you silence the bug.

The finding was a career-defining achievement in itself. Researchers often only get this far—learning something new that hasn’t been known before. But Lan wanted more. She knew the finding represented an exploitable weakness, one that could be developed into a method of control. Imagine, for example, dropping a pellet into a pool of standing water, where mosquitoes lay their eggs, that would deliver a knock-out blow to the eggs’ cholesterol-uptake capacity. Although her focus had been on mosquitoes of the species aedes egypti, which carry yellow fever, Lan was confident it would work for malaria- and West Nile-transmitting mosquitoes, as well. The idea of those little pellets preventing a disease-carrying swarm from hatching, Lan says, “is really satisfying.”

But what would flip the switch? Lan needed a chemical that could knock the gene out of order. And that chemical needed to pose as little threat to humans, animals or the environment as possible. The last thing she wanted was to create another DDT. To avoid this, she took a trip to see a few robots on the west side of campus.

Housed in the Paul P. Carbone Comprehensive Cancer Center at the UW-Madison School of Medicine and Public Health, the Small-Molecule Screening Facility allows researchers to conduct thousands of experiments simultaneously. The facility boasts three robots that store tens of thousands of chemicals. Introduce those robots to a cell line or protein, and they’ll introduce it to a few molecules of every chemical at their disposal. Advanced and sensitive instruments monitor each experiment and alert researchers when there’s a “hit,” or, rather, when one chemical has achieved its desired results. And that’s what happened when Lan’s lab took sterol carrier protein-2 for run through the robot gauntlet: Out of tens of thousands of chemicals, they found a dozen that worked. And they all worked in much the same way. Like a game of molecular musical chairs, these synthetic chemicals competed with cholesterol for a seat on sterol carrier protein-2. For every molecule of the chemical that bound to the protein, a cholesterol molecule was out of luck. Lan left the facility with a plan—introduce enough molecules of the chemical to the game, and developing mosquitoes don’t get enough cholesterol to ever hatch from their eggs.

The trouble with synthetic chemicals, though, is that they hang around in the ecosystem long after they’ve been applied. If Lan’s chemical tool were going to see wide use, a better alternative would be to employ a natural chemical to muck with the bug’s genes. So Lan again turned to the library to find a natural chemical that mimicked the activity of the synthetics.

The source was unexpected—an Asian fruit called mangosteen, which contains a chemical that turns out to be a dead ringer for the best-performing of the synthetic chemicals Lan tested. Touted for the rejuvenating power of its juice, mangosteen is called “queen of the fruit” in parts of Southeast Asia, and Lan finds the fact that a malaria-infested country could harbor a promising new natural agent against the disease a delicious irony.

“We’re pretty sure this quality is one of (mangosteen’s) main evolutionary traits. It’s a naturally occurring defense compound,” she says. “We would never have imagined to use (mangosteen extract) on insects. Not in a million years if we didn’t get it from our library screening.”

Susan Paskewitz, a CALS entomology professor who also works on mosquito-borne disease, thinks there’s great promise in this new way of methodically developing insecticides. “In the old days we might have started with something that from lab experiments was known to kill agricultural pests and then tested it on mosquitoes,” she says. The power of genetics is to look at species-specific approaches, which could mean fewer unintended consequences.

And that seems true for Lan’s genetic attack strategy. Since the chemical approach employs a different mode of action than traditional pesticides, it promises to be effective against species that have grown resistant to those applications. There’s also little danger of the chemical affecting humans or other animals since chemicals bind differently in our DNA. And even if some of the chemicals bound and prevented uptake of cholesterol, it wouldn’t matter much since vertebrates make their own cholesterol.

Lan has taken this particular avenue of research as far as she can as a researcher. Her naturally derived cholesterol inhibitor has been submitted for a patent, and she’s now waiting to hear if industry will license the technology and develop a commercial product from it. She knows her find is not the “answer” to the malaria question. But she is convinced it will be a welcome addition to the fight.

“The toolbox is almost empty,” she says. “We’re just putting more tools into the toolbox.”

Of course, Lan knows her new tool won’t last forever. Someday the compound will grow obsolete as mosquitoes slowly evolve resistance. But she is confident science will uncover new weaknesses in mosquitoes’ makeup and reveal new routes of attack.

“You’re never going to win,” she says. “(Mosquitoes) have been around for millions of years, and they’re going to be around for another million years. We just try to avoid their contact (with humans) in high-density populations. That’s all we can do.” But, mosquitoes, beware. Just because she knows she can’t win, doesn’t mean Lan isn’t going to fight. As long as little girls  shiver under heavy blankets in the sweltering heat, she won’t give up. What that mosquito started back in 1973, Lan will never finish.

Fighting Poverty: A Life Science

On the cover of this magazine are four broad issues that we consider central to the CALS cause: food, agriculture, health and the environment. But there is another theme that underlies all of these areas, one that we aren’t accustomed to considering as part of a science-oriented college. That issue is financial security

Without the means to sustain themselves economically, people cannot hope to have nutritious and sufficient food supplies, sound agriculture and a healthy environment. As a result, we too often witness global epidemics of poor nutrition and disease, where communities are plagued by environmental contamination that makes even a simple drink of water a life-threatening risk.

Unfortunately, this is the reality faced by hundreds of millions around the world. More than 1 billion people—one-sixth of our planet’s population—have less than $1 a day to feed, house and clothe their families. An estimated 300 to 400 million of those are chronically poor. Too many of our kind are trapped in this cycle of poverty, with little hope of realizing the basic stability that most of us take for granted.

In countries such as Peru, CALS is creating strategies that attack the constraints of poverty and pave a path to financial stability.

This is why I am so heartened by the work in CALS to study and combat global poverty. Our researchers are helping to identify the constraints that keep people in poverty, such as the vulnerability created when poor farmers have little access to financial instruments such as crop insurance—and thus no way to shelter their labors from disaster. In countries such as Peru, CALS is creating and testing strategies that attack those constraints and pave a path to financial stability. You can read more about this exciting project on page 10 of this issue—
if these small-scale experiments succeed, they can be replicated in other parts of the world as one way to begin to address the global scale of poverty.

We hope to build on projects such as these by creating a college-wide initiative to combat global poverty. This initiative would allow us to augment the many poverty-related research projects in CALS with new opportunities in teaching and learning, such as the creation of a global public health certificate for undergraduates. We know students have strong interest in this area, and a global health focus would help prepare them to contribute meaningfully to service-learning projects around the world.

This aim goes to the heart of our college’s mission. So much of what we do is dedicated to improving the lives of those around us. One sure way to build a better environment and a better life is to begin with a better livelihood.