Science and charity come together in Africa
A chat with epidemiologist Mark Booth
6 January 2008
I’m sure we could foster more respect for scientists if there were more regular and informative liaisons between them and the public
Editor’s note:: Dr Mark Booth is an epidemiologist at Cambridge who also runs The Matangini Project, a charitable venture to help supply safe water to Africa. LabLit.com recently caught up with him to find out more.
What’s your scientific background, and how did you become interested in researching parasitic infections?
My interest in parasitology started towards the end of my first degree in Zoology at Imperial College London. There was a field course run jointly with Royal Holloway College (it is still going, I believe). Part of the course focused on parasite infections of animals, and I took up the challenge of mapping the distribution of dog poo samples containing Toxocara canis eggs at a local recreation ground. It was grim work, but someone had to do it, and fortunately my sense of smell was (and still is) well below the national average. My interest in epidemiology of parasitic infections was borne out of lectures by Sir Roy Anderson and others, and a desire to travel to exotic locations outside of the tourist hordes.
What is the focus of your research currently?
I quickly moved from parasites of dogs to those of humans. I’ve had a long-term interest in trying to understand patterns of co-infection with multiple species of parasite. Typically, people living in rural areas of developing countries will be exposed to a number of different pathogens. There is evidence from animal models that parasites of different species can either facilitate or impede each other’s survival and reproduction. Whether this is true in humans, and what the effects might be on the health of affected individuals, are two of my research questions.
More recently, I’ve taken a step sideways, and undergone my own epidemiological transition from infectious to chronic diseases. Later this year (funding permitted), I’ll be co-ordinating a study of Type II diabetes in Uganda.
When you first visited East Africa for your research, did you already have a mind to get involved in charity work?
The idea for conducting charity work myself took a long while to emerge. I’ve always been aware of working for the public good (my mother was a nurse), but never considered that I was capable of organising something charitable until I promised to raise money for a borehole in one school in Kenya. Once I started, I found that I did have the incentive and motivation to continue.
How do villagers react to the presence of foreign scientists, and how do the relationships evolve?
My studies often take me to new communities that may never have encountered western scientists before. Depending on the location and ethnic background there will be different challenges to surmount before work can begin. Superstition or fear of outside interference sometimes needs to be overcome. Generally though, the populations are welcoming and co-operative, and the longer we stay, the more we can achieve as the trust grows. Factors outside our control – such as tribal unrest, epidemics of Ebola, environmental disasters and elections – are harder to accommodate.
Tell us a bit about the Matangini Project. What are the main goals and what have you achieved thus far?
The goal of the project is simple – we are raising money to put boreholes or wells in the grounds of rural primary schools in Kenya. The original idea involved implementing the charity work within my existing research, using visits to the field sites to oversee the borehole construction. Since becoming part of Stand Up for Africa the outlook has changed, and we are now about to join forces with an existing Kenyan organisation – this will allow us to widen our efforts. So far we have completed one borehole – using manual labour to keep costs down. In the last year I’ve raised enough money for several more, and we are now en route to implement the wider programme.
Are your department and the university quite supportive of the project? How did they first react when you had the idea?
The department and university learnt about the project when I started selling photo gifts based on photographs I’ve taken during visits to East Africa. Support from within the department and the university has generally come from sympathetic individuals. I can’t say the project has generated much Institute-wide enthusiasm – this may be partly because my work is well outside that conducted within the rest of the department, and people’s exposure to Africa is generally very limited. Cambridge University is incredibly fragmented and has so much going on that it can be hard to be heard.
Does it help your research to have a personal connection with the people inflicted with the parasites you are trying to understand?
Absolutely. I started my career working on data that had been collected beforehand. Although I could gain some insights, it is only by spending time in affected communities that I’ve obtained a much fuller understanding of what needs to be measured, the limitations of study, the potential biases and sources of error, etc. I’ve also been able to widen the scope of my research to include social and ecological measurements.
Taking this a bit further, do you think all scientists who study diseases should be taking a more active and personal role with the patients who are afflicted by these diseases?
I think each individual has a duty to enlighten themselves as much as they feel appropriate. I’m sure we could foster more respect for scientists if there were more regular and informative liaisons between them and the public (not just patients). Meeting patients and explaining research would probably help both parties – the patient would hopefully be pleased to learn just how much work is being done, and the scientist would be given an emotive boost to help keep them motivated.
What was the most satisfying thing you’ve ever experienced in your work in East Africa?
There isn’t one experience in particular that stands out. I’ve been many times and have had many adventures. Walking around villages and meeting people, hearing children sing, handing out treatment, having the occasional moment of epiphany, drinking the local beer – these are all satisfying in different ways.
And what was the biggest surprise?
How delicious goat meat tasted the first time I tried it (I can’t stand goat-cheese). I’m still struck on a regular basis by how ingenious people can be under extremely testing conditions with almost no resources.
You must have to do a lot of long-term epidemiological studies in the villages. Is it difficult to get people to comply to continued treatment and follow-up? What are the biggest challenges?
It’s more difficult to get funding than compliance. Where we work, people tend to stay for long periods unless the economic situation favours a move elsewhere. We recently conducted an 8-year follow-up in a rural village and managed to re-enrol half the original cohort. The greatest challenges are those factors we can’t control. Once a population sees the benefits of treatment, we are often invited back for more!
You are responsible for a great blog called ‘The Wonderful World of Joseph McCrumble – Celebrity Parasitologist’. How did this come about?
I’ve been writing short stories since I was a child, and it occurred to me that the blog format was ideal in this respect. My partner, Joanna Tyler, had started a personal blog and I was intrigued at its potential – though I didn’t think anyone would be interested in my day-to-day life. So I created McCrumble as a minor celebrity scientist-artist and just started writing – with no idea where I was going. It seemed obvious to make him a parasitologist, but he is more interested in dissecting the local fauna than dealing with humans (that field course proved inspiring). I’ve continued to write as if McCrumble is living each day as it comes. He creates and reacts to situations in his own way, which is invariably the wrong way. One of the challenges is to maintain continuity and make sure everything remains connected. It’s probably most like writing a soap opera with very short lead times.
The blog is now two years old and still going, albeit sporadically. The poor chap is now living destitute and is no longer a celebrity. I haven’t decided what to do with him next. Like Gwyneth Paltrow in Sliding Doors, he could go one way or the other.
Feedback has been very positive from people who read the blog or have bought the book. Getting a proper review of the book outside the university has been difficult as I have self-published and therefore occupy the sewers of the authoring hierarchy.
How did McCrumble become involved in your charity work?
After about nine months of writing the blog, I realised that I had enough material for a book. I thought I could use the book to raise money by offering up my royalties to the Matangini Project. I reckoned I would be unlikely to get a publisher interested very quickly, so I decided to self-publish. The publishing time and margins on each book are much better than I could expect from the traditional route, but I have to do my own marketing – an area where I lack experience, or skills or resources. I am a poor marketing manager – something that McCrumble chides me for on a regular basis.
Has the project or McCrumble spread beyond the university?
Sort of. I’m a fellow at a Cambridge College (Hughes Hall). Last year, the University Chancellor (HRH Prince Philip) came to visit the College, and I was asked to talk to him about a collection of photos I had on display to promote the Matangini Project. After casting the Royal Eye over the nicely composed, carefully selected photos of people, places and wildlife he said “Looks just like Africa” and walked off. I’ve not heard from him since, nor have I received a Royal Donation. McCrumble has made it onto several foreign Amazon sites. In the US he’s currently languishing at No. 4,461,325. This figure may shift upwards by a few hundred thousand if I sell another copy by Easter!
Who is your favorite scientist in a work of fiction, and why?
It would have to be Dr Doolittle as played by Eddy Murphy. No wait – I don’t really have one. I have to confess that my reading of literature containing scientists as the protagonist is very limited. Films with scientists are nearly always a load of grossly inaccurate hokum. Hats off to Danny Boyle for getting hold of a bona fide physicist to advise on Sunshine.
Are you aware of any good works of fiction that feature parasites or parasitology? If not, would your field be a good basis for a novel and why? Who’d play you in the film?
Parasites feature rarely in their own right, but horror stories do regularly contain creatures that borrow some of the less savoury aspects of some parasite life-cycles (think Alien). There is a film called Parasite (the original starred Demi Moore. I might have seen it during my Demi Moore appreciation phase, but I can’t remember what happened). In literature, I think McCrumble may be unique as the hero-protagonist being a parasitologist.
If epidemiology were to be the focus, I could easily envisage a scenario where the hero (in the film I’ll be played by Kevin Spacey, thanks) finds unusual demographic patterns of infection suggesting parasite evolution is speeding up. The race is on to find the key before the parasites win the arms race (I’m copywriting this idea by writing it here!).
Are we making good progress on vaccines and treatments for malaria and other deadly parasitic diseases? What is the biggest barrier?
Malaria vaccine research is a serious business. There are several vaccine candidates, and a few trials in progress. The biggest barrier is a frustrating lack of efficacy in field trials despite promising lab data. We still don’t know what is happening. Other parasites don’t drive the same level of interest as malaria because they don’t kill as many children.
Do you envisage other extracurricular projects in the future and if so, what might they be?
I’ve always had one eye on bringing McCrumble to the screen. Imagine being able to show him dissecting a rat and pulling out a foot-long roundworm in close-up (complete with slurping sound effects). Audiences would be revolted and fascinated at the same time. A reviewer recently said McCrumble was like car-crash literature – you don’t want to look but you can’t take your eyes off the carnage. Perfect cinema material, yes?
How can people contribute to the Matagini Project?
The book is always available for sale. If anyone has any marketing experience, and wants to lend their resources, I’ll be their best friend. Donations are always welcome, or if anyone wants to host a fundraising event (a mixture of alcohol and music usually does well) then I’d be pleased to talk with them!
More information about parasitology can be found at The British Society for Parasitology, of which Booth is the Honorary Communications Secretary.