At 6 o’clock in the morning there is just enough light cutting through the front entrance of the thatched home where Ernesto Ortiz, Axel Berky, and a nurse technician from the Peruvian Ministry of Health (MINSA) work alongside each other and ask questions listed on their clipboards. The home belongs to a Peruvian family that has consented to participate in one of the largest baseline health studies ever conducted in the Amazon. Now the three researchers focus on collecting the family’s information before the men leave to work in their fields and on the river.
Ortiz and Berky, research associates in the Duke Global Health Institute (DGHI), talk with the head of the household, carefully recording responses to a wide range of topics, from the family’s migration and employment history, to food consumption, to illness history. Simultaneously, the nurse begins to prick the mother’s finger to screen for anemia and collect spots of blood on filter paper. She records the results and sorts them with the other hair, fingernail, blood, and urine samples to be analyzed for health data.
Ortiz, Berky, and the nurse are visiting one of the 1,200 households enrolled in a large epidemiological research study led by William Pan, assistant professor of global environmental health at DGHI and the Nicholas School. The study examines human health and environmental impacts affecting twenty-three communities within the Amarakaeri Reserve, a national protected zone of mountainous and biodiverse rainforest in the Madre de Dios region of Peru, as a result of ongoing artisanal gold mining and exploratory gas extraction. The project, funded by Hunt Oil, aims to develop strategies for improved human and environmental health in the region by engaging communities, government health ministries, and private industry. The project has forged a strong partnership with Peruvian health entities including MINSA, the Regional Health Directorates (DIRESA), and the Center for Public Health Research and Services in the Amazon (CENSAP) that, according to the DGHI team, is mutually beneficial and has helped foster trust in study communities and provide immediate benefits to public health.
This past March these collaborative partnerships were challenged. Rapid point-of-care blood tests administered by the DGHI team revealed previously unidentified clusters of Hepatitis B viral infections in two indigenous communities located along narrow tributaries of the Madre de Dios River in a largely undisturbed expanse of the Amazon rainforest. Approximately 27 percent of individuals tested positive for Hepatitis B. Ortiz immediately traveled from the secluded communities to inform physicians at the nearest local health post; that contact triggered outbreak- response efforts from national public-health authorities. MINSA headquarters in Peru’s capital city, Lima, dispatched a health brigade to perform further confirmatory Hepatitis B tests. Officials at MINSA, DIRESA, and CENSAP then worked with affected communities to administer Hepatitis B vaccinations and offer educational “charlas” on sexually transmitted infections.
The outbreak tested the DGHI team and their Peruvian health partners, yet a history of cooperation yielded quick intervention. Since Pan and his DGHI team began work in Madre de Dios in 2011, the DGHI research has supplemented the health tests and data collected by Peruvian health ministries. The team has also helped to transport medical supplies to remote health posts. In the case of the 2015 Hepatitis B Outbreaks, Peruvian partnerships facilitated the DGHI team’s ability to immediately influence a previously unknown public-health issue affecting the communities with which they worked. Often, it can take months for global health studies and data collections to be completed and analyzed, and for study findings to be used to advance public health. Team members say the collaborative network in which this study was rooted also allowed for timely reporting and action after the discovery of Hepatitis B infections. The DGHI team’s work and prompt, open communication with Peruvian health officials enabled, Ortiz says, “immediate public-health benefits that would otherwise have taken years of submitting and analyzing data.”