From the Containment Lab to the Developing World
Professor Yanis Ben Amor began his career as a molecular biologist in a containment laboratory; now he works in the field in developing countries. He has witnessed first-hand how young girls and women in developing countries continue to suffer the most from infectious diseases due to lack of support and inadequate resources for their reproductive health. Ben Amor is working to fix that by finding ways to improve access to health care in rural and remote areas in Africa and South Asia.
Apart from being the executive director of the Center for Sustainable Development at the Earth Institute, he is also the director of the Earth Institute’s Tropical Laboratory Initiative. He has worked relentlessly to improve diagnostic tests for infectious diseases like tuberculosis, Ebola, and HIV/AIDs. In a candid interview with the State of the Planet, he talks about his various projects and experiences in the field.
Can you tell us more about your background and how you first started working at the Earth Institute?
I spent the first 18 years of my life in Tunisia, Africa, and I’m fluent in both Arabic and German, as my father is Tunisian and my mother is from Switzerland.
I originally wanted to become a medical doctor. But, the very sight of other people’s blood used to bother me. I first studied biology and then molecular biology, because that was, in my opinion, the second-best way to stay in the field of health. During my Ph.D., when I was working long hours in the lab on tuberculosis, I used to wear a suit from head to toe the entire day in a pressurized containment lab, with zero contact with other humans for most of the day. I remember thinking, ‘This is not what I want to do for the rest of my life.’
The first time I got the opportunity to work on the ground in developing countries was during the beginning of the Millennium Villages Project, in 2004. For my postdoc at Columbia University under Professor Jeffrey Sachs’s team, I was sent to Kigali, the capital of Rwanda, to help kickstart the project as an infectious disease expert, with a particular focus on tuberculosis, where I worked closely with local experts. That was how I first made the transition from solely working in the laboratory to working more on the development agenda.
After two years focusing on tuberculosis in Rwanda, I continued working closely with Jeffrey Sachs on the Millennium Villages Project, and expanded my portfolio to also work on HIV/AIDS-related issues. Therefore, when Columbia started working with the United Nation’s Program on HIV/AIDS in 2009, we took on a project that aimed to increase the prevention of mother-to-child HIV transmission.
In Uganda, it was visible how the HIV epidemic particularly affected young girls disproportionately and rather unfairly. HIV prevalence is much higher in girls than boys at the same age. That meant they were not born with the virus. It became increasingly obvious how these young girls were the victims of men who believed sleeping with an underage virgin would miraculously “cleanse them” of HIV. That was how I first moved from only doing health-related research to focusing more on gender and education as well.
How did you get involved in also improving children’s access to education in developing countries?
While working with communities in these rural areas, I realized only having access to a clinic for getting anti-retroviral drugs is not enough. They also need access to education and reproductive health-related programs.
I first started working with students in Uganda where my team and I used social-emotional learning to reach out to them. [Social-emotional learning focuses developing self-awareness, self-control and interpersonal skills that are vital for school, work and life.] That was very successful and after learning and adapting from that work, a few years later in 2015, we had a great opportunity to start a big project in India.
We first began working in Telangana, a place right outside the city of Hyderabad in South India. We started an education attendance program where we aimed to make more children living in nearby rural areas go to school. Low attendance is one of the biggest issues as most of these children tend to drop out of school due to a lack of support and resources.
In the past, the local government used to rope in people from the community to do the same work of following up with school students in rural India. But, it’s not that simple. The community resource person was also supposed to go to the house and find children who are not coming to school, but the reality is they are not doing that. That is because there is such high absenteeism of teachers in these schools that they end up becoming substitute teachers and don’t have time to keep following up with absentee students.
We used a system of biometric fingerprinting that I had first started working on to track tuberculosis patients in Uganda. We first spoke to district collectors and health officials in Telangana who agreed to use this technology, as the data was encrypted and stored in India. Once that was in place, we went and followed up with students in a district who had not been attending school for more than three days, by actually sending someone to their houses. That way, we were able to decrease absenteeism by two-thirds in 2016. This project is still ongoing, except that we have now moved to a different district. We did this to check if those hired by the government could deliver similar results.
What are some of the other recent projects you have been working on?
We are now working closely with Syrian displaced populations in Turkey and Lebanon. Unfortunately, most of the refugees do not speak the local language in Turkey and that means Syrian women and girls have barriers in accessing reproductive health services, as informational resources, and the number of translators are limited. In fact, a lot of the health services are available for free in Turkey, but they just don’t know that.
We are now attempting to develop a digital health tool to make sure that they know more about reliable health information resources and their rights regarding healthcare. Despite efforts, there are missed opportunities in providing the services — such as family planning and pre- and post-natal care — to Syrian women who need them the most.
In Lebanon, while everybody speaks Arabic, displaced Syrians face financial, cultural and other barriers in accessing healthcare. We are in the process of investigating how some of these barriers for refugees can be lowered via digital health technologies.
How did you get involved in improving the diagnosis of Ebola?
During the Ebola epidemic in West Africa back in 2014, we were specifically told not to go to any of the affected countries. Jeffrey Sachs thought that it was unbelievable that with the level of expertise we have at Columbia, we were not going to be able to help those in the field.
In 2015, we launched a local center in Guinea, one of the countries that was the most affected by the Ebola epidemic. Working with the community health workers, we realized that they were the key to breaking the cycle of suspected Ebola cases being admitted to the hospital — even in cases where they will not test positive, making them more vulnerable to coming in contact with other Ebola patients. So, my colleagues developed a mobile app for community health workers to be able to track people who might have come in contact with the pathogens, without the patients needing to remain in the hospital.
The way this works is very simple. It takes 21 days for the disease to develop once you’re infected. So, if after the 23rd day, you don’t have symptoms, that means you’re not sick at all. The major challenge is to follow up every single suspicious case for 21 days without a comprehensive list of suspected cases.
Our app conducted geo-mapping of an entire area. If there was a confirmed Ebola case, the community health workers will go and interview everyone who came in contact with that patient. They are then immediately added to our database. While they are at home, the community health workers are responsible for taking their temperature for the next 21 days and making sure that they are not developing any symptoms.
One of the problems was that there were no reliable, rapid diagnostic tests for Ebola at the time in 2014. That meant they still had to collect samples and send it to an urban hospital far away, and wait for the results to come back. In the meantime, the patients were either dead or had left and health workers had no idea where they went. Our app was successful in keeping track of them, and we’re also collaborating with some companies to validate new diagnostic tests. We hope that the combination of both innovations will help to save lives in future Ebola outbreaks.