Kenya Climate and Health Working Group established

As one of the follow-ups to our Africa-wide Climate and Health Challenge Dialogue, the organizing team has provided all the resources developed during the Dialogue process to support a new Kenya Climate and Health Working Group.

Their first planning/stakeholder workshop was held 8-9 December 2008 at the PanAfric hotel in Nairobi.

Patti Kristjanson presented 'Linking Climate and Health Research to Reduce Africa's Infectious Disease Burden: Lessons from an African Challenge Dialogue' summarizing the Challenge Dialogue process and outputs and potential usefulness for the Kenya Working Group.

Christine Jost gave a presentation on 'Climate and Zoonoses Adaptation and Mitigation - Learning from Rift Valley Fever and Avian Influenza (HPAI)'. She discussed an example of the implementation of a one health concept in Kenya, i.e. the use of a decision support tool jointly developed by FAO, ILRI and others that has been applied recently by a technical group made up of veterinary and public health members (over 10 departments/insitutions in all) in response to a climate prediction that the conditions for Rift Valley Fever are once again very high for this year and early next year in Kenya. She also discussed some of ILRI/partner's lessons regarding risk mapping and adaptation and mitigation efforts and approaches regarding avian influenza, H5N1 HPAI.

Links to the Media Clippings

Deadly fever likely to hit again, warns UN
Daily Nation; 30 September 2008

Climate Change may lead to new diseases in Africa
The East African; September 28 2008

World leaders embrace goal of ending Malaria deaths by 2015
Washington Post; September 26 2008

Climate change to spread diseases, Scientists warn
Business Daily; September 26 2008

Detect epidemics before they start
Wired News, USA; September 22 2008

Work Together Or Face 'Disastrous Consequences' For Health In Africa, Experts Warn
Science Daily; September 22 2008

Experts warn climate change could cause health disaster
Voice of America (VOA); 19 September 19 2008

Climate, health experts warn of “Disastrous Consequences” if each worked separately
Africa Science News Service; September 19 2008

Mobiles combat Kenyan Polio outbreak
BBC News, 18 September 2008

Google's Philanthropy arm leads effort to use weather data to fight diseases
New York Times; September 01 2008

Reflections on the workshop

Well, I think our workshop was a huge success! It built upon our dialogue to date (including ideas from people that weren't at the workshop) and I’d like to thank all the participants for their enthusiastic and numerous contributions.

The Challenge for the Workshop was ‘to engage a diverse set of participants in the further exploration of the challenge we have set out for ourselves (linking climate and health to reduce Africa’s infectious disease burden) and in designing collaborative actions that will improve our response to this burden’.

As reported in Progress Report #1 our Working Proposition was revised on the basis of the feedback from the Challenge Dialogue, as:

Links among climate and human health and animal health are significant. A changing and more variable climate poses increasing risks to human health and well being. For example, rising temperatures are expected to lead to an expansion of the range, incidence and impact of many infectious diseases. We expect that climate and health specialists across Africa can improve their effectiveness through better collaboration and that collaboration across these communities can improve Africa’s capacity to predict, prevent and mitigate the impacts of climate-sensitive infectious diseases, largely by dramatically improving early warning and response times.

The 50 or so workshop participants, from all over the world and from a broad range of disciplines and experiences, reinforced the validity of this working proposition through their discussions of several case studies, including malaria, bird flu and Rift Valley Fever, that exemplified the need for strong linkages and better communication between communities, climate/environmental, human and animal health researchers and practitioners if we are to improve responses to infectious diseases in Africa.

The presentations and participants’ comments are on this blog. In addition to networking and relationship building, we started out with 3 objectives for the Workshop. They are closely aligned with the revised Expected Outcomes in the Progress Report. In addition to further exploration of this complex challenge, the group was challenged to start to identify some concrete actions aimed at improving our ability to respond to climate sensitive infectious diseases across Africa and further develop:
1. Common Conceptual Frameworks for a Shared Vision and Collaboration – to develop a draft framework(s) that portrays an integrated, holistic and interdisciplinary view of climate, infectious diseases, human health, animal health and disease vectors.
2. Collaborative Project Opportunities – to identify and develop opportunities for collaborative projects and initiatives that in particular can apply and leverage multi-inter-disciplinary expertise, knowledge, tools and resources.
3. Networks and Communities of Practice – to explore and design ways in which the participants and their organizations might form informal, self-forming networks where people with shared interests and values can come together and interact for various purposes (e.g., collaborative project support teams, knowledge alliances, learning communities, shared resource opportunities, etc.)

During the workshop, several other action areas were proposed, including:

• Data, information, tools and knowledge management - we need to be able to ‘cross-query’ the data we’re collecting!


• Taking stock: existing initiatives, data, models, capacity and gaps


• Bridging gaps between community needs for information and what knowledge scientists are generating; make indigenous knowledge available and used!


• A flagship collaborative project for this group – e.g. initiative supporting African ‘one-health’ PhD’s


• A declaration/accord – one page that articulates this group’s understanding and strategic intent to move forward

We have already made progress on many of these objectives – e.g. we have several conceptual frameworks that are being refined after receiving feedback from the workshop group; we have started a list of organizations and initiatives involved in climate and health issues across Africa; we have put together an annotated bibliography and compilation of key documents.

We had stimulating examples of the role technologies can play in improving knowledge and response to diseases – the Digital Villages being established across Kenya by Virtual City; how Google Earth and other Google applications can improve communication, networking and visual presentation of things like climate change (picture a Minister watching a 3-D map and seeing parts of his country turn from yellow to orange to red over the next 50 years as average temperatures or variability in rainfall increase; or a map showing where the poor are with where the health facilities or water sources are found); and how Health Map is already showing disease outbreaks globally in real time. We learned how outcome mapping is a powerful tool for showing how outcomes in one sector are linked to outcomes in other sectors, and can inform strategies for change towards ambitious goals such as the one we’ve set ourselves. We saw how a highly collaborative effort on surveillance, forecasting, preparedness and response to malaria is working in southern Africa, providing evidence of our hypothesis that improved collaboration and integrated approaches make a difference. And while we were cautioned by our community leaders on concerns regarding language (e.g. making the results and implications of climate models more easily understandable) and poor infrastructure, a memorable moment came when Mary Nakirya (BROSDI) described a rural woman in Uganda googling ‘cabbages + Kampala’!

The organizing committee is now synthesizing the numerous ideas that came up during the workshop in the other areas and will be posting and sending out a second Progress Report within the next few weeks.

So, our journey continues....

We'd love to hear your thoughts! Please share them by using the 'comments' facility on this blog!

Links to key documents...

Here's the list of key documents so far.....

Annotated bibliography on Climate and Disease (by author, in alphabetical order)

The Prospectus (May 2008)

The Challenge Paper (May 2008)

Progress Report #1 (August 2008)

The Workshop Workbook: Linking Climate and Health Research to Reduce Africa ’s Infectious Disease Burden: An exploratory dialogue (September 2008)

We'll keep updating the list here!

Here's the presentations!

This picture, taken outside a school near Axum, Tigray, Ethiopia in 2005, captures the feeling and optimism at the workshop! David Rogers, thanks for the photo from your presentation!

Phil Thornton - Where are we heading with climate science projections for improving infectious disease response?

Andrew Githeko - How can we get the knowledge benefit from recent advances in climate science and observation? Botswana case study

Stephen Connor - How can we get the knowledge benefit from recent advances in climate science and observation? Ethiopia case study

Andrew Githeko - From concept to practice: Developing the malaria epidemic prediction

Jeff Mariner: Lessons learnt from the HPAI response

John Waibochi - Community 'Digital Villages' concept

David Rogers - Science and development: The bigger picture (this is a big 6.7MB file)

Economists and greens now talking ‘adaptation’

An article in this week’s Economist (UK) reports that environmentalists and economists are now coming round to the idea of adaptation rather than just talking about climate change prevention. This new focus on 'coping' is manifesting in a number of private and public sector projects. But even if poor countries do get adaptation money, there will be tough choices over how to use it. For example, if infectious diseases are rising, do you spend money trying to eradicate the worst ones, like malaria, or do you spend it on health and nutrition in general? No doubt everyone will be divided over the ‘right answer’.

Caroline gives a community perspective

Caroline Nyamai Kisia from Action Africa Help International (AAHI) said she was encouraged to see so much climate and health expertise in one room focusing on African diseases. What she wants is for this knowledge to be translated into practical things that can help communities on the ground - something that people can add to their armoury against climate and diseases.

Caroline says she's an optimist. From a community perspective, she knows that much of the knowledge and technology is already out there.

I'm sure the next time there is an outbreak of RVF, we will control it much better. I ask you to reduce the gap between your specialized knowledge and the action that could help.

If I were a minister and had all the good data in the world, and limited resources, and wanted to do my very best, would I be able to access the best knowledge to make the best possible decision under the circumstances?

Please give that information to decision-makers so that they can make a difference.

Patti on participatory research

On Wednesday Jeff Mariner talked about 'participatory epidemiology' and explained how villagers are central to disease detection and control efforts. Patti Kristjanson then referred to her earlier participatory work in Uganda and Kenya where community members provided current and historical information that enabled researchers to better understand how people got into and out of poverty.

'By probing for information, we gain knowledge, said Patti. We definitely need more participatory research. Yes, it is more ethical to involve the communities, but now researchers are also recognizing the major benefits that come from participatory approaches and tapping into indigenous knowledge. This includes faster and better results on the ground, for example when detecting disease outbreaks, better understanding of the local context and greater sensitivity to social and cultural issues, and more sustainable solutions for example in cases where community members decide to continue certain activities after researchers leave.'

And so we are reminded of an African saying "If you want to go fast - go alone. If you want to go far - go together" But what if you want to go fast AND far? Perhaps this is the role for the new generation of African scientists?

Hockey stick holds up!

Nature research highlights (10 September 2008) confirm that the "Hockey stick holds up":

"A fresh analysis of climate indicators shows that the Northern Hemisphere is warmer now than it has been in at least 1,300 years. Previous analyses of climatic history by Michael Mann of Pennsylvania State University in University Park and his colleagues produced a distinctive 'hockey stick' shape; but some of this analysis, and the tree-ring data it used, came under attack.

"The latest work by Mann and his co-workers involves various climate proxies, including corals, ice cores, historical records and marine sediments. The authors show that current warming is anomalous even if all tree-ring data are eschewed."

Phil says 'it's one more piece in the puzzle concerning human impacts on the environment and makes it harder for us to deny climate change.'

Ref: The full article is available on the PNAS website: Proc. Natl Acad. Sci. USA 105, 13252–13257 (2008)

John on digital villages

John Waibochi of Virtual City gave a stimulating talk on overcoming barriers to getting modern technologies and infrastructure into rural areas. Virtual City is a private indigenous Kenyan company specialising in the development of knowledge management solutions for local business and community groups using web-based technologies.

John described Digital Villages (a Government of Kenya and World Bank-funded initiative) established in July 2007. Each Digital Village offers a range of communication and business functions that are not generally available or accessible in poor rural communities. And each Digital Village is different based on the specific needs of the local community. This personalisation is what makes them self-sustaining because people know they are going to benefit and the initiative is already having positive economic and social impacts within participating communities.

Why the second stomach?

At the end of John Waibochi's session he mentioned a tagging and tracking system for beef cattle that is now being implemented in Kenya to provide the assurances about health status that are required for export sales. Radio Frequency Identification (RFID) tags hold digital information in a microchip and this communicates with a 'reader' to provide all sorts of information about the animal's origin, disease history and health status.

He told us the device is placed in the cow's second stomach. Ok! We try to visualise ..... then Onesmo bravely asked what the rest of the non-vets are wondering: why the second stomach? how on earth do you get it there? and how do you make sure it doesn't come back out? David admitted that he doesn't know why the second stomach but hoped there was a vet in the audience that could help! Brian Perry told us that the second stomach is used to ensure that it's not expelled! And Brian also told us you get it there by 'shooting' it in through the mouth with a special 'applicator'. A quick google search and hey presto - we think we have a pic of the device! Brian, is this it?

Jeff on bird flu

Jeff Mariner talked about lessons learned from responses to highly pathogenic avian influenza (HPAI) and the different approaches that have been taken. Jeff says: Never has so much money been spent with so little strategic thought.

He talked about the shortcomings of conventional 'technically driven' interventions and the use of short term consultants. He contrasted this with community-centred 'people-driven' approaches like the one he and colleagues are using, called 'participatory epidemiology', to fight bird flu in Indonesia . This involves teams of veterinarians going into villages and tapping into local knowledge by talking to people to find out where and when bird flu outbreaks are occurring and then getting villagers to help with control efforts.

Rosemary Sang on lessons from RVF outbreak

Rosemary Sang led a session on Rift Valley Fever (RVF) and the lessons learned from the major RVF outbreak in Kenya in 2006-07 where 155 people died.

RVF is a vector=borne viral disease that comes after heavy persistent rains and flooding. People get RVF from handling livestock and their products or through infected mosquitos or secondary vectors.

Rosemary explained the sequence of events from October 2006 when the heavy rains first started (providing the breeding ground for the vectors that transmit RVF) through to the first veterinary cases (17 Nov) to the first human case (30 Nov) to the first medical response (11 Dec) to the peak of the outbreak (24 Dec) to the first veterinary intervention (14 Jan) (see figure below for dates).

How could we move the first response time back to October when all the signs were there?

The reality is that there are few health facilities in the area where people and animals were getting sick and dying. There is no mobile phone network either in the more remote regions. Rosemary explained that trying to get to the sick people was a major challenge. The heavy rains had cut off roads and when the medical response team got 5km out of Garissa town in northern Kenya, they found themselves out of mobile phone network range.

But it can be argued that more people were saved this time compared with the 1998 outbreak in the same area where 600 people died. What helped in this case was a ban slapped on slaughtering animals which prevented RVF being transmitted to more people. There's many lessons we can learn, said Rosemary, including the need for closer interaction between the veterinary and medical communities.

Patti Kristjanson explained that the workshop organizing committee had chosen RVF as a case study because it has all the complexities that we are dealing with in this challenge dialogue and how to have better response to disease.

Keith Jones summarised lessons learned:

• accessing information from community important


• prediction-related; how to improve; how to communicate better;


• importance of working together; 'one health' concept
  
• role of communications/ICTs and possibilities
  
• economic-related: tourism, trade, livelihoods, etc are all impacted; not just people's and animal's health
  
• evidence - need more basic science (eg still biological gaps including controversy over the vector!); priority research issues can be identified.

In the discussion that followed Chris Wood said that with the basic poverty and lack of health facilities in these remote area, it's hard to get people to spend time and energy thinking of how to prevent future problems when their current problem is how to survive their poverty.

Christian Borgemeister said you have 10-14 days after the start of the rains to kill mosquitos in their breeding sites.

News Report #1

This morning the communications folks led a discussion on potential news stories. Jeff Haskins from Burness Communications is here to provide media expertise and organised for journalists from the Economist, Wall Street Journal, and the Daily Nation Kenya to attend the workshop yesterday.

While the discussions going on here are very important, we need to find a way to tell the story so the media will be interested, and as a result, we can bring about more public awareness and thus support and funding of this science, using predictive technologies to eradicate/manage infections diseases across the globe.

The communicators thought there might be potential for stories on malaria and mapping, but it's early days yet.....

Storms inside and outside

The day ended with two energizing "reflections of the day" statements from two participants, Caroline Kisia and David Rogers.

Caroline said: "As a big user of the kinds of information the scientists gathered here provide, for me to hear from you all directly was very, very interesting. There is so much know-how in this room! But we all speak very different languages. The question remains, how do we take such specialized knowledge to health care and community workers? That is, in spite of all the uncertainty of climate data and modeling, what are some of the practical, actionable things we can do?"

David offered a few "heresies":
"(1) Technology is part of the solution, not the whole solution---and we mustn't impose our solutions on other people's problems. Radio is a missed opportunity here.
(2) We don't all share data---and we're not all going to share it soon. Data is power and people don't give up power easily.
(3) The good news is that these diseases are connected, so that when you begin to get better control over one, that gives you leverage over some others.
(4) Silo busting is a state of mind.
(5) We need to look at problems as they are experienced on the ground.
(6) It's all about poverty, really; we should be looking at the environment-poverty-health nexus rather than the climate-human health-animal health nexus.
David ended with a story. A farmer he met in Ethiopia told him: "My child is dying of malaria. But it's tryps [animal trypanosomosis] that's killing her."

"We owe it to that farmer to integrate our knowledge more," said David.

And, in the midst of a storm of rain, the first day of this workshop ended.

Arguments continue.....The great data debate!

We notified you earlier about the 'Start of arguments' and as we expected, they continued! And guess what!? - they're still about data!

Steve Kemp had a lively session after lunch and provoked lots of questions, opinions and passion! At the start of his talk, he (bravely) said: "There's been a collosal failure of biologists to manage their own data. Biologists have no idea how bad they are at managing data."

After his talk, many hands were raised for both questions and opinions!

Onesmo ole-MoiYoi said he was aware there's ignorance amongst animal and human health people. The plant people are aware of this too. Ecologists and agronomists have been tackling this for years!

Phil Thornton said: I don't think it is right to tar all biologists with the same brush!

Saidi Apale, a young brilliant Kenyan bioinformatician, seemed intrigued by the following quote (in this workshop's workbook) from WIRED magazine:

Scientists have always relied on hypothesis and experimentation. Now, in the era of massive data, there's a better way." - Chris Anderson, WIRED, July 2008

Siadi then asked Steve three questions:
1. Do you agree with Chris Anderson that data is replacing hypothesis?
2. Is it already happening?
3. Should we be doing it?

Steve replied saying: Yes, yes and yes!
(We think a few eyebrows were raised at this point as this might mean that machines could replace scientists!)

Steve has offered to convene a session with participants interested in further exploring the Great Data Debates!

Interestingly last week a Nature Special Issue (4 Sep) examined what big data sets mean for science? The Nature editiorial says:

"Beyond a certain point, as an increasing number of research disciplines are discovering, the vast amounts of data are presenting fresh challenges that urgently need ot be addressed.

"Above all, data on today's scales require scientific and computational intelligence. Google may now have its critics, but no one can deny its impact, which ultimately stems from the cleverness of its informatics.
The future of science depends in part on such cleverness again being applied to data for their own sake, complementing scientific hypotheses as a basis for exploring today's information cornucopia."

As the debate continues, what do you all think?

P.S. This Nature article also reminds us that it's Google Search's 10th Birthday. So prior to that you wouldn't have been able to "Google" anyone or anything! Can anyone remember that!? Happy Birthday, Google Search!

Networking for Solutions: Taking the time for collaboration

Often the science of climate change and the environment is not enough to find solutions.

The collaboration of scientists, both disease and environment specialists is needed to bring about larger more sustainable solutions.

The importance of this dialogue cannot be stressed enough, bringing scientists and practitioners together, bridging the gaps from these very different perspectives from social and environment communities. We can learn so much more from this dual pronged approach.

This collaborative workshop brings together the science complexities and social complexities of climate change and infectious diseases and how experts in these areas can come together for practical actions to get to solutions.

The first step is taking the time to network with individuals in related fields in order to start bridging some of these information gaps. `

Phil on hockey sticks!?

"In 2005 we heard about the death of the climate hockey stick!

"But just last week the BBC advised that the hockey stick has been revived!"

Ref:
Mann et al.’s “hockey stick” (1998): the multi-proxy temperature reconstruction of the Northern Hemisphere for the past 1,000 years (IPCC 2001).

Intrigued? We'll be posting Phil's presentation here shortly!

Onesmo on eradicating malaria

Onesmo ole MoiYoi talks about eradicating malaria and believes that it can be done. In fact he says it's already been greatly controlled in the highlands of Kenya, where we haven't had an epidemic since 2003.

'The burden of disease in sub-Saharan African countries contributes greatly to the continent's underdevelopment. Diseases conspire with malnutrition to weaken Africa's populations.'

'A child dies every 30 seconds of malaria in Africa. In hyper-malaria areas, 25% of household income is pent on treating malaria.

'We need to keep mosquitoes from flying. To do that we need to involve the communities fighting malaria in our research and control programs.

'We are failing because of linear thinking. Linear thinking is characteristic of the pharmaceutical industry and malaria researchers.

'We are always going after "a" solution. What we need is a holistic strategy.'

Four things you need to control malaria: 1. destroy breeding sites. 2. nets 3. get affordable drugs into the hands of people who need them. .4. community driven actions;

The Roll Back Malaria campaign which began in 2000 had all the information needed in its Abuja Declaration. It didn't suceed because at the country level that knowledge wasn't translated into actions.'

He concludes: 'I am convinced that we can control malaria with the tools we have, without waiting for a new vaccine or drugs.

'So why are we failing after 25 years? I think it's because we don't have a holistic strategy!'

This morning's quotable quotes

John McDermott at the opening:
The challenges we are attempting to address - like enhancing the health of people, animals and environments - all at the same time - these challenges are so grand that no one community dares take responsibility for them!

Keith Jones on setting the stage:
We're inviting participants to open "the zone" the
Interdisciplinary
Collaborative
Opportunity
Zone
or ICOZ for short!

Mark Smolinski on setting the scene:
google.org brings an information and technology lens to this area. We think technology can make a difference. 75% of new human diseases are zoonotic. Some are interested in the climate-human-animal health interface. Can we predict and prevent the next epidemic? We think it's a matter of not only what we know but what we should know and what we could know.

We want to get two steps ahead of the disease curve. We need to know where to look. We need to better identify hotspots. We need to integrate data sets to spur new research. And we need to use new technology. Can we, for example, somehow automate analyses of rumours of disease to stop outbreaks more quickly?

Onesmo ole-MoiYoi asks:
Why should Africa continue to use DDT when the rest of the world is not using it?

Google Earth and Predict and Prevent

In the morning Mark de Blois of Google.com's Kenya office demonstrated Google Earth now used by 400 million people worldwide. Wow! This is a 3D spinning globe that lets you drop down to view any part of the world! He also demonstrated Health Map and MapMaker which lets everyone collectively deepen information in map format.



Before this Mark Smolinski of Google.org introduced their new 'Predict and Prevent' program and explained why they chose an infectious diseases and climate focus and what they saw as the opportunities of bringing together the climate and health communities.

Starts of arguments (to be continued)

Steve Kemp, molecular geneticist:
It's all in the data; everything you're talking about can be restated as a data challenge problem.

Keith Jones, forest biologist:
Data aren't the answer. Data don't solve anything. People are the answer. They always have been.

Phil Thornton, systems analyst:
The climate data is crap, you know. We all know that.

The Start

So, the workshop hasn't even started yet---I'm just at the drinks / get together on Monday evening ---and I'm looking forward to hear about "cool" new technology stuff from the google gang and others and the first thing I hear is a story from West Africa circa 1910 (isn't that always the way). David Rogers (pictured on the left) is telling me about a British colonial medical officer in Accra named Ronald Ross, famous as a malaria modeller, who noticed standing water in villages led to mosquito and malaria outbreaks. So he built storm drains and fixed the problem! Listening intently to this conversation was Chris Woods (pictured on the right), who this summer got his OBE from the Queen! He's a brother of Sir Michael Woods - both started AMREF - a flying doctor service, some one hundred years ago :) (a third brother named Martin invented MRI in the UK as a hobby. And I start to wonder---is there anything new coming out of Africa? Anything new for Africa?

UGLY Words

We have not yet begun this workshop but already have started our "ugly words" contest.

What are your favourites?

Here are two to start us off with:

operationalize: Amy Luers couldn't even get her mouth around that (OP) word several times yesterday (which just goes to show you what good taste she has).

assimilable: actually uttered by Phil Thornton at 2.36 pm today (but he had just got off the all-night flight from UK).

Welcome to the workshop blog!

Karibu! Welcome to Nairobi! And welcome to our workshop blog on Linking Climate and Health Research to Reduce Africa's Infectious Disease Burden. The workshop is being held in Uthiru, northwest of Nairobi city centre.

We're particularly interested in making our virtual participants feel part of this workshop - despite the distance! We'll be posting regular news and updates and promise to keep things interesting, informative, provocative and fun! We encourage you to become involved and share your comments with us.

Keith Jones wondering what he's going to do now the velcro has run out!

Here's Julius Nyangaga and Muthoni Njiru on Monday evening wondering how they're going to hang posters on walls that are covered with fabric!

We look forward to engaging with you over the next three exciting, challenging and fun days!

Best wishes from Nairobi!

-- The organizing committee!

P.S. The weather on Monday was predominantly warm and sunny! If you want to keep up to date with the weather in Nairobi - check out this link to weather satelite images for Nairobi. They're fed by a receiver housed here at the International Livestock Research Institute campus. The receiver was created by a workshop participant (molecular geneticist!) at modest cost. In fact, by cutting up six coathangers and sticking them through a drainpipe! And it works!