Fighting a hidden enemy

Mario Grijalva takes on Chagas Disease

 

By Nick Piotrowicz and Anita Martin

Mario Grijalva, Ph.D., has made a career of exposing and stalking a silent killer. The culprit is Chagas disease. Even though up to 10 million people are infected and 100 million people are at risk, little had been done in Grijalva’s native Ecuador to address—or even acknowledge—the problem. That is, until he and his colleagues at Ohio University (OHIO) took up the fight.

Grijalva, associate professor of biomedical sciences, runs
OU-COM’s Tropical Disease Institute (TDI), which runs multiple programs in Ecuador. The institute, founded in 1987 by Edwin Rowland, Ph.D., associate professor of microbiology at the Ohio University College of Osteopathic Medicine (OU-COM), and William Romoser, Ph.D., OU-COM early-retired professor of medical entomology, was the first Ecuadorian institution to focus on Chagas Disease. The TDI now works with international researchers and student volunteers from OHIO and around the world.

Despite its prevalence in Latin America, Grijalva had never heard of Chagas Disease until he came to OHIO to earn his Ph.D. under Rowland in 1992.

“I learned about Chagas right here in Irvine Hall,” says Grijalva. “Later I went to Ecuador’s Ministry of Health to ask about it. They said, ‘we don’t have that here.’”

They did have Chagas Disease, Grijalva would soon learn and document, and to an alarming degree. What they didn’t have was information.

From snakes to bugs

While rare in the United States, Chagas disease runs rampant through parts of South and Central America. One contracts Chagas disease from contact with the feces of triatomine insects, known as “the kissing bug.” Chronic Chagas disease decreases life expectancy by an average of nearly ten years.

The carrier insects thrive in poor housing, Grijalva says, which makes Chagas a disease of poverty. The insects thrive in Ecuador, where 38 percent of the population lives below the poverty line.

Grijalva knew little about infectious disease when he first met Rowland in Ecuador in the late 80s. At the time, Grijalva was studying snake venoms for his bachelor’s degree in biochemistry at the Pontifical Catholic University in Ecuador (PUCE), when he was recruited to join the TDI by Rowland’s colleagues, Romoser and Malcolm Powell, Ph.D., retired OHIO biologist.

The work of Ohio University’s researchers at the TDI inspired Grijalva to earn his Ph.D. in immunoparasitology and molecular biology at OHIO.

Blood banks and healthy housing

In 1999, after a brief postdoctoral stint at the Centers for Disease Control and Prevention (CDC) in Atlanta, Ga., Grijalva returned to join OU-COM’s biomedical sciences faculty. One year later, he established and directed the Center for Infectious Disease Research at PUCE, created in partnership with Ohio University.

Grijalva was named director of the TDI in 2006. “TDI recognizes the importance of science as a tool to help the people,” Grijalva says. “I have grown with the institute, and once I was able to, I took it further.”

Among other things, the institute now focuses on cleaning up the Ecuadorian blood supply. Because people with Chagas can go decades before they notice symptoms, many blood donors have the disease without knowing it, he explains.

“We found that the blood screening for Chagas was not adequate,” Grijalva says. “Then we dug deeper and found that there were major difficulties with blood screenings for all diseases.”

In response, the TDI established the External Performance Evaluation Program for the Blood Banks of Ecuador, which periodically tests the ability of the blood banks to screen the blood supply and offers a certificate training program to blood bank workers. The certificate is now required for all Ecuadorian blood bank technicians.

However, part of the problem is that many small, dispersed blood banks cannot afford to maintain the necessary quality control. Grijalva has been promoting the centralization of all blood-bank screening to one major facility in Ecuador. That facility has been built, and testing is gradually being transferred there from all over the country.

Although documenting the problem and cleaning up the blood supply are major victories, the fight against Chagas doesn’t end there.

“It’s clear to me that unless something is done about housing conditions, we will never be able to prevent Chagas disease on a large scale.” Grijalva says.

The TDI’s latest project, provisionally termed Homes for Health, will investigate and implement strategies in improving housing. Grijalva is working in partnership with OHIO’s Center for International Studies and PUCE to launch the effort in summer 2010, but the scope is long-term; Grijalva estimates that this is at least a 10- to 12-year project. The first step, he says, is to better understand the housing situation from a socio-cultural perspective, in order to find solutions that are effective, sustainable and accepted by the population. He and a team of students are beginning to assess available resources and examine what other institutions have done to improve housing.

Student collaboration

In addition to Ohio University, the TDI has hosted students from more than 20 universities across the U.S., Europe, Australia and New Zealand as volunteer research assistants.

One Ohio University participant, Cara Norvell OMS II, will never forget the first time she saw the poverty in Ecuador up close. Driving down a dirt road on a muggy June night, she could see the Ecuadorians in their home settings because, she says, their houses have multiple large gaps in the wood exterior.

“The houses were not even up to American standards of poverty,” Norvell says. “Insects could come in and out of the house without restriction.”

Grijalva and his TDI team of students and scientists do everything from gathering field data to searching homes for nests of kissing bugs and killing them with insecticide. Lately, Grijalva has been collaborating with faculty and students from OHIO’s School of Media Arts Studies and its School of Visual Communications to create multimedia projects documenting and promoting their efforts.

“He takes students from every level—graduate, undergraduate and medical—and gets great reviews in every category,” says Deborah Meyer, Ph.D., R.N., administrator of the OU-COM Department of Geriatric Medicine and Gerontology.  “And what strikes me was how high the (program) ratings are, across the board.”

 

For Grijalva, seeing how students respond to conditions among underserved populations makes the process more rewarding. “It’s really inspirational to see the dedication of the students, the passion they show and their eagerness to serve people who need it most,” he says.

 

Forward march

Now in its 22^nd year, the TDI is as successful as ever. In addition to the support it receives from OHIO, the TDI received nearly $265,000 in external grants during the last fiscal year, including more than $200,000 from the National Institutes of Health. The TDI’s documentation of Chagas disease through records, both written and multimedia, has encouraged the Ecuadorian government to support their efforts to stop Chagas.

Meanwhile, Grijalva has taken his expertise to an international forum. In 2007, he joined the Global Chagas Initiative within the United Nations’ World Health Organization. He serves as a co-coordinator of the Surveillance and Information Systems Group.

As Grijalva and the TDI keep churning along, solving the problem no longer seems impossible.

“I have a clear vision of what we need to have in place to advance these efforts, so I have been working for many years to make that vision a reality. And, I’m pleased to say, significant progress has been made,” Grijalva says. “One step at a time, but every day we are closer to our long-term goals.”