This month, we sat down with researchers to hear more about a collaborative project in Suriname, the smallest country in South America. Through grant funding provided by the NIH Global Environmental and Occupational Health (GEOHealth) program, lead researchers Maureen Lichtveld, M.D., Wilco Zijlmans, M.D., Ph.D., and Dennis Mans, Ph.D., are working to better understand environmental health threats and build research capacity in Suriname.
Rainforests, rivers, sporadic power, and limited roads are only a few of the challenges the research team faces while developing and conducting the first environmental health research projects in Suriname. But solar freezers, airplanes, and boats will help the team overcome these challenges through their newly established Caribbean Consortium for Research in Environmental and Occupational Health, the very first NIH-funded research program in the country.
The consortium, or hub, is a result of awards through the GEOHealth Program, which have facilitated a unique partnership between institutes in the U.S. (Lichtveld) and the Research Center at the Academic Hospital Paramaribo (Zijlmans) and the Faculty of Medical Sciences at the Anton de Kom University of Suriname (Mans), both in Suriname.
Developing a Partnership and Implementing Research
Lichtveld and Mans, who met years ago as grade school classmates in Suriname, reconnected in 2008 and began an informal collaboration between their respective institutes. In 2014, joined by Zijlmans, they officially established the Caribbean Consortium for Research in Environmental and Occupational Health with the help of a GEOHealth hub planning grant.
The planning grant allowed the team to conduct initial work to characterize and quantify environmental health threats in Suriname. Building on this work, the team recently received a 5 year award to study the health impacts of neurotoxins from mining and agricultural development.
“Suriname is facing a triple public health burden: high perinatal mortality, environmental contamination potentially related to growing mining and agricultural development, and a lack of environmental policies to protect their populations, especially vulnerable pregnant women and their infants,” Zijlmans noted describing the team’s inspiration.
The team’s first project focuses on mercury contamination in fish and waterways from artisanal mining operations. Prompted by its previous findings that fish living in Suriname’s rivers contain elevated levels of mercury, the team is now exploring how mercury exposure from fish consumption may impact human health.
After detecting levels of unregulated, internationally banned pesticides in local produce, the research team initiated a second project that is exploring the extent of pesticide contamination and potential impacts on residents. In addition to produce, the team is investigating commonly used medicinal plants and herbal remedies and how, despite their potential protective value, these may introduce additional exposure to contaminants.
Understanding how environmental exposures affect child health and development is a major focus for the research team. For its primary project, the team will initiate a maternal and child cohort study — the first of its kind in Suriname. Set to launch in May 2016, the team will follow 1,000 pregnant mothers from various regions of Suriname from their first trimester to delivery. Children of mothers who experience the highest and lowest exposures will be followed for four years. The team will then study how changes in DNA are influenced by exposure to pesticides and other environmental stressors and whether these DNA changes could predict future disease outcomes.
“Mother and child-care has been my priority both as a clinician and researcher from the very beginning.” Zijlmans noted, adding that his past studies have helped inspire the team’s current work. “I was previously involved in a nationwide prospective study on perinatal and infant mortality. Preliminary findings indicate high rates of perinatal mortality and approximately 1 in 5 pregnancies end in at least one negative birth outcome. From this research, there are piling indications that as a result of its abundant use, neurotoxicants have a negative impact on perinatal mortality; however, we do not know the exact impact on the health of mother and child since we were never able to measure it properly. With this research project we hope to find answers and proof.”
Leveraging Local Knowledge and Engaging Communities
Zijlmans, a pediatrician by training, has worked closely with many of the Suriname medical mission clinics that provide health care to native communities. His experiences and relationships have helped ensure access to villages and care workers as well as help build local relationships and trust. Through his existing relationships with medical mission clinics and communities, he has helped the project address the logistical challenges of returning samples from the field to the capital city of Paramaribo.
Brad Hawkins, Ph.D., a research coordinator for the studies in Suriname, noted that his team was reminded of the importance of education and community outreach when they returned to a village to explain mercury findings. “Previously, the village residents had blood readings taken. As we explained what mercury was, they started bragging about who had the ‘highest number’. Although these results had been available to them previously, they were not provided with any context or education on why mercury is bad for their health.”
One of the core elements of the GEOHealth program is building research capacity and training.
Each summer, masters and undergraduate level public health students from Tulane have the opportunity to travel to Suriname to learn first-hand about research challenges and needs there.
Short-term training and longer-term degree training are integral components of building research capacity in Suriname. Five researchers involved in the maternal and child health cohort study are also working to earn their doctoral degree from the University of Suriname through courses instructed by Tulane faculty.
“The training program reflects the embedded participatory nature of public health,” Lichtveld noted. “When we get together on this study, it’s not just two different countries. It involves researchers from five or six different disciplines. A multidisciplinary team is how public health works, and that is reflected in the diverse interests of our Ph.D. candidates.”
Looking to the Future
The team has initiated briefings with government ministries of health and education to discuss their research interests and findings. “We want to help build the science base to inform the necessary environmental policies,” Lichtveld stated. They are also working to establish relationships so that their findings are trusted and can be used in making policy decisions.
“We have to start building their engagement and understanding now, so that our results can be used in the future,” Ziljmans added. “there is a growing awareness in the whole of Suriname on the negative impact of these neurotoxicants, especially in the interior there are Amerindian villages where women purposely avoid pregnancy for that reason. If we find that neurotoxicants have a large impact on the health of women and their children, we will report this to the authorities in order to adjust current health care policies. We are grateful that the Director of the Suriname Ministry of Health is on our External Advisory Board and that we have had full support of the Minister of Health himself from the very beginning.”
Global Environmental and Occupational Health Hubs (GEOHealth)
The GEOHealth program aims to explore global, environmental, and occupational health worldwide and supports development of institutions in low- or middle-income countries (LMIC) that serve as regional hubs for collaborative research, data management, and training. These hubs are supported by two coordinated, linked awards: one to a LMIC institution for research and another to a U.S. institution to coordinate research training.
The Fogarty International Center (FIC) is coordinating and partially funding the awards, in collaboration with the National Cancer Institute and NIEHS. Also providing support is the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention. Canada's International Development Research Centre is contributing to the funding of research led by LMIC scientists. The Global Alliance for Clean Cookstoves is also participating in the GEOHealth program by offering supplemental funds.