Penn One Health goes abroad

J

ames Ferrara, a third-year student in Penn’s School of Veterinary Medicine, grew up in Montvale, N.J., with his family’s Labrador retriever, Cody. When Ferrara was 10 years old, Cody, also 10, suffered from arthritis and had to be put down. Ferrara says that this childhood experience encouraged his interest in veterinary medicine. While he hoped to one day minimize animal suffering, he later learned that animals and humans have a global impact on each other’s health. 

As an undergraduate at University of Colorado Boulder, Ferrara met students from Nepal who volunteered for an organization called GlobeMed, which partners grassroots efforts at universities with non-profit organizations. Ferrara’s GlobeMed chapter worked with Himalayan Healthcare to address issues in impoverished areas of Nepal, and he says he learned a lot about global health from the Nepali community in Boulder. Ferrara found he could combine his love for animals with a public-health perspective through One Health, which analyzes and addresses health issues at the intersections of human, animal, and environmental health. 

Ferrara has carried that interest into his graduate studies and outreach work at Penn Vet. In early August, he will travel to Kathmandu, Nepal, with two other Penn students, Akudo Ejelonu and Hanna Stambakio. Ejelonu earned master’s degrees in public health and environmental studies (M.P.H./M.E.S.), and will soon begin work on a Ph.D. in demography through Penn’s Population Studies Center. Stambakio has an M.P.H. and works as a clinical researcher at PennMed Urology, and she’s working on an M.E.S. as well. The team received the Provost’s Fellowship for Interdisciplinary Innovation and will partner with the Center of Molecular Dynamics Nepal (CMDN) to conduct baseline research on Campylobacter, a bacteria found in unpasteurized milk and animals’ digestive systems. 

The bacterium causes campylobacteriosis, an infection that can produce bloody diarrhea and severe abdominal cramps, and is often accompanied by nausea and vomiting. If someone has a weakened immune system, campylobacteriosis can spread to the bloodstream, causing a life-threatening infection. 

“People in Nepal consume a lot of raw milk,” says Ferrara. “Because Nepal’s dairy industry isn’t consolidated, there aren’t standardized practices for dairy, which means it’s overall less safe.”

Ferrara explains that there’s not much information about Campylobacter in Nepal currently. Because the disease is zoonotic, meaning it can be transmitted between humans and animals, Ferrara and his peers decided to utilize a One Health, holistic perspective to conduct initial surveys related to risk factors by asking people how they consume milk, how they treat it after purchasing it at markets, and how farmers avoid risk factors on their farms. They’ll also ask how people interact with animals, along with questions about hygiene habits. 

“We really want to hear their perspective on animal health,” says Ferrara. “This animal perspective is particularly important to our One Health approach because Hindu cultures often revere cows, which are the reservoirs for disease in this case.”

Because of their reverence for cows, Nepalis don’t euthanize those that are sick, Ferrara explains. Instead, they isolate sick cows for life. While this might raise ethical concerns, it also can lead to disease transmission; even if the cow is isolated, Campylobacter can travel via water runoff, infecting both human and animal drinking water. 

With CMDN, the team plans to collect sewage and water samples to detect levels of Campylobacter. They’ll also analyze fecal samples from children younger than five, because they are more susceptible to disease. 

“If we detect Campylobacter in a sample, we’ll ask that child’s parents about risk factors. Then we analyze the risk factors: What are those with Campylobacter doing differently? That’s how you make interventions. That’s how you start public health education.”

Along with a focus on humans and animals, Ferrara says the environment will play an eventual role in the study as well. The Center of Molecular Dynamics Nepal will provide yearly average temperatures so that the Penn team can compare these with bacterial loads. Ferrara suspects that, as the climate warms, the bacteria will thrive, leading to even more frequent transmission of the disease. 

“The One Health perspective is inherently interdisciplinary,” says Ferrara. “As a vet student, I understand disease dynamics in the animals and how that impacts humans. Akudo studies demography, so the cultural aspects are right up her alley. Hanna is a clinical researcher in urology, and she’s in the environmental studies program, so she knows a lot about creating and conducting surveys. Things really come together when you get a lot of collaborators who are outside of your own field.”

The three students met in a class called One Health Study Design, which Ferrara helped to create with Jennifer Punt, the associate dean of One Health education at Penn Vet. Ejelonu and Stambakio were among three students outside of Penn Vet who signed up for the course. Ferrara teamed up with them on a class assignment to give a presentation about how climate change in Chad can lead to vitamin A-deficient plants, which in turn leads to vitamin A-deficient cows, and eventually leads to vitamin A deficiency in humans who rely on cow products.

“Vitamin-A deficiency is a huge indicator of malnutrition,” says Ferrara. “It can cause blindness. After presenting other researchers’ studies in class, now we’re doing our own study on a different health issue, this time in Nepal.”

Ferrara says he has thought a lot about how to make this trip both impactful and sustainable. “This is really important to me,” he says. “Our mindset has to be a learning one. While we’re on our way, we’re not experts yet, and we have so much to learn.” 

Ferrara  has ambitious goals for the Nepal project. He envisions widespread public health education and disease-intervention projects in Kathmandu. He also wants to create a lasting partnership with CMDN and maybe even expand the partnership to all of Penn Vet.

He says he also hopes his trip to Nepal will serve as a model for future projects and sees no bounds for One Health’s potential at Penn. Eventually, Ferrara wants to establish a One Health Center on campus where students and researchers can foster ideas and develop intervention projects. 

“It’s really about the One Health perspective,” he says. “Maybe we have our separate expertise, but One Health is a vehicle to bring people together to tackle more complex, interdisciplinary issues.” 

It’s a model he hopes to continue using throughout his career.  

“In 10 years, if I was doing this same kind of research and if I was able to implement interventions based on research, I’d have the ideal career. I love the idea of discovering global health information you can use.”