Science and Health Care in Madagascar:
An Integrated Approach

Herrnsteins Donate $3M to Establish Global Health Institute, Simons Match Raises Total Impact to $6M 

Herrnstein Family

On one of Jim Herrnstein’s early visits to Centre ValBio, a frantic mother rushed into the Madagascar research station carrying her four-year-old daughter. The little girl was burning with fever. It wasn’t malaria, but, beyond that, the cause of her sickness was anyone’s guess. A staff member sped the child to the nearest hospital, hours away, but the little girl didn’t survive the trip. Jim, having watched the events unfold, was deeply struck by the loss of the little girl.

“There's just an enormous need, in terms of the health of the people, and you can't help but see that when you're over there,” he said.

The native Malagasy people are among the world’s poorest; more than two-thirds of the population of 22 million live on less than one dollar per day. The mortality rate for children under five in the region surrounding Centre ValBio is a dismal 18 percent.

Jim Herrnstein and his wife, Robin, are parents of five children themselves. They are also accomplished astrophysicists — each holds a doctorate from Harvard. When Jim and Robin see a problem, they approach it not only as compassionate parents, but also with the systematic precision of scientists.

They threw their support behind the construction of Center ValBio’s state-of-the-art research facility, NamanaBe Hall, by funding a $3.5 million facility that includes a biosafety level 2 laboratory for infectious disease research. The research station now houses robust conservation biology and infectious disease research programs. Robin serves on Centre ValBio’s advisory board, and Jim is the chair of the board. 

The research center is the product of nearly three decades of work by primatologist Pat Wright, a professor of anthropology at Stony Brook who founded Centre ValBio in 2003 after establishing a national park nearby in 1991. Pat’s close relationships with local Malagasy communities and the rich scientific potential of Centre ValBio are what drew Jim and Robin to Madagascar in the first place, they say.

“Pat’s remarkable efforts in Madagascar and the fact that we have a state-of-the-art research facility there are incredible advantages,” said Stony Brook President Samuel L. Stanley Jr., MD. “They provide a very strong foundation for research programs in the region.”

“Many great things were already happening at Centre ValBio when we arrived, in terms of research and conservation and outreach. It was clear that these efforts were all feeding off one another, and from the start we were focused on making even more explicit the interplay between the science and the conservation and the outreach,” said Jim. “We were constantly asking ourselves ‘Can we do more, and do it in a scientific way?’”

Now, Jim and Robin Herrnstein have launched an ambitious new effort to bring health care resources to the region. Their recent gift of $3 million will help establish a new Global Health Institute at Stony Brook University. The Institute will drive cutting-edge health research in the region while working closely with Centre ValBio researchers and the Herrnsteins’ new nongovernmental organization, called PIVOT (www.pivotworks.org), which will be tasked with health care delivery in local villages.

“People say, ‘Why make it so complicated? Why pour money into labs and infrastructure at a scientific research facility instead of simply building clinics and sending over medicine?’” said Robin.

“But it comes down to this conviction we have: scientists with the NGO, the Global Health Institute and the conservation effort all working together in the same room as the people doing the health care intervention — it could lead to something really spectacular,” said Jim. “Not only saving a lot of lives, but doing so in a more sustainable, more scientific, more generalized way.”

“We really think we can break the cycles of poverty and disease,” he added. “There are complicated relationships between health, birth rates, economics and so on, and causality can be difficult to untangle: Are the people sick because they are poor, or poor because they are sick? Are high birth rates driven primarily by infant mortality rates, by economics, or by ignorance? What is the relationship between ecological and human well-being? The answers will undoubtedly be as complicated as the questions, but we feel we are in a special position to address these problems head-on. In the process, we hope to save many, many lives, and this is the bottom line we are focused on. But we also hope to make real progress in understanding the dynamics of, and interplay between, poverty and disease. Along the way, our ambition is to break these people out of the poverty trap they are stuck in.”

A special place

Jim and Robin HerrnsteinLocated off the southeastern coast of Africa in the Indian Ocean, the island of Madagascar encompasses a wide range of ecosystems, from deserts to dense rainforests. Despite its rich biodiversity, the country is among the ten poorest in the world.

When primatologist Pat Wright began working in Madagascar 26 years ago, she went with the intent of tracking down a lost species of lemur. Her field research eventually blossomed into a full-blown conservation and humanitarian endeavor as she led the effort to establish Ranomafana National Park and coordinate outreach programs to help the struggling villages abutting the park.
 
“The first time I visited all these villages, about 60 of them, was 1987, and I realized how poor the people were and how much they really needed assistance,” said Wright. “And I wanted to do whatever I could to make their lives better.”

Wright founded Centre ValBio to help both indigenous people and the international community better understand the value of conservation in Madagascar and around the world.
 
“When I visited in 2009, I was immediately struck by not only the beauty of the spot — it's so utterly remote and beautiful, and the ecosystem is so spectacular and unusual and pristine — but also Pat’s connection with the locals,” said Jim. “It’s really a relationship built on mutual respect.”
For this, Wright credits the wide scope of Centre ValBio’s research objectives.

“We started studying humans and wildlife at the same time, and that’s been a very good thing for this region,” said Wright.

Research efforts have included studying how villages’ economies affected their use of the park and their deforestation habits. A recent paper showed that people receiving benefits from the park, such as funds from entrance fees, are causing less forest destruction, and their villages are more economically sound than others. The Centre also employs medical staff and social workers who regularly visit local villages.

“Pat lives in a world where what's good for the people is also good for the rain forest,” said Jim. “She doesn't believe it's an either/or scenario. If you educate the people, teach them about conservation, improve their health and provide them with some sort of economic boost, perhaps via eco-tourism, it will be good for the people and it will be good for the rainforest and the lemurs. That's her holistic view, and it’s hard not to buy into it when you visit Centre ValBio.”

“It’s also hard not to immediately become connected with the people,” said Robin. “The Malagasy are incredibly open and friendly, and they just want help making it on their own. It’s very easy to get caught up in their lives. They, along with Pat, are what drew us to this region.”

A unique partnership

Stony Brook’s new Global Health Institute will work hand-in-hand with PIVOT, the Herrnsteins’ new NGO, and Centre ValBio’s research facilities. In addition, PIVOT will receive a healthy dose of support and guidance from Partners in Health, an organization with ties to Harvard University and Brigham and Women’s Hospital that’s successfully led health care interventions in Rwanda, Haiti and other locations.

“Talking with Partners in Health, it became clear that for a manageable amount of money, we could make a huge difference,” said Jim. “We’re going to do it in such a way, using the critical resources of Centre ValBio, that we can take a scientific approach — collecting data, evaluating what we're doing and making sure we're doing it in the most effective way.”

The strength of the partnership is two-fold, Robin added. Besides partitioning research and intervention responsibilities between the Institute and PIVOT, the close working relationships among those involved will likely lead to a productive, collaborative environment. 

“Everybody is doing what they do best,” Robin said. “People with PIVOT will be working on actually delivering health care, and the University will focus on research and education, but we're all doing it together, at the same place and at the same time. If the Global Health Institute can build a reputation for doing that well, I think we’ll call it a success.”

The Herrnsteins, together with Dr. Stanley, who is a nationally renowned expert in the field of emerging infectious diseases, expect the new Institute will take on broad global health research initiatives. Bench science, including molecular biology, microbiology and infectious disease research, will certainly be a major component, as will a broad range of health-related sciences. 

The Institute could also be a unique training ground for both residents from Stony Brook and Malagasy doctors, Jim said. For example, later this year, through a project launched 14 years ago by Stony Brook paleontologist David Krause, a team from the dental school will visit the region, marking the first time local villagers will have ever received professional dental care. 

“This partnership is special because, 1) Centre ValBio has been there for 30 years and Pat has a wonderful infrastructure in a remote area where there's a huge need, and 2) at the same time the Global Health Institute is coming to life a new NGO is coming into existence,” said Jim. “We're hoping that those two will work together and feed off each other. There's no substitute for having people on the ground doing health care in the villages, collecting data and experiencing first-hand what the actual health issues are.”

The Herrnsteins’ NGO, PIVOT, especially in its early stages, will rely on the guidance of health care intervention experts from Partners in Health, including Matt Bonds, a Harvard researcher who holds doctorates in economics and ecology. Bonds serves as the interim director of PIVOT.

“What's most unique about the overall scheme in Madagascar is its extra focus on research and scientific inquiry, led by Stony Brook, that aims to amplify the health impact,” said Bonds. “That’s where I see great potential, and it’s especially exciting if done well.”

For example, an initial survey found that the cause of 80 percent of all fevers in the villages around Ranomafana National Park is unknown — like the fever that sickened the little girl during Jim’s visit years ago. Local clinics can test for malaria, but if that test comes back negative, doctors are left guessing.

“They just throw some broad spectrum antibiotics at them and say, ‘We hope you get better,’” Robin said. “You can't treat people if you don't even know what they're sick with. If you have scientists in the field doing health-related research, suddenly at least there's information there and people will know what diseases are being carried by the human population, the livestock and the animals within the rainforest.”

Having Centre ValBio as a state-of-the-art research and academic hub is an incredible advantage for this partnership, said Dr. Stanley. Another major advantage is the Herrnsteins themselves.

“In Jim and Robin, you have two people who are very special. They have extraordinary commitment to this, and I'm continually impressed by their dedication,” Dr. Stanley said.

Bonds, of Partners in Health, believes the single biggest advantage is Jim and Robin.

“For most new NGOs, funding is what keeps the directors up at night. While we will still need to fundraise, Jim and Robin provide a very strong foundation that we can rely on, which allows us to focus on our jobs,” he said.

“It could take five, maybe even ten years before others see the real extraordinary vision behind this initiative,” Bonds added. “It amounts to unique relationships between a health care NGO, cutting-edge scientific research and a conservation effort in one of the world’s biodiversity hotspots. There is an intellectual backbone to this health initiative that is more rigorous and exploratory than any I've known. Thanks to the groundwork already done by Pat Wright, I have a feeling that we'll all, especially the field team, be continually inspired by the opportunity and also by each other.”

People make a big difference

Finding the right person to lead that team is the next challenge for Dr. Stanley and the Herrnsteins.

“People make a big difference,” said Dr. Stanley. “The inaugural director of the Global Health Institute will be a very exciting position, but it's going to require the skill set of someone who has a vision and is also capable of implementing it.”

Jim Herrnstein stresses the multiple roles the director will need to embrace.

“We need someone who has the imagination and resources to pull together a Global Health Institute that’s designed to take advantage of the unique relationship with Centre ValBio and PIVOT,” he said. “That means a director who is capable of wearing many hats. Three immediately come to mind: someone who is capable of promoting health sciences, broadly speaking; someone who will promote the kind of research that will directly benefit the health intervention, such as collecting economic data and evaluating the intervention’s progress; and someone who's comfortable working with Stony Brook’s medical school.”

Dr. Stanley is enthusiastic about the new Institute and sees it as an opportunity to pull disparate parts of the University together. Though benefits will be dramatic in the region around Centre ValBio, they will likely extend far beyond Madagascar.

“Global health is an immediate problem for everyone. With today's jet travel, there is no more natural isolation. Controlling and containing infectious diseases in other regions helps prevent their spread around the world, so advances in health delivery and implementation can have positive impacts in the U.S. as well,” said Dr. Stanley. “As we think globally as an institute and as a country, the benefits of promoting health worldwide are immense.”

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