COURTESY OF PAM MCELWEE
Peter Piot got his first dose of global public-health work in Zaire more than 35 years ago, at the bedside of the world’s earliest Ebola patients. The scene was gruesome: patients oozed thick, dark blood from every opening and died atop the rusty springs of mattressless beds. The victims of the new, lethal virus had begun trickling into the country’s dilapidated rural clinics in September 1976. By October, Piot, a Belgian clinician who had co-identified the virus just weeks earlier, was bushwhacking through Zaire’s lush jungle and sordid politics to help stymie the outbreak. He had no experience in epidemiology and it was his first trip to the country—his first time seeing the poorly equipped clinics, with untrained staff, empty medicine cabinets, and filthy conditions.
In the months and years that followed, Piot forged lasting collaborations with local researchers and doctors in Zaire, now the Democratic Republic of the Congo, as well as with international health experts. Together, when the HIV/AIDS epidemic hit the continent a few years later, they trained clinic staff, ensured that dirty needles weren’t reused—an issue that caused the first Ebola outbreak, Piot and his colleagues discovered—and helped bring new blood tests and equipment to hospitals. By 1990, the public-health laboratory they partnered with in the city of Lubumbashi had proper blood screenings and a fully functional clinical lab.
Piot’s determination to equip and train African health workers was a pioneering effort in what has come to be known as “capacity building,” defined by the United Nations as work to increase the ability of individuals, institutions, and societies to perform functions, solve problems, and set and achieve objectives sustainably. Though slow to catch on, capacity building has grown dramatically over the past several decades, with $70 million in US federal funds now dedicated annually to projects coordinated by the National Institutes of Health’s John E. Fogarty International Center.
We’re shifting away from a lone-scientist-in-a-lab model to a much more connected model.— Pam McElwee, Rutgers University
“We’re shifting away from a lone-scientist-in-a-lab model to a much more connected model,” says Pam McElwee, a human ecologist and environmental scientist at Rutgers University who studies how households and communities in Vietnam use and conserve environmental resources. Scientists are collaborating with the residents of even remote field sites, she says, and improving the local circumstances benefits both the communities and the research.
Many researchers working in developing nations see capacity building as an obligation to the communities they are studying. “It was my personal commitment to the region,” says agronomist Miguel Altieri, of the University of California, Berkeley, who for decades has worked with rural farmers across Latin America. But it’s not a straightforward endeavor. Politics within his own institution have presented the biggest obstacles for Altieri, while the logistics and shortage of resources that challenge any type of fieldwork in these areas serve to make capacity-building efforts even more difficult.
“It’s not for everyone,” McElwee admits. But the benefits to your research and the added personal perks make the extra work worthwhile, she says.
From the ground up
COURTESY OF PAM MCELWEEDespite not initially writing capacity building into her grant applications as a graduate student at Yale University in the early 2000s, McElwee soon learned that her chosen work on deforestation was a natural fit. “In the applied sciences, there are very clear connections between capacity building and research,” she says. She found, for example, that Vietnamese communities were cutting down trees largely for charcoal and illegal timber harvesting. After partnering with a local nongovernmental organization (NGO), she collected data that fueled initiatives to fund cooking stoves—which provide a reliable cooking method for villagers while sparing the delicate forest ecosystems—as well as to invest in alternative income opportunities for villagers, such as giving villagers loans for livestock. “[You] can’t really wrap your head around the problems of deforestation without dealing with the human element,” she says.
Recognizing the link between community conditions and resource use, McElwee chose to study anthropology as well as environmental science. She focused her research on resource use in the tropics, where deforestation is a major problem, and on a whim, selected Vietnam as her study site. At that time, the socialist country was just beginning to embrace a market economy, becoming more open to foreign commerce. And the fact that there were still few foreigners in the country actually turned out to be an advantage—McElwee found she had unprecedented access to top government officials, who helped her understand the nation’s environmental policy priorities. Landing a meeting with a key politician for environmental policies might take only a phone call, she recalls fondly. Now, reaching political bigwigs in Vietnam often requires several attempts and a long wait in line behind other researchers.
Talking to villagers was also crucial, she realized, but a bit trickier. She signed up for a year-long language-immersion program to get a foothold in the culture, and conducted all of her subsequent fieldwork in Vietnamese. The decision proved invaluable for long surveys and questionnaires about resource usage, and she began to understand how environmental decisions—such as cutting down a forest or preserving an estuary—affected people’s daily lives.
“People had legitimate questions about ‘Why is this person I’ve never seen before in my village, and what are they doing?’” McElwee admits. To be accepted by the villagers, she used her newly acquired language skills, but says their culture of respect for scientists also came in handy.
After she obtained her doctorate in 2004, McElwee and her now-husband Chris Duncan of Arizona State University received funding from the John D. and Catherine T. MacArthur Foundation’s Program on Global Security and Sustainability to independently study how migrants into Vietnam and Indonesia weigh decisions of development and conservation. The grant committee encouraged McElwee and Duncan to incorporate capacity building into the project, using their expertise to help train local social-science researchers.
“[G]rants are often designed to strengthen the ability of local individuals and institutions,” Jorgen Thomsen, director of conservation and sustainable development at the MacArthur Foundation, writes to The Scientist in an e-mail. This could include building capacity in land management and infrastructure development, he adds, and training locals to monitor social and environmental impacts of mining and oil extraction.
According to her husband, the work comes naturally to McElwee. “She’s a great diplomat, but she’s also willing to do the give-and-take,” Duncan says. When government officials requested her help in translating scientific reports into English, or collaborators asked her to help train a student, she would always agree, which would garner favors and good will. “She’s put a lot of time and effort into building networks,” he says.
And with such networks in place, McElwee has continued to write capacity-building projects into her grants. When she moved to Arizona State University in 2006 as an assistant professor, she started to research how climate change was altering food production and water use in Vietnam, and how these changes were affecting people’s decisions on land use and resource conservation. “Coastal areas were already seeing salinity more inland,” which is harmful to agricultural crops and alters where people choose to get water for their households, McElwee says. Furthermore, according to a study performed by the International Centre for Environmental Management (ICEM) in 2008, Vietnam’s average surface temperature has risen 0.7°C since 1950, and the flood and typhoon seasons are now longer.
In the summer of 2010, McElwee took on a consulting job with the World Bank in order to help villagers deal with the effects of climate change. She worked with Vietnamese colleagues to organize groups of villagers and farmers into workshops with bureaucrats, environmental advocates, NGO employees, and researchers, and to translate the scientific jargon of the most up-to-date global climate models into easy-to-understand local risks of increased flooding, abnormal salinity, and sea-level rises. In one workshop in March 2010, McElwee and her team gathered 69 people into an army-run hotel in Hanoi and helped kick off a brainstorming session to identify which areas were most vulnerable to lower crop yields and fewer water sources, and to develop strategies to deal with these changes. The group took over the hotel’s pool deck, laying out bulletin boards with scribbled notes and ideas tacked on.
“It was really interesting from the research standpoint because one of the main findings was that there are a lot of things that a community can do that don’t require a lot of resources and infrastructure,” McElwee says. For instance, the discussions yielded plans to adjust local lending practices so that farmers who lose their crops in violent storms or floods can quickly access funds to replant. The group also developed plans to bank some locally generated drought-resistant rice crops at a government-run research lab. The successful grassroots effort was a revelation for many international and government agencies, which had underestimated the potential for mitigating the effects of climate change in areas without substantial funding or upgraded infrastructure.
The work was successful, but it was also time-consuming, noted McElwee, who would pour hours into collecting climate and demographic data that could aid the brainstorming efforts. By this point, “half my time was spent on capacity building,” she says. But the collaborative discussions and melding of perspectives is fruitful for research, she adds. The opportunity to listen to communities tackling ongoing climate change challenges has given her a rare insider’s perspective on how the locals establish priorities and ultimately make decisions about how to use their environmental resources. She has also had a chance to observe how different groups interact with each other and has noticed some inequities. In many countries, for example, women are still held back from gaining education and prestigious positions. In one of the latest grants she won, McElwee asked for money specifically to improve the professional standings of women already trained in research—promotions that would earn them respect within their communities.
“That, I think, is something that people are going to hopefully look at and say, ‘Oh yeah, women in these positions are doing a great job,’ ” she says. “It’s shaking things up a little bit.”
A conspicuous insider
COURTESY OF MIGUEL ALTIERIMiguel Altieri trained in his native Chile as an agronomist, but during the 1973 coup d’état—in which the elected socialist president Salvador Allende was overthrown by the military-backed opposition—he fled to Colombia, where he worked on a master’s degree studying how knowledge of native agricultural systems and local traditions can improve food production. Years later, as a professor of agroecology at the University of California, Berkeley, he returned to help South American communities adopt the sustainable, crop-boosting techniques he had started developing as a grad student.
After joining the faculty at Berkeley in 1981, Altieri began taking trips to Chile, Colombia, and Brazil. Building on the established practice of intermixing crops to enhance soil nutrients and reduce crop-specific pests, Altieri provided local farmers with starter seeds of a cover crop that would boost phosphorus in the soil. Returning year after year, he watched as local farmers brought jars full of the cover-crop seeds to community meetings to share the successful strategy and help their neighbors improve soil nutrients, crop yields, and crop quality at their own farms.
He partnered with local, agriculture-focused NGOs to organize and design a three-level education system: workshops that taught basic agroecological practices, such as composting and crop rotation; then seminars on how to select native varieties of crops, including cover crops, adapted to location-specific conditions; and finally, deeper studies of soil health and large-scale pest-management methods. The trainees became trainers, and the network quickly grew to more than 2,000 peasant farmers.
By the 1990s, Altieri was working with multiple communities and had begun collaborating with the successful Campesino a Campesino network—a sustainable, farmer-led movement that began with peasant farmers in the Guatemalan highlands in the 1970s and has now spread throughout Latin America. Altieri’s group has teamed up with Campesino a Campesino members to share agroecological methods and help locals trouble-shoot challenging crops. Hillside farmers in Honduras, for example, more than tripled their crop yield by adopting new soil-conservation practices promoted by the networks. By improving their crop yield and, as a result, their influence in local markets, the farmers also gained power and prestige in their local governments; some were even elected mayors.
For a while, such capacity-building work was a side venture for Altieri, who continued to focus on his research on agricultural insect-control methods at Berkeley. The farmers were largely self-motivated, he said, actively participating in the design and management of experimental crop fields. And Altieri let his graduate students act as his hands in the field, while he met with farming organizations and led training sessions. “I could be doing both things at the same time,” he says.
Nevertheless, as he stole away to Latin America during the summers, holiday breaks, and his sabbatical semesters, Altieri’s reputation began to suffer. “I’ve never had anyone tell me you can’t do this or you can’t do that,” he recalls, but he began to feel that he was being passed up for academic promotions. When he finally raised the issue about 8 years ago with an ethics committee at Berkeley, the committee investigated and found that among his cohort of faculty members he was the second-most-productive academic, but had the smallest salary and had made the least progress along the tenure track given his time at the university. In light of the committee’s findings, the university promptly promoted him to full professor.
Despite the turmoil of his academic trajectory, Altieri still feels a strong commitment to collaborate with farmers. And like McElwee, he feels it’s to the benefit of research—if not of his salary. “We need to get away from this top-down notion that we know best,” he says, adding that although researchers like him have theoretical and technical knowledge, the traditional and region-specific know-how of local farmers is critical for creating sustainable, productive agricultural systems. “We can learn from the south,” he says.
The experience can also help motivate young researchers in an entirely new way, adds Altieri, noting that his graduate students feel just as beholden to the farmers as they do to him as an advisor. “They have to return to their community with results,” he says.
Building a home
COURTESY OF JOEL BREMENPeter Piot learned early on in his career that to get significant, long-term results, you need partnerships. Collaborating to improve living and working conditions will be slow, he says, “but it will also be more fun and you’ll make friends for life.”
Working in Zaire in the 1970s to stem the first Ebola outbreak, he was struck by the desperate poverty. But he soon realized he had a lot to learn. By spending time experiencing the local culture, “I felt . . . that socially, politically, and in terms of the epidemic’s vectors and trajectory, I could understand a little better what was going on in Kinshasa,” the capital of Zaire, he writes in his 2012 memoir No Time To Lose: A Life in Pursuit of Deadly Viruses. So when he returned from Zaire to earn his PhD in microbiology from the University of Antwerp, he maintained his connections and collaborations with researchers and health experts in Africa. And when the AIDS epidemic hit the continent, he had a front-row seat.
In 1979, he helped autopsy a Greek fisherman living in Zaire, who had died of severe meningitis and had a rare mycobacterium infection that is now known to be a hallmark of a collapsed immune system. It was Piot’s first encounter with an AIDS victim. Rekindling collaborations he had established during the Ebola outbreak, he gained access to clinic wards caring for the continent’s first HIV/AIDS patients. From Zaire and Kenya to South Africa, Zambia, and Mumbai, he treated patients holistically and allied with local researchers and doctors to improve their services. In Zambia, where poor female fishers often had to have sex with shop owners who owned refrigerators in order to store their catch overnight en route to the market, Piot and his colleagues helped arrange for women to buy their own fridges. And in Nairobi, Kenya, Piot helped set up a self-sustaining clinic and research facility on sexually transmitted infections and HIV/AIDS. Thirty years later, the project is entirely run by Kenyans.
Part of capacity building is giving a voice to people who don’t normally have a voice.— Peter Piot, London School of Hygiene
& Tropical Medicine
By the early 1990s, Piot had become increasingly involved in policy, first as the director of the International AIDS Society in 1991, then an advisor to the World Health Organization (WHO) a year later. And in 1994, he was anointed the first executive director of the United Nations’ AIDS program (UNAIDS). Seeing that he could do as much good in policy as in research, he used his authority to negotiate lower prices for antiretroviral drugs and to help build research and clinical capacity across the globe. Piot also made a conscious effort to involve HIV/AIDS patients in international policy decisions, inviting African patients to UN meetings to express their concerns and share their experiences with top leaders.
“Part of capacity building is giving a voice to people who don’t normally have a voice,” explains Piot, now a director and professor of Global Health at the London School of Hygiene & Tropical Medicine. He found himself enjoying his new role as a globetrotting policy maker, and though he admits that the travel and added time away from his family is difficult, the collaborative aspect of his work made it worthwhile. “When you’re in international research, it’s a global community, and people do everything they can to make you feel at home.”
A former intern at The Scientist, Beth Marie Mole is currently a freelance writer and an intern at Nature.