Adaptation Key in Director's Fight Against Parasites

In Guatemala 25 years ago, on a coffee farm situated at the slope of a volcano, Frank O. Richards Jr., M.D., sat under a thinly thatched roof talking with an old man. Chickens foraged on the dirt floor, and a mangy dog slept in the corner. As the day's last rays of sunlight streamed in, Richards asked the old man in Spanish, "What is the most important disease in this community?" Richards was field-testing survey questions to see how receptive people would be to taking a new medicine to treat the parasitic disease river blindness.

"Can you imagine that the poverty here in this community simply cannot be escaped?" the man said.

To Richards, the man's insight was profound. "It was like an arrow to my brain — the idea that poverty and hopelessness promote disease. It's a cause and a consequence," he said. "And a downward spiral."

As director of several health programs at The Carter Center, Richards has seen the link between poverty and disease around the globe. And although poor living conditions persist in the communities where the Center works, significant progress has been made since that day on the coffee farm.

Richards is still on the front lines of the fight against river blindness in Guatemala, and last year the country announced it had stopped transmission of the disease, which can cause severe itching and rashes and lead to blindness. The feat was accomplished through a 20-year program at the Guatemala Ministry of Health in partnership with The Carter Center and others, involving twice-per-year administration of the drug Mectizan® (donated by Merck) and health education.

"This success has been a tremendous thing for me both personally and professionally," Richards said.

A native of St. Louis, Mo., Richards followed in the footsteps of his father when he pursued a medical degree. But while his father was a practicing surgeon, the younger Dr. Richards began to pursue a career in global health with single-minded interest during medical school at Cornell University. "After a lecture on schistosomiasis, I was sold," said Richards, who also now heads the Carter Center's Schistosomiasis Program.

He specialized in pediatrics because he knew that in the developing world, children suffer the most. With a focus on preventive medicine, Richards wanted to give these children a better chance at healthier lives.

"Besides treating children who are sick, pediatricians worry about vaccinations. They worry about growth and development. It's about keeping children well," he said.

After his internship at Children's Hospital Los Angeles, he headed straight for the Centers for Disease Control and Prevention and eventually landing a five-year assignment in Guatemala to research malaria and river blindness.

"I worked on these two diseases from the human side and also the insect vector side," Richards said. A vector is the transmitting agent in infectious disease, a tiny black fly in the case of river blindness and a mosquito in the case of malaria. "One unique aspect of the Carter Center's work is our focus on the vectors," he said, noting that most nongovernmental organizations focus primarily on program implementation, rather than research.

Calling the approach "interventional research," Richards and his colleagues on the Center's health staff constantly monitor and evaluate their work, publishing results whenever possible in medical journals. Such an intense focus on analysis provides the foundation for swift adaptation.

"We need to be flexible and aggressive in our efforts to stop transmission of these diseases," he said. "A one-size approach does not fit all needs. Where interventions are not working, we alter or ratchet up our efforts."

Although the rigorous analysis is gratifying for Richards, it is also a means to an end — better lives for people in poor communities. "There is this interconnectedness with the science, an economic, social, political, and cultural fabric that relates disadvantage and poverty with these diseases," he said. "I think about that a lot."