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Eva Harris: Making Science Democratic and Sustainable

See also: Expanding Reach! (blog by Deven)

Jan 16, 2016

Geet: I am really excited to be having a conversation with Eva. She is a Professor in the Division of Infectious Diseases in the School of Public Health and Director of the Center for Global Public Health at the University of California Berkeley. It was while peering down a microscope at High School that Eva first became fascinated with the possibilities that science could offer. She says, "I am still amazed by the beauty and the structure and the processes of the human cells. I think of the cell as a molecular corollary of human life. With so many different structures and functions working together for the greater good of the whole." She abandoned post doc plans to focus on scientific capacity building, running workshops in Ecuador, Bolivia, Cuba and Guatemala. She continued her work in Nicaragua, which at that time was centered on Lieshmaniasis. Her profile was an emerging power of what we now know as Global Health. This resulted in prestigious MacArthur fellowship in 1997, which enabled her and like minded colleagues to create the sustainable science institute in San Francisco, of which she is the President. When she is not working, she enjoys spending time with her 14 years old son and dancing.  So welcome Eva!

Eva: Thank You!

Geet: Your first exposure to Central America, especially Nicaragua, seems to have happened under very interesting circumstances. That was the time of your undergraduate studies. Could you share why you chose to go there and what your initial experiences were?

Eva: First, I just wanted to thank you very much for inviting to be on this call. It's just a really interesting space and I really applaud bringing together people who care about a more just society and changing the world for the better. It’s wonderful way to pull people together.  Thank you so much for including me. I'm really honored to be considered a part of this community.

As you mentioned, I was always been really fascinated by science, but I also felt this driving need to make some kind of impact in the world and trying to put those together wasn't inherently obvious about 25- 30 years ago when I was starting all this work.

I had a pretty traditional academic career to that point and had done my undergraduate in Bio-chemical sciences at Harvard. That was during the Reagan 80's. And I was very upset, as I am today about US Foreign policy and Domestic policy. In this case it was the Contra war against the democratically elected government in Nicaragua. Death squads were being supported in El Salvador and really nasty stuff was going on. In addition, Harvard at that point invested in South African Apartheid regime. Those together made a lot of political activity during my Undergraduate year. During that time period we ended up divesting from South Africa, which is really important. We did a lot of protests around that and then also around the Central America issue.

I felt that, here is my training in the hard sciences and yet there was a lot of political motion and I felt very strongly about trying to make a difference. I was trying to put the two together. And so I figured after doing many demonstrations and doing what I could here, I felt that the next step would be, as they say put your money where your mouth is, and actually go and do something. I chose at that point to go to Nicaragua because there was a revolution that was ongoing and it was during the 80's towards the end of it. It was in 1988.

At that point they were really trying to create a new society and put health and education at the front. And I wanted to see whether I could use my scientific training in some ways. So I ended up going and connecting with an organization that took volunteers to Nicaragua and got the visas and what not. It was kind of humorous because most of the people that they worked with were folks like computer scientist who had 2 weeks off and could do something useful in a short period of time as a volunteer and I wanted to do something in biology. Really, no one new what to do with me. I grew up between New York and Paris. So I was fluent in French but I did not know Spanish at that point. So I had taken may be four weeks of Spanish in Barcelona, again inspired by the Spanish Civil war to be there and So I had just some rudimentary Spanish and I just decided to go and landed in middle of Central America during the war between the United States and Nicaragua where there had been an embargo for about 10 years.

So it was a really dramatic moment, because it also happened to be the two hottest months of the year. So it was over 100 degrees and actually there was nothing on the country. There was barely any water. There were no plastic bags; there was no toilet paper. It was very dramatic after all of the years of work there. The day I got there the US had sent troops to the border and they devalued their currency by thousand fold. So I kind of had no money for the time that I would be there. So it was just a phenomenal experience because I was kind of a drop off at the ministry of health and here I had been trained in Harvard and Paris and I had worked in Switzerland and all these wonderful places and came here with way different set of skills from the reality. It was kind of most humbling and frightening experience in my life because, people turn to me and I was may 21 years old, with a completely different kind of training which actually is not a match with the conditions. The problem I had to solve was that I needed to get endotoxin free serum to the soldiers at the front lines and they had Vitamin A deficiency and they had infectious diseases and I had a completely different back ground.

I felt really overwhelmed thinking, "How could I at this stage in my life help people who have been running their own lives and their revolution and creating their own voice against the most powerful country in the world and here I am supposed to help them?" It just seemed so laughable. But I took that on as a life challenge and listened to what it is that they needed and started teaching, English, scientific English, started learning about the diseases that they were working on and then over the next, now 28 years, have ... when I first came back, I just looked for ways to help with what they were doing. But then, one of the things that I really wanted to learn was molecular biology. And at that point we were able to make a link despite the rudimentary conditions there through new revolutionary methods in molecular biology that we were able to acquire directly to the health problems in Nicaragua and actually it turns out in all of the Central America and a lot of developing world as well in terms of diagnostics. So identifying the agents that cause infectious diseases and understanding how they cause disease and being able to act upon that. So that became the life pathway along with setting up more sustainable structures to help build more scientific capacities in developing countries.

Geet: That's a fascinating story. So was that the reason you wanted to pursue a PhD after that? Was that the inspiration behind it?

Eva: No. Actually, I have a split life. Part of my life look as if it is a standard career. Like I said, I did my degree in Bio-chemical sciences and at that point the next thing you do is to apply to graduate school. I love science and so I did that and then did Post Doc and now I'm a professor. But I also have a very different value set from the rest of the academia, shall we say? I have this real commitment to service and through which I founded this Non-profit organization and also run my life around those principles. So I was always in this kind of split situation. I had previously already applied to a number of universities and got accepted to programs from a doctoral degree and also got some prestigious fellowships. But I turned them all down because I decided to take a year off and actually go to Nicaragua. I deferred them and re-competed and got them again and then went on. So when I came to the university, I had something I hadn't planned and I had taken a year off. But that I brought that experience of Nicaragua and the mission that I had uncovered for my life, which was quite unformed at that time, but it was very clear direction. I just did that in the context of getting my degree and going on in the academic system.

Geet: When I was reading about you, I found that you authored a book on biology titled, "Low Cost approach to PCR " which I still have to get my hands on. It was really interesting what I read about it. I want to share that with the audience.  You say that, "I've always felt the need to take science out of the ivory tower and apply to real life problems. While certain disciplines of science such as public health and medicine are readily applicable to the problems in the real world, it is less obvious how to make basic molecular biology research directly relevant."  My background is biological research and I remember, I would come out of the microscope room and I wouldn't know how to relate to the real world. It was something that I was seeing in the microscope and if I had to translate it to my friends I could never do it. Can you share how a little about how you made biology research relevant to the real world with your work?

Eva: Certainly! The work that we were doing, like you say, in the lab in the "first world" were not directly relevant. What I realized was that, the technology, or the techniques that we were using could be applied in a relevant way to the problems that existed. The first question was identifying what are the problems? It wasn't only in Nicaragua. At that time I spent time in may be ten countries in Latin America, mostly the smaller, and scientifically lagging places. Listening to, in this case, what were the priorities and look to the methodologies and the techniques, which exist and essentially deconstruct and reinvent those techniques on site, in countries and under the condition where they would need to be applied to address local problems.

To give you a really specific example, in Nicaragua, it was a dream to learn to molecular biology. Molecular biology is fundamentally a study of DNA, RNA etc. When it was first mentioned that this is what they wanted, it was overwhelming because there was no running water, except for twice a week and electricity was spotty because the Contras were blowing up power stations. It was very difficult and different from the lab systems where I had been trained. Yet, I also felt," How can you just say, you can't learn about microbiology because you cant do it here?" It was completely outrageous and offensive. But then, the question was," Here's all the great stuff we can do elsewhere and not be able to do it there." My first challenge was, "How do I make molecular biology, the study of DNA applicable and relevant in these conditions?" I was really lucky in time and space in the sense that, just at the moment, mid to late 80's a new technique had been invented called the polymerase chain reaction, PCR, which has since revolutionized lot of science and molecular biology. It can be used in many ways from very applied to very sophisticated applications. I was lucky enough to be at UC Berkeley right when this was invented, couple doors down at Cetus, one of the companies. And one of the people who I worked with, Christian Oregon who was a professor at UC Berkeley was very close to that process and was able to train me and explained how this process worked, right when it was in the process of getting patented and becoming available and being discovered in the "first world' as well.

And essentially what this method is, it identifies a sequence of DNA which every organism has and is specific to every organism, because that's what essentially dictates who we are and what species we are etc. It’s because of the ACTG etc. that make our DNA, chromosome. The idea is, if you are looking for a pathogen, like tuberculosis or cholera or malaria or dengue virus in a sample from somebody that is infected, instead of growing up large quantities of this infectious pathogen, which can be very tricky and dangerous, you can just identify the DNA for that pathogen. The way you do it is, you need to know a little bit about the sequence of the DNA or their RNA and you can target it and through a method of amplifying from 1 molecule to 2 to 4 to 8 to 18 etc. And by the time you've done 30 cycles you have a billion molecules of exactly the target that you are interested in. You can visualize that in a very straightforward manner. And it turns out that these cycles are vey easy. What you do is you split the DNA into its two strands at 94 degrees and then you set down the matching piece of DNA, which is called primers at another temperature at 50 degrees. You extend the DNA at 72 degrees. Then you make your copy and you do that 30 times. It's a very fancy technique where you just need to buy this $10,000 machine and you put these compounds A, B, and C into this tube and you program the computer and go away. But you can also break that down once you know what the biochemical and biophysical processes are and know that you need the DNA, you need the polymerase and you need magnesium and you break down what is it that you need and why and then you put it in this tube and do 30 cycles at different temperatures. But if you don't have the fancy machine, you understand that you need three different temperatures 30 times and you can set up water baths at 3 different temperatures and just time it and moves the tubes around and amplify your DNA. It was just a revolutionary deconstruction or demystification of this process.

So the very first time we wanted to do this, we were able to actually diagnose this terrible parasitic disease called Leishmaniasis, which was a huge problem in Nicaragua. Leishmaniasis is usually found in the jungles and the forests. But since they were fighting the war against the Contras, the kids were in the army and in these areas and were getting infected and were coming back into the cities and then there was whole new disease epidemiology that they have not seen before that needed to be diagnosed and treated. So what we were able to do was to take a little sample from some of the patients and then apply this technique. But then there was no water and no electricity. So what we were able to do was to create those three different temperatures by using beakers of water and Bunsen burners and thermometer and ice to regulate the temperature. And we were able to diagnose and unequivocally prove that the patients had been infected with Leishmania. And it was this incredible moment because it was the first time that anyone in the country had ever seen DNA or has been able to work with it. And here we were taking this cutting edge and really complex technique and breaking it down and to be able to actually do it in a context where it was actually useful and critical. It actually became the national method for diagnosis right after that. So that was a really exciting transformation which was also a eureka moment for me. I realized that you could really make science applicable and impactful in the rest of the world.

Geet: Eva made it sound really easy, but I want to add that having a biology background, I know how hard that whole process of doing the PCR itself and not using the $10,000 machine is. Really amazing. Hats off to you. I am thinking about how we use the calculator or how some people like me use GPS and not know how to orient ourselves. It's similar to that. The analogy may not fit but it's like knowing how to find your way vs. knowing how to use the machine to get there. Just having that tool empowers you in an amazing manner.

Eva: You bring up a really important point. Part of all of this is the concept of analogy to research. It's very different from the pharma or where the companies hold the information and then tell people out there, “oh! You just put A and b together and it turns blue." and of course if there is anything wrong with it, you don't know where to start trouble shooting because you don't understand what the processes are and of course on purpose, right? They want to create a dependency on a particular company and particular product. Our whole concept is completely the opposite. Teach the knowledge first. Understand the processes and then you can build it from the bottom up. The theme of my whole life's work has been really building from the bottom up. Of course that's been extended beyond one particular technique. But it's also how we work. How do you apply those methods? How do you choose what the methods are? Well, first you need to know, you have to have the knowledge to see what is it that is out there and then choose what is going to solve your problem and then build that into your science and into your public health policy and the whole approach of building something that works by addressing the problems locally with everything that you can apply in the world as opposed to feeling you are stuck into a single path because of resource constraints.

Geet: That actually leads into the next question, which is sort of related. You received the MacArthur award for your work and are considered a leader in the field of global health. And yet you have stated in an interview that, "Leadership for me is about democratization of science, listening, problem solving, leading but not being a leader." You also said that, "I am not about being a star, I am about making a difference." This might be particularly interesting for our listeners because in the Servicespace ecosystem, we are oriented the notion of laddership. We briefly chatted about that Eva, referring to many to many paradigm as opposed to the conventional one to many paradigm of leadership. Can you share your perspective of leadership and how that shaped your work?

Eva: I adore this concept of laddership and I am really excited to hear about it. In general I always felt terribly uncomfortable with this concept of a leader. I do recognize that I do have certain qualities that project me and I have a terrible amount of energy all the time and I like to get up and organize people and make things happen and I'm not afraid of leaving the beaten tract. Infact, I am attracted to taking off and creating the new path. That’s all fine and good but I never wanted to be the one and to direct other people. I really dislike that about the whole system, many systems but certainly the capital system, having one person, one leader and having people below. I completely disagree with that.

The way I try to lead is by having people take ownership of all of the projects. Whether it's in the laboratory or whether it’s in Nicaragua, where I listen to what people's ideas are and I enable those ideas to take place. I may have a project in the lab and we need to x, y, z, but then post doc may have an idea and I’d say, "Great! Let’s do that. Lets see how we can answer these questions using your ideas or let's just put initial questions aside and lets expand and make your project a reality." Nicaragua is the same thing. We have many different projects, 150- 200 people working on different projects and different diseases and we work in hospitals, health centers and directly in communities and in laboratories. There are leaders in each of those areas and as well as people who work inside of those projects, they also rise and they take over, take pride and ownership in what they are doing. You can really feel the difference because of the big projects we have and we have a lot of funding, we have number of site visitors and donors who come to see our projects and they all say that it is just so unique in our program because, they just see this incredible pride and ownership by the Nicaraguanenses for their work. That is because they need to take the lead not me and I am a facilitator. And that’s how I look at it.

I just think of it as us and never as me. I work with people. I hate it when they say, "I work for Eva." I immediately correct it and say, “No you work with me." It is a team effort and really that is where so much joy comes from and by developing partners with people. For instance, the person who introduced me to you Josefina Coloma, we met in 1992 and have created this whole vision together. It’s just been a wonderful partnership. Along the way, growing relations with people and having them grow with you is, the most satisfying thing. Especially when you are lucky enough to have contacts, you can actually make an impact on the world as well.

Geet: I love how you said about us vs. me. How do you find the balance between the two parallel lives? I don't think they are two different lives. I know they are intertwined with each other; do you see a difference first of all and if you do how do you balance the two lives?

Eva: When you day two lives, do you mean what I was referring to before, the academic and service aspects?

Geet: Yes.

Eva: Well, by not sleeping! Like I said, I don't know if I was blessed or haunted by this huge energy. I have been able to lead this life by pretty much sleeping 3-4 hours a day for 25 years. Now I am all the way up to 5 hours. That is like every restful. Now I have this fantastic 15-year-old son and I try to spend as much time as possible with him. It is definitely challenging. You know, there is only 24 hours in a day and 7 days in a week and they go by way too fast. Time has always been my nemesis. I think that is my biggest challenge. Academia is very demanding, shall we say and it has certain lifestyle and value. Well I won't even a call it a value, I'm not even sure I believe there are values, but there is certain way you are supposed to proceed with your life and I check of the boxes that I don’t ascribe to that philosophy.

For me the priorities are not about publishing, not about being the director of XYZ. I'll direct if I have to, if there needs to be a leader who can make things happen. But again, I define leadership in a different way. I try to use academia to spread these ideas from within. I strike the system from within and bring consciousness of equality and changing the world through your science and acting locally and thinking globally and the reverse and seep that into the value system in my own laboratory and in my own projects. Also I teach my students in broader classes, always keep this philosophy and the concept of values. I think in this country, we don't even think about the value system at all. This is kind of consumerism. I find that incredibly empty and despairing to not have the reason for why you are alive and aspiring to a better planet and what not. And I try and bring the concept of values of equality and decency and respect and human dignity into all of how we work from the lab on out.

Then there is other aspect, definitely more at home and in the non-profit structure and in Nicaragua directly. But then all that needs to have resources. I feel like I sacrificed the part of me that wants to spend most of my time in the latter arena, by having to have a foot in the academia and a foot in the United States and in places where I can access resources to enable more service oriented work to go forward.

Geet: I am just fascinated by all your stories. This is great. There is this notion in the academia of publish or perish. I know you really don't believe in that. With the whole pressure of that, how does that work for you and how does that impact your decisions. You said you have strong values, how do you manage between that?

Eva: Like I said, what I do is that, I do that and I do the rest of my life. It kills me that way it kills many people in terms of their spirit, you know. If you just had to be about yourself and your ego and your own papers and your own authorship, that's so awful. That the part I really dislike about science and certainly science in the industrialized world, which has permeated everywhere. Like I said, I do science for a different reason. Of course I do have to do all that. It's a frightening world out there. It’s very difficult to get funded through the NIH or the Gates foundation. I do that. I compete and I had difficult periods. Right now I just got a whole set of really big grants and funding and had really nice papers published this last year and before. I am very prolific and I kind of do all that also. We look at real problems and we address them using a very broad approach and we have wonderful people who are attracted to our philosophy and who are fantastic scientists but who also care about the rest of the world. And those are the people that I really love interacting with.

So I choose great people to be in my lab and in my program. We do really good science and we write papers and we write grants and we compete. It's really difficult and extremely stressful. So I am not going to pretend that it is not. But the way I survive in that world is by knowing that it is about something bigger. After I have been in this country for three or four yeas, I can feel myself getting depressed. It's the pettiness of what is important. It is so ridiculous, but you get pulled into it. Because that is what defines the system in which one is. But I need to get out and go to Nicaragua and be with my real project and people and see again why I am doing the work. It is life and death, it is black and white and its primary colors. This is why we do this work. And I can take that energy and say, " Make that all happen. I’ll deal with the system here." I don't know honestly how people who don't have some counter weight or some kind of mission or motive can get through. You know just kind of battling it out for one paper or the other, I find it very hollow. But that' me, that's who I am and there is a lot of other people in the world. So there you go.

Geet: I just love who you are!

Eva: Thank you.

Geet: You also stated that your contributions through biology are your way of being political. Can you say more about what you mean by that and what in your upbringing influenced your perspective?

Eva: There are several layers to that. Science can change the world and it can be powerful. You can take technologies and you can use them in a good way and you can use them in a bad way. I just tried o give you an example of how you can deconstruct all those methodologies like PCR and apply it into a new way that actually is helpful in new areas and in underprivileged arenas. There is also another way. I am well known and go all over the world and have been giving talks everywhere and through that influence, I am on panels and I am on committees and through that, I can also infuse this different value system into the conversation. I am often the one person on the board or the person in the room who is actually not afraid to say," Can we look at this from a different point of view or I am not sure that's the ethical approach or how about these values or may be we can do this in a different way?"

I am not afraid to say that because those are firmly my beliefs and I essentially feel that, the fact that I can be on these high level panels or situations that is where I can bring my politics into it. And when I am interviewed, I am always very explicit about where I am coming from. I may not say the words capitalism and this and that in every interview, but if you read between the lines, that is exactly what I am saying. There are alternative system and other values and alternative visions of the world. I bring that to pretty much everywhere I can, with the dial of explicitness depending on the situation. But everyone is very clear on where I am coming from.

It has always been a surprise to me, because I am very upfront about my opinions. I am not offensive most of the time I think, which is why I guess I still seem to be accepted within the system. But I am also clear in my critique. I kind of feel that's another way that I can bring my politics in.

Another way is also to infusing these values, that philosophy in training the new generation of people who work with me and people who take my courses and who I can influence through interaction and through interviews and through what have you. Its just kind of way of saying that there is a different way of approaching science and approaching life.

Geet: This question actually might fascinate you. What do you believe is true even though you can't prove it?

Eva: I think my answer to that would be that, I believe that a just society is possible even though we have not seen that since the Native American and other native populations were decimated many hundreds of years ago. My son has been working on a paragraph for his history class. It was about the use of violence or not in revolution and whether it is justified. So this is what we are discussing on our plane trip here. I agree with his answer to the question. The most powerful way to fight violence is through non- violence. Because, essentially you are breaking the principles of the previous system. Look at Mahatma Gandhi and Martin Luther King. There wasn't a complete revolution in terms of transforming a society mostly because King was assassinated before he could finish that program.
The concept is that you really need to change the premise. And fighting violence with violence you end up many cases creating a similar system in the long run. I feel like we haven’t been able to ever see a Just society because most of the transformations have come about through violence. But I do strongly believe that, the number of fantastic people that I meet, the organizations and really great work that people are doing throughout the world that you read about, the people that I am so lucky to work with in all aspects of my work is just remarkable. I look at your organization and I look at so many wonderful people doing really important transformative work around human dignity and just society that I can't but believe that it would be possible. Unfortunately there are vested interests in massive financial underpinnings, and multinational corporations for the political systems that exist. So it is very difficult to bring that alternative vision in to reality, but I do believe that it is possible.

Geet: Mahatma Gandhi is a role model for us at Servicespace. In your life, who has been your role model?

Eva: I would say El Che. Che Guevara, his idiom is "Hasta la victoria siempre which means until victory always. Also there is a wonderful quote in French loosely translated means, the impossible is achievable. There is a quote from him about that which really inspires me. Of course Martin Luther King and I am so excited that coming Monday is Martin Luther King Day. Every time I hear his speeches, I have a dream or any other speech they are so moving and inspirational. I have also people, who in my own life, very personally, my parents and people that I grew up around. I was brought up in an alternative, European socialist environment. One of the women in our group, who took care of me when I was little, fought in a Russian revolution. All of our circle of friends have been in the Germans and movement in World War I and the French resistance in World War II. European socialist tradition is very much my upbringing. They were certainly thought leaders but not leaders in traditional sense of the word but their actions... they just had hearts of gold. I knew what they did during moments of hardship for other people and that was incredibly inspirational to me. SO I always felt that giving back and doing for others is the only way to make sense and have meaning in my life.

Geet: You certainly are making the impossible possible. It is really nice to have role models who keep inspiring you every step of your life and I am really honored to be doing this today. You mentioned that you posses this great energy. At the end of the day what grounds you? How do you center yourself?

Eva: How do I center myself? #1 my son who is now 15 and he is the biggest joy in my life. He is a phenomenal person from day 0. It is so exciting now, for instance to discuss about his assignment in History. We travel together. He comes with me when I go for conferences. We explore new parts of the world. We go on walks together in the Marina. We do everything together and it is wonderful. It just gives me incredible joy and grounding. I just can't wait for the day to be done so I can see him. Water, I am looking over now Lake Michigan and I just love seeing expanses of water. That’s very helpful. Breathing, as I mentioned, that's the other thing I tend to forget to do. I remind myself to take three deep breaths. And of course, exercising and mostly dancing. Any chance I can get, I can dance all night and be fresh as a daisy three minutes later because it is so energizing and fun.

Geet: On our Servicespace feed we invite people to share their questions for the Awakin Call guests. This question was suggested there. What do you consider most interesting recent scientific news and what makes it important?

Eva: This is not as exciting as you probably want to hear in terms of earth shattering news. But its something that is so close to home that I can't help thinking about this all the time. In Nicaragua and my work in general, I ended up working on mosquito born illness called Dengue, which many of you probably have heard of. Half the world's population is at risk and it is a nasty disease. We have done a lot of work across the board on it. The virology and the immune response, clinical aspects and community based ways of controlling it. That has been going on for 20 years. And suddenly we have this new introduction of another mosquito borne virus called the Chikungunya, which has blown in to the Central and South America. It has been a problem in other areas including India. That has made us re orient around Chikungunya.

And now, this is where the scientific question comes in, now there is a new virus, which is also spreading out from Brazil. It is spreading into all countries and is called Zika virus. It is very similar in its structure to Dengue virus and is a problem in terms of the diagnosis etc. What is really concerning is that, it is not a very severe disease on surface. But there seems to be two issues that makes it more concerning. And that is where there is a lot of scientific concern. One is, it is associated with Guillain-Barre like neurological impact and there is also an association potentially with microcephaly. Babies are being born with small heads. That's happening in Brazil. It's not like the scientific discovery that you are asking me for but this is what I am thinking about a lot. And it is just sweeping into Central America right now. So everyone is just scrambling trying to figure out how to deal with this and trying to understand whether these associations are real, why we are seeing them now. Is it because there are huge numbers of cases and so the rare events are becoming more visible or what. That's the science that I am most concerned about right now.

Kozo: Beautiful! I actually have a follow up question on that last one. I am kind of answering the question myself and asking you about it. What has been really exciting for me lately is the Genetics. Changing gene expressions through environmental factors. This comes from a layman's point of view on Epigenetics. I heard that children of parents who experienced really traumatic lives, famine or drought or revolution have the same gene expressions. I wonder if you have encountered that. That's one side of the question in Nicaragua especially. The other side of the question is this idea that if we can offer the environment of compassion and love and trust, could that change the gene expression for the better? I am wondering if you have any views on that or any ideas because you are in that war zone literally.

Eva: There are so many factors in real life complex situations. Going back to the attributable risk of the demethylation pattern, which you are referring to, is very difficult to decipher and dissect in human populations at that level. There is some really interesting work going on right now. My colleague at UC Berkeley kind of addresses this. This idea of Epigenomics actually... We think about the central dogmas. The DNA goes to RNA goes to proteins and proteins carry out the function but they are coded by DNA. Only changes on the nucleotide sequence or mutations there in can lead to disease etc. Now, for the last 10 years or so there has been a burgeoning field of looking at modifications that are not in the genetic code but are in the process of methylation, which is adding certain chemical groups to the bases that make up our DNA. That can actually change the expression pattern of genes and there have downstream functional consequences. And the question is, can those be transmitted? Even though they are not directly coded in the genome, can epigenetic traits be transmitted and how are they influenced by environment?

I would agree that this is incredibly interesting area right now. Lot of the work to really understand that is done in animal models because you can control the situation and make a particular specific exposure and look at the result. For instance there is one woman who works in the area of stress, Darlene, Francis is her name and she is in UC Berkeley as well. She looks both in animal models as well as human populations and can actually start to map the methylation state due to particular stresses in mothers and their effect on children. It has some really interesting results through that work. Both in animal and in human populations and inner city stressful situations.

Another thing that I just heard yesterday, there is different times in gestation where treatment with certain immune modulators that people could be exposed to easily during that time period, and again this is in animal models that show, for instance in autisim, just having an exposure in x trimester to some chemicals can actually effect the offspring causing autism and other similar spectrum. That's not genetic. It is an inflammatory situation, which is related to stress. Now we are just starting to understand how stress interacts with immune system, interacts with epigenetic phenomenon.

Kozo: Wow.

Eva: I agree that it is really interesting and it is very burgeoning, very new and it's vey powerful. A friend of mine has come up with phenomenal system. It's called CRISPR/Cas9. It is a new system for gene editing that came from studying bacteria but it is being used as a tool to do all kinds of really useful manipulations of the genome in the laboratory. It also can be used for gene therapies and lot of other applications, which is really great but brings up ethical quandary about germ line manipulation. There is very strong response to that in the scientific community. Every technology and every new breakthrough is like a double-edged sword. That's a very exciting new technology but also brings its dangers as well.

Kozo: What is really exciting about epigenomics is, it is kind of almost on the verge of proving a lot of things that mystic or spiritual people have been practicing. I just saw a new study where they took a chapel group and half of them they made them exercise 5 times a week and the other half they did volunteer work one tie a week. They measured their health. They found out that if you do one day of volunteer work, you will live longer than if you do five days of exercise a week.

Eva: And much longer than if you go to McDonalds' seven days a week! Yes. We got a long way to go. It’s absolutely fascinating. It is really interesting. The whole concept of well being and is kind of filtering into even the western world actually. There is a center for well being at UC Berkeley. Western medicine and others have raised their eyebrows at certain things. But now that you can prove a causal relation between stress and inflammatory situation that creates and physical changes to the genome, that link stress and well being to bad and good outcomes in terms of medicine and biology. It is really interesting and fascinating because it is bringing mechanistic pathways to bear on stuff that people have known for many thousands of years

Kozo: What I vision in relation to what you are talking about that, hopefully that will deconstruct the methodology. We have the hard science down. What about factors like what is the emotional environment in the operating room like? We can break it down the same way you took the western science and deconstructed in the Nicaragua jungles, now we can take what the indigenous cultures have been saying and deconstruct in a western medicine facilities in a laboratory.

Eva: Absolutely! That’s very hopeful. Also, certainly the link between cancer and nutrition and well-being, psychosomatic effect is extremely powerful. It is very clear that there is a major role in that space. But just a note of caution, may be pessimism on some level, we know so many things already, something so obvious like diet. We don't even have to convince anyone about processed foods and soda. There is so much evidence that sugar and soda are terrible. The obesity, the tremendous epidemic is being felt worldwide. We know this already. The marketing and unregulated industries and profit seeking of the multi national corporations is let loose on the susceptible populations. We don't even have to make the link like what we were saying about the potential link between the stress and outcome. We know what the link is, just like we know that tobacco causes lung cancer and other cancers. But, what an effort it is to fight back against the industry and the corporations supported by governments! There is definitely lot of battle to do in terms of regulating industry on the stuff that we already know. But I love the idea of expanding that to stress and to ways of being and organizing life as well as operating rooms for instance. That's a great concept.

Deven: Eva, being a students of science, I am always fascinated by potential for solving problems for people using science. What I heard from you today is so impactful. After reading your profile, what excited me even more is that you are trying to use biotechnology breakthroughs for helping people in Nicaragua and developing world. Can you share a story or two may be, that you about your work in Nicaragua. May be an inspirational story or may be a story where you had a transformation or realization that changed your work or who you are?

Eva: You asked me about my initial experiences in Nicaragua and that is why I gave you the PCR story. I do want to make clear that, it is not necessarily at the level now of teaching everybody how to do manual cycling etc. Now the world has gone beyond that. Many labs and centers have gone beyond that, Africa, Central America and Asia for sure have access to this already. It is no longer breaking down the methods or creating the "blenderfuge", the centrifuge made from the blender. It is a little bit beyond that now. The new challenge that I have taken is to be ready the local level for the challenges that come. As an example, we have these sweeping epidemics that come through and Ebola is a perfect example of this in West Africa recently, which is a horrific situation where you had a dangerous situation explode well beyond what it should have because of lack of infrastructure in terms of public health and health care systems. In Nicaragua, which is actually second poorest country in the western hemisphere, there are not many resources.

Over the years we have been able to have wonderful, trained, smart counterpart within the Ministry of Health, which is really our main counterparts and collaborators in the country. We have been able to stay one step ahead of all of the Pandemics and epidemics as they come through.

One was the Leishmania where we were able to have national diagnostic system in place to deal with that problem. Then we tackled Dengue and then there was Pandemic Flu, then Chikungunya and now Zika, one after the other. We can see it coming and through my connection with academia I can get my hands on the primers that you need for PCR or monoclonal antibodies are what we need to create a serological diagnostic system, meaning looking for antibodies in people's blood stream so you have a way to diagnose people whether they have been infected and then bring that to Nicaragua. The Nicaraguans will put together the diagnostic systems that are needed. We will validate them and then we will decentralize them to all the regional labs so that it is actually ready when the next disease comes in. That is a very powerful way of having an impact. It's a very small country, but by having ready team that is really capable and can be very helpful.
For instance with Chikungunya, new methods at a molecular and serological level were created, validated and decentralized within a period of six months. It is really exciting to see that in practice in real time

Deven: How exciting and how inspiring! If I may ask one more question, while doing all this work, what has been the shift in your perspective? How is it impacting you personally?

Eva: I am kind of an external person. I reflect about life but I don't reflect about myself nearly as much as I should. I am sure I have all kinds of internal issues that I could certainly deal with and fix if I had the time to sit down. But I am kind of functional, so I just keep barreling forward.

It is just a deep satisfaction. I adore the people that I work with and it is so exciting for me to be able to do work and then see and impact and feel like I am contributing. I just feel that is such an honor to be able to work with the people that I work with, both in my laboratory and in Nicaragua and other countries that I collaborate with. It is very fulfilling at a personal level. I really like to work with people who I like and I like to work really hard. It is an amazing feeling from working and achieving together. For instance, writing papers. We had some very exciting discoveries. W have a new Dengue virus protein that we found causes vascular leak and it is very exciting. We have a team of people in your lab and you are working really closely on writing a paper and figuring out these experiments. It is so intellectually satisfying and also personally satisfying since I like them so much. I love that process. It is a very intimate, intellectual stimulating but also impactful process.

On top of that I get to work with people and see a real impact in the world and feel that we have been able to convince the Ministry of Health and it is important to bring research and act on the research findings in the public sector. That has been a twenty-year battle but we have been making some progress in that area. I just feel so lucky and so satisfied to be able to work with such great people and feel as a team we are advancing. Both a science and something about a better world, which is where this all started.

Deven: What an inspiring story, making a difference to so many people. Thank you Eva! Thank You Kozo!

Caller: I recently heard a venture capitalist speak about how infrastructure for open source software is severely under funded and under supported. Probably because it is not supporting immediate impact work. Do you that are true for the kind of science you have been speaking about? And more broadly, how can we support more long-term thinking outside of the market forces? People often think entrepreneurs will create new solutions, but it seems that what we really need are people like Jonas Salk, Werner Heisenberg, Neils Bohr and Louis Pasteur who did science for the sake of it and not monetary rewards.

Eva: Yes! That's a packed question. I am going to address few aspects of that. One of them is around entrepreneur and science and the issues with that. Second is informatics is what you are talking about and then potentially that concept in biology.

I think it is incredibly short sighted and wrong to drive science from a profit motive. I probably made that clear in other parts of the call. There are two aspects that are hurt. One as you mentioned is science for science sake. The truth is, basic science is where it all starts. When you have discoveries in the clinical or applied arena, they almost invariably come from discovery twenty years earlier in the pure basic science filed. It is extremely important to have that continuance. I did not mean to be such a flippant earlier in the call. There are many fantastic scientists, in Berkeley as well, who are doing that kind of science and are publishing good work. You can definitely be a successful and have integrity in current academic system. There is just a pressure for that publish or perish bit.

There is wonderful science being done by excellent scientists and excellent people as well. I think it is incredibly important and I agree with you on that front.

I also think it is incredibly important to have public funding and public sector outcomes for science. For instance, other than basic science derivation and discovery, there is also the support of capacity to roll it out. It is not nearly as sexy and not nearly as profit making, but it is incredibly important. Just to go back to the last example of preparedness for new outbreaks and pandemics in Nicaragua for instance, there are lot of people making diagnostics and make the point of care dipsticks that see the pathogen as they comes in but then no one can afford it. . And it exists but then it is marketed at a price point that no public sector laboratories, or even us as an academia supporting our study in Nicaragua, we cannot afford that test. It is absurd to have the profit motive driving something, which is then only marketed in private clinics and actually has the roll out or the impact in the public sector or reference laboratories because it is too expensive, even though it does not cost that much to make it. We recently recreated an existing diagnostic for essentially pennies because it is being sold at $6- $10 a test. So all this effort to recreate it, but one has to because these kind of things need to be for public good. And the capacity, what I call scientific capacity building, which is to create the human infrastructure, as we now have in Nicaragua after 25 - 30 years. But no body wants to fund that. I have been through so many different organizations.

Now, people are starting to turn around a little bit especially after the Ebola disaster. Realizing that if you don't have people in country you can't respond! This is obvious but no one wants to spend money on people. Foundations and certainly entrepreneurs want to invest in gadgets and devices not in people. And of course the fundamental change is going to be by investing in people. So that's a big issue. The last thing has to do with the open source arena. I did not mention at all, we have a huge team in Nicaragua that has been working on open source informatics and has been incredibly successful. It is very exciting project and that arena is far beyond what we have in biology and pretty much in any other sector in terms of being able to collaborate world wide. In terms of the funding of that, you are right, it is not very high. But it is also very collaborative and so you can do a lot for very little investment. But certainly, the more the merrier.

For instance, in one of our cohort studies, we follow 3500 children now over 12 years. We have to collect samples and we look at all of their medical episodes etc. All of that needs to be tracked. We have informatics expert in Nicaragua who have put together bar codes and GPS and all kinds of different methodologies and cell phone based apps to follow the children the in studies and analyze the data in real time. But then, after we started that in 2004, 11 years ago, since we work with Ministry of Heath, the idea from the ministries point of view is to apply these tools into real public health issues like pregnancy and prenatal health, vaccination coverage etc. We actually created a number of apps and other long-term informatics solutions for Nicaragua. Most recently we have come up with a platform for the health ministry for gathering information and reporting on all infectious diseases. It started around Dengue. But since we listened and worked with center to understand what they wanted, this has become a system they want to use for their whole health system. And all of this is open source. I think that it can be customized to each country and I think there is huge promise in that area.

I don't know if that answered your questions that I was trying to address them as they came forth.

Kozo: I think there is wealth of information coming forth.

Geet: I am really enjoying the stories of community and team building. The more I hear about it; I have a complete different perspective of the whole science industry from which I sort of walked out. It's really insightful. Thank you Eva. I have to keep saying Thank you again and again.  I have two questions. One on your motherhood. How that has changed your understanding or added to your understanding of science? Another question about how in your opinion science needs to evolve?

Eva: Motherhood, I don't think affected my science as much as my life style and my perspective. It is such an incredible process to bring wonderful human into the word and it is so miraculous and to watch them grow.. For me every second we are alive is a miracle once you understand how complex the molecular and cellular biology is. And then to be part of the process is so exciting. It off sets all of this, as you say publish or perish philosophy. You just get caught up in something and the you break and say," No, No, this is not most in my life. My son is most important." So I think from a perspective point if view where it has been incredibly important for me and in terms of meaning. And all of that will impact my science in an indirect way.

And in the internal way that you keep asking me to talk about, there is internal transformation from the science and the work but, very much so from the motherhood point view. It is extremely difficult to travel as much as I do and to have the very pressure lifestyle that I do. That can't but impact on my son. And it is very painful when I have to be for meetings or In Nicaragua. I bring him as much as I can, but it is very painful for me and certainly for him. So I live in constant guilt at that. I think it is important to acknowledge that this entire racing around and saving the world does have a personal price in terms of having his mother at his side. Obviously, I am there in spirit and as much as I can in body and in person, but it is very difficult. I just need to put that out there.

The other question of where science is going? I think there is an interesting point about basic science. I think there is a role for basic science. There is always this concept that the more basic and the more erudite and the more divorced from reality the better and harder the science is. That I feel is wrong. I feel that the applied science is equally valid and very difficult because you are working in human populations with all sorts of variables that you don't have in the laboratories. So I would say that some kind of equalizing of that. The gradient from the basic to the applied is wrong and there should be some kind of respect or the more applied sciences. And having kind of done the entire spectrum, I can tell you that the applied work is very difficult and rewarding but it is also has its challenges.

The other is that, fundamentally about the value system. There is nothing wrong about the basic science that is done in universities. The massive focus on the ego and on the individual and the career and on the success of one person really distorts that. So I would hope in the broader sense that there could be a transformation of the way the science is done and the value system that underwrites it. Because I think that would have a profound and positive effect to get away from that model. You would then really focus on content and not on the person. I also think that looking at what people need and listening and addressing problems.. Traditionally there is this 10-90 gap where the 90 % of the resources are directed to diseases that affect 10 % of the population and vice versa. That should be corrected. That of course is resource driven by the industrialized countries for the most part. Being able to correct that balance would be useful.

Geet: Wonderful! I am really inspired. Thank You!

Kozo: How can we as larger Servicespace community support your work? What can we do for you?

Eva: I just want to mention one thing which is not directly answering that question. One enormous piece of work, which I did not talk about it at all that I have to mention because it is so related to this. I mentioned that we work all the way across the spectrum and work all the way into the community. We have this really fantastic project, which is collaboration with the Non-Profit. We work directly in communities to essentially to look for ways that address the Dengue and Chikungunya and other problem from the community standpoint. That is very directly learning and listening. Essentially what we found is that the community has ideas about how to control the mosquito population with their own life style, come from them with their experience, which has been very effective. We have been able to do a huge study, Randomized controlled study in 80000 people in Mexico and Nicaragua, which showed that by using this kind of home grown solutions to stop the mosquito breeding, you reduce the infestation of mosquitoes and also the infection rate of children and also the disease.

All that has come directly from community and something that really needs to be brought to the fore. It is not only biological, biomedical solutions. Definitely community based solutions are possible. But you have to listen to the people and have them be motivated by their own ownership and participation. The thing that is really important is that, we go in with the banner of Dengue for instance, but really it is about social mobilization. And social mobilization involves much beyond Dengue. So we end up addressing issues of sexual and domestic violence and access to water. These are much bigger issues to the community but hey learn to organize around this concept of say Dengue transmitting mosquito. With those skills they are able to address much big broader thing. I just want to mention that experience even though it didn't actually come up in our conversation.

About community help ... By just being a community that cares about making a better world inspires me. So that's wonderful to know that I have the honor of being a part of such a community and I thank you for that. Definitely we have our little Non - profit called the sustainable sciences institute, which doggedly tries to maintain a mission about capacity building in a broader sense. That has been incredibly difficult to fund raise for. So the way SSI keeps alive is through the grants we get for the studies we do. For instance on Dengue or influenza etc. We still have this mission but it shouldn't be so directed from a particular concept or a particular grant. It still should be able to listen and address people’s issues from the ground up. That's very difficult to und raise for. If anybody has any ideas or rich friends, we love to have any ideas. We have volunteer opportunities for translating articles for going trips with us. We teach manuscript writing, we teach proposal writing and of course more technical aspects. Its n exciting kind of service based organization. Very small, but doggedly committed to staying true to our integrity and our principles and to support human infrastructure and capacity building in developing world. So that's like the most direct way that o can think of, a link between our organizations.

And of course keeping in touch with your community would be wonderful for me.

Kozo: I just wanted to say, thank you for the work you are doing in this world. What I take away from this call and from your work is, impossible is possible! Whether it is the crazy gene sequencing in the jungles of Nicaragua or balancing act of academia and social service. I think a lot of listeners find themselves conflicted, but what you are doing is a great balance there and making it work. The other piece about making the impossible possible is this idea that we can have a just society and just to plant that seeds. Just a power call and I really thank you for being the person that you are.