Interview with Richard Leakey and Craig Lehmann

Stony Brook, N.Y. – Richard Leakey, world-renowned paleoanthropologist, conservationist and Stony Brook faculty member, is the founder of the Turkana Basin Institute, a research organization housed at Stony Brook, and has a base of operations at Lake Turkana, in Kenya. Lake Turkana has been the site of a series of very important archeological discoveries, yet the area is extremely remote, and the local population is beset by various public health problems. Dr. Leakey created the institute not only to provide fellowships to anthropologists in training, but also to create links to the local population and provide opportunities for economic development.

One of the steps involved in dealing with the public health issue was completing a needs assessment of the local community. Craig Lehmann, Dean of the School of Health and Technology Management, was asked by Dr. Leakey to assemble a team and analyze the situation at Lake Turkana.

I interviewed Dr. Leakey about the development of the public health project and Dean Lehmann about the medical team’s trip to Kenya this past winter:

Paul Bugyi (Newsletter): How did the public health project begin alongside this research?

Richard Leakey: I started looking for fossils in Lake Turkana in 1968, and it has become one of the most important sites related to the study of human origins. And one of the concerns we’ve had, is the vastness of this area. When we first recognized its scientific importance, there were very few, if any, people there. It wasn’t that it wasn’t suitable for people, but that there were competing interests from different tribes, and it was so isolated that were was no government intervention to stop people from slaughtering each other. So basically people stayed away from the area.

Once we had a permanent presence there, and a National Park was created, they could protect the area from people collecting things ad hoc. With this came stability, and with stability, the tribesmen wanted to move and stay in the area. And initially there was a spirited effort to keep the cattle out because they did such damage to the fossils. But over the years this has become more and more difficult as the cattle population increased, not only due to good  breeding, but because more and more people came in once they realized there was opportunity for good grazing. People began to say “What is this? You people are coming up from Nairobi to find these fossils. And you have nice tents and nice vehicles, and you’re overall pretty wealthy, and then you go away and we’re left with abject poverty and you tell us we can’t raise cattle on the fossil sites because it’s [causing damage].

Richard Leakey

So this is where I’ve been for awhile, and although I had been aware of it, it was nothing I could do anything about. At the early stages, I was working for the National Museum, which is part of the Kenyan Government, and all the fossils were banked at the national museum. First, I came to the conclusion that we needed a proper research institute up in the area so the fossils stayed and didn’t go back to Nairobi. Second, I felt that if we were really going to get the local people to participate in some sort of protection for this area we would have to get them some benefits. I came to Stony Brook initially to develop the prehistory program, thinking perhaps through that we would be able to help the community at Turkana and at the same time provide opportunities for Stony Brook students to gain some international experience in public health. We had already started to create a more permanent base for ourselves on the side of the lake that Craig visited.

Once I got to the university however, and started talking to President Kenny and Lawrence Martin, we realized there was so much more we could do, so we approached Craig to talk about doing some health care programs with us. We started to do some fund raising for the locals, which had never been done before, and ended up with around $30-40,000 per year that’s been used to pay for school fees, nurseries, teacher’s salaries and the like.  It’s modest, but they had nothing before, so this is a start. So while initially I went there to work on the fossils, it was obvious that we needed to live together in a good relationship, with the locals, so I started to think of ways we could help them, and sort of help themselves too.

The more I thought about it, and the more we talked about it, the more it made sense. We  knew that there were problems in the past with having people come over there, because they would live in these little pop up tents, there’s a problem with sanitary water, there’s so much sand and dust, security is a problem.  But we knew with a more permanent base, we could alleviate some of those problems and make it more comfortable. At least with a permanent research facility people would have access to a computer for work and e-mails, stay in touch with people back home, and feel less isolated. If there’s a fridge in the building, you can come back to base in the evening to sit, relax and even  have a cold beer. This part of Kenya is so different from Long Island, it would be a great experience for Stony Brook students to go there, and be able to help people who never received help from anyone before!   So our efforts and our goals have changed now, the whole face of it has changed.

A Kenyan student, Samia, was here studying for her masters, and I suggested to her that we try to get a group up to the Basin; Craig asked us to do a needs assessment, so Samia went back to Illeret and produced quite an impressive report.  It was on the strength of that report that Craig decided  they should have a real, serious look at the place and my ideas, so we’ve been working together.

In the end, we really have dual purposes. And while I wouldn’t really classify it as a priority, my primary goal was to show the locals community that the fossils would benefit them. Now, they see development of a school, and the Kenyan government is trying to solve the problem of the public health crisis. We’re trying to help them with that piece too. So now, when we ask them to restrict the number of cattle going through the area,  because it’s protecting the land for them, for eternity, they seem to understand it. There’s a lot less pressure on the fossil sites now. We built this great little school, we’ve got 13 or 14 teachers, new desks, we’re doing sports camps for the kids and we’re doing environmental clean ups. And a lot of this stuff we’re doing in the community, no one ever conceived of before.

PB: What benefits do you or they think can get out of this relationship?

RL: Well the benefits they are already getting is a bursary fund, which they’ve never had before, so they can get their kids to secondary school, and there are no secondary schools in the area. We’re building classrooms and schools, we’re bringing in papers and workbooks, teachers and salaries. With Craig’s help we’ll put in a lab, a small hospital, a little inpatient facility for 4 or 5 people with the possibility of getting some local diagnostic things done. There are some things we can get through the Kenyan government such as an adequate supply of drugs that we can look after, so that if someone needs something it’s in a refrigerator. And Craig will talk to you about introducing a corporation, perhaps IBM, some absolutely new technology that will give the opportunity to actually get medical records from people and follow them through, perhaps by a finger print. I mean, nobody knows who’s who, many people share the same name and it’s hopeless.

PB: So what has been the local’s response to this?

RL: Hugely positive. Hugely positive.

PB: Do they worry in the future that this may be a temporary thing, that you might leave after awhile if the money runs out?

RL: Well, I’ve been there 40 years, and they know me very well. We’re leasing a big piece of land, about 100 hectares, for a research station, housing for a medical team. The hospital will be built in the village. We will certainly put clean water in there. If you have a hospital you’re going to have to have clean water, if you have a research base you’re going to need clean water. It may not be enough so everybody can have washing machines, but it will certainly be enough so people can draw drinking water and cooking water which they’ve never had before. I mean they’ve asked the same question, “What’s this all about?” And this has actually gone a lot further than ever thought it would. And, I’ve told Craig of my concerns that before he became involved, it seemed we were doing more in the way of prehistory and not public health.

PB: I’d imagine that the region is so rich for research opportunities that you’ll be there for awhile.

RL: It’s huge. And there are also tourism opportunities around this research facility, but there’s never been a place where people could stay. So if we can build, invest and build a simple facility where visitors can have accommodations at reasonable rates and let the community own that and participate in a major way so they can get a substantial component of the profits, then these things can be used. It requires that we train them how to use money, something that’s not done very well in Kenya generally. People see money as theirs, and the idea that you tax people to spend on people rather than tax people so you can make off with it. It’s a new concept.

PB: And what’s transportation like right now?

RL: Hopeless. I was just telling Craig that Samia raised $50,000 from a contact to buy a vehicle for a mobile clinic. Craig raised money to hire a nurse for the first year. With Samia’s money we’ll have funds for fuel. And I think you’ll see this thing starting to have an outreach. And it is increasingly clear to me that if you have a problem with people going into the park for grazing, but outside the park there is a hospital and a clinic and a school and a boarding house. And if the clinic doesn’t go into the park, and we can’t treat people if they’re breaking the law, I think there will be a very quick turnaround on this thing.

The other thing is jobs. I think the other thing that’s interesting about this facility, is if you’ve got interesting fossils there, a number of “important” people go there to see it firsthand. Many of these people have a lot of money, and a lot of these people are potential investors and all sorts of things, and I think the thing will develop a life of its own.

PB: Did Richard ask you to do this assessment?

Craig Lehmann

Craig Lehmann: Lawrence [Martin] and Richard asked me if I could lead a medical group up there to do an assessment, and it was no problem to get everyone to come. I think many of them were in shock when they first realized how remote it was and the living conditions of the individuals who lived there. But it was very much a great experience for every single one. Taking everything into account, they are probably the most loving people, especially the children, that you could ever encounter. They don’t have the social problems, that we have here, it’s about getting up in the morning and eating and getting ready for the day. The children, who we are really building this for, in my belief, they are just beautiful people, and you want to do whatever you can. It was just a given when all of us were getting back into the airplane that we can’t just get away from this. It touches you, and you need to fix it, and that’s what we are going to do.

RL: And I think that we all agree that there’s an opportunity for the students here…

CL: Oh, absolutely. Once it’s created, or close to creation…in my school alone between nurses and social workers and physical therapists and physicians assistants and nurse practitioners, I mean it goes on and on, they would be here in a second if they knew there was an opportunity…

RL: Even a few months up there is a life-changing experience as everyone who has been up there says, and you come back with totally different values – which is good.

PB: Have you done this type of work before?

CL: Yes, I’ve been in India, elsewhere in Kenya. But my specialty area is clinical biochemist by trade, but many years ago I got off track and got into diagnostic technology which led to e-health and those kinds of things. So this technology now available, it’s wireless, you can take vital signs on patients, you can download them to Stony Brook if you want. You can take video clips, you can do virtual visits with patients. It’s at a point now where it can open up the entire continent of Africa. Our goal, this piece of it anyway, is to put a project together to show its potential in providing healthcare. The healthcare will come with nurses and doctors. Many of their problems exist because there are no medical records of any kind. Just before we were there and shortly after we arrived, there was an outbreak of polio, and there are 250,000 kids on the street. There’s no way of knowing who might have received which vaccine; they could be walking around with tuberculosis, and that’s the problem.

And so with this technology, with what Richard said, we have a system by which we can begin to create a  wireless medical record of someone. And no matter where anyone goes they just go into the system, the patient puts their finger on it and boom, it brings up their records. Providers will know if they’ve had their shots, who the physician is, if they’ve been hospitalized and for what ailment; that’s the potential of it.

PB: Who developed this technology?

CL: It started in Japan years back. They started the first, e-health system, but it’s grown and now there are many companies involved in it. But this is the 3rd generation that’s available – it’s all wireless now, which is incredible. You can run it off your Blackberry.

PB: Was this specifically developed for this type of thing?

CL: It was originally developed for the aging population in the U.S. and Britain. And as the baby boomers were coming, everyone, including myself, was writing about the economics of it, how are we going to take care of the baby boomers, because they’re not only coming in a big bubble, they’re living 20 or 30 years longer than they should. It’s all under the United States, it’s all under Medicare. Then at the same time I was looking at the ratio of the elderly to those who were producing tax revenue, and it’s shrunk, so it’s going to be for every three who are receiving aid, there will be one person producing tax revenue that will support them, so it’s not going to work. What grew the technology was visiting home services, trying to keep people out of the hospital, which was very expensive. So we do vital signs, we can do blood pressure, lung sounds, heart sounds, glucose, cholesterol, hemoglobin, all by fingers touching buttons, using Bluetooth. I can be in Nairobi and just send it to my Blackberry and then to my medical records here.

RL: And we can showcase this as working in an environment such as this. It undoubtedly has huge applications.

PB: Is it typically used here?

RL: It needs to be. I was in a hospital a couple of years ago with a kidney transplant, and with the number of medical records, nobody read them because they got lost in the bottom of the file.

CL: Well, in the United States, we’re building the RHIO now. Regional Health Information Organization. We’re connecting the hospitals in eastern Suffolk County with Stony Brook, with the physicians, with the nursing homes, so that if the patients join they can get the files moved to any place they want to go. And that’s for a developed country. In Kenya, there is a piece of paper, and if they lose it, they’ve lost their medical records. So it’s a real problem.

PB: Especially for these people where there isn’t a facility that holds these records? I guess they would have to keep them themselves?

RL: They don’t even have houses with floors, and roofs where the rain comes through…

CL: It’s a real problem. And when someone becomes an orphan in Kenya, and they are sent into one of these group homes, they could have full-blown tuberculosis and bring it to the whole group in a matter of weeks because the sanitation isn’t great – the public health issues are many. But it’s all fixable now.

PB: What is the local’s perception of the introduction of this technology? Because they must have a very different conception of what disease is and what life is. There is the strange technological, Western way of organization…

CL: Well, they’ve accepted the medication very much so. They know to go to the infirmary or the clinic that they have there when they’re sick. And I think they’re willing to accept what makes them feel better. It’s very limited now but we’re going to change that.

RL: I think the medical cadre in a country like Kenya are pretty well educated, and they’re deeply frustrated by the kinds of problems, and I think they’ll accept this for the local population…

CL: When I went to Meru hospital, which is about 5 1/2 hours up from Nairobi, which is where they take care of a bunch of these children – there are about a thousand – and when I sat down with them and I had my laptop, I was going to show them slides on what e-health was and they said “I already know about it, I was in London, and it was part of the presentations. I know exactly what it can do.” He saved me an hour’s talk and we just started talking how it could help him and his colleagues, and he’s a hundred percent behind it. And he’s the key because everything else is peripheral to their hospital, and they’re far away.

If a child in the home I support in Meru becomes ill or just doesn’t feel well, the adults have to decide if they should put them in a vehicle and drive them to the hospital, get on a line to wait for care, or not go. There’s a way to change all of that by putting in a kiosk, where they enter the child’s vital signs, and a provider at the hospital can tell them to either come in, or to simply go to the chemist for medications that will make them feel better.  That’s the piece we’re working on now.

PB: And since transportation is such a huge problem…

CL: Especially in the Turkana Basin. When I was there, people walk in this desert for miles and miles…

RL: 30, 40 miles…

PB: What is the climate like?

RL: Very hot. High altitude. Very hot, and very dry.

PB: Like the American Southwest?

RL: Hotter.

CL: I was drinking a gallon and a half of water every day and never sweated. I never urinated either, it just [disappears].

PB: Any big problems that you’ve faced so far?

RL: No, not really. I think the opportunities are enormous. We’ve built a base on one side of the lake, we’re going to build another on the other side of the lake. The opportunities, not just in public health, in other areas, obviously anthropology, geology, but there will be other areas too – human ecology. If we play our cards right, not only could Stony Brook an enormous help to Kenya and all we’re trying to set up through TBI, but the connection to TBI can create an opportunity for Stony Brook to become one of a very small group of universities in the United States that really offers an opportunity to do things that you can’t do because they have no bases in these places. It could be really good for the school here.

CL: We think of health problems, there are technical problems with  IT systems put in this environment, refrigeration. We have engineers, we have computer scientists, we have all this at our fingertips, and as a team looking at the problems, if you just look at Kenya alone, there’s probably not one field here that can’t be applicable in bringing solutions to this part of the world. We have the team, we have the health scientists, we have the engineers and  mathematicians and everything together gives us a great product to bring to Kenya.

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