Engineering Primary Prevention

Assistant Professor Karen Kosinski, EG11, is bridging the gap between engineering and community health as she works to develop scalable, sustainable solutions to water borne diseases in Ghana, particularly schistosomiasis. Her work has been supported in part by Tisch College’s Active Citizenship Summer (ACS) program, which for several years provided funding for teams of undergraduates to travel to Ghana with Kosinski.

After completing her Ph.D. from the School of Engineering, Kosinski became a faculty member in the community health program of the School of Arts and Sciences, and now works with an interdisciplinary team including faculty from the School of Engineering, the Friedman School of Nutrition, and the School of Medicine.

“Our focus is prevention,” said Kosinski.  “Institutions like the World Health Organization focus on controlling morbidity, which means mass treatments with drugs because that’s the most cost-effective solution currently available.  We want to take the next step, and use infrastructure to reduce or eliminate human contact with contaminated water.”

Grappling with the complexity of the problem was what brought Kosinski to Tufts as a graduate student.

“When I first met Karen, she told me she wanted to do community scale work using the engineering skillset in a way that would change peoples’ lives,” said Associate Professor David Gute, a member of the Tisch College Faculty Executive Committee and Kosinski’s thesis advisor.  “And she’s done it.”

An epidemiologist in the School of Engineering’s environmental health group, Gute sees Kosinski’s work as part of a larger re-convergence of engineering and public health.

“In the 19^th century, public health and engineering were practically synonymous,” he said.  “The term public health engineering was is in the literature throughout the ’30s, ’40s, and ’50s.  Waste handling, water distribution, housing, sanitation, these were the breakthroughs of that era.  I think there’s a clear echo in the buzzwords of today: interdisciplinarity, sustainability, and the like.  These concepts recognize that to achieve public health goals you need to consider the built environment, and find ways to enable it to support public health goals.”

Kosinski has been spending up to three months each year in Ghana for the past five years.  Working in six communities, she and her team of undergraduates have screened and treated thousands of children and young adults for schistosomiasis.  One of the most widespread parasitic diseases in the world, schistosomiasis affects between 200 and 500 million people, mainly in sub-Saharan Africa; the World Health Organization ranks it second only to malaria on its list of devastating parasites.  Coming back year after year, Kosinski has been able to track who gets reinfected, and why.

“To understand how parasites like schistosomes infect and affect a community, you need a holistic understanding of that community, and you need the participation of the whole community,” said Kosinski.  “This kind of research is a collaboration with the people who live in these towns.”

That research contributed to the recent awarding of a grant from the National Institutes of Health (NIH) to further study the kinds of infrastructure that prevent disease.

“This grant will allow us to consider how various pieces of civil infrastructure at the household and community level influence and support population health,” said Gute.

Water recreation has been a particular interest of Kosinski’s.

“The importance of drinking water is universally understood,” she said, “but water for recreation is also incredibly important to both the physical and social health of children and adults, particularly in a hot climate like Ghana’s.”

For Kosinski, the rewards of active citizenship have been deeply felt.

“It’s been a tremendous education and I know I’ve gotten so much out of it,” she said.  “There is an understanding of your place and role and ways of being that comes from interacting with people and seeing their communities, and I’m deeply committed to ensuring that these are mutual relationships that bring opportunities and benefits to all the participants.”