Alejandro Cravioto / Illustration by GIANNI DE CONNO
Inspiring Lives: Alejandro Cravioto
Developing Lifesaving Solutions, from Mexico to BangladeshFrom his office at the International Center for Diarrhoeal Disease Research in Dhaka, Bangladesh (ICDDR,B), Alejandro Cravioto can keep a close eye on the bamboo-pole tents erected in the parking lot through the lead-up to monsoon season each year. During that time, this teeming city of 14 million, which has never had a safe water supply, becomes a melting pot of infectious disease. The institute’s hospital, which houses 280 beds, must expand to accommodate 700 people per day as potable water becomes scarce. Rickshaw cyclists, perspiring in the humid weather, risk cholera to stay hydrated on whatever water they can find. For the young children of Bangladesh, as Cravioto well knows, diarrhea can be deadly.
“Imagine you have half the population of the United States living in the state of Iowa, except 70 percent of the country is flooded,” Cravioto says. “That is Bangladesh.” In 2008, the per capita income was just $520, making it one of the poorest countries in the world. That level of need is precisely what inspired this 62-year-old pediatrician and diarrhea expert to leave his native Mexico four years ago, joining the institute he now leads.
Cravioto, the son of a physician, had no illusions about the direction of his career. He studied medicine at the National University of Mexico—the oldest medical school in the western hemisphere—and went on to get a Ph.D. from the London School of Hygiene and Tropical Medicine. “At the time, diarrhea in Mexico was the number one cause of death in children under five years of age,” Craviota says, “and it also leads to malnourishment, which was a problem in the long run on growth and development.”
Working at the Central Public Health Laboratory in Colindale, London, Cravioto studied how bacteria interacted with receptors in the lining of the intestine, encouraging it to oversecrete water and potassium. “That comes out as diarrhea,” he says. He realized early on that it may be possible to use these bacterial proteins to vaccinate children against diarrhea. Today, this strategy is still being pursued by vaccinologist Ann-Mari Svennerholm of Gothenburg University in Sweden, who has known Cravioto since he was seven years old.
“We played together,” Svennerholm says, explaining that Cravioto’s father came to Sweden to collaborate with her own father, who was a neurochemist. In fact, Svennerholm provided one of Cravioto’s early connections to the Bangladesh institute: In the 1980s, she worked on a clinical trial for an oral cholera vaccine at the ICDDR,B field site in Matlab, and that vaccine is still the primary one endorsed by the World Health Organization. “The ICDDR,B is a unique place because it is located in an undeveloped country but has a strong research capability,” she says.
While Svennerholm pursued a research-focused career in Europe, Cravioto would be torn between working as a pediatrician in private practice and continuing his research at severely under-funded Mexican universities. Eventually, he managed to commit full time to research and medical education in Mexico, becoming the dean of the medical school at his former alma mater in 1995. However, such positions are limited to an eight-year term and by 2003, Mexico had surmounted its most dire pediatric health challenges. Cravioto was looking for new challenges.
ICDDR,B was looking for a new leader. The institute was founded by the U.S. National Institutes of Health in the 1960s as a laboratory to study and prevent cholera in the massive delta of the Ganges river. In 1971, Bangladesh won independence from Pakistan in a nine-month war, and in 1978 declared that ICDDR,B would be run under international governance, a strategy not unlike agricultural centers elsewhere that study rice and potato genetics. Today, it is governed by a board of 17 members from around the world and receives donations from 55 countries and organizations. The health of newborns remains a focus of ICDDR,B, and it is working to help meet the United Nations Millennium Development Goal of reducing child mortality by two thirds between 1990 and 2015.
At the same time, the ICDDR,B has gone beyond its original mandate. Today, Cravioto says the institute conducts work on HIV awareness among sex workers, on the prevention of domestic violence against women, and a malaria surveillance project on the border with Burma (Myanmar). For her part, Cravioto’s childhood friend has been thrilled that he has come back to his roots in global health. “It’s fantastic that he has kept his interests in this field and has been able to do research despite his demanding career in Mexico,” Svennerholm says.
Cravioto does not plan on staying in Bangladesh permanently. His family still lives in Mexico, and he has plans to return in three years. Even so, he says, “This has been a wonderful experience.”
Photo: Alejandro Cravioto / Illustration by GIANNI DE CONNO
