Scientist realizes roots as healer in visit to Iran

Hopkins biostatistician helps doctors in search of leishmaniasis vaccine

May 30, 1999|By Ann LoLordo | Ann LoLordo,SUN FOREIGN STAFF

TEHRAN, Iran -- A centuries-old scourge brought Larry Moulton to this land where generations of his family ministered to the sick.

Flying across an ocean and two continents, the Johns Hopkins public health specialist traveled to this capital city and villages beyond to help an Iranian research team find a vaccine for a deadly, disfiguring parasitic disease.

For Moulton, this is not the land vilified by his government. It is a land recollected in childhood stories, the Persian rugs in his parent's homes, the Iranian miniatures on the walls, the whirling dervish begging bowl he played with as a boy.

This was the land of his mother Mary's birth, the place where his maternal great-grandfather, Dr. Joseph P. Cochran, founded a hospital and medical school in the late 19th century.

Moulton's great-grandfather Cochran, and his father before him, the Rev. Joseph G. Cochran, both died of typhoid fever in Iran. Moulton, a former Peace Corps worker in West Africa, always wanted to visit the family graves in northeastern Iran.

"Chance of a lifetime," the bearded and bespectacled scientist says of his opportunity to work here.

"In science, there is no border, no religion, no politics. Just science," added Dr. Ali Khamesipour, Moulton's Iranian host.

Moulton initially knew little about the disease the Iranian doctors were battling. Ranked as one of the world's most confounding public health concerns, leishmaniasis afflicts about 12 million people in 88 countries.

International health experts suspect that as many as 350 million people in Africa, South America, the Indian subcontinent, parts of Asia and the Mediterranean coast of southern Europe may be at risk of contracting the disease.

In its most virulent form, leishmaniasis kills. The strain, known as "kalazar" or visceral leishmaniasis, killed more than 50,000 people during an epidemic in southern Sudan between 1991 and 1993.

Moulton, a droll, 42-year-old biostatistician, learned of the Iranian project at a 1996 seminar at the Johns Hopkins School of Hygiene and Public Health. The vaccine trials offered him a unique opportunity to work in a country virtually closed to Americans for 20 years.

But the real draw was the chance to realize his boyhood dream to visit the places where his Presbyterian grandfather, great-grandfather and great-great-grandfather ministered to the Muslim and Christian villagers of northern Iran.

In Iran, the doctor overseeing the vaccine trials was Ali Khamesipour. The disease has taken the American-trained, Iranian microbiologist from his medical laboratory in Tehran to rural health clinics and schools across the country -- to places like Dastgard in a dusty agricultural region of central Iran where two forms of the disease are endemic, and spreading fast.

At the girls school there, a wide-eyed third-grader in white Muslim headdress and gray smock offered her small hand to Khamesipour.

He spotted the leishmaniasis sore immediately, a lesion seen in this country as long ago as the ninth century. Khamesipour asked Marziah Barati whether anyone in her family had the sores.

Two brothers and a sister, she replied.

Named for a 19th-century British army surgeon who discovered the disease-causing parasite, leishmaniasis is transmitted by the bites of a mosquito-like sand fly or a gerbil-like rodent.

Small bumps appear under the skin. They bloom into lesions that can become ulcerous and painful. In its acute and yet most benign form, the lesions heal within several months. But some patients live with the sores for years, some with several dozen.

If the lesions heal, they often leave a horrible scar that, in this traditional society, can affect a family's ability to marry off its daughters.

The scars are so prevalent that Taghi Shafioff, the school's male nurse, says that "in the past, they used to believe that anybody who doesn't have the scar of leishmaniasis is a bastard."

Shafioff has seven scars. The school's custodian turned her left cheek to reveal a spider web-like scar. The vice principal lifted up the hem of her coat-like manteau to show a scarred leg.

In a class of 35 fifth-graders, 13 said they have had "salak," the Farsi word for the disease.

`My face would be ruined'

Vahideh Maimar fears she will wake one day to find a sore on her face. "My face would be ruined," the 11-year-old said. "I would be ugly."

Khamesipour and his team of Iranian researchers are at the forefront of efforts to test a vaccine against leishmaniasis.

"There is not a single effective vaccine against any human parasitic infection," said David Sacks, an immunologist at the National Institutes of Health in Bethesda and a volunteer consultant to the Iranian trials. "`There's not one against malaria or sleeping sickness. Even a vaccine against leishmaniasis that worked marginally would be somewhat of a first."

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