At 1:30 a.m. on a chilly autumn night, the telephone rings in a brick house in North Baltimore and awakens Keith P. West Jr.
Of a long list of possible callers from a dozen time zones, it turns out to be a cargo supervisor at Los Angeles International Airport.
A gray plastic shipping container the size of a dishwasher has toppled off a conveyor belt. White fog is seeping from the seams, and West's name is on the address label.
Should I call the fire department? the panicky cargo man asks.
No need, says West. It's just liquid nitrogen at minus 196 degrees Celsius, keeping frozen some blood serum from Nepal. Tip the tank back up and the fog should stop leaking, he says.
Then he goes back to sleep, leaving the airport's night staff to wonder at the strange stuff people send around the world.
West -- absent-minded professor of international nutrition, folk-rock guitarist, speaker of broken Nepali and rusty Japanese, doting father, accumulator of 900,000 frequent-flyer miles on United Airlines alone -- is founder of Johns Hopkins' vitamin studies in Nepal.
Twelve years ago, he built an information factory there, in a place as different from his Homeland neighborhood as it is possible to imagine. It produces invaluable evidence of how vitamins can reduce deaths among malnourished people.
Yet the work raises difficult questions: about the obligations of scientists to their subjects, the different aims of aid and research, the conflict between gathering data and relieving suffering. West and his colleagues operate between two cultures, where short-term benefits and long-term goals often clash.
The nitrogen tanks that travel each month by mountain roads and air freight from the mud-and-dung huts of Sarlahi District to the gleaming digital clutter of the nutrition lab at the Hopkins School of Public Health shuttle between two extremes of human existence. They link illiterate Nepalese subsistence farmers who do not know their own ages with ambitious American scientists competing for multimillion-dollar grants.
Nepal's per capita gross national product is about $220 a year, compared with $29,080 in the United States. It is a nation of 24 million people, yet its budget of $1.32 billion is smaller than the $1.6 billion budget of the Johns Hopkins University.
Even the clock and calendar underscore the gulf between researchers and their subjects: In Nepal, today is the eighth day of Kartik in the year 2057. And the country has a unique time zone -- not an even nine hours, but nine hours and 45 minutes ahead of Baltimore.
The latest tank of frozen blood samples from Nepal will be analyzed on $50,000 machines that measure levels of vitamins and minerals, creating nutritional snapshots of hundreds of pregnant villagers. But for now, it goes to a bunker-like basement at the School of Public Health protected by electronic locks, video cameras and alarms. Here, inside dozens of industrial freezers set at minus 80 C, is what may be the costliest collection of bodily fluids on the planet.
Saliva from Russia. Blood from Peru. Breast milk from Indonesia. Urine from Bangladesh. And on and on -- a global sampling of malnutrition and disease.
The school spends $162 million a year on the strange alchemy of public health research: Human lives are reduced to data on zinc blood levels or pregnancy complications or measles incidence. Then the data are converted into programs aimed at improving human lives.
In the Nepal Nutrition Intervention Project, West, 50, has been such an alchemist. The work has required not only the solitary brainpower of any science, but also more practical skills: endless tea-drinking with skeptical bureaucrats, sharp bargaining for gasoline during a fuel embargo, lobbying for funds in the "Dilbert" cubicles of the U.S. Agency for International Development.
He leaves his wife, Hopkins biostatistician Marie Diener-West, and their 12-year-old daughter, Natalie, for months each year, traveling on airlines not known for their safety records to places not listed in any tourist guidebook. He has a habit of getting sick soon after arriving overseas; he recently had a memorable tangle with dengue fever.
But for the data these huge public health trials produce, West would put up with far more. He has an unshakeable faith in the power of rigorous experiments to find truth.
"If you can lock in a finding with real consequences -- if it can withstand the onslaught of scientific criticism and politics and changes in fashion -- it becomes permanent," he says. "It changes the world."
In the Nepal project's earlier phases, West confirmed that vitamin A can sharply cut child mortality and discovered that it may also reduce deaths of pregnant women. Now, as his colleague Parul Christian oversees the latest phase, he is building a parallel organization in neighboring Bangladesh for larger trials to confirm or disprove the results from Nepal.
