Three Questions: Michael Murphy of MASS Design

by Andrew Wade

As part of the Polis Three Questions series, we interviewed Michael Murphy, executive director and co-founder of MASS Design Group. The not-for-profit firm's design for Butaro Hospital in Rwanda was a poetic argument for the merging of design and public health. Motivated by the idea that "Design is never neutral — it either helps or it hurts," MASS worked with Partners in Health on the project, which aims to mitigate the transmission of airborne disease. By approaching design holistically and seeking to make use of local materials and empower local communities, MASS demonstrates the potential social impact of design.


Butaro Hospital in Rwanda.

Can you tell us what you're particularly excited to be working on at the moment, and what lies ahead for you?

We have been working on a few projects in Haiti since a year after the earthquake that are exciting on several levels — both for the growth they bring to MASS as an organization and for their impact in community health. In particular, we have a center for cholera treatment currently under construction that continues our research in identifying the "direct" impacts of the built environment on our health. We have seen evidence of the incubation and transmission of tuberculosis due to poorly designed buildings, but cholera is really about a failed sanitary system — one that once infected can perpetuate outbreaks. To combat infection, our new cholera center will offer a micro-solution to wastewater treatment on site. We hope this inspires a dialogue about investment in better buildings and infrastructure as a health argument.

Also on the horizon in the coming year, we will be starting a few projects in southern Uganda which seek to address the problem of "brain drain," combating the large-scale emigration of skill capacity.


GHESKIO Cholera Treatment Center, during construction.


Rendering of the GHESKIO Tuberculosis Hospital.

What do you consider the most pressing issues we face as a society today, and how should we go about addressing them?

I think it’s becoming publicly evident that our poorly constructed built environment is an urgent and growing concern. As seen in rising sea levels, in Haiti’s 2010 earthquake, and most recently during Hurricane Sandy, cities are not built to absorb change and catastrophe. Buildings shouldn't exist simply as commodities; they need to be rethought and redesigned in such a way that keeps the residents’ health and safety in mind. The only way to achieve this is to invest more heavily in design research and in our infrastructure at both the local and national level. Our design schools need to reprioritize their emphasis, and new practice models need to be sponsored to offer market solutions to this serious global crisis.

What do you find inspiring?

I am inspired by entrepreneurs, tinkerers, designers who find a way to innovate within the calcified systems, while also maintaining a perspective of the entire system itself. I'm inspired by health innovators like Dr. Raj Panjabi of Tiyatien Health in Liberia and Josh Nesbit at Medic Mobile — both of whom are making a really incredible impact on public health.

I also met an amazing actor, Bryan Doerries, who runs an organization called Theater of War. He uses classical plays to help communities cope with tragedy and disaster, and his method of effecting change is completely unique.

I am in awe of material scientists and building experts like John Ochsendorf, and altruistic curators like Courtney Martin and John Cary inspire me daily with their belief in the sharing of ideas with the public. We all owe them a lot.

In terms of design and architecture, I have been in awe of TAM Associati in Italy, the genius of Francis Kéré and the work of TYIN in Norway.

Credits: Images from MASS Design.

+ share

Three Questions: Fadi Tofeili of Portal 9

by Natalia Echeverri

In the walls and ramparts surrounding nineteenth-century Beirut were seven fortified gates, or portals. The number was considered a symbol of perfection and represented the seven families who guarded those entrances. As the walled town grew beyond its enclosures, an eighth gate was added. Portal 9 is an imaginary opening into the city, an intensive exploration of the urban condition from architecture and planning to metropolitan mores and cultural pursuits. It is a gateway to endless possibilities.

— Fadi Tofeili in "The Imagined," Portal 9, Issue 1

Fadi Tofeili is a Lebanese journalist, poet and translator who has published three books of poetry and translated many works of literature. He is also editor in chief of Portal 9, a new journal that features creative and critical writing on cities. We asked Fadi if he would take part in the Polis Three Questions interview series, and he graciously agreed. By way of introduction, we've added an opening question about the origins and identity of Portal 9.



How did Portal 9 come about, and what makes it unique?

The idea came up in a conversation with my friend Nathalie Elmir (creative director of Portal 9), a year and a half ago. We wanted to start a publication that would bring together diverse perspectives on cities in the Middle East. We also wanted to help re-engage people with Beirut's city center — which has endured devastating violence — and revitalize the city's public realm.

Portal 9 began with a three-day workshop at Solidere in central Beirut, where we gathered a group to exchange ideas. The participants included an architect, an urban planner, a novelist, a photographer, a publisher, an artist, a journalist, an academic, a theater director and a designer. We discussed a structure for the journal and assembled an editorial team based in Beirut (managing editor Eyad Houssami and me), London (editor at large Malu Halasa), Liverpool (reviews and critique editor Omar Kholeif) and Amsterdam (urbanography editor Todd Reisz).

Each edition of Portal 9 revolves around a particular theme, offering conceptual context. Within the theme, we combine the freshness of conversations and interviews, the adventure of creative writing, the rigor of academic research and the liveliness of cultural critique. The concept helps this varied content become a coherent whole.



What are you most excited about working on at Portal 9, and what lies ahead for the journal?

Working on a bilingual publication in Arabic and English, with a diverse group of writers, editors and contributors, is what I find most exciting. It enables a rich exchange of information and ideas, expanding the range of possibilities within each theme. Having launched "The Imagined," our inaugural issue, we will continue to develop Portal 9 into a platform for exploring the city through multiple genres. We also plan to keep weaving together urban, social, architectural, artistic and linguistic perspectives.

What do you consider the most pressing issues we face as a society today, and how should we go about addressing them?

Conflicts around identity at the local and international levels, including religious, ethnic, national and class identities. Cities are growing more condensed, coded and complicated. One might argue that urbanization leads to cosmopolitan social relations, yet divisions remain; and in some cases people who live in proximity are still aliens to each other. With communal identities urging for representation, partitions between different communities become more serious. In order to address these sociopolitical dynamics, we need to adopt the highest degree of openness. We need to study the human condition in the most complex of fields: urban fabrics. How do we penetrate the partitions that barricade different communities? How do we come to terms with identity in writing truthfully about the city?



What do you find inspiring?

Primarily change, or ways in which things take on new appearances and meanings with time. Although change is often cruel, it also inspires. It can spark reflection and creativity. Today it happens at a shockingly fast pace, and requires us to respond almost instantly. The concept of time, which is a core aspect of writing, is largely about change. Unwritten stories also inspire me. I find photographs, old newspaper articles and keepsakes from personal archives fascinating. They are great sources of insight into places and their inhabitants.

Credits: Spreads from "The Imagined" appear courtesy of Portal 9.

+ share

Three Questions: Cassim Shepard of Urban Omnibus

by Andrew Wade

As part of the Polis Three Questions series, we present an interview with Cassim Shepard, editor of Urban Omnibus, Adjunct Assistant Professor of Architecture at Columbia University and Poiesis Fellow at the Institute for Public Knowledge at New York University.


"Goregaon Railway Bridge," part three of Shepard's five-part series on street life in Mumbai.

Trained in filmmaking, urban geography and city planning, Shepard also produces non-fiction media about cities, buildings and places. He has exhibited his films at museums in Québec, Bologna, Milan, Portland and St. Louis, as well as at the 2006 Venice Architecture Biennale and the United Nations. His most recent video project, "Informal Urbanisms," chronicled life in six informal settlements around the world for the Cooper-Hewitt exhibition "Design with the Other 90%: CITIES."

Thank you for making time to answer our questions. Can you tell us about what you're particularly excited to be working on now, and what lies ahead for you?

For the past four years, I've been very fortunate to edit Urban Omnibus, The Architectural League of New York's online publication dedicated to defining and enriching the culture of citymaking. We present innovative projects in and perspectives on the built environment of New York City, essentially new or exemplary ways of interpreting or intervening in the urban landscape. So, what's particularly exciting for me is the opportunity to talk to creative thinkers in a wide range of disciplines — architects, urban planners, artists, community activists, city government officials, scholars, engaged citizens — and then to help connect the diverse ways people are acting locally to improve their city or neighborhood to a broader, international discourse of urbanism.


Aerial view of the Brooklyn Navy Yard, by Robert Clark. Source: Urban Omnibus

What does improving the experience of a waiting room in a central courthouse have to do with national shifts in the philosophy of the criminal justice system? What might the plans for a former shipbuilding facility on the Brooklyn waterfront teach us about how to encourage a sensible, 21st-century manufacturing policy for this country? How can the adventures of a thrill-seeking sewer diver inform our understanding of complex urban hydrological systems? I never get tired of thinking about those kinds of connections across different scales.

For me, this fits into a broader project that's motivated, in one way or another, every project I've been working on since I first started taking pictures in high school: trying to share my sense of awe at all the intentional choices that go into making human-made environments work, and trying to tease out how the accretion of those choices over time reflects particular cultural attitudes.


Video stills from Shepard's "Montage City" course at Columbia. Source: Urban Omnibus

After studying filmmaking in college, I spent several years making documentaries and video installations internationally with a couple pauses to study urban geography and urban planning. So after seven years living in many different places around the world and trying to tell many different kinds of stories audio-visually, I was very excited to take on something like Urban Omnibus that allowed me to explore one city, and its dense concentration of creative urbanists, in great depth.


"Shanghai" video montage by Shepard for the Venice Architecture Biennale 2006.

Now I think the time has come to continue and advance the work of connecting what's going on here in this city to what's happening elsewhere in the world. Discovering ways that cities — especially city governments, but also community-based organizations, consultancies, and non-profit organizations — can learn from each other's experiments and failures is a more complex challenge than it might seem. I'm interested in the role that sophisticated communication can play, whether it's high-quality journalism, visual art, online media, exchange programs for students as well as policymakers, or good old-fashioned storytelling.

What do you consider the most pressing issues we face as a society today, and how should we go about addressing them?

In a phrase: climate change. But naming that as an urgent challenge doesn't get us very far. Because it's not really one challenge, but a series of overlapping ones that include consumption habits, settlement patterns, energy production and distribution, infrastructure investment, manufacturing and supply chains — the list goes on.


Lower Manhattan on October 29, 2012, by Eric Chang. Source: Urban Omnibus

In the immediate aftermath of Superstorm Sandy last week, my colleague Varick Shute and I offered some thoughts to our readers that touched on the "new reality" of climate change in terms of infrastructure investment and scales of government. Climate change is so big and so planetary in scale that the role of the community is often obscured. We know what we're told as individuals about lightbulbs or gas mileage or plastic bags, and we know what we hope for from nation-states about carbon emissions standards or energy production. But the urban and community scales are a little harder to define in the climate-crisis conversation.

I'm especially interested in those infrastructural innovations that will bring greater flexibility and resilience to our urban environments and help to mitigate some of the effects of rising sea levels and stronger storms. As one example: retrofitting our impervious streetscape with permeable paving to absorb some of the stormwater flooding down our streets and off our rooftops, which overwhelms sewage systems. If federal governments aren't going to step up with coherent climate change policies, how can municipal governments leverage their unique assets — whether it's municipal infrastructure or an engaged citizenry — to make change?


"Archipelago," by Urban Omnibus, explores a day in the life of five New York neighborhoods.

What do you find inspiring?

Taking the subway from Brooklyn over the Manhattan Bridge every morning never ceases to amaze me. What I love most about living in a dense city like New York is the forced proximity to people unlike myself, with such different life experiences, cultures and perspectives. So I find the systems we've created for such a diverse group of people to share, to hold in common, pretty awe-inspiring for a number of reasons. And at the moment in my daily commute when the train comes out of the tunnel, somehow I always (no matter how late or preoccupied I might be) marvel simultaneously at the sociological story unfolding in my subway car, the infrastructural story of the subway system and the bridge, the natural story of the river and the shoreline, and the architectural story of Lower Manhattan's skyline. For me, thinking about how it got to be that way — and how it might work just a little bit better — really never gets old.

+ share

Three Questions: Annette Kim of M.I.T. Sidewalk Lab

by Peter Sigrist

As part of the Polis Three Questions series, in which we present the same three questions to a range of people doing impressive work related to cities, we bring you an interview with Annette Kim, professor of international urban development at the M.I.T. Department of Urban Studies and Planning.


Source: SLAB / Narrative Maps

Annette is founding director of SLAB, or Sidewalk Lab, an interdisciplinary research group that uses cartography to generate knowledge about the public space between streets and buildings. Her research and teaching encompass property rights, critical cartography, market transition, urban housing, entrepreneurship, public space and municipal finance. Recent publications include "Real Rights to the City: Cases of Property Rights Changes Towards Equity in Eastern Asia," "Takings in the Twenty-First Century: Comparisons of Urban Land Development Controversies in the US, China and Vietnam" and the forthcoming "Sidewalk City: Re-Mapping Public Space in Ho Chi Minh City." Annette has worked as a consultant to the U.N. Centre for Human Settlements, a designer of low-income housing and a manager for construction projects in cities around the world. In this interview, we discuss her current work, future plans and sources of inspiration.


Source: SLAB / Physical Survey Research

What is your most exciting project at the moment?

The last two years have been exciting with the formation of SLAB — a completely different mode of scholarship for me that reconciles a number of issues: collaborative yet directed inquiry, social science and art, academic scholarship and public engagement, etc. We have mostly been focused on one output for our research — the book "Sidewalk City: Re-mapping Public Space in Ho Chi Minh City," which is being published by the University of Chicago Press. We are just now sending it off to go into press production.


Source: SLAB / Street Vendor Interviews

So now we are turning to constructing a traveling exhibit of our critical cartography to engage with a slightly broader public, with the high point being an exhibit in Ho Chi Minh City itself, where the role of sidewalks and street vendors is a big social debate. The show is really exciting to me because moving from print into installation unleashes all kinds of possibilities. We are now working on animated maps, tactile maps, interactive maps, all of which are very large. One of the things I learned from writing the book was that the most promising direction forward is to develop a narrative, almost cinematic, map in order to integrate analysis of space-time and the material-social, as well as to communicate better. With the accessibility and development of technology and the continued experimental melding of the disciplines, the possibilities are quite in reach. There is a heck of a lot of visualization out there in the sciences, humanities, design, etc. But, core to SLAB is the pursuit of a humane ethos and aesthetic, so we are careful to not get too slick or complex for our own good, although we can appreciate the wizardry of others.


Source: SLAB / Public Space Maps

What do you plan to take on next?

In keeping with SLAB’s vein of mapping overlooked spaces and overlooked peoples, I see the next stage of SLAB moving to a different geography. There are an estimated 2 million people living underground in Beijing, in old bomb shelters and basements, because that's the best space that they could afford in the city. I suppose you could think of it as excavating the subterranean dimensions of rapid urbanization. The situation is somewhat remniscent of Jacob Riis's New York, but different as well.

In any case, I look forward to an in-depth period of fieldwork again. I think one thing I contribute to scholarship is to not rely solely on either remote technology or remote theorizing, but to engage in a spatial ethnography. I’m taking Mandarin classes!


Source: SLAB / Photography

What do you find inspiring?

I have found many sources of inspiration: people, nature, places, growth, grace, etc. Rather, it seems the question is whether I’m in a state sensitive enough to notice inspiration. Its so easy to become deaf and blind — it’s truly amazing! That is what critical cartography is about: to help us notice, to navigate ourselves to greater awareness. And like receiving inspiration, it paradoxically takes discipline.

+ share

Three Questions: Cities Through the Eyes of Chauncy Primm

by Peter Sigrist



One of my favorite sources of inspiration is a Flickr photostream by Chauncy Primm, a young nursing assistant who lives in Salisbury, Maryland. Chauncy has assembled over 2000 images, mostly of architecture in and around Baltimore (as well as a remarkable tour of pre-WWII buildings in Manhattan). He adds historical background, related articles, insightful commentary, and tags for referencing buildings with common features. He also includes unexpected, self-revelatory images and samples of his artwork. Chauncy's photostream reveals a fascinating perspective on cities, architecture, history, development, and preservation. We recently interviewed him as part of our Three Questions series. Each image in this post is linked to its place in the photostream, which includes additional information.



What inspired you to start photographing and drawing buildings?

Ever since 4th grade I've wanted to be an architect. I love and live for all forms of art, but nothing inspired me more than Victorian architecture. In 2005, when I started my first year at Morgan State as an architecture major, I was exposed to historical buildings in Baltimore. They were so striking to me and so "random-sourced" compared with the more standardized designs of today. I had to capture them in photos so I could marvel at what I saw over and over again. Flickr gave me a place to display what I had captured.



I draw buildings because I love to try to recreate the splendors of the past with my own creative input. It's challenging to try to do highly detailed drawings like those of nineteenth-century architecture firms. I really want to be able to create imaginative landscapes using watercolor or chalk or ink like they did.

Are there certain structures that stand out to you as great examples of urban design? If so, what are some of their characteristics?

Downtown Baltimore is a small triumph in that the designers took away the worst of what was there and kept what gave the city character, adding high-quality new buildings and spaces that visitors and Baltimoreans really appreciate.



The American Brewery (above), on Gay Street, is one of my favorite buildings. The best bricklayers of the time were employed in its construction, which helps account for its survival since the 1880s. It has perfectly round windows and arches, multiple roof lines and towers, and dormers and brackets that accentuate its presence. It has found a new purpose as the headquarters for Humanim, which I admire more than anything. It is a timeless structure that completely graces the neighborhoods of Middle East and Oliver.



With the Bank of America building (above), you get a sense of grandeur as well as something hand-made. It almost resembles a mountain with a beautifully rendered copper mansard roof. Multiple setbacks, sculptures, and gold and limestone accents give it center stage. It's a relatively unknown Art Deco masterpiece. People rarely look to Baltimore for the best of building arts and sciences from the 1920s, but here is one hidden in plain sight.

How might architecture help improve the quality of life in cities?

Quality design and materials should be top priority. I worry intensely over buildings with barely passing standards, cost-cutting everywhere you turn, with windows or ceilings or walls that have to be replaced before the building is even 5 years old. Nobody wants to live or work in a building that is of poor quality from the start. Historical buildings still exist because time was taken to make sure they were structurally sound and visually appealing.



To improve the quality of life in a city by way of architecture, I think one has to examine what buildings might contribute to the places where they'll be built. Will they spark a sense of pride and initiative for residents who don't feel inspired to contribute to their neighborhoods? Developers should be "people conscious" in whatever they construct, thinking about the needs of building inhabitants as well as the local community. This makes life better for urban residents and makes it more likely that buildings will be preserved.

Three Questions: Dawn Biehler on Pests and Public Health

by Peter Sigrist



As part of the Polis Three Questions series, we present a conversation with Dr. Dawn Biehler of the UMBC Department of Geography and Environmental Systems. Her research covers intersections between public health, environmental justice, historical geography, housing, interspecies interaction, and political ecology in urban environments. Dawn worked with William Cronon on her doctoral studies, focusing on the political and ecological history of pests in cities. More information on her work can be found here.

Thank you for speaking with us, Dawn. Your work shows a very original perspective on public health and environmental justice in cities. How did you become interested in urban health issues?

I grew up on a farm and became passionate about wildlife conservation at a young age, so it took some powerful people and experiences to wrest my attention away from rural and wilderness concerns. Not that I don't care about these any more, but I'm now very much focused on urban environments. The most powerful person was definitely Dr. Craig Wilder, an urban history professor whom I met as an undergrad. Dr. Wilder often made the point in his classes that for decades affluent do-gooders had been trying to help city kids escape to farms, suburbs and nature parks during the summer, but few of those do-gooders ever tried to empower urban communities to improve the environments they lived in every day.

This struck a chord with me — perhaps because I was inclined to become that kind of do-gooder — and led me to a couple of powerful experiences: after college I worked for two small community organizations dedication to urban food and housing. I met city residents who were struggling to make their neighborhoods and homes healthy places to live. Yet, all too often, I saw that those communities were blamed for poor health. I resolved to learn the stories of city-dwellers and lay health activists, how they were treated by the state, businesses, health professionals, and the like.



What led you to focus on domestic pests and other interspecies interactions?

This is where my farm upbringing stuck with me. I was always fascinated by the fact that my parents lovingly nurtured some animals — our pets and livestock, and the many injured wild birds that my dad brought home to nurse back to health — but cursed and even killed others that were detrimental to our crops. I realized later that farms and cities are not all that different from one another when it comes to animals. Namely, landscapes that are dramatically transformed by humans tend to encourage other species to flourish as well — the creatures we call pests. These creatures are then detrimental to the very reasons for those landscapes to exist — to produce crops or to sustain healthy communities. Of course, it's not the animals' fault; it just so happens that they have adapted to the niches we create.

“Pests connect us with our neighbors through their transgressions of spatial boundaries. Pest populations do not respect property lines — in some situations, they don't even respect walls, sometimes not even our bodies. Therefore they can help us recognize that the home is not merely an isolated, modern, private space, but deeply linked with nature and the rest of the city.”

In cities, our garbage, the vegetation we plant, our buildings, all of these features that we create stimulate particular ecological responses in the animal populations we live with. The animals in turn elicit particular responses among residents, activists, the state, businesses. They are fleshy manifestations of urban social inequality: the neglect of garbage and housing in some neighborhoods versus others that are well-served by garbage collection and housing investment, this is one important factor in pest distribution and ecology. Furthermore, pests connect us with our neighbors through their transgressions of spatial boundaries. Pest populations do not respect property lines — in some situations, they don't even respect walls, sometimes not even our bodies. Therefore they can help us recognize that the home is not merely an isolated, modern, private space, but deeply linked with nature and the rest of the city. They are often the routes by which poor environmental conditions become embodied — for example, studies have connected poor housing conditions with severe German cockroach infestation, and severe infestation with asthma problems in children. This all is not to say, of course, that pests are good things and we should like them; rather, their existence and distribution tells us something about our society, if we are willing to think about them.

“This all is not to say, of course, that pests are good things and we should like them; rather, their existence and distribution tells us something about our society, if we are willing to think about them.”

Through your research, have you come across any groups doing promising work to bring about healthy and socially just urban environments?

There are a lot of groups that say, we have to educate the public, especially poor communities, about the environment so that they can make good decisions about their health. But too many organizations stop there, and I find that to be a half-measure and really disrespectful to communities. My historical research has turned up a lot of urban environmental campaigns that focus on education without making fundamental changes to the way the state or businesses operate in those communities. That puts all of the burden upon regular folks to change themselves, and such projects have rarely been sustainable.



The organizations that have truly impressed me are those that either arose through grassroots citizen action, or else involve the community at the most basic levels of program development and implementation. This way, the community's knowledge about environmental health problems gets incorporated into everything the group does. These groups tend to work for systemic change while also reaching out to residents. One group that has impressed me very positively is Environmental Health Watch in Cleveland. Healthy housing is one of their main campaigns, and at the same time as they alert residents to hazards like mold, lead, and pests and pesticides in their homes, they are also working to hold local government and businesses accountable. They are also helping make physicians into advocates for healthy homes and urban environments by showing them that many health conditions are related to the environment, and that the environment needs to be part of diagnosis, treatment, and prevention.

“This way, the community's knowledge about environmental health problems gets incorporated into everything the group does. These groups tend to work for systemic change while also reaching out to residents.”

I'll just mention a couple more groups that I find really exciting, both of them in New York. West Harlem Environmental Action (WE ACT) works on environmental justice issues at many scales. They have convened a Climate Justice conference but, when I last talked with someone from that group, they were also working on a very narrowly-targeted Integrated Pest Management (IPM) pilot project on a couple of blocks where businesses were disposing of their garbage improperly, leading to serious problems with rats, mice, roaches, and the like. IPM is a pest control approach that stresses systemic environmental change and either no pesticides or very low-toxicity pesticides. Residents were very involved, sharing their knowledge about problem areas with garbage and pests. WE ACT has also been involved in a lawsuit against EPA that charged the agency had done too little to protect children from rodenticides and other pesticides. WE ACT's leader, Peggy Shepard, also helped show that it took a long time for banned pesticides to be removed from convenience store shelves in the neighborhood.

The other New York group, Little Sisters of the Assumption, provides health services in East Harlem. One staffer there, Ray Lopez, has been recognized by the Robert Wood Johnson Foundation with a Community Health Leader Award. He got a lot of media attention in New York for his work helping families manage bedbug problems with IPM, but he works on a range of healthy housing issues. He visits families' homes to help them learn how to manage pests and other health hazards, and at the same time has been very effective in pressuring landlords, housing staff, inspectors, contractors, and the like to improve the housing environment. I think families realized that he was genuinely listening to them when they described their problems — say, no one will come fix that pipe and it is attracting roaches, or the garbage collector has been skipping our building — and was using that information to demand real changes from more powerful stakeholders. Why should a family invest time in the rather laborious tasks of IPM if something else beyond their control will continue to attract pests anyway? But when they see that someone is listening and making sure they have a voice in how housing is managed, then they have every reason to do their part.

Thank you for answering our questions. We wish you the very best with your work.

Credits: Photo of project buildings from Hip Hop Beats 800. Drawing of rats from NPR. Photo of Deepti KC from WE ACT.

Three Questions: Nayer Khazeni on Urban Influenza

by Peter Sigrist



As part of our new series called Three Questions, in which we post brief interviews with people doing inspiring work related to cities, today we're fortunate to talk with Nayer Khazeni, pulmonary/critical care physician, researcher, and educator at the Stanford Center for Health Policy (CHP). Dr. Khazeni's research focuses on international health policy, pulmonary infectious disease, and strategic planning for global health catastrophes. More detailed information can be found at her CHP profile.

As public health issues become increasingly global, we see great potential in your work for improving the quality of life in cities around the world. Can you tell us about your current projects?

For the past few years, I've been using computer-simulated mathematical models to examine pandemic influenza preparedness and response strategies for an urban center based on New York City. By spring of 2009, my teams had completed assessments of vaccine and antiviral stockpiling options for a future influenza pandemic [full text of the resulting articles can be viewed here and here]. When the A (H1N1) pandemic started, we were able to rapidly update our model parameters to reflect the spread of the virus and help guide public policy regarding the national vaccination campaign [full text here, with related overviews here and here].



Even though three major influenza pandemics occurred in the 20th century (1918, 1957, and 1968), we have little data from these. Because the 2009 (H1N1) pandemic occurred in a time of advanced technology and health care data collection, we now have a fantastic opportunity to plan and prepare for the next pandemic. In one of my upcoming projects, I will be analyzing data collected during the pandemic in order to model the temporal spread of influenza from urban epicenters to neighboring communities. This type of model can help local health officials plan for surges of pandemic influenza and allocate resources during a more severe pandemic.

Can you share some of the pressing issues related to your research on global threats to public heath?

Both pandemic and intra-pandemic influenza have a much more significant impact on individuals in developing countries than developed ones. Because of the way pandemic influenza viruses come about (close proximity of birds, pigs, and humans facilitate pandemic mutations), they often begin in Southeast Asia. One current pandemic threat virus, influenza A (H5N1) (sometimes called "avian flu" in the press) is having a devastating impact on several Southeast Asian countries. More than 60% of people who are infected with the virus die, and because A (H5N1) is causing a pandemic in birds, frequent poultry slaughters are disastrous to local economies. Many of these and other developing countries throughout the world have very limited access to health care we take for granted. In the case of influenza, this includes antiviral drugs and vaccines.



A few years ago, Indonesia, a country particularly hard hit by A (H5N1) (of 163 confirmed cases to date, 135 have been fatal), made a decision to stop sharing virus samples with the World Health Organization (WHO). The Indonesian government cited that free samples from developing countries were being used by pharmaceutical companies in wealthy countries to develop drugs and vaccines that the developing countries could not afford. Hopefully, in time, international governments can work together to ensure more equal distribution of pharmaceutical resources for influenza and other diseases. In the meantime, I am working on building a statistical model to predict groups at higher risk for complications and death from influenza in developing countries. This information may help public health officials in those countries allocate scarce pharmaceutical resources to groups who need it most.



Are you reading anything interesting at the moment?

Philip Hensher's The Mulberry Empire. It's about the British occupation of Afghanistan in the 1830s. I just started, but I'm enjoying it. Before that, the last fun novel I read was Déjame Que Te Cuente, by Jorge Bucay. It is the story of a young man who goes to a therapist with a new problem each chapter. The therapist helps address his concerns by telling a tale--many of the fables are about ancient times, kingdoms, and faraway places, but the lessons are remarkably relevant to our seemingly more modern dilemmas.

Credits: The photo of women in protective masks is from topnews.in. The photo of children gargling to prevent influenza is from iayork.com. The photo of workers testing an infected bird is from britannica.com. The photo of Red Cross nurses working during the influenza pandemic of 1918 is from old-picture.com.