Out of Africa
Winning the MacArthur “genius grant” was a career highlight for Rice professor Rebecca Richards-Kortum. But it was a visit to Malawi that changed her life.
Before Rice University bioengineering professor Rebecca Richards-Kortum won a MacArthur Fellowship in September (“the first Houston scientist, the first Houston woman, and the first Rice faculty member to win the award,” the university noted), it’s likely that few people outside her discipline had heard of her. The work she does as the founding director of Rice’s 360° Institute for Global Health—bringing low-cost, innovative medical tools to the underserved—isn’t exactly the sort of thing that makes headlines. But since her days at the University of Texas at Austin, where she taught until 2005, the 52-year-old Nebraska native has been working hard to improve health outcomes for people in places from Malawi to the Rio Grande Valley.
Mimi Swartz: You’re a woman in a male-dominated field. How hard has it been to establish that you’re a legitimate scientist?
Rebecca Richards-Kortum: I don’t feel like there have been huge overt biases to overcome. Nobody has ever said to me, “You can’t do that.” It’s been much more subtle. People will say things that later make you wonder, “Do I belong?” For example, sometimes I would get on the elevator at my office, and my colleagues would talk to me about my kids, whereas they would talk to my male colleagues about the grant they just applied for or that paper they just published. I’m sure they meant to be nice, but it definitely made me feel like they were noticing something different about me.
MS: When you were in graduate school, how many women were in your class?
RRK: There were about eighty students in my entering class and there were three who were women. As an undergrad, I was the only woman in the major that I graduated in. I remember on the first day of my junior lab the instructor was taking attendance, and he got to my name and he looked up at me and said, “Oh, you must be Richards.”
MS: Did everybody laugh?
MS: What drew you to science?
RRK: I just always really loved math and science. And when I got to the University of Nebraska, I decided that I was going to take physics because I thought it was the hardest science, and I had this amazing teacher—he just was extraordinary—named Paul Burrow. One of the best teachers I’ve ever had. He made it so interesting and so fun that I decided that that’s what I wanted to major in. Then my sophomore year I was thinking of switching to engineering because my boyfriend told me I would make more money as an engineer.
MS: Was he an engineer?
RRK: Yes. He’s now my husband. So I went to visit the chairman of the physics department, and I said, “I’m majoring in physics, but I’m thinking of switching to engineering. What’s your advice?” He said, “You should come and work in my lab. You really should start doing research.” At that time I didn’t even know there was a thing called research. I thought college professors just taught classes. So naive I was. So you know, he loved physics, he loved his research. It was a way to sort of share it with students, and he completely changed the trajectory of my career.
MS: And you had no idea before that?
RRK: No. So I went to work in his lab, and he was interested in material science. He was studying metallic glasses, looking at some of their conductive properties. My job was to make the samples, which was really interesting. But I felt like the time scale between when the world would see a benefit from that work was longer than I wanted for the things that I focused on in my career. So I decided I wanted to do more biomedical work, where I could see a more direct connection to how the work benefits [people].
MS: Did you grow up with a sense of social justice? With your background—you have two graduate degrees from MIT—you could have become an engineer for a big oil company.
RRK: When I was at UT I was asked to develop an engineering course that would satisfy the general science requirement—there aren’t very many. So I was thinking, “How do I make biomedical engineering accessible and interesting to English majors and philosophy majors?” And I decided to do a course on biomedical engineering and global health. That was how I first learned about global health, and it was so much fun and so interesting to teach the class. I loved it. Then when I moved to Rice, I was invited to the opening of a clinic in Malawi. I came back a different person. I told the people in my group, “We’re going to change what we’re doing.” And we now have a minor in global health technologies. It was a transformational trip.
MS: If you go to parts of south Houston, there are places where the health care conditions are pretty bad. It almost seems as if it’s easier to access some medical technologies in Malawi than here.
RRK: I think there are really important differences. When I walk into a community hospital in Malawi, I can look around and see 27 different things immediately that I could design that they don’t have. But even if someone said, “Here’s some money, go buy what you need,” they can’t just buy it, because there isn’t anything on the market that’s designed to work in an environment where power is so unstable, where there’s no climate control.
MS: Whereas in a clinic in Houston—
RRK: It’s got power, it’s got air-conditioning, it’s got water. The question is, Can a patient get in the door there? It’s access to the system that’s a problem.
I think the opportunity as a technologist is then to think about how do you make things that are cheaper so that systems can better afford them and how do you make them so that they can work closer to the point of care, so you can put them in the hands of, say, a nurse or a nurse practitioner or a community health worker, and how do you develop educational tools that can incentivize behavior change that relates to chronic illnesses like diabetes and obesity and cardiovascular disease? We have programs that are focused on improving health in the Rio Grande Valley.
MS: This has come up quite a bit in Houston, where you’ve got the world’s largest medical center in the country’s fourth-largest city and you’ve got an incredibly underserved population. Is that a technological issue or is that a question of will and politics?
RRK: From an engineering perspective, right now we’re at the beginning of thinking about what’s our part of the solution. For instance, I’m really interested in cervical cancer prevention. Because if we cannot prevent cervical cancer, I don’t know what cancer we can ever prevent. We have a vaccine to prevent HPV infection, we have HPV tests to screen if you’re infected, we can treat you if you have cervical pre-cancer. We have so many tools to prevent cervical cancer. Yet in the Rio Grande Valley, fewer than 10 percent of women who should be getting screened are getting screened. It’s terrible. As a result, the cervical cancer rates in the Valley are 31 percent higher than they are in the rest of the state.
So I’ve been working with Kathleen Schmeler, who’s a gynecologist at MD Anderson Cancer Center. She and her team are mentoring teams of obstetricians and gynecologists who are taking care of women who are at risk. We have developed a fiber-optic microscope that you can use to actually visualize precancerous changes without the need to take a biopsy. I’ve been working with Kathleen in Brazil to put this on a mobile van—they drive it out into the countryside in Brazil. That’s what we’re trying to do now in the Valley to work with our colleagues there at UT Medical Branch and UT Rio Grande Valley to put the same technology at their mobile health clinics that are staffed by nurse practitioners.
MS: Let’s talk about working with students. There was a quote of yours that I loved, the Haitian quote.
RRK: It’s “You don’t learn to swim in a library. You learn to swim in the river.” I think that has come to be more and more important to me the longer that I’ve been teaching. When I compare the way I learned as an undergraduate compared to the way I learned as a graduate student—as a graduate student somebody gave me a problem and said, “Go find the solution to this problem.” So you learn in this very experiential way. Whereas as an undergraduate, often you get a problem set, you do the problem set, you look in the back of the book to see if you got the answer right, and if you didn’t get the answer right then you go back and you keep trying. I think for me, the experiential problems where you feel like you’re working on something that’s really important are so motivational. That’s what we’re trying to do for our undergraduates here in our Global Health Technologies Program. I was just looking at some of our retention data with some of my colleagues, and if you look at students who come to Rice and say they want to major in science or engineering and then you look at whether they actually graduate in science or engineering, students who take one or more classes where they have a project where the problem comes from a real client—they’re significantly more likely to graduate. And that impact is bigger for women and it’s bigger for underrepresented minorities. I was so excited when I saw that data.
MS: I know that you work with medical students from Malawi. How is that different from working with your Rice students?
RRK: For the past two summers we’ve had a group of Rice students working side by side with a group of students from the University of Malawi. One group working in Houston, one group working there. When the Malawian students come here, they’ve never worked in an environment where information is so easy to come by, because in Malawi internet access is very slow. So when the Rice students approached a problem, the first thing they would do is Google it, find ten articles, read those articles, and really quickly be up to speed. And the students from Malawi didn’t know how to do that, because they’ve never had the opportunity to do that.
Whereas we had a team of Rice students in Malawi and they were working with this suction machine that’s used in surgery but often fails. So they came up with an idea for a fix that required an LED and a photodiode. And the Rice students were like, “I’m just going to go online and I’m going to try and order them from Amazon.” And then they were like, “But wait, I’m in Malawi.” And the Malawian students said, “Well, we’re going to go down to Shoprite, and we’re going to look at television remote controls, because they have exactly the parts that you need and you can scavenge those parts and you can build it.” And our students would have been just totally incapable of doing that.
MS: Here’s something you said to the Houston Chronicle: “There are a lot of problems in the world that resonate with women’s lives that women are more likely to be attuned to and fix. If there were more women scientists and inventors, society would make more progress in these areas.” Can you talk about that a little more?
RRK: One of the most important goals for my team in the next decade is to think about how we end preventable newborn death in places like Malawi. I think I and many of my colleagues bring a certain perspective to that, because we’re moms. We all worried when we were pregnant, we all wanted to have healthy babies and to see them grow up healthy. And we can all imagine what it’s like to not have access to the tools that have reduced newborn mortality in the United States. If you look at current rates of progress right now, it will be 150 years before a child born in Africa has the same chance of survival as a child born in North America. I don’t want to live in a world that says it’s okay to just wait 150 years.
We’re working on a set of seventeen technologies that we think together can end 85 percent of preventable newborn death if they’re just available in places like Malawi. And I think it’s so important in thinking about ending preventable newborn death. I sometimes get asked a question—it used to really piss me off—that goes along the lines of, “You know, I salute you, you’re doing God’s work in Malawi, but I just have to ask, maybe you save these babies, but don’t they just go on to starve to death or to have a horrible life? Are you really doing the right thing?” And I would just be offended by that question, but I’ve been thinking a lot about what’s the right answer. And the right answer is, if you look at societal progress and economic development in low-income countries, progress starts with ending child mortality, with reducing child mortality. Because what happens when you bring child mortality down is women start to have fewer children, because they believe their children are going to live. So as fertility rates fall, what happens is, you get this bulge of young adults in your population. And when they’re old enough to work, if you have jobs for them, you get what’s called a demographic dividend, where you have more workers than you have dependents. So your so-called dependency ratio goes down. That’s what happened in Bangladesh, that’s what happened all across East Asia. When child mortality came down, very shortly after, fertility rates came down, and very shortly after that you had this huge economic growth. And when there became more jobs for women then the dividend was even bigger. So for me there’s a really interesting and appealing connection between addressing this challenge of outcomes for babies, but also thinking of it in terms of how do you empower women in countries like this? We have so many women engineering students both at Rice but also at Malawi Polytechnic who are drawn to these challenges. It’s really exciting to see it all come together.
MS: This makes me think about Texas maternal mortality rates, which are very high. Is there a correlation there? If you can’t prevent maternal mortality what are the repercussions?
RRK: There is very good data that says children do very badly if their mothers do not survive. So it’s certainly in the interest of children to be sure that their mothers are there to take care of them. Both children and families do better. Overall, maternal mortality in Texas is worse than it is in China and worse than it is in Russia. In Malawi, women are dying in childbirth literally, whereas here it’s more about the impact of access to care for chronic-disease management in the year following childbirth. I’m getting out of my area of expertise, but it counts as a maternal mortality the whole year after you give birth. So if you had a chronic disease or a substance abuse problem, you can get emergency Medicaid for ninety days after childbirth, but after ninety days you lose that access. So if you don’t otherwise have access to Medicaid—from what I’m hearing this is when those deaths are occurring in Texas.
MS: I’m a writer, and people ask me all the time, “Where do you get your ideas?” And when you were talking a few minutes ago about walking into a clinic in Malawi and seeing 27 different things that you could do, I wondered where you get your ideas from—how you spot the problems and figure out the solutions.
RRK: The best ideas I get come when two things happen. One is when I get an opportunity just to watch physicians and nurses—mostly nurses—do their jobs and ask them a lot of questions about what’s hard, what do they wish they had that they don’t have, what do they wish was different in their environment. And then I find that I need some sort of quiet space to consider those ideas. I’m a runner, and that’s where I get that time. I just got back actually from D.C. yesterday, for the Marine Corps marathon. It’s good mental white space. And then just being able to sort of brainstorm with colleagues too.
MS: And working with students . . .?
RRK: Oh yeah, they’re so creative. That’s the fun part, the brainstorming stage. Because at that point all ideas work. You haven’t proven how hard it is yet.