Compassion and epidemiological modelling - a conversation with Maria-Gloria Basáñez
Does compassion have a role to play in epidemiology, mathematical modelling and global health? The Centre for Compassion & Global Health's Dr David Addiss speaks with Imperial College London's Prof Maria-Gloria Basanez about the positive impact of a good epidemiological model.
Created in 2008 the Centre for Compassion & Global Health is an initiative that seeks to bring compassion back into the centre of global health discord.
As the Centre's founder David Addiss explains, “Global health is rooted in the value of compassion. It is grounded in an awareness of our interconnectedness and a concern with the whole. Global health and compassion both seek to build bridges between people who are separated by geography, politics, resources, and other factors.”
David: Thank you for being with us today, Maria-Gloria. When we met, back in 2002, you were already working on epidemiology and mathematical models to better understand neglected tropical diseases (NTDs). What is it about modelling that appeals to you?
Maria-Gloria: The scientific aspects of modelling are exciting! Dynamic modelling takes into account how populations of vectors, parasites, reservoirs, and humans interact. Modelling helps you understand that things are not linear, and understanding the nonlinearity of the world allows you to understand things in other fields. For example, if you tell me that the planet is warming up at a higher rate than anticipated, that doesn’t surprise me. Modellers don’t expect things to change at a constant rate. We expect them to change at a rate that is, itself, always changing, either with time or as a function of other variables. You see that everything interacts, sometimes in unexpected ways. This is both exciting and sobering.
David: What does compassion have to do with epidemiologic modelling and working in a competitive academic environment?
Maria-Gloria: Compassion is really what motivates me. If you develop a good epidemiological model – and by that I mean an honest model, with rigorous methodology, that you can refine and validate, and go back to the drawing board if necessary, one that’s going to be useful for the countries affected by the diseases – that brings you back to the center of things. Yes, publishing papers is important, getting grants is important, but if the models are useful– this is the main motivation. A good model is a tool that can actually be used to help program managers and communities that are affected by neglected tropical diseases understand the important issues and make programmatic decisions. How many treatments should we give? Once a year or twice a year? To whom? For how long? There are many relevant questions that can be addressed by modelling.
But returning to compassion, I think that alleviating suffering is the ultimate goal. I didn’t study medicine, so I don’t make decisions about particular patients. But programs that have a population-level impact also help individual people. In epidemiology we tend to think more about populations, but I think we also need to bear in mind the individuals who form part of these populations.
David: Do you find it challenging when you are dealing with grants and papers and equations to keep in mind the faces of the people that you are ultimately trying to serve?
Maria-Gloria: Sometimes, but they are always there. Sometimes I need to refocus. Sometimes we have to keep listening and to do some soul-searching. We always look at our models carefully and try to make them more rigorous and complete. We constantly think about this, but in the end we want the models to help improve the health and lives of people.
David: That commitment to listening and re-evaluating suggests a need for humility. Would you say that humility is a characteristic of a good modeller?
Maria-Gloria: I think humility should be the characteristic of any good scientist, but it’s not a characteristic I see very often. There is a constant need to get grants and write papers, to put yourself forward as an expert. And of course everybody wants recognition, but, yes, humility is very important.
David: Years ago I was flying back from China, sitting next to an American man who was learning Chinese. He wrote a phrase for me in Chinese, a quote from Lao Tzu, I think, which said, “The essence of nobility is indifference to recognition”.
Maria-Gloria: The need for recognition is very human. I see it all across science – I see it everywhere – this need to say, “Here I am, this is what I do.” I see it in my little five-year-old, and even in my dogs!
David: What has given you the most joy in your work?
Maria-Gloria: Publishing a paper is a great experience, especially if the journal has a high impact factor. But is that joy? If so, it’s short-lived. An important joy is to see my students grow, and to see them learning and developing their own compassion, and developing their own interest in helping and engaging with others through these quantitative methods. Working with brilliant young minds, and with students who are motivated to do something about the suffering of populations, is really my main source of joy.
David: To help your students develop their capacity for compassion you’re providing them with technical tools and ways of thinking. Roshi Joan Halifax says that compassion is made up of non-compassion elements. It involves empathy, but also awareness and mindfulness, perception and memory. It also has a strong cognitive component. It strikes me that you’re talking about giving students both experiences and the cognitive tools to increase their awareness, which then helps them develop compassion. Does that resonate?
Maria-Gloria: Yes, people who get into modelling sometimes tend to be a little nerdy, mostly interested in technology. Some people say that mathematicians are located somewhere on the autism spectrum. But seeing the connection between the mathematics and the humans who are suffering – that increases motivation. You need both the emotional and the cognitive elements, you need all of it. You need to be emotionally motivated and engaged, and also, you need to acquire the “dry” (if you want to call them that) tools to actually get somewhere.
David: Several years ago I became interested in the epidemiology of compassion. The idea that there is an epidemiology of compassion seems like nonsense to some people. But I ask them, “Do you think compassion is uniformly distributed in space and time?” And on reflection, most people say, “Well no, I feel compassion or observe it more in certain times and places.” If that’s true, then there’s an epidemiology of compassion: it clusters in space and time. As an epidemiological modeller, do you think it’s possible to understand the epidemiology of compassion?
Maria-Gloria: I think compassion can be learned to some extent, and I think the epidemiology of compassion may have an analogy with communicable diseases if it catches on and is rewarded.
David: Yes, I agree. Compassion is communicable. It’s transmissible.
Maria-Gloria: Exactly, so I think if you teach your children to be compassionate, they will become more compassionate themselves. With young adults, the patterns may already be set, and it may be harder to teach them compassion. But with that in mind, in my lectures, I include pictures of people affected by NTDs and refer to historical and geographical facts that enhance the connection. That helps the students to connect emotionally with the people who have the diseases they are studying, or who may have acquired them if they are displaced as refugees. I think that you really can communicate and transmit compassion and steer young bright minds to be passionate and compassionate about alleviating the burden of NTDs.
David: You are speaking about the responsibility we as teachers have for fanning that flame of compassion.
Maria-Gloria: Yes, and for helping the students to keep that focus. To return to the epidemiology of compassion, I think it’s clear that compassion increases fitness, in evolutionary terms. Mothers are inherently compassionate about their children, and that definitely increases fitness of the individuals. Now we are talking about ‘memes’ rather than genes, but it would be interesting to study the ‘epigenetics’ of compassion – how the environment fosters compassionate traits. What are the genetic effects of a compassionate environment? Biology teaches us that cooperation and compassion are innate in many species. If we understood this, I believe we would take better care of our beloved planet.
Whether we’re talking about environments or animal populations or graduate students, we all have pressures – the pressure of survival or getting a job or a position at a university. You might be very compassionate but you also have to be competitive and very determined to succeed, because the environment rewards that. That’s the difficulty, because society selects for other traits. So we need to focus not only on the level of the individual but on how to change the environment so that compassion is rewarded. Modelling compassion might help us change the system, change the paradigm from competing to collaborating. If it is rewarded and leads to greater success, collaboration and compassion would have the upper hand.
David: In the early days of the NTD movement, the Bill & Melinda Gates Foundation told us, “We are going to reward collaboration – you have to work together,” and that changed the way we worked.
Maria-Gloria: And people do want to work together; not only is it more personally rewarding but also more scientifically rigorous. You learn more about your modelling if you engage in collaboration and comparison rather than in competition. But we often go in the other direction. It used to be that we applied for project grants, then programme grants, and now there are “investigator awards,” which go to the individual investigator. That doesn’t reward the collaborative spirit.
But although it may take you longer to arrive where you want to be if you collaborate and are compassionate, you’re going to get there. That’s what I say: it’s possible. It is possible to be a good teacher, mentor your students, do good research, and have social impact. Going back again to what gives most joy, it is this collaboration and this love of “teaching as gardening.” You mentor your students (the equivalent of finding a good spot for your plants and watering and feeding) and see them grow and blossom.
I’m a little bit of a rebel. Doing things this way is something different, and I like that. It feels rebellious. You can be different, you can think differently, you don’t have to do whatever everybody else is doing and what everybody else is telling you to do if you want to have a successful career. I’m going to do it my way, differently, compassionately, more like an oak or a yew tree. It will take a long time! But hopefully it will endure.
Adapted from original article available at ccagh.org
Selected research by Maria-Gloria
- Research project: Developing Models of Loiasis Transmission To Inform Control of the Disease
- Research project: NTD Modelling Consortium: Reaching the 2020 Goals for human onchocerciasis
- Research project: Modelling of Chagas disease, health-care burden and access to care
- Research publication: Strategies for tackling Taenia solium taeniosis/cysticercosis
- Research publication: Model-Based Geostatistical Mapping of the Prevalence of Onchocerca volvulusin West Africa
- Research publication: Spatiotemporal distribution and population at risk of soil-transmitted helminth infections following an eight-year school-based deworming programme in Burundi, 2007-2014.
- Research publication: River Blindness: Mathematical Models for Control and Elimination