Science through Global Challenges: A Funds of Knowledge-Rooted Independent Study of Malaria Treatment and Prevention


By Mbaye Ndiaye; Jeremy B. Heyman, PhD; Stefania Macaluso, PhD; Fanta Bathily —


Introduction

By Stefania Macaluso, PhD

A key to achieving academic success is providing students with meaningful experiences and skills to negotiate how these experiences affect them and the society in which they live. Although students strive for academic success, a challenge that faces many international students that have completed their necessary coursework or credits, primarily in their senior year, is finding ways to further promote higher order reasoning as well as advance their academic writing skills as they prepare for college. In turn, the question that often remains for the administration is, “What do we do with these advanced 4th year students?” A possible answer is independent study.

Serving as a science coach for English Language Learners & Internationals Support (ELLIS) Preparatory Academy, I was able to support the process in co-developing and outlining a piloted independent study with Dr. Jeremy Heyman, who served as the primary mentor to two students, Mbaye Ndiaye and Fanta Bathily.  The study group met once a week starting in September in lieu of their science class sections and have continued meeting in trimester three. 

In the following sections you’ll hear the voice of our students and Dr. Heyman, guiding the process from a pedagogical standpoint and more importantly sharing the scientific implications of their literature research. This paper not only shows the outstanding prospect of a successful independent study program but discusses scientific discourse within a literature review as well as the development of a small community of practice where ideas and funds of knowledge have been created, shared and built upon.  


Cultivating the roots and STEM-ing the Stage: Context, process, and how the project came to life

By Jeremy Heyman, PhD

Within our small public high school serving a high-needs population of 16-21 year-old newcomer immigrant emergent bilingual/multilingual students with widely varying prior educational backgrounds, we try to serve the needs of our individual students.  Due to the nature of our population and the challenges faced by so many of them, there arises a natural tendency or need to focus immense energy and resources on the pressing needs of supporting more struggling students to successfully stay in school and progress toward graduation.  An unintended consequence in such high-needs settings lacking the economies of scale of a larger or more well-resourced setting is that the strongest students are not always challenged.  Much of my work focuses on maximizing students’ potential and readiness for postsecondary success, with a focus on STEM opportunities, so I was concerned last summer in thinking about three rising seniors who had exhausted our school’s science offerings, especially after a last-minute staffing change left us without the ability to offer an advanced or college-credit science course.  While some of our top students complete paid science and engineering research internships in top research labs at the likes of Columbia University over the summer prior to their senior year, this would not solve our problem for the academic year.  One of these students was able to corral a continued internship in addition to a College Now computer science course to fill in for having exhausted ELLIS science courses as well as ELLIS and College Now math courses (with College Now cancelling any Calculus courses that he could have otherwise taken), but for the most part, our students do not have access to many core science courses through College Now, and I did not want to leave the other two students with no science learning opportunities for their entire senior year.

With a background in socially and culturally relevant pedagogy, and a strong belief in the value of students’ funds of knowledge (Gonzalez et al, 2006) from my time as a chemistry/ESL teacher and science education researcher, I pitched the idea of a weekly independent study to the two students with no particular topic in mind; rather, we would discuss and co-construct a topic together based on their particular interests and experiences.  It would be less ideal than a daily class, but with weekly meetings and time between classes to read and interpret complex scientific literature, we hoped the students could further develop their understanding of scientific inquiry and research, as well as really strengthening their cognitive academic language proficiency (Cummins, 2003) with high-level texts as emergent multilingual students with just three years in the US (and a similar length of time exposed to the English language).

The year started with the two students brainstorming their interests and questions that they were curious to answer related to the natural sciences, with the hopes of closing in on a research question that could set the stage for our study.  To maximize interest and the potential for developing a topic and research questions relevant to current, cutting-edge science, we examined the global challenges identified by the National Academies of Sciences, Engineering, and Medicine, a short list of the most pressing problems needing scientists’ attention to improve the lives of humans and other life on our planet.  The students decided they wanted to focus on the global health challenge of malaria treatment and prevention, with the students discussing their own experiences with the disease: one student had battled malaria as a girl in Mali, and the other student had seen others in his life fighting malaria when he was growing up in Senegal.  After initially finding relevant articles for the students, which they would summarize, ask questions, and then discuss at our next meeting, they moved on to searching and reading articles more independently.  We would check in to discuss what they were learning and to consider what to research next so as to follow their interests and new questions while also gaining a comprehensive sense of how society might best attack the ongoing struggles against malaria in places like their home countries.

After building background knowledge about malaria and the parasite that causes it, one of the initial driving questions connected to concerns over the spread of drug-resistant malaria strains that was rendering treatments that were recently cutting-edge to be increasingly ineffective in many locales.  As such, the students unpacked research articles related to novel artemisinin-combination therapies (ACTs), cocktails of multiple drugs which are modern medicine’s leading treatments today, even as scientists continue searching for their next wonder drug.  We explored the basics of drug-receptor binding and how to interpret the results of pharmacological studies, exploring some of the basics of biochemistry on a need-to-know basis in order to answer the students’ own research questions.  Finding one totally effective treatment strategy did not seem efficient or even possible, so the students investigated prevention strategies as well, from the bed nets they knew in their childhoods to new vaccines still in development to methods of controlling pathogen-carrying mosquito populations.  

Throughout the process of finding, scouring, and analyzing articles and asking new questions, the students were faced with text far beyond what is typically expected of high school students, especially ELL / emergent bi/multilingual students.  I often wished we could have delved deeper into the texts and concepts presented, but the students grew significantly in their research abilities and used their funds of knowledge, alongside occasional videos and other visuals that we reviewed, as vital schema for unpacking scientific findings without most of the scaffolds that they typically had available in their regular classes.  Some of the deepest learning and engagement came when the project took an even more personal turn.

In learning that the historical blockbuster drugs for malaria treatments came from plants native to communities impacted by malaria, the students were curious to learn more about the traditional treatments indigenous to their own home communities, as they also shared insights about how different individuals in their home communities viewed “modern” versus “traditional” medicine depending on the situation.

Consequently, the research pivoted to the students interviewing a family member in their home country about native plant treatments used within their families, such as the nguerr (guiera senegalensis) plants of Senegal and the tirotiya (neem) trees of Mali.  One student also interviewed a classmate, a struggling student who did not have secular schooling prior to his immigration and enrollment at ELLIS (i.e. SIFE) and is rarely consulted by others for help, who had learned informally about the uses of various plants in the village where he had grown up.  The group expanded on this indigenous knowledge by finding recent ethnopharmacology papers that reviewed these very plants, as well as others, whose parts or extracts were used to treat various forms of malaria in their native region of West Africa and beyond.  

From here, the group discussed and compared the relative promise of whole plants and their extracts with the so-called “modern” ACT therapies.  This also raised discrepancies in the types of data reported, the methodologies used, and possible disparities in equipment to which different researchers in different parts of the world (and with different areas of expertise) had access.  Students also raised poignant questions as to why some plant remedies that were shown to be quite effective, at least for uncomplicated cases and for the populations tested, have not become more widespread. A disconnect seemed to arise between these two types of studies and their researchers, and it seemed that perhaps the indigenous knowledge of some peoples were valued above that of other groups.  While the students did not engage in original research per se, this point, along with the group’s suggestion of increased collaboration between ethnopharmacologists (and those with indigenous knowledge of plants and their extracts) and the medicinal chemists and pharmacologists at the universities and pharmaceutical firms that publish in top research journals, is put forward as a form of original scientific thought or contribution to the field, just one of many examples where I have been deeply impressed and moved by my students’ work throughout this process. On that note, please enjoy this literature review and research synthesis of what the students took away from this experience, which I hope to spur these students and others to learning science on a need-to-know basis through the lens of attacking pressing challenges faced by their communities and the world.

References
Cummins, J. (2003). Basic interpersonal communicative skills and cognitive academic language proficiency. BICS and CALP.

González, N., Neff, D., Amanti, C., & Moll, L. (2006). Funds of knowledge for teaching: Using a qualitative approach to connect homes and classrooms. In Funds of knowledge (pp. 83-100). Routledge.

(2017). Global challenges. National Academy of Sciences. Retrieved from

http://sites.nationalacademies.org/International/INTERNATIONAL_052200


The Scavenger Hunt for the Alternative Antimalarial Weapon

By Mbaye Ndiaye and Fanta Bathily

Introduction

Malaria is one of the deadliest diseases in the world; it kills a child every thirty seconds. In fact, it kills more than a million people every year, and 90 percent of its cases occur in Sub-Saharan Africa (1). What causes malaria is neither a bacteria nor a virus, but plasmodium parasites which are carried by the female Anopheles mosquitoes to humans. When the mosquitoes bite and leave the parasite in the human body, the parasite, which is unicellular, would then multiply itself inside the human’s white blood cells (5). There are four types of this plasmodium parasite: p. falciparum, p. malariae, p. ovale and p. vivax (2). The deadliest of these parasites, the one responsible for most malaria cases in Africa, is the p. falciparum. It usually takes 7-18 days for symptoms to start to manifest after one is infected by the parasite. These symptoms include vomiting, chills, fever, nausea and fatigue. The biggest reason for the steadiness of the high rate of malaria deaths is the hardship and complexity in finding an absolute, effective treatment that can fight the p. falciparum perfectly off the host-infected victim. That is because the p. falciparum is a smart living organism that, after transmitted to the host by a mosquito, will find ways of staying alive. In other words, it adapts by developing resistance to any drug scientists have discovered to damage it. Because of this, drugs become ineffective for curing malaria. It is very rare to encounter a West African native who hadn’t been affected by malaria; in 2016, there was an estimated 216 million cases of malaria in 91 countries and 445,000 deaths.

Below is a story from Fanta Bathily, who was infected by the disease when she was in her home country.

I remember when I was ten in Bamako, Mali. I got sick. It started at rainy season, because in Africa when it’s raining children like to be under the rain to have fun and wet. My parents always tell me not to stay longer under the rain, but NO, I never listen, because as children we always want to be curious. There is a lot of grass and sand outside, where the water stayed and also where the mosquitoes come. Some of the grass becomes dirty, because the water stays there and nobody clean it. Later I refuse to sleep under the net; because at the season almost everyone sleep under the net or spray but some people don’t like it as I. While I was not sleeping under the net, I have been bitten by the mosquitoes a lot. A few days later I started having fever and nausea. I couldn’t eat anything, because everything that I eat always throw it out; and cut my appetite. My parents and I thought that it was a simple fever and that once they give me a traditional medicine that it going to go away. It worked but didn’t go away. I spend almost three weeks on that fever before they bring me to the hospital to see if it’s going to work or not.  The traditional remedy, the tirotiya tea (from the neem tree), was working but I think there were something else to complete the treatment so it can stop the fever forever. So when they brought me to the hospital and I got some clinical trial to help me, because I suffer. Any medicine that they had prescribe me, all of them had hours from each other. I also had three sting in each of my leg at the same day, I didn’t know why but I felt like they were cutting my leg off; and couldn’t stop crying and screaming at the hospital. The doctor also prescribe me some serum, and my serum was due in my house by my big sister who had learn nursing. Almost every morning and evening I got one. From the help of my parents and doctor; I started getting well, because traditional medicine and clinical trial both worked.

SECTION 1: “Modern” drug treatments

Malaria is not, yet, a disease that has a potent cure, like smallpox with its vaccine. Right before the 1930s, Quinine was discovered from the “bark of the Cinchona tree” (3) and it still remains effective in fighting off the parasite. The problem with Quinine is that its side effects are severe; some victims who took this drug were urinating some of their white blood cells. As effective and dangerous as it is, the drug is only recommended for severe malarial cases. In the 1940s, scientists came up with Chloroquine. Effective in treating and preventing malaria with unserious side effects as it was, Chloroquine becomes inoperative in some cases, because the p. falciparum developed resistance to it. Many other drugs had been discovered but, just like Quinine and Chloroquine, they were either too cytotoxic or ineffective to use. Today, artesunate and artemether are the two best and most used antimalarial drugs. They both come from the same Chinese plant, artemisia annua. However, due to drug-resistance, researchers had to find a new way of keeping these drugs effective by combining artemisinin with other antimalarial drugs. This is called Artemisinin-based Combination Therapy (ACT). This does not, however, end the war with malaria. As an article titled The Hunt for the Next Artemisinin says: “scientists are searching urgently for new drugs, given the possibility that, sooner or later, resistance to artemisinin may develop” (4). According to Tulane University, a new drug called AQ-13 had been developed and it seems to be as effective as the ACTs. To test this drug, researchers tried to treat 61 Malian adult male patients of non-severe malaria. 28 of them were given the AQ-13 while the other 33 were given the ACTs—specifically, artemether/lumefantrine combination. The patients of both groups were treated effectively and cured, except two people who were given the ACT had treatment failures. In short, both groups had similar cure rates with a very minimal and unserious failure. Before recommending this drug as a new alternative antimalarial treatment, there are questions to be answered: How effective would the AQ-13 be for women? What about the children? These questions remained unanswered as the study promised to expand its experiments and include women and children (6). Another question that remained unanswered is why scientists are not using quinine as part of a combination therapy. It seems that there should be other drugs, extracts or molecules of some plants out there that would help reduce or stop the side effects of the quinine, so that it can be used thoroughly as the next antimalarial shield.

SECTION 2: Traditional medicine treatments

The fact that scientists are busy searching for the next weapon against p. Falciparum does not mean that infected Africans are just sitting still waiting for the results. Most Africans are familiar with using traditional medicines. In fact, with more severe malaria, these people are more likely to rely more on the traditional medicines for their accessibility—as the severer malaria the more expensive the hospital charges—and their spirituality—as they start to believe such sickness is a curse from God and one can only come near to God through nature. They find the bark, the leaves, or even the roots of certain shrubs and plants effective against malaria. Some plants help cure the disease while others help halt some malarial symptoms, such as vomiting and diarrhea. One of these shrubs is Guiera. It grows in the western and central parts of Africa. Guiera is used as a traditional medicine to treat numerous of diseases, such as malaria, diarrhea, cough, cold and others. By extracting Guiera, Phytochemical screeners, who closely study molecules found by preparing extractions from the plants, found compounds such as alkaloids, flavonoids, tannin, saponin, and terpenoids/sterols in both the leaves and roots of the shrub (7). Researchers found the methanolic root extracts to be effective for fighting off tuberculosis, diarrhea, plasmodia and some fungi. Also according to researchers, Guerra is better at healing when it is eaten or drunk rather than injected into one’s body: “Further toxicological studies are also warranted as it has been shown that most extracts when orally ingested seem to be relatively harmless, but when injected most extracts are toxic to varying levels” (7).

There is also an African fruit that turns out to be effective against the p. Falciparum, called the African star apple. African Star Apple is considered to have the ability of curing “drug-resistant infections”, therefore holds the possibility of curing the vancomycin-resistant Staphylococcus aureus (VRSA)—Plasmodium parasite infection. To kill the pathogen in this study, scientists used the extract fraction from the star apple with low concentration and minimal contact time and found it effective in fighting the menace of VRSAs in humans. “The seed extract suppressed early infection by 72.97 percent and 97.30 percent, at 500 and 1000 mg/kg, respectively. The pulp juice recorded 72.97 percent and 81.08 percent, at 500 and 1000 mg/kg, respectively. At 500 mg/kg dose, the level of parasite control on day seven was the same (96.10 percent) for both seed and pulp” (8). This means if a victim with early malarial infection consume 1000 mg/kg of the African star apple seed, then there is a 97% chance of the person being cured, or/and if that victim consume 1000 mg/kg of the juice, then there’s a 81% chance of  being cured. This fruit is more effective than most synthetic drugs that scientists are developing. This makes one ask: are these traditional medicine experts and synthetic drug developers actually communicating discussing their finds amongst themselves? The extracts of such plant should be able to serve as a part of the future for antimalarial drugs. Such plants should be taken care of and planted as many areas as possible–made accessible for all, because something is better than nothing.

SECTION 3: Prevention

Although there are both tradition and artificial medicines being discovered every year around the globe, to prevent will always be better than to cure. Scientists found other ways of preventing the disease, so that there will be less death, because there will be less people infected with the parasite. One of those ways of prevention is the Insecticide-treated bed nets (ITNs). The ITN is a big veil with a lot of small holes, that the mosquitos cannot pass through, and it has insecticide on it that can damage the mosquitos. A high level of use of ITNs in a community results to a low population of mosquitoes transmitting the disease in that community as a whole – benefiting even those who don’t use the nets. If taken seriously, “ITNs reduces the incidence of uncomplicated malaria episodes by 50 percent and all-cause mortality in children under five by about 20 percent” (9). Therefore, the ITN is an effective way of preventing malaria. Many African leaders stress the use of the net.

Vaccines are another recognizable ways of preventing malaria. There is also a vaccine that help to reduce the risk of severe malaria disease and a lot of children death and the vaccine will protect them more than one year. Scientist have found three kinds of vaccines that can fight against different microbes, which are Live Attenuated vaccines, inactive vaccines, and subunit vaccines. The Live Attenuated vaccine uses the virus that has been weakened to the point that it is incapable of causing disease. It made by decreasing the virulence of a pathogen, but still keeping workable. Inactivated vaccines contain a virus that has been killed and is completely incapable of provoking disease. The vaccine subunit is made of antigen and has one part of the pathogen. It prevents disease caused by bacteria that produce toxins in the body. RTS,S is the new vaccine that, since 2001, the two great organizations, PATH and GSK, have been collaborating and working on. Scientists concluded that if used along preventions, such as the nets and insecticide, then RTS,S vaccine would bring great positive result in reducing malaria in children. However, the findings of researchers confirm that this vaccine is not perfect and therefore shouldn’t be a reliable weapon against the parasite. They tried the vaccine in more than 15,000 children, “who were followed for up to four years in seven countries in sub-Saharan Africa, found that a series of four shots reduced the number of malaria cases by only 36% in young children, and by 26% in infants” (10). Four shots for four years and it only prevented less than 36 percent of children from getting the disease, keeping in mind that the vaccine costed them US$565 million, the RST,S is a failure. But of course, one can always argue that 36% of prevention is always better that 0% of prevention.

Many Africans burn mosquito coils to prevent malaria. Mosquitoes coils are mosquitoes-repelling smoke that is made with the dried powder of pyrethrum. Regardless of its familiarity in African houses, studies have actually proven that there is no evidence that mosquitoes-coil prevent malaria. Furthermore, the smoke isn’t good for both humans and the environment (11). However, maybe the fact that these people believe that the coils have a power in preventing malaria gives the coil that mysterious power. Here’s the perspective of a mosquito-coil user:

“The mosquitoes coil preclude malaria, very successful, because once all the smoke are gone out of the room, and next to the window there is trash or dirty water, the mosquitoes are going to come back and transmit their parasite. Also sometimes the mosquito coils kill them and sometimes they don’t, that’s why they were smart of making a lot to kill them before they kill people, such as antimalarial mosquitoes spray, etc…”

Another way of preventing malaria is getting rid of the mosquitoes that transmit the parasite. A research study conducted in 2014 says that researchers found that they can eliminate the P. Plasmodium parasite inside the mosquitoes by feeding bacteria to the mosquitoes. Scientists fed the bacteria, called Chromobacterium, to a bunch of mosquitoes, and they found out that not only did it cleaned all the plasmodium pathogens out of the mosquitoes but it also killed them. According to researchers, the death of the parasites can be explained in two ways; it was because either the bacteria had activated the immune system of the mosquitoes that fought off the pathogens; or, the chromobacterium had brought up some chemicals that killed the parasites. Even though chromobacterium isn’t a bad bacteria for humans, scientists want to conduct more research to see if this method—feeding bacteria to mosquitoes—is safe for humans, who will be stung by the mosquitoes anyways (12). A question this study raised is how are they going to expose all the mosquitoes to such bacteria?

Conclusion

Out of all these different methods of approaching this deadly disease, traditional medicines seem to be the most promising step-forward to take to fight malaria. As it is well known, the search for the alternative drug is urgent, since the effectiveness of the most promising one there is now, artemisinin, is being weakened by the parasite’s resistance. Traditional medicines have two benefits: they can be used as a whole, or their extracts can be used into the new drugs–the more of different extracts a drug has the harder and longer it is going to take the parasite to develop resistance to such drug, because the parasite would have to identify and study each extracts and that might take a long time. For the preventions, they do definitely help reduce possibility of catching the disease, however according to these findings, they shouldn’t be scientists’ main focus. People would not always sleep under the nets. They are uncomfortable. And the coils’ chemical smoke are badly affecting people and the environment. To conclude, the government should help farmers and traditional medicine experts with tools and lands to identify plants that are found to be promising, to be the alternative cure for malaria, because hope lays on the traditional medicine. Bringing ethnomedicine and modern medicine can lead to a satisfying results–to the perfect alternative antimalarial drug that the whole globe, especially, West Africa had been waiting for. One might argue as well that maybe scientists should improve the dying drugs that they already have instead of searching for new ones. This they already did with artemisinin by combining it with others, the ACTs, however, why not do the same combinations with quinine–the side effects are bad, but they can there ought to be extracts that can eliminate those side effects. It sounds like they are developing and discovering drugs without continuing the experiments. The AQ-13, Guiera, and the African star apple sound effective, but they raised important questions that their experimentations didn’t answer For example, how effective they are on children? Are they only effective on early infections or more serious, advanced malaria as well? Many other questions also arose. Should all scientists work together, including those who examine plant remedies (e.g. ethnopharmacologists) and those who research “modern” medicines, and answer these questions instead of going about looking for new medicines separately?

References

  1. “The Reality of Malaria.” UNICEF, n.d. Web. 25 May 2018.
  2. “Malaria.” World Health Organization, World Health Organization, 17 May 2018.
  3. “Malaria: Past and Present.” Nobelprize.org. N.p., n.d. Web. 17 May 2018.
  4. “Malaria – Causes.” Malaria, NHS Choices, 27 Nov. 2015. Web. 25 March 2018.
  5. NHS Choices. NHS, n.d. Web. 24 May 2018.
  6. “New Drug Effective against Malaria.” ScienceDaily. ScienceDaily, 12 Sept. 2017. Web. 24 May 2018.
  7. Hamad, Mubarak Siddig, Hassan Elsafi, Ahmed Saeed, Eltayeb Fadul, and Reem Hassan Ahmed. “A Review on the Taxonomy, Ethnobotany, Phytochemistry and Pharmacology of Guriea Senegalensis J.F.Gmel. (Combretaceae).” OMICS International. OMICS International, 09 July 2017. Web. 24 May 2018.
  8. Ihekwereme, Chibueze Peter, Frances Kaosiso Okoye, Sandra Chinenye Agu, and Angus Nnamdi Oli. Advances in Pediatrics. U.S. National Library of Medicine, 2017. Web. 24 May 2018.
  9. “PMI, President’s Malaria Initiative, Fighting Malaria and Saving Lives.” Uganda | PMI. N.p., n.d. Web. 24 May 2018.
  10. “Malaria Vaccine Cautiously Recommended for Use in Africa.” Nature News. Nature Publishing Group, n.d. Web. 24 May 2018.
  11. Lawrance, Clare E., Croft, and Ashley M. “Do Mosquito Coils Prevent Malaria? A Systematic Review of Trials | Journal of Travel Medicine | Oxford Academic.” OUP Academic. Oxford University Press, 10 Mar. 2006. Web. 24 May 2018.
  12. Letzter, Rafi. “To Kill Malaria Parasite, Feed Bacteria To Mosquitoes.” Popular Science. Popular Science, 27 Oct. 2014. Web. 24 May 2018.

Jeremy B. Heyman, PhD, and Stefania Macaluso, PhD work at ELLIS Preparatory Academy, NYC Dept. of Education, Bronx, NY.  Mbaye Ndiaye and Fanta Bathily are former students and graduates of this school.
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