A Search for Solutions: Preventing Harmful Heavy Metal Exposures in Central Asia
By Jennifer PersonsMarc Nascarella, PhD, MS, CPH, (center, wearing green) at a meeting in Osh, Kyrgyzstan with project collaborators and Ministry of Health representatives.
MCPHS has received a federal grant to create and implement an interprofessional training program for environmental professionals and clinicians in Kyrgyzstan.
For the past decade in Massachusetts, whenever issues arose, such as contamination in drinking water, a mercury spill, or a community exposed to harmful chemicals like lead, Dr. Marc Nascarella was the person to call.
“Our team would assess contamination in an area or a building after a contamination was discovered,” he explained. “At that point, the immediate risk is addressed, people would be out of a harmful situation, but they’d want to know things like: Is it safe to go back inside? We’re not sick now, but will this make us sick? What do we do if we get sick? It was my team’s job to answer them.”
Marc Nascarella, PhD, MS, CPH, was Senior Environmental Health Scientist and State Toxicologist at the Mass. Department of Public Health (DPH) before he joined Massachusetts College of Pharmacy and Health Sciences (MCPHS) faculty last summer. The change has allowed him to dedicate more time to addressing global environmental public health.
Dr. Nascarella is leading a multi-institution effort to create an education curriculum for healthcare providers and environmental professionals in Kyrgyzstan, focused on addressing heavy metal exposures in the mining communities in the Batken Region of the Central Asian country. The University received a State Department grant of $50,000 from the U.S. Embassy in the Kyrgyz Republic for the project.
“The people in Kyrgyzstan have the same questions as the people in Massachusetts about environmental exposures,” he said. “We’re trying to find a way to educate people in the simplest and most effective way to prevent harmful levels of exposure.”
Exposing Heavy Metal Concerns
During his tenure as the State Toxicologist at DPH, Dr. Nascarella led a biomonitoring initiative. His team measured the amounts of heavy metals in Massachusetts residents’ bodies to better understand how the chemicals might be affecting their health. He has also served as an environmental toxicology expert on a panel for the Environmental Protection Agency (EPA), developing a new health-based standard for lead in drinking water. Through the panel, Dr. Nascarella met other scientists doing similar work around the world.
“I was at a meeting with other heavy metals experts, and one of them asked me if I knew anything about something called antimony, which is a metal. I had been measuring antimony in Massachusetts for years,” Dr. Nascarella recalled. “Several months later, he called me and asked if I was interested in looking into the issue in Kyrgyzstan.”
At the time, Doctors Without Borders was working in Kyrgyzstan, providing humanitarian and emergency medical care to people who were chronically ill. Dr. Nascarella worked closely with the organization to assist with understanding the risks of heavy metal contamination and how it might impact the health of humanitarian workers and the people who lived in the region. But unfortunately, it was not a permanent solution.
“There came the time when Doctors Without Borders had to move on and to go other places with urgent needs,” he said. “The training program we are developing is a direct extension of that work. Our project partners saw it as an opportunity to stay engaged and bring U.S. resources to this problem because the need is still there.”
Finding a Sustainable Solution
Kyrgyzstan is rich in minerals, so mining is a major industry there. Dr. Nascarella is particularly concerned about a region known for its antimony and mercury, both of which can cause serious health issues, including organ damage, for people who live near the mines.
“This community is isolated from most advanced medical toxicology and diagnostic laboratory services,” he explained. “The area is seismically active. There are large piles of mining waste. There’s drought, and there are floods. There’s not a lot of money. There are border disputes and physical violence. A lot is going on in the region, and there’s not a lot of bandwidth for the local government to put out a lot of fires at once.”
With the State Department grant, Dr. Nascarella is developing a training program for Ministry of Health clinicians and environmental professionals to work together, identify people at risk of heavy metal exposure, and implement interventions to prevent harm. He leads and represents MCPHS on the project, partnering with TerraGraphics International Foundation, an Idaho based environmental health non-profit, the Ministry of Health of the Kyrgyz Republic, and the International Higher School of Medicine in Bishkek.
“Our partners in Kyrgyzstan are experts and have great scientific acumen and capability. They just don’t have the capacity at the local level to develop this kind of training alone,” Dr. Nascarella said. “They’re telling us about the challenges they face, and we’re working together to find solutions. We’re also building it to be scalable to other regions in the country.”
In spring, Dr. Nascarella will visit Kyrgyzstan to discuss the training curriculum the team is developing with national and local leaders. He plans to return at the end of the summer to implement and evaluate a pilot, expressing optimism about how the program is progressing.
“We would’ve gotten anywhere in the country without the support of a premier medical school in Kyrgyzstan or their national health leaders,” he said. “They’re excited we can elevate these issues and provide state-of-the-art, scientific training.”
His work in Kyrgyzstan aligns with his role at MCPHS as Associate Professor of Health Sciences and Director of Health Sciences Research in the Doctor of Health Sciences Program. This semester, he’s teaching a new course called Translating Research in Environmental Assessment to Mitigate Exposures (TREAT ME). Much like the training program in Kyrgyzstan, this class is open to all disciplines to help providers understand the science of environmental health so they can respond to some of the challenges.
“I want to expose as many clinicians as possible to environmental health,” Dr. Nascarella said. “There’s tremendous opportunity to address the non-medical social determinant of health and avoid the burden of so many diseases through exposure reduction and primary prevention.”
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