Environmental Disturbance and the Emergence of Tropical Disease: Lessons From the Gold Fields of Ghana

This forest feels like an eternity as our four-wheel drive vehicle plods down yet another washed-out dirt road. This is the Central Region of Ghana and the lack of infrastructure only adds the ambiance as groups of women pass by with their loads of firewood balanced effortlessly on their head, their babies dozing comfortably in tow. Abruptly, the trees stop and a barren dirt-scape throws the equatorial sun back into our faces. Compared to the shade of the canopy, this feels like the surface of the sun. And yet, despite the devastating heat, I can easily make out the distant silhouettes of people shoveling and sifting and working through this terrible hole in the earth.

As we get closer, the figures assume the faces and nuances of the tired men and women that they are. Holes in boots; tattered, stained clothing; knee deep in stagnant water with shovels or pick-axes or buckets of mud in hand. All for a paltry daily bounty of gold and the eternal promise to strike it rich someday. It's enough to keep them busy and fed for now, but at a terrible cost to their bodies and the land. This is the face of unregistered small-scale mining in Ghana, called "galamsey" by the locals.

Ghana, the proverbial "Gold Coast", has furnished the world with the gold for hundreds of years and although the mechanisms have changed -- a colonial administration has been replaced by economic structures that are equally exploitative -- the fundamental ethos remains the same: the wealth contained within this land does not belong to those that live and work it, but to those with the might to control it.

Mining concessions are acquired by multinational companies in a variety of ways. But whether legal and legitimate or illegal and fraudulent, the siphoning of mineral wealth from Africa is a faucet that continues to flow to the detriment of local peoples, often even despite truly noteworthy progress in terms of corporate social responsibility and promising partnerships between research and extractive industries. Governments with poor economies that lack the ability to commercialize their own resources rely on foreign corporations for the dominant influx of financial capital, technological know-how, and assets to glean any profits from their land. This service does not come for free, of course, as these companies take more than their fair share. Whatever profits the governments keep, such as royalties, risk being eaten up by inefficient and corrupt bureaucracies. Little, if anything but poverty wages and environmental degradation seems to filter down to those local people upon whose livelihoods the mining companies and often complicit local chiefs thrive.

For Ghanaians who seek the promises of gold without the corporate structure, or those who lack the education to be hired by mining companies, there is always the option to go at it alone. It has become quite common across Ghana for groups of men and also women to begin their own small-scale mining operations, increasingly through partnerships with Chinese operators. With minimal investment, a group of galamsey miners can earn as much in a day as even the best cocoa farmers (Ghana's leading agricultural export). The problem, of course, is that once the gold has been extracted from the land through dangerous and damaging practices, nothing -- not gold, nor farm land, nor forest -- can take its place. Once an area is cleared and mined and no rehabilitation occurs, that land has lost virtually all value. It is a vicious and unsustainable cycle, but one with enticing short-term economic prospects, especially for poor young people with limited options.

From the ground and from satellite images, the communal dislocation and general destruction that these mining practices bring to the land and the communities that live there is abundantly obvious. What is not as evident is the extent of the environmental contamination that results from entirely upending the soil column and exposing all manner of sub-soil elements to everyday erosive forces. One such fallout that is now being tied to mining practices is Buruli ulcer, a flesh-eating bacterial infection that seems to be largely associated with contaminated and stagnant or slow-flowing water.

One of the world's most neglected tropical diseases, Buruli ulcer (BU) is as horrific as it is challenging to understand. Beginning harmlessly enough as a painless nodule under the skin, the course of the disease quickly proceeds to massive, open lesions across large tracts of the body. The health consequences of BU can range from massive deformations and scarring, to atrophied or amputated limbs, to secondary opportunistic infections and even death. And while the disease is treatable with antibiotics if caught soon, in the impoverished backwoods of rural Ghana where both health-care facilities and knowledge are quite limited, it is no surprise that this disease continues to claim lives each year.

The reality is that even in our era of modern medicine, thousands of people around the world suffer from a completely treatable disease whose prevalence may largely be driven by devastating and unchecked economic profiteering from the environment.

What makes BU so difficult to manage and to causally link to mining practices specifically is not only the unknown path of transmission but the considerable lag time between contact with the bacterium and the emergence of preliminary symptoms. It is virtually impossible to identify an exact point of infection in communities where water sources are communal and where a great number of other variables, such as hygiene and environmental exposure, are involved. BU functions as one of many potential consequence in an extremely complex system of environmental, social, and economic factors.

This problem is only confounded further as increasingly heavier and more unpredictable rainfall patterns -- a result of global climate change -- impact the region each year. These rains not only affect the already degraded landscapes even more, but they increase the presence of stagnant water bodies that may play temporary host to the bacterium responsible for BU.

It seems that the very neoliberal economic paradigm that is leading to catastrophic global climate change has already visited itself twofold upon Ghana: first, by creating economic conditions that promote destructive mining practices at multiple levels and, second, by exacerbating existing environmental problems through climatic disruption.

Since 2009, the reBUild project has been studying and working throughout Ghana in order to get a better grasp on the complex interactions between mining, climate change, and emergent tropical diseases such as BU. Funded by the National Science Foundation, this collaboration between the Pennsylvania State University, as well as several other US and Ghanaian institutions, has been lending a geographic perspective to this multivariate problem.

Through an interdisciplinary coupled systems approach, combining satellite imagery, national health information, livelihood mapping, community surveys and interviews, researchers are hoping to build a more practical understanding of how this disease emerges from disturbed environments. By isolating key variables at different spatial scales, reBUild aims to unravel the mystery behind this debilitating disease that could become more even prevalent in the coming decades as climate change and global economic demand continue to manifest upon those in the our world least responsible for and least able to bear the costs.

At a small clinic in the town of Nkotumso, the reBUild team, including myself, visited with some patients being treated for their BU infections. It was a warm afternoon and I watched a small group as they sat together under a fruit tree with their limbs wrapped in fresh dressings to cover their healing ulcers. It was a sobering scene but one not entirely without its glimmer of hope. Despite the terrible prospects for this disease in the years to come, there is always the possibility that through the joint efforts of collaborative research, education, and international partnerships, we might be slowly uncovering the tools we need to solve this complex problem and many more like it.