-- the new disease that he had helped to identify. Carlo was the infectious
disease specialist in the World Health Organization (WHO) office
in the Vietnamese capital, Hanoi. In late February 2003, he was asked to
advise on a case of suspected atypical pneumonia in an American businessman
who had been admitted to the city's French hospital. Immediately, Carlo
understood the severity of the syndrome and was aware of the threat. He
advised hospital staff about protective measures, including patient isolation,
high-filter masks, and double-gowning -- not routine measures in Vietnam.
On 9 Mar 2003, Carlo met officials at the ministry of health. He explained
the need to isolate patients and to screen travellers, despite the possible
harmful effect on Vietnam's economy and image. WHO's world infectious diseases
surveillance system was also informed, leading to the worldwide alert,
which resulted in a concerted global response. Thanks to his prompt action,
the epidemic was contained in Vietnam. However, because of close daily
contact with SARS patients, he contracted the infection. On 11 Mar 2003
he was admitted to hospital in Bangkok and isolated. Less than 3 weeks
later he died. He graduated in medicine from the University of Ancona in
1981, and took a higher degree in infectious diseases 3 years later. He
continued this work at the university, and from 1990 at Macerata Hospital.
He had always been attracted by the challenge of international health.
In the late 1980s, he visited Mauritania several times with a group of
volunteers to support its ministry of health in parasitic disease control.
While at Macerata, Carlo contacted WHO, and from 1993 began working with
it on temporary assignments in the Maldives, Mauritania, and Guinea. In
1995, I went with him to the Maldives: as coordinator of the WHO's parasitic
diseases and vector (disease-carrying organism) control team in Geneva,
I was able to appreciate his qualities -- notably his attitude and dedication
-- at close quarters. We worked from sunrise to sunset, ignoring the beaches,
tracking the epidemiology of the hookworm (a serious intestinal infection)
and training laboratory technicians to test for worms. Over simple evening
meals of rice and fish we joked: "Nobody at headquarters is going to believe
that we have spent our days in the Maldives poring over faecal samples."
In Mauritania, Carlo was the first to document transmission of Schistosoma
mansoni,
an infection affecting over 200 million people worldwide. In 1997, Carlo
joined Medecins sans Frontieres (MSF) Switzerland, and worked in Cambodia.
MSF had contacted WHO, which was looking for an infectious disease specialist
with a background in parasites. Carlo's work led to innovative approaches
in the control of Schistosoma
mekongi,
a parasitic flatworm causing intestinal schistosomiasis, transmitted only
on the river Mekong. If left untreated, this serious disease irreversibly
damages the liver, causing fibrosis that eventually kills the patient.
On the Mekong, Carlo noted rocks that were the natural habitat of tiny
snails acting as intermediate hosts of the flatworm. He developed a simple
questionnaire for children, asking about rocks where they bathed, to identify
schools where pupils needed regular treatment. This approach reduced the
need for costly diagnosis. As a result, children in Cambodia now receive
regular treatment to prevent irreversible complications in adulthood. On
his return to Italy, Carlo continued his involvement with MSF, and in 1999
he was appointed president of the Italian section. He was invited to Oslo
that year to receive the Nobel Peace Prize on behalf of MSF. He saw it
as rewarding the idea that "health and dignity are indissociable in human
beings and that it is a duty to stay close to victims and guarantee their
rights". In 2000 he was recruited by WHO to the Hanoi post, as expert in
communicable diseases for Laos, Cambodia, and Vietnam. He recommended novel
approaches for adapting global helminth (parasitic worm) control in areas
where foodborne trematodes (such as clonorchiasis, which affects 7 million
people, mostly in Asia) and cestodes are endemic. He also advocated regular
treatment of children with praziquantel to prevent cholangiocarcinoma of
the liver, a severe form of cancer that is a late complication of untreated
clonorchiasis. His wife Giuliana told me that a few days before falling
ill he had argued with her. She was concerned to see him working with patients
with such a deadly disease. He said: "If I cannot work in such situations,
what am I here for -- answering emails, going to cocktail parties, and
pushing paper?". He is survived by his wife, sons Tommaso and Luca, and
daughter Maddalena
in Angola's capital Luanda
