Analysis and Commentary
Чащин Максим Валерьевич, заведующий научно-исследовательской лабораторией Арктической медицины ФБГОУ ВО «Северо-Западный государственный медицинский университет имени И.И. Мечникова» Минздрава России

Maxim Chashchin: The most ambitious projects ever have been launched in Russia’s Arctic region

The Arctic Medicine Research Laboratory led by Maxim Chashchin was established at the Mechnikov North-Western State Medical University over a year ago. Maxim Chashchin talks with Arctic.ru about the laboratory, the future of telemedicine and new Arctic infections.

Please, tell us about your expeditions. When did they take place and why?

All of us try to spend time doing what we love doing and we hope that this will benefit both some individuals and society as a whole. Being a researcher is an extremely interesting and exciting job aimed at receiving new knowledge in the interests of humankind. Expeditions in the Arctic were of this very nature.

The Arctic Medicine Research Laboratory took over Arctic research from the North-West Public Health Research Center. The first Arctic expeditions were held in 2001 within the framework of an international project on persistent toxic substances, food security and indigenous people of the Russian North. The subsequent trips to the Polar circle, including the recent expeditions to the Chukchi Autonomous Area, were undertaken to study the problem of pollution in the Russian Arctic and its effects on the indigenous people and to draft proposals to improve the environmental situation in the region.

Can you tell us about the work of the Arctic medical cluster, please? Which universities does it include? Is its development over, and if so, how is it working? And how is it financed?

In late 2015, an Arctic medicine research laboratory was established at the Mechnikov University. The lab was given two tasks. The first one is related to the administrative and methodological activities of the Mechnikov University as the coordinator of the Severny (Northern) research and education cluster. The second one is to provide research support to Russia's priority Arctic healthcare programs. At this point, we are looking for interesting projects and compiling a list of promising Arctic projects. For example, the university supports The Arctic: Made in Russia educational youth forum.

The creation of the Severny (Northern) research and education cluster — we call it the Arctic cluster — was proposed by the Healthcare Ministry. Our colleagues often said that we need to coordinate the operation of medical and other research and educational centers in the Russian Arctic. The intensive development of Arctic regions, which began in the mid-20th century, the construction of over a hundred industrial cities and towns, and the involvement of indigenous people of the North in economic activities have attracted the attention of prominent research teams to the subject of negative influence of the cold Arctic climate on human health.

A new research field — Arctic medicine — has been developed in Russia. The world's largest epidemiological studies were conducted by researchers from the Institute for Clinical and Experimental Medicine, the Research Institute of Physiology and Basic Medicine (Novosibirsk), the Research Institute for Medical Problems in the North (Krasnoyarsk), the Research Institute for Medical Problems of the Extreme North (Nadym) and other research institutes of the Siberian Branch of the Russian Academy of Medical Sciences, from the Arctic and Antarctic Research Institute of the Federal Service for Hydrometeorology and Environmental Monitoring (Rosgidromet) and from medical institutes and universities. They have become deeply involved in the studies of human adaptation to extreme weather conditions in the Arctic.

Gradually, progress in the sphere of biomedical sciences has broadened our horizon, leading to the study of genetic disorders of the indigenous people of the North and the influence of anthropogenic or man-induced pollution on health. The first institutes that supported the Healthcare Ministry's initiative of the Severny (Northern) research and education cluster, were the Mechnikov University (project coordinator), the Northern State Medical University of the Healthcare Ministry, and the North-West Public Health Research Center of Rosgidromet. We have received a tentative agreement to join the cluster from the Arctic Research Center of the Yamal-Nenets Autonomous Area. I am sure that the number of resident institutes will increase when this cluster gathers momentum and joint research and education projects are launched by similar centers.

You said in one of your interviews that certain infections that are unusual for this zone have appeared in the Arctic. For example, the area of tick-borne encephalitis virus has increased by between 30 and 40 percent over the past five years, you said. Which other unusual infections are there in the Arctic? What is their cause? How can we fight them?

Arctic warming has influenced the level of infectious diseases in the region. The reasons for this include the spread of forest boundary northward, which has increased the area of tick-borne infectious diseases; the increasing incidence of disease among marine mammals, birds, fish and shellfish species, such as botulism, pneumoconiosis, fowl plague, bird and herpes-like virus of oysters, which are subsequently transmitted to humans. Many zoonoses are widespread among Arctic host animals, such as fox rabies, goat fever among hooved animals, foxes and bears, dog tapeworm among rodents and dogs, toxoplasmosis in cats, and Q fever of cattle. These diseases can spread northward by the above animals migrating north from their traditional habitat. Many insects that transmit various diseases, such as West Nile fever that was never reported in high latitudes before, can survive polar winters now due to the growing temperature in pre-Polar and Polar areas.

The changing of bird migration paths is another possible reason for the expanding area of infectious diseases. Migrating birds usually travel the same courses, but exotic Asian birds, which can transmit various tropical fevers, have been recently reported in the Arctic. One more reason for the spreading of infectious diseases is the growing intensity of navigation and the discharge of ballast water into the Arctic. This results in the uncontrollable introduction of competing microorganisms, which are changing the balance in the Arctic ecosystem and stimulate the development of "new" diseases in Polar plants and animals.

We are facing a challenging task of halting the spread of dangerous and extremely dangerous infectious diseases in the Russian Arctic, with due regard for climate change and increasing economic activity. Medical preventive measures, in particular individual rather than population-based preventive measures appear to be most effective in this respect. A case in point is a system of vaccination against tick-borne encephalitis when only risk groups are inoculated, such as forest rangers and active mushroom and berry collectors. However, the development of such individual prevention programs should be based on a careful scientific analysis and substantiation.

How is all of this influencing the life of small indigenous people of the North?

Climate warming has had an adverse effect on the health and traditional occupations of small indigenous people of the North. The disapearing ice cover in the East Siberian and Chukchi seas, the northern part of the Bering Sea and the Beaufort Sea is a big problem. For example, the lack of ice in the summer and autumn has affected the fattening conditions for the Pacific walrus, which is a traditional game mammal for the local people. Overall, the walrus population has decreased, the southern walrus rookeries have been abandoned, the young are dying fast, and the physical condition of adult animals has worsened. The deteriorating health of game animals is having a direct negative effect on the quality of food of local people in the coastal areas of Eastern Chukotka who traditionally eat these animals' meat and fat too. Warming and the related extension of the ice-free season in the sea, the decreasing ice cover and ice thickness, the changing migration paths and food supply of reindeer, and the decreasing population of sea animals can affect the traditional occupations of local people and, ultimately, their traditional diets.

In some regions where indigenous people have westernized their traditional diets and settled down, we see a growing number of cardiovascular diseases, diabetes, caries and obesity. Traditional diets form the basis of local customs and socioeconomic and cultural wellbeing. Moreover, hunting, fishing, foraging and reindeer breeding not only provide food but are also vital sources of earning for the local homesteads people and communities. These activities provide a connection between the local indigenous people and the environment, which distinguishes them from the non-indigenous people and definitely influences the preservation of their indigenous identity and territory.

Also, warming in the norther territories has a negative effect on food preservation, which can lead to the spreading of intestinal infections.

Unable to use traditional hunting, fishing and transportation methods, the local people encounter a shortage of food and other supplies. This has resulted in the growing number of interpersonal conflicts, depression and other forms of social stress.

An increasing number of hot days in the Arctic has had a negative effect on the health of locals. This problem has been thoroughly studied in Canada, where senior people reported breathing problems during extremely hot periods, when temperatures rose to plus 30 degrees Celsius. People in some Arctic regions reported a respiratory distress on unusually hot summer days. An increase in the daily temperature by 1 degree Celsius in northern Sweden has resulted in a dramatic increase in the number of heart problems, such as acute nonfatal myocardial infarction.

What medical assistance do local indigenous people receive? It is obvious that medical assistance in the Arctic is complicated by distance, weather and other factors.

You have raised a very serious and open question of emergency medical assistance and first aid in the Arctic. The medical situation of the Saami who live in the Murmansk Region is relatively good. But it is a big problem in the other parts of the Russian North, where the number of beds in township hospitals is decreasing, medical emergency stations in outlying villages have been closed, and medical teams that travel with nomadic reindeer breeders have no certified doctors.

At the same time, unusual weather conditions in the Arctic is disrupting transportation, which affects the quality and accessibility of medical assistance. Since no regular flights are made to small outlying villages, their populations are isolated from civilization for long periods in the spring and autumn, because there is too much ice in the water to use boats, but not enough ice to use dogsleds or snowmobiles. Medical aviation is the only way to provide emergency medical assistance, or even any other form of medical assistance, in many Arctic regions. However, there are problems with using medevac aircraft. This service should be integrated into the system of mandatory medical assistance and allocations for the purchase, licensing, storage, repair and use of aircraft must be increased.

Much is being said about the prospects of telemedicine. In your opinion do you think that such a project is useful? When can it be implemented, and how will it work? Is telemedicine successful worldwide?

It is common knowledge that telemedicine is a promising direction based on the use of computers and telecommunications technology for exchanging medical information between experts. This makes it possible to more effectively diagnose health problems and treat specific patients. Is it possible to use this technology in the Arctic? Yes, of course it is, especially in the light of the fact that the Telemedicine Law which has not yet been approved by the State Duma stipulates such applications as preventive treatment, monitoring the condition of patients, etc. In the near future, telemedicine technology will help us to improve the quality of medical treatment and to make it more affordable for Arctic residents. The formalization of the concept "a doctor's long-distance medical advice" is the most interesting aspect. This concept stipulating diagnostic and preventive treatment applications has been implemented in many industrial countries using telemedicine technology. Population distribution specifics, vast distances and rudimentary transportation routes, as well as the spread of the broadband Internet, are urging us to more actively use the potential of telemedicine.

The United States, Canada, Germany and some other countries boast about their interesting experience of boosting the efficiency of medical diagnostic measures and even conducting long-distance surgery.

Many talented early-career scientists and doctors live in Russia. Some of them are romantics who often recite the words of the famous song written by bard Yury Kukin from Leningrad in 1964: "I am following and following the dreams, the fog and the smell of the taiga." In other words, such people are ready to go and work in the Extreme North. Russia is now starting to implement the most ambitious projects in the history of the human race, including the development of the Northern Sea Route, in its Arctic zone. This will require tremendous human resources. A number of government organizations, including the Federal Agency for Youth Affairs and the Arctic Youth Center of Competences, are now actively recruiting skilled experts in all areas of knowledge, including medical sciences, for the Arctic.