From the deck of Aeolus, Capt. F DeWolfe Miller checks the depth of the water with a hand-held device. "100 feet" he says with a smile. The 42-foot, double ended Valiant cuts through the water at roughly 7.5 knots, its sails grabbing air to speed it along Oahu's southern coastline. On our port (left) side, about a dozen sailboats from the Waikiki Yacht Club swiftly pass us.
"Don't mind them," Miller tells our crew. Their skippers are eager to make the loop from Honolulu Harbor to Diamond Head and back in time for Friday happy hour at the club's well-stocked bar. "We're in no rush; we'll be back in time for dinner," he assures us.
Passing Waikiki Beach, with its iconic hotels and mix of water sport activities, one can just make out tourists in the waves testing out their surfing skills. The mountains of Oahu tower over Honolulu, and ahead, Diamond Head crater rises dramatically out of the landscape, its graceful long crescent slope ending in the Pacific.
"I know this is Hawaii, but today is an especially beautiful day for a sunset sail," observes Miller, hauling up the jib and giving Aeolus a little more speed.
Sailing is just one of Miller's many passions, which also include riding horses and motorcycles, free diving, discovering and studying Egyptian mummies, and expertly cracking a bullwhip should the need arise. "You're Indiana Jones," I tell him. He smiles at the comparison with the popular movie character.
But Miller's greatest passion is infectious disease. He's an epidemiologist at the University of Hawaii and for the last 20 years he's been tracking and documenting an outbreak of Hepatitis C in Egypt. Fifteen percent of the population has been infected with the virus and 10 to 13 percent are also infectious with the blood-borne pathogen that causes it, according to the World Health Organization (WHO). Egypt has the highest prevalence of Hepatitis C in the world.
Hepatitis C leads to inflammation of the liver and in some cases liver cancer. It is spread by blood-to-blood contact. Many people infected do not develop symptoms until much later on in life — sometimes decades after their initial infection. Hepatitis C can be treated with medication and between 51-80 percent of treated patients are cured, according to the NIH.
Miller is lobbying for funds to help the Egyptian government and its people build a program that will reduce transmission of Hepatitis C. "We can beat this," he says, adding, "we just need to get things to crystallize."
Miller is on a crusade. How he got to this point is as winding and twisting as the story of the fictional character he resembles.
F DeWolfe Miller, was born in 1943 and raised in east Tennessee on a farm about 100 miles north of Knoxville, between the Cumberland Mountains and Appalachia. He's from a long line of F DeWolfe Millers, one even fought for the Confederacy during the Civil War. And what does the F stand for? "Beats me," he says. He answers to Dr. Miller or as his friends call him, De.
The Millers were educated people of German decent; his father was a professor of English at the University of Tennessee (UT). The family grew tobacco because it made money. Miller grew up splitting his time between the city and working on the farm. It was wonderful, he says, reflecting back on his youth. But it was also overbearing. Miller came of age in the 1960s when seemingly "everything was happening in a place called Berkeley," he says, his eyes popping with excitement. "I had to get the hell of there."
So after getting his Master's in Microbiology from UT, Miller packed his bags and spent five years traveling the world. "I was a hippie," he chuckles. He spent a good amount of time in the Middle East, particularly Iran, where to earn some needed cash he taught biology to medical students in Shiraz. "It's the town of 1001 nights, where Scheherazade told all her stories," he says. "It was a magical time and place." At the end of the year he bought a German motorcycle for $100 and drove it through Afghanistan, on into Pakistan, across into India, and finally ending in mountainous Nepal.
To cover his living expenses, Miller got a job at a hospital laboratory outside of Katmandu. There, he says, a little white-haired lady taught him parasitology. "The Nepalis don't have one parasite, they have multiple parasites," he explains. "You would see live filariasis in the blood smears. It was like, 'Wow, what was that?' " Nepal hooked Miller on infectious disease. "I realized you could do a lot with a little and have a big impact," he says.
It was in Egypt that Miller made a name for himself, covering an epidemic of schistosomiasis, also known as snail fever, a parasitic disease that can damage internal organs and, in children, impair growth and cognitive development. Urinary schistosomiasis can lead to bladder cancer. For his Ph.D. Miller tracked the disease all over the Egyptian countryside trying to figure out how it got started. The thinking of the time was that the outbreak was connected with the building of the Aswan High Dam in 1962. But Miller's investigation proved otherwise. "This thing started long before the building of the dam," Miller says. When the British came to Egypt in the 1880s, they saw the Nile Delta as a great place to grow cotton, but Egypt is dry and required irrigation, he explains. So they built canals that unknowingly provided a perfect breeding ground for the parasite. "This snail releases a larvae. So if you go swimming in the canal it can penetrate your skin," he says, adding, "Egypt is hot and kids love canals."
He ended up spending 10 years in Egypt studying and publishing extensively on schistosomiasis, which lead to a faculty job at the University of Hawaii in 1989. He now splits his time between the two places, collecting friends and cultivating important connections within the Egyptian Ministry of Health during his Egypt time.
It was during his early days studying schistosomiasis that he met a young man who sparked his interest in Egyptian archeology. The young man's name was Zahi Hawass, an inspector in antiquities who didn't appear to have a bright future ahead of him. "I used to think poor Zahi. These guys don't get paid anything, they never go anywhere, they work for the Egyptian government," recalls Miller. "Boy was I wrong," he laughs. Years later, Hawass, became the Director of the Great Pyramids of Giza.
In 1996, Hawass called up his buddy De and asked him for a favor. He told Miller about some recently discovered mummies in Bahrryia, an oasis about 250 miles out in Egypt's western desert. "Take the boys out there," Hawaas told Miller referring to his young crew of diggers. So they piled into a pickup truck and headed out to the desert. Six kilometers outside of the local small town they saw the shallow tombs. "It was ridiculous. You could just push the sand off and see gold mummies come up," Miller recalls with excitement. Following the discovery in Bahrryia, Miller suggested to Hawass they work together on a project that would look at health and disease in ancient Egypt. "I got Zahi his first CAT scanner (thanks to NatGeo)," Miller notes proudly. And among their first scanned mummies? "Tutankhamun of course," he says sheepishly.
The death of King Tut at 18 had long been shrouded in mystery. One standing theory was that Tut had been murdered; X-rays taken at the time of the tomb's discovery seemed to back up that idea. But Tut's CAT scan told another story. "He had a lot of bizarre characteristics," says Miller. Tut was frail and his skull was abnormal in shape. He had a partial cleft palate, buck teeth, a huge embedded molar, and a broken leg.
That break was a mortal wound, according to Miller.
"Back in Tut's time, with a break like that, he could have died from the shock alone. They had no way of managing this," says Miller. But how did he break it? "An accident, likely a fall. He was frail, I'm not a specialist, but at the museum you can see a case full of canes that he used to walk with and they had been used."
Even though Miller loves working on Egyptian archeology— he's spent countless hours in the basement of the Cairo museum cataloging mummies for a database he's created — it is merely a side project to his work on infectious disease and his current effort to stop the transmission of Hepatitis C in Egypt.
In the 1990s, Miller was amongst the first to test Egyptians for the disease. Miller and his Egyptian colleagues were shocked by what they found. Of some 2COMMANUMBER500 tests given in a 2-3 week time period, 10 percent of first time healthy blood donors were positive. "No one saw that coming," he says.
Medical care in Egypt isn't quite up to Western standards for controlling a blood borne pathogen. Hospitals might reuse needles and not properly clean them, which can easily transmit the disease. Miller witnessed this firsthand in the basement of a district hospital where a line of 16-year-old girls were being blood typed. Egyptian law requires everyone at age 16 to get blood typed in order to receive a national ID card. The person administering the test had one lancet and did not clean it in between uses. "You could see the needle go in, 'twonkCOMMAAPOSTROPHE next, 'twonkCOMMAAPOSTROPHE" Miller recalls. Fortunately this testing has now been stopped.
Miller doesn't blame Egypt or its medical system for not using proper infection control procedures. "Egypt's poor. It has always been poor. They have to do with what they have...In fact they actually give much better health care than most developing countries," he insists. Miller says that the Western medical world unwittingly promoted this virus in the mid-20th century with its use of glass syringes and reusable needles. "It wasn't till the HIV epidemic that we really started to pay attention to being more careful and instituting standard procedures like changing gloves, washing your hands, using one needle once, and only once — and throw it away, don't reuse it," he says.
In 1994 it became mandatory by law to test all blood for Hepatitis C in Egypt, something that Miller feels very good about having helped institute, but says more should be done to prevent the spread of the disease. "They get distracted by H1NI or Avian Flu. They can take their eyes off of it because the disease is silent. You get infected, there's no acute phase of this disease, so you don't know you got infected. Ten years later, twenty years later, some infected [people] start getting liver damage," he says.
Currently, the Egyptian Ministry of Health's approach to prevention is directed at the Egyptian people which according to Miller doesn't work. "An average Egyptian is not in a position to implement infection control measures in the medical system and confronting a doctor or nurse would be considered culturally inappropriate — you don't tell them what to do," he says.
Miller wants to change the dialogue from the lay public to health care providers. He envisions local NGOs going to providers and training them to make sure they are using proper prevention techniques. Miller says prevention measures are inexpensive. "You can use the same lancet — just dip it in alcohol in between uses, or wash it with soap and water — the disease is very frail and soap and water is enough to kill it," he says.
Miller created a website for his prevention project, www.hcvegypt.com. Through the site he hopes to build support, raise awareness and needed funds. "I know the Egyptian system, I know the people, I have the connections within Egypt," he says, sighing. "I need money support to make it happen."
Back on the deck of Aeolus, Miller wrestles with the jib rigging which has gotten entangled, preventing the boat from "coming about.\" After some negotiation, he's able to free the sail and we work together to swing the boat around.
With the sun quickly setting, Miller takes the wheel and guides us back toward Honolulu Harbor.
"This is where I am right now in my life," he says. "I don't want to do anything else. I don't want to publish papers, I don't want to be an academic. I just want go and actually do at what I used to look down on — you know, have a cause and save the world."
- Miller's Hepatitis C website