Book Review: The Trembling Mountain: A Personal Account of Kuru, Cannibals and Mad Cow Disease.

Klitzman studied how Kuru, a rare prion disease endemic to the Fore region of Papua New Guinea was transmitted, its incubation periods and most importantly through perseverance he provided the evidence of the first Kuru clusters and demonstrated that Kuru was transmitted through transumption and the consumption of the brains of deceased relatives during funerary feasts. Kiltzman's time in the Fore region was after the peak in cases and it was a race to find the incubation period. His book has a personal nature and explores why transumption occurred and the rituals associated with it. The Fore were at this time, a people that believed heavily in sorcery and did not believe that Kuru was spread through the consumption of others. Despite the Fore's strong belief in sorcery as the cause of Kuru, they were open and willing to share their knowledge and they became active contributors to the epidemiological research. They shared their incredible oral knowledge and the history of Kuru in not only their lifetimes but their forbearers before them. This is intertwined in their beliefs and now forgotten secrets of spell casting and sorcery.

Robert was among the few lucky enough to experience one of the last pristine wildernesses where he was able to live with and study a Stone Age culture and its people. His work demonstrates the harsh realities and conditions endured when doing field work and neuroepidemiology. As nurses we frequently access epidemiological works as we plan and evaluate strategies to prevent illnesses, but we often don’t appreciate the work involved in undertaking neuro-epidemiological research. Our understanding of the epidemiology of neurological diseases is gained through the trials and challenges others have faced in the presentation and publication of works across a range of fields from neuro-oncology to neurodegenerative diseases. It is through these works that we can understand the origins, causes and progression of neurological diseases.

During his year with the Fore people, Robert faced the challenges of practicing without the marvels of modern medicine and in an environment that was unforgiving. His despair is palpable as he is faced with a disease with no cure, and there is little he can do to help people apart from making them comfortable. As nurses we regularly provide care and comfort for individuals faced with terminal illnesses and in a variety of settings. To understand the terminal phase of Kuru Klitzman often had to negotiate with elders and spend days exchanging translated messages of reassurance so he could enter homes and assess dying individuals.

This book is so much more than a dry and sterile anthropologic book it explores the dangers, sweat and hardships endured while studying not only a disease but also a culture. As nurses the development of cultural awareness remains vital so we can care for and respond effectively to individuals from diverse backgrounds. The medical aspects of the book are of great interest but of more interest is the setting and unique time period that the Fore were facing as the old was slowly being replaced with the new western way, ancestral practices were being replaced with transistor radios and Western clothing. The Stone Age culture was slowly being lost and there was a race to learn from the village elders who had witnessed and participated in transumption of loved ones. The clinical histories that Kiltzman collected offer an incredible insight and took on a new importance when Bovine Spongi-form Encephalopathy (BSE or commonly called ‘mad cow disease’) broke out in Britian. Not even Robert could have predicted that the long incubation periods he studied in the Fore people infected with Kuru would have implications for the tens of million people in Britian potentially exposed to BSE through contaminated beef.

Klitzman further explores the cultural and social implications of epidemics and the risks and denial of danger that individuals place themselves in, be it through eating dead relatives, consuming beef during a sweeping outbreak of neurological disease in cattle or participating in unsafe sex during an AIDS epidemic. His work involving the psychological, ethical and social aspects of decision making provides a great foundation for our own practices for example the genetic testing of Huntington's family members.

Having undertaken several large epidemiological studies, I related to this book as it was brutely honest in the interactions Robert had with the Fore and the difficulties he faced, he persevered where many would have surrendered because of the challenges. Epidemiological research is not always adventure and romance there are roadblocks and mountains to climb be it trolling through piles of epidemiological notes and statistics or trying to make sense of and connections between interviews. This book leaves me with a renewed sense of respect for those who sacrifice their time and energy for the advancement of science. Unlike Variant Creutzfeldt-Jakob disease and Mad Cow Disease, Kuru was not a tabloid size horror that the world knew about but who could have predicted its importance.