Difference between revisions of "Team:Cork Ireland/Practices"

Outreach

We decided as part of our project to send one of our members to an African hospital in Malawi, in order to investigate the usefulness of our detection system in a third world hospital lab as well as to increase the awareness of synthetic biology among the Malawian people. This was an opportunity to get up close and personal to investigate the logistic potential and receive feedback regarding our novel method of DNA diagnostics in a developing countries’ hospital laboratory.

Donnchadh spent the month of June in Malawi at Nkhoma Hospital. Nkhoma Mission Hospital is a 220-bed facility and includes all major departments. The hospital's primary catchment area is the surrounding rural population of 32,000 people, but it serves patients from all over Malawi and it’s neighbouring country Mozambique. It offers inpatient and outpatient care on site and conducts mobile clinics within its catchment area. The laboratory is an essential part of patient care at Nkhoma Hospital. It analyses samples from almost every patient that comes to the hospital.

The laboratory performs the following analysis: Haemoglobin, Malaria, Full Blood Count, Blood Transfusions, Sickle cell, Erythrocyte Sedimentation Rate, Urine & Stool Analysis, Pregnancy, HIV, Syphilis, Hepatitis B, Ascites, CSF and pleural fluid analysis, Meningococcal Antigen, and CD4 analysis. It also has a equipment which can perform multiple analyses on blood serum for liver function tests, Lactate, Glucose, Sodium, Potassium, Bilirubin, and many other beneficial chemical analyses.

Integrating Human Practices

When Donnchadh arrived at Nkhoma Hospital, his main goal was to identify a potential application for our novel DNA detection system. He spent the first few days at the Hospital speaking to the doctors, nursing staff and lab technicians about the diagnostic facilities available at there as well as other hospitals and health care clinics in Malawi.

It was evident that Tuberculosis (TB), an infectious disease caused predominantly by Mycobacterium tuberculosis, was a serious problem and one that our project needed to target. According to the World Health Organisation (WHO), one-third of the world's population is thought to have been infected with M. tuberculosis and new infections occur in about 1% of the population each year. WHO’s sixteenth global report on tuberculosis reported that there was between 1.3 and 1.5 million associated deaths and most of these were in developing countries. More people in the developing world contract tuberculosis largely due to high rates of HIV infection and the corresponding development of AIDS. Donnchadh was in constant communication with our iGEM team regarding the lab facilities available and the potential use and application of our DNA detection system. We decided to extensively research the requirements for and applications of an easy to use, low cost and reliable TB detector for use in third world hospital labs. Donnchadh’s feedback was very helpful but see what the lab technicians had to say below!

Our proposed Bacterial-DNA Detection System

We constructed a survey for the laboratory staff which explained our project, the detection system and its potential applications. We investigated what knowledge the laboratory staff had regarding synthetic biology and whether they thought that our detection system could be implemented in their laboratory.

The feedback we received was very positive. As an initial impression it was felt that our project may ‘result in the development or use of highly sensitive and specific methods for detecting pathogens.. The method may also be time efficient’ and ‘It might help us to run tests quickly so our patients have results on time.

Knowledge regarding synthetic biology was diverse. Some saying that it is “using bacteria to make vaccines and drugs” and others explaining that they ‘don’t know anything about synthetic biology’.

There were no concerns regarding the use of synthetic biology except one lab assistant worrying about costs because ‘the use of technology is expensive; especially in developing countries’.

Everyone surveyed at Nkhoma Hosptial laboratory answered that they would like to use our new DNA detection system and that they felt there was potential for its implementation. Our detection system was seen as helpful because it’s ‘very fast, easy to use, cost efficient’... ’and people will be helped in getting treatment on time’.

Challenges

The Laboratory Manager pointed out potential barriers as he felt ‘it will be difficult to sustain the service’. He felt there would be ‘problems in terms of who to order the reagents’ and for the ’training of personnel on when to order and in what condition’ and also that ‘since it will be a new test, stigma will crop in’. He also felt that the biggest problems were with regard to ‘consumables, educators and training, logistic support, electricity, dust, protocol, and bio-safety’.

One of the laboratory assistants felt that ‘since we don’t have any idea or knowledge how it works, doctors might not be able to accept the results unless they are oriented on how it works. We also need to be trained on the working principle’. She felt that the biggest problems that she could foresee were the ‘lack of educators, inadequate logistic support and insufficient monitoring of test quality’.

Despite the barriers that must be overcome, they felt that ‘this is a good development to our hospital and country since the test will require few reagents’ and that ‘the project is good’ and that there is ‘no need of big storage facilities’.

Including the Community

Donnchadh went to several out-reach clinics and schools to increase awareness of synthetic biology among the Malawian people. Donnchadh used a translator to communicate with the locals and gave a brief presentation to the mothers who used to come to the out-reach clinics for vaccinating their children. He explained to the iGEM team when he came back that ‘the outreach was a great chance to meet the locals and talk to them about the potential benefits of synthetic biology. I told them that we were hoping to use bacteria to detect viruses and the things that make people sick. They all seemed very positive about the project and about synthetic biology as a whole.

Donnchadh also went to the local primary and secondary schools. He gave a presentation to each of the classes. The teachers were happy to learn from the presentation too and informed Donnchadh after he left the school that he had augmented interest in science among the kids and that the presentation had ‘inspired the teachers to get more involved in the world of science and synthetic biology too’.

Witchdoctors and Basehunter

While at the outreach clinics and schools, Donnchadh learned about the culture of witchdoctors in Malawi- a strong tradition even to this day. The witchdoctors are very important in Malawi and have a lot of influence over the people and are seen as educators as well as healers.

Through the mission hospital, Donnchadh organised to meet the witchdoctor with a group a medics and a translator. The witchdoctor explained how her powers work and her role in society. She spoke about the herbal treatment she advises to the sick people who visit her.

Donnchadh spoke to her about synthetic biology and our DNA detection project. The witchdoctor thought the project was a great idea and noted the importance of science and education for the Malawian people. She also mentioned that she recommends visiting a medical professional to people that she will not be able to help.

An Adaptive Future

The feedback from the locals and lab technicians regarding synthetic biology and our project was extremely positive. The implementation of our DNA test kits at Nkhoma Mission Hospital is real possibility and welcomed by all.

‘My Malawian experience was fantastic, the people are so friendly and supportive of our work. I definitely see a role for our DNA detection system in resource poor hospitals not only in this hospital but hospitals all over Africa. Nkhoma a major hospital in Malawi but our project could be used in many other hospitals with poorer resourced labs as well. Now the next step the Giant Jamboree!’