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Revision as of 13:06, 4 September 2015
Basehunter Cork iGEM
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 Nhkoma Hospital. Nkhoma Mission hospital is a 220-bed facility, with all major departments and a busy eye department. The Hospital's primary catchment area is the surrounding rural 32,000-strong community, but it serves patients from all over Malawi as well as from neighbouring 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, ESR (Erythrocyte Sedimentation Rate), Urine & Stool Analysis, Pregnancy, HIV, Syphilis, Hepatitis B, Ascites, CSF and pleural fluid analysis, Meningococcal Antigen, Tuberculosis and CD4 analysis. It also has a chemistry machine which can perform multiple analyses on blood serum for liver function tests, Lactate, Glucose, Sodium, Potassium, Bilirubin, Protein and many other beneficial chemical analyses.
Donnchadh's Work
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.
IMG OF QS
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’.
INSERT IMG OF COST ANALYSIS
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. Donnchadh explained synthetic biology and our DNA detection project. The witchdoctor thought the project was a great idea and sees that times are changing and that the importance of science and education for the Malawian people are increasingly more important.
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!’
Medal Requirements
This year Cork iGEM identified intellectual property rights as an issue. We interviewed the (INSERT TITLE HERE) Cathal Garvey to investigate the issue and see his views on the issue.
Issues relating to the safety of the system for use as a diagnostic were identified. As with all diagnostics, this system must be optimised, standardised and deemed as good as or better than current procedures. The use of live cells in a diagnostic system is a unique feature which may lead to unforeseen complications such as unsuitable growth conditions in some settings or the impact of contaminating growth on results. To address this, we investigated suitable controls and validates our results by having outside labs (TCD & UCL) carry out our tests. We also sought the advice of experienced Biomedical Scientist, Dr. Brigid Lucey on the issue.
Another aspect of our human practices work was that done by team member Donnchadh in Malawi. The issue of sustainability of our detector in a real life lab setting was investigated by Donnchadh as he visited hospital labs in Malawi where the detector may theoretically be used. He surveyed staff members on the equipment and reagents they had and whether they believed such a detector was a viable and sustainable tool. We considered this in the design of our prototype and what to include in kits sent to TCD & UCL labs.
Also while in Malawi, Donnchadh evaluated resources in the lab and what diagnostics tests are available to patients of that hospital. The issue of social justice arose as gaps were clear between the hospital described by Biomedical Scientist with experience working in Ireland, Dr. Brigid Lucey, and that described by the Malawi biomedical scientists. Our project aims to bring first class molecular diagnostics to areas where it currently is not by providing an alternative to expensive equipment such as PCR machines. With this in mind, we designed our kits to be low cost, easy to ship and practical for use in labs which may be small and under-resourced.
Knowledge of synthetic biology was also limited in Malawi and this may hinder acceptance of our detector. To address this, Donnchadh explained our project and gave detail on what exactly synthetic biology is to workers in the hospital lab. We also learned of a culture of seeking medical care from witch doctors in Malawi. Donnchadh explained the concept of synthetic biology to this figure in the community where he worked, and got her approval of this and an acknowledgment that other advancements in science and medicine can aid in healing also.
