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Julia Royall, MA

Julia Royall is with International Programs, National Library of Medicine, National Institutes of Health, Bethesda, Md, and the Communication Network, Multilateral Initiative on Malaria.

Correspondence: Requests for reprints should be sent to Julia Royall, MA, International Programs, National Library of Medicine, National Institutes of Health, 8600 Rockville Pike, Bldg 38, Room 2S-22, Bethesda, MD 20894 (e-mail: jroyall{at}nlm.nih.gov).

	INTRODUCTION

TOP INTRODUCTION Dr Isabella Quakyi Dr Wilfred Mbacham Dr Andrew Githeko

 
There are African voices that you don’t hear in sound bites, whose faces you don’t see in photos of disease and despair. These voices and faces are unheard and unseen in the popular press but speak with great strength and hope. They belong to African professionals who carry out the day-to-day work of science and medicine under difficult circumstances and with limited resources.

The malaria researchers you will meet in the excerpts to follow represent a sample of some 40 individuals I interviewed as part of my work with the Multilateral Initiative on Malaria. I wanted participants to tell their own stories about the choices they have made to work in their countries, choices that, when taken together, affect the future health of Africa, where a child dies of malaria every 30 seconds.

Isabella Quakyi

Isabella Quakyi, PhD, has returned home to Accra, Ghana, to carry on her teaching and research after nearly a 20-year absence during which she was based in the United States. Wilfred Mbacham, PhD, left Yaounde, Cameroon, to complete his education and is now back, devoted to encouraging young people in science and working in public health. Andrew Githeko, PhD, describes how Internet connectivity has brought him into the world of international research and allowed him to work effectively in a remote, malarious area of Kenya.

	Dr Isabella Quakyi

TOP INTRODUCTION Dr Isabella Quakyi Dr Wilfred Mbacham Dr Andrew Githeko

 
Before returning to Ghana, Isabella Quakyi was employed as a fellow at the US National Institutes of Health and then as a professor at Georgetown University. Her first degree was from the University of Surrey in England, and she earned her PhD from the London School of Hygiene and Tropical Medicine, where she focused on immunology and malaria. She is now a professor of immunology and parasitology at the School of Public Health in Accra. I interviewed her only days after she had stepped off the plane from Washington.

"Everyone sees me, and they can’t believe that I’m home for good. One of the many things I have been interested in over a number of years is to have a good critical mass of interesting immunological study in the university. So that’s one of my mandates, to build up a strong postgraduate studies department in immunology. The second interest is in research capacity building, and the third is clinical laboratory immunology. For me, coming back home provides me with opportunities to make contributions in all of these areas.

When I left in 1983, I think all my colleagues and friends in Ghana felt there was a dearth of intellectual stimuli because of the politics and the economy. We were all seeking avenues to enrich ourselves intellectually; for me, the opportunity was as a World Health Organization [WHO] fellow at the National Institutes of Health [NIH] in Bethesda, Md. I saw that my going would allow me to create or improve my knowledge in my fields of interest, build up a critical mass of knowledge, acquire contacts—important contacts—and, hopefully, some day come home. I was able to do a lot of good work: 8 years at NIH and 11 years at Georgetown University.

Coming back home was a little difficult because most of my contemporaries in Ghana are about to retire or have retired. They stayed and maintained the system so that people like us could come back. A lot of excellent and exciting malaria research is going on to which I hope to contribute.

I’m also interested in the future of Ghanaian women scientists. I’ve had so many in training, but often they can’t fit their family schedules into their scientific operations. As a result, very good scientists have to give up the rigors of scientific life. We have to make the system flexible so that women with children can plan their research day around their families, because they bring their resources as mothers and as grandparents to bear on the work of the research institute. Having more women in research in Africa will really improve our concept of what needs to be done, and I think our goals will also be more oriented to address fundamental goals related to children, mothers, and the whole family. We need to make the work environment more family friendly so that women can see where they can integrate their family life and also continue their intellectual pursuits.

One of the major important things I hope to do is to create a college of immunology. Already, I have founded an immunology interest group in the medical school, a crowd of young physicians and scientists meeting periodically to discuss new areas of interaction. We need to start by training our young doctors in immunology, vaccinations, and prevention measures. This is where I hope to make an impact. How does a child’s immune system cope with overcoming multiple infections? And how do we even consider giving vaccinations to this child carrying different infections? These are the challenges of the medical scientists in Africa, in Ghana, that I hope to promote. We can use our environment to promote our scientific knowledge and make a contribution towards solving our basic problems.

I was brought up in a family where strong preventive health measures were important, especially in malaria control. My father headed the School of Hygiene for many years in the Ministry of Health, and I grew up sleeping under bed nets before there were bed net programs.

I was fortunate in having summer jobs at the then Medical Research Laboratories Center when I worked with a group who were the pioneers in kwashiorkor calorie, protein calorie malnutrition. Some of the early scientific work in this field was carried out at this center in Korle-Bu. What impressed me as a young person was that the scientists I worked with would leave their very comfortable homes and dedicate themselves to trying to rid Africa of its parasitic diseases. I felt the least I could do was to follow in their footsteps and also make a contribution to my country. I am indeed back for the long haul."

	Dr Wilfred Mbacham

TOP INTRODUCTION Dr Isabella Quakyi Dr Wilfred Mbacham Dr Andrew Githeko

 

Wilfred Mbacham

Wilfred Mbacham is an assistant professor in the Biochemistry Department and a researcher at the Biotechnology Center at the University of Yaounde in Cameroon. He conducts research on the molecular epidemiology of resistance markers in malaria.

He received his PhD from the Harvard School of Public Health after earning degrees in zoology and in biochemistry from the University of Yaounde. He is currently the holder of a Gates Foundation fellowship.

During his Boston years, Mbacham initiated and executed many public health programs both at the Harvard School of Public Health and in the city itself. He has received numerous awards for his achievements as an academic and a volunteer in the service of public health.

"At the Biotechnology Center at the University of Yaounde, my little team and I focus on molecular biology. But because I also trained in public health, we are able to look at the data we generate and see how [they] can be used in control and policy issues.

I have been involved in re-interesting young people in research. I almost sacrificed my career training them, as it required a lot of time. But we have now built a critical mass of researchers and have been able to obtain 2 major grants. I guess that was out of faith, believing that we could deliver the goods and have publications coming in rapid succession. If African researchers can just persist and do good work, they will be noticed by the funders. This is what Africa needs, not a brain drain to the West, leaving Africa to suffer.

I am also involved in a program in Cameroon in which we try to "recycle" university lecturers and high school teachers of biology in biotechnology, which is bringing them into the lab. The program is picking up steam because more people are asking to come. Slowly, you realize there is an interest. Just by retraining them to make observations and engage in simple discussions, we have seen some startling innovations in their approach to science.

You know for someone who was born in Africa, came to the United States, and was not attracted by all the opportunities that are there, I felt I had to return and make things happen back here. I am satisfied because I have been able to touch the lives of many people. Money for me wasn’t the ultimate happiness, and just by being persistent, the money is starting to come. We will continue to push as far as our energies permit and hope that there are other people who will take over."

	Dr Andrew Githeko

TOP INTRODUCTION Dr Isabella Quakyi Dr Wilfred Mbacham Dr Andrew Githeko

 
Andrew Githeko is a pioneer in the use of the Internet to end professional isolation. He has accessed climatic databases from around the world, which he has used to predict and prepare for malaria epidemics in Kenya. He is a senior scientist at the Kenyan Medical Research Institute in Kisian; here he talks about his work before and after the installation of satellite communications in July 1999.

"We had 1 computer to handle all the e-mail. This was an open system. We had to dial out hoping that the telephone wire was working, and most of the time it didn’t work. We couldn’t send big documents, couldn’t go onto the Internet, couldn’t use the library. The system was slow, and everybody could read one another’s mail.

We never dreamed we would have a direct satellite link at Kisian. When our VSAT [very small aperture terminal] finally arrived here in July of 1999, it was pure magic. I mean I could log on to the National Library of Medicine in the US, I could log on to the World Bank, WHO sites, and UNICEF. It was so fast, so reliable. We could download huge files, send huge files. I mean I was connected, totally connected.

My agenda has expanded tremendously. For one thing, people in Europe and the US discovered that they could get in touch with me. They are interested in people who are sitting in endemic areas. Their frustration was how to get in touch with us. Once the new communications system was in place, they could talk to me at any time and ask questions, ask opinions, ask me to write papers.

One of the discoveries I made started with the Internet. Just by going to the IRI [International Research Institute for Climate Prediction] databases and doing some very basic and straightforward analysis, I was able to observe that, in some parts of Africa, we have very huge anomalies in maximum temperatures. In fact, this was happening in East Africa, where we have had malaria epidemics.

I wondered what the relationship was between these anomalies and malaria epidemics. Then I went to the local hospitals and looked for hospital data. I also approached the meteorological department and collected historical data. We discovered that these epidemics are actually preceded by some huge anomalies in maximum temperatures. We can explain what those temperatures are doing to the mosquitoes and to the parasites to create an epidemic.

Now, having worked that out, we could construct a model to predict malaria epidemics. We were able to test our idea on the ground. Fortunately, we found it worked and actually has an application: we can now predict an epidemic with this system 4 months before it happens.

We are in the process of getting the Ministry of Health to use the system to plan logistics, drug delivery, and vector interventions. They have been taking huge resources to areas where they expect an epidemic, and for some bizarre reasons, which we now understand, the epidemic doesn’t come. Now we have a system that uses scientific facts to predict epidemics. Before we were just guessing and had no idea what was going to happen.

Our communication system at Kisian is as good as those in the US and Europe. More importantly, we are a part [of the malaria research network]. We manage projects, some set in Maryland, some set in [the] UK. We forward mail to each other, we plan, we agree and disagree. We are a part. It is not one man writing a letter, giving instructions. There is a difference here. It’s a completely different way of communicating."

These 3 African health professionals tell the story of continued dedication to the improvement of health on the continent. They are but a small sample of the scientists who are devoted to achieving that goal by working within African countries.

	Acknowledgments

 
I thank Drs Isabella Quakyi, Wilfred Mbacham, and Andrew Githeko, whose comments appear in this article, and Donald A. B. Lindberg, MD, of the National Library of Medicine for his ongoing support and encouragement.

	Footnotes

 
Peer Reviewed

Accepted for publication September 30, 2004.

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