With assistance from Burnet Institute’s Dr Jack Richards, third-year Deakin University medical student, Britt Haller, recently completed a three-week elective at the Pailin Referral Hospital near the Thai-Cambodia border where she observed how malaria studies are conducted in this global hotspot for anti-malarial artemisinin drug resistance.
Britt prepared this report on her elective for Burnet.
Pailin is a small province in western Cambodia, near the border with Thailand, well known as the location of early development of artemisinin drug resistance.
Pailin Referral Hospital caters to a small but constant patient load within its numerous sparsely furnished buildings.
Nurses and health assistants supplement the few on-site doctors to service emergency, maternity, paediatric, general medicine and surgical wards.
Many of the patients must be referred onward for specialist services, and many who stay are malaria patients, although Pailin is a low transmission province.
For two weeks I had the pleasure of observing and engaging in research activities related to a clinical trial of an antimalarial drug (Pyramax®) based at this hospital.
This involved gaining an understanding of the processes in conducting a clinical trial including: engagement with study participants and health care workers, consent, screening, study enrolment, sample collection, performing diagnostic tests, administration of treatment, and participant follow-up; monitoring clinical outcomes and the clearance of malaria parasites.
I had the opportunity to attend a monthly Village Malaria Worker (VMW) meeting at nearby Krachab Health Centre and visited remote Osleov village, during which I gained an appreciation of the distances travelled by patients for follow-up treatment, and the difficulty achieving high follow-up rates.
I was also able to contribute to the capacity building of the research project by assisting with English lessons to hospital staff.
The timing of my visit made for a very interesting introduction to drug resistance, clinical drug trials, tropical medicine, malaria and global health research in action.
I was able to observe the clinical and laboratory based management of delayed parasite clearance, recurrent infection, as well as one patient suffering severe malaria and shock.
I faced many personal challenges when confronted with the primary healthcare needs of the community, as well as the difficulties of communicating with very limited local language.
This experience impressed upon me the immense logistical challenges faced by a research project at a field level where distances are large and study participants are very mobile.
I am extremely grateful to Dr Sara Canavati of Mahidol University, Bangkok (pictured above, right) and Dr Jack Richards (Burnet Institute, Australia), for providing this opportunity for such a comprehensive foray into the malaria research and tropical medicine sphere.
It has motivated me to continue to extend my understanding of the challenges faced in this area of global health, in anticipation that I might contribute to advancing the health of developing nations in my future career.