As a doctor and a restless spirit, in my personal and professional life I have always had the opportunity to work, travel... However, the opportunity to collaborate on projects such as IGOCARDIA, focused on supporting the Liberian institution responsible for regulating and developing regulatory capacity for Medicines and Health Products (LMHRA, for its acronym in English) and in malaria diagnostic research that can improve morbidity from this cause in endemic countries like Liberia, is not always there.
In August 2018, the opportunity arose, and I was ready for this challenge and to give my all. The Juan Ciudad NGO Foundation contacted me to present the project to the team of researcher Alfredo Mayor, from ISGlobal, and to learn of my interest in coordinating it from Monrovia, Liberia, at a time of many personal and professional changes for me.
How was my first contact with Monrovia?
Anyone who has traveled to the African continent will have felt that everything has a different order than we know, that within the apparent chaos, there are rules and regulations known only to locals. Roberts International Airport, in the Liberian capital, is no exception.
At dawn, exhausted from the preparations for the move, my first challenge in Liberia was to gather all my suitcases and my dogs in an airport room where everything is in chaos. Test passed! Off to Saint Joseph Hospital!
My place of work and residence, Saint Joseph Catholic Hospital
Since October 2018, I have been based at the Hospital of the Order of Saint John of God, which is closely linked to Spain, for almost three months now.
It wasn't difficult for me to adapt. I was housed in one of the small cottages the hospital has for its staff and had my own office to carry out project activities. The hospital is right by the sea and nestled among palm trees and other native trees.
Both the brothers of the Hospitaller Order of Saint John of God, who manage the hospital, and the hospital staff welcomed me with open arms and helped me with everything. In just this time, I've gone from not knowing how to locate Monrovia on a map to its warmth, its rhythm, and its generous smiles, which have become my permanent home.
Daily challenges with the country and work
After years of civil war and an Ebola epidemic, Monrovia seems like a city mired in eternal poverty and destruction. Walking through its streets, I see people surviving inside damp-blackened buildings, feeding their children a handful of rice once a day. But just when the hopelessness seems to weigh on me, a group of children on the beach surround me, amazed by my skinny greyhound, and in moments they begin to perform pirouettes and dance and laugh nonstop, adding color to my day!
Regarding my activities, the actions sought to be implemented through the IGORCADIA project are not always easy, either due to a lack of qualified resources within the country or the lack of an efficient management system.
On the other hand, I must admit that my previous experience in this type of project was limited, and that taking ownership of an already-underway project hasn't been easy, although it has been very challenging.
The Project: My Tasks and Activities
As the IGORCADIA coordinator located locally in Monrovia, my activities focus on the Support for the Liberian Medicines & Health Products Regulatory Authority (LMHRA), focusing on the implementation of good clinical and laboratory practices, managing available resources, and ensuring that the deadlines and budgets established by the project sponsor â EDCTP â are met.
Furthermore, I work closely with the Hospital and its clinical analysis laboratory, a future reference center for the implementation, development, and monitoring of the procedures the project aims to introduce.
Among my main tasks at IGORCADIA are: assistance in the preparation of regulatory frameworks that help establish improved operational protocols; delivery of training programs to strengthen the skills of healthcare personnel who must comply with operational protocols; assistance in the creation of working groups; and improvement of communication and relationships between authorities, hospitals, pharmaceutical companies, etc.
One of the project activities that I have been most excited about has been organizing documentation, posters and presentations for promote gender equality and opportunities among collaborating institutionsIt was great to hear the local IGORCADIA team discuss respect in a society that coexists with discrimination based on gender identity and sexual orientation in the personal, family, and professional spheres, and where there is no available data on women's participation in research.
Forecasts for 2019
During 2019, we will launch a Malaria diagnostic research study, with the aim of determining the sensitivity of microscopy and rapid diagnostic tests (RDT) compared to molecular biology techniques for diagnosing malaria infections among patients attending St. Joseph's Catholic Hospital.
The availability of rapid diagnostic tests for malaria in recent years has significantly facilitated access to diagnostics for this disease. Since the World Health Organization (WHO) recommended in 2010 that all suspected malaria cases be tested, RDTs have taken on a crucial role in clinical case management, supplanting conventional light microscopy as the diagnostic standard and accounting for 63% of all suspected cases in the WHO African Region in 2016.
Results from previous research suggest that the "deletion" of the parasite's Pfhrp2 antigen could have an adverse impact on the life of an affected individual as a result of delayed or untreated treatment. As the number of false negatives from RDT increases in African countries, the WHO has emphasized the need to monitor malaria parasites lacking the Pfhrp2 gene.
In this context, the research exercise that we will develop has as its aim To determine the performance of microscopy and RTDs at St. Joseph Catholic Hospital and to quantify the presence of Pfhrp2 and Pfhrp3 deletions in P. falciparum isolates from individuals with fever (temperature â„37.5°C) or a history of fever in the previous 24 hours (as recommended by the WHO for malaria-endemic countries), as well as from pregnant women at their first prenatal visit. As secondary objectives, we intend to establish a biobank of samples for future research studies.
In short, after two months, I feel very motivated by the achievements I've made, and particularly fascinated by Liberia. I feel the need to help its people, and I believe that by being involved in this project, I am doing just that.
Text and photos by: Cristina Muñoz.
More information:Â www.igorcadia.org
Project: Improving Governance and Research Capacity in Infectious Disease Diagnostics at the Liberia Drug and Health Products Regulatory Authority
Project: Improved Governance and Research Capacities in Diagnostics for Infectious Diseases of the Liberian Medicines and Health Products Regulatory Authority (IGORCADIA)
The EDCTP2 program is supported under Horizon 2020, the European Union's Framework Program for Research and Innovation
