Developing research

Otago’s new Centre for International Health is helping to build health research capacity in the developing world.

Otago Magazine, Issue 23: June 2009

Developing research
Otago’s new Centre for International Health is helping to build health research capacity in the developing world.

Like many people who travel to Nepal, Professor Philip Hill was seeking some sort of enlightenment when he went there on his three-month medical elective in 1991.

He expected inspiration from the mountain grandeur, but was also hoping to understand the challenges of providing effective health care in a developing nation and how he might play a role. It led him to turn his mind towards community health.

It is a path that ultimately saw him appointed the inaugural McAuley Professor of International Health and foundation director of the University of Otago Centre for International Health, officially opened in March.

Both the chair and the centre were established under the Leading Thinkers Initiative through a significant $1.5 million gift, made through Mercy Hospital by the Sisters of Mercy and matched dollar-for-dollar by the Government under its Partnerships for Excellence Programme.

A clinical epidemiologist with a strong track record in infectious disease research in the Gambia, Hill’s focus is increasingly on training international students, equipping them to pursue much-needed research into the medical problems affecting their local population.

The new centre’s vision statement talks about being a centre for international health with an international reputation and Hill says that is reflected in their two key objectives. “One is to help build the research capacity of the countries we are involved with, to do research.

“The second is to do projects in genuine partnership with local investigators, which ask research questions that are relevant to their countries – and that those projects actually lead, either directly or indirectly, to changes in policy that might affect health outcomes.”

One of the key challenges is identifying individuals with a research make-up, he says.

“It’s not just about helping someone gain a degree – it’s actually working to identify those who have the research talent and then helping them develop that ability to be able to compete on the international stage.”

Hill hopes that this will be a point of difference for the centre because, even though western institutions host many students from developing countries on scholarships, very few become internationally competitive researchers, and even fewer do so back in their own countries.

“In the developing country setting, a much lower proportion of the population actually train to a postgraduate level and, then, only a small proportion of these have the right mix of gifts to thrive in research.

“It also depends on whether there is a career track. Many countries have so little money to spend on health in general so earmarking money for health research is not something that is on their priority list.”

Hill’s own CV illustrates just how long that career track can be, even for someone from a developed nation.

The son of a surgeon who had spent time working in missionary hospitals, he himself was not surgically inclined and his interest in the health needs of developing countries burgeoned on his elective in Nepal when he was exposed to community health intervention programmes.

“I had to persuade the surgeon that I was working with in Nepal to let me go – that I wasn’t enjoying the surgery and would prefer to look at some other things. He had the vision to do this.”

After Nepal he worked to tailor his training, eventually undertaking advanced clinical training in infectious diseases, at the same time as completing a Master of Public Health and advanced training in public health.

That path led him to the Gambia in 2001 as a clinical epidemiologist for the UK Medical Research Council
(MRC) Laboratories.

Eighteen months into his time there he was asked to step into the breach and co-ordinate the tuberculosis research group after the head left.

“It worked out very well. We put in a five-year plan for the TB programme which was accepted with very positive reviews and we produced a very successful project that yielded a lot of publications.”

So much so, they have now published their 50th paper from their Gambian work, a study that shed new light on factors affecting access to health care for sick children.

This work also brought him into closer contact with the Gates Foundation, which included a project to develop a surveillance system to monitor the introduction of pneumococcal conjugate vaccine. This vaccine is being introduced to the Gambia ahead of any other African country.

That association is set to continue, with Hill serving on an advisory board for the Gates Grand Challenges Programme – a multi-centre collaboration between American and European institutes and a variety of field sites across Africa.

The Centre for International Health has forged ahead since Hill arrived at Otago in February. This includes gaining official University Theme status for the Otago International Health Research Network of researchers across the University, and a growing research and training reach with projects and students in several developing countries.

Hill is involved in supervising PhD students in the Gambia, Botswana and Cambodia, and the centre has just begun a new case contact study in Indonesia. This will assess a new diagnostic test for TB with plans for more studies, including a study looking at the reasons why people stop taking TB medication.

They have put a proposal into the Gates Foundation, in collaboration with the University of Otago, Christchurch, to assess a new breath test for TB, a project that won an Otago Innovation grant.

They have funding towards a junior research fellow there and have found funding for an Indonesian student to undertake an MSc in Epidemiology through the London School of Hygiene and Tropical Medicine.

The centre is also involved with nutrition research in Cambodia.

Closer to home, Ministry of Health funding has enabled them to employ Samoan-based senior research fellow Dr Tamasailau Sua’alii, who is beginning work on a project on traditional birth attendants in Samoa.

“There is a philosophical thing in all of that. It’s a statement of intent actually to put a Samoan into that job and to develop Pacific Island researchers. I think it is going to bear huge fruit in time as we were fortunate to attract someone of Dr Sua’alii’s calibre.”