Pioneers in malaria research

Although clinics can be made more accessible, while education and information can address attitudes to health and medication, other factors limiting women's access to clinics are less easy to change: reluctance to travel alone, language barriers (Karen- speaking women typically have less experience of Thai-speaking culture than men), socio-cultural reasons such as discomfort on entering an alien environment, and greater willingness to rely on traditional healing. In addition, there is pregnancy - a matter of particular significance to women. Drugs administered by the malaria clinics are known to be effective and have a reputation for causing strong side-effects, evidence of their curative power. I have been asked many times by young women receiving drugs in a malaria clinic whether the medication is harmful during preg- nancy. Chloroquine is safe for use during pregnancy, and so is proguanil. Other anti-malarial drugs are either not recommended for use by pregnant women, or else the side-effects are unknown. Unfortunately, some preg- nant women rely instead on sub- optimal dosing with drugs they have bought themselves. Dr Krongthong and I found that the local and mobile clinics did much to encourage and enable women suffer- ing from malaria to attend and receive effective treatment. Barriers of dis- tance, cost and travel could be over- come by bringing the clinic closer to home. In some instances, women themselves became the cultural inter- preters between clinic and community, overcoming the more subtle barriers of language and custom. And integrating the mobile clinic into the fabric of community life did much to promote private and public goals to improve health. But a good deal remains to be done. Women and children are particularly vulnerable to malaria infection because their ·immunity is either not yet fully formed or has been reduced by pregnancy. Those who plan and put into effect programmes for the detection and treatment of malaria can no longer be satisfied to offer low-cost and effective treatment only to those who arrive at facilities such as the malaria clinics in Maesot. All of these patients are offered excellent and appropriate care. But many people remain unserved. The planners must also actively seek to identify those who do not receive the benefit of services, and must adapt the services to the needs and sensibilities of all members of the community. • 12 Pioneers in malaria research by Cynthia Laitman Editor with WHO's Special Programme for Research and Training in Tropical Diseases, and author of "DES: the complete story" I n 1958, when Professor Khu-nying Tranakchit Harinasuta first suggested to other physi- cians that malaria parasites might be developing resistance to the drug, chloroquine, she recalls the resounding reply, "No such thing!" Chloroquine, developed in 1939, had been so effective in treating malaria that it was over- whelmingly considered the defi~ nitive answer to this major tropical disease killer. But she was correct and her observations made malaria history. "There were many bar- riers to conducting my early stu- dies," says Professor Khunying Tranakchit of her work to demonstrate that there was indeed resistance. "We didn't have any money. We weren't sure of how to design a study. We didn't even know how many times a day to take blood samples." At times using her own money to keep the studies going, she was finally able to show beyond doubt that her early observations were correct. Since 1962, when she formally pre- sented the results of her studies to a sceptical scientific com- munity, malaria parasite resist- ance to chloroquine has been recognised wherever malaria is a problem, and has prompted a major new scientific search for alternative treatments and control strategies. Dr Khunying Tranakchit Harinasuta Professor Khunying Tranakchit earned her medical degree from Mahidol University, Bangkok, in 1944 and a doctorate in tropical medicine and hygiene from the School of Tropical Medicine in Liverpool, United Kingdom, in 1953. A life-time of scientific achievements has earned her an array of honours and awards and worldwide recognition, including the title Khunying which is the equivalent of the British title, Dame. Although she is now in her seventies, she shows no sign of slowing down her professional pace. Her protegee on the Faculty of Tropical Medicine at Mahidol University is Dr Juntra Karb- wang. She has a medical degree as well as a doctoral degree in clinical pharmacology in tropical medicine, and is the only such expert in Thailand. "We are very lucky that Dr Juntra has joined our staff," says Professor Khuny- ing Thanakchit, "because there are many questions to be answered about the new anti- malarial drugs currently under investigation." Dr Juntra Karbwang "The problem," explains Dr Juntra, "is that pharmaceutical companies in western countries are not interested in the costly process of developing drugs for diseases which basically do not affect western populations. Nor are there adequate opportunities for researchers in non-endemic countries to study these [tropi- cal] diseases." That is why both doctors consider it essential that highly trained tropical disease researchers work in endemic countries. However, they share their expertise with the interna- tional research community, parti- cipating in meetings and conferences, and both are expert consultants to WHO. Although of different genera- tions - Professor Khunying Tha- nakchit was born in 1918 and Dr Juntra in 1954 - they are both pioneers in malaria research. Together they are forging new paths of knowledge that will ultimately help millions of malaria sufferers. •