By Diana Wangari,
The documentary film Switching the Poles by the Institute of Tropical Medicine (ITM) in Antwerp, with the support of Belgian Development Cooperation, is a public-broadcast quality production with subtitles that is ideal for both professional medical practitioners and intelligent lay people.
It also showcases the far-flung good works of the ITM, one of the world’s greatest training and research institutes with a bias for assistance to developing-nation healthcare systems in tropical medicine.
As the credits roll at the end, after 45 riveting minutes, they include even the names of non-professional/researcher participating members of the public, including a recovering patient of Buruli ulcer in Benin, about whom more presently.
The documentary, filmed in Benin, India, Burkina Faso, Peru and Cambodia, has world-class production values and presents complex medical issues and procedures in a lucid, jargon-free and instantly eminently communicative manner. The cinematography and voice-over narrative as well as the multi-lingual interviews with clear subtitles that linger long enough to read at least twice are outstanding.
Its theme is of the first importance – ITM’s mission to share information, expertise and best practice by engaging and guiding health experts from the South (the developing nations) in research and healthcare to global best-practice standards. ITM’s promotion and enhancement of health systems at every level – from global to regional, national and local – a true ‘switching of the poles’, or horizontal collaboration, is shown in action in a memorable and informative way.
Like the best documentaries, Switching the Poles hits the ground running, as it were, taking the viewer to Laboratoire de Référence des Mycobactéries (LRM), Cotonou, Benin, and its research into Tuberculosis (TB), one of the world’s major poverty-related diseases.
The layman and woman quickly learn from Dissou Affolabi, the LRM Vice Director, that TB is transmitted by coughing and 10% of its sufferers actually develop the disease, with each patient infecting on average 15 other persons.
TB is difficult to treat and requires a mixture of antibiotics for a minimum period of six months. Later in the documentary, we are informed that TB kills 2 million people annually.
Laboratory test results are essential to monitor treatment and reveal how the TB bacterium responds to antibiotics. As with many other diseases, early detection is all-important for more effective treatment.
Affolabi makes the important point that, originally, the ITM did everything, but has gradually helped them put in place all the relevant techniques, beginning with microscopy and then microbiological culture.
The emphasis on research is impressive and has an immediate impact, providing a useful learning curve. Affolabi introduces the case study of Mama Blanche Tamimomo-Kledjo, a researcher at LRM, who went for training at the ITM in these techniques. Blanche herself makes a point that, in my opinion, should be this research documentary’s masthead quote:
‘I saw how you must use sterile techniques to get a good result. And I pass that on every day to all my colleagues, to the young people here. I constantly show them the rigour needed to achieve a good result.’
By the time Affolabi informs us that the World Health Organization (WHO) sees LRM as a candidate for a supranational laboratory, we are mightily impressed but hardly surprised, given the close-ups of laboratory researchers, equipment and techniques captured in entertainingly cinematic fashion by the cinematography and explained in the informative voice over. All LRM requires to achieve supranational status is a P3 laboratory, which is already under construction, as a shot of the site, with builders as busy as bees, clearly shows us.
Despite its unrelentingly grim subject matter, this documentary is unfailingly informative, entertaining and frequently eye-opening.
In the segment on the Buruli Ulcer Clinic at Allada, also in Benin, ITM’s work in spearheading the unravelling of the secrets of mycobacterium ulcerans comes to the fore with superb high-definition videography, particularly of the lesions and massive mutilating ulcers. This is a horrible disease but non-deadly disease that is largely neglected by the pharmaceutical industry on the basis of too little profit margins and returns on investment.
Early diagnosis of Buruli ulcer by a reliable laboratory is supremely important. We learn that real-time PCR (Polymerase Chain Reaction), popularly known among medics as molecular photocopying, is one of the foremost lab weapons against Buruli. LRM is the only lab performing this test in Benin. In the past, pain, exhaustion and amputations characterized this disease, a situation that has since been alleviated for sufferers by LRM’s interventions, with more than 100 patients cured.
Indeed, Joel Tchekpo, a recovering Buruli ulcer patient, speaking directly to the camera, attributes the Allada clinic’s good work to God: ‘Thank God the centre came here. We have to thank God.’
Affolabi notes that the ITM is interested in strengthening local talent, not in just passing on techniques, but first and foremost in training people, including many other PhDs besides himself.
In Switching the Poles, the Institute chooses to focus on neglected diseases in addition to the mainstream public health issues that the rest of the world is emphasizing. Prof Dr Eduardo Gotuzzo, Director of the Instituto de Medicina Tropical Alexander von Humboldt, Peru, describes one neglected disease, Leishmaniasis, as being ‘not on the list of priorities’ of commercial pharmaceutical companies when it comes to investing in research.
Dr Gotuzzo then offers this remarkable and truly depressing statistic: ‘In the last 20 years there have been 2,000 new drugs. Only 12 drugs are for neglected tropical diseases. The investment in tropical diseases is really nothing.’
It’s simply tragic that we put so much focus on HIV, yet diseases such as malaria that are curable and easily preventable are being overlooked. Coming from a country where malaria remains (for the past 10 years) the Number One killer of children, efforts made with both preventing and managing the disease, no matter how ‘unappealing’ they might be to those who keep an eye on the profit margins of multi-national organizations, can’t be taken for granted as they are indeed the difference between life and death.
I found the documentary enlightening in terms of how similar healthcare challenges are in resource- poor countries. Take, for example, the India case study; I found myself relating to the discussion as it is something I witness on a daily basis. Our medical school utilizes the largest referral hospital in East Africa – the Kenyatta National Hospital (KNH) – for practical purposes as well as ward teaching. Therefore, I get to see and hear from patients and oftentimes most say they would indeed rather go to a private hospital as the doctors aren’t available in sufficient numbers to cater for the patient capacity, hence the doctors end up being overworked and lack motivation. Patients have to stand in long queues and when you are just about to sigh in relief that you are finally at the front of the queue, you realize that the next department that you are being sent to has a longer queue than the one you just left!
Thus, for one to be treated or attended to you must factor in at least an entire half day, not for medical care but for standing in queues. Understandably, the patients then find private hospitals to be faster and the doctors friendlier.
And if it weren’t for the fact that most of these patients simply cannot afford the cost of care in private institutions, they would most definitely seek out private clinics.
As Vijay Kumar, the Indian tamarind seller from Tumkur, remarks in the India segment of Switching the Poles, in his country even the poor prefer private hospitals for the simple reason that there are not enough doctors in public hospitals and the doctors available are massively overworked.
We learn an interesting statistic from Dr Vijayashree H.Y., of the Institute of Public Health (IPH) in Bangalore, when she says that 70% of Indians prefer to go to private hospitals.
What really stood out for me is the level of dedication that graduates from ITM have. More often than not, graduates who study abroad will choose to remain there or take advantage of more profitable opportunities in developed countries as compared to returning to a low income country where opportunities are limited. Hence for Dr Halidou Tinto, of the Clinical Research Unit of Nanoro, to choose to return to Burkina Faso is most commendable. And for him to return to start a community-based institution that tackles a fundamental issue such as Malaria is simply motivational. And for him to start all this from scratch, equipped with only knowledge acquired and the support of ITM, is simply a story that needs to be told for others to emulate. In this outstanding documentary, it is a story that is very well told indeed.
I was particularly moved by Top Nhey, the HIV patient from Phnom Penh. I have heard of similar stories in Kenya, where a wife was infected by the husband. It goes to the extent of marital rape if the wife insists on using protection and the husband disagrees, at times resulting in a pattern of domestic violence. It was touching to learn that Nhey, despite all the challenges she was facing in her own life, took on her closest friend’s children and in the process shouldered their health and challenges as well. Furthermore, the concept of support groups is one that really needs to be mobilized in our country and I could see it does make a huge difference in the quality of life. I could feel her excitement at the possibility of finding an HIV cure so that she can see her kids grow up, and her gratitude for literally having shoulders to lean on. Nevertheless, I was surprised at the level of stigma that exists in Cambodia. Certainly, stigma isn’t a new phenomenon, especially in a not dissimilarly low-income country such as Kenya.
But the fact that these poor Cambodians have to migrate ever so often as they will be completely ostracized from the community adds a different and distressingly eye-opening perspective.
Women constitute a large number of those living with HIV as seen in Kenya as well. There has always been the belief that HIV in men goes largely undocumented, as not many men are willing to be tested, let alone admit they are positive, even when faced with the truth – for example if the wife tests positive yet she has undoubtedly adhered to a monogamous relationship, the man would rather accuse her of being unfaithful and even go a step further and leave his wife, proclaiming infidelity and ‘fear for my life’ to be the causes. ANYTHING to not admit the truth – and come face-to-face with the reality that is his status.
A simpler example, and much closer to home, is the fact very few of my own friends and my male colleagues would actually step into a VCT centre to be tested – at least not in public. They would rather claim to be too busy and, later on, individually make their way to a secluded centre where their ‘business will be handled privately’, as they like to say. Mind you, these are educated individuals, some of them prospective medics, but the thought of ‘what people might think’ or ‘the wrong ideas that people will whisper to one another’ leaves them paralysed with unreasoning fear.
The ITM’s approach of ‘Switching the Poles’ is clearly very effective. Indeed, in Prof Dr Bruno Gryseels words, ‘You can train a scientist but if he cannot find a job, if he cannot find a laboratory or if he cannot find a management that takes care of his needs and provide sufficient funding then he cannot do his work’.
This echoes the situation as it is in many low- and middle-income countries, it depicts the picture as it is on the ground, it tells a story that is found in not just Benin, India, Burkina Faso, Cambodia, or Peru, but in Kenya as well.
Dr N. Devadasan, the Director of India’s IPH, tells viewers of Switching the Poles that his Institute trains professionals at district and national levels in India through an e-learning course supported by ITM that is the first of its kind in that country of 1.3 billion people. IPH research is rooted in local experiences.
Dr Devadasan describes IPH’s relationship with ITM in the following memorable and eminently quotable terms:
‘ITM has helped us grow as an institution. Our relationship with ITM is based on a solid foundation of trust and transparency. We treat each other as equals and we learn from each other. Truly a two-way interaction.’
Towards the end, and just before the credits roll Switching the Poles leaves us with this inspiring piece of information:
‘Yearly, an average of 500 scientists, medical doctors and nurses, follow advanced courses at the Institute. 120 international students are working on their PhD at ITM.’
As Dr. Roopa Devadasan said on-camera, ‘ITM has an enormous network of people who are doing very similar things to what you are doing in your country and that exchange is dynamic, it’s explosive because you come back having seen and talked to people who are trying things themselves and that’s a fantastic learning experience’.
And, in my book, that’s a true definition of learning. This is a medical research documentary to cherish and it rewards more than two viewings.