The unsung heroes of medicine

Everyone who has been to either a clinic or hospital is familiar with a doctor. They alongside nurses and physiotherapists have direct contact with patients and as a result the public holds medical doctors in high esteem. Parents encourage their children to become doctors, and students with an aptitude for science aspire to be physicians.

The importance of medical doctors is indisputable but there are other medical professionals just as important but often over looked. Chief among the over looked medical professionals are Medical Laboratory Scientists (MLS professionals).  

They are the scientists who handle stool, urine, blood and all manner of samples from the human body to conduct tests which will identify the cause of illness. They are the pillar upon which evidence based medicine stands on.

Without diagnostic tests being carried out doctors rely on clinical methods to determine the cause of illness in a patient. Clinical methods rely on an assessment of symptoms manifesting in the patient and they do not guarantee an accurate diagnosis. The uncertainty of clinical tests makes laboratory tests all the more important regardless of their expense because a wrong diagnosis is a potential disaster.

Tapiwa Mugadza, a MLS professional at Optimum Health laboratories advocates strongly for evidence based medicine. When asked if there can ever be a compromise on laboratory tests he said, “there should be no compromise on evidence based medicine, it can cost individuals and institutions significant monetary losses in miss-prescribed drugs and worse still, false diagnosis may result in loss of life” He goes on to describe circumstances in which both can occur.

In one scenario a doctor after assessing the symptoms of a patient identifies that the patient is anaemic. Assuming the patient has an iron deficiency the physician goes on to prescribe iron tablets, yet the reality is that the patient’s anemia is due to a low platelet count.

Though the doctor may eventually realise the error and prescribe the correct treatment iron tablets would have been wasted. Such an error is costly to the patient who purchases their own drugs, it is costly to medical aid companies which cover cost of treatment for their clients and it is costly to tax payers whose money runs public clinics and hospitals.

In another situation a patient has meningitis; meningitis can either be caused by a virus, fungus or bacteria. The appropriate treatment depends on which type of meningitis it is and a delay in treatment can be fatal. To prevent unnecessary loss of life it is important that a laboratory test be done to determine the cause of meningitis and consequently apply the correct treatment.

Such errors are not common place in Botswana because there are plenty of laboratories both public and private such as Diagnofirm which are available to ensure the standards of evidence based medicine are upheld.

Dr. Denys R. Estrada a Dermatologist at Letlalo Skin Medical Centre also believes strongly in the importance of laboratory tests but he points out that in a field such as dermatology clinical examinations are often enough to correctly diagnose a patient. He adds that there are very few circumstances in which a laboratory test will be needed to determine the cause of a skin condition.

The importance of medical laboratory science has not gone unnoticed by key policy makers in government. Since 2008 the University of Botswana (UB) has been steadily making major strides in improving the curriculum of this science.

Mr. Modisa Motswaledi the Head of the School of Allied Health Professions and the President of the Botswana Institute for Clinical Laboratory Professionals is particularly proud of the progress UB has made. He points out that the B.Sc. in cytototechnology and B.Sc. in histotechnology offered at UB are not available in most African countries. This means that UB is not only training scientists for Botswana alone but for the whole of Africa.

Not an HIV cure, but a step in the right direction

The severity of HIV/AIDS is not unknown to Batswana. With a prevalence rate of about 18.5% and an estimated rate of 1.35% it is hard to find a family completely untouched by HIV. Though HIV is still a serious threat to the lives of Batswana there have been notable accomplishments in the struggle against the pandemic, particularly the use of anti-retroviral drugs (ARV’s) as a treatment for those infected with the virus.

Through the use of ARV’s, individuals can expect to live up to twenty years longer than is possible without them. However as good as ARV’s are, they are in no way a final solution in HIV treatment.

A team of scientists at the University of Botswana (UB) have been working on developing compounds superior to the current ARV’s on the market in the treatment of HIV.  This research is championed by four academics; Dr. Mapolelo, Dr. Natiyane, Dr. Nkwe and Dr. Nareetsile.

The need for better ARV’s is a pressing concern because of drug toxicity. James Matshwele, a research assistant in the team and prospective Master’s student in chemistry says that “until treatment which does not induce side effects and cause any long term damage from continuous dosage is developed, research must continue.”

The investigation for better therapies at the University began when PhD student, Scotch Ndlovu put together literature research which showed that there are a class of compounds called metal complexes capable of inhibiting HIV replication.

The inhibition of HIV replication is an important effect in that it slows or possibly even halts the multiplication of HIV within a host. With the spread of the HIV infection effectively contained within the host, the onset of AIDS is delayed and the infected individual is less likely to infect others.

The ability of some of the metal complexes to inhibit HIV replication was shown to be better than azidothymidine (AZT). AZT is the main compound used in current antiretroviral medication. It slows HIV replication in patients but does not stop it entirely and HIV may become AZT resistant over time.

The work done by Mr. Ndlovu prompted further research by the University chemistry department.

James Matshwele, who was a final year student in 2015 did his project conducting experiments demonstrating the effectiveness of metal complexes in inhibiting HIV replication.

Mr. Matshwele went on to present his work at an international science conference in South Africa. Since then the research team has formed collaborations with Botswana International University of Science and Technology (BIUST), FORT HARE University in South Africa and University of Johannesburg also in South Africa. Dr. Nareetsile anticipates a three-year timeline till the conclusion of the research.

However, she does admit to a few challenges in the way of advancing the research.   She cites funding as a minor challenge, secure in the knowledge that funds will be made available by both the University of Botswana and BIUST. Her main concern is that there are too few scientists available for research.

Doctors and Professors typically rely on their post graduate students to spend time in the laboratory conducting experiments and collecting data for research. Due to notably few students pursuing post graduate degrees in science there are even fewer students available to participate in research projects the university will be engaged in.

Dr. Nareetsile points out that a possible reason for the shortage in students is that most top performing science students prefer to pursue further studies abroad and the rest often don’t satisfy the strict entry criteria required by the university.  

In addition, there is an economic challenge for citizens since there is no sponsorship available for citizens wishing to pursue a post graduate degree. All things considered the research on metal complexes presents many exciting possibilities.

Should favourable results come out of the research better ARV’s will be developed which will extend the life expectancy of HIV patients. Young people who get infected will still be able to live long lives, comparable even to those uninfected.

Also because the drugs would have been developed primarily from research done in Botswana the cost of acquiring the drugs for the populace will be lower because the intellectual property will not be owned by foreign entities.

Meanwhile Batswana students involved benefit from the capacity building they will be exposed to and the prestige from working on research of such a caliber.

Botswana looks to the stars with SKA

Prof. Philip Diamond the SKA Director-General

On Monday the 4th of July at the Square Kilometre Array (SKA) global headquarters in the UK, Prof. Philip Diamond the SKA Director-General announced the addition of a new precursor telescope located in South Africa.

SKA is a large multi radio telescope project primarily being built in South Africa and Australia and is anticipated to be complete by 2025.

Other outstations will be built in Botswana, Ghana, Kenya, Madagascar, Mauritius, Mozambique, Namibia and Zambia; all equipped with radio telescopes contributing to the network. Once complete SKA will be the most advanced radio astronomy array, fifty times more sensitive than any other instrument and ten thousand times faster.

The first telescope to ever be turned towards the heavens was made by Galileo Galilei, with it he was the first to see craters in the moon. Galileo also observed that the Earth and all the other planets circle the sun, he made this observation at a time when celestial bodies were thought to orbit the Earth.

There is no telling what SKA will show us but expectations are plenty. Einstein’s theory of general relativity will be tested, billions of galaxies mapped out to the very edge of the observable universe and the processes leading to the birth and evolution of galaxies will be studied.

Most exciting of all; SKA will be able to look closer at Sun-like stars where Earth-like planets or moons are most likely to have environments favourable for the development of life. This combined with an ability to search for complex organic compounds will make the search for life outside the planet Earth a reality.

These functions outlined on the official SKA website are not exhaustive. A greater appreciation of this technology and the implications it brings comes with a greater understanding of space related sciences. With that in mind Botswana is making preparations to train Batswana scientists, so that when the SKA project is implemented in Botswana in 2023 they will be in a position to make use of the advantages offered by hosting radio telescopes.

In a published press release in April this year the Botswana International University of Science and Technology (BIUST) announced that the institution would host Botswana’s radio-astronomy training facility.

The funding to setup this facility comes from the Newton Fund, an initiative established by the British Council in 2014 to promote economic development and welfare by strengthening science and innovation capacity. Dr. Mhlambululi Mafu in the Department of Physics and Astronomy at BIUST will lead the training facility project.

The new telescope granted precursor status by SKA is the Hydrogen Epoch of Reionisation Array (HERA). Precursors are telescopes located at future SKA sites and serve as a form of prototype for future SKA telescopes.

The scientific goal of HERA is detecting the Epoch of Reionisation signal. Detecting this signal will give insight on many fundamental questions in cosmology, such as properties of the first galaxies, formation of very metal poor stars and many other important research topics in astrophysics which will give a view on what the universe looked like when it was half a billion years old. For now the world continues to watch and to wait, and recall the words of a Roman philosopher named Seneca who lived 2000 years ago.

“The time will come when diligent research over long periods will bring to light things which now lie hidden. A single lifetime, even though entirely devoted to the sky, would not be enough for the investigation of so vast a subject... And so this knowledge will be unfolded only through long successive ages. There will come a time when our descendants will be amazed that we did not know things that are so plain to them... Many discoveries are reserved for ages still to come, when memory of us will have been effaced.”

UB Chemist vows to mainstream herbal knowledge

In 1999 a man from Mogoditshane with claims to have a cure for HIV/AIDS approached the University of Botswana (UB) and asked researchers to examine his product and verify his claim. This man had attracted a significant following and many believed in his ‘cure’.

The idea of an HIV cure coming from an uneducated man living in a village was ridiculous, and as such no funds were spared for the investigation. To Dr. David Tanyala Takuwa, an analytical chemist and lecturer at UB, that was a terrible oversight.

Though it was clear to him that the village man’s herbs could not be a cure, he figured that there must be substances in the herbs with some effect on HIV. Analysis of the supposed cure might have given insight on compounds with activity on HIV, possibly leading to development of refined treatment products. However, no research was ever done and knowledge of the Mogoditshane man’s herbs was lost.

Today Dr. Takuwa focuses all his scientific acumen into investigating traditional herbal knowledge. He has filtered through forests of information from his laboratory showing that the lore of herbalists should not be easily dismissed.
Currently, he has three PhD students doing research which will develop methods to identify indigenous plants with therapeutic properties.

One of the students, Margaret Mkambamkhami’s investigations is focused on researching on diabetes. Anitha Immaculate is investigating anticancer properties, and Abibu Moshood is analysing vitamin content and has collaborated with Mr Kakanda, a herbalist living in Francistown, and are working on producing green chemistry pesticides. The pesticides they are developing unlike synthesized pesticides will not be a pollutant and will thus be safe for the environment.

The greatest challenge Dr. Takuwa has faced so far is lack of funding but that doesn’t discourage him. He is optimistic about the future and certain that more people will come to appreciate the value of research.

President, Lt Gen Dr Ian Khama speaking at the African Academy of Science conference in Kasane earlier this year said, “Africans should have more innovations relevant to Africa.” These sentiments, he said have given him some hope.

Also, UB has an initiative for community projects. Through this initiative, members of the community seeking to refine their traditional knowledge with the empiricism of science can be engaged. This initiative however only freely serves those with the desire to empower their communities and not those pursuing their self-interests.

The intellectual property developed through this initiative is retained by the community; the university along with the scientists working at UB make no claim to it. Through this initiative Dr. Takuwa investigated the cosmetic properties of donkey milk. His research led to the production of a whole range of donkey milk products including soaps, lotions, and creams.

Mr Olefile Sebonego, whose keen eye for business had him take interest in donkey milk research, is now working on establishing large scale donkey milk farming in Botswana. He has been successful in Mmathethe, Moshupa, and Francistown; and he is determined to keep going till Botswana becomes an exporter of cosmetic products.