The questions about when and how we return to continue our infectious disease field work in East Timor started on our last day in the Bairo Pité Clinic. Previous field lab visits to central Sri Lanka and northern Malaysia had prepared us for the stress of separation. Managing expectations comes with the territory.

We aim to develop, deploy and demonstrate capability, but our small team does not yet have the capacity to continue a prolonged campaign on our own. What we did last week in Dili was more like a preliminary reconnaissance; a feasibility study for future in-country development activity.

This first formal project by Lab Without Walls looks a bit like a road show, with its supporting cast of logistic and technical experts. Experience has shown that it is these support activities that make or break a field lab deployment. Interesting then that inspiration should come from the entertainment industry via the inner pages of the West Australian weekend paper. The up-coming U2 gig will feature a huge 360º stage known as ‘the Claw’ for the band that takes 4 days to assemble and two to pack up. We can do better than that with our malaria/TB/dengue/septicaemia/STD lab – one day to set up and run technical checks; a few hours to dismantle and pack away. And the mobile module can be set up to support a remote clinic in around 30 minutes. Just imagine what could be achieved with a logistic support team of 240 roadies in a country the size of East Timor. But this doesn’t quite answer the question.

We have demonstrated technical capability. The next stage of development is gathering financial, technical and ongoing technical support. If the dream of TB, malaria and HIV eradication is to be realised in a population around the size of the Perth metro area, we need to find Timorese staff to take the toolbox outside the capital, operate it to support community health programmes and develop an accurate appreciation of how to target scarce resources. This may all take a bit of time. The quicker we can raise the support, the sooner we will return.

So why all the emphasis on one of the back office functions of medical care? Well, if you think how much decision-making depends on pathology tests, try re-imagining your doctor working out what antibiotics to use, how long to use them for and how to cope with a serious outbreak in a country where no hospital currently cultures any clinical sample, where no antibiotic sensitivities are tested and where no definitive tests are available to check screening test performance. We might not be able to do it all on a shoestring budget, but there are new lab methods that would take the guesswork out of tackling headline infectious diseases like TB and malaria. Small lab footprint; modular concept; flexible test repertoire. The Lab Without Walls Team demonstrated that capability under austere conditions last week.

Now that the MicroGnome can reliably get lecture notes onto this Blog, here is the Malaria series for students of tropical medicine:

Not only is today ANZAC Day; it’s also the day we note the achievements and continuing challenges of the Rollback Malaria campaign – World Malaria Day.

To mark the occasion, the Lancet has run a special feature edition on malaria.

The μGnome has nailed his colours to the mast in our FACTM pt 1 malaria series. Here is a short summary; highlights of the malaria unit.

Download (PPT, 910KB)

The second Charlie’s postgraduate Tropical Medicine sessions takes place next Tuesday (27th April)  at 06:50 in the ED seminar room. Notes can be found on this site here.

This is part of the FACTM pt 1 series, and concludes our malaria unit.

Revision of the earlier two modules is also available on this site.

A light breakfast will be provided.

For those who’ve been following the μGnome’s series on all things malarial, the full set of learning modules can now be found on the Priobe Net Plasmodium page, along with an interactive malaria risk map and other malaria resources.

Powerpoint files can be downloaded in PDF for personal and educational use. There are separate PDFs here if all you need is the Plasmodium life cycle or the mosquito recognition chart. A link has been added to the WHO interactive travel health map. This allows you to update the information as changing malaria risk alters the global risk map. If studying for the FACTM pt 1, note the chapters in the recommended list of short textbooks, and a superbly written chapter on malaria in Manson’s Tropical Diseases by Nick White.

Malaria modules 3 and 4

The μGnome has finished preparing Malaria module 3 and Malaria module 4. These cover public health, travel health and expedition medicine aspects of malaria and vector biology. The two mini-lectures are presented here to help those studying for the FACTM pt 1 exam later this year. They complement modules 1 and 2.

Download (PDF, 1.91MB)

Download (PDF, 358.12KB)

More details can be found on the excellent Malaria site run by the WHO.

Settings for which the μGnome needed professional travel health and expedition medicine advice included Brazil and Sri Lanka. Click on the links for more on those expeditions.

Did you ever think how useful it would be to have all your malaria learning material in the same place? I did. After all, it was getting a bit untidy. So they’ve all been moved to the Priobe Net home page. Links will take you from there to all our malaria media. Future items will be linked to there as well.

Postgraduate tropical medicine training has finally arrived.

The long-anticipated clinical tropical medicine course for the ACTM part 1 Fellowship exam will start next week

• at 0650hr  (finishes 0755hr, prompt)
• on Tuesday, 13th April
• in the Emergency Department seminar room at Sir Charles Gairdner Hospital
• the course starts with Malaria modules 1 and 2
• aimed at registrar and consultant level

Those intending to attend should e-mail to ensure we have enough muffins & coffee ordered for breakfast.

Supplementary materials can be found here:

• malaria review article
• malaria cycle
• Ronald Ross
• FACTM part 1 reading list
• FACTM part 1 revision questions

The μgnome got out his drawing set and sketched out a schematic diagram of how Plasmodium species (the cause of malaria) uses both humans and Anopheles mosquitoes to keep its numbers up. Note how it finds multiple opportunities to amplify its numbers.

Malaria is one of the top three infectious disease challanges worldwide, accounting for millions of deaths per annum worldwide. More colourful diagrams can be found courtesy EMRO (WHO) and Nature, generously provided for educational purposes.

These illustrations will be useful for FACTM exam preparation. Clinical and Paraclinical FACTM model questions can be found here.

How Plasmodium parasites use human and mosquito biology to amplify their numbers

14th March, 2010.