Feature: Molyneux in Malawi
02 June 2008. By Penny Bailey.
“Two things that strike you immediately when you first arrive in Malawi are the cordiality of the people and the beauty of the country,” says Prof. Molyneux. “Very soon you realise how big the challenges are that communities face every day, and how resilient people are in making use of very limited resources.” His affection for the country began when he and his wife Elizabeth spent a decade from the mid-1970s to mid-1980s working as doctors in the south of the country, first in a mission hospital and then in the national hospital in Blantyre.
In 1995, after 11 years in Liverpool, he returned to Malawi to set up a research programme in Blantyre - to function as the principal overseas focus for the newly formed Wellcome Trust Centre for Research in Clinical Tropical Medicine at the University of Liverpool (which he established with his colleague Professor Peter Winstanley). “We wanted the programme to contribute to the livelihood of Malawi’s newly formed medical school, the College of Medicine (University of Malawi),” he says. “Patients at the hospital suffer from a huge burden of diseases that need improved understanding and improved care - both of which research can help to provide. Having an integrated research unit that is closely involved in the wards of the hospital allows the research to respond to local priorities. It contributes to good clinical practice as scientists and clinicians work together to find what can be done to improve people’s health.”
Training local doctors and graduates, Prof. Molyneux says, is key. “It’s a privilege to be involved in the nurturing of a strong cadre of locally trained experts. These are the people who will become the country’s health leaders in both medicine and research.” Some graduates have already begun research careers in clinical, laboratory or field disciplines, and many combine clinical specialisation with some research interest. “For all, a major challenge is that they are pioneers - Malawians have not preceded them on this journey, and there are no well-trodden career pathways to follow.”
Tackling health issues
As in many other countries in Africa, malaria is a major challenge to Malawi’s healthcare system. It is responsible for 30 per cent of deaths in children under five, and 30 per cent of all hospital admissions. “We’ve been helping to tackle malaria in a number of different ways,” says Prof. Molyneux. “Working with the Ministry of Health’s national Malaria Control Programme, we have carried out a series of trials of existing and new antimalarial therapies - testing new artemesinin combination therapies for the treatment of malaria [these have now replaced previous therapies that were failing], assessing suppository treatment for severe malaria [of potential value at village level], and evaluating new possibilities for the control of both parasites and mosquitoes.” The team has now been awarded a Gates Foundation grant to look at the effects of rolling out artemisinin combination therapies on a broad scale in the population.
In addition to malaria, scientists in the Programme have been studying HIV, which affects 14 per cent of Malawi’s population (over 70 per cent of adults in the medical wards are infected). The research has concentrated on bacterial infections to which HIV-infected people are prone, especially Streptococcus pneumoniae, nontyphoidal salmonellae and tuberculosis. In all of these areas, the prospects for existing or possible vaccines have been high on the research agenda.
When their formal employments come to an end on New Year’s Day 2009, Prof. Molyneux and his wife hope to continue to work in Malawi, with the usual mixture of research, clinical practice and teaching. But they will also have more time off to visit grandchildren in Kenya and Britain and to enjoy music and mountains in Malawi and elsewhere.
