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Interview with Margriet Den Boer about Leishmaniasis: MSF Scientific Day May 25th 2012!

May 23, 2012
Margriet

So on Monday I spoke a little bit about MSF’s Scientific Day (to be held this Friday, May 25th 2012). Today, I’m welcoming Margriet Den Boer, MSc, PharmD, MPH, to the blog to talk about her experiences in Bangladesh dealing with Leishmaniasis. Margriet completed her PharmD in the Netherlands and obtained a Masters Degree in Public Health in Developing Countries at the London School of Tropical Medicine. The last 10 years Margriet worked with MSF and WHO, in a combination of activities related to leishmaniasis and pharmaceutical matters, including access to drugs. Her focus is to draw more attention to leishmaniasis, and lift it out of its status of neglected disease.

For those who want to learn more about leishmaniasis, @EpiDoctor (Michael Walsh) has a great post on his blog Infection Landscapes.

Remember: You can follow along online on the MSF Facebook page, Twitter @msf_uk or by using the hashtag #MSFSD.

How did you end up with Medecins sans Frontieres? Was this always part of “the plan”?

Yes, I was always hoping to work in humanitarian aid, and especially for Medecins sans Frontieres, even though with my background in pharmacy and pharmacology there are not that many possibilities. I was very lucky as MSF Holland opened up a pharmacist position after I finished my studies. At that time I was the only pharmacist in MSF – now there is a whole network of them.

The life cycle of the leishmaniasis parasite (from CDC via Infection Landscapes)

So your study was titled “Post-kala azar dermal leishmaniasis in Bangladesh: outcomes of short-course AmBisome regimens.” Let’s talk about that a little. First off, what is “kala azar dermal leishmaniasis”? How many people does it affect?

Visceral leishmaniasis, also known as kala azar, is a parasitic disease that is transmitted by sandflies. It is endemic in 99 countries. There are about 200,000-400,000 new cases each year, of which 90% occur in India, Bangladesh, Nepal, South Sudan, Sudan and Brazil. The disease generally affects the poorest of the poorest. Kala azar is the second largest cause of parasitic death after malaria, and without treatment, most patients die. Symptoms are prolonged fever, severe weight loss, an enlarged spleen, anaemia and suppression of the immune system. Post-kala-azar dermal leishmaniasis (PKDL) is a skin rash that appears in some apparently cured kala-azar patients (in Bangladesh: 10-15%), usually several years after the end of treatment. It can be highly infectious as parasites have been found in the lesions. It may last for weeks to years and in some cases becomes a serious disease, with lesions also involving the mucous membranes.

In a nutshell, what did you do?

In Bangladesh, MSF started treating PKDL patients with AmBisome, which had never been done before on a large scale. I analysed a database that contained data on the progress of these patients after they received treatment. We followed the patients at regular intervals during one year. We also took pictures of each patient so that I could compare those with what was recorded in the database by the doctors and patients themselves.

What was the biggest barrier you faced doing your research?

I have made short visits to the project in Bangladesh, but I was not there for most of the time that the data were collected. Of course, looking at the database retrospectively, I see ways to make small improvement to the data collection that I wished we could have introduced at the time.

So what’s next for you? What do you do with these findings?

Based on the findings we may be able to influence the government of Bangladesh to change the national policy-treatment of PKDL now consist of a very long course of painful and potentially toxic injections with pentavalent antimonials. The results also form a basis for further research, for example, a dose finding study in order to identify the minimally effective dose of AmBisome for PKDL.

What advice do you have for those interested in working for MSF and in public health?

Follow your heart! To work in public health in developing countries is both satisfying and inspiring. There  is plenty of space for innovative thinking, and there are more and more possibilities for those wanting to get involved- also without a medical degree.

Thanks Margriet for your time!

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