By David A. Taylor, Science Magazine | Vol. 332 | No. 6037 | Jun. 24, 2011
BAMAKO, MALI—On a bluff overlooking a flat Sahelian landscape, evening finds most offices empty at the University of Bamako’s Faculty of Medicine. But a few lights remain on in the Malaria Research and Training Center (MRTC), and three Ph.D. candidates wait to speak with the director, Ogobara Doumbo. He leaves in a few days for Geneva to present new research affecting World Health Organization (WHO) guidelines on malaria prevention for children. But he makes space in the lab to discuss with a visitor what makes MRTC a paradox.
Doumbo, in his mid-50s but still looking like a student, smiles faintly when he speaks about his protégés, who recently led a roomful of top West African scientists through a comprehensive research discussion. Only in Mali, he says, will you find a critical mass of African Ph.D.s, with no loss to brain drain.
Bamako, a capital city of dusty streets on the banks of the Niger River, is not a place you expect to find a world center for research. Serving one of the world’s poorest countries, Mali’s health system is stretched to the breaking point. Yet on this bluff known as Point G, with a colonial-era hospital from 1906, Doumbo has built MRTC and nurtured, by his count, five generations of researchers committed to solving one of the continent’s most intransigent problems.
Since co-founding MRTC with support from the U.S. National Institutes of Health (NIH) in 1992, Doumbo has led it into state-of-the-art research on mosquito genetics, vaccine testing, and drug resistance. Furthermore, MRTC supports a network of research-affiliated clinics throughout Mali in very basic village settings. Doumbo has cultivated this cadre for 15 years, what he calls “the bush doctor initiative,” to bring top-quality medical research and practice to villages. The conditions would seem ripe for an exodus of highly trained physicians. In most developing countries, simply keeping capable scientists in the capital is difficult. A 2007 World Bank study noted the accelerated migration of skilled professionals, particularly in medicine, and its important effects on poor countries. MRTC has found another path.
“Quite often many senior researchers who could mentor the younger ones have themselves left,” says Wilfred Mbacham, executive director of the Multilateral Initiative on Malaria, based in Yaoundé, Cameroon. Those who aren’t lured to higher-paying international jobs get tapped for political appointments away from the university, he adds. A country’s political climate—and its valuation of research—are contributing factors. Mbacham has known Doumbo since 2003 and says that Doumbo saw the need to create a stable environment. “Very early on, he set up a grant-administration program that was attractive for more funding,” Mbacham says.
Mali has many problems shared by other sub-Saharan countries, including minimal infrastructure and corruption. In 2010, the Global Fund to Fight AIDS, Tuberculosis and Malaria suspended its malaria programs in Mali after an internal report found health department officials (not MRTC) had siphoned program funds.
Nor has MRTC been immune to charges that it benefited from donor favoritism. In the early years, says Stephanie James, director of science at the Foundation for the National Institutes of Health, a public charity in Bethesda, Maryland, “I know there were some jealousies in the university.” And some predicted that Doumbo “would never relinquish control over projects,” recalls Christopher Plowe, a researcher at the University of Maryland School of Medicine in Baltimore and an MRTC collaborator. “Last year I was struck by how wrong that prediction was.”
Doumbo, a son and grandson of traditional healers, grew up in a Dogon village 965 kilometers northeast of the capital. He first rode in a car as a teenager in 1971, to take his secondary-school certification exam in the town of Bandiagara. He never intended to go into research. “I really wanted to be a doctor and to serve in the bush,” he says.
After obtaining an M.D. degree at the University of Bamako and finishing a residency in internal medicine at Point G, Doumbo began to practice in 1981 at a clinic at Selingué, about 2½ hours south of the capital. There he aimed to win over local skeptics of Western medicine. The many C-section deliveries he performed were dramatic proof that his methods could save lives. “He was famous for being the guy who handled complicated obstetric labor emergencies and surgeries,” Plowe says.
In Selingué, Doumbo found larger problems: river blindness, schistosomiasis, and malaria. “I saw a lot of people suffering,” he says. He realized he could have greater impact by recruiting more young doctors to help. He returned to his studies, earning an M.Sc. in tropical medicine from the University of Marseille studying under parasitologist Philippe Ranque and a Ph.D. in parasitology from the University of Montpellier.
Doumbo also saw a role for indigenous medicine. Pragmatically, he saw traditional healers as scarce health care providers already treating rural dwellers, often with useful local knowledge, and thought it better to gain them as partners. “The best way to promote traditional medicine is to show that both types of medicine can work together to resolve a public health problem. This is what we are doing with malaria.”
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What an inspiring piece. The integration of Traditional with Western for a practical end is exactly what I too aspire to do in my Ghanaian context! Thanks.