|FACE TO FACE
|Year : 2016 | Volume
| Issue : 2 | Page : 159-162
An E-mail interview with Dr. Nadira Karunaweera, Senior Professor and Chair, Head of Department Parasitology, Faculty of Medicine, University of Colombo, Sri Lanka
|Date of Acceptance||17-Jul-2016|
|Date of Web Publication||19-Sep-2016|
|How to cite this article:|
. An E-mail interview with Dr. Nadira Karunaweera, Senior Professor and Chair, Head of Department Parasitology, Faculty of Medicine, University of Colombo, Sri Lanka. Trop Parasitol 2016;6:159-62
|How to cite this URL:|
. An E-mail interview with Dr. Nadira Karunaweera, Senior Professor and Chair, Head of Department Parasitology, Faculty of Medicine, University of Colombo, Sri Lanka. Trop Parasitol [serial online] 2016 [cited 2019 Oct 18];6:159-62. Available from: http://www.tropicalparasitology.org/text.asp?2016/6/2/159/190837
Tropical Parasitology (TP): Being one of the leading parasitology researchers from Sri Lanka, could you please explain how your research findings made an impact on the National Leishmaniasis Control Program?
Dr. Nadira Karunaweera: I am pleased to say that our research program on leishmaniasis has had a major impact on health policy decisions on several fronts during the past decade or so that has helped to lay the foundation and facilitated the process for better management and control of this disease in Sri Lanka. First, the published information on clinical and epidemiological aspects of leishmaniasis made available the hard data on the burden of disease in Sri Lanka, both in the form of patient incidence data and spatial distribution of infection within the country. This information provided the basis for the declaration of leishmaniasis as a "notifiable disease" by the Ministry of Health, Sri Lanka, during the latter part of the year 2008. This was a significant milestone in the history of leishmaniasis in Sri Lanka since this health policy decision made the recording of case information and data flow to the central epidemiology unit a mandatory requirement within the country's health sector. This has ensured more accurate information on case numbers and its spread within Sri Lanka, which in turn inform the authorities and help in resource allocation, particularly with regard to posting of specialist medical officers, training of medical and paramedical personnel, and distribution of drugs. As a result, there is an improvement in detection rates and effective treatment of patients that help in the containment of disease.
Second, our findings also pointed out the need for better training of laboratory technical staff to strengthen the diagnostic capacity within the health sector hospitals to manage leishmaniasis patients more efficiently and effectively. To assist with this task, we established the "Center for Training, Research and Diagnosis of Leishmaniasis" (http://www.med.cmb.ac.lk/index.php/2012-05-16-05-25-21/centre-for-leishmaniasis) that provides infrastructure support to conduct regular training programs for both state and private sector medical and paramedical personnel enabling capacity building in laboratory diagnosis of leishmaniasis. The molecular and serological diagnoses that are offered through our laboratory also help the clinicians in their patient management.
Third, the need for improvement in awareness regarding this disease among both the general public and the health staff was also pointed out through our studies. This led us to spearhead regular awareness programs for the public through mass media, as well as leaflets for targeted groups, for example, soldiers and through lecture/discussions conducted for medical and paramedical personnel. The latter programs were particularly organized through relevant professional bodies that ensured quality and wider coverage.
More recent studies that we conducted on a novel therapeutic tool in the form of a thermosurgery device that was tested through a randomized controlled clinical trial provided evidence for the utility of a safe and cost-effective treatment option for local cutaneous leishmaniasis. This is now considered as an attractive alternative for the traditional painful intralesional injections of antimony that are presently used as regular treatment mode in Sri Lanka.
TP: What is the current scenario of vector-borne diseases in your region with special reference to malaria and leishmaniasis?
Dr. Nadira Karunaweera: Vector-borne diseases, including malaria and leishmaniasis, remain endemic in most of the Asian countries where environmental factors remain conducive for development and spread of insect vectors including mosquitoes in the case of malaria and sandflies, the vector of leishmaniasis. Therefore, vector-borne diseases remain as a priority public health concern in this region. With the recent optimism related to the elimination of such diseases using available tools and technologies, most governments have taken on the challenge of adopting measures to rid their countries from the menace. The level of success of this exercise has been variable depending on the disease and the country concerned. The elimination targets appear more reachable for some infections such as malaria, at least in particular countries, while it remains far and unrealistic for some others; dengue being a good example. Sri Lanka has had success in achieving elimination targets for both malaria and lymphatic filariasis by the end of 2015. However, with a tremendous increase in travel in and out of the country since the cessation of the civil war and continued the presence of vectors, there is a looming threat for the re-establishment of these infections. Therefore, securing its borders against imported infections and prevention of re-introduction of disease remain as formidable challenges to the local health authorities. The situation with regard to leishmaniasis in the region, however, remains different. Although plans for elimination of kala-azar from the Indian subcontinent were put in place as far back as 2005, the outcome so far has not been very impressive with India, Nepal, and Bangladesh contributing largely to the world's visceral leishmaniasis burden. In Sri Lanka, leishmaniasis is a relatively newly established disease, and the country is yet to put in place a formal control program. However, considering the fact that the causative species of leishmaniasis in Sri Lanka is Leishmania donovani, which is very closely related to the disease agent found in the rest of South Asia, it would be prudent to adopt measures for effective containment sooner rather than later. In this backdrop, the focus of our research remains to gain better insights into different aspects of this disease that include the parasite, vector, host, and the environment to gather the necessary evidence to enable formulation of sustainable and reliable control measures according to the country's needs.
TP: An eminent expert member of various organizations, please share your views on research progress in developing countries with respect to neglected tropical diseases?
Dr. Nadira Karunaweera: Neglected tropical diseases (NTDs) are named as such due to their strong association with poverty, increased spread in impoverished environments and thriving best in tropical countries where they often co-exist. These diseases have been wiped out to a larger extent from the developed world due to the improved socioeconomic conditions and better sanitation. NTDs have traditionally gained minimal attention from the national and international health authorities and organizations, including the grant awarding bodies due to the poor visibility of the affected or at-risk individuals. Furthermore, NTDs offer little incentive to industry to invest in developing new or better products for a market that cannot pay. This has had drastic effects on the progress of research with respect to these diseases. The poor allocations for science and technology in developing countries through their own national budgets has not helped the situation either. The outcome has been the poor progress of research on NTDs and a limited number of tools that are at our disposal for their control and management. Fortunately, these problems are now much better documented and much more widely recognized. Even more importantly, they are also being addressed. It is encouraging to note the policy changes of governments, particularly in developed countries and international organizations that have taken place over the past few years. Governments and foundations have contributed substantial funds during the past few years for research to develop new tools for NTDs (such as medicines, diagnostics, vaccines, and medical devices) and improve the delivery of existing ones. The momentum continues to grow and has led to the appearance of strong research groups within developing nations with inter-country collaborations, which gives a lot of hope for the future.
TP: Leishmaniasis has been linked to environmental changes such as deforestation, building of dams, irrigation schemes, and urbanization. How far is it true in the Sri Lankan scenario?
Dr. Nadira Karunaweera: Sand flies have been in existence for centuries in Sri Lanka with the first published report in the early 1900s. It is an insect that is found throughout the country with variable abundance depending on many factors including climate and vegetation. However, the lack of evidence for local leishmaniasis transmission until the 1980s may have been due to the lack of an adequate pool of infectious agents. Even after the discovery of the first autochthonous case, the patients were sporadic in their detection until 2001. Therefore, in Sri Lanka, the key factor that may have led to the occurrence of the leishmaniasis outbreak is likely to be the civil war situation that prevailed in the country for nearly three decades since 1983. This led to the construction of army camps bordering jungle areas and soldiers moving into such areas with increased vulnerability to acquire the disease. The fact that the first outbreak of cutaneous leishmaniasis in Sri Lanka occurred in soldiers, who kept vigil within bunkers built bordering the jungles in Welioya in the North Central province, strongly supports this theory. Sand flies were rampant in such areas, and there was plenty of potential reservoir hosts like wild rodents in the vicinity. Although it was not possible to isolate parasites from either the vectors or possible reservoir animals in the vicinity of these camps due to the war situation that prevailed at that time, the evidence is compelling. Since then, the infected soldiers may have acted as human reservoirs spreading the infection both among fellow soldiers and the civilians. With the cessation of the civil war and increased travel within the country the infection is likely to have spread to all parts of the country as evident at present.
TP: Could you please elaborate on your patented work related to the thermostable clay device for maintenance of Leishmania cultures and neural network architecture for the automated recognition of malaria parasites in stained blood films?
Dr. Nadira Karunaweera: As any laboratory scientist who has worked on Leishmania cultures would know, the parasites are temperature-sensitive and require a temperature of around 25°C for their growth. In a tropical country like Sri Lanka, this requires either an air-conditioned room, with the temperature regulated and maintained throughout the day and night or a refrigerated incubator. Both these options are expensive and not environment-friendly. These limitations led us to seek more suitable alternatives.
Traditionally, Sri Lankans use clay pots for cooking and also for storage of drinking water. Tall clay containers that store drinking water are a common sight in most households in the country since it ensure the provision of "cool" refreshing water, even during warm hours of the day. This is due to the nature of clay that has pores through which water seeps through and evaporates from the surface absorbing thermal energy from water within, reducing the temperature of the stored water. We used this simple concept in the thermostable device, which is merely a clay box with a corrugated surface to increase the surface area for evaporation of water. Hence, when the clay box is filled with tap water, the temperature of water within the clay box drops below the room temperature and is maintained around 25°C. This provides a suitable temperature for the growth of parasite cultures when the culture tubes are immersed in the water. Hence, it is simply a modest clay device that uses traditional techniques known for centuries in Sri Lanka to maintain the optimum temperature for the Leishmania cultures in an environmental-friendly and cost-effective manner.
The neural network architecture is a concept we patented for its use for the automated detection of malaria parasites in a stained blood film. This has the advantage of being objective and the ability to read as many blood films as needed without the need to factor in the human fatigue component. It does, however, require a camera device connected to the microscope to capture the image that is analyzed through a computer for detection of parasites. This concept may become particularly attractive for countries that have eliminated malaria and is struggling to maintain the technical skills of microscopists with scanty numbers of malaria slides seen by them annually.
TP: It has been a major concern that in the recent decade or so Plasmodium vivax malaria is turning out to be severe like Plasmodium falciparum, what is your take on this issue?
Dr. Nadira Karunaweera: We have not experienced any cases of severe Plasmodium vivax malaria in Sri Lanka so far; therefore, I am unable to comment through personal experience. However, through our genetic studies on P. vivax we figured that these parasites are very highly diverse organisms, more so than Plasmodium falciparum. Therefore, mutations are likely to be rampant and frequent. The observations made elsewhere with regard to severe P. vivax cases should make us more alert with regard to this risk, particularly in the backdrop of our community becoming largely vulnerable and nonimmune against malaria with zero levels of local transmission.
TP: What you would like to suggest to young aspirants who would like to take up parasitology as a research interest?
Dr. Nadira Karunaweera: Most parasitic diseases remain as NTDs with many gaps in knowledge. Hence, obviously there are a lot of opportunities for research. Good, inquiring, and passionate young minds are needed to address the gaps in knowledge and take on the challenge to fight against the odds, particularly with regard to the lack of funding through local means and resist the urge to move on to more popular research agendas. It is noteworthy that the self-satisfaction accrued through the contributions rendered toward a needy and neglected disease in one's own community or region will make what you do more meaningful. Hence, my advice is not to think twice if you get an opportunity to study a parasitic disease but to grab it with both hands and work hard to realize your goals and make a contribution to this field.
TP: You have been working all over the world, what is your opinion on research approach in developing countries when compared to developed nations?
Dr. Nadira Karunaweera: I feel, the research agendas are mainly driven through the availability of finances, irrespective of where you are located in. Researchers are forced to cater to the priority areas as defined by the grant awarding bodies. While research is an essential and integral part of academic life in developed nations (due to the nature of their job appointments and salary structures) that is not so in most developing countries. This has led to fewer academics taking on in-depth and high-quality scientific research in developing countries, with less productivity and contributions of research toward national development. The situation is aggravated by the education systems that prevail in developing countries that do not encourage inquiring minds or scientific approaches in problem solving. These countries also lack proper infrastructure and logistical support for research even in academic or standard research institutions. Therefore, the resultant research approaches are adaptations to accommodate and overcome the zillion numbers of hurdles and frustrations that are encountered during the journey. However, I believe this situation makes researchers in this region strong and practical in their approaches.
TP: Different novel strategies are being publicized globally for malaria control, which of these do you consider would be practically feasible?
Dr. Nadira Karunaweera: There are many technological advances in the field of malaria that have come to light during the past few years. Those related to "omics" technologies are probably the most talked about as cutting-edge research. Of these, the "genomics" I believe still take center stage in its usage and popularity. Availability of genomes of both parasites and the vectors have revolutionized the applications used both in diagnostics and control of malaria. The technological advances have made many tasks that were too expensive and too time consuming in the past to become more affordable and quick; whole genome sequencing being a good example. The use of genomic barcoding for parasite tracking is another smart approach that uses novel tools to aid malaria control and elimination. Similarly, genetically modified vectors continue to stir up much enthusiasm among many. These are just a few examples of novel approaches that have been tested to aid malaria control. However, the fact remains that malaria is endemic in countries that have limited resources and infrastructure. Therefore, unless these tools are made to be cost-effective, easy to use, and applicable in field settings, they will be of little value for endemic countries, particularly for sustained control efforts.
Financial support and sponsorship
NK's research is financially supported by the National Institute Of Allergy And Infectious Diseases of the National Institutes of Health under Award Number R01AI099602. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Conflicts of interest
There are no conflicts of interest.