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Trial WitnessClemente Botelho

Trial Witness

The first time that I saw malaria up close was more than 20 years ago on Thailand’s northern border with Burma. I was living tem-porarily in the area called Tak with thousands of refugees, migrant workers and students who left Burma because of political and economic instability. Malaria was endemic in the area.

At that time, a lot of antimalarial drugs were failing. Malaria was basically a death sentence for pregnant women. They are more susceptible to malaria infection, tend to have severe complications and do not respond as well to drugs.

It was a helpless and hopeless situation.

I witnessed the power of research to reverse a situation that seemed so hopeless only 10 years before.

When I returned 10 years later as a medical student with the Oxford-Mahidol Research Group, things were very different. The group was leading a large clinical trial testing artemisinin combination therapy (ACT) in pregnant women in the Mae La refugee camp, which housed about 30,000 people. ACT gave pregnant women a much greater chance of survival.

However, not all pregnancies had good outcomes.

I remember a woman who was seven months pregnant. We treated her for a urinary tract infection. She tested negative for malaria, but a few days later she became very ill. Her blood pressure dropped suddenly. We urgently treated her with intravenous quinine and other therapy and then drove her to the hospital. She died of malaria. It was a tragic reminder of how quickly malaria can kill, particularly those with insufficient immunity such as pregnant women.

Fortunately, ACT helped most patients get better. It was wonderful to see researchers and others working in a concerted effort to screen women and treat them with ACT. That’s when I became excited about doing field clinical research. I witnessed the power of research in making effective changes and in reversing a situation that seemed so hopeless only 10 years before. I was inspired by these researchers.

Since then, I have focused my research on how drugs work in pregnant women. There is not a lot of data about antimalarial drugs and pregnant women. We’re starting a study in Mali now to examine how HIV and antimalarial drugs work together in pregnant women who are co-infected. It is complex because we are treating two patients—mother and fetus—simultaneously, each with a unique set of dynamic physiology and metabolism that is quite different from the general population.

We have a lot to learn.

Myaing Nyunt, MD, PhD, MPH, is an assistant professor in International Health and a faculty member in the Johns Hopkins Malaria Research Institute.

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