One of the readings I had to do for a unit I'm doing this semester was titled 'Saviour Siblings'. It's more or less a situation where a couple have another child just to save the life of the other. That is, (to put it into context), say a couple have only one child and that child needs an organ transplant of some sort or genetic disorder, they will then have another child(most often than not through assistive reproductive methods) so when the 2nd child is older, they harvest, if you like, the organs for the 2nd child to cater for the transplant of the first.

I know that as humans we should be attentive to the needs of others and help when we should, or if the situation allows us to be of help. But I believe this is a totally different matter, it's almost like turning people into commodities. This poses the ultimate question of morality and ethics. Is that morally/ethically acceptable? To bring up a human being for one sole purpose- an organ farm? And if so, how do you justify it?
It also poses the question of wether or not it is a wise use of medical technology and know-how.
The matter has even been voted in the British House of Lords as lawful.
The reading posed a lot of questions, some answerable some not so, hence I just thought I'd gather some thoughts on this.

BLESSINGS, PEACE, LOVE & Happy Independence Celebs to you all!!

Yes, this happens mostly for stem cells. Stem cells as you may be aware are precursor cells or the original cells, which later differentiate to specific cells for particular organs. In this context, what is most commonly used is the stem cells from the umbilical cord or bone marrow. These cells can then be 'programmed' to become liver cells if one wants a new liver etc.
It is, at the moment, not intended for total organ transplant from one individual to another.
I think I would have another child to help save the other child. (Just my thoughts).

How old shoud the second child be before that child has be killed to harvest organs?

Not necesarily to kill, but what I mean is that, the prime purpose for having the child was to use him/her to help their brother or sister because they both have the same genetic make-up. Death of the saviour sibling is not the result of it.
My question is, if the prime purpose of having the 2nd child was to save the life of the first, what happens afterwards? After the life of the first child has been saved/lost? Have they planned that far?

Previous post by me!

What happens to the second child?
1. I do not think the parents will provide less for the second child once the first child recovers. The 2nd child may be more appreciated by the parents and the first child and the whole family because of this.
2. The question comes about how the 2nd child feels. The second child may appreciate the cause and effect of helping to save a sibling. However, during times of rebellion, the second child may raise the idea of "being used" and not "being wanted" as the reason for its birth.
3. Either way, I think the parents would not do this without careful thought and planning - thus, in the true sense, this is infact a planned pregnancy.

NB: I would not attemp this in resource poor countries where the birth rates are high and the cost of living exhorbitant.

Now what do you think?

So the second child is born and one his/her organs is donated to the first sibling, is that the way they are proposing it?

This is like some science fiction coming true!

OK, there are only a few organs that can be donated as a whole from a person (not stem cells) and they are:

kidney (you can survive with one),
lung (only in specialised hospitals),
whole liver (dead person) or part (still experimental and not well established),
cornea from eyes (either you will have one eye only or from dead person)
heart (dead person)

Bone marrow transplant-special case because you are can harvest undifferentiated pluripotent cells from anybody. Can be done in PNG if given the proper facilities. Very simple procedure to harvest but patient needs to be in a specialised room to prevent infection.

Stem cells - the medical technology available today is not enough to grow an entire organ in the Lab. In theory possible, but not practically. Cells can be grown in a perti-dish to several layers thick but not to a full organ.

Back to the savior child. It takes 9 months from concerption to birth. Will the child needing organ transplant survive that long? Then add the months or few years the savior child has to grow to be strong and healthy before the savior-child undergoes surgery for organ haversting! Will the first child needing organ survive that long?

Organs are harvested from heathy normal adults, not babies! and if children, there is no `standard` age from which an organ can be harvested for donation! Furthermore, to give an organ for transplant you have to give consent and sign a form for legal purposes. Does the parents have the right to give consent for the savior-child to donate organ to his/her sibling? If the answer is obiously no than the savior child has be old enough to give consent and that he/she must be above the legal age deemed old enough to make his/her decision. The first child is most probably dead already and there will be no need for organ donation.

I am just scratching the surface here and only on the practical and technological aspects, not to mention the ethics and the morality of it all.

Anyway, an excellent discussion topic though.

This is an eye opener.

From Dr.Who's assessment.I understand that if the 2nd child is to give an organ to the 1st child (Kidney or eye) than the 2nd child has to be old enough to survive. Then there are 2 dilemmas

1. What if its the organ is not a kidney, whole liver, lung or heart then this require a dead donor.

2. If the parents wait for the 2nd child to be strong enough(adult), the 1st child may die.

For the 1st part...to kill for organ is unthinkable
For the 2nd part...1st child may not die, the 2nd child may live to donate either a kidney and eye and hence live but if its a heart, lung or liver. Then the 2nd child dies.

Then there is one other important aspect, Human bonding, the 2nd child has to be a rock or a devil not to be loved by the parents just to be harvest. For instance, if he/she is to be harvested at age 16yrs, seems like he/she must be kept in a cage, fattened and nourshied ready for havest. I'm not a doctor but entics, morals, human rights, conscience and love makes this a terrible path to take in saving a person. I'm pretty much sure that there are other notable advances in the field of medicine than making babies just to kill, and disadvantage a young life to save another.

Very interesting information for layman in the medical field like me.

This is inhuman or absured. Never, heard anything like that, probably it happens only in movies. I think the love of parents to every child is equal.

Liver transplant or part of it from a living donor is now possible.

Stem cells are basically 2 kinds:
1. Embryonal
2. Adult derived

Embryonal is before a baby is fully formed and adult onset is stem cells from adult. Yes, we have stem cells to regenerate worn out cells. Embryonal stem cell research is slowed because of ethical issues.

Adult derived bone marrow stem cells, messenchymal and hemopoetic type are hot topics of current stem cell research.In the lab they can be made to change into any kind of cell, nerves, bone, skin cells etc. but not a complete organ yet.

Organs cannot be made in the lab yet.

WNM

WMN, in japs, i'm sure you are fully aware, they have a large ageing population. So one of the challenges to keeping them metally fit and health is sony, nintendo and other game makers band up together to make computer games for the old people. So now when i'm breezing round tokyo, you see the lapuns with game boy etc...playing donkey kong or TMNT on games.

Anyway, since you mentioned rejuvenation of body cells using stem cell technology. Is it possible to stay young using stem cell tech?

liklik askim tasol..btw, i don't want to live forever though
cheers

Apart from the problems mentioned in terms of which organs could be harvested wihout killing the other child and the waiting times involved there is also the bigger problem of rejection.

No 2 siblings are exactly genetically alike except for identical twins. In terms of the major components of the immune sytem that reject or accept foreign tissues (HLA/MHC system) there is in siblings a 1 in 4 chance that there may be matching of the HLA system so that there is only a 25% chance that a sibling will not respond with a major rejection reaction. Minor histocompatibility antigens can also be a problem.

One way to overcome this problem is to either clone (technical very difficult) or to have embryos dividing early (mimicking identical twins) in test tubes.

(For medicos out there the reciprocal of rejection is of course graft versus host disease)

Ta

I think President George Bush signed a ligislation this year to fasilitate stem cell reserach in the USA. Saw it on Yahoo news. So we expect to see some interesting research in the not to distant future.

A sheep was succesfully cloned. We all know of Dolly the ship. BTW, she is dead!

I think stem cell research will now advance at a faster rate in the USA now that a legislation to enable this has been signed by their president.

For us in PNG, I think we have lot research minded people and there is now a critical mass of PhD level scientists who want to further not only medical research but other research in the country. What we lack is political will and support.

If the government makes the necessary legislations for specific kind of research, provide the policy framework then fund these researches, I honestly believe PNG can advance at a faster rate than what we are doing currently.

Very true,

PNG has potential for high quality research into any field and problems unique to PNG. For us young PNGeans, it is an area we should seriously thinkg about.

'Tissue engineering' is a fast evolving field of research. This involves trying to form an artificial scaffold or frame work over which stem cells can grow to form organs in the lab. In Japan the leading or number one centre for tissue engineering is Kyoto University. The Japanese government is spending alot of money in research, since their economy is dependent on their advancement in technology.

If PNG could invest early in technology, then we could 'double' the gain in the near future.

As for aging, some people say it is natural, since an aging population creates more economic problems, as in the case of Japan. However, on the other hand people have a natural desire to look young & to live longer.

Scientists have related aging to the gene for telomerase enzyme. A kind of internally, built biological clock which tells the body when it should start aging (when all system should slowly start to disintergrate).

Aging is a complex, you could say physiological process. In our life time our adult body has stem cells capable of renewing its entire self:

1. basal cell to regenerate skin and linning of guts & mucosa
2. bone marrow
a/ hemopoetic cells to regenerate all blood cells as well as any other cells
b/ messenchymal cells to regenerate any other cells
c/ hair follicle cells to regenerate hair, skin and any other cells

Research has shown that bone marrow stem cells migrate to wound sites through the blood stream, to assist healing. An interesting point is that even after a person dies, if the above stem cells are isolated and grown under the right condition in the lab they can go on forever living or other wise cryo (liquid nitrogen) freezing at -180 degree celcius can sustain their living for many many years.

Why can't these stem cells in our body regenerate all our worn out cells so that we can remain forever young?

Currently, there is no technology to reverse the process of aging. Cosmetic or aesthetic surgery procedures are design to attenuate the end result of aging. That is mainly the weakening of dermal collagen that holds our skin tightly together, so that wrinkle formation is prevented. Simply, saying it is like making a 'mask' out of the patient's or client's face. However, the client seems to accept this 'masked-up' face because in modern societies looks seems more important than a person's character or the real internal aging.

In labs, research has shown that prevention of telomere shortening has elongated life spans in simple creatures but not large creatures and humans yet.

Stimulating the stem cells that we already have in our body in the exact location where they are rather than removing them & growing them in the lab is an exciting & new field of research. However, it is hard to asses and quantify the end results or outcome precisly, without bias, that's why people grow them in the lab.

Cell labelling or tagging techniques are current methods to monitor the fate of a stem cell after it has been injected into an animal (no human experiment yet).

Hope, I've cleared some aspects.

Remember, easier to say but hard to prove. My supervisor always ask me, 'what method can you use to prove your hypothesis' and is that method reliable & widely accepted? if not we're only talking".

Thanks!

WNM

Fascinating stuff. However I fail to see how this sort of cutting edge science and technology can help solve Health problems in PNG in the short term in terms of PNG scientists within PNG. Again the problem of cost-benefit ratios come in.

WOuldn't it make more sense to allow what is basic science type research done in Western Institutions where financial, scientific and logistic support is available instead of wasting valuable resources in PNG where we can only duplicate what is best done elsewhere.

I have no problems with basic scientific research done as applied to immediate clinical problems we have in PNG e.g. work on malaria vaccines etc.

If PNG scientists are involved in these sort of research overseas I would greatly support them in these institutions where they can work with the world's best yet be able to have some insight into how spin-offs from these cutting edge research could be applied to third world health problems.

The problem of getting adequate funding and political will always be a major hurdle. Two years ago a small group of us were looking at how to insert a paragraph into the PM's speech for the Symposium opening (2005 Medical symposium) binding the government to a fixed proportion of GDP being channelled into Health research. It was of course largely edited by the PM's staff but it did come out in his speech but we have yet to see it come out in his real life though IMR is getting reasonable funding both internally and as fixed grants from AusAid.

Ta

Obviously,

we cannot catch up with the developed countries on the kinds of research they are doing. However, we have some medical problems unique to us so we could take advantage. Research, benefiting us economically could take a long time, but lets look ahead.

Research into malaria vaccination is a cutting edge research, and a very expensive one, I suppose and much more difficult then stem cell research. I don't know how far PNGIMR has gone into it. The Japanese, although they have resources they don't have the clinical cases to investigate and that is why many have come to PNG for such research.

We don't need to go straight into cutting edge research. Areas such herbal medication is a potential area where we could benefit economically. Also clinical research into newer combinations of existing drugs and treatment strategy that could save us money and time in the long run. Also, further research into the medical effects and benefits of betelnut, which Prof. Kevau & Dr. Itaki has commenced could be another area.

For example, Fiji has been marketing & promoting 'Kava' in Europe. It went very well until, there were false claims (no real scientific evidence) that it damages the liver. Probably, these claims were by competitors & or pharmaceutical companies. Only, if Fiji scientists/Drs could have done some real scientific research to say that 'Kava' is really beneficial and publish their data in some well recognised journals then it could have been an economic boost for them. BUT THEY FAILED TO DO THAT, so you see how important research is.

On the other hand, Japanese company, Chugai pharmaceuticals have produced a simple drug called 'OK-432'. Infact, not a drug at all, it is simply normal bacteria that lives on our skin & pharynx. They isolate & multiply it, then kill them using heat & penicillin. They claim it enhances immunotherapy of terminal cancer patients. With several research they have convinced the world, that it really works. It has slowly, penetrated America and Europe and is currently on clinical trial. These are a few examples, I'm just thinking, if PNG could produce beer then it could easily make such things as 'OK-432'.

Broadly, speaking research is the area that gives 'life' to science, otherwise we are practicing 'dead' science. Research in the long run brings self reliance & economic benefits.

Thanks!

WNM

To add to those other statements:

1. If our own government sponsor local PNG Drs & scientists to research overseas then we could have a say or
have control on the research topics. In the University I'm studying in (Japan), the Egyptian government has
done such a thing.

2. Currently, we are sponsored by foreign government so they are in full control of research topics.

3. Well, personally, I always think, "how could I apply this knowledge in PNG".

4. It has always been exciting & fascinating for me to know what is going on in the frontline of medical research.
(Don't know other areas but the areas directly related to my current research).

5. Finally, findings of cutting edge research into wound healing mechanisms and even use of autologus stem cells
to enhance wound healing is cheap & could be applied even in PNG to manage difficult wounds, such as
diabetic foot etc.

Thanks!

WNM

I agree with your comments. But at the end of the day it boils down to what funding and resources we have available to engage in such research. One assumes that all research would be profitable but the greater majority of research can be esoteric and wasteful.

The malaria vaccine is a good example. Over 20 years of basic science research went into identification of antigens that would evoke good immune responses. Fortunately the brunt of cost and actually doing the research was borne by the Walter and Eliza Hall Research Institute in Melbourne. Once suitable antigens were identified the field trials were performed in ESP. The results were not good enough to use the vaccine.

If that research was done in PNG fully funded by the PNG government we would have wasted a lot of money and resources that would have been useful elsewhere. However such collaboration where the basic science research is done elsewhere and the clinical trials performed in PNG is a good model. Currently IMR is carrying out field trials of pneumococcal vaccine in the EHP to see if the burden of childhood disease could be reduced. The basic science part of the work has been done elsewhere with those aspects pertinent to PNG carried out in Perth where several PNG scientists have gone to spend time there. The clinical trials are now being conducted in PNG.

Developing useful drugs from plants is another good example. Out of several hundred thousand or even millions of plants tested only one or two will turn out to be useful. It would be gross wastage of funds to carry out basic science research into these plants in PNG. Even phase 1 to phase 3 drug trials would not be economically feasible and possibilities of a phase 4 randomised controlled trial would be carefully considered. The process from the bench to field trial costs billions of dollars. The current situation where collaboration with overseas institutions with some lab work shared between PNG and the partners overseas is the ideal situation and is already occurring now.

The other problem with research in PNG is that it must be done properly. It is unethical to use patients to carry out research with poor study designs or inadequate sample sizes (read editorial by D. Altman BMJ 1994 29th January). It must be good enough to be published in peer reviewed journals (presenting in scientific meetings is still not good enough as we all know).

I agree that your work on wound healing in Japan is useful for clinical situations in PNG. Perhaps the bench work is best done over there and field trials could be applied here.

Ta

Apologies for a minor mistake in my posting above. Randomised controlled trials of a drug are phase 3 trials. (Phase 4 is usually post marketing surveillance I think).

Ofcourse,

it is easy to say but hard and very expensive to do (research in PNG). Although, if one is creative enough some researches could be affaordable & beneficial in the short term.

That was exactly, what I meant, learning from the researches done here & applying the findings in PNG (benefiting from the spin offs). I wonder if all clinical trials in PNG conform to some kinds of ethical guidlines and I wonder what kinds of guidlines they are and who makes them.

How far has the clinical trials for malaria & pneumococcal vaccines gone? It could be interesting to know, since last year, there were no related presentations at the PNG Medical Symposium. Anyway, I do not know much & have no experience about research into such topics as above so I wouldn't say much. But I'm glad our IMR has received alot of funding this year & I hope for a bright future. Another, role I believe the IMR has to play is to encourage & make use of our local, younge research minded Drs & scientists. I personally, wish to work with them someday.

Finally, I am looking forward to some real interesting & scientific presentations of already published data, in this year's PNG medical symposium.

By the way last year at the symposium, the only presentation I thought was inspiring, was a presentation about the antiTB effect of a bark extract that was traditionally used in Manus Province. It was a laboratory investigation done by a pharmacology post graduate student at UPNG. It was found to signifficantly inhibit the in vitro growth of TB. I was amazed that such laboratory research could be done in PNG.

Thanks!

WNM

Research into vaccine designs are huge projects which consumes time, money, manpower & lifetimes. Designing of short term researches could be cheap & immediately beneficial. But that depends on the Drs' or the scientists' experience & creativity.

Research into herbal medication would make sense if only those plants that has been used traditionally & has been found to work are identified & first screened in the lab, such as the bark from Manus rather than randomly screening many plants.

WNM

I think we can do a lot of quality research in PNG. PNGIMR is already a world recognised institution.

One of the factors limiting the scientific and medical research output from PNG, and I want to make particular reference to UPNG, is that we are working in isolation.

What I think we need to do is to combine all the research fascilities, e.g for biochemistry, physiology, pharmacology, microbiology and others to come under one umbrella, say - "The UPNG Central Science Laboratorys" (or something similar) and pool all the resources together including the scientific minds and conduct targeted researches with clearly defined objectives. Some may argure that this will take away the academic freedom of research. And I agree with that argument. But I am sure if some flexibility is given to those participating academics and scientits to conduct their own research but at the same contribute their time and expertise to achive the overal objects of the "central laboratory", this may work well.

The central laboratory can also bid for research contracts from companies or other organisations. This will enable improvement in the infrastructure and provide income to cover expenses.

The central laboratory can also perform other testing for government departments like Police (forensic, DNA testing) Environment and Conservation and others on a contractual agreement. Another way of getting funding.

The other added benefit will be that combing the resources will enable us to train our own graduate students to attain PhD degrees.

All these will tremendoudly increase the work output and some of the work can be published in quality journals. Again, another way to showcase the quality of work that can be done to attract more funding.

This is the way to go Dr. Who. It would be better if the central labs are at UPNG, & as you suggested, it would be easier to get funding once we are organised. Probably, the PNGIMR could be doing clinical research & trials, while this central lab at UPNG could be more involved in researches into basic medical sciences under the headings you have stated.

I hope old & young PNG Drs could come together, put our minds together, pysch each other up & change PNG in terms of medical research. Enough of working in isolation, discouraging & underestimating each other and depending too much on foreigners.

Lets be independent or atleast try to be independent by first organising ourselves. I'm with you all the way Dr. Who.

WNM

I agree with all those comments. But the limiting factor is funding. We have to fight every inch for a few hundred kina here. DO you seriously think the government is suddenly going to wake up and allocate millions of kina into building laboratories.

There are examples of collaborative work going on here that could be expanded but that depends on the collaborative partners. In fact the lady who presented the work on plant extract with anti TB activitiy at the last symposium was working from A/Prof Matainaho's lab where currently several honours, masters and 1 Phd student is working.

I do not mean to discourage you but you have to live with reality. For a long time yet the PNG government will have priorities elsewhere and will not fund that sort of work. In the recent MTDS higher institutions were not recognised as a priority so that the univerisities are left high and dry.

Our best bet is alternative sources of funding and you fellows are well placed to develop links that could result in bringing collaborative work into PNG. And like all things it may mean starting small but growing if there is like minded thinking among PNG researchers.

I do agree with the funding factor and I realise that. Thats everywhere in the world, not only in PNG.

My suggestion was COMBINGING our existing resources. I did not imply that we ASK government for more funding. Because I know they will give me zero kina!

I am fully aware of the UPNG-UCLA work currently going on. That resulted thanks to the effort of one person.

People have been using the funding excuse for just about anything and I think we are begining to use it also to make up for our lack of vision, determination and innovation in working under tight budgets to produce quality research.

We are only limited by what we think we are capable of.

If we think we can not make it (and wait for funding), then we have already failed.

I know exactly the government funding situation. I am not saying its easy to get funding, I know that was & will be a hurdle. Thanks for informing me about Prof Matainaho's lab. I wish to find out more & collaborate with him, if possible. Starting from scrape is always hard. Anyway, so far no-one in PNG seems to reply my previous letters for collaborative work. I'm wondering what this means.

Yes, it's a challenge & a dream for me to be a link to try to engage some funding. However, haven't done much yet. Funding is usually given to a well organised or well recognised group so I'm considering this point too.

Anyway, I still believe (& have been thinking about it) that there are some beneficial clinical researches that can be done cheaply at mainly PMGH with the currently, available resources, WITHOUT ANY FUNDING AT ALL (That was suppose to be the point of my initial discussions). I don't want to make some research proposals now but only if those people higher up in the hierarchy allows (paper works, politics etc.) then I wish to commence, otherwise, I will still be talking.

Thanks! for elaborating this discussion.

WNM

Research into medicinal plant is already happening at UPNG, under Dr. Maitanaho, funded by the Americans. I didn't know that. Read the full report in the national here:

http://www.thenational.com.pg/0312/w1.htm

That was exactly what I meant, such research would be beneficial to our economy, in the long run. The lab itself can support other side researches too.

Does Dr. Maitanaho's lab has a home page or an email address?

Curious!

WNM

I think I shall close the discussion on basic sceince research as we really agree fundamentally on the fact that there needs to be innovative thinking in getting funding and collaborative (physically or otherwise) work as well as continuing to talk critically among fellow scientists and other professionals (as I am not a scientist I have not been in any way involved with basic science research and I do not think I am qualified to make any further comments).

However in terms of clinical research (alas I am a clinician) I think as you say above there is a lot of area for doing simple clinical research backed by good laboratory facilities. There is a little bit done at the moment but it needs to be expanded. As I mentioned much earlier in the piece a lot of clinical research was wasted effort as study designs were not suitable or sample sizes were too small or there was not the push to get the work published in peer reviewed journals. This resulted in a lot of good work not reaching the desired endpoints.

On the other hand some work has had the desired endpoint; that is in affecting policy decisions and in determining standard treatment regimes and clinical practice. That is slowly improving but we do need good supervisors and a statistian on staff to really help us do those things properly and the requirement for MMED projects will inevitably push future clinicians into thinking about those issues.

Ta

I wish to add abit to your final comments. I think the main factor in clinical research being not completed or done properly is because:

1. Clinicians (like yourself) are fully occupied with clinical duties or patient management & there is no time or
energy & motivation left to engage in research.

2. No access to the internet (web journals & other related information)

Here in Japan (what I have observed in our department), is that, it is a must for young trainny Drs to engage first in clinical research or to write at least a paper in any clinical topics, regarding management, digging into past charts etc. It doesn't have to be a huge prospective study. Our professor is checking regularly how far we are going.

To tell the truth in research (both clinical & basic), atleast in my experience there is no supervision, although there is someone to check once in a while. The only supervisor I had & I am having now is the internet. Regularly checking related topics & adjusting your research, as you go alone. Even statistic programs & tutorials can be downloaded from the internet, that's what all fellow researchers in our department are doing. Even our Professor or other fellow researchers don't know what each one is doing until each one gives a report once a month. I haven't seen anyone in our department consult a statistician yet, although, there is a statistics department here for consultation. I believe if you spend enough time reading related topics & papers, then you can design a good research plan/proposal & eventually complete your research.

If we hook up internet & register with various journals & also encourage our younge research minded Drs to take at least a year or 2 off to engage only/fully in research then clinical research is feasible. If possible a clinical research department at PMGH can be opened to co-ordinate all of such activities.
Infact, I've been thinking about this idea but with our 'politics' at PMGH, I know definitely, this idea will not bear fruit.

So finally, clinical research should be an ongoing or dynamic process, it shouldn't stop.

Thanks for letting me adding this bit.

WNM

Absolutely. The inadequate access to internet means one needs to have some supervision on hand. It doesnt mean we need supervision at all times but the crucial discussions at the begininng when deciding study designs, agreeing on what sample size to give an adequate answer etc with checking of final analysis at the end with occasional discussions in between helps to keep the project on track. It may ensure that the work is publishable.

Being in a good overseas unit where cross-fertilization between people working on research projects that span a wide range from clinical to basic sciences to social sciences I know is a very stimulating experience and that atmosphere brings to you a richness and depth of experience that you cannot bring about when you are working in a secluded unit so I encourage you to make the most of it.

The clinicians in PMGH who are most likely to do research are UPNG academics who also apart from clinical duties arevheavily involved in the MBBS course which is labour intenstive so their research input is likely to be nil on their own but can be involved in supervision of registrars.

The Medical library has started to give some sessions on how to do internet searches and how to use HINARI which is a WHO sponsored website that offers free access to over 3000 journals on line to registrars (it is now a regular part of the MBBS curriculum).

So slowly I guess things are moving in the right direction.

Keep up the good work.
Ta

Sorry but forgot to add on to your comments at the end about a clinical research unit at PMGH. THis has been flagged for some years now but for many reasons including some that you mention has not got anywhere.

In terms of statistics the basic analysis can be done but we run into problems when we want to do a little more complex stuff like multivariate analysis and have had to consult with statisticians from IMR etc but you cant find them when they are out of country or on field trips. This is necessary because most clinical endpoints are the result of many factors (variables) and doing bivariate analysis does not account for other "confounding factors" which need a little more complex analysis such as logistic regression modelling which one cannot adequately learn to do from books etc.

Finding people who would be interested in doing research is also problematic. COmmittment was given by 2 successive secretaries for Health for two fully funded positons for clinical research fellwoships and we have 2 similar positions offered by professional bodies in Australia (with research funding as well)but over more than 3 years no one has who showed interest. Partly this may be due to pressure to get people out onto service positions in the provinces. (this is only applicable to our specialty). On the other hand links with IMR continue and young doctors with research interest have been identified and facilitated entry into IMR research programs for MSc with some of their clinico-epidemiology projects.

So I think slowly as the mindset changes we are going to see more and more of this.

Ta

This has been a very stimulating discussion. Thankyou WNM and 'anon'. Btw, anon can u get an alias on vortex? At least i know who I'm talking to instead of mentioning 'anon'. No offense.

The current situation at UPNG is becoming more clearer. Thanks for the updates. I am just curious, apart from Dr. Maitanaho's lab what are the other researches that are going on, or probably, non-existent at all. It has become clearer that we have almost all the recourses so research is possible if we put a little bit more time & energy in organising ourselves. With the internet we can consult our statician & each other from wherever, we are.

Personally, I'm not going to be in Japan forever. However, if situation & seniors don't allow or permit then the same trend will continue whereby Drs look for greener pastures else where. There is no point in struggling when there is opportunities to enjoy life better elsewhere.

Finally, I would like to ask 'unknown' a question. Do you think I stand a chance to get into UPNG to persue my interest in clinical research under this new department which will be fully deicated to clinical research?

WNM

Thanks and sorry,I did not say it was UPNG and it is not laboratory oriented research but particulary within auspices of clinical specialties where clinical questions of a practical nature are subjected to clinical research with much of the laboratory analysis being done by collaborative institutions overseas. Unfortunately it is not groundbreaking staff but little clinical problems that need direct answers which can then be woven into policy and treatment guidelines.

In terms of basic laboratory research I cannot answer. Apart from the Pharmacology lab there are 2 groups in Biochemistry; one in molecular biology (Dr Masta and previously Dr Hombuhanje) and the other one by Dr V Temple who has worked on Iodine and brought in a CDC collaborative group from Atlanta who have just completed a comprehensive nutritional survey in selected cluster samples of communities in PNG.

I think there is a lot of merit in what Dr Who suggested about such work seeing some merging of resources and manpower. Funding from government is hard but I suppose as a group there would be much more negotiating power.

Currently with UPNG I dont really know, you would probably find yourself swamped under with teaching committments and clinical duties and I could not speak for those basic science groups as to what you can or cannot do.

As to purely clinical research I would think there would be lots of opportunities provided you have a support structure around you. Currently you would have to be in obstetrics or paediatrics to make use of opportunites in collaboration with Australian instituttions whilst in internal medicine lots of opportunities in HIV medicine. However those are really in Public Health and clinical fields.

As to whether you want to come back to PNG or not is clearly an individual choice. You will have something to contribute whether you are here or not or if you come back earlier or later. I suspect you will know in good time when you want to come back.

I also think that if you do come back at some stage and decide you have done enough laboratory stuff and want to be a clinician full time I do not think the laboratory time would have been wasted. It would give a depth to your teaching and work that would be so much richer even if you arent engaged in basic science stuff.

I spent a lot of time overseas too but I decided to come home and I am enjoying myself here now and do want to go away again ever. A lot of training I received in state of the art instutions I do not use here anymore but what I do do here are small things that are of some use in the long run. And that is what clinical medicine and clinical researhc is all about; the small jig jaw puzle that adds to the big picture. One can choose to be depressed and run away or one can say; life is boring if there are no problems to solve (and to hell with who really is at fault).

ta

Thanks for the detailed updates & the very mature advice.

Anyway, to clarify a few aspects regarding what I'm actually doing, let me first start this way. The department I'm in is a clinical department. Almost 80 % is clinical work. There are other departments who do pure lab research, however, our department is involved more in clinical research.I think simple clinical research that can be applied immediately is more interesting & economical.

With that I'd like to come to PNG sometime in the future & contribute my part. It was worth discussing because I got some idea about the current situation regarding medical research.

I think the real challenge is not where we have gone to study but to do some real work back at home when we return. I would like to encourage all our young Drs & scientists to come home & contribute your part. If you don't bring about any change then the country will never change.

Thanks!

WNM