::: Star Weekend Magazine :::

Endeavour

Simple solutions to deadly diseases

Christine Wanner

Finally, his family took him to the "cholera hospital". Only skin and bones, too weak to walk, he was carried, by a simple carriage, pulled by his family members. Muslim is one of the 200 patients, which is the number of people who come daily, searching for free care and cure at the "cholera hospital", officially called ICDDR'B, international Centre for Diarrhoeal Disease Research, Bangladesh.

After the registration, he will have to swallow a white coloured solution, basically one spoon of each, sugar and salt, dissolved in water. This is ORS, Oral Rehydration Solution, discovered by the centre in the late sixties.

Thrilled by their discovery, scientists of the hospitals' research section spread their knowledge without caring for their right of intellectual property. While a lucrative opportunity had slipped away, this important discovery saved millions of lives and in the end contributed to the institution's international recognition and integration into the scientific community.

"Anything that comes from Bangladesh is considered suspect and is scrutinised, that is why it took the international community so long to accept our treatment", says Ishtiaque A. Zaman, head of external relations. "ORS appeared too simple to be a proper treatment for a deadly disease, in the developed countries. It took over 20 years for the recognition of ORS not just as 'the poor man's medicine'."

In the past few decades, the centre's activities have broadened; it is involved in clinic research and vaccine sciences, in reproductive health (HIV/AIDS) and family planning, in nutrition research and mother and childcare.

These programmes have to be covered by annual donations. In the last few years, this has reached around 18 million US dollars, donated from 55 countries and partner organisations, including the Government of Bangladesh (6%), universities and NGOs.

Most of the donations in the past were for special projects and thus bound to research projects. The donors wanted to be sure that their money was being utilised properly. The centre itself, of course, prefers 'core funding' to be used to the hospital's needs. That fund allowed, for example, free treatment of flood-related disease last summer.

By then, 900 patients were knocking at the hospital's door every day. "Our capacity is very flexible," smiles Hannah Lemon, senior associate of external relations, "we then expanded to the roof of the hospital. Improvised beds, additional staff were deployed for late shifts and for distributing treatment and food to the patients and their waiting relatives, as well as cleaning up the beds and floors."

With international recognition and with its treatments being recommended by the WHO and Unicef, research, knowledge transfer and the dissemination of treatments, developed by the Bangladesh based centre will be much easier. As Ishtiaque Zaman puts it, the hospital is "a gold mine" to what concerns the research potential, without naming costs, returns on investment or profits, as the centre understands itself as a non profit organisation.

For voluntarily taking part in the centre's studies, patients of the hospital get up to 1000 Taka, depending on the duration and the costs. To that amount of money, developed countries could not find willing patients.

Furthermore, ICDDR'B has been fostering a health-related, socio-demographic database for the past forty years. During that time, a population of 2,20,000 persons have been monitored in its second centre at Matlab, some 130 kilometers further south of Dhaka.

"We know everything about these people: when they were born, vaccinated, when they have got married, become pregnant, took contraceptives, moved their homes, and even when and where they died," resumes Dr. Mohammad Yunus, who heads the Matlab research centre and has been shaping it and its science since 1968.

The gathered knowledge extends to eating and working habits of the monitored population, which makes the ICDDR'B an attractive partner for the WHO and international NGOs, in dealing with health issues in developing countries. "Our solutions must be practical in daily rural life and affordable for poor people," says Dr. Yunus.

If the international donors expect profits from the centre's knowledge and research, the centre's head of external relations, Ishtiaque Zaman answers: "Of course, the pharmaceutical companies are all in the game. But when it comes to commercialisation, one has to come to an agreement."

This is planned to happen with the centre's latest discovery, a dissolvable zinc tablet for malnourished children. After ORS incident, the centre has become more cautious. "We have to be sure, that we keep the intellectual properties of our discoveries," says Zaman.

"Besides that, the treatment has to be affordable for the poorest of the poor. Therefore, it will not be a profit making business." Isthiaque Zaman is convinced.

The zinc tablet is a part of a programme in the sector of child health and nutrition research, called, Scaling Up Zinc Treatment for Young Children (SUZY). Zinc, it has been discovered, shortens the time of illness in case of diarrhoea by a forth. In addition, it prevents further relapses. Moreover, it seems to have a positive effect to the recovering process from pneumonia as well.

In developing countries, 18 to 20% of the infected children under five years do not survive diarrhoea or pneumonia. Thus, malnutrition especially zinc deficiency plays a vital role. Over 60% of children less than five years are malnourished in Bangladesh.

SUZY has been launched in 2004 and is supported by powerful US based Gates Foundation. "It is likely to become our new flagship, after ORS," says Isthiaque A. Zaman.