Most medical researchers maintain, through circumstance if not design, substantial clinical distance from the people whose lives their work will touch. There is no such luxury for scientists doing field work on malaria in Papua New Guinea, which is precisely how Dr Leanne Robinson likes it.
In the early phase of her research she lived for months at a stretch in remote parts of East Sepik Province, where malaria has long loomed as a deadly threat, especially to babies and small children. Her interest was in studying the natural immune responses in children living in malarial zones.
Which responses protect against malaria infection and sickness, and which ones drive inflammation? This information holds powerful clues for developing effective vaccines. It’s involved collecting blood samples from hundreds of school children over several years.
These days Robinson spends most of her time in the coastal centre of Madang, at the PNG Institute of Medical Research (PNGIMR), where she heads the Vector Borne Diseases Unit on secondment from the Walter and Eliza Hall Institute. While she’s now more likely to be found in the laboratory or office than in the field, she and her husband and their two toddler sons remain deeply immersed in the raw reality of life in PNG.
Robinson’s six years in the country have coincided with significant improvements in malaria control, thanks to a national program funded by The Global Fund. “It’s been really successful in reducing the prevalence in many areas of the country,” she says. “In some parts it has gone from a prevalance of 20 per cent down to two per cent”, hopefully putting PNG on track to the pre-elimination phase already achieved in the Solomon Islands and Vanuatu.
A good news story it may be, “but we are still seeing a high burden in some areas, and there is also a fear that unless there is continued momentum to keep the program going we will see a rebound”.
As the disease profile changes it also throws up new challenges, and these are what Robinson and her colleagues are now working to unpack and anticipate.
For instance, in the past, the key focus of many health programs were children aged under five, the hardest hit by sickness and the most likely to die. Now the hypothesis is that with less malaria being transmitted, babies and small children are having less exposure and acquiring less immunity. “So do we need to consider that in the next 10 years the vulnerable age group might shift upwards and what impact this will have in terms of transmission and control?”
“We’re also interested in any changes in the behaviour of the mosquito vectors – biting earlier in the night, biting outdoors rather than indoors – that might end up making control measures less effective than they are now, so that we can inform the next round of interventions.” In addition she is involved with teams doing clinical studies trialling new combinations of anti-malarial drugs.
In common with many medical researchers, Robinson credits a passionate, brilliant high-school biology teacher for putting her on her career course. “I was more on a pathway to becoming a medical doctor,” she says, but the teacher opened her eyes to other ways to practice medicine and ask and investigate critical questions.
The next defining influence came mid-way through her studies. Travelling and volunteering in Ghana galvanised an interest in global health issues. In PNG Robinson has found herself becoming more focused on wider epidemiological questions around patterns of disease in populations.
Robinson is still in the early phase of her career. Having initially signed on for two years in PNG, she now anticipates she likely has at least that much time still ahead, before work and family compel the next move.
“It’s a big body of work I’ve been involved in here. You invest so much of yourself in all sides of the operation – not just the analysis and the scientific questions and the writing up of the work, but in working closely to train individuals, developing the teams, and building organisational capacity. “I’m already proud of what has been achieved during my time here, but it is still going to be difficult to walk away.”