The 2019 malaria season is the second year of our clinical trial — enrollment is slow because malaria control efforts in Malawi are working: more children are being diagnosed and treated earlier in their illness, so we are seeing many fewer patients at “Queens.” We’re all thrilled, of course, but it does add to the challenge of carrying out the clinical trial
During the malaria season of 2011, we carried out a pilot study of a new-ish imaging technique, transcranial Doppler ultrasound (TCD). It is similar to any other kind of ultrasound — a probe is placed on the skin and records information. In this case, it is information about blood flow velocity, and if the probe is placed properly, we learn about blood flow into and out of the brain.
Back in 2011, the equipment was large, clunky and finicky — but it was clear that the approach was useful. We could see distinctly different wave patterns in different patients.
The technology has improved greatly, now. The equipment can be carried in a backpack, acquiring the wave forms is easily taught to ancillary health personnel, and the “post-processing” of the wave forms has become much more sophisticated. We thought that combining all we are learning about the patients in the clinical trial with the additional information provided by the TCD machine would be very helpful in understanding why the brains become swollen in some children with cerebral malaria.
There were two stumbling blocks: acquiring a machine, and involving a TCD expert. I was telling Bob Garvey of the Warm Hearts Foundation (the co-host of this summer’s Malawi Update at the Garvey Barn) about the machine during the summer of 2017. He realized how much we might learn from adding it in to our routine assessent of patients — and he offered to buy a TCD machine, through the foundation. ZIKOMO!!
At the SAME TIME, summer of 2017, one of our new colleagues on the clinical trial, the aptly named Dr. Allan Doctor, of Washington University in St. Louis (his med school nametag read “A. Doctor”) was professor for a day at Ohio State University. When he mentioned that he was working on a cerebral malaria project in Malawi, he was immediately introduced to Dr. Nicole O’Brien, an adult and pediatric critical care specialist who had established a research capacity in the Democratic Republic of Congo. As it happened (you can’t make this stuff up …), Dr. O’Brien had just finished a large study using TCD on cerebral malaria patients in Congo. Dr. Doctor arranged for Dr. O’Brien to present her work to our group and we were wowed (check it out for yourself: O’Brien N, et al., Pediatr. 2018 Sep 14. pii: S0022-3476(18)31074-6.8).
Dr. O’Brien has visited Malawi several times already and — serendipity alert — when I was talking about her work with our NIH program officer at the American Society of Tropical Medicine and Hygiene annual meeting a year ago, he suggested I write a supplement to our grant to support her research with us. The supplemental grant was awarded and as a result, Dr. O’Brien will be able to spend four months in Malawi during each of the next four malaria seasons.