From the lab to the field

May 2009

The reality of his PhD work came home to Dr Darren Creek when he travelled to Uganda for volunteer work on a project that investigated the impact of medications on malaria incidence.

Dr Darren Creek volunteering in Uganda, investigating the impact of medications on malaria incidence.

Darren graduated with a Bachelor of Pharmacy (Honours) in 2002, winning the Pharmacy Gold Medal. He completed his internship year at the Royal Melbourne Hospital, then commenced his PhD in 2004 with Professors Susan Charman and Bill Charman at the Centre for Drug Candidate Optimisation, within MIPS. There he worked on the internationally-recognised peroxide antimalarial (OZ) project, funded by the Medicines for Malaria Venture (Geneva, Switzerland), which aims to design new antimalarials that are active, easy to use and affordable.

In 2007, Darren completed his PhD (which included seven publications in leading scientific journals and one international patent application) and in 2008 he took time out to travel around the world, a journey that included six months of volunteer work in Uganda. Here he explains his role in the Ugandan project.

“My work was based at a clinic in the rural Ugandan town of Tororo, and mainly dealt with HIV and malaria. The Tororo district suffers from very high malaria transmission, with an estimated 562 infectious mosquito bites per person and hundreds of children dying every year.

The clinic was operated by a research collaboration between Ugandan and US-based universities. It provided comprehensive care for a cohort of 350 infants, and collected data to investigate various aspects of HIV, malaria and interactions of the drugs used to treat these diseases. Malaria causes one million deaths per year, the vast majority of which are young children living in rural areas of sub-Saharan Africa. This is not the easiest demographic for facilitating collection of clinical data, underlining the important and challenging nature of our study

International funding has improved access to HIV management in Africa, including distribution of anti-retrovirals and prophylactic antibiotics. This study was designed to investigate the impact of these medications on malaria incidence, treatment and the development of immunity.

Another major focus was to compare the effectiveness of two leading malaria treatments, and my major role was to initiate a pharmacokinetic study to evaluate these therapies. My background in pharmacy and pharmaceutical science was appreciated by the local doctors and nurses who, despite their excellent clinical skills in treating patients, were only just learning the importance of drug absorption, blood concentrations and the strict procedures required to generate quality research data capable of influencing future practice.

Blood samples are collected to check for malaria and drug concentrations.

The scientific and clinical nature of the work made it very enjoyable, but the greatest sense of achievement was felt after we successfully implemented the logistical procedures required to run the study. Keeping hundreds of blood samples frozen in a town that has only sporadic electricity supply was not a simple task, but with the help of liquid nitrogen and many very rough five-hour journeys to Kampala (Uganda’s capital), the study was successful.

Sadly, the eradication of malaria is not feasible in this environment in the short term, but treatment is possible. All 621 malaria cases I saw were successfully treated by following international guidelines that recommend artemisinin-combination therapy (ACT). Unfortunately, many Ugandans cannot access or afford ACT, and prefer to use older, cheaper drugs such as chloroquine or Fansidar, that are ineffective in most cases because of the prevalence of drug-resistant parasites.

This is just one of the many frustrations I faced working in a developing country where poverty, inequality, poor infrastructure and limited education affect so many aspects of life. Thankfully, I had an opportunity to improve this situation in a small way, not only by direct contribution to healthcare and clinical practice in Africa, but perhaps more importantly through my PhD work with CDCO, which will hopefully lead to the availability of cheaper alternatives to ACT that would make treatment more accessible to those who need it. Overall I had a great time in Uganda. The lifestyle and workplace was very relaxed (sometimes too relaxed!) and the impact that a few healthcare professionals could have on so many lives was visible and fulfilling.”

Back in Melbourne in 2009, Darren has returned to the CDCO for a period of further research on the OZ project. His next role – a postdoctoral research position at the University of Glasgow, Scotland – will involve using modern metabolomics technology to investigate drugs for the Trypanosoma parasite that causes African sleeping sickness.