Pacific Family Health Journal with Dr Rodney Itaki
TB Research in PNG: Lack of Resource is an Incentive for Innovative Thinking
One day of every week for 6 months I interviewed, examined and obtained needle biopsies from patients with enlarged glands for Genexpert TB testing at the Central Public Laboratory (CPHL) housed within PMGH. I interviewed over 1000 patients with possible TB of the gland (aka lymph node TB) and of these 107 patients agreed to participate in my research.
Medical research around the world, including testing of new drugs or vaccines will not progress without the consent and participation of patients willing to advance medical practice. Most times breakthrough in medical treatment or diagnosis is announced with little acknowledgment of study participants. In countries like PNG where systems to monitor and ensure patient safety during medical research is weak, researchers are required to have a high level of ethical care towards study subjects.
During the planning discussions with my supervisor, Dr Francis Bannick, we discovered that in other similar Genexpert studies in Africa, a liquid solution called phosphate buffer was used for mixing the needle biopsies before feeding samples into the machine for testing. I proposed we tried using normal saline – the normal hydration fluid you would get if you were given a ‘drip’ in hospital. The reason being saline is cheap and available in almost all health facilities in PNG. So that is what we agreed.
From my preliminary reading I knew that normal saline had not been tried in Genexpert testing for TB gland. I biopsied the patients using a small needle and mixed the samples with 2mls of normal saline and sent the samples to CPHL for testing. In parallel I also did the usual microscopy testing for TB that is routinely done at PMGH. I wanted to compare the 2 ways of testing – “Was Genexpert testing of TB gland using samples from needle biopsies same or better than routine microscopy testing at PMGH?”. That was main research question I wanted to answer.
End of each week I reported the microscopy TB test results with specialist Pathologists that were assisting me and compiled all the Genexpert TB test results from CPHL in a large folder. I created a small Excel data base and entered all information. At the end of the study period I wanted to compare the microscopy TB gland test results with Genexpert TB gland test results. Dr Jacklyn Joseph, Pathologist at PMGH would sit with me every week to validate and pass out the microscopy TB test results. When I did the final analysis – the results changed how we tested for TB gland using Genexpert in PNG.
Next week I conclude my story and share with you the results of the study and how it changed how TB gland testing is done in PNG.
Dr Rodney Itaki, MBBS, BMedSci
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