As a research scientist working in Kisumu, I still remember the shock and horror I felt when I first learnt that the Walter Reed Medical Research facility in Kericho had been surrounded by members of the local community who appeared to be determined to burn it to the ground.
What had happened is that word had gone round that this facility was actually a place where blood was being taken from children illegally and sold overseas. The Kenyan rumour mill being what it is, some people took it even further and spoke of “devil worshippers”, “Freemasons”, “Illuminati” and all the usual suspects routinely dredged up when Kenyans become suspicious of the intentions of “foreigners”.
For those of us who know the Walter Reed Project, and have friends and colleagues who have worked alongside the Americans who head it, this was a sad and unfortunate event. For the Walter Reed Project is the medical intervention arm of the US diplomatic mission in Kenya and has done a lot of great work all over the country. Above all, at each of the centres it creates or supports, medical services are provided free. And these are medical services of exceptionally high quality, usually provided to those who need them most. I know many lives that have been saved because relatives took their loved ones to Walter Reed-supported facilities.
Photo Caption: Making friends and influencing U.S. senators: The U.S. Senate buildings. ‘Dr. Elizabeth A. Bukusi is not the first child of a Kenyan parent to stand at a Capitol Hill podium with the seal of the U.S. Senate. But it’s doubtful that even former Sen. Barack Obama had an audience more rapt as she recounted the story of a Kenyan girl named Atieno who died during childbirth of a postpartum hemorrhage.’
What the Walter Reed Project was undertaking in Kericho was a standard research project focusing on Malaria and HIV/AIDS. And in both these cases – and irrespective of whether the research patients are children or adults – at some point blood has to be drawn and sent to the laboratory.
And since this was a research project it necessarily involved drawing blood over a period of time, i.e. repeated samples would have to be taken over the treatment period or over the examination period.
Simple misunderstanding, tragic consequences
I suppose this is what eventually gave rise to the rumours. If a mother sees that each time she takes her child to hospital, a certain amount of blood is taken from the child and maybe is taken from her as well, and this keeps happening, it is quite easy for a misunderstanding to arise as to why this blood is being taken.
But while the misunderstanding itself is simple enough, the potential consequences can be tragic.
And so it was in this case, where a modern and fully equipped biomedical research centre would have been burned to the ground, by the very people who were receiving its incomparable benefits, if it had not been for the quick action of the local leaders and government officials.
What I know of such research projects is that if indeed this research centre had been burned down, then it probably would not have been rebuilt in Kericho, or even elsewhere in Kenya. The project would have relocated elsewhere outside of Kenya and started from scratch. The ultimate losers would have been the people in that locality who by then had long grown accustomed to first class medical care given absolutely free of charge. This incident is perhaps the best example I can think of, of a phenomenon seen in this country from time to time. This is the lack of understanding that would emerge regarding what biomedical research involves.
And perhaps I should admit that the other side of the coin is that those of us involved in biomedical research do not do enough to explain our work to the public.
Research literacy in the communities we work in should be stepped up and community voices heard and addressed, where possible. I remember several years ago I stepped in and engaged listeners of a local radio station where research was being bashed and explained the process of research and ended up by pointing out that we have all gone, or taken loved ones, to health facilities for treatment; that treatment is based on research – research on drugs, research on dosage, research on routes of administration, research on medical devices, and so on. We therefore all benefit from research someone else participated in and proved to us that the drugs we take, the injections we receive, the procedures we undergo are all research-backed and if people we do not even know declined to participate, there would be no modern medical services we all benefit from so much now.
Why am I reminded of these events?
I say this in the context of recent reports in the newspapers of allegations arising form a parliamentary committee looking into the affairs of the Kenya Medical Research Institute. And one of the outcomes of this enquiry being a claim that a world-renowned research colleague, Prof Elizabeth Bukusi, the Deputy Director Research and Development at KEMRI, had in some way crossed the line because she was reportedly also conducting research through an NGO which does the same sort of work as KEMRI . The reports I read in the media were somewhat incomplete, but I gathered that the impression created was that if indeed the Deputy Director of KEMRI in charge of Research also had any affiliation or relationship with an NGO on the side, this could lead to potential funding for KEMRI being instead diverted to the NGO.
However, as someone who knows Prof Bukusi’s work and even having collaborated with her or been mentored by her on some research projects, I beg to kindly (and with all due respect to all parties) bring some clarity to this issue. For it is an issue, from my reading of the newspaper articles, which arises from an acute misunderstanding of how biomedical research is conducted.
But before I go into this, I would be failing in my responsibility if I did not mention that I thoroughly approve of Parliament looking into this matter. Because, as a matter of principle and the public interest, there should be no question of anything happening within this country, whether involving the private or the public sector, that should be outside parliamentary oversight. Having said that let me kindly explain what I believe this misunderstanding is: I want to make three points to explain this.
What, really, is a ‘Principal Investigator’?
Outside of scientific research circles it may not be widely understood what it means to be a Principal Investigator (PI) on a research project. Maybe a little illustration would help me to put across what I am relaying to the readers. Our various ministries have a Cabinet Secretary (CS) as the political head, and the administrative head who controls the expenditure is the Principal Secretary (PS). A Principal Investigator on a scientific project may be erroneously equated with a Principal Secretary in a government ministry. And sometimes a Principal Investigator is perceived as an equivalent of the CEO of that project. I may be wrong, but the newspaper reports left me thinking that perhaps this misconception led to an assumption that Prof Bukusi was “wearing two hats” in a context that necessarily guaranteed a conflict of interest.
But as it happens nothing could be further from the truth. This is the structure of a present day grant-driven biomedical research project:
The funding organisation that has identified priorities, and is willing to dedicate money to seeking solutions, issues a “Call for Applications” which invites government-supported institutions, independent academic institutions, NGOs, or even commercial organisations who believe they can fulfill the requirements of this project, to write their proposals, and apply for a grant.
Central to this proposal is the Principal Investigator. This has to be someone who has done it all before; has risen up the ranks over an extended period of time; played increasingly significant roles in similar earlier research projects; and at least reached a point in their career where they can be a team leader within the specific legal entity seeking this grant, as well as a collaborator with other research institutions, whether local or oversees.
At any one time, and more so in a country like ours, there are only a handful of top biomedical research scientists who could convincingly serve as a Principal Investigator in a cutting edge research project supported by a major donor organization, and edge out top-notch competitors that include universities and research organizations from the same countries funding the studies.
Why Biomedical research is inherently collaborative
The second thing to be noted about biomedical research is that it is inherently collaborative. Scientists have long recognized that it is pointless re-inventing the wheel and creating new projects or building new centres which only duplicate what is being done elsewhere. And they know no single individual, however accomplished, has all the expertise needed to conduct successful projects on a solo basis.
So among the organizations which have the vast resources needed to create research grants, a key consideration is to look at the personal history and qualifications of the Principal Investigator who will be working together with others on a project and to see if they form a good match for what the donor organization has in mind.
That is why you will find that in many Kenyan universities the faculty of Medicine has got research units working closely with research centres within Africa or in Europe, or even in America.
Two of the most outstanding such examples of vast and significant biomedical research centres are the Botswana-Harvard Partnership, which has a large ultra-modern research facility in Gaborone, Botswana (and where a number of Kenyan scientists have been employed). And there is also the South African KwaZulu-Natal Research Institute and the Howard Hughes Medical Institute collaboration in Durban South African (where some Kenyans are also employed and doing great work, such as Dr Thumbi Ndugu).
In Kenya, probably the best known is the University of Nairobi-University of Washington collaboration that has seen hundreds of Kenyans trained in research – at no cost to them or to the county – and returned home to lead most of the great research studies in Kenya.
Both Prof Bukusi and I are beneficiaries of this collaboration.
Why I believe top researchers must wear more than one hat
My third and final point is this – in a world of multi-disciplinary, multi-sectorial and multi-institutional research, nothing is likely to be more natural than that a leading researcher should wear more than one hat.
All the prominent biomedical researchers I know in America and in Europe serve as Principal Investigators or consultants or hold a position on an advisory board in several institutions, including NGOs, universities and stand-alone research centres (such as KEMRI) and they also do this across continents.
If this had been better known within Kenya, the investigation on KEMRI would actually have been seen to reveal that Prof Bukusi is actually one of our top biomedical researchers and much in demand for research projects, often consulted by institutions applying for grants. I have myself requested her many times to collaborate on my studies, to strengthen my applications.
To my mind, and comparing with others I know in her calibre, it did not come as a surprise to me that she was a Principal Investigator on a project run by an NGO dedicated to medical interventions, while serving as Deputy Director of Research at KEMRI.
Indeed, I could point out, with some pride, that the two hats leading to all this controversy are not even the half of it. Like all world-class research scientists, Prof Bukusi does not just wear two hats but several.
Why I take off my hat to Prof Elizabeth Bukusi
Although much younger than I, she is my mentor in research. I currently run a local (100% Kenyan) research organization that employs between 650-1,000 Kenyans and greatly contributes to the local economy, as I believe her countless mentees at KEMRI and the other organizations she is affiliated do.
Two or so years ago, I attended the 30th
anniversary of KEMRI’s collaborations with multiple universities in and outside the United States, the majority of which Prof Bukusi negotiated over the years. It was amazing the number of young Kenyans who have been mentored into great researchers without necessarily going to any foreign country, those she has supported to get scholarships to study outside Kenya, the huge buildings located within government health facilities constructed through her collaboration, and, above all, almost 100,000 Kenyans on HIV care and treatment, thanks to her grant-writing prowess.
Photo Caption:
Seeking solutions to Kenya’s medical challenges: KEMRI Research facilities near Kisumu. ‘There is a lack of understanding as to what biomedical research involves. And perhaps I should admit that the other side of the coin is that those of us involved in biomedical research do not do enough to explain our work to the public.’
Within Kenya, Prof Bukusi is an honorary lecturer at the University of Nairobi’s Department of Obstetrics and Gynecology, and also in a similar department at the Aga Khan University in Kenya.
Within Africa, she is the only non-South African to have been invited to serve on the Board of Management of the South African Medical Research Council, a leading research organization on the continent.
In Asia, she serves on the faculty of the Sind Institute of Urology and Transplantations Centre for Bioethics and Culture, Karachi, Pakistan.
In the US, she is an Associate Professor at the University of Washington’s Department of Obstetrics and Gynecology with a joint position in the Department of Global Health. At the University of California, San Francisco, she serves as Volunteer Faculty Professor in the Department of Obstetrics, Gynecology and Reproductive Sciences.
And in Europe, she has regularly served in various capacities in the World Health Organization Department of Reproductive Health and currently serves as the Co-chair of the Human Research Programme (HRP) Alliance and the Africa Regional Chair.
The most prestigious prize
As a result of all this and of her pioneering and mentoring of many scientists, she was last year a
recipient of the 2015 Award at the Biomedical HIV Prevention Forum in Harare during the International Conference of AIDs and STDs in Africa, easily the most prestigious prize within Africa for any scientist engaged in HIV research.
This was specifically in recognition of her outstanding contributions in the development of female-initiated methods of HIV prevention, including Pre-Exposure Prophylaxis, Microbicides and Multiple Prevention Technologies. As one of the Kenyans sitting in the audience at the award ceremony, it was a very proud moment for me as the Kenyan Ambassador to Zimbabwe, Her Excellency Lucy Chelimo, received the award on her behalf.
I should also mention the inaugural recipient of this award, and, to my mind, Africa’s most distinguished biomedical scientist, Prof Salim Abdool Karim, the Pro Vice Chancellor for Research at the University of Kwa Zulu Natal and the Director of the Centre for the AIDS Programme of Research (CAPRISA) in Durban, South Africa.
Photo Caption: AFRICAN GIANT: Prof Salim Abdool Karim. ‘Africa’s most distinguished biomedical scientist. He is the Pro Vice Chancellor for Research at the University of Kwa Zulu Natal and the Director of the Centre for the AIDS Programme of Research in Durban.’
If I was to start counting how many hats Prof Abdool Karim wears, I would have to write another article. But most prominent is that he is also a Professor of Clinical Epidemiology at the Mailman Columbia University; Adjunct Professor of Medicine at the Weill Medical College of Cornell University; and Associate Member of the Ragon Institute of Massachusetts’s General Hospital (MGH), the Massachusetts Institute of Technology (MIT) and Harvard University.
He Co-Chairs the UNAIDS Scientific Panel (of which Prof Bukusi is a member) and has been elected to the World Academy of Sciences. These are seven hats, besides CAPRISA which employs him.
In conclusion, I must admit I have taken the trouble to explain all this because the controversy which arose recently is, to my mind, simply a misunderstanding: Apparently it was unclear why the Deputy Director Research at KEMRI could also be guiding, or be linked to, any research or programmes at another institution.
That said, I feel those of us involved in research should make a greater effort to explain our work to the public. I believe that is what I have done with regards to this issue.
The media can help us in this by seeking us out and by encouraging us to explain our work so that we all see how complementary all our different areas of work are, and the gaps that researchers fill in the development of our county.
Parliament should not only seek out biomedical researchers when scandals – real or perceived – arise; we beseech them to invite us to their televised committee sessions to explain what foreign and Kenyan taxpayer’s money is doing for Kenyans in our fields.
We know our beloved President has committed to give 2% of GDP to the newly formed National Research Fund. And no doubt he set a standard for other African states by this commitment. But we also know that research is expensive and other support must continue.
Given the scale of the medical challenges in Kenya, and the plain fact that most of the money currently used in biomedical research comes from donors, researchers should not tire; we should continue working harder and look for more funds to bridge the gap, because if we relax, funds will simply go to other countries and the top-notch research portfolio Kenya has built would fade.
A most eloquent presentation of the Kenyan case – before the United States Senate
Before I end, allow me to mention one more proud moment for Kenya:
Prof Bukusi is the only Kenyan biomedical scientist I know of who has been invited to the US Senate to make a presentation that would guide their deliberations – an honour which, even in America, is reserved for only the highest elite of the most accomplished academics and research scientists in Ivy League institutions.
Prof Bukusi stood before the Senate committee which had invited her to its deliberations and made an eloquent argument for increasing research funding to Africa so as to enable African scientists do more work towards ending the endemic diseases that have long tragically plagued our continent.
A US media report on this event, begins with these words: "Dr. Elizabeth A. Bukusi is not the first child of a Kenyan parent to stand at a Capitol Hill podium with the seal of the U.S. Senate. But it’s doubtful that even former Sen. Barack Obama had an audience more rapt as she recounted the story of a Kenyan girl named Atieno who died during childbirth of a postpartum hemorrhage."
It ends "...when Bukusi speaks to young medical students, she thinks of Atieno and the difference that research and capacity building may have made. Research is the key to the multiplier effect, she exhorts her students. "It may be a long time before you have an impact," she tells them, "but when it happens you will touch the lives of millions of people who may never know you by name, but you will have changed their lives dramatically."
Kawango Agot, PhD, MPH
Research Scientist
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