Interview: Professor Christian Burri
Overcoming Cultural Differences
Professor Christian Burri is Deputy Head of the Department of Medicine and Head of the Medicines Implementation Research Unit at the Swiss Tropical and Public Health Institute (Swiss TPH) in Basel. He and his team are searching for ways to defeat diseases like African sleeping sickness, Chagas and malaria.
||Professor Christian Burri, Deputy Head of the Department of Medicine at the Swiss Tropical and Public Health Institute (Swiss TPH), has been researching tropical and poverty-related diseases for 25 years.
Under what professional conditions do you conduct your studies in, for example, Africa?
Although there are excellent clinics and research centers in Africa, they usually specialize in major diseases like tuberculosis, HIV and AIDS. However, the situation is completely different when it comes to neglected tropical diseases – or NTDs, for short. In the small health centers, far out in remote areas where these diseases typically occur, the staff are trained to provide the population with basic healthcare services. They have never taken part in highly complex trials. We first have to give the staff basic training in research methods, ethics, good clinical practice and full work documentation.
What role does logistics play in such regions?
Many areas are only accessible by air, and the few planes that exist don't exactly inspire confidence. The alternative is journeys lasting several days by jeep on poorly maintained gravel roads. Often the clinics have neither electricity nor communication facilities. And every time a piece of equipment is forgotten or stops working, there are long delays, or the mission is aborted prematurely because replacements have to be brought in from Europe or America.
||The gravel road to Uìge, Angola makes the travel to the next hospital a hard trip for patients and medical professionals.
|In the early 2000s, during the peak of the African sleeping sickness crisis in Angola, the Provincial Hospital of Uìge, Angola had to establish a temporary sleeping sickness ward.
||Also patients in the Caritas Hospital of Mbanza congo, Angola had their beds in a temporary sleeping sickness ward.
What difficulties do you experience in finding study participants?
The enrollment process requires a lot of sensitivity because people in some other cultures regard diseases as a punishment for bad behavior or as the result of a curse inflicted by a third party. And sick people hide their suffering because they are often stigmatized and excluded from the community.
Furthermore, one should not underestimate the influence of traditional healers and the means they use. As a rule, visits to a medicine man are kept secret from foreign medical researchers. However, in many cases, the plants a medicine man administers contain potent molecules, or even extremely effective poisons, which can interact with drugs and lead to complications.
||Traditional Head of Village, Kikongo-Tanku, Democratic Republic of Congo
What role do local administration and politics play?
The time it takes to get an approval can be a major challenge. Something that would take 30 days in Switzerland can drag on for six to eight months in Africa. In addition, there might be rioting during elections, a coup d'état or outbreaks of war. All of these are factors that can make our work extremely difficult.
If you succeed in developing effective new drugs, do they really reach the patients?
Quite often, the health systems of the countries concerned have difficulties managing the approval procedure, and then do not have the ability to distribute the products. Many members of staff at the Swiss TPH are dealing with this problem, too. They are looking for causes, such as a lack of training among the staff, gaps in the supply chains or funding bottlenecks.
What is the most fulfilling part of your work?
It is a long journey from the first pipette tip to the moment when a drug finally arrives at the patient's bedside, but the spectrum of our work – covering everything from the molecule to politics – is always fascinating, and being able to help people is a huge reward.
The Swiss Tropical & Public Health Institute Basel (Swiss TPH)
The Swiss TPH is a public institution established in 1943 in Basel, Switzerland by the founding director Rudolf Geigy, a member of the Royal Society of Tropical Medicine. Today, it is a world-leading institute for global health. It has over 800 staff members from 70 nations and carries out projects in 105 mainly low-income countries. Swiss TPH is associated with the University of Basel and combines research, services, and education and training at the local, national and international level. The focus is on infectious and non-communicable diseases, environment, society and health as well as health systems and interventions. In Basel, the institute also offers vaccination and medical consultations .
Professor Christian Burri is a trained pharmacist (University of Berne, Switzerland), with a PhD in medical parasitology (University of Basel, Switzerland), postdoctoral education in molecular pharmacology (Johns Hopkins University) and a Diploma in Pharmaceutical Medicine from the Swiss Association of Pharmaceutical Professionals (SwAPP). He is Professor for Pharmacy & Clinical Pharmacology in Basel, Switzerland. He is also Deputy Head of the Swiss TPH Department of Medicine & Head, Medicines Implementation research Unit, Basel Switzerland.
 Swiss THP, 2018