The diploma brought together students from all over the world, although less from far flung corners of Africa, Asia and South America than I was expecting. Nonetheless, there were several from places including Tanzania, Rwanda, Nigeria, Ethiopia, South Africa, Uganda, Ghana, India, and Peru. There was a decent block from Canada and the States, mostly with ED backgrounds which i found slightly unsual source of those interested in tropical medicine. Several Europeans and about a quarter of the class from the UK made up the rest of the majority. And 5 of us from the Antipodes made the cut, probably later to the regret of the course directors…
The course ripped through the big diseases of tropical medicine such as HIV, Malaria, and with depth but enough succinctness that they were covered in about a week each. Then came to the worms. Worms in the gut, the skin, the lungs, the iiver, the brain, as well as graphical videos of Loa Loa migrating across the eye – for those squeamish, luckily only found in rural parts of Gabon and Cameroon!
The sense of history at the school is impressive. With lecture theatres named after Sir Patrick Manson (who discovered that the filaria causing lympatic filariasis and elephantiasis were only present in the blood at night, and found the link with mosquitos as vectors. This principle continued with Ronald Ross’ work discovering mosquito as the vector of malaria. The major trop med text continues to bear is name following his original edition in 1898) and Sir John Snow (the father of epidemiology, who discovered where the source of the outbreak in Cholera in Soho was coming from, and in the process pioneered a new field) there was always going to be an impressive resume. Since that time, the school has been churning out gurus like they are going out of fashion.
An unexpectedly enjoyable part of the course was getting back into a lab. Gone were the days of histology labs where I’m sure the only difference of what we were trying to look at were the rotation of the slide and what colour they chose. Instead, they were sessions where we actually felt like we were getting practical skills that would come in value in the coming months and years. Who would have known that differentiating malarial species by the differences in dots, thickness of rings, and pigment, or looking at faecal smears for tell-tale cysts with their different shaped walls and nuclei would have been so engaging. There was a great team teaching the course and occasional yelps of success across the room as someone tracked down elusive hook worm ova, or finally realised the difference between L1 and L3 larva of Strongyloides. Despite what it sounds like, it was actually fun.
The course also had a big chunk on wider public health issues, some of which I may try and regurgitate/rant about/do a disservice, in later episodes of this blog. Effectiveness of aid, limitations of NGOs, lack of funding, knock on negative effects of progress made etc helped to provide some clarity to what is a very romanticised, emotive and prejudiced area of humanity. After it all, it does make one a bit of a cynic about what we are trying to achieve. However, most of us did come away feeling like it had at least provided us with a groundwork to start working in a critically important field for medicine and the world. It also did a good job of breaking the mould set by many of the western training colleges and health systems that the clock is ticking, and you need to get sucked into the training pathway apparatus only to be spat out in 6 or 7 years having lost the rest of your 20s and early 30s.
The course was taught bya smattering of global gurus, many of them from the UK, but a good bunch visiting from Africa and Asia. It was only on sorting out notes at the end of the course and throwing out the reading list, that all of the primary authors on all the major text books on Tropical Medicine, Parasitology and Public Health were the same people that had to put up with our (often my) inane questions and people having post lunch inappropriate front row naps. Sirs, Professors and quoting of lecturers own groundbreaking research seemed to be the norm. Not to mention the head of the School Peter Piot who after discovering Ebola in the original outbreak in 1976, went on to single handedly tackle (thats how he made it sound anyway…) the HIV/AIDS epidemic as the head of the newly formed UNAIDS, who under his leadership played an integral role in reversing the trend incidence (new infections) for the disease. No big deal.
In the presence of people with vast tropical medicine experience or infectious disease advanced trainess or consultants, this seemed appropriate, although some of us did wonder how punters like us made the cut. Maybe self labelled titles in the CV such as “Tukapa Senior Third second most valuable loose head prop to come off the bench” was misunderstood and given undue credit…
By the end of the course, I think it was fair to say that NZ was probably the country that got the least mention. Although we do have the worlds highest rate of Giardia, even the Arctic had more ‘tropical’ than us with a decent amount of TB and HIV up there.