Australian researchers and the quest to curb tuberculosis in Vietnam
Updated 21 September 2015, 15:15 AEST
The cultural immersion of Australian researchers working to solve the problem of tuberculosis in Vietnam, is key to both the progress of research and their ability to see past the data to understand exactly what is going on.
For more than twenty years, tuberculosis (TB) has been declared "a global public health emergency" by the World Health Organisation owing to the emergence of multi-drug resistant tuberculosis (MDR-TB) and the lack of development of new drugs.
One country with a high incidence of TB is Vietnam, which ranks twelfth in the world. The Vietnamese government manages a national TB program, but the emergence of MDR-TB is one of the many threats to its success. Currently, the estimated rate of TB in Vietnam is 144 per 100,000 people and 17,000 deaths each year.
In recent years, Vietnam has received funding for TB research from international research organisations such as the Woolcock Institute of Medical Research, an Australian leader in respiratory (lung) and sleep research. Tuberculosis - an infectious disease that typically affects the lungs - is part of the Woolcock's research agenda.
The Woolcock Institute has been researching TB in Vietnam since 2009. It has an office in Hanoi, Vietnam's capital city, and several field offices. For more than five years the team has conducted several large-scale and ongoing research projects, screening tens of thousands of people for different strains of TB.
Professor Guy Marks leads the research program, which focuses on public health and clinical aspects of TB.
"Australian researchers are actively engaged in research on tuberculosis in Vietnam, working together closely with the Vietnam TB program throughout the country," he says.
"In addition, we are working with hospitals and institutes in Vietnam and training people on health and medical research. We have a number of Australians there for various periods of time doing training and research."
One of the Australian TB researchers living in Vietnam is Dr Jennifer Ho, an infectious diseases physician and microbiologist. She is currently undertaking a PhD and will live in Vietnam for the duration of her research project.
"I'm very interested in working in south-east Asia in developing country settings so I thought doing a PhD in Vietnam would give me the opportunity to do research and to also live there. So it's been a really fantastic opportunity for me personally, but it's been one of the most challenging things I’ve done, working in such a different environment," she says.
Dr Ho believes that the key to working well in another cultural context such as Vietnam is to take the time to understand how things work.
I've worked in other cultures as well, and I think it's really important to know the culture and to know how people think in that sort of environment before you'll know how to work with them. That's what I've learned the most.
"Also learning the language is probably one of the best things in terms of learning the culture and actually being able to communication with people better."
One aspect of her experience which has surprised her is how she is treated as an Australian researcher with Chinese heritage living in a rural part of Vietnam. Her time in the country has given her unusual insight into local life.
"My last name's Ho and I look exactly Vietnamese so I get treated like a Vietnamese person; I don't get treated like a foreigner!"
Dr Greg Fox is another Australian researcher currently living in Vietnam. He is a respiratory physician whose PhD focused on genetic factors of TB in Vietnam. Like Dr Ho, Dr Fox has invested significant time into learning the Vietnamese language.
"I think the function of language in relation to cross-cultural communication has several layers. As a Caucasian Australian person speaking Vietnamese it firstly breaks the need to go through an interpreter and that helps a lot of with directly engaging with people on a personal level and on a collaborative level.
"Secondly, it can communicate meaning to some extent. However, unless you’re a fluent Vietnamese speaker then that's going to have some limitations. Essentially, the greater the depth of language, the greater the capacity that you have to go and meaningfully engage.
"Some of our key collaborators speak very good English and we’re making an effort to come to the table and speak Vietnamese. I think that sort of mutual engagement is a symbol of the way we try and do our research as well," says Dr Fox.
Because of the way he has immersed himself in Vietnam while conducting research, Dr Fox appreciates the complexities involved in trying to see past the data to understand exactly what is going on.
"When you're dealing with research you need to do that research in a system, and to understand the system is much more complex. Because even people who are in the system don’t necessarily articulate how the system works. So it's been a mutual process of discovery [with our collaborators] and we're now able to do more and more sophisticated interventions because we’re able to understand the system better."
Last year, Dr Fox was awarded a $A 3.23 million grant from Australia's National Health and Medical Research Council to commence a new research trial targeting MDR-TB in Vietnam. The trial is due to commence shortly and will be implemented in 150 district clinics in ten provinces throughout the country. The research will continue until at least 2020 and builds on the research team's previous work with Vietnamese researchers and collaborators.
"I've really enjoyed the opportunities provided by the Vietnamese to work alongside them and to learn from them to confront a really important health problem. It's also good to be reminded of your own limitations and to learn how to draw upon other people.
"Our Vietnamese partners have enormous capacity to do things. They're currently building a research network called VICTORY [Vietnam Integrated Center for TB and Respiratory Disease Research] and it's going to be a collaboration that's Vietnam-led," says Dr Fox.
"I think it's really exciting that they’re wanting to take ownership of the research agenda so we can be partners in that and listen to what they want."
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