A New Research Center is Born

The Macha Center, December 2003

Combining old-world and high-tech resources, the Malaria Institute at Macha is preparing for the painstaking detective work required for the prevention and control of the mosquito-borne illness that kills its victims, mostly children, in numbers that rival the scourge of AIDS in Africa.The Malaria Institute at Macha embodies the spirit of collaboration, observes Clive Shiff, PhD, who is principal investigator for the new field research station. It's a partnership of the Johns Hopkins Malaria Research Institute and the Macha Malaria Research Institute, which has been operating out of the adjacent mission hospital for several years. Shiff, who grew up in Zimbabwe and first worked as a medical entomologist in northern Rhodesia, now Zambia, says that time spent at the site is like coming home again. He is encouraged by the widespread support the project has attracted, including political support from the Zambian government and local support from many of the 100,000 residents of the 290 village units within the 30-kilometer-radius catchment area.

Local Support 
"Chief Macha has been eloquent in his praise and has spoken forcefully about the importance of this development," Shiff says of the principal leader in the area. "Our plans are very much appreciated because many children, in particular, suffer from malaria infection. It's seen as a major problem." In this endemic malaria region, in fact, approximately 270 stricken children are admitted to the mission hospital each month during the five-month malaria season.

Rapid Progress
These numbers lend a sense of urgency to the project, and the 16.5-acre site has already been transformed. Scrub brush has been cleared, the compound has been fenced for security and against nuisance animals, and buildings are rising with remarkable speed. Facilities include housing for resident scientists and their families, as well as temporary flats for a parade of researchers whose work will be advanced through shorter stints at the Center.

"Roads have been laid out, and water lines have been dug," says Shiff. "Electrical power has been brought in, and we have a transformer and standby generators on site. Local builders are completing inside plumbing, plastering and electrical circuitry for the two staff houses, and they're up to window height on the six flats. We buy the timber locally, and local workers make the roof trusses on site. The buildings are of locally made brick, burned and delivered to us. We'll soon have a substantial workshop garage for vehicles and supplies as well as a main building with meeting rooms, computers, and a library."

Water and Communications
Water is provided courtesy of a borehole, a small opening in the earth made by a drill that punches some 55 meters through layers of rock to reach the clean, potable contents of the aquifer. Setting up a communication system, however, is more complicated. There are no telephone lines or towers for relaying cell-phone calls, so the Center will rely on that increasingly popular means of global communication, the Internet. A dish at the compound will connect to rented satellite space, directly linking Macha researchers to Johns Hopkins colleagues and Welch Library resources. "It really is a tremendous asset to have direct access to the literature as it comes online," notes Shiff. "In addition, a Hopkins professor with a student in Zambia can be in daily communication."

Gathering Data
The skies will also help provide the baseline demographic and geographic data for research. Through a Global Positioning System, the entire area is being mapped, including houses, rivers, streams and wetlands. "We'll map paths to the river and chart where malaria occurs, where it starts and how it spreads," Shiff says.

"Our field staff are using the GPS to map the distribution of potential breeding sites and their relation to houses. It's important to find out what cues mosquitoes use to find people."

Involving Local People
Local mapping and demography are under the direction of Sungano Mharakurwa, PhD, the primary liaison between Hopkins and the Macha facility. The Oxford-educated native of Zimbabwe will live at the Center to facilitate research projects and supervise students who are in training. In overseeing the clinical aspects of research at Macha, Mharakurwa will employ local nurses to collect blood and train local people to be lab technicians. Local field workers will learn to conduct informational interviews.

Dr. Phil Thuma
The Macha researchers will also work closely with the medical staff at the nearby 200-bed Macha Mission Hospital, established in 1954 by the father of Dr. Phil Thuma. A pediatrician who did his residency at Johns Hopkins, Thuma will serve as the new Center's on-site liaison with the hospital and community. He has already conducted malaria research at a clinic near the hospital for six months each year, and he will now extend his residency to nine months a year.

On-Site Training and Research
Hopkins investigators, including faculty, doctoral and postdoctoral students, and their collaborators from other institutions, will journey to Macha for on-site research and training. In addition, the Malaria Institute at Macha will help train local physicians and researchers from Zambia and Zimbabwe in malariology, data management and computer skills. Some of the advanced training will be provided in collaboration with the Zambian Malaria Control Program. Certain courses will be held in Lusaka, and a master's degree is being offered through a cooperative arrangement with the University of Witwatersrand in South Africa.

The Local Environment
The Macha area provides a relatively pristine research environment. The rural population has not applied insecticides or employed bed nets, so the circumstances lend themselves to productive research results. One of the first studies will assess the cost effectiveness of treating malaria symptoms prior to a blood-test diagnosis. The study, funded by the World Health Organization, is a collaborative effort of Zambian and Hopkins research workers. Thus far, however, the researchers have little information on area mosquito populations and what percentage might carry malaria. They're still trying to build a foundation of knowledge that will enable them to formulate the right questions. The scientists will strive to understand both human and mosquito behaviors so thoroughly that they can create illuminating prevention and treatment studies.

Equiping the Center
The Macha research, while focused primarily on malaria, will include other studies as well. "Malaria exists in conjunction with other conditions that relate to the intensity of the infection," Shiff cautions. "We don't want to look at malaria in isolation." All the studies will depend on supporting facilities, and the Hopkins Macha team has also been busy equipping the site's research laboratory. A cargo container was packed in Baltimore and sent by ship to Africa, where the contents were transferred to trucks for arrival in Macha in December. From a $4 rain gauge to a $400 icemaker to a $4,000 microfuge, the items are revealing. On the list are mosquito dippers and jewelers forceps, beakers and tubing, and Post-It Notes, all the stuff of modern research methodology.

Although many supplies are foreign, the environment will reflect a healthy regard for native flora. Shiff insists that the compound be planted only with indigenous species. "African trees are extraordinarily diverse and beautiful," he says, "and the flowering trees attract birds that will add to the local fauna." Considering the enormity of the undertaking, progress on the Malaria Institute at Macha has been astounding. "In June, we didn't have one brick on site," Shiff recalls. "I was there at the beginning of November, and in that five months, all of this happened. Manpower was mobilized, and people worked very hard until the sun went down in the evening. There's a lot of enthusiasm for this project and what it can do to stop this terrible disease."