“When you see so many kids with ulcers, you understand it is necessary to do all that can be done to end this epidemic”

This past winter, yaws was in the media spotlight in Spain after the New England Journal of Medicine (NEJM) published a study which confirmed it is possible to eradicate this disease. The World Health Organisation plans to do it by 2020. The news, which hit the headlines in February, led to Oriol Mitjà, an ISGlobal’s researcher leading the studies on yaws in the island of Lihir in Papua New Guinea, being flooded with interview requests.

For me, research has to lead to an improvement in the wellbeing and health of my patientsWe have taken advantage of one of these hot summer days in Barcelona to speak to Oriol who arrived in Lihir five years ago.  He tells us about his first day on the island in the summer of 2010, when a girl with ulcers on her skin walked into his consulting room. The diagnosis was yaws, a tropical disease that can be very painful, producing skin lesions and bone deformation. At that time it could only be treated with penicillin. That day led Oriol to dedicate the next five years to researching this neglected disease. In that time he has demonstrated that it is possible to cure yaws with one dose of azithromycin, a cheap antibiotic much easier to administrate than penicillin.

Oriol Mitjà in Lihir island. Photo by David Fontseca.

What has been the impact of the study’s publication in the New England Journal?

It has helped strengthen the position of yaws on the global health agenda and has generated a new interest from various institutions. We, the researchers, are the pack at the front of the race. We develop the tools and then the rest have to follow – the representatives from endemic countries, the international institutions--, and implement their programmes on a world scale.

There has been a lot of interest from the media and you have done a ton of interviews, is there any question you felt was missing in your interviews?

Although my work is mainly focused on researching, it is necessary to make an effort so that the results have a real impact in societyJournalists often don’t ask themselves about the socio-economic factors that predispose someone to suffer from yaws or perpetuate it, nor about the people who suffer it. Yaws is a disease that goes hand in hand with poverty. And as can be seen in Lihir, poverty is multidimensional. There are environmental, educational and economic factors. With no access to drinking water, for example, there are more diaorrheal diseases. Without education, many people are illiterate and they don’t know they need to wash their children or clean their skin. And due to the lack of economic development, people from the villages often have to walk for over an hour to reach health care centres where they lack the most basic treatment.

You have treated patients every day for five years. Is there any patient that has stuck in your mind?

Yaws disease is very sad. I remember the case of a 12 year old who came in with inflammation of the wrists and fingers. The boy was in great pain. He had travelled by boat from an island that was four hours away by boat. He was admitted to the Emergency ward, and when I went to see him and he saw me, he cried, in fear and desperation. He had been many days unable to sleep or play. Thanks to azithromycin, the swelling of the bones goes down and the ulcers disappear. Soon he got better. When we visited him at home, he was playing tag.

Many doctors don’t do research, and many researchers don’t do clinical practice. You do both, is there any tension between the two roles?

Both research and medical practice are important and I am on the frontier between them. For me, research has to lead to an improvement in the wellbeing and health of my patients. If I am in the consulting room and there are children with ulcers, I will have to look into what is causing those ulcers, and what I can do to solve their problem. It is difficult to find the balance in how resources are assigned to one or another discipline. When the resources are limited, it is important to use them in the best possible way.

Your experience working as a doctor in Papua New Guinea must be very different to your medical practice in Barcelona…

As a doctor I find myself in very difficult situations, treating people who are suffering and who end up developing serious illnesses. There are many times when I ask myself, what more could I do for this person? In poor countries, many people die prematurely: children or youngsters whose lives end before they barely have the chance to live them.

You have disseminated your findings, raised awareness and worked to get funding. As well as being a doctor and researcher, there is a bit of an activist in you. How do you juggle it all?

My first memory of the island is the image you see when you arrive in a propeller plane: dense vegetation surrounded by turquoise waterWhen you go to the schools and see so many kids with ulcers, you understand it is necessary to do all that can be done to end this epidemic. To see them improve is what keeps you going. Kids should be healthy. Although my work is mainly focused on researching, it is necessary to make an effort so that the results have a real impact in society.

Finally, how would you describe Lihir, for those of us who have never been there?

My first memory of the island is the image you see when you arrive in a propeller plane: dense vegetation surrounded by turquoise water. The villages are on the coast and the houses are made of bamboo. When evening comes, and the children have returned home from school and the mothers have returned from the forest carrying loads of coconuts or root vegetables, they light a communal fire for the entire village. They heat up the stones and they cook rice, vegetables… If it is a special day they might cook some protein, but it’s not the norm. And that is the typical village in Lihir. There is no industry; they live on what they harvest and until now, the hunting of wild pig. Farming and cattle raising is only starting now and with the mine, there is a bit more trade.