nErvE! staff magazine for the faculty of medicine at lund university

issue 4| 2014

vänd för svenska

Capacity building & university partnershipstheme: teaming uP in africa

lunds universitet box 117221 00 lundtel 046-222 00 00www.lu.se

nobel laureate Peter Agre shares his ideas on leadership and researchsPecial feature

news in briefNews in Brief gives you short translated versions of some of the Swedish articles. If you want more information about any of the articles on this page, please email elisabeth.dawson@med.lu.se

14

gunilla westergren- thorsson, dean

The African continent is currently

experiencing a great amount of

development. Its population

is young and growing rapidly,

and there is vast potential for

higher education and research.

The United Nations’ Millennium

Development Goals of improved

health, increased welfare and

sustainable development in the

poor areas of the world are goals that we can help achieve

through research and education with collaboration partners

in African countries.

In 2010, Lund University decided to establish a collective

strategy for Africa, as part of the internationalisation action

plan. On 21 May 2014, Deputy Vice-Chancellor Eva Wiberg

approved a project plan for strategic collaboration with Africa

on a university-wide basis, which is already in full swing.

Our own faculty started working towards a strategic in-

vestment in African collaboration projects in 2013. During the

autumn of last year we carried out an inventory of existing

collaboration projects in African countries and held a seminar

about African collaboration.

This autumn, myself and several other members of the Fa-

culty of Medicine’s management team spent one week visiting

colleagues and partners in Uganda and Ethiopia. We chose to

visit these particular countries as we have a great number of

well-established and successful collaboration projects already

in place, particularly within the areas of infectious diseases

and public health. The aim of our visit was to strengthen

existing relationships and research platforms, as well as to

identify further opportunities for collaboration. We left with

many concrete ideas of how to develop our research and edu-

cation together with our colleagues in Uganda and Ethiopia.

We are very happy to be taking these new steps towards

our strategic goal of ensuring that “our education and re-

search are to be characterised by a global knowledge per-

spective which stimulates learning capable of contributing to

the solution of global health problems.”

Teaming up in Africa

Primary care research networkCare and treatment that was tra-ditionally carried out in hospitals is more and more commonly pro-vided at local health centres and GP surgeries. This creates new opportunities for research that both the university and Region Skåne are trying to make the most of. As of 2009, Skåne has had a network of health centres in place that are home to PhD students and research coordinators, who act as catalysts for research through e.g. education and supervision for PhD students, Bachelor’s students and medical interns. The network is managed by the Centre for Primary Care Research and its Operations Manager Jan Sundquist.

forum medicumEarlier this autumn, the Faculty of Medicine held a Vision Day for the Forum Medicum project. Ingemar Carlstedt, Steering Group Chairman, explains that

the next step in the project is to ask three architecture firms to draw up proposals for a new building that connects to BMC. The proposals will then be evaluated and plans made for how to

proceed with the build. He says it is important to note that the faculty is not paying for the new building up front, but rather through a yearly rent. As the current HSC building requires extensive refurbishment, the rent increase from a new build would not be much higher than for a refurbished HSC. A new building is a strategic investment in the future.

new statistics courses for Phd studentsAn entirely new level-appropriate set of statistics courses in four stages will be launched in spring 2015. PhD students will then have the opportunity to study statistics on a level that is appropriate for their area of research. This change has come about as a result of a review of existing statistics courses at the Faculty of Medicine and how they meet the increased requi-rements for statistical analysis for e.g. publication of scientific articles.

award for work towards gender equalityThe Faculty of Medicine’s Dean, Gunnilla Westergren-Thorsson, and Assistant Dean, Anna Maria Drake, have been given the 2015 Gunnilla Jarlbro award for courage and strength in their work towards achieving gender equality at the faculty.

PHOTO: Charlotte Carlberg Bärg

Should I know more biology or more programming?

15

The accelerating rate of progress

in science and technology has

transformed traditional categories

of disciplines. The lines between

different subjects are fading and

lots of interdisciplinary fi elds are

emerging. Accordingly, the nature

of biological research has changed

signifi cantly. Many disciplines such

as nanotechnology, information technology, chemistry, mat-

hematics and cognitive science are merging with biology. Bio-

informatics, biostatistics, nanobiotechnology and biophysical

chemistry are examples of inter-disciplines in modern biology.

But what kind of skills do current and future biologists

need in order to be successful in this interdisciplinary era?

How should they manage to improve their capabilities from

mathematics and computer programing to chemistry and wet

lab work?

a common challengeAs a PhD student in bioinformatics, I see this as a common

challenge among students in different fi elds of biology. We

are concerned about not having enough potential to manage

all aspects of our research. People who used to work in wet

labs are afraid of computer programing, and people with

computational background are not familiar with laboratory

work. In my project, sometimes I think that I should improve

my knowledge of mathematics. Programing skills are often

critical, and sometimes without knowing about some wet-lab

techniques, I wonder what my role in the project would be.

In fact, I am trying to improve my skills in different subjects

without being an expert in any of them.

exPert in nothingHow should the education system be organised to deal with

this issue? What is the role of faculties, study administrators

and research consultants to provide opportunities for students

to increase their abilities in diverse eras?

Interdisciplinary subjects are challenging to teach, learn

and evaluate. To be able to research across multiple discipli-

nes, it is important that students understand the perspective

of each relevant discipline, learn how to integrate and keep

balance among them. Evaluation of students’ work is also

diffi cult. Due to the novelty of interdisciplinary research, it is

diffi cult to fi nd examiners who know how all the disparate

parts fi t together. Without a suitable infrastructure, there

would be a risk of ending up being an expert in nothing.

a new landscaPe for learningFuture biologists are trained today. It is necessary to educate

them in a way that they can incorporate biology, mathematics,

physics, chemistry, and computer science to gain interdiscipli-

nary perception. It is crucial for university departments and

research teams to understand the needs of interdisciplinary

research and facilitate learning for students.

Mina Ali is a PhD student at the Department of Laboratory Medicine Lund.

mina alicolumnist

call for columnistsIf you would like to be a part of a rotating group of columnists for Nerve!, then we would love to hear from you. No previous experience required. For more information email: elisabeth.dawson@med.lu.se

PHOTO: Most photos

biology Programming

12

“We worked on the aquaporins for about twenty years and

bigger and bigger groups got involved. I like to work on the

fringe. I was eager to get involved in field studies in Africa,”

Peter Agre reflects. “I’m now concentrating on malaria be-

cause that’s where my heart is. Aquaporins are taking care of

themselves nowadays. I see science as a series of adventures,”

he continues. “We did explore the aquaporins as a potential

drug target for malaria, but to stay in the lab working on

aquaporins would not permit fieldwork, so I’m following my

heart and need for adventure. I actually intended to work in

tropical disease long before I ever got involved in aquaporins.”

You’ve compared yourself to Huckleberry Finn; so how does Huckleberry Finn deal with setbacks in and out of the lab? “Life is a series of setbacks and if we dwell on setbacks, we’re

constantly in damage repair mode. I think you can learn from

setbacks, and you can learn from other people’s setbacks.

But it’s success that drives your energy. I don’t think it’s good

for a person who’s consumed by remorse over setbacks to go

into science. I guess if someone wants to become a welder

they have to be aware that they are going to get burned

sometimes,” Peter Agre smiles.

There’s one interview where you said that it is really important to hire people who are kind and fit into the family atmosphere of the lab. Why is that so important? “We spend more time with our scientific or academic col-

leagues than we spend with our families. So when you get the

opportunity to build a scientific group, it’s important to recruit

people with the intellectual capacity to deal with conflicts and

problems, and who also have enthusiasm and curiosity to look

for answers to the unknown. If there are clashes of persona-

lity, it ruins everything. It’s not common for a person to have

all bad qualities; it’s usually just a mismatch of interests, and

insensitivity. It’s important to find a place where you fit in well

and you are happy.”

But still; doesn’t science require sharp elbows someti-mes? “Well, yeah. I think challenging people intellectually is part of

science. It’s the data and the interpretation, not the quality of

the person’s life that is the validity of the scientist. You can

challenge the data without insulting the scientist. I think it is

good to have some intellectual conflict. Nobody gets a free

pass; you have to prove the data.”

So, what can you tell me about leadership?“When I was a young scientist I didn’t take it very seriously,

and I’ve had some experiences along the way where the

leadership was not

good, which was very

damaging. I think

leaders who consume

resources to support

themselves or don’t

foster the careers of

young people should

not be leaders. Lead-

ership should be about

generosity – a bit like

being a parent. You

put everything into

your child’s success. If

you can use your posi-

tion to encourage people to fulfill their potential then you’re

an excellent leader.”

You talk about mentors and leaders who are inspiring, but what do you think about teaching? “There are two levels of teaching; there’s lecturing and com-

municating to groups and classes and I’ve done some, but

not a lot, of that. I’ve done more mentorship in terms of

helping the young people in my lab with scientific direction.

Yesterday I had lunch with some junior researchers here at

Lund University’s Faculty of Medicine. I didn’t sit them down

and tell them about aquaporin one and two. It wasn’t infor-

mation exchange, but more of a philosophical discussion, of

the challenges of science and the advantages of science. I’m

sure the local senior faculty could have had a great lunch on

the very same topic. But sometimes, when you are in your

own camp, it’s less convincing than when someone comes

from the outside. We’re trying to encourage young people

to proceed in science. You don’t have to be a genius. That

term works retroactively; when you succeed, then others say

`that’s brilliant´. It’s actually also very lucky. 90% of success is

not brilliance but luck.”

In the past, you’ve called yourself a Bolshevik, and you’ve considered running for senate. Have your travels influenced your political views, or is it the political views that have influenced the travels? “When I was seventeen years old I had the great opportunity

sPecial feature

nobel Prize laureate Professor Peter AgreProfessor Peter Agre is an American physician, professor, and molecular biologist who shared the 2003 nobel Prize in Chemistry with roderick MacKinnon, for the discovery of aquaporins. Aquaporins are proteins that move water through the cell membrane. In the beginning of October Peter Agre was invited to visit the Faculty of Medicine in Lund. nerve met him for a conversation that took a turn for adventure and global health matters.

13

what is you background?I am a British veterinarian (graduate of the Royal Veterinary

College in London) who has lived and worked in Sweden for

over twenty years. I started my professional life in research

working with the Africa Medical and Research Foundation

(‘Flying Doctors’) in a field-based team in northern Kenya

studying the unique dog - man lifecycle of the parasite

Echinococcus granulosus.

In the late 80’s I returned to the UK with my two sons,

and in the early 90’s moved to Sweden. Although animals

play an enormously important role in my life, I decided

that clinical practice was not the job for me. I became in-

creasingly interested in veterinary business management

issues. Most veterinary clinics are run by their veterinary

owners, and a good clinician does not necessarily make a

good business manager.

I have held many workshops and courses around the

world on the subjects essential to a strong business deve-

lopment that are not covered in veterinary college such as

leadership, strategic planning, client communication, deal-

ing with conflicts, coaching and developing your staff, and

so on. I have also written many articles for the veterinary

press, and my book on the subject has been translated into

five languages.

why the medical faculty in lund?The opportunity to work at Lund University, one of Europe’s

leading education and research institutions was one to grab

with both hands and I was delighted to be accepted as

Manager of the Animal Facility in August of this year. This

is a completely new world for me, and it is already proving

to be a very interesting one.

your Passion?On the professional front, enabling people to be at their

best and fulfill their potential. I find human psychology -

what makes people ’tick ‘ - fascinating. It is also interesting

to see how we often create our own limitations - which of

course lead to limitations within an organisation. It is my

job as a leader to identify and remove these barriers and

support the people I work with, so they can reach new and

greater goals.

On the private front, my family, my animals, and time

to be out in nature.

Introducing Caroline Bäcknew manager of the animal facility

to travel in the Soviet Union. This was in 1966 at the height of

the cold war. I travelled in the Soviet Union for about 6 weeks

and saw it up close, camping with the Russians. It was obvious

that the system had flaws, but the people where beautiful,

generous, curious and wonderful. Systems can change and

learn from each other. During the cold war when the Soviets

and the Americans were at loggerheads, it was the contact

between American and Soviet physicists that just kept a little

connection.

I was president of the AAAS, the American Association

for Advancement of Science in 2009-2010 and chairman of

the board 2011-2012. I led scientific groups to visit countries

with adversarial governments, like Myanmar, Iran, and Cuba.

We weren’t there to create regime change, but science has a

special opportunity to connect to people of different cultures

and countries where our governments are adversarial. This is

something very special.”

So let’s turn our focus back to global health. Ebola. is it scarier than malaria? “Yes and no. Yes, because most malaria victims survive. Most

Ebola victims do not survive. It’s also less scary because Ebola

should be tractable; a vaccine should be developed, and I

think will be developed. The fact that it hasn’t is really due to

the neglect of yet another tropical disease affecting a small

number of people in remote areas. No company is going to

make money from that. But now, suddenly it’s in big cities,

with thousands, maybe tens of thousands of victims. We can

largely protect our citizens in countries like Sweden, Germany

and the United States, but a few will get through. Ebola is

extremely frightening. And there are other similar problems

out there. That’s one of the reasons we need to support sci-

entists, because we don’t know which problem is going to

come up next.”

On a more positive note; what would you like to see happen in your field in the near future? “The best thing would be the political prerequisites to prevent

malaria in the most difficult cases, places like Congo. Ebola

is going to be a bit of a setback. I can’t send young people

to places where there’s a chance that they get Ebola. We’re

working to go in to Congo right now – Eastern Congo, the

Katanga province. It is wild with malaria. In many villages

100 % of the children have malaria.”

“We don’t have to kill every mosquito in Africa if we

have proper prevention – rapid diagnosis and treatment. Par-

ticularly for those who are carriers and don’t realize they have

it. I don’t think we need any new basic science discoveries to

make that happen. I’d like really effective malaria vaccines.

Or new tricks: A Swedish scientist at Johns Hopkins, George

Dimopoulos, and a Brazilian scientist independently found

bacteria which colonize the mid-guts of mosquitos and knock

down the transmission of malaria. That would be a simple way

of treating the mosquitos so that they are no longer able to

transmit malaria. If it works it would be brilliant. I don’t want

to jinx them, but it might even be Nobel Prize worthy…”

text & Photo: anna aPPelberg

10

theme: teaming up in africaity

The foundations for increasing collaboration with Afri-can universities are already in place, through initiatives such as the successful partnership with Mbarara Univer-sity in Uganda.

Back in 2001 a formal partnership was established between

the research group for Social Medicine and Global Health, the

Faculty of Medicine at Lund University and Mbarara University

for Science and Technology (MUST) in southern Uganda –

LUMUST.

Mbarara University has a number of international partner-

ships (including Harvard School of Medicine), but their con-

nection with Lund University is among the oldest and most

well-established.

”There is high priority for collaborating with MUST. More

and more universities in Europe and the United States of Ame-

rica have begun to see the value of research and student col-

laboration in Africa. Opportunities for placements, exchange

programmes and degree projects for students, PhD students

and teachers are also highly attractive.” says Anette Agardh,

Associate Professor and Head of Social Medicine and Global

Health.

The first connections between Lund and Mbarara were

made with the help of SIDA (the Swedish International De-

velopment Cooperation Agency) as early as 2001, leading

to a two-way researcher exchange within the area of public

health. There was a strong emphasis on a lively student ex-

change programme from the very beginning.

Within the scope of the programme, four medical students

from Lund and Mbarara were given the task of producing a

report on how student exchange opportunities within the

project could work. The formal partnership then developed

quickly to include several other components such as support

for the development of Bachelor and Master’s programmes

(e.g. a Master’s programme in Public Health), development

of support structures such as library and ICT, administrative

processes, a research policy, new research projects, and a

peer education programme among the students for preven-

ting HIV/AIDS and promoting sexual and reproductive health

and rights.

Anette Agardh and Per-Olof Östergren from Lund Univer-

sity formed a project steering group together with Jerome

Kabakyenga and Gad Ruzaaza from MUST. Over the last 14

years the partnership has both developed and intensified. For

example, more than 50 students from the Faculty of Medicine

have taken part in degree projects and placements at the

hospital and university in Mbarara. They in turn have sent

students to Lund University. Various staff exchanges, joint

courses in public health and research collaborations focusing

on e.g. child and maternal health, and youth sexual and re-

productive health and rights, are a few other examples of ac-

tivities within the LUMUST project. Even Sweden’s healthcare

system has expressed their interest, and staff from Skåne’s

university hospitals have been able to do clinical placements

in Uganda within the framework of the project.

What have you learned from the partnership’s successes and challenges over the years?”It is difficult – nearly impossible – to design a collaboration

project like this and know from the start how it is going to

progress. The strengths of the LUMUST project are that we

were given the opportunity to develop the partnership with

an ‘open agenda’, and that we designed our proposals to be

viable in the real world. That requires understanding from

funders, as well as an equal two-way partnership.” say Per-

Olof Östergren and Anette Agardh.

Curiosity levels were high when the Faculty Board visited

Mbarara in October of this year. Anette Agardh hopes that

even more research and study programmes will create ties

with MUST and other universities in Africa as a result.

text: björn martinssontranslation: elisabeth dawson

To Mbarara and back

about mbarara university for science and technologyThe university was founded in 1989. Science and Medicine are the university’s flagship subjects, and it is currently home to approximately 3,200 students at Bachelor and Masters’ level. Find out more on http://www.must.ac.ug/

Below: Anette Agardh in discussion with Gad Ruzaaza, a col-league at the Medical Faculty at Mbarara University for Science and Technoloy. Photo: Johanna Sandahl

11

theme: teaming up in africa

Bumper to bumper trucks line the motorway that connects the small country of Djibouti on the Horn of Africa to Ethiopia’s capital city Ad-dis Abeba, transporting goods from Djibouti’s harbour into Ethiopia. The abundant transport traffic brings with it prostitution, creating the conditions for the spreading of HIV.

Per Björkman, Associate Professor in infectious

diseases, has spearheaded a research project since

2010 in the city of Adama, Ethiopa, which lies along

this motorway. Just as in many other low-income

countries, many HIV sufferers also develop tuber-

culosis – the most common cause of death among

the world’s HIV-affected population.

He has experience of working as an adviser all

over the world in issues regarding HIV treatment

in poor countries. Access to antiretroviral therapy

(ART) has increased significantly in low-income

countries over the last ten years, yet less than half

of the people in need of treatment actually receive

it.

“What is lacking are practical methods that can

be used for diagnostic purposes in primary health-

care in low-income countries, which is where most

people receive their treatment. We also need to

know how the antiretroviral HIV treatment works

– particularly in patients suffering from both HIV

and tuberculosis. The guidelines that the treatment

recommendations are built on are still, in many ca-

ses, based on studies carried out in high-income

countries.” Per Björkman explains.

In order to answer these questions, researchers are now

collecting patient data from five public healthcare centres

in the Adama region. These healthcare centres are staffed

entirely by nurses, and are the foundation of the Ethiopian

healthcare system. It is where HIV-positive patients go for

their antiretroviral treatment, which has been free of charge

in Ethiopia since 2006.

Per Björkman has put a lot of time and resources into

building a functioning infrastructure for the project. Staff

members at the healthcare centres have been trained, and

a project office has been set up in Adama where two data

handlers are now working to gather and check information.

By this stage the walls of the small project office are lined with

endless reams of patient data.

He emphasises the importance of building a local net-

work. One of the people on the ground is his Ethiopian PhD

student Taye Balcha, who also works at the regional depart-

ment of health.

”In our project the local nurses handle everything to do

with the patients at the health centres.” says Per Björkman.

“They are highly dedicated and take great pride in partici-

pating in, and contributing to research that is relevant for

their patients. This kind of ‘capacity building’ is extremely

rewarding to be a part of.” he continues.

For the last couple of years Patrik Medstrand, Professor of

clinical virology, has also been involved in the project.

“We follow up on how the patients receiving treatment

are doing. Is the virus developing resistance? Are those re-

sistant stems spreading? These are questions we need to

answer.” Patrik Medstrand says. ”This project would have

been impossible if Per had not already established a network

and an infrastructure.” he adds.

Patrik Medstrand also has a PhD student in place in Ethio-

pia – Dawit Aseffa – who works at the Ethiopian Public Health

Institute.

“It is incredibly important for us to have a strong part-

nership in Africa. Initially we had many discussions with the

institute, but they have started coming around as the project

has developed.” says Patrik Medstrand. “The challenge in

this type of research project is to find a long-term source of

funding. Projects like this take years to establish, and years to

complete. That kind of funding does not exist today.”

text & Photo: johanna sandahltranslation: elisabeth dawson

Capacity building in the Adama region

Per Björkman (left) meets staff working with antiretroviral therapy at a health centre in Adama. Pictured right is Patrik Medstrand’s PhD student Dawit Aseffa.