The Cambodia Oxford Medical Research Unit (COMRU) is based in Siem Reap, northern Cambodia, which remains one of the poorest countries in South East Asia with extremely limited health services. Dr Paul Turner is working to better understand the key causes of infections in Cambodian children in order to improve diagnostic, treatment, and prevention strategies.
Infectious diseases are prevalent in Cambodia, a country that is struggling with poor infrastructure. Streptococcus pneumoniae causes the most severe form of pneumonia and is now targeted by the pneumococcal conjugate vaccine. Dr Paul Turner is studying the effect of this vaccine in field conditions in SE Asia, as well as other direct applications such as the evaluation of a new diagnostic test for Typhoid and interventions to reduce the burden of infections acquired within hospitals.
Ultimately, medical research must translate into improved treatments for patients. At the Nuffield Department of Medicine, our researchers collaborate to develop better health care, improved quality of life, and enhanced preventative measures for all patients. Our findings in the laboratory are translated into changes in clinical practice, from bench to bedside.
Q: You are the Director of the Cambodia Oxford Medical Research Unit. Can you tell us a bit about what the unit does?
Paul Turner: The Cambodia Oxford Medical Research Unit or COMRU is one of the youngest members of the Oxford Tropical Network. We are based within a children’s Hospital, the Angkor Hospital for Children in Siem Reap, Cambodia.
We run a programme of research which is directly relevant to the diseases that we see in children presented to the hospital and diseases that are particularly important in Cambodia: mostly infectious diseases. Pneumonia is the commonest cause of admission to the hospital. We also see a lot of typhus, typhoid and other infectious diseases that are common throughout the tropics.
Q: Can you tell us about your own personal research interests?
PT: My major research over the years has been childhood pneumonia, and in particular, one bacterium which is a common cause of the most severe presentations of pneumonia: Streptococcus pneumoniae. I am particularly interested in how that bacterium goes from asymptomatically colonising the back of a child’s nose to then going on and causing disease, in particular pneumonia but also meningitis and sepsis.
Q: You are a microbiologist, what are some of the biggest challenges working as a microbiologist in a place like Cambodia?
PT: Cambodia is still struggling to recover from its recent history, in particular the Khmer Rouge genocide and the subsequent civil war. This has left the country with a very limited infrastructure and we have to overcome problems related to that on a daily basis.
Particular issues that we struggle with are erratic electricity: we have wonderful equipment but we often suffer early failures because of poor voltage stabilisation. We also struggle to maintain our supply chain: all of our reagents and consumables are imported and it can often be frustratingly slow to receive essential supplies.
Q: What are the most important lines of research that have emerged in the last 5-10 years?
PT: There has been a massive leap forward in terms of pneumococcal disease and pneumonia that occurred as a result of the introduction of the pneumococcal conjugate vaccine. This is a vaccine, or a series of vaccines, that stimulate the immune system in children and protect against up to 13 of the more than 90 types of this one bacterium that I am interested in. This has changed things enormously and we can now prevent a large proportion of these infections.
However, what we don’t know so well is how this vaccine will work in less developed settings. The trials were mostly in high income countries and not in countries where there is a significant burden of antimicrobial resistance for example. We are working now to map the introduction of the vaccine in Cambodia and see if those impacts that we saw in the trials are seen in field conditions in South East Asia.
Q: Why does your line of research matter and why should we fund it?
PT: I think the important thing about our research is that it is very practical and based on diseases and infections that actually affect the population that we work with. We know that South East Asia is a very heterogenous region: there are relatively affluent areas but also often forgotten areas of poverty such as Cambodia, Myanmar and Laos. Our projects are rooted in those countries and really working towards improving the health of the population overall South East Asia, and where applicable we use that knowledge to improve the situation in other areas. We always try and make sure that the work we do is based on a clinical need.
Q: How does your research fit into translation medicine within the department?
PT: With our research projects, we always try to answer a practical question, one that is of immediate or almost immediate benefit to the population. An example is evaluating, with colleagues in Laos, a new diagnostic test for Typhoid that would lead to a quicker diagnosis in patients, and we hope a better outcome. Other examples are trying to understand the burden of infections that are acquired within the hospital, to come up with interventions that will work in settings such as ours. We are not really interested in abstract questions, we want to make a difference to our patient population.