For some time now, the Kenya Medical Research Institute (KEMRI) was better known for the controversies  swilling around it than for the sterling scientific work it was undertaking. But that is now behind it. Under new Director Dr Solomon Mpoke, KEMRI has its sights firmly focused on its core mandate of medical and scientific research; not on research for its own sake but to alleviate sickness and people’s suffering.

In this regard, it has undertaken and continues to undertake ground-breaking research in the developing of products such as the pneumococcal vaccine to be used for protection against pneumonia and other respiratory infections. It is also one of key sites being used to develop the eagerly-awaited malaria vaccine that could be used to tame Africa’s worse killer, which claims as many as five million children annually.

Indeed, even its most promising and significant discovery, Kemron, the anti-HIV/AIDS drug was sacrificed for what Dr Mpoke refers to as “politics of manufacture rather than the efficacy of the drug.”

CDC's Dr Breiman Shares his wide experience with DEA REPORTER

DIPLOMAT EAST AFRICA: We’d like to know how you came to this place.

DR BREIMAN: Well, let me even start before me because stories shouldn’t start with the person but more of the relationship CDC has had with Kenya that goes back to 1979, actually. The CDC began working in Lake Victoria back then. Initially focused on malaria, the interest expanded to other diseases that are common in that area like schistosomiasis and then in the late ’90s and the early part of this century, there came much greater involvement, more involved in HIV and more resources became available to deal with HIV.

So, CDC has actually been here in Kenya in a formal way working with the Kenya Medical Research Institute (KEMRI) since 1979, for more than 30 years. And in the first say three or four years of the 21st Century, the biggest amount of work out here was in HIV/AIDS and it still continues to be a major part of the work that we do. But in 2004, CDC met with what was the Ministry of Health, before there was the Ministry of Public Health and Sanitation, to talk about setting up the capacity here to detect emerging infectious diseases. These are diseases that can appear suddenly and spread without warning and create problems for people living locally in the area as well as spread beyond borders to other countries and eventually around the world — like we saw with influenza

The Director of KEMRI's Research Programme in Kilifi takes DEA's REPORTERS through his 21 years of scientific works in Kenya

DIPLOMAT EAST AFRICA:  Maybe you can start by telling us in some chronological order how you came to this place, how you came to have this job.

PROF. MARSH: Well, I first visited Kenya in 1987. I was in fact to attend a scientific meeting. At that time I was working in Oxford, the Oxford University, having recently returned from the Gambia in West Africa where I began my research work and training in tropical medicine and health research. At that time, I was planning to, with colleagues, develop a research programme, probably in West Africa, because the programme was about malaria so its location wasn’t an issue. It was about malaria.

And colleagues in Kenya suggested that this was the best meeting. I came down to Kilifi just to visit the place and during that period I got to talk to people in hospitals and people in KEMRI at that time and it became clear that this was a very interesting place because it is developing some collaborative research. That is because KEMRI, in the late 80s, was interested in developing research on the Coast. There was no other research on the Coast.  When we came to look at the problems of malaria in this area, we realised that there was a major problem and it was the kind of problem that we were strictly interested in.

• The Wellcome Trust has been supporting work in Kenya since pre-independence. It begun in 1989 with two projects about malaria and has grown from a project to a program which now has about 800 staff. The work of the KEMRI-Wellcome Trust Research Programme is to carry out research at the highest international scientific and ethical standards on major causes of morbidity and mortality in Africa. TIt aims to build strong and sustainable internationally competitive, national and regional research capacity and to work in a way that facilitates integration and cross fertilisation of scientific disciplines. To conduct intervention research and basic research in parallel as well as having a direct input to local and international health policy. The Programme is committed to capacity strengthening within Kenya and the East African region. The programme has developed a core group of productive researchers who hold around £25 million of competitively awarded grants and contribute high-quality papers to the scientific literature. All work is designed to generate useful information that can inform the delivery of healthcare within existing structures. More broadly, the Programme aims to gather insights that could inform the delivery of medical care across sub-Saharan Africa.

DIPLOMAT EAST AFRICA

What actually happened?

A: To understand what happened in Mtwapa it is important to note KEMRI works very closely with NASCOP, the National body responsible for HIV/AIDS. Now, NASCOP and the Ministries of Health are particularly concerned about high-risk groups within Kenya. HIV obviously is transmitted across a population but there are groups that are particularly high-risk and they act as an  important source in epidemics. So with NASCOP and the Ministry of Health, a number of high-risk groups have been identified which include men who have sex with men. And of course that’s an area in many countries which leads to interests or as you put it, controversy, because it’s a social and cultural issue that goes beyond health.

We have worked very closely with the communities over this and in general, the work is very important nationally within Kenya. What actually happened in Mtwapa is that there was a group of people who were unhappy with this work involving gay men.

US Army Col. Thomas Logan speaks of his involvement in the endevour to tame infectious diseases such as Malaria, Influenza, Leishmaniasis, Rift Valley Fever and others. DEA interviewed him in Nairobi.

DIPLOMAT EAST AFRICA:  Tell us briefly about your journey to this office and this job.

COL. LOGAN:     I was assigned to U.S. Army Medical Research-Kenya (USAMRU-K), commonly called “The Walter Reed Project”, in the late 1980s.  After a series of other assignments and several attempts to return I now have the good fortune to once again live and work in Kenya.

DEA: So, what is Walter Reed actually?

COL. LOGAN:  Walter Reed was an army officer in the Medical Corps and he was a major. He was very instrumental in the early medical research done by the army. He was the scientist that actually scientifically determined that mosquitoes transmit yellow fever. So yellow fever is a devastating disease, similar to malaria here. It’s a devastating disease in the Western Hemisphere, particularly in Latin America, like Cuba and all those nations there. So he devised a scientific protocol to scientifically prove that a certain type of mosquitoes transmitted yellow fever from human to human.

An alumnus of the Prestigious Alliance High, he traces his steps through the university of Nairobi and in the US and how he ended up heading KEMRI. Dr Solomon Mpoke spoke to DEA's SCIENCE WRITER

DIPLOMAT EAST AFRICA:  Tell us about yourself. How you embarked on your journey to this place. Whether it was a simple straight forward story or a very exciting one, I think the public would be interested to know.

DR. MPOKE: Basically, I grew up in a very small rural community in Kajiado where I received my local education all the way up to secondary level, where I performed well during my O levels and secured a place at Alliance High School for A-levels, that is Forms Five and Six.  Soon after my O-levels, I was privileged to meet Professor Onesmo ole MoiYoi, who was working at the then International Laboratory for Research on Animal Diseases (ILRAD). We discussed about my future professional development and he advised me to think of the sciences. Incidentally, I had done fairly well in Mathematics, Physics, Chemistry and Biology in my O-levels. With these subject combinations, I was poised to pursue A-level studies that would lead to either Medicine or Engineering.

The Institute will reamin faithfull to its research mandate. But the research will be more relevant to national aspirations and will include setting up of a graduate school.Dr MPOKEshares this new drive withDEA's SCIENCE WRITER

DIPLOMAT EAST AFRICA: Let’s talk about your vision for KEMRI. In other words we are now at 2011. By say 2015 or 2016, assuming the efforts you have put into structures; into policies; into ensuring people are incentivised; all these other things; assuming all this works as expected, where do you see KEMRI going and equally important, what will  you need, whether from government, from donors, from the public? What will you need if you are to get there?

DR. MPOKE: Well, first of all, our core mandate, which is what KEMRI has been doing since the inception of the institute in 1979, is research. That mandate has not changed, it will remain. And I see in the next few years, us intensifying our efforts towards research, and I would say here, relevant research.

Our long-term vision is that we want to see a healthy Kenya. We want to see everybody in Kenya healthy. That’s what drives what we do. In terms of vision, for us the key issue is the building of a very strong group of Kenyan scientists to lead the research:- Prof Marsh shares his vision with DEA Reporters

DIPLOMAT EAST AFRICA: What challenges have  you faced that have either slowed down your work or acted as setbacks during your stay and work here?

PROF. MARSH:It’s almost like difficult. If you focus on what you call setbacks, in a way, one person’s setback is another person’s challenge and opportunity. I mean, science is hard to do, research is hard to do anywhere in the world. To obtain funding is hard to do. To build up a research centre in a rural town on the coast of Kenya has challenges because for instance, when staff are thinking ‘where do I want to work,’ many people, many trained professionals wouldn’t see coming to a rural town as their favourite. They want to work in Nairobi. So those kinds of things you could regard as challenges and setbacks and we certainly have to work quite hard to make it the place that people want to work and come to but I don’t see that as a problem, I just see that as the concept we work in and the outcomes.  I think we are actually very lucky in not having major setbacks. I think, we do expansion of our support. As I said to you, we’ve gone for 21 years from about 15 people to 800 people. We’ve been able to have a huge group. We’ve actually developed this research centre. As you go around, you’ll see that it’s a research centre which Kenya can be proud of.

Nagasaki University has had a long and mutually beneficial relationships with KEMRI. Prof. Yoshio Ichinose explains

DIPLOMAT EAST AFRICA: Many Kenyans don’t know much about your University and its affiliation with KEMRI. Could you tell us how the University came to be working with KEMRI?

PROF. ICHINOSE: The Government of Japan has collaboration with Kenyan health sector since 1966. JICA, (the Japan International Cooperation Agency) established technical cooperation with the Rift Valley Provincial Hospital where medical doctors from our university provided specialised health services to the local patients, which lasted ten years.

In 1979, JICA initiated a long-term medical research cooperation with KEMRI in which Nagasaki University played a key role.  Through this cooperation the Government of Japan supported the construction of the initial KEMRI and supported the Institution with equipment and funding for different research programme.  Recently the Japanese Government supported the construction and equipping of the training center.

KEMRI has been in the vanguard of the search for solutions to problems associated with the management of patients, the resistance to ARV drugs and the search for better alternatives. DR MPOKE talks of KEMRI's role in the exercise to DEA's SCIENCE WRITER

DEA: Now there’s one area, I know you’ve given us three very good examples, but the disease which worries Kenyans more than anything else is HIV. What has KEMRI done in that field?

DR. MPOKE: KEMRI has done quite a lot of research on HIV/AIDS. First of all when the disease was detected back in 1983 in the US, our scientists immediately started being part of that global group of people asking what this disease was. You will recall nobody knew anything about HIV/AIDS shortly before 1983. In 1984, scientists developed diagnostic tests for HIV and  in 1985, the first HIV diagnosis was actually done here in Kenya; specifically here in KEMRI. So we are the pioneers in terms of HIV diagnosis here in Kenya and we were the first to report that HIV is also here in Kenya.

Apart from the pneumococcal vaccine that protects against pneumonia, one against malaria that is still being tested. Dr. Mpoke tellsDEA'sSCIENCE WRITERabout other research being undertaken

DEA: Now, the ordinary man in the streets would not know what the pneumococcal vaccine is supposed to prevent. It’s vaccination against what?

DR. MPOKE: This is against pneumococcal infections which cause significant mortality among children. Such infections if not prevented or treated early will lead to death or complications later on, including predisposal to other life threatening illnesses. It becomes very cheap to prevent death and control all these other illnesses by giving the vaccine.

DEA:  So, you now wish that you had more effectively used that occasion to explain to the public exactly how this invention is helping very many people?

KEMRI DIRECTOR, DR SOLOMON MPOKE speaks candidly of the organisation's turn-around, the efforts to win back the confidence of it's collaborators, raise staff morale and the pursuit of excellence. He spoke to DEA's SCIENCE WRITER

DIPLOMAT EAST AFRICA:  What are some of the changes that you have brought at KEMRI as CEO?

DR. SOLOMON MPOKE:The first area that I focused on was our operation systems. I noted that there were several documents meant to enable us operate efficiently and transparently that were either not in place or not up to date. The lack of relevant policy documents presents opportunities for systems to be abused. One of the things I did was to constitute a committee to develop a finance manual to streamline handling of funds from donors, exchequer and from other sources like the income generating activities that we run. We now have a Finance Manual in place.

We next focused on a very critical area - the human resource. Although we have been running the human resource (HR) department for many years, we felt there was a need to review some of the documents in use at the HR department. This became necessary because the government has also been very pro-active in ensuring that the terms and conditions of service of its labour force is constantly reviewed to enhance effectiveness, competitiveness and fairness in the discharge of assigned responsibilities