Photo: © Paul Joseph Brown/GAPPS
We depart the crowded, noisy, bustling capital city of Dhaka, first by road and then we board a small outboard motorboat. We move downriver, the noisy motorboat cutting through the warm, boggy air of the Bangladesh delta. We pass the quiet work of fishermen casting nets from canoes, low flat barges of coal and cattle, small villages of corrugated tin, women washing clothes, tall spires of kilns making handmade brick. We arrive at our destination, stepping out of the boat and walking the short path from the river to the hospital. We pass through a dark hallway that opens to a sunny courtyard.
And today we have come to help support the work of icddr,b to address the next frontier – the one area of child survival that has seen the most limited gains: the relentless burden of death of newborns. We arrive to help support the development of research studies of pregnant women, to establish ways to monitor women throughout their pregnancies, and start to unravel the complex and elusive systems that regulate pregnancy and cause preterm birth. These efforts are aimed at discovering ways to identify women at risk and find new solutions to prevent preterm birth, the leading cause of newborn deaths worldwide. I have confronted supposedly quixotic issues already many times in my career. I’ve worked on malaria in the days of emerging drug resistance and studies of insecticide-treated bednets, and I’ve worked to get AIDS treatment to Africa in the earliest days of antiretroviral therapy. Remarkably, I’ve seen dramatic accomplishment in these fields. But we don’t have answers on how to prevent preterm birth. I don’t know if this can be accomplished in my lifetime. But here we are. We are all here together – these experienced icddr,b epidemiologists, doctors, nurses, laboratory technicians, and data managers.
We have all come to roll up our sleeves and start. Start somewhere.
Photo: © Paul Joseph Brown / GAPPS
The team of midwives that we are working with is a formidable group. Between them, they have decades of experience with pregnant women. You can feel their presence and collective experience, their clear command of managing complex medical situations in the most difficult conditions. We gather together in a small room for ultrasound training. They are already experienced practitioners in ultrasound. We’re now building rigorous systems to accurately assess gestational age. The information to be collected by the midwives forms the cornerstone for the complex array of biological investigations on preterm birth. The decade of bench research that will follow relies on the precision of the work of these women.
Photo: © Eve Lackritz / GAPPS
We’re facing a large and complex study – with a projected sample size of 4,000 pregnant women in Bangladesh alone, collecting specimens four times in pregnancy, attending deliveries at all hospitals in the area. The specimens will be shared with a consortium of the top preterm birth researchers in the world, as part of the Preventing Preterm Birth initiative. If it can be done, this group can do it. And if we do it right, we hope even more investigators will join this endeavor, all with the hope to find new answers to the complex problem of preterm birth.
We finally depart our visit. The next frontier has been set in their sights. We leave this ambitious group undaunted by the mission.