Finding the true burden of RSV and influenza among the youngest children in Sierra Leone
March/ April 2022 | Volume 21 Number 2
Dr. Robert Samuels is a physician scientist at the Kenema Government Hospital (KGH) in Sierra Leone. After completing his medical training, he studied the impact of hepatitis B on Ebola survivors and Lassa fever patients. He did a one-year fellowship with the Vanderbilt Vaccine Research Program, serving as a research assistant on the Moderna phase III COVID-19 vaccine trial. Currently he is completing an evaluation of the prevalence of influenza and respiratory syncytial virus (RSV) in children under 2 hospitalized at KGH.
Q & A with Robert Samuels
Robert Samuels, MBChB, MSCI
Tell us about your current Fogarty project.
Most patients with respiratory signs and symptoms are treated for bacterial pneumonia without laboratory confirmation. This can lead to problems. Patients blindly given antibiotics have a high probability of developing resistance. If we give antibiotics to patients who don't need them, we deprive patients who do need them. Also, an incorrect diagnosis sometimes leads to longer hospital stays with higher risk of nosocomial infections (infections originating in the hospital).
My study aims to understand the true burden and seasonal variation of RSV and influenza among the youngest children in our region. If the data shows high numbers of RSV and flu infections, that justifies the need for rapid diagnostic tests. These tests would help us make correct diagnoses — lowering both hospital admissions and antibiotic misuse — while also improving our district labs. We've collected samples from 503 participants and expect to find not only RSV and flu but other respiratory viruses: human rhinovirus, parainfluenza, metapneumovirus, adenovirus and coronaviruses. In the end, I hope this data informs diagnosis and treatment policies and provides a foundation for long-term viral surveillance.
What skills did you acquire as a Fogarty trainee?
I acquired skills for mentoring, managing projects, and writing proposals and publications. The Vanderbilt Vaccine Research Center gave me hands-on experience during the Moderna vaccine trial. I was involved in pre- and post-vaccination assessments of participants, and I also took part in the decision-making processes, including organizing parts of the trial. Through collaborations and networking, I developed partnerships with researchers from the U.S. and other countries. I also helped Vanderbilt University medical students on research proposals and projects related to Sierra Leone. Fogarty has not only helped me but also my colleagues and Sierra Leone.
How can Sierra Leone improve health care?
First, we need to develop our human resources. Currently, we have epidemiologists, often specialized, but we need a broader base of clinical and public health scientists. We need to develop scientific
teams —biostatisticians, clinical trial experts, bioethicists, lab technicians, and all the other occupations that make research possible. We also need people educated to practice clinical specialties at the Masters' level or higher instead of the level of certificates and short courses.
Another priority is infrastructure: Building new research centers with electronic records while strengthening old ones. These centers need an established data management system that extends through hospitals so that the flow of data is uniform. Right now, most of our data is paper-based and most of our lab capacity and infrastructure is based in the city. We need to decentralize labs and equip them to a higher level so that district labs can do cultures and other specialized tests.
Finally, we need to create mentorship programs that start in the undergrad years and move into postgrad. I benefited greatly from my mentors. Aside from personal development, an established program can also help a community or region develop because it leads to publications that influence and inform local policies.
Over the past year or two, the health ministry has placed a lot of attention on using quality data to inform policies and overhaul the system. Lab assessments have been performed and funding is being sought. We now have a postgraduate college with community health and clinical research programs. So, our government is working on these goals… despite the over-time required! Also, my generation will keep up the pressure to drive these changes.
How do you balance patients and research?
In the mornings and early afternoons, I work as a clinician on the pediatric and Lassa fever wards, which includes treating both pediatric and adult infectious disease cases. In the afternoons, I work on research activities. Currently, I supervise two teams—one works on the RSV/influenza study, another works on a pediatric mental health study. I also serve as co-PI on other projects. When I find the time, I also clean and analyze research data, review papers and write research proposals. My days are busy, but I love what I do.
I became a doctor because I wanted to use my skills and knowledge to bring about change in people's lives—mostly patients —and to help governments and stakeholders make required changes to the health sector. Doctors in resource-limited settings, like ours, often lack the necessary tools and data to treat patients. So really my greatest desire is to combine clinical medicine and research so we can practice evidence-based medicine. This requires establishing systems so physicians can collect and use data to bring about necessary change.
First on my list is to complete my research project — after we finish analyzing the samples, I will write and prepare a manuscript for publication. I've also been training nurses in data management at KGH. My intention is to roll out data training to the entire hospital. I have coordinated the renovation of a data office in the pediatric ward with plans of extending this to the entire hospital. Finally, I’m working on a study of preexisting COVID-19 immunity with plans for clinical trials this year. In 2023, I hope to secure scholarships for a Ph.D. in clinical immunology. Finally, developing a robust mentorship program for Sierra Leone is a goal I hope to accomplish in the next several years.
Generally, I plan to use my position to push for informed policies based on quality data. I talk with colleagues and partners about the need for data collection and management, clinical trials, and long-term viral surveillance. I enjoy working with younger researchers.
Updated April 22, 2022
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