How to develop research partnerships in India
Sheila MacNeil, Professor of Tissue Engineering in Materials Science and Engineering, has been working with her partner clinician Dr Virender Sangwen at the L.V. Prasad Eye Institute in Hyderabad India since 2012. Here is Sheila's quick guide to developing a successful research partnership.
Find a safe and responsible clinician champion
"You must have evidence of scientific quality and a personal recommendation. Look at who is publishing sound and recent academic papers. Good people in your specialism here will know good people in your partner country. You only get to lose your reputation once; proceed cautiously and slowly. Also, the best decision we made was to hire a regulatory consultant in India.
"I’d failed to find a UK partner who was interested and willing to work in this area with me. My Indian postdoc returned to her home for a holiday and via her father, a clinician, we found LV Prasad Eye Institute. Luckily there was a funding scheme that had started up, Wellcome Affordable Healthcare for India, and we applied to it."
Put a lot of time into communication
"You need to develop really robust relationships – visit, discuss, argue, fall out, pick yourself up, get back on with it – because things will go wrong and there needs to be real respect on both sides. Spend enough time in India with your new colleagues to really tune into the problems that are on the ground. They are often not the ones you expect. Make sure that what you’re proposing to develop is appropriate for India."
Be willing to change your focus
“I always come back from India feeling energised. What we do there has to be economical for the country and I’ve really tried to take on board the discipline of affordability. Research has got to be able to leave the lab door by engaging with end users – patients or clinicians. If our trials are successful, any eye surgeon will be able to do the procedure with an off-the-shelf membrane."
Appreciate what your new colleagues can offer
“Folk in India are unsinkable, no matter what red tape they hit. They are very enthusiastic but not unrealistic. That’s what I love about working in India. Genuine communication between clinicians and non-clinicians is more difficult than you think and not easy in UK (or India). My Indian clinical colleagues have been great for spending time with me. I’ve been able to sit down with them and ask the same questions several times to gain a real understanding of the actual problems.”
Enjoy cultural differences
“There’s a fascinating idea in the research centre I work with in India called the Sight Savers Club. Wealthy people seeking treatment are asked if they can pay more and poorer people only pay what they can afford, even if that is nothing.
"Also, my colleague Tony Ryan explained the meaning of a particular headshake in India which means neither 'yes' or 'no' but simply 'I’m listening' - it’s delightful!”
Sheila is pioneering a new technique that offers an affordable way of treating damage to the cornea, the transparent layer on the front of the eye, which is one of the major causes of blindness in the world.
Currently patients with extensive scarring of the cornea can only be treated in specialist centres where cells from the unaffected eye are cultured and grafted back to the scarred eye using a human amniotic membrane (derived from donated placenta) to deliver them. While the success with this technique is good, there are less than 12 centres in the world, and only three in India, offering this technology to patients.
Sheila’s idea is much simpler. It combines two modifications to the existing technique. It substitutes a very thin biodegradable synthetic membrane for the donor human amniotic membrane currently used to deliver cells to the eye. And it uses tiny pieces of tissue taken from the unaffected eye to regrow a new cornea epithelium on the scarred eye rather than culturing patients corneal cells in clean rooms over several weeks.
“I love the people I’m working with in India, they’ve already got a pretty good solution to what they’re doing, but we think that by working together we can make it better, it’s a real synergy.”
The first technique eliminates the risk of passing on bacterial and viral infections and is much safer and more economical. The second idea of using small pieces of corneal tissue to regrow a new cornea has already been tested on amniotic membrane and indeed a new cornea will grow out from the tissue pieces over an eight-week period with the patient experiencing continual improvement over this time.
It has taken since 2012 but about six months ago Sheila and her team were given approval to work with 10 patients in a first in man clinical safety trial and they've now been treating one patient for four months.
Sheila says that the ultimate hope is that successful trials will go on to help millions of people to regain their sight following scarring of the cornea.
This project has already led to two others. Sheila's colleague Professor Steve Rimmer is leading on developing a low-cost bedside detection for infection in the eye. Their Indian partner says around 300 eyes could be saved every year with early detection. The third project is looking at ways to tackle antibiotic resistance in India by developing a treatment for infections that doesn’t use antibiotics.
If you have a question for Sheila, email her at firstname.lastname@example.org or call x 25995