Research that saves lives

Walking barefoot on exposed earth hides an invisible threat in many tropical areas: infection with the dwarf threadworm “Strongyloides stercoralis”. Many sufferers experience abdominal pain, diarrhoea and skin rashes for the rest of their lives – and in some cases the disease is life-threatening. There are drugs that effectively combat strongyloidiasis, but the number of reported cases is increasing in parts of Indonesia. “The problem is diagnostics,” says Dr. Elsa Murhandarwati of the University Gadjah Mada (UGM) in Yogyakarta on the island of Java. “Since the larvae are difficult to identify using conventional microscopic methods, a lot of patients fail to receive appropriate treatment.” 

Since 2019, a project being run jointly by the UGM and Saarland University Hospital has significantly improved the situation: microbiological diagnostic laboratories have been set up at the UGM and in hospitals and reference laboratories on four other Indonesian islands. Medical staff have also been trained in the use of qualitative PCR tests that enable a reliable diagnosis. “We and our partner hospitals now routinely use PCR tests when patients are admitted with unexplained gastrointestinal complaints,” says Murhandarwati. 

In a new project, the partners are currently conducting research into the epidemiological spread of strongyloidiasis in Indonesia.  “The collaboration is inspiring,” says Professor Sören Becker of Saarland University Hospital. “We benefit from our colleagues’ experience of tropical diseases that rarely occur in our country.” 

The two projects were made possible by the programme “Hospital Partnerships – Partners Strengthen Health”. Initiated in 2016, this programme promotes long-term partnerships between German health sector organisations and public health facilities in low- and middle-income countries. It is funded by the Federal Ministry for Economic Cooperation and Development (BMZ) and the Else Kröner-Fresenius Foundation, and it is implemented on their behalf by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ). Around 560 projects have been funded worldwide to date. 

Detecting retinal diseases at an earlier stage

Eye diseases are the focus of the collaboration between University Hospital Bonn (UKB) and the Sankara Eye Foundation in India. In 2017 the partners established a new procedure for the early detection of diabetic retinopathy (DR) – first in Bangalore and then in 24 other regions. This retinal disease can result in severe visual impairment and even blindness, but the first symptoms don’t appear until the disease is in its later stages. “If sufferers fail to seek medical advice before then, the damage is often permanent,” says Dr. Maximilian Wintergerst of UKB. 

The new smartphone-based, telemedical DR screening is particularly fast and cost-effective: in addition to a trained technician, all that is needed is a smartphone, an adapter and a lens to take images of the back of the eye, which are then sent to local ophthalmologists for analysis. The successful project is now being extended to Bangladesh, Nigeria and Ghana. 

In 2024, UKB and the Sankara Eye Foundation launched another hospital partnership project together with Microsoft Research India: here, the surgical technique commonly used for cataracts in the global South is to be improved using artificial intelligence. The aim is to apply AI analysis to surgical videos to help eye surgeons detect errors and improve their technique. “The long-term goal is to recognise dangerous situations live during the operation,” says Wintergerst.

Appropriate therapies after snakebites

The World Health Organisation (WHO) classifies snakebite envenoming as a “neglected tropical disease of the highest urgency”. Some 7,500 people die from it every year in Bangladesh, while many more suffer severe impairments such as kidney damage, sometimes requiring amputations. For 20 years, Goethe University Frankfurt has been conducting joint research with Chittagong Medical College (CMC) on venomous snakes and their toxins. 

The partners launched their first hospital partnership project in 2020: a skill lab was set up at the CMC where doctors, nursing staff and students can learn life-sustaining measures in response to all kinds of envenoming and poisoning. In addition, mobile ultrasound equipment was purchased to enable fast and reliable diagnoses around the clock, directly at the patient’s bedside. “Previously, patients had to be taken to external private clinics for ultrasound examinations. They no longer have to bear the strain of transport and high costs,” says toxinologist Dr. Ulrich Kuch of Goethe University. 

In search of a remedy against the venom of the Russell’s viper

The partners are currently working on a pilot project funded by the Government of Bangladesh to produce a new product specifically to combat the venom of the Russell’s viper. Since the development of such antidotes takes a long time, the researchers are also involved in a hospital partnership project to find a quick interim solution: they are investigating whether existing antivenoms for the Thai Russell’s viper are effective in Bangladesh, too, and can gain regulatory approval there. 

Strengthening the healthcare system in Bangladesh

The collaboration is of great interest to the German partners as well and has provided valuable momentum for strengthening the healthcare system, says Kuch: “Other university hospitals in Bangladesh now want to set up their own toxicology wards and skill labs, and the Government of Bangladesh is looking to invest more in equipment for its state hospitals.” Cases of snakebite envenoming are “like a crash test for healthcare systems” because they affect so many different areas – including health education, patient transport, and emergency and intensive care medicine, as well as rehabilitation. “If you have all this well under control, there’s virtually nothing else you can’t manage.”