Fellowship Site: Mali

The University of Maryland and the University of Bamako have worked in close partnership for 15 years on studies of malaria drug resistance, pathogenesis, immunity, epidemiology, genetics and clinical trials of vaccines and drugs. This successful research partnership has resulted in 40 peer-reviewed scientific papers since 1995, in the process creating a rich environment for training U.S. and Malian clinical translational malaria researchers.

In 1988, the Malaria Research and Training Center (MRTC) was created within the Department of Epidemiology of Parasitic Diseases at the University of Bamako, through a partnership grant from the Rockefeller Foundation and the World Health Organization (WHO) to a consortium including the National School of Medicine and Pharmacy (now the Faculty of Medicine, Pharmacy and Dentistry) in Bamako and the Laboratory of Parasitic Diseases at the U.S. National Institutes of Health (NIH).

Professor Ogobara Doumbo, the chairman of the DEAP since its inception and the current MRTC Director, and Professor Yeya Toure, the former Director of the MRTC and a renowned entomologist, built one of the strongest malaria research institutions in Africa, with support from numerous funding agencies and collaborative relationships with several Northern and Southern research institutions. The MRTC is now a large campus of seven buildings with laboratories, offices and a guest house, and its research scope includes clinical trials, clinical and molecular parasitology, immunology, pathogenesis, drug resistance, basic and molecular epidemiology, basic and molecular entomology, and geographic information systems and remote sensing.

Malaria vaccine development and testing is now a major component of the MRTC's scientific mission, with an active program on transmission-blocking vaccine development, state-of-the-art clinical and immunology laboratory facilities, and multiple clinical trials sites. The most fully developed of these, the Bandiagara Malaria Project, is an NIH-supported collaboration between the MRTC and the University of Maryland's Center for Vaccine Development, and has been the site of four malaria vaccine trials and numerous epidemiological studies.

The MRTC offers a rich scientific environment for malaria research trainees. In addition to direct mentoring provided by senior MRTC investigators, Fogarty Clinical Research Scholars have an opportunity to interact with distinguished visiting scientists from collaborating African, U.S. and European institutions. These interactions range from informal discussions over dinner at the Guest House in Bamako, to attending scientific seminars by visiting scientists, to direct collaboration on research projects. When appropriate, Scholars may attend international scientific meetings. For example, 2005-2006 Scholar Craig Conard attended the 4th Multilateral Initiative on Malaria Pan-African Malaria Conference in Yaounde, Cameroon in 2005.

Research training is a major part of the MRTC's mission. Professor Doumbo and Professor Christopher Plowe have led a Fogarty Malaria Training Grant since 2000, providing graduate degree training in malaria research to Malian scientists, with an emphasis on clinical trials and bioinformatics. The MRTC has organized and hosted many international training courses sponsored by the FIC, the MacArthur Foundation, the World Health Organization and the International Atomic Energy Agency, on topics including epidemiology, entomology, malariology, bioethics and molecular assays for drug resistant malaria. Good Clinical Practices (GCP) courses have been held at the MRTC annually since 2001. MRTC faculty serve as thesis advisors for numerous MD and PharmD degree candidates each year, and provide postgraduate training in malaria research to Malian science graduates.

Professor Doumbo serves as the Mali Program Director for the Maryland-Mali Fogarty training grants, and is assisted by several other senior faculty who provide mentoring for clinical and laboratory-based research.

In 2002, the University of Bamako Faculty of Medicine was designated one of three NIAID International Centers of Excellence in Research (ICERs), based mainly on the scientific accomplishments of the MRTC. In 2003 the FIC awarded a grant to the University of Alabama at Birmingham that provided training in clinical research management to the ICERs, providing institutional capacity strengthening for the MRTC and other research groups at the School to enhance their ability to conduct clinical trials and manage research.

Current NIH-funded clinical research at the MRTC includes the following projects:

1. Randomized, Double Blind Phase 1 Clinical Trial on the Innocuousness and Immunogenicity of the AMA1-C1/Alhydrogel® Vaccine against Malaria caused by Plasmodium falciparum in Semi-immune Adults in Donéguébougou, Mali
2. Randomized, Double Blind Phase 1/2 Clinical Trial on the Innocuousness and Immunogenicity of Essai Clinique de Phase 1/2 of the AMA1-C1/Alhydrogel® Vaccine against Malaria caused by Plasmodium falciparum in Children in Donéguébougou and Bancoumana, Mali
3. Randomized, Phase 1 Clinical Trial on the Innocuousness and Immunogenicity of the AMA1-C1/Alhydrogel® + CPG 7909 Vaccine against Malaria caused by Plasmodium falciparum in Semi-immune Adults in Mali (Donéguébougou)
4. Randomized, Double Blind, Dose Escalation Phase 1 Clinical Trial on the Innocuousness, Reactogenicity, and Immunogenicity of the AMA1-C1/Alhydrogel® + CPG 7909 Vaccine against Malaria caused by Plasmodium falciparum in Children in Mali (Donéguébougou)
5. Randomized, Controlled, Dose Escalation Phase 1 Clinical Trial to Evaluate the Safety and Immunogenicity of WRAIR’s AMA-1 Malaria Vaccine (FMP2.1) Adjuvanted in GSKBio’s AS02A vs. Rabie Vaccine in 1-6 year-old Children in Bandiagara, Mali
6. Randomized, Controlled Phase 2 Clinical Trial to Evaluate the Safety, Immunogenicity and Efficacy of the AMA-1 Malaria Vaccine FMP2.1/AS02A vs. Rabies Vaccine in 1-6 year old children in Bandiagara, Mali
7. Malaria Incidence study in infant, Bancoumana site
8. Longitudinal Analysis of B cell Immune response to P. falciparum in Kambila, Mali
9. Establishment of normal immunological parameters among healthy volunteers in Kambila, Mali
10. Malaria and erythrocytes studies at Kangaba/Kela, Mali
11. Congenital and neo-natal malaria in Mali

More Project Details from the NIH/CRISP database

In addition to the NIH-funded research projects described above, a large number of research projects funded by other European and international sources (e.g. WHO) are active at the MRTC.

Following orientation at the FIC and at the University of Maryland's Center for Vaccine Development, Scholars will arrive in Mali and receive an orientation to the MRTC. Scholars are expected to have one primary project and one or more secondary projects. Based on their interviews and correspondence with the Program Directors, some Scholars may already have chosen a project and will begin work shortly after arrival, following training in malaria microscopy and basic malariology. Scholars who have not chosen a project in advance may rotate through several laboratory-based and/or field-based projects before choosing one. Typically, Scholars work primarily on a clinical trial, functioning as a full member of the clinical investigative team, after Human Subjects certification and GCP training. Since most clinical trial activity is concentrated in the July-December malaria transmission season, Scholars usually spend more of their time in the field during the first months of the training period and more time working on data analysis and write-up in Bamako during the latter part of their experience. During the winter and spring months it is also possible for fellows to do laboratory-based rotations in malaria immunology or genetics at the MRTC campus in Bamako, to round out their malaria research training experience.

It is not usually feasible for Scholars to develop entirely new projects, write protocols, and obtain necessary approvals and resources to conduct these projects all within the 10-month training period. For this reason Scholars are expected to work on funded, approved projects that are already planned or underway at the start of their training. However, opportunities do exist for novel ideas and secondary projects nested within existing projects. Most MRTC projects are well funded and can absorb modest additional costs of Scholar-initiated sub-projects, but funds will be budgeted for additional materials and reagents for Scholar projects. In addition, the Fogarty Malaria Training Grant and Dr. Plowe's Howard Hughes award have discretionary funds that can be used for this purpose.

Housing Availability:
The MRTC has a fully furnished Guest House located on campus. The Guest House provides basic facilities and amenities at a level found in 2-star hotels, including a full time cook, free washer and dryer, satellite television, telephone and reading and video libraries. Free high speed internet is available. Some previous Scholars have elected to live in private apartments in Bamako after an initial period at the Guest House. There is also additional housing available in downtown Bamako associated with the MRTC. There are ample apartments available for rent in downtown Bamako as well for a decent price ($100–$200 per month, utilities not included). Houses typically rent for $700–$800 per month for a 3 bedroom. When working at rural field sites, Scholars share housing and meals with the MRTC research team. Rural field site housing ranges from well-established vaccine trial sites with air-conditioning, hot water and internet to more rustic facilities at smaller sites, which are nevertheless popular with U.S. students. Other trainees and visiting investigators will also be staying at the Guest House and at larger field sites, providing Mali-experienced companions for meals, shopping and other excursions. Approximately 2-4 University of Maryland medical students visiting Mali as Doris Duke Malaria Research Fellows will be in Mali each summer at the time the FICRS Scholar arrives.

The Guest House is located on-campus. The main field sites are 30 minutes to 2 hours from Bamako by car, with the exception of the Bandiagara Malaria Project, which is 8 hours drive from Bamako, in the Dogon Country. Students typically spend more of their time at field sites during the fall rainy season, when malaria transmission peaks, and more time at the main MRTC campus during the spring. Those staying at sites within a few hours drive of Bamako often return to Bamako on some weekends to do laundry and enjoy other amenities.

The rate for students for full room and board at the Guest House is $1100/month. At field sites accommodation is free and food costs $5–10/day.

The guest house and all laboratories and offices at the main MRTC campus in Bamako as well as the Bandiagara Malaria Project research clinic are linked to the NIH computer network. Wireless internet access is available at most MRTC facilities including the guest house.

Health Issues and Immunizations Needed for this Site:
See the Centers for Disease Control and Prevention Web site and The Yellow Book: Health Information for International Travel.

The FICRS program mandates that all Scholars see a physician prior to their assignment abroad. The site will require a formal letter from your physician stating that you have received the necessary immunizations prior to the start of your fellowship (hepatitis A, yellow fever, typhoid, polio, meningicoccal).

Scholars are provided with pre-travel health evaluations and immunizations, and with evacuation insurance from SOS. Country-specific travel health advice is provided in the orientation packet, with a focus on preventing and treating travelers' diarrhea and malaria, and road travel safety. Clinical research staff are trained in Universal Precautions for Preventino of Transmissoin of HIV and management of accidental exposures to infectious agents. Treatment and SOPs for accidental exposure to blood-borne pathogens are available at all clinical research sites. The HIV seroprevalence in Mali is among the lowest in sub-Saharan Africa, at approximately 2%.

Safety and Danger Issues:
Mali is one of the safest countries in Africa. Violent crime is rare, though burglary is common as it is in any poor country. Students receive an orientation guide which advises them to use common sense, e.g. not to venture out alone at night, to keep valuables in a safe place, not to wear ostentatious jewelry in crowded public places, etc.. It is generally safe to walk around at night even in the capital city of Bamako, but women are advised to go out at night in groups. From time to time, the U.S. State Department issues a travel advisory for remote areas in the far north of Mali; however, the rural research sites students visit are hundreds of miles away from the trouble areas and are very safe.

Mali is one of the most stable democracies in Africa. However, in the unlikely event of major civil unrest, we would work closely with the U.S. Embassy to arrange safe evacuation of Scholars, with assistance from the resident NIH Senior Scientist (Dr. Richard Sakai) who is officially attached to the U.S. Embassy in Bamako and who receives all emergency bulletins from the Embassy by cell phone and short-wave radio.

See the U.S. State Department Web site for additional information.

Language Requirements Other than English:
French is the official language in Mali. For clinical trainees, some level of French is helpful, but most of the staff is bilingual and many non-French-speaking students have had excellent training experiences. Training in French as well as major local languages (Bambara, Peuhl, Dogon) can be arranged.

What is it like to live in Mali?
Mali is a large land-locked country in West Africa comprised of Sahara desert in the north, Sahel in the middle and Savannah in the south. It is the site of centuries-old empires, with a long and illustrious history of civilization, education, trade, religion and culture. Today the population of approximately 10 million is predominately Muslim, but many other religious groups and many different ethnic groups live harmoniously in Mali. It is one of the poorest countries in the world, but has one of the richest cultures in Africa. The stable transition to democracy, the excellent university and the community of world-class scientists have made Mali a favorite of northern governments, aid organizations and research funding agencies. Please refer to www.care.org/virtual_trip/mali for more information on Mali.