Recap: 2017 ICEH Alumni Workshop & 2015/16 Graduation Ceremony, 7-10 March, 2017

Alumni Workshop 2017 2

The 2017 ICEH Alumni Workshop was held 7-10 March, 2017 and it was a great success. I wish I could thank each one of you in person for the success of the workshop, but until that time comes please enjoy the photo gallery of the week’s celebration (link below).

Just like last year the alumni and current MSc Public Health for Eye Care students have expressed how valuable the alumni workshop is for them and this is accredited to the support and enthusiasm of everyone involved in attendance and those from afar throughout their entire MSc experience. As this is the only workshop of its kind at LSHTM we are happy to hear this.

There has been a large interest in the alumni presentations. Below is a summary of the presentations of the alumni who were in attendance at the workshop for your viewing.

On behalf of the Disability and Eye Health Group, thank you to everyone who contributing to a successful workshop and we look forward to celebrating our new alumni next year and the years to come.

Photos: Click here to view photos on Flikr

ICEH Alumni Presentation Summaries: Alumni Workshop 2017 – Presentation Summary

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TB superbugs need special attention – why do we continue to turn a blind eye?

David_MooreBy David Moore, Professor of Infectious Diseases and Tropical Medicine at the London School of Hygiene & Tropical Medicine

“It is quite possible that we will see a drug-resistant tuberculosis epidemic of unprecedented global scale.” The view of Dr David W Dowdy from Johns Hopkins Bloomberg School of Public Health in a Lancet Respiratory Medicine comment piece this week. Alarming words, and we need to listen.

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Converting shipping containers into clinics in Haiti and Namibia

Diploma in Health Planning, Policy and Finance (HPPF) alumna (1995) Elizabeth Sheehan founded Care 2 Communities (C2C) in 2008. At the time, having worked as a physician’s assistant in the developing world for more than 10 years, she saw women and children dying, and families falling apart, simply because they had no access to care. Elizabeth consulted with health and development experts to explore innovative solutions, and came up with a concept: convert the surplus of used shipping containers around the world into clinics. C2C ensures these clinics provide comprehensive primary care and education closer to where women and children live. The clinics offer quality pharmaceuticals and a lab where patients can get accurate results and diagnoses on-site. C2C hires talented local clinicians who are a part of the communities in which they work. C2C builds a strong supply chain and efficient operations so the clinics are open to serve families every day. Elizabeth refused to accept the status quo and instead combined quality services and innovative design. Since she founded the organization, C2C has opened three clinics – two in Haiti and one in Namibia, which have served more than 15,000 women and their families. Learn more about the work of C2C in this alumni report written by Elizabeth Sheehan.

In poor countries like Haiti, the major causes of death and disability are treatable, preventable illnesses. The need for accessible, affordable primary care is urgent. According to a study from the World Bank, interventions at the primary care level are able to address 90% of community health care demands (Doherty & Govender, 2004). In fact, a health system based on strong primary care delivers better health outcomes at lower cost (Starfield et al., 2005). Primary care affords greater accessibility to the community, especially the poor.

 

Figure 1

Figure 1

 

In 2013, Care 2 Communities launched a social enterprise model for primary health care delivery to low-income communities in northern Haiti: one of the most challenging global markets for healthcare operations. The need for high-quality, community-based care is urgent: government facilities are under-resourced and care standards are low, operations costs are high, and market forces are distorted by an influx of subsidized, intermittent operators that do not meaningfully or reliably reach those in need.

Using the social enterprise model (Figure 1), Care 2 Communities seeks to deliver high-quality health services to poor and low-income families in Haiti. C2C is a fundamentally “mission-driven” organization which has borrowed elements of a private-sector operating model.  This is because we believe that Haitian families need and deserve a reliable, long-term solution to their health challenges — a solution that cannot be achieved through donor funding alone.

Poor families are made more vulnerable by inconsistent or unreliable health service providers. We intend to change that. By running clinics as social enterprises, C2C offers something unique and important to our patients: a guarantee that low-cost, high-quality services will keep the community healthy. C2C offers quality services at the lowest possible cost, and uses these affordable patient fees to support clinics consistently. Focusing on primary care “brings the greatest benefits to the health of families and communities”. Mothers are able to care for their children, children can stay in school, and the entire community will benefit from a  healthy workforce.

 

Maylennie’s Story

Maylennie’s story highlights the impact C2C clinics have on the communities in which they serve:

Maylennie is just over two years old. Her mother was 22 years old when she was pregnant with Maylennie and her twin, who did not survive past four months. As Maylennie’s father lives in the bordering Dominican Republic and can rarely afford to send money home to his family, her mother struggles with caring for her four children on her own. Since birth, Maylennie has experienced numerous health issues. She was hospitalized at two months of age for weight loss and skin infections, but her health never really improved.

Image 2Last August, Maylennie was the first child to join C2C’s malnutrition program. On her first day, she weighed 6.8kg (14.9 lbs) and had an arm circumference of 11 cm and edema on her feet, both clear indicators of Severe Acute Malnutrition (SAM). After 12 weeks in the program, Maylennie reached a target weight of 8.6 kg (19 lbs) and her health has significantly improved, with her playful personality showing.

With the personalized nutrition education Maylennie’s mother received, along with continued support from community health workers and C2C medical staff, we know that Maylennie now has a fighting chance for a healthy future. In a landscape of under-resourced, low-quality clinics, C2C sets itself apart with a commitment to the highest standard of care, from nutrition support for little ones like Maylennie to using a social business model to ensure that care can continue to be accessible for poor families that need it most.

For more information on Care 2 Communities, please visit their website at care2communities.org.

References:

Doherty J, Govender R. Washington: World Bank, World Health Organisation, Fogarty International Centre of the U.S. National Institutes of Health; 2004. The cost-effectiveness of primary care services in developing countries: a review of the international literature. Working Paper No. 37. Disease Control Priorities Project.

Contribution of primary care to health systems and health. Starfield B, Shi L, Macinko J. Milbank Q. 2005; 83(3):457-502.

Images courtesy of Elizabeth Sheehan

Special collection for World TB Day 2017: Insights from recent health policy and systems research

By Mishal Khan (London School of Hygiene & Tropical Medicine)

Background

Tuberculosis (TB) is now the leading cause of death from an infectious disease, and in addition to its impact in terms of mortality, TB has considerable social and economic consequences for individuals. Furthermore, the long (6 to 8 month) duration of treatment, and critical need to ensure adherence to treatment in order to avoid generation of drug resistance, places a substantial burden on already overstretched health systems in low- and middle-income countries. TB is not a new disease, however, and was declared a ‘global emergency’ by the World Health Organisation (WHO) in 1993.

While there have been many successes in TB control in recent decades, particularly around standardisation of case management and recording in public health facilities, progress towards disease reduction is far below what is needed and what is planned. If we keep going as we are – with global incidence declining just over one percent per annum – it will take more than 150 years to meet the 2035 End TB targets of reducing deaths by 95% and incidence by 90%. This signals, I believe, a need for critical reflection on the design and implementation of health systems and policies to control TB, and investigations on how to improve our approach to TB control. Here, more health policy and systems research is critical, and has to some extent failed to receive the attention it deserves. For example, the Global Plan to Stop TB 2011–2015 set a target US$10 billion for Research and Development (R&D) across five key areas – drugs, basic science, vaccines, diagnostics and operational research – with health policy and systems research notably lacking.

HPP’s special collection to mark the day

To mark WorlMishal 3d TB Day, Health Policy and Planning has made some key recent papers freely available in a special collection. It is hoped that these will generate debate and spur future studies to inform policy and public health practitioners and researchers.

The global strategy to control TB, which was originally known as DOTS and has now evolved to become the Global Plan to Stop TB, can have a huge influence on national TB control programmes. The first paper in the collection, by Quissel and Walt (2016), examines how a ‘global network’ for TB control formed, how it shaped policy, and factors influencing its effectiveness over time.  While having a standardised ‘global’ strategy for TB control – or any disease for that matter – has some advantages, appropriateness for different contexts is a major challenge. This is illustrated by an important study by Birch et al (2016), which raises questions about the requirement for daily observation of treatment, and how best to consider patients’ needs during the lengthy course of treatment. The study, which is available as part of the special collection, found that a requirement to visit a clinic daily to access treatment in South Africa may result patients being more likely to miss treatment.

Of course critiquing existing strategies may well be easier than designing better ones, and a recent systematic analysis (2015) of the emerging TB control strategy in Myanmar highlighted critical gaps in evidence to inform policy and resource allocation. In this setting and many others, policy and public health practitioners are therefore making decisions on how to allocate large sums on donor funding without an evidence base to guide them.

Finally, taking a step back to examine the global TB control strategy and what may have shaped it, a policy analysis by Shearer et al (2016) highlights the important role of changes in institutions and ideas to drive policymaking, but proposes that change in policy networks is a necessary intermediate step. Indeed, although the current approach is to have separate (vertical) disease control programs for TB, HIV, malaria and other diseases, a concern with this is that wider health system issues that are not disease specific get neglected. An example of a wider health system issue that impacts on TB control – engaging with for-profit private healthcare providers dominating health service provision in many low- and middle-income countries – is addressed in the final paper in the collection.


Check out our special online collection out together by Dr Khan to mark #WorldTBDay here: https://academic.oup.com/heapol/pages/world_tb_day_2017.

Also listen to our podcast with Dr Mishal Khan explaining the importance of the day along with how we can keep up the momentum and discussion: http://bit.ly/2ocHiFP.

Link to the live webcast of the World TB Day event hosted by LSHTM and UCL: http://www.ucl.ac.uk/live/world-tb-day.

Mishal was also on facebook.com/financialtimes for an interview with them.

Pedometer challenge meets male middle aged civil servants from 1970s

 

The belief that ’10,000’ steps is good for you is relatively ingrained fitness lore worldwide. The belief has spread through high profile global step fitness challenges and the prevalence of relatively cheap, accurate digital step counters. However, before we all became fixated with collecting our own personal health stats and viewing everything as units of ‘steps’, there was a time when such a practice was peculiar: namely the 1970s* [* or, any other time but for narrative purposes let’s say the 1970s].

 

Pedometer from the 1970s

Back then, pedometers were hardly known and were mainly used as a medical instrument. It was for this purpose they were used by groups of randomly chosen male middle-aged civil servants measure rates of exercise in 1970, as part of Whitehall Study.  The study aim was to measure exercise in a typical week that would account for walking at work and during leisure time. The potential effect of the level of physical exertion and rates of coronary heart disease [CHD] had then only recently been indicated, with the MRC trial of anticoagulant therapy on myocardial infarction (1969) noticing that rates of CHD were more frequent and fatal within inactive workers.

 

The follow-up study involved randomly selected Whitehall Study volunteers receiving an invitation from Dr Geoffrey Rose, the study’s lead investigator, whether they would be willing to participate in the study. Volunteers who agreed to participate in the study would then receive a mileage record sheet, pedometer and a pedometer instruction sheet.

 

Whitehall_Followup002

Instructions for using a pedometer

The alien nature of the pedometer was encapsulated by Dr Rose’s description of a pedometer as a little instrument looking like a pocket watch, which clips onto your trousers, or goes in a pocket, and the dial records the distance that the wearer walks. The instructions sheet sent to those volunteers emphasized the care needed to prevent false readings through any other transport other than by foot, as it was reliable to record mileage by bus, train, car or bicycle.

 

Whitehall_Followup007

Extract from a letter from a volunteer expressing his difficulty in performing test due to unusual work circumstances and a German exchange student.

 

The correspondence within the archives leave a record of the difficulty associated in getting volunteers to ‘volunteer’, with several letters back to Geoffrey Rose explaining their difficulties in participating. Letters received back were often apologetic citing holidays, overseas placements or change in work environment. Others raised the difficulty of finding a typical working week to undergo the test, as the letter expresses below (though doesn’t fully make clear how hosting a German exchange student was going to effect the test).

 

The researchers also had to factor in the unreliability of the post office in delivering the pedometers and the failure of the instrument itself. Mr Broadbent noted that ‘this pedometer over-registered mileage by about 50%. Suspecting this, I timed myself over a 40-minute walk in Seaford. I walked fairly briskly and covered probably about 2 miles. The pedometer showed 3 miles”. Dr Rose wrote back a very candid response noting first that pedometer performance had never been satisfactory, and that the over-representation was possibly down to the average stride with some individuals having a much larger stride than the average.

 

Whitehall_Followup005Whitehall_Followup004

 

 

 

 

 

 

 

 

 

It does not seem that the results of the pedometer trial were the basis of any major changes within the direction of the Whitehall Study but displayed how the study had expanded from its original remit on surveying cardiorespiratory risk to include physical exercise and social factors. The longitudinal data from the study confirmed that high physical exercise rates gave protection from a range of mortality outcomes and not just CHD [G. David Batty et al. 2010].

Whitehall_Followup001

Table showing some of the results from pedometer trial group. Average miles walked for the group was 1.89 miles or 3992 steps if you prefer

 

References:

Forget walking 10,000 steps a day – I have another solution, Stuart Heritage, The Guardian, Tuesday 21 February 2017

Physical Activity and Coronary Heart Disease, Geoffrey Rose, Proceedings of the Royal Society of Medicine, Volume 62, November 1969, pp 1183-1188

Walking Pace, Leisure Time Physical Activity, and Resting Heart Rate in Relation to Disease-Specific Mortality in London: 40 Years Follow-Up of the Original Whitehall Study. An Update of Our Work with Professor Jerry N. Morris (1910–2009), G. David Batty, Martin J Shipley, Mika Kivimaki, Michael Marmot & George Davey Smith, Annals of Epidemiology, 2010

 

World Tuberculosis Day – Unite to End TB in Papua New Guinea

By Jeremy Hill (London School of Hygiene & Tropical Medicine)

World tuberculosis (TB) day is a valuable opportunity to focus on the global epidemic of tuberculosis. In London, I’ll be attending a symposium hosted by LSHTM and UCL  where the program includes the breadth of topics: from the natural history of TB, through to strategies for its elimination. While I’m there I will also be thinking of TB Day last year, which I spent in a very different setting; Daru, the capital of Papua New Guinea’s Western Province and my home for most of 2015 and 2016. My role there was as a doctor at Daru General Hospital; primarily, I was looking after patients affected by a severe epidemic of tuberculosis. Aside from the large number of people affected, the epidemic in Daru is made all the more challenging by high rates of drug resistant TB, including the most difficult to treat infectious strains,  multi-drug resistant and extensively-drug resistant TB (MDR- and XDR-TB). Being a small town of 16,500 people in a remote and under-served part of the world, this slow-burn humanitarian crisis is not very well known, especially in comparison to the much larger scale of the epidemic in more populous parts of the world. However the intensity of the problem, the devastating impact on people and their communities, and the committed response of program leaders and their teams on the ground are all good reasons for members of the health policy community to pay attention.

Context

DOTSY - TB day PNGLet’s start with some context. Daru is an island, 5km across, located just off the southern coast of Western Province. To the south, across the narrow Torres Strait, is the Australian state of Queensland, to the east is the mouth of the Fly River (Papua New Guinea’s longest), and to the West is the protected coastline and the border with Indonesia’s West Papua. The mainland to the north is a remote, sparsely populated region of swamps, forest and waterways – people coming from villages in the South and Middle Fly Districts often travel for days by foot, vehicle and canoe to access essential services in Daru. Responding to droughts, resource limitation affecting regional services, and degradation of the Fly River by the Ok Tedi mine in its headwaters, many displaced people have stayed in Daru to form overcrowded waterfront settlements. This combination of displaced and transitory populations, resource limitation, food insecurity and health seeking across international borders sets the scene for amplified TB transmission and for big challenges to the continuity of TB care.

Papua New Guinea is included on on all three high-burden lists published by the WHO (overall burden, and separate lists for DR-TB and TB/HIV coinfection), with an overall case notification rate in 2015 of 368 per 100,000. However, the TB epidemic in Daru is much more intense: in 2015 we diagnosed 120 people with DR-TB, yielding a local case notification rate of more than 700 per 100,000 for DR-TB alone. For all forms of TB, the notification rate was around 3000 – compare this to the rate of 6 per 100,000 just a few kilometres south in Australia. The burden of disease in Daru is extraordinary, and the impact on the community was profound. Remembering that DR-TB treatment involves at least 20 months of daily observed medicines, with 8 months of daily injections, imagine the prominent place that DR-TB treatment of 120 new patients each year would have in a small town. Imagine schoolchildren excusing themselves from class once a day, or adults managing this around work, or the hundreds of people contributing to the implementation of this sort of treatment program. Imagine a similar program of IV chemotherapy if it were a large cluster of cancer cases in a similar low resource setting. I’m still blown away by the resilience and ingenuity of staff and patients in Daru – and with this in mind I will highlight a few personal observations.

  1. Patients are almost always resilient and committed to their treatment, even those TB clinicwho are missing it

While working as a doctor in Daru, I encountered the convenient attitude of blaming drug-resistance on patients
who don’t take their treatment. I encountered this amongst, patients, leaders, nurses, doctors and myself. In contrast with this perception, patients who missed treatment usually had genuine, understandable reasons for doing so – sometimes a consequence of the treatment regimen itself. Reviewing our program data for weekly treatment adherence conclusively put this to rest: adherence to treatment remained higher than 90% regardless of the resources or staff available. Further, we could pick out the groups of patients who were vulnerable to missed treatment. Families dependent on subsistence fishing or farming, for example, would occasionally miss treatment to obtain food. This emphasised to me the common sense approach of improving adherence by identifying and helping patients deal with the day to day difficulties that TB treatment causes.

  1. Innovations and policy changes at a global level can directly and immediately affect programmatic management

Although Daru is remote and inaccessible, the peer reviewed findings, recommendations, guidelines agreed and published by multilateral organisations or journals such as Health Policy and Planning are not. In addition to this, the TB epidemic in Daru is exceptional – TB is the leading cause of death in Papua New Guinea, and with transmission of DS-, MDR- and XDR-TB occurring in the community, new tools and innovations can and should be rapidly implemented with commensurate monitoring and support. Health policy actors should orient their work to make it accessible to decision makers in high-burden settings; efforts to do so are welcome and already having an effect.

  1. Multiple partner organisations collaborated to deliver a high-quality DR-TB treatment program despite limited resources

By collaborating, working towards shared goals, and adapting where necessary, Daru General Hospital and the Western Province Health Office worked with partners World Vision, the Burnet Institute and HHISP to rapidly improve the DR-TB program in short order. By drawing on the expertise of multiple different partners to deliver basic outcomes, the program built trust with the Daru community, National TB Program, funders from the Australian Department of Foreign Affairs and Trade and multilateral organisations. Starting with infection control and triage at the hospital, and ending with community based treatment and implementation of new TB drugs, leaders at these organisations demonstrated that many aspects of programmatic management of DR-TB are low-tech but administratively complex, and can be done well with limited resources.

Conclusion

Despite the improvement in the curative program, the epidemic is undiminished – of course, treating patients as they arrive at the hospital will not put a dent in that. In response, program leaders are planning a systematic screening initiative, a dramatic intervention that will require support at all levels, including multilateral TB policies and peer-reviewed publications. So, wherever you are on the 24th, remember that our discussions, publications, tweets and actions in this field should be oriented towards the patients and communities affected by TB. Know that patients are committed, know that people want treatment, and remember that policies to support scale up of case finding, diagnosis, treatment and prevention should respond to that – this is true of the largest scale epidemics, the smaller but focused burden in Daru, and everything in between.

Look out for our #WorldTBDay special online collection and further blogs and podcast on Friday 24th March!

“Let’s Face It” – Alumni Photo Competition 2017

Enter the 2017 Alumni Photo Competition for the opportunity to have your photo published on the front cover of the Alumni News Magazine!

The 2017 Alumni Photo Competition opens on Monday 27 March 2017 – the theme this year is “Let’s Face It”.

The theme “Let’s Face It” can be interpreted as narrowly or widely as you like.

Show us what you see on a daily basis – it is your opportunity to share a photo of unique, humorous or griping daily life in your area of work.

The deadline for entries is midnight (GMT) on Sunday 7 May 2017.

Prize: The winning entry will be used as the front cover of the 2017 issue of Alumni News and the winner will receive a selection of School merchandise.

Competition Images

Images from the 2016 Alumni Photo Competition

 

Competition Guidelines:

Alumni may enter a maximum of three photographs. Only alumni of the School may enter the competition.

Entries must be in JPEG format and emailed to alumni@lshtm.ac.uk with “Alumni Photo Competition” in the subject line.

In the email please include: your full name; the date the photograph was taken; course studied at the School and year graduated; an up-to-date phone number; and your current job position and organisation if applicable (only your full name, course studied and year graduated will be made public).

Please provide a caption for your photos (maximum 40 words) – this will be included in the Alumni magazine and may appear in other print and digital publications and on social media. The caption may be edited.

If identifiable individuals appear in your photo, please ensure that you have their permission before submission.

Photos must be in colour only and have been taken within the last three years.

Entries will be judged on originality, quality, composition and appropriateness to the theme.

All entries will appear on the School’s photo library, Assetbank, which is accessible to School staff and students, and the Alumni Flickr page, which is open to the public.

Entries may be selected to appear on the School’s website and social media platforms, which are open to the public.

The winning entry for will appear in the 2017 edition of the School’s annual alumni magazine, Alumni News.

Entries may be used for promotional purposes e.g. School website, social media, Annual Report, Chariot, prospectus, exhibitions, postcards and others.

Copyright – by entering the competition, competitors warrant that they own the copyright in their photograph and they give consent to the London School of Hygiene & Tropical Medicine to store the image and reproduce it in any School-related publication or medium.

If the winning photo does not fit the format necessary for the magazine cover, we reserve the right to use another photo (either from other photo entries or from another source).

11 – 17 March 2017

Karl Blanchet provides comment to Reuters on a new study that shows more needs to be done to protect Syrian healthcare workers as medical services become targets of war: “Syria is just the tip of the iceberg. In Afghanistan and Yemen today, international humanitarian organizations …report attacks on health facilities every week.” The article generates coverage in outlets worldwide including Voice of America, Daily Mail, Channel News Asia and Yahoo.

WIRED UK highlight the ’20 things we learned’ at the WIRED Health conference held earlier this month, including how to address the ongoing HIV epidemic which was the subject of Peter Piot’s talk. Peter says: First of all it has to be back on the top agenda, by that I mean the political agenda, business agenda.”

Martin McKee is interviewed by CNN for a piece comparing various healthcare systems used across the world and how the UK can learn from these models: “The growing number of older people with multi-morbidities are having very very complex trajectories through the health and social care system.”

The Economist discuss research recently published by Martin McKee and Lucinda Hiam that linked the 2015 England & Wales mortality spike to failures in the health and social care system. Martin also writes for BMJ blogs discussing the future of the European Health Insurance Card for UK citizens.

Val Curtis provides comment to NetDoctor following research that suggests eating food that has momentarily been on the floor is very unlikely to cause harm. Val says: “Whilst dropping food on the floor and then picking it up and eating it is less than ideal behaviour, it’s unlikely to make you seriously sick. Much more worrying is people who go to the toilet, or touch raw meat and then don’t wash their hands with soap and then prepare food.”

An editorial written by Charlotte Warren-Gash is quoted in Healio in reference to a study linking non-steroidal anti-inflammatory drugs to a higher risk or heart attack in patients with existing respiratory infections: “Clinicians should consider both medical conditions and existing medications when prescribing NSAIDs for symptomatic acute respiratory infection relief.”

Royal Central cover Her Royal Highness The Countess of Wessex’s trip to Malawi which included visits to a hospital and school to observe Peek (Portable Eye Examination Kit) first-hand and the activities to end avoidable blindness co-ordinated by the School.
Global-Citizen interview Peek co-founder Andrew Bastawrous following his recognition as a 2016 Rolex Award for Enterprise Laureate.

Collection of the Month – James T. Duncan (1884-1958)

61st Session, October-December 1919 with Duncan circled

61st Session, October-December 1919 with Duncan circled

 

It may surprise you to learn that the collection of the month for March consists of only one file, notes made by mycologist James T. Duncan on the ‘Principles of standardisation of agglutinable cultures’.

Who was James T. Duncan?

Principles of standardisation of agglutinable cultures'.

Principles of standardisation of agglutinable cultures’.

James T. Duncan was born in Dublin in 1884 and attended the Dublin Royal College of Physicians and Surgeons, a move that was delayed for five years due to Duncan’s accountancy apprenticeship. Fortunately, Duncan completed his studies in Ireland and travelled to the USA and Canada to visit various medical colleges before returning to England. Instead of taking a position in England, Duncan chose an appointment as a surgeon in Singapore in 1914 and later the Acting Principal at the King Edward VII Medical School (now the Yong Loo Lin School of Medicine).

Did Duncan teach or attend the London School of Hygiene & Tropical Medicine?

London School of Tropical Medicine, Albert Docks

London School of Tropical Medicine, Albert Docks

In 1919, after five years working in Singapore Duncan attended the London School of Tropical Medicine to complete the diploma in Tropical Medicine & Hygiene. Duncan was one of the last students to attend the course at the Albert Dock Hospital before the School moved to the Endsleigh Gardens site.

Dr Newham in 1910

Dr Newham in 1910

Whilst studying Duncan became the assistant to Dr Newham until 1929 where Duncan worked in the Bacteriological Department studying Salmonella and Brucella. Indeed, Bruce suffered for his dedication to the School, in 1927 Duncan contracted undulant fever from a patient at the School, which left him incapacitated for a year afterwards.

Why is Duncan Collection of the Month?

When Duncan moved to Winchester with the Emergency Medical Services, during the outbreak of the Second World War, he was made Chairman of the Medical Research Council Committee on Mycology. His position enabled him to establish a Medical Mycology centre at the London School of Hygiene & Tropical Medicine. In this unit, Duncan was able to collect valuable pathogenic fungi, developed strong links with fellow mycologists globally and was able to examine up to 3,000 specimens annually. The success of the centre led to the formation of other mycology units opening up in England and Scotland.

More importantly, he was greatly respected at the School. In the words of Sir Philip Manson-Bahr:

‘Duncan is a very versatile person who is gifted with a charming and jovial personality who with his merry laugh and chuckle makes a myriad of friends.’