Primary liver cancer, of which hepatocellular carcinoma (HCC) constitutes 80-85%, is the third largest cause of cancer mortality in the world with an aggressive and unequal distribution that falls heavily on sub-Saharan Africa and Asia. The HCC prevalence rates in such areas are influenced by certain disease risks, especially chronic viral hepatitis B (HBV) and hepatitis C (HCV). While therapies for HBV and HCV are available in the developed world, there is less access in the developing world. Even in countries where these disease profiles are lower (such as the UK), alcoholic liver disease is another prime culprit, therefore making HCC a truly global problem. Managing the risk factors in the aetiology of HCC remains a great challenge to reducing incidence rates of this unforgiving disease in the developing world. However, Imperial College London’s Liver and Anti-Viral Centre is leading hepatic research by evaluating urinary biomarkers that could distinguish who is at risk of HCC in resource constrained areas.
The Imperial College Liver Research team have been driving a unique partnership with Jos University Teaching Hospital (JUTH), Nigeria, in order to reduce the risk of HCC in Africa by first targeting chronic viral hepatitis B. This is part of a greater collaboration between European and African researchers, formalised through the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) consortium. Initial analyses had been hampered as previous samples sent by courier arrived in London thawed and potentially unusable. As a research assistant, I was then tasked with bringing the biological samples back from Nigeria and keeping them frozen at all costs. Through this incredible opportunity I gained an exciting insight into cutting-edge medical investigations which have the potential to help mitigate key global health concerns.
It is possible that Nigeria’s unpredictable and risky reputation prohibits much needed medical research from taking place, particularly as the Foreign & Commonwealth Office advise against all but essential travel to prospective field-sites such as Jos. I then had to stay in Abuja, the federal capital, and have the samples transported by staff from JUTH. Insecurity is all the more unfortunate as everyday Nigerian people were so welcoming. They fully realised the extortionate human cost of HCC, as almost everybody I met knew of somebody who died of liver cancer. This really shows how political instability continues to have a direct impact on medical advancements in the developing world.
Arriving in Nigeria and finding my hotel room without a freezer unleashed a sense of panic. Where on earth could I keep these solidified, safe and within my reach at all times? I had no choice but to approach the hotel’s burly Scottish chef and ask to store the human fluid samples in his meat freezer. Although, I pleaded that the frozen tests were not a bio-hazard and posed no risk of infection, this only made him despair more. The thought of having body fluids in his kitchen and in his freezer was clearly giving him a coronary, despite my best assurances. Looking back, negotiating with the chef and convincing him to store the samples made Nigerian immigration (with all their AK 47s) look like teddy bears. The security staff, once they fully understood my mission, simply said ‘please come back one day and help us’, instead of refusing to clear the samples. It was quite moving to see how the words liver cancer could evoke so much fear, understanding and hope in people.
The greatest challenge I faced in Abuja was having such little control over the sample’s welfare, what if the chef couldn’t see how useful this study was? What if customs tried to make my life difficult? What if the plane lost my luggage? Nigeria was a valuable lesson in how to be nimble, how to think on your feet, and think fast. I can’t imagine how anxious the clinical research team were to have somebody inexperienced (let alone not yet a medical student) have the responsibility of escorting the frozen fluids from Abuja, hurdling the chef and clearing Nigerian immigration with category B samples. However, their decision to allow me to participate in their study is solid proof of their progressive, flexible and holistic approach to research and their knowledge that everybody has to start somewhere.
Absolute recognition goes to the team at Imperial College for being brave enough to let me assist with their study, to Stefan the chef for saving my bacon and to Dr. Carol Brosgart, who works in the field of HIV, HBV, HCV, for never failing to inspire me.