The history of Medial research in
Sudan
A M EL Hassan
Early history of research
• This presentation is about some of the heights
of early research in Sudan and the more
recent research activities in the country
• Some of the early history is based on a PhD
thesis by Dr Ahmed Bayoumi
Early history
• The beginning of medical research was mainly
due to Sir Henry Wellcome in 1902 when he
donated lab equipment, a library and a museum
to Sudan
• In 1903 Sir Andrew Belfour assumed the
responsibility of Director of research (Wellcome
Research lab). He was also Medical Officer of
Health in Khartoum province and sanitary advisor
to the Sudan Medical Department. This was the
early link between medical research and services
in Sudan
Early history
• The objectives of the Wellcome Research Lab
was to study health problems of importance in
humans and animals in Sudan, particularly
infectious tropical disease and to promote
technical education in these areas
Early history
• Andrew Balfour succeeded in eliminating
mosquitoes and malaria in Khartoum as a result
of his applied field research
• Another important disease that was addressed
was Visceral leishmaniasis which was diagnosed
in Sudan in 1904 but there was no known
treatment for it and it was invariably fatal
• JB Christopherson, working in the Khartoum
succeeded in treating some VL patients with
Sodium Antimony Tartrate but the drug was toxic
A tribute to J B Christopherson
• Christopherson was a physician and Director of Khartoum
and Omdurman Hospitals and was also Director of the
Department of Health in the early part of the 20th century
• As I mentioned he was the first to treat VL by Sodium
Antimony Titrate in 1906 and the first to diagnose Mucosal
leishmaniasis in 1914.
• In 1919 he treated Schistosomiasis with Sodium Antimony
Tartrate. Until I was a medical student in 1950s we were
using this treatment
• He vaccinated 10,000 individuals against small pox in the
greater Khartoum area
• He was also involved with others in the research on
mycetoma
A tribute to J B Christopherson
• This is how JBC moved
around Khartoum and
Omdurman: the
milkman’s way!
A book about Christopherson
By his great granddaughter
who visited us here and we
held A special meeting about
Bilharzia in honor JBC
Earl research in mycetoma
• Dr. Albert Chalmers, Director of the Wellcome Tropical
Research laboratories (1913-1920), together with Captain
R.G. Archibald, pathologist, and Dr. J.B. Christopherson,
carried out valuable systemic mycological and pathological
studies of the causal organisms of mycetoma.
• Chalmers and Archibald gave quite an elaborative and
specific definition of mycetoma.
• For the first time they introduced the terms
Maduromycosis and Actinomycosis, described the structure
of the grains of Maduromycetoma which are composed of
large segmented mycelia and Actinomycetoma whose
grains are composed of fine non-segmented filaments.
Stack labs
• In 1925 the Wellcome Labs were taken over by
Sudan under the Department of Education and
were moved to the Stack Labs near the Khartoum
Civil Hospital and the Kitchener School of
Medicine. The lab was named after Sir lee Stack
Governor General of Sudan who was assassinated
in Egypt in 1924
• Malaria entomological surveys were carried out
in the Gezira by Louis
• Yellow fever was discovered by Kirk and Louis in
Western Sudan in 1934
• I give examples of how research was
flourishing in selected institutions in the
country and how this has been adversely
affected by sanctions.
• Had it not been for some NGOs based abroad
who came to our rescue, it would have been
impossible to undertake meaningful research
that addresses the health problems of the
poor marginalized communities.
Mohamed Hamad Sati
• In the years that followed, the Stack Labs
undertook epidemiological, operational and basic
research in many diseases such as leishmaniasis,
Onchocerciasis, meningitis, relapsing fever,
Rabies, enteric fever and others
• Notable is the work of Satti, Kirk and Lewis in
leishmaniasis that led to the mapping of vectors,
and detailed descriptions of the various forms of
leishmaniases. This culminated in the discovery of
Pentostam for the treatment of VL in 1940. We
use the drug till today
Mohamed Hamad Sati and his recommendation to
establish a medical research council: a great foresight
• M H Satti was the first to recommend the
establishment of a Medical Research Council
under the University of Khartoum and the
Ministry of Health.
• He stressed that the need for a council was
urgent since many clinicians were trained in
Europe and were not exposed to tropical diseases
and needed training in this area. They also
needed training in research
• Unfortunately his recommendation was not
implemented at the time
Sudanese Ministry of Health
• The Ministry was established in 1949
• Mansour Ali Haseeb was appointed Assistant Director of
Research in 1952 and he was also the Director of Stack
• One of his main achievements is in establishing training
center of lab assistants at the Stack labs. He sent some of
them for further training in Lebanon. Among them was
Mohamed Salih EL Faki who establish a tissue culture lab in
the mid 1960s. I used this lab for the study of interaction
between lymphocytes and infected macrophages
• This shows the standard to which technicians were trained
The National Council or Research
(NCR)
• Dr Sati's recommendation to establish a Medical Research
Council made earlier saw light when the National Council for
Research was established in 1970. The late Dr Elsamany A
Yaagoub was the Director.
• The Medical Research Council was one of its five sub-councils
of the NCR. MA Haseeb was the Chairman of the MRC
followed by A M EL Hassan and M Amin.
• In 1972 an Institute of Tropical Medicine was established by
the Medical Research Council. The first Director was AM EL
Hassan, followed by Sati. Other staff were Mutamed Amin,
Asim Dafaa Allah, and Suaad Suleiman .
• The Institute of Tropical Diseases included a
Tropical Diseases Hospital in Omdurman. The first
Director was Dr Abdel Ghaffar Abdel Raheem
• Five researchers were trained in Britain. Following
the retirement of Dr Abdel Ghaffar Dr Elkadaro
became the Director.
• He and his staff in collaboration with Institute of
Endemic Diseases started working on
leishmaniasis and other diseases. This
collaboration is still going on
More recent history of Research in
Sudan
• I next review some of the recent
developments in research in Sudan and
discuss some of the problems encountered
• The research flourished as more graduate
students became eager to work on research.
• We started to work closely with colleagues
abroad on problems in Sudan, mainly in the
are of endemic diseases
Collaboration with foreign research
institutions
• The research problems were identified by us and
the protocols were developed by both Sudanese
and foreign researchers. An important part was
the training of both Sudanese and foreign
students in these projects and the development
of infrastructure in Sudan
• The financing was mainly from International
Organizations and the collaborating countries
• We started with North South collaborations but
more recently we have South-South collaboration
The start of North-South collaboration: MSF
Holland
• In 1990 MSF Holland initiated research and
health services in Gedarif State by supporting
a group of Sudanese scientists from the
Faculty of Medicine and the National Public
Health Laboratory to work in remote villages
in Gedarif Sate where visceral leishmaniasis
and malaria were important health problem.
• The main endemic diseases in Gedarif were malaria,
visceral leishmaniasis (kala-azar) and leprosy. Kala-azar
was rife. The drug Pentostam for treating Kala-azar was
only available in the hospitals.
• In 1993 when the Institute of Endemic Diseases was
established with the help of the then VC Prof Mamoun,
we started our research on visceral leishmaniasis and
PKDL. We continued to be supported by MSF Holland.
• We felt obliged to render services to the community
and not limit our work to research.
North-South Collaboration between
Denmark and Sudan
• The project covered the period from 1991 to
1999 and was supported by the Danish
International Development Assistance (DANIDA).
It covered two main health problems: malaria
and leishmaniasis, two of the major health
problems in the Sudan.
• The work on malaria headed by Ibrahim EL
Hassan of the IEND Dr Riyad Bayoumi of the
Department of Biochemistry faculty of Medicine
U of K, Dr Thor Theander from Denmark and Dr
David Arnot from Scotland
• Unfortunately the project was terminated by
the Danish Government because of human
rights issues in the Sudan.
• The results of this collaboration will be
discussed in presentations by Dr A M Musa,
myself in and by Prof M Mukhtar in this
conference. David Arnot will discuss the
malaria part
Collaborations between Sudan and
Britain
• Prof M E Ibrahim of the Institute of Endemic
Diseases collaborated with three distinguished
scientists in Britain: Douglas Barker, Jennifer
Blackwell and Dominic Kwiatkowski.
• This is what Dr Ibrahim said: ‘Douglas Barker,
Jennifer Blackwell and Dominic Kwiatkowski are
three distinguished scientists and wonderful
people from distinguished institutions with whom
I was more than privileged to work.
• Dr Barker and Prof Blackwell collaborated with
the Institute of Endemic Diseases in the
molecular diagnosis and genetics of VL and PKDL
• The researchers discovered new facts and
trained many students. Dr Hiba Salah from the
IEND was awarded a prize by the Royal Society in
Britain for her work on genetics of leishmaniasis
in humans. She was competing with 50
researchers from different parts of the
developing countries
Collaboration between Sudan and the
United States in health research:
• An important project was started in the 1980s between
Michigan University and the National Public Health
laboratory in Sudan.
• The research was on Onchocerciasis. Prof Mamoun.
Prof Hashim W Ghalib, Prof EL Hady A EL Shaikh and
others were the Sudanese scientist involved with the
American scientists.
• The project addressed several issues in onchocerciasis
that included epidemiology, clinical manifestations,
immunology, prevention and treatment. The drug
Ivermectin was used as an effective therapy.
Onchocerciasis in Abu Hamad
• Onchocerciasis in Abu Hamad was first described
by the ate Prof H V Morgan in the 1950s. As a
little boy I came across this disease in a relative
from Abu Hamad that used to visit us in Berber. I
sued to prepare the Tagarouga, Ibrigue and a
rough stone for scratching! I wondered about
what he had. I never dreamt that one day I will be
studying the pathology of Oncho !!
• One of the great achievements to control
Onchocerciasis is in Abu Hamad area in Sudan.
•
Onchocerciasis in Abu Hamad
• Higazi TB, Zarroug IM, Mohamed HA, Elmubark WA, Deran TC,
Aziz N, Katabarwa M, Hassan HK, Unnasch TR, Mackenzie CD,
Richards F, Hashim K. Interruption of Onchocerca volvulus
transmission in the Abu Hamed focus, Sudan. Am J Trop Med
Hyg. 2013 Jul;89(1):51-7. doi: 10.4269/ajtmh.13-0112. Epub
2013 May 20.
• This is what Dr Kamal Hashim, Director of the National
Program for the Prevention of Blindness at Sudan Federal
Ministry of Health, had to say about the project: “ I am proud
that Sudan accepted the elimination challenge in 2006, and it
gives me great joy to declare that we've succeeded in
interrupting transmission of this ancient scourge in Abu
Hamad."
The Blue Nile Health Project (9811985) and continued till 1990
• This was one of the most successful research projects
• Its objective was to control malaria, Schistosomiasis and
other water born diseases in the Gazira and Mangil
• It was organized by WHO and Sudan Government. Two
eminent researchers were involved: Prof Mutamed Ahmed
Amin, Regional Minister of Health Welfare (Wad Madani) at
the time and Prof A A Elgaddal the Project Director
• As a result of this project, Malaria was less than 1% and
Schistosomiasis was less than 10% in the area by 1990
• Prof Amin who is now in charge of research at Ahfad
University for Women continued to work in Schistosomiasis
and found a change in its pattern. In some areas Mansoni
infection has changeg to S hematobium
Collaboration in mycetoma research
between Sudan and Britain:
• This collaboration was started by Prof Elshieskh
Mahgoub in the 9160s
• It culminated in the establishment of the Mycetoma
Research Center at Soba University Hospital. The
center is headed by Prof A H Fahal. It offers services to
mycetoma patients in addition to research
• Soba Center collaborates with scientists in Holland
• Mycetoma is now included as a neglected disease by
the Drugs for Neglected Disease Initiative (DNDi) and
consequently Prof Fahal has been awarded a grant to
develop and evaluate new drugs for mycetomas
• The collaboration with Holland in Mycetoma
had enabled several young scientists to be
trained in Rotterdam and to transfer some
modern technology to Sudan.
• Twenty four high quality articles were
published in high impact journals.
South-South collaboration in research
• The Drugs for Neglected Diseases Initiative
(DNDi) is a collaborative, patients’ needs-driven,
non-profit drug research and development (R&D)
organization. It was first established in Sudan in a
meeting hosted by the IEND
• It supports research in several endemic diseases
including leishmaniasis
• It established research facilities in East Africa with
objective of developing new drugs of
leishmaniasis as will be discussed by A M Musa
Cancer research
• In 1966 a Cancer Registry was established by the late Sayed Daoud
from the Stack lab and AM EL Hassan with funds obtained from the
International Agency against Cancer through the help of Denis
Burkitt. It continued till 1982 and stopped
• A new Registry was recently planned but it did not function well
• The Cancer Hospital in Khartoum and the University of ELgazira
have their own Cancer Registries and have published on the subject
• The IEND works on the etiology of some cancers, particularly the
breast and colon
• Ibn Sina Hospital is researching gastrointestinal disease. They
disseminate their research findings through publications and
meetings every month for the last 30 years
Research in the Sudanese Universities
• Research was pioneered by the University of Khartoum and
the University of Gazira
• It is gratifying that the new universities are doing research
and training Graduate Students in research. Their research
initiatives can be accessed through their Websites.
• One University, Alneelain established a Deanship of
research. Prof Mohamed Elamin Ahmed is the first Dean
for Research. His main research is in Hydatid disease, one
of the neglected disease in Sudan and worldwide. He
collaborates with different local institutions including the
Faculty of Veterinary Medicine of Khartoum University
• The 25th International Conference on Echinococcosis was
organized by Prof Ahmed last month in Khartoum.
Research in Traditional Medicine: Prof
Ahmed AL Safi at Maharat Center
• Traditional Medicine Research Institute of the
National Council for Research, was founded by
Professor Ahmad Al Safi in 1980, and the WHO
Collaborating Centre for Research in
Traditional Medicine in Khartoum was
founded by him in 1983.
• Both Institutes are still functioning under
Ministry of Science and Technology.
Other important activities of Maharat
• Professor Safi launched a major ongoing project called
Sudan Health Trilogy in 2006. Its main documents include:
• The Biographical Dictionary of Health Care Professionals
in Sudan documenting the lives and work of the men and
women who have served in health care institutions or
contributed to health and medicine in service and research
in the 20th century.
• A Bibliography of Biomedical Literature in Sudan (19002000). Six thousand entries reached. (This needs updating)
• Other running activities include:
• Al Safi’s most recent publication a book (AL Hakeem)
Introduction of genetics and molecular
biology in Sudan: a great highlight
• Recent years have witnessed a very important
development. Sate of the art methodologies
were introduced in Sudan in the area of
genetics and molecular biology by Prof Imad
Fadl EL Mula at Alneelain University and Prof
Muntaser EL Tayeb at the IEND. These lead to
a better understanding of important diseases
in Sudan at the cellular and subcellular levels.
Many publications attest to this
Introduction of genetics and molecular
biology in Sudan: a great highlight
• Prof Imad Fadl EL Mula of Al Neelain was the first
Clinical Geneticist in Sudan. He founded the
department of clinical genetics at the Radiation and
Isotope Center
• His research output was in the fields of molecular
biology of cancer, disorders of sex differentiation,
urological oncology and molecular biology of
Meningiomas
• All these activities improved the diagnosis of important
diseases at the cellular and subcellular levels
• He now has a grant to study Leptospirosis. He
discovered many cases of meningitis due to Leptospira
Introduction of genetics and molecular
biology in Sudan: a great highlight
• Prof Muntaser introduced Molecular biology
at first in the National Public health lab and
later at the IEND
• He worked on the genetics of endemic
diseases and cancer
• He established the first MSc degree in
molecular biology. Many scientists and health
professionals have been trained and are now
active in their own research
Problems after the sanctions
• There was an improvement in research output since 2003
in some Sudanese Institutions, largely as a result of working
with foreign colleagues in projects supported by European
Universities and NGOs.
• With the sanctions, this collaboration is largely not
possible
• There is now a big problem in obtaining equipment and
reagents for research and diagnostic purposes. In my own
histopathology services lab and at the Instate of Endemic
Diseases there are important reagents that we simply
cannot obtain. If we write to a firm, they either do not
answer or if they do they state that Sudan is under
sanctions.
Publications
• There are problems with publication too
• Even if we have a paper that has been accepted for
publication we are not able to cover the expenses of
the publication. We cannot transfer money from
Sudan. Our personal bank accounts in England and
other European countries have been frozen.
• We therefore have to publish in local journals or in a
WHO, Arab or African periodical.
• However this year some good journal abroad have
published papers from Sudan. Indeed some of us are
reviewers for high impact journals
Local funds for Research and the poor
career structure of researchers
• Lack of funds is a major problem. In several
strategic research plans conducted over the last
30 years it was recommended that 1-3% of GNP
should be allocated to research. This was never
implemented.
• Because of the problems of obtaining funds from
outside the country, the meager or lack of local
funds and due to the poor career structure of
researchers, qualified researchers are leaving the
country
A new phenomenon. Research the easy way: Hunters
and gatherers
•
•
Because of the constraints faced by
potential researchers they fall easy
prey to practices that serve them
individually but are harmful for
research development in the country.
One of these practices is to team up
with a foreign researcher or group of
researchers to do research on a
problem in the Sudan. It is irrelevant
whether this is a priority for Sudan or
not. Often the collaboration is not
through local institutions. The role of
the researcher is then to collect
material and data for a project that
was conceived, designed and largely
implemented abroad. Ethical issues
may be ignored and local capacity
building is nil.
Brain drain
• On 2/12/012 the Ministry of Labour published
the following figures for emigration from
Sudan:
• The number of medical Doctors who left the
country in the last 5 years was 5028.
• This may be an underestimate
Causes of the exodus
• What are the causes of the exodus?
• We have well trained medical professionals
but they are rendered impotent because they
lack the facilities to practice their professions.
• the career structure for researchers and
medical practitioners is poor and financial
rewards are ridiculously low.
A tribute to the Sudanese abroad
• Those who left the country to Europe, the United
States or other countries have done extremely well and
have contributed to medicine and science in the name
of Sudan.
• They never forgot their homeland. They participate in
all the annual scientific meetings held by the different
Sudanese associations. Some regularly visit the country
to render services in the area of their expertise.
• This conference is an example of how the Sudanese
abroad are always extending a helping hand to their
homeland
• One final problem is the absence of a national
body for research policy, a body that sets
priorities of research in the country, co-ordinate
research activities and most importantly fund
research.
• This was the function of the National Council for
Research in the 1980s which was dissolved along
with its specialized councils.
• Research should address not only endemic
diseases but also the emerging or the so called
diseases of civilization
Thank you
EL Hassan 2005