When accepting the 2018 Prize of the Dr LEE Jong-wook Memorial Foundation, Dr Nazni Wasi Ahmad from Malaysia quoted Paulo Coelho: "Don't allow your wounds to transform you into someone you are not!"
A scientist from the Institute of Medical Research at the Ministry of Health of Malaysia, Dr Ahmad was recognized with the prestigious award for her exceptional work of healing diabetic wounds and preventing limb amputation.
Dr Ahmed’s team invented an innovative, effective treatment that heals foot ulceration of diabetic patients. They brought their research findings from the laboratories to the bedside of people with diabetes, with huge public health gains as the prevalence of diabetes in the country is 20% for people above 30 years of age. Their method was to apply live, sterile larvae (maggots) of a local strain of blowfly directly into necrotic wounds. This reduces the bacterial contamination of the wound and stimulates healing of intractable foot ulcers. Foot amputations are therefore prevented, avoiding the psychological burden and social stigma from which amputees and their families suffer.
"There is nothing more satisfying than seeing my research finding being used for the benefit of mankind, when it saved the limbs of patients," says Dr Ahmed. She remembers a retired diabetic policeman who had been told his affected limb had to be amputated. He did not give up hope and volunteered to be the first patient to test her new maggot therapy. The trial was a huge success and his limb saved. "I can never forget seeing his happiness and gratitude, being saved by maggots!"
The innovative maggot debridement therapy was then broadly introduced in primary health care settings across the country, even in hard-to-reach areas. "Isn’t this exactly what primary health care is all about, as advocated by WHO?" exclaims Dr Ahmed. "We have given an easily accessible and affordable treatment for people suffering of diabetes complications, even those who are socially, economically and geographically disadvantaged."
It has not been an easy journey for Dr Ahmed and her team at the Institute. "Flies are disliked by all humans on earth," she sighs. "They are considered the dirtiest creatures of no value at all, since times immemorial." However, having worked on controlling vectors and flies, the team was inspired to look at the other side of the coin. Apart from applications in forensic science, they discovered the precious potential of using them to treat diabetic wounds. The result has been remarkable, but they are looking further ahead.
Vector-borne diseases such as dengue and chikungunya are also under their radar: they would like to explore the potential to apply their techniques to supress the disease-transmitting mosquitoes populations and 'replace' them with 'good' mosquitoes that are not able to transmit infections. They also consider possible vaccine development, as well as leech therapy – already widely used in various medical conditions. "This is an amazingly promising area for improvement in healing diabetic wounds," says Dr Ahmed. "Patients will no longer need to take multiple antibiotics as prophylactic, which can save many people who develop complications because of antimicrobial resistance that occurs when antibiotics are prescribed in big quantities."
Dr Ahmed has a vision: she and her team would not want to see increased number of patients who benefit from their treatment! This is because they hope that less and less diabetics in Malaysia will suffer from severe complications if they are diagnosed early. She even hopes for a reduced burden of diabetes, by increase of awareness and decrease of risk factors.
"WHO’s diabetes programme has been a global leap in curbing diabetes," she says. "My country, like many others, struggle to control this chronic disease in the best way possible, and help people live an active and productive lives. But maybe the children of today will find a cure for diabetes? Perhaps using stem cells? Or deriving drugs from plants? The future is ahead for the researchers coming next. In the meantime, we are working tirelessly to minimize complications and maximize the quality of life for all people with diabetes."
Until treatment is discovered, the therapy invented by Dr Ahmed, awarded by the Dr LEE Jong-wook Memorial Prize for Public Health, prevents limb amputations and ensures quality of life for thousands of people suffering of diabetes. Her work is an example of how research brings benefits to patients.