Leading the fight against asthma.
Professor Eric Donn Bateman is both a global leader in research about asthma (and related diseases) and in improved methods of delivering primary care in low to middle income countries.
These are two different areas of expertise and they tell a story of a man who is not afraid to move into new areas where he sees a need. But he doesn’t just move into a new area, he makes such a significant impact that the world sits up and takes notice.
Currently 66 and with an A2 research rating, Bateman is the director at the University of Cape Town (UCT) Lung Institute and honorary consultant at the division of pulmonology, UCT department of medicine.
He recognised early in his career the need to address chronic lung diseases in South Africa, in particular asthma, chronic obstructive lung disease (COPD), tuberculosis (TB) and pneumonia. These constitute almost a third of the reasons for patients visiting primary healthcare workers. Asthma is the most common chronic disease in children.
Helping people breathe
The burden of these diseases motivated him, in 2000, to found the UCT Lung Institute. Through the Institute, he has led research programmes about asthma, COPD and lung disease in general.
His work on asthma had begun earlier. A landmark paper showed that control over asthma can be achieved. It changed international guidelines and goals around treatment. “Patients and their physicians were accepting a chronic level of impairment and poor quality of life,” said Bateman. The goal became leading a normal life.
It was one of the biggest asthma studies at the time. His work was widely acclaimed and he is still spoken about as “the man who changed the way we treat asthma”.
Bateman has also produced guidelines for the management of asthma and COPD in South Africa. (COPD is a progressive disease that makes it hard to breathe; cigarette smoking is the leading cause.)
In 2002, he was appointed to the Science Committee of the Global Initiative for Asthma (GINA) and was later the chair. GINA’s annually-updated report forms the basis for most national evidence-based asthma guidelines.
He used this opportunity to promote asthma as a global health priority, and was a founding executive member of the World Health Organisation (WHO) Global Alliance against Chronic Respiratory Diseases (GARD).
By 2006, he was convenor and lead author of a major revision of the GINA asthma report.
In another direction and motivated by a desire for practical intervention, he was concurrently looking at treatment of lung diseases at a primary health level. (This later came to include treating the main chronic and infectious diseases seen in South Africa.)
Shortly after forming the Institute in 2000, Bateman and his team conducted preliminary research on assessing the true burden of lung disease and how to improve care. The focus areas were asthma, COPD, TB and pneumonia. Using a WHO programme called Practical Application to Lung health (PAL) as a base, they produced PALSA, Practical Application to Lung health in South Africa. The programme is an integrated care manual with evidence-based clinical practice guidelines for primary health workers. It empowers them to diagnose, treat appropriately and refer for further treatment if needed.
“At that stage, it included the palliative treatment for HIV. This was during a time when no ARVs were available in the public health sector,” explained Bateman.
The programme underwent extensive testing in large clinical studies. It was unique and the research was published in prestigious international journals.
The research team then expanded PALSA to PALSA PLUS, which contained detailed management of patients with HIV. Because nurses could now prescribe ARVs, 100 000s of patients were able to gain access to the needed drugs.
The initial research had been done in the Free State. Following requests from other provinces and the national Department of Health (DOH), PALSA PLUS was rolled out in most provinces.
“A key component of PALSA PLUS is its educational outreach, involving onsite case-based adult learning techniques that provide for rapid scale up. In all, more than 60 000 copies of PALSA PLUS have been distributed to primary care facilities and in excess of 30 000 nurses have been trained,” said Bateman. PALSA PLUS also forms part of the curriculum in nursing colleges.
Thereafter, at the request of the national DOH, PALSA PLUS was developed into Primary Care 101 (PC101) to include a range of priority chronic diseases. This is currently being rolled out in 16 of the 52 health districts, covering a population of 14.7-million. It will eventually cover the whole country.
A real impact
The impact of this programme can be measured by the fact that 85% of South Africa’s population are dependent upon state facilities for healthcare.
“A major part of PALSA’s development into PC101 was to test with rigorous clinical trials in real-life settings within the public health system,” said Bateman. This is in contrast to most health interventions, including those internationally.
To date, research papers on PALSA/PC101 include more than 15 publications. It makes it one of the most rigorously evaluated public health programmes in the world. It is also internationally recognised as one of the most outstanding examples of validated integrated primary care.
The next version of PALSA is called Practical Aid to Care Kit (PACK). In December 2013, PACK was selected as one of 15 innovations for exhibition at the World Innovation in Health congress.
Bateman and his team at the Lung Institute have now developed PACK Global as many countries requested a similar programme. This has already been trialled in Malawi, Mexico City and Brazil.
Beyond what has been mentioned about asthma and the public health interventions, Bateman has also developed new ways of measuring the impact of lung diseases on patients in South Africa. Research around the impact of environmental influences on lung health has provided evidence to support policymakers. His research work also led to the recognition that previous TB is responsible for a large proportion of obstructive lung disease in South Africa.
Across his life’s work, Bateman has published 226 papers in peer-reviewed journals, 22 book chapters and 11 letters to journals and seven other scientific publications.
He is currently a member of the Academy of Science of SA and serves on the board and science committee of GINA and the International Advisory Board of the Burden of Obstructive Lung Disease initiative. He is also a member of the Pulmonary Subcommittee of the US National Institutes of Health Centres of Excellence for Chronic Non-Communicable Diseases Initiative.
The professor serves on the editorial or advisory boards of several international journals and is a frequent reviewer for international and national science journals.
His work has been recognised through a number of awards. Locally, in 2013 he was awarded a Lifetime Achievement Award: Platinum Medal from the South African Medical Research Council.
He received the 2012 Alan Pifer ABateman said that while there are many challenges in being a clinician-scientist in South Africa, it remained a rewarding environment because the health needs are extensive.
“The recent past has shown that medical scientists in South Africa can be global leaders with an impact greater than their resourcing should permit,” said Bateman.