“I started to apply the short treatment regimen in my new country. Most of my patients are now cured and we maintain a durable friendship with them and their families.”

“I started to apply the short treatment regimen in my new country. Most of my patients are now cured and we maintain a durable friendship with them and their families.”

Alberto Piubello, Co-ordinator, The Union’s Drug Resistant TB Programme

Treating patients under a mango tree in Niger with no resources but a table, a chair and medications is a pretty good précis of how Alberto Piubello approaches his work – with steely determination.

As the Co-ordinator of the Drug Resistant TB (DR-TB) Programme, Alberto has over 27 years experience working in Public Health in low-income countries in Africa specialising in TB, HIV, Malaria and, of course, MDR-TB.

Recalling that time under the mango tree, he explains why, despite its limitations, he resolved not to let his patients down. He had seen how Dr Armand Van Deun’s research into a shortened treatment regime for MDR-TB was criticised at the beginning of this pioneering work but that Dr Van Deun had never given up. “It was really inspiring for me,” says Alberto. “It gave me a strong determination to treat my own patients. In 2007, I moved to Niger as Country Representative of the Damien Foundation and I started to apply the short treatment regimen in my new country. Most of my patients are now cured and we maintain a durable friendship with them and their families.”

It was this work that, eventually, led Alberto to The Union. He knew The Union was supporting the shortened regimen and started to collaborate with Union colleagues in 2012 before becoming fully involved as a consultant and, in 2017, as Co-ordinator of the DR-TB Programme.

“Since I was a young doctor my idea was to provide solutions for people living in settings with limited resources. I was inspired by the work of an Italian doctor, Giuseppe Moscati who worked as a researcher in the University of Naples at the beginning of the 20th Century. He viewed his practice of medical science as a way of alleviating suffering, not as a way of making profits. I found the vision of The Union perfectly consistent with my idea of health. I think that, after 22 years working in Southern countries, I may be able to identify and provide practical solutions to concrete problems.”

Alberto does that by travelling – a lot – to provide technical assistance and training in several countries. When he is at home in Niamey, he treats MDR-TB patients with complicated situations while at the same time continuing to help in other countries by providing remote online assistance. “Of course, I try to save time for clinical investigation and discussions with my colleagues too. I am also involved in writing guidelines.”

Alberto is referring to the upcoming Union Short Treatment Regimen for MDR-TB Guide. This is going to be an international guide but Alberto admits it didn’t quite start out that way.

“I was writing a national guideline for Niger and, when I started to share the first draft with my colleagues and partners, many of them wanted a similar version for their country. They wanted, and encouraged me, to write a short and practical guide containing basic elements for MDR-TB management.”

This work hasn’t been without its challenges though. Alberto explains: “It’s not so easy to have an international edition as the settings are not homogeneous of course and we have a high level of uncertainty in international recommendations which move on so quickly. I have tried, however, to gather all the field experience of The Union in MDR-TB as the guide should be practical and follow the well-known Union approach.”

The guideline will be published later this year. Alberto is eager that this guide will ensure his work, and that of the Union, continues to have impact around the world.

He first became interested in treatments for MDR-TB while working in Cameroon in 1996. “I was involved in the organisation of a health system for a population with limited resources in Douala and we succeeded in building two hospitals and helped to organise the important work of five primary health care centres. In these centres, besides primary health care, we had control programmes of malaria, HIV and TB. As MDR-TB was a real challenge, I was attracted by the preliminary results of Dr Van Deun’s short treatment regimen study in Bangladesh and we started to apply it to our patients in Cameroon with my colleagues Dr Christopher Kuaban and Dr Jürgen Noeske and then, when I moved to Niger, I also started to apply it there.”

This work with MDR-TB and shortened treatment regimens is, says Alberto, his most proud achievement.  “Seeing more and more patients being cured is my greatest satisfaction.” he enthuses.

Alberto has already achieved so much yet has high goals for the future, with a key aim to raise awareness about the benefits of shortened regimens.

“The challenges of MDR-TB are well known: there’s low case detection and, most of all, low cure rates in the world. Of course research and development of new diagnostic tools and new drugs are the fundamentals that we should continue to work on.  But I must underline that, for the moment, we have an extraordinary tool with the short treatment regimen and the MDR-TB community should be aware of its potential.”

Indeed there is a United Nations General Assembly High Level Meeting on Tuberculosis that takes place in New York on September 26th. It is the first time the UN has dedicated a High Level Meeting to TB where it is hoped that global political leaders will be able to make real commitments to tackling the disease around the world.

“It is very important to have an international commitment at this level for MDR-TB. I expect a real engagement and more resources to strengthen our response in the field against this mortal disease,” says Alberto.

He also knows that The Union will play a crucial role in this battle. “In a world dominated by money and managers I think that The Union must remain focused on its technical, medical and human values. The Union has a strong connection with the field and a deep knowledge of the countries that it works with. That’s why our methods of technical assistance, training and operational research are appreciated. We have excellent relationships with National TB Programmes all around the world which means we have colleagues across the globe who are very skilled in MDR-TB and with whom we can have stimulating conversations.”

As well as The Union, Alberto also continues to work with the Damien Foundation as well as The Autonomous University of Barcelona and he collaborates with the Institute of Tropical Medicine in Antwerp on a course in clinical decision-making for DR-TB.

His work is truly global and, although born in Verona in Italy, Alberto was always drawn to work in limited resource countries. He has fallen in love with Africa and has dedicated much of his career to treating patients across the continent. “I have never known a morning in Africa when I woke up and was not happy. I didn’t come here assuming that I could or would save people. I came to share my knowledge in places where doctors are few. During the 22 years I have lived here, I have seen young, African professionals learn and grow and become key players in the struggle against MDR-TB across their continent and, indeed, throughout the world. I’m particularly proud that the investigations on shortened treatment regimens came from the Southern countries. I see a lot of potential in the young people of these countries to carry on this work for future generations.”

Alberto does, however, still maintain a love of his home country and keeps it close to him through his passion for Italian cooking. His favourite recipe is ‘bucatini all’amatriciana’ - a pasta prepared with a traditional sauce made by guanciale, tomatoes, white wine, peppers and pecorino cheese made to the original Amatrice recipe.

“My other passion is travelling and discovering ancient cultures and nature.  I think there are some places in the world where you can find a deep peace in your soul.  One of them is, of course, the magnificent Gulf of Naples.  The other is Imam Square (the ancient Naqsh-E-Jahan which means the image of the world) in Esfahan, Iran, which is my favourite among the 70 countries I have visited.  It has a charming culture, breathtaking architecture and landscapes, and extraordinary, friendly people.”

There can be little doubt that the hundreds of patients Alberto has helped over his many years as a doctor, and continues to help today, would say the same of him – that he is both charming and determined and extraordinary.

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