Dr Ignacio Monedero: Sharing knowledge and building capacity to address MDR-TB

Dr Ignacio Monedero: Sharing knowledge and building capacity to address MDR-TB

Dr Ignacio “Nacho” Monedero likes the challenge of practicing medicine in difficult circumstances. Whether it’s rescuing injured climbers on a Spanish mountainside or working in an African bush clinic, he is drawn to situations that remind him why went into medicine.

During medical school in Madrid, he gained invaluable experience by working on an ambulance; and, even before he had completed his training, he took positions with non-governmental agencies that sent him to settings ranging from rural Panama to the favelas (urban slums) of Brazil. He chose to specialise in family and community medicine, because it would provide him with the broad range of knowledge and skills needed by an international or humanitarian worker.

In 2004 Monedero first went to Africa, which he calls “a tough and very good school”. He was the TB-HIV technical advisor for Equatorial Guinea, where for two years he conducted epidemiological studies, wrote national TB and HIV/AIDS guidelines, introduced DOTS and fixed-dose combinations, designed databases for monitoring and evaluation, trained staff and consulted on clinically complicated cases.

There he came into contact with The Union when he took an intensive course on multidrug-resistant tuberculosis (MDR-TB) taught by Dr Jose “Pepe” Caminero. It was “an enlightening moment,” he says, and he knew from that time that he wanted to teach – and work with The Union.

“I wanted to train doctors and nurses because it makes it possible to  do something bigger than my own work with patients,” he says. “The knowledge I share with them can eventually be translated into better diagnoses and treatment – and many more people can be helped.”

To move towards this goal, he earned a master’s degree in public health in developing countries at the London School of Tropical Medicine and Hygiene, and in 2008 he was hired as a TB and HIV consultant for The Union.

Since then, Monedero has worked in 30 countries, teaching courses and providing technical assistance on MDR-TB and TB-HIV, and conducting operational research that has led to 19 published papers.

Teaching continues to bring him great pleasure as an opportunity to put all of his knowledge and experience to work. “I can put on the shoes of a doctor in the Zimbabwe bush because I have been one,” he says.

Like Pepe Caminero, who has been his mentor and colleague, he constantly refreshes and customises his course content, using a blend of the academic and the personal, the theoretical and the real life.

Treating patients with MDR-TB, or who are coinfected with TB and HIV, is very complex and often produces difficult side effects, he says. Physicians are not always prepared for this, so he aims to ensure that they know the basics and provides clear, simple explanations for complex problems “to bring everyone on board.”

For his PhD, which he completed in 2013, Monedero chose to focus on one of the most difficult public health challenges today – how to improve the management of MDR-TB in developing countries. 

“Looking at the figures, so far, globally we are losing the MDR-TB battle,” he says, but he has seen that much more is achievable.

While he calls it “a shame” that it has taken 40 years to develop any new TB drugs, he believes that The Union’s approach can bring good results with its emphasis on good clinical and operational management combined with sensitivity to the patients’ social context.

He’s also encouraged by new variables in the MDR-TB picture, such as the greater global access to new research and information afforded by mobile phones, and new treatments, such as the shortened MDR-TB regimens being tested in The Union’s STREAM clinical trial.

As the physician in charge of the most challenging drug-resistant cases at his home base, Barcelona, he has become convinced that, with a well-organised programme, enough resources and the involvement of key stakeholders, cure rates of 85 to 95 per cent are possible.

This makes it clear that MDR-TB patients can – and should – be cured. “By sharing knowledge and building capacity, we will continue to get closer to this goal.”