Antibiotics

When I arrived at the School I thought perhaps that I had come to the wrong place. It didn’t look like a graduate school to me: at lunchtime on Wednesday the cobbled street outside was empty and almost silent. I called into the director’s office and he took me to find some students, but there was only one person in the student kitchen – a tiny figure waiting for the microwave to ping.

When she turned around, she looked so young that for a strange moment I wondered where her mother was. The director introduced us slightly awkwardly – this wasn’t normally part of his job. ‘Manasa is an undergraduate at the university of Chennai, she’s in Germany for six months on exchange. Manasa is working on her dissertation study of antibiotic resistance. Er…and Daisy is an English writer.’

Manasa took a bowl of pale and limp noodles out of the microwave. We seated ourselves at opposite sides of the long table. The Director left so that we could talk, and Manasa looked at me levelly. She didn’t seem to feel the need to speak. I couldn’t tell whether she was shy, or just composed, and so I tried to break the ice. What it was like to come to Germany from India? ‘Jena is very clean and peaceful, but I miss the food in Chennai.’ And what was she studying, at home that had to do with antibiotics – was she training to be a doctor? Manasa smiled: ‘Believe it or not I am an engineer’. In Chennai, she told me, they have a saying. ‘Perhaps you are familiar with it: Either you are a doctor or you are an engineer.’ I told her that we do not have this saying in Yorkshire, and I asked how serious the problem of antibiotic resistance really is, if it has the engineers as well as the doctors working on it. I’d been reading about official warnings from the World Health Organisation, and a speech the British Chancellor made to the IMF in Washington, in which he said that millions of people would be dying within a few years. Should we be scared? What are we doing about it? Manasa put down her fork and stopped smiling. ‘It’s a real danger.’

Bacteria can live anywhere – they live, in fact, almost everywhere. On the roots of every single living plant; in nuclear reactors; in your mouth. One species of bacterium recently discovered in the USA had made a habitat of the hospital detergent that was designed to kill it. There is currently no single solution to pathogenic resistance to antibiotics. Rather, disease-by-disease, different combinations of drugs and diagnostic methods are holding things together, for now.

Manasa’s project at the JSMC investigated antibiotic resistance in colonies of bacteria. But she wasn’t actually working on a pathogen. ‘I’m only an undergraduate and it wouldn’t be permitted. I’m working with a common soil bacterium, it’s harmless. You could practically eat my bacterium.’ She looked at her noodles.

It was a previous placement, very different from Jena, that first got her interested. Last year, she did an internship in a hospital laboratory in Chennai. Manasa’s job there was to identify species of pathogen from samples of blood, spit or urine. I asked what she saw, under the microscope, and she put her head on one side to think, and then described circles. In the lab, sickness looked like circles within circles: the antibiotic appeared on the circular plate as smaller, coloured discs. If there was a space around these discs, the medicine was working because the pathogen was being destroyed all around it. But when the space was small the problem was urgent.

It was usually easy to identify any disease by sight, but then one day Manasa looked through her microscope and saw something she had never seen before. When she showed it to her superiors, they didn’t know what it was either – they said they’d never had this species in the hospital before.  The pathogen, whatever it was, was resistant to its antibiotics. ‘The patient was very ill, and had already received both a liver transplant and a kidney transplant.’ Manasa did not tell me what happened to the patient.

Silence fell. Manasa rose, and washed up her bowl before returning to the lab: she didn’t take a long lunchbreak.

‘What do you want to do next?’ I asked. ‘I want to continue working on this problem of antibiotic resistance.’ She grinned, suddenly. ‘This is my idea of interesting.’

Advertisements