Phase 3: Meeting with experts
As a team growth purpose, we decided to contact an expert in order to obtain better knowledge about the problem, but also ways to address it in the community with people who are not experts in the area of biology, medicine and public health.
Meeting with PhD Alejandro Gonzalez Mora
Figure 6 Meeting with PhD Alejandro Morales
Our first meeting revolved around the use of bacteriophages as a key part of our project, in this sense, we met with PhD Alejandro Gonzalez who has been working with bacteriophages for the past 5 years by the development of bacteriophage vaccines using the display of peptides on the coating of M13 bacteriophage, he gave us special insight both on the technical side of the phages and on how to perform and control the protocols and more importantly for our human practices on the landscape of the use of viruses as therapies both in farming and health protocols, this gave us valuable insights on the need to create awareness on what are viruses and the fact that not all of them represent an imminent danger for humans.
This allowed us to re-establish our communication strategies. In a more technical manner he instructed us on the phage-display techniques through the PIII protein of the M13 phage and how to use linker peptides as tools that allow to maintain flexible both sides of the modified protein.
Meeting with Juan Manuel Domínguez
Juan Manuel Domínguez Granillo founded the company "Farmasana" in 2001 and since then has been dedicated to the distribution and sale of patent, generic and natural medicines throughout Mexico. Its innovative pharmacy franchise scheme has allowed Farmasana to have a presence in states such as Mexico City, State of Mexico, Guanajuato, Puebla, Quintana Roo, Veracruz, Guerrero, among others.
We had a virtual session with him, and as an entrepreneur himself being deeply involved in the healthcare and pharmaceutical industry he gave us insights on the social, and political context of healthcare and antibiotic resistance in Mexico, which helped us to connect the dots in our mapping of the system. He also gave us a very insightful perspective on how pharmaceutical companies in Mexico would probably have conflicts of interest, as they are more interested in selling 4th generation antibiotics than actually solving the problem; this due to the fact that 4th generation antibiotics are more profitable than 1st generation antibiotics. This allowed us to have a broader vision of the problem, seeing the diverse sectors that include it and how it is that, regardless of the diversity of the areas that affect it, they all fall into said problem.
Figure 7. Meeting with Juan Manuel Dominguez
Ph.D. Benjamín Vázquez Rodríguez
Dr. Benjamin has a bachelor degree and Ph.D. in Biotechnology Engineering and Bioprocesses. Dr. Benjamin is a bioprocess specialist in extraction, purification and analysis of novel chemical compounds and their further stabilization for the development of new products. Dr. Benjamin evaluated our project , and gave us advice on the creation of our liposome encapsulated nebulizer and the scalability of our project.
Figure 8. Meeting with Ph.D.Benjamín Vázquez
Meeting with Ph. D. Martin Canizales
Our third meeting was with Ph.D. Martin Canizales who is a part of the Tec de Monterrey health department, known as Tec Salud. Dr. Martin has a Ph..D in Molecular-Cell Biology- Biomedical Engineering Biochemical , and a PostDoc from the University of Texas Health Science Center at Houston. Dr. Martin is the head researcher at Sulfagenix, Inc. which is a company built on decades of research on modifying existing molecules to improve safety, bioavailability and efficacy for new uses. He is highly skilled in gene silencing systems in eukaryotes. This meeting was a milestone in our project, as we gathered valuable information for the software team. After this meeting we sought to search that gene sections were more conserved between strains of the same species in order to deliminate the design parameters for the RNA.
Figure 9. Meeting with Ph.D. Martin Canizales
Meeting with Ph.D. David A. Perez-Perez
Dr. David has a bachelor degree in pharmaceutical biochemistry , he holds a masters degree and Ph.D. in Applied Microbiology and Biotechnology. He worked as a laboratory scientist in a public hospital in Ciudad Victoria. He has also taught nursing , and bioengineering students, and is a researcher at Centro de Biotecnología FEMSA.
Figure 10. Meeting with Ph.D. David A. Perez-Perez
Dr. David gave us insights from the pharmaceutical perspective of our project, and the context in which it can be applied. His comments regarding the importance of testing immune response , and clinical trials were very punctual and relevant for the next stages of our project. He invited us to perform cytotoxicity assays with mammal cells once the nebulizer and the complex are ready. He also gave us an idea for the future, in which the nebulizer can also supply the antibiotic necessary to kill the bacterias, this in order to create a full therapy.
Furthermore, he enlightened us on the pharmacological process we would need to follow to ensure the safety and efficiency of our therapy. After this session, we realized that there is still a long way to go. This is very exciting as we hope to continue building up our project, and we also invite iGEM teams and scientists to collaborate with us to make RNAir possible in the future.
Meeting with PhD Carlos Amábile
Dr. Carlos Amabile is a national authority on Antimicrobial Resistance. He has published in renowned science magazines since 1995. He studied pharmacology at the Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, and held a position as fellow in the Laboratory of Toxicology in Harvard School of Public Health from 1990-1991.
We contacted Dr. Carlos Amábile, who guided us through sessions on 2 important factors. The first were, the identification of areas for improvement in our project as well as what we should focus on in our proposed program. And the second point was to enlighten us on how to work with society on this project, to make the information easier to convey, this meeting led us to consolidate our communication strategies and also to understand the antibiotic resistance problem in our community. Dr. Carlos was key in order to better understand the system dynamics , what we could build on , and how we could shape our project.
Figure 11. Meeting with PhD Carlos Amábile
From this mentorship came what we call “Human Day”. It was a 2-day event that sought to work with the community on this topic with people of different bachelors. This has the purpose of being able to expand knowledge through various areas, focusing on being able to have a greater reach of people who are experts in other branches outside of science. The first day we had a round table between students from various approaches, such as business, arts, engineering, among many other speciality areas. The purpose was to have a debate divided into 4 phases. The first was the introduction, where what was going to be discussed was introduced.
Then the second point was “investigation”, which made emphasis on the observation experts made throughout the years. Here we sought to make the speaker aware of the problem we are addressing. Successively we got to point 3, which is “research”. Here we mentioned everything that has become important over the years to solve this problem, and the impact it has had. Finally, our last point is called “call to action”. Here we concluded by once more highlighting the importance of the topic, so students could understand the problem, why we should care, and what we could do. At the end of the round table, we had another antibiogram workshop due to the high demand it previously had, succeeding in getting people interested in antibiotic resistance
On the second day, we focused on contacting an expert on the topic to have a conversation with several people in the community. We worked with Dr. Carlos Amábile Cuevas, a member of the Lusara Foundation for Scientific Research AC. He has been involved in the importance of antibiotic resistance for several years now, almost 35 years since his first publication about the topic. During the conversation we had 2 dynamics. The first half consisted of an explanation of the myths the society has created regarding this problem, as well as the true statistics that affect not only our country, but also internationally. Successively, the second half of the conference consisted of a round table, where we discussed with Dr. Carlos doubts that arose with the students, as well as sharing experiences with said subject. We also showed him our project.
The students and community that answered the survey contributed with very valuable data about the real and current situation of awareness, self medication, resistance and also their habits on following treatments. The answers of the people around us were necessary and very eye-opening, they made us aware of the importance of the project for the benefit of the community; in order to avoid the spread and development of resistance. It should be mentioned that the main target of this project were young people between 18-30 years old, since we seek to generate awareness in the people who will be the guide of the next generation. This work is due to a good communication strategy that was followed between the projects in order to be clear about the main objective, which was to be able to reach the community in the correct way, as well as to be able to carry out quality work with a broad focus.
Meeting with BPC. María Isaías Pineda Villanueva and Mónica Padua Ahumada
María Isaías Pineda Villanueva and Monica Padua Ahumada have degrees in bacteriology and pharmaceutical chemistry, currently working as laboratory leaders at the ISSSTE medical center, a public hospital.
Through the session with both BPC, the importance of resistance to antibiotics was addressed, telling us from their chemical point of view why this daily use is due. This talk presented a problem where medicines are prescribed in hospitals and leftover pills are kept at home, encouraging self-medication and not allowing medical consultation, emerging new resistant microorganisms that at first glance seem harmless. However, they shared the emphasis that we must have on them since in the long term they could have a negative effect on our daily lives due to the indiscriminate use of antibiotics.
Likewise, it was commented that the medical section lacks a doctor-pharmacy organization to avoid medication leftovers after treatment. This has been of crucial importance in our work since it focuses us on improving communication with the community, devising ways to generate various projects where they can share their experiences with self-medication, as well as ways to be able to talk with them and share the importance of a correct way of prevention.
Figure 12. Meeting with BPC. María Isaías Pineda Villanueva and Mónica Padua Ahumada
Meeting with Dra. Silvia Cecilia Britton Robles and team
In order to give a broader perspective on the usefulness of the nebulizer and the scope of our project, we expanded our search for opinions to experts in the area of pediatrics, so we contacted Dr. Silvia Britton, specialists in Cardiology with a subspecialty in Congenital Heart Disease and Pediatric Echocardiography, and her team of resident doctors.
During this meeting, it was mentioned that within the area of pediatrics, superbugs are a growing threat to children, since they are part of one of the highest-risk groups due to the fact that their immune system is not fully developed, which mainly affects your lungs. One of the greatest contributions we had during this meeting was the successful design of the nebulizer since it works as a fast, direct, and optimal method for medical emergency situations, however, he mentioned that we could focus it on a treatment developed for the public. children since in Mexico the area of pediatrics is abandoned by the Mexican government either in the public or private sector.
Figure 13. Meeting with Dra. Silvia Cecilia Britton Robles and team
Meeting with RN Edgar Rodriguez
Edgar Rodriguez is a registered nurse belonging to the public health sector. He works full-time at Unidad clínica 23 in Coahuila de Zaragoza, Mexico. Edgar, being part of the public healthcare system himself, helped us validate our Human Practices. He emphasized how patients often self-medicate, do not follow the drug treatment prescribed by doctors, and only take their medication when they are not feeling well creating with this resistant bacteria. He mentioned that this makes it harder for healthcare workers, as they have to use more complex antibiotics each time. We also showed him and told him about our nebulizer , to get his first impression , because although it would not be used on him, nurses will be the main users of our nebulizer, as they are the ones manipulating medical equipment to offer treatment to patients. He said that this therapeutic is a great innovative idea he would be more than glad to have to treat his patients. He also mentioned the need of the government to invest in these types of technologies and that although the journey for us in Mexico is hard, to continue pursuing our research in the quest of the well-being of our community and world.
Figure 14. Meeting with RN Edgar Rodriguez
When the season first started, we knew that antibiotics impacted several areas of our life, but we were not as aware as to how the system was constituted. Therefore we decided to do a general research about antibiotic resistance and make a rough draft of the ideas we found regarding this topic. We came up with this initial map, which despite its simplicity, helped us identify our area of opportunity for the project: multidrug resistant bacteria causal of nosocomial infections.
After 8 months of extensive work with our community, experts, we were able to build our project and come up with a deeper and broader version of this map, now focusing on antibiotic resistance in Mexico in the health sector and how the inequalities of the healthcare system contribute to it. Along with the extensive research and community engagement we went on to further understand the culture of self prescription and the idiosyncrasy of the mexican healthcare system through dialoguing with healthcare professionals (nurses, doctors , chemist-pharmacy biologists, and experts in antibiotic resistance).The engagement we had with the community and experts through sessions , weekly activations, summer camp, social media, surveys, and round tables helped us shape our project and come with this mapping of the system.
Figure 16. Final Integrated Systemic Thinking Mapping of the System : Antibiotic Resistance in Mexico
In summary, this map portrays that the stratification in the healthcare system in Mexico roots itself in multiple factors, most of them coming from the socioeconomic inequalities and hence the complex structures of power in the social system. Factors such as the economics, educational level, physical environment, social support networks and political legislation, play a key role in health. These factors often lead to an increase in dangerous practices and behaviors regarding the self-prescription of drugs such as antibiotics, contributing to the appearance of multidrug resistant bacteria, which is a serious threat for world public health. In order to make a change in this matter, governmental institutions must search for the wellbeing of the population and not just the political status given by inefficient and deficient social programs, and instead invest more in efficient health programs that decrease inequalities leading to social justice. In conclusion, there are multiple stakeholders playing a role such as the Mexican government, pharmaceutical companies, the private initiative, health professionals, minority groups, among others, and in the end, it all comes to the power dynamics of a complex system that favors those on the top.