Thursday, April 2, 2009

Marrakech (1 of 7): Welcome!

It’s definitely a North African trip. You can tell from the organisation.
Over the summer I was supposed to fix a date for this 5-day visit with our Moroccan collaborators. But I was gone some weeks, my boss YJ gone others, the summertime and all, and by the time I got around to it, there was not a single 5 day block available to both of us that was at least two months away (a rule of our sponsors, the INSERM) and still in 2008. So I thought, Failure Tax, and let it go.
Then in November, email from the INSERM wanting us to confirm dates for our visit - our partners in Rabat wanted to know.
The woman at INSERM was very nice, saying, in complete defiance of all the beloved rules, that sure, they understand how hard it is to schedule. Just plan now, and take the trip as soon as possible.
Which turned out to be today.
In the meantime, I’ve been more or less in contact with our Moroccan hosts, mostly with the junior guy who stayed in my lab for a month, learning the ropes. Jamal. He’s a good egg.
About a month ago, he said they’d love for us to give talks, my boss and I.
Okay, no problem.
But then, nothing. No idea what sort of audience we’ll be talking to. No idea if we’ll be seeing patients, as YJ wants to.
Friday, after one last request for information, I get news that we’ll be speaking in front of a group of doctors. That’s fine; I’ve prepared a very basic slide show, only 18 slides, including the bla-blah. Anything more and I’ll lose them.

Meeting up at the airport this morning, it seems he’s had additional information. We’ll be met at the airport (good to know, since we never were sent our hotel information). And Tuesday we are to preside at the thesis talk of one of their students. As part of the jury.
I vaguely remember Jamal mentioning late last year that somebody on their staff was doing a thesis on the breast cancer families they had sent us for analysis. I said great, glad to help out. But never hearing any more of it, the student had completely slipped my mind. YJ seems to have forgotten too. Or perhaps the boss in Marrakech, BB, assumed that her guy Jamal in telling me would automatically be inviting my boss to be on this jury. Well, I thought that any such invitation would surely be passed directly boss to boss. That's how these things are done.
But wanting to help out with this thesis or not, how can we be expected to do so having never seen it?
We’re happy to listen, even to ask questions off the cuff, but that’s not how you judge a thesis. You have to read it first! Consider the strengths and flaws. See how the oral presentation complements the written. Mostly, the written document allows you to formulate pertinent questions and have a meaningful discussion.
And it’s being sprung on us for tomorrow?
Well, I hope they don’t absolutely need us as jurors, because we’re not happy to rubber-stamp our approval.
This is symptomatic of the whole North African system. All seat-of-the-pants, under-the-table, handshake-between-friends. It’s not serious. Well, the definition of serious is vastly different.
Will there be any science in there? The student in question has never - not once- contacted us. If you’re doing a thesis on familial breast cancer, why not take advantage of our expertise?
I’ve not got a good feeling about this. Whatever knowledge Jamal took back with him - and he gained a lot in his month here - just last week he asked me for directions on how to draw pedigrees.
Um, last week you guys were at Lesson One in genetics?
I’ve been looking forward to seeing the pedigrees of the 40 families we’ve analyzed for them. Tomorrow I’ll see how they’ve got on with drawing them out.

This all reminds me of our collaboration with the group in Algiers. Amina A is just as hard to get in touch with (in fact, I invited her to join us in Marrakech because the comparison of the Algerian and Moroccan populations I’ve analyzed is really interesting, but never heard back), and it was just as hard to get the message across that only breast and ovarian cancer count when you’re looking at genetic breast/ovarian cancer risk. Please do not send us leukemia patients! But there’s also a parallel that hereditary breast cancer risk is just a curiosity to them. AA and BB are so hard put to keep up with basic medical care, that treating breast cancer is all they can do. Going out and finding it with screening programs is for tomorrow sometime. Finding families at risk and following up on women who aren’t even sick yet is just beyond their resources, and beyond even their ideas of what resources should ever be used for. Genetic testing is a Western luxury.
I wonder if the difficulty in convincing them that breast cancer risk is related to breast cancer cases in families is finally the reason why in the Moroccans we have almost no mutations at all - they’ve sent us whatever samples were available, not pertinent ones. I know they sent us samples from husbands (set aside), and from young children (set aside), but are the women really women with breast cancer, as promised? If they are, there’s something to look into.

I’ll try to get on line again later, but it isn’t easy!

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