 This is a podcast of the Nuffield Department of Medicine from Mahadol University in Thailand. Professor Nick Day talks about rural populations in Thailand and the challenges they face when confronted with infectious diseases. The Mahadol Oxford Topical Medicine Research Unit is a collaboration between University of Oxford and Mahadol University, funded mainly by the Wellcome Trust. It's more than 30 years old now. The MOU was signed between the three organisations back in 1978, unit opened in 1979, and we've been working here and in the region ever since. The major health challenges in this region are those of the whole world really. Within 2,000 miles of Vancouver as a four hour flight, you have half the world's population. You have very rich countries, such as Singapore, Hong Kong. You have densely populated countries developing farce like India and China, and in Southeast Asia you have very, very poor countries like Myanmar and Laos and Cambodia and up and coming middle income countries, particularly Thailand and also Vietnam. So you have the problems of tropical diseases in rural, poor and malnourished populations, but increasingly you have urbanisation, the problems associated with urbanisation and the diseases of the rich increasingly a problem. We traditionally concentrate on tropical diseases. They tend to be infectious diseases but also some nutritional deficiencies. Malaria for example in particular has been a problem for a long time in this region. What are the major lines of research that have developed in the last five years? About half of what we do is malaria research, and over the past 25 years we've worked on the Artemisoline group of drugs. These are very powerful anti-malarials derived from a plant discovered from research into Chinese traditional medicine. The units have been very active in developing these, developing Artemisoline based combination therapies and getting them accepted as the standard treatment for malaria first line throughout the world. In the last five years we've shown that the intravenous form of Artemisoline, artesionate, saves lives in severe malaria when compared with the traditional intravenous quinine is associated with about 30% reduction in mortality both in Southeast Asian adults and also in African children. So that's a major finding of the last five years. In the last five years as well unfortunately we have seen the emergence of Artemisoline resistance for the first time on the Thai Cambodian border. It's probably been present for 10 or 15 years but now it's got such a prevalence that we're now able to detect it clinically and it's beginning to cause a public health problem. Why does your research matter and why should we put money into it? Yes, for us we only do research that has a direct impact on health or is possibly going to have a direct impact on health so we don't do blue sky research. For example in any laboratory research we do is to support clinical research and in general we look at the illnesses and the populations that we work with and we let the patients ask the questions, that's what drives our research. Looking further afield though, our malaria research is particularly important because we want to try and stop, at least to define, provide some tools for stopping the spread of Artemisoline resistance, malaria parasites from Southeast Asia where they are now to Africa where the great burden of malaria is. Is that will then translate into a major problem for malaria control. How does your research fit into translational medicine within the department? I think most of what we do is translational. Increasingly we don't just look to see what treatments are more effective, what diagnostics are more diagnostic utility. We also look at the practical implementation of new therapies and we look at the health economics of that. We have a health economics team to look at whether it's cost effective to deploy a new treatment or vaccine or diagnostic for example. So in that way I think that what we do is practical and hopefully will make a difference in terms of health. Are there any unique challenges to working in an overseas environment? I think there are challenges to working in any environment and a lot of the challenges to be faced here are the same as the challenges that researchers face in Europe or North America. The unique challenges I think are the wide variety of cultures that we work with although of course this is increasingly the case in places like Oxford with globalization. We also have a lot of travelling because many of our study sites are quite widely dispersed. Thank you.