Maria Antònia Pou: “Gout is an unknown disease, even for health professionals”

In the summer of 2023, the Barcelona City Research Support Unit researcher went to Auckland, New Zealand, for four months, with a mobility aid from IDIAPJGol, to collaborate with researchers who study gout, a quite unknown and stigmatized disease in our country, which is highly prevalent in this southern Pacific archipelago. She explains to us what the experience was like.

 

From June to September 2023, the researcher from the Research Group on Prevalent Diseases of the Locomotor System in Primary Care (GREMPAL), from the IDIAPJGol’s Barcelona City Research Support Unit, Maria Antònia Pou, spent a stay at the University of Auckland, in New Zealand. Pou left with a mobility scholarship from the 2022 edition of the ICS / IDIAP grants. Traveling with her was her husband, also a researcher at the Sant Pau Research Institute and a member of GREMPAL, who also enjoyed an aid granted by the centre where he works, and her three children, who at that time were fifteen, twelve and eight years old.

The IDIAPJGol researcher and her husband research gout, a disease that is quite unknown and stigmatized in our country, even among health professionals. The stay has allowed them to establish links with researchers from that country and to start a new line of research at the Institute on this condition. It has also allowed him to realize the importance of collaboration between different research groups.

Why New Zealand?

From the GREMPAL group we are trying to launch a line of research into microcrystalline arthropathies, what we commonly know as gout and chondrocalcinosis. In New Zealand they are experts in this disease because it has a very high prevalence. This condition has a genetic component and is very common among Maori and among descendants of the English. With the mixture of populations, the prevalence of gout in the country is much higher than in Catalonia and, in addition, it is expressed with greater intensity, to the point that it represents a public health problem. There the prevalence among adults is around 10 %, while in our country it is 2.5 %. It affects them in a similar proportion to that of type 2 diabetes among our population.

How do they address the disease there?

They have a different health system than ours. I didn’t know this before going there; hospital care is free, but primary care is co-paid. The primary health centres are private, financed by the government but also by what the population pays when they want to be treated. For this reason, the most disadvantaged population cannot access primary care and has problems controlling gout and other chronic diseases.

A funny thing is that health centres in New Zealand are usually found in shopping centres. There, the cities have a structure like typical cities in the United States, with houses with gardens and services concentrated in shopping centres, where you can find everything. There you have the primary health centre next to the pharmacy, the supermarket, the travel agency...

The disease is addressed from any point in the health system, just like here, but patients can take time to be diagnosed and treated, meaning they can spend a long period suffering alone.

And there you met a research group that studies gout...

We had contact with two research groups that depend on the University of Auckland. One for primary care and another specialized in diseases of the musculoskeletal system. They both do active research on gout. We had already had contact before with a researcher from the musculoskeletal system group and we collaborated punctually with them from Barcelona. In fact, they were the ones who told us about the collaboration they were doing with the primary care group. This was a qualitative study to determine the degree of adherence to treatments among people with gout.

The primary care research group is multidisciplinary. It is led by Dr Goodyear-Smith, head of the Department of Family Medicine at the University of Auckland, and collaborates with several family doctors, many of them of Māori ethnicity, and with other professional profiles, such as a sociologist from one of the Pacific islands, where they are called islanders, and also with patients. The research being carried out by this research group came from the Māori themselves. They are a people that does a lot of community life, and they contacted the University of Auckland to propose improving gout control and its diagnosis among the population. This research program is very good. It addresses the disease from all points of view, considering the needs of patients and families, but also those of health professionals. Now, however, this project is at a standstill, because they realize that if the government is not more involved, it will end up dying, and it is for this reason that in the end we were not able to actively collaborate with them. We hope to be able to follow their evolution, maintaining contact with them. 

 

 

And the other research group, the musculoskeletal system, what does they study?

In this research group, led by Dr. Dalbeth, there are family doctors, rheumatologists, nurses, psychologists, and a physiotherapist who deals with database management and organizational issues. When we were there, we collaborated with them on a qualitative study to find out how gout affects patients' work activities. We interviewed more than twenty people, transcribed and analysed the interviews... It was very interesting and enriching. Plus, it was the opportunity to learn how to do some qualitative research. This group is very consolidated. Each of the researchers did their work and, every fifteen days, they sat down and shared their projects. We saw that the various studies they are carrying out draw heavily on the patients themselves, which makes the work much easier. In addition, the research building where the group is located is one hundred meters from the Faculty of Medicine and one hundred meters from Auckland Hospital. This makes collaboration easier. There you have the Hospital residents doing rotations in the research building and Faculty students doing their theses. It’s a win-win.

 

Are you still collaborating with them?

Yes, in fact, we are now jointly doing other qualitative work, with patients from there and here, which we will publish together. In addition, I am working on a couple more projects, in the field work phase, on which they have given me a lot of advice. The group’s principal investigator, Dr Dalbeth, who was our mentor there, despite her responsibilities, dedicated many hours to us, and we hope to physically see some members of Dr Goodyear-Smith’s group again at the next conference of the WONKA World.

What have you learned from your stay? What things have been useful for your research activity?

From that experience I have learned that you must always consider the reality of the country before researching. What they do there is not entirely applicable here. I have also learned that we have a lot of potential here, but we spend very little time talking to each other. There the University researchers shared physical space. They were diverse research groups that exchanged ideas and interacted with each other. Sharing physical space allows you to share more things. Here, family doctors who provide care and research are very alone. Everyone is on their team and has their day-to-day life.

Furthermore, during my stay in Auckland I have realized that in our country we have a lot of work to do in addressing gout. First, we need to do a lot of pedagogy. Gout is a disease little located on the map. It is a stigmatized disease, and this greatly influences affected people, who are often slow to ask for help. It is perceived as an ancient disease, which affected kings who gorged themselves on seafood and meat. This idea is wrong. What you eat influences uric acid levels only ten percent. The remaining ninety percent depends on a genetic predisposition. To improve the control of the disease, we must first carry out prior education, information and destigmatization work. Starting with the health professionals themselves. 

 

 

On a personal level, how has the experience been?

It has been wonderful. My husband and I had twenty years of professional life. We had had some international experience when we were younger, but then you get into the day-to-day life and... Furthermore, after a pandemic that has kept us locked up, we wanted to open doors. We considered it without yet having the scholarships. We asked the University of Auckland if they wanted to carry out an external rotation and they told us yes. They wrote us acceptance letters; we prepared the project with them, and then we applied for the scholarships.

At first, our children told us “You’re crazy,” but little by little we all started to join in. My children went to school there. Here it was summer, and they had vacations, but there it was winter and there had classes. We promised them that they were going to school to learn English and make friends and that they didn’t need to take exams. It would be a different summer. We convinced them and the truth is that the five of us had a great time. Now, in addition to preparing the research part, we spent months preparing the trip, looking for schools and a place to live, balancing the budget... Keep in mind that we still did not have scholarships. I received mine a month and a half before I left.