Challenges for microcirculation research in developing countries

4.1 Limited technical infrastructure

In developed countries microcirculation researcher usually have access to sophisticated imaging techniques and modern hard and software to analyze microcirculatory data whereas older hardware and manual analysis methods are often used in developing countries which can give rise to erroneous outcomes.

Routine validation, evaluation and updating of the methods, instruments and available facilities involved play a crucial role in microcirculation research [8, 9]. Different techniques such as orthogonal polarization spectral (OPS), sidestream dark field (SDF) and incident dark field (IDF) imaging have been developed for microcirculatory imaging [4–8]. Such imaging techniques are non-invasive and widely used for superficial tissues such as sublingual and buccal mucosa analysis [12]. Analyzing software is continuously improving with a clear trend to automated approaches [13]. Implementation of such imaging and analyzing techniques is still hardly feasible for the developing countries [14]. For more quantitative analyses such as measuring the proportion of oxygenated and deoxygenated hemoglobin in tissues, sophisticated devices like near-infrared spectroscopy (NIRS) has been developed [15–17]. However, application of such expensive technologies in research is often not feasible in the context of developing countries.

4.2 Inadequate hospital resources

Since adequate clinical data are the prerequisites for a successful study, limited hospital resources often hinder high quality clinical studies in developing countries. For example, in angina and cardiogenic shock - two commonly occurring, serious medical conditions in emergency departments, microvascular parameters can be studied along with important biomarkers, e.g. troponin to generate novel scientific data. However, in developing countries, such clinical tests are rarely referred to those patients. As another example, detection of poor peripheral perfusion also plays a vital role for treating children with septic shock [18]. However, the limited resource setting in developing countries makes it difficult to treat these vulnerable patients [19].

4.3 Lack of collaborative research between developing and developed countries

The collaboration of the experienced scientists from the field of microcirculation research with the medical faculties of the developing countries can open the door for knowledge exchange, channeling opportunity and resources to conduct quality research on microvascular diseases. The peer scientists from the developing countries can make an impact on collaborative research by providing local data, support, and contextual knowledge and skills [20]. A report published in 2004 states that, developing countries are the hub of only 27% of the total researchers of the world [21]. Integration of this nominal yet prominent portion of the scientists in the international community of the researchers from the developed countries could have a positive influence on the practice of science and research [21]. In addition to the research integration, microcirculation researchers from the developing countries should be brought under the attention of the international research community to attract potential collaborators [22]. A study on the published research on health and medical topics from the year 1991 to 2001 in the Institute for Scientific Information reported that only 1.2% of the total published research works were from South Asian researchers. This is indicative of the limited sharing and conduction of medical research in the developing countries which attributed to the failure of drawing the attention of the advanced research community for collaboration [20, 22]. Nevertheless, in the absence or with limited national funding in the developing countries for research, collaborators from the developed countries might impel the investigators from the partner developing countries to accept the research plan set by the collaborators which could result in a vertical research relationship [23]. Due to such demands from the partnered countries on the participant developing countries, it might impede the process of establishing any estimable project plan. But in long run, high impact research would be much achievable through the development of the equitable research partnership [24].

4.4 Low funding opportunities

The low funding opportunity is another major drawback at both institutional and national level for the developing countries. At the national level, government planning for the fiscal years often allocates an insignificant portion of the budget for research and development since other national issues related to electricity, water, transportation etc. are prioritized. Apart from that, the political turmoil, unstable economy and dependency on foreign aid to support the deficient amount of the fiscal budget plan can also contribute towards the unwillingness or inability of the government to fund such intricate research works [25].

Research units at the institutional level are often unsuccessful in the bridging of good understanding and relation with the national policymakers in the developing countries. As a result, the government-funded projects are found to be limited which directs the reliance on international funding on the rise. In addition to these, the key focus of investments in medical universities and colleges is mostly to meet up the basic requirements for patient treatment and care rather than medical research. According to the Global Forum for Health Reports, merely 10% of the research fund is utilized on worldwide health issues and merely 5% of such funding is spent on addressing medical and health research for the developing countries [25, 26]. Lack of coherence, resource allocation and mobilization and most importantly investments have been contributing towards the low medical research output particularly on very sophisticated fields like microcirculation [27]. Above all, every country and government must realize the impact of medical research on improving the life expectancy of their people and bolster the biomedical researcher community to carry out impactful research [28].

4.5 Lack of skilled human resources

Disturbances in the microcirculation are early indicators for many different diseases. Microcirculation research has been distinguished as an interplay between theoretical modeling, system biology or otherwise stated as computational modeling, experimental modeling [29, 30]. Since it is an interdisciplinary science, researchers from physics, engineering, medical sciences background have been playing a pivotal role in research [29]. However, in case of developing countries where constricted funding has become one of the major concerns for carrying out such complex research, lack of expert human resources could also be much of a bigger concern [23]. To execute high-quality impactful microcirculation research, senior investigators could play a vital role in the design, development and implementation of the research while training the younger investigators through recruitment in the projects and sustain the research activity on the field of microcirculation research. Unfortunately, this has not been a common scenario especially in the field of microcirculation research which involves the use of sophisticated techniques and expertise. Lack of funding, inappropriate infrastructure, and inappropriate remunerations may drive the researchers on such fields to pursue their research career in the developed countries where ample opportunities are provided. As such, “brain drain” to developed countries has been one of the root causes behind the inadequate number of expert researchers on microcirculation in the developing countries. A number of times different schemes have been planned to promote research-oriented career through research awards and supplementation of researcher’s salary but none of these approaches were systematically evaluated [27, 31]. Intellectual isolation may also play a role in the undeveloped expertise of human resources on microcirculation research though through the use of web services and involvement with national, regional and global networks such isolation can be eradicated.

Additionally, the microcirculation research is not limited to hospital setting or laboratory set up but mostly interplay of both the setups. Expert human resources are indispensable in both the framework and only rudimentary training to develop such skills will not be enough to meet the needs of skilled technicians [29]. Another reason behind the inadequate number of research experts on microcirculation research could be overburdened medical researchers with mundane duty tasks which leaves minimum time and effort to get engaged in research and skill development [32].