Vigorous efforts to achieve the global collective vision of a TB-free world drove senior scientist in the Centre for the AIDS Programme of Research in South Africa (CAPRISA) and Specialist Physician and Pulmonologist in the Department of Pulmonology and Critical Care at Inkosi Albert Luthuli Central Hospital (IALCH), Dr Rubeshan Perumal to conduct his doctoral study on Optimising the pharmacological treatment of drug-susceptible pulmonary tuberculosis.
Co-supervised by world-class scientists, Professors Kogie Naidoo and Nesri Padayatchi from CAPRISA, the study investigated the relationship between first-line anti-tuberculosis (TB) drug pharmacokinetics and treatment outcomes.
The findings provide key insights for optimising the treatment of drug-susceptible TB, including the importance of vigilance for unexpected drug-drug interactions in the design of novel treatment regimens and therapeutic drug monitoring’s potential to improve drug exposure in critically ill TB patients. This will inform the design of future treatment options.
Perumal said: ‘The studies within my thesis advance our understanding of first-line TB drug pharmacokinetics, provide a robust evaluation of a fluoroquinolone-containing regimen for recurrent TB, identify potential challenges from unexpected, altered drug exposure from drug-drug interactions, illuminate the problem of low rifampicin concentrations in critically ill patients with TB, and provide evidence to support the implementation of therapeutic drug monitoring for dose-optimisation in this patient population.’
Taken together, the results contribute to improving the treatment of TB, and will help to guide future research on new drug strategies for the disease. Several make new and valuable findings in this field.
Perumal said TB and HIV have shaped the global health landscape in recent decades, leading to tremendous human suffering and loss of life. ‘Despite being a curable infectious disease, TB kills more than 1.5 million people each year, and a substantial amount of work remains to be done if we are to turn the tide on this ancient relentless scourge.’
His early career mentorship by esteemed Professors Salim Abdool Karim, Quarraisha Abdool Karim, Naidoo, Padayatchi, and Keertan Dheda nurtured his commitment to a scientific career in TB and HIV research. ‘Their examples serve as a constant reminder of what can be achieved through unwavering dedication to pioneering and meticulous science combined with a deeply personal commitment to responding to the most pressing problems in global health.
‘I am truly delighted to have had the opportunity to fulfill this long-held academic aspiration. I am also deeply grateful to my supervisors, mentors, and family for their unflinching support and commitment to my academic development. Professors Kogie Naidoo and Nesri Padayatchi have been inspirational in their ongoing pursuit of incisive, pioneering, robust, and meticulous science. I hope to continue my development as an independent clinician-scientist as I redouble my efforts to achieve the global collective vision of a TB-free world.’
Perumal persevered despite several of his projects being brought to a halt during the COVID-19 pandemic as his attention shifted to his work in the intensive care unit and as research laboratories pivoted to the urgent scientific needs of that time. ‘While the pandemic significantly delayed my PhD, I have no regrets about completely dedicating that part of my life to the care of the most gravely ill patients in our intensive care units.’
He expressed his gratitude to his supervisors, whom he described as ‘a source of enriching intellectual engagements. They inspired my passion for locally relevant and globally impactful science. Their rich constructive feedback and constant vigilance for new opportunities to strengthen my scientific growth were instrumental to my development.’
One of the examiners of his PhD said: ‘The student has far exceeded the requirements for a PhD. The thesis represents an incredible amount of work that has been executed meticulously. In reading your acknowledgements and dedication, one gets the sense that you have made your supervisors and family incredibly proud.’ Another said: ‘This is a very impressive body of work – well structured, comprehensive, detailed and with some valuable results that are likely to have an impact in the TB field. I believe the requirements for a PhD have been fulfilled a few times over.’
Born and raised in Reservoir Hills, Durban, where a strong sense of community, educational aspiration, and service to humanity were deeply entrenched in shared values, his father, the late Professor Ronnie Perumal, served as his compass and guide, and a shining example of the incredible joy that emanates from a lifelong dedication to education, scholarship, and service to humanity. ‘All that I am and all that I hope to be is inspired by his selfless career at UKZN and his courageous pursuit of progress for the disadvantaged and under-served.’
Perumal’s passion for both science and the arts made Medicine a natural fit ‘as life as a doctor straddles the beautiful and poetic intersection between the purity of scientific empiricism and the deeply humane artistry inherent in the delivery of sincere and compassionate care.’
He holds masters’ degrees in Medicine, Public Health and Philosophy – each of which he feels has contributed to his scientific competence and deepened his commitment to pursuing his academic journey.
Perumal enjoys long trail walks with his family and immersing himself in the wonders of the natural world. ‘When time permits (an increasing rarity), I enjoy watching foreign-language movies or shows at the theatre.’
Words: Lunga Memela
Photograph: Sethu Dlamini
