We find our first schistosomes, what a fluke!
Having sadly waved goodbye to the 9-seater plane carrying Steve back towards Tana (a 39 minute journey compared to the 4 days drive to get here) we now had to pull our reduced team together and make sure we continued the good work.
Steve has been absolutely instrumental in this trip, and it’s essential that we pay him due credit here.
After becoming interested in schistomiasis on a medical placement to Egypt, Steve started firing off emails to WHO Madagascar and others over 2 years ago to investigate the possibility of research in Madagascar. Since then he has put in countless hours of work, in front of and behind the scenes, to make sure that the trip has continued to fruition. Whilst Hannah, Anthony and I have had our share of jobs over the last year, tailoring plans and finalising details, Steve has been there as a constant galvaniser, supplier of advice and reassurance for us, and string puller in all directions to make sure that everything came together. We’re so grateful to have had the opportunity to take on this expedition, and aren’t for a minute forgetting that without Steve none of it would have been possible. The only thing I’ve really seen Steve fail at is in gaining us access to the Gold Lounge in Nairobi Airport. ‘You have not been using your air-miles, Dr. Spencer!’ Ivory Lounge was the best that Steve’s measly air-miles could scrounge, and there wasn’t one in Nairobi, so back to standard non-AC lounge it was for us.
Anyway, eulogy over, but thanks so much, Steve, we’re all incredibly grateful.
I’m writing from Ambohitelo primary school, which is perched next to the village football pitch right on the banks of the Nosivolo river. For our 3 days here we’ve been given one of the school’s two buildings to double as both dormitory and laboratory. The schoolkids so far have spent their time playing football, performing a kind of elastic skipping rope game, or staring at us as we try to convince our microscopes to work, so we don’t feel too guilty for robbing them of a classroom for a day or two.
After Steve left Marolambo we had our first full run of slide preparation and microscope examination with the team that will see us through the next 2 1/2 weeks. A full sample of 70 kids’ poo and pee from Marolambo primary school was obtained, stained, and the entire next day was spent analysing these under the microscope. After initial frustration at the slowness of reading each slide, and worried that we wouldn’t have the capacity to continue with our planned sample size, by midday we’d found our rhythm and by the evening we’d gone through 70 slides and had identified our first really high schistosome egg counts. Coupled with the 90+% schistosomiasis prevalence found in the school by urinary antigen tests, these high egg counts indicate intense infection in the area. Whilst bad news for the community, this was confirmation for us that we had come to the right place in terms of looking for areas of high infection, where appropriate interventions could make a significant difference, and so to some extent, real vindication for us of the value of the expedition.
In each school, Daniel and Anjara, our fantastic team members from Antananarivo University, deliver an education programme to the kids about the nature of schistosomiasis and advising how to avoid it and other parasitic infections. They use the school’s blackboards, coupled with some brilliant posters from the UoM Immunology Dept, to emphasise the importance of how handwashing, hygienic eating habits, and awareness of the river as the harbour of schistosomiasis can reduce illness. It’s been very rewarding so far to see the kids really listening to and engaging with the sessions, and then also how parents and teachers will listen just as attentively from the back of the classroom, following up with questions and queries. As well as our additional supplying of drug treatment to the local health centres, we’re hoping that this will help reinforce the long term reduction in the amount of schistosomiasis in the region.
Since Marolambo, we’ve screened another 80 children in Ampasimbola primary school just 15 minutes walk and a log-canoe river crossing away, and have now travelled to Ambohitelo, our third school in the region, 1 hour’s walk up the river. Over the next 2 weeks we plan to screen three more schools, totalling 6 along the Nosivolo. Bellarmin, our envoy and organiser supreme from Durrell Conservation, has accompanied us so far, making the invaluable introductions to the village chiefs and headmasters, without which our work and integration in the villages would be impossible.
As I have written this in the dying light, Hannah and Anthony have gone through another 15 slides, Daniel and Anjana have done more brilliant work interviewing the headmaster on his perception of the health needs of the school, and the wife of the village chief has brought us a huge canteen of heavily cane-sugared coffee and a plate of mofokondro (battered deep-fried bananas), for which we are fast developing a taste.
It’s a constant privilege to work here. Everyone we have met has been unbelievably welcoming, it’s a fascinating culture to be immersed in for this short while, and whilst sifting through poo 1 day in every 3 isn’t everybody’s idea of a summer well spent, I wouldn’t swap it for anything.