Bondo, medical district center
Bondo is an village in the district near Tanga (60km). It’s a village, I know I call Wageningen a village but compared to Bongo, Wageningen is a true metropolis. There is no running water or electricity. Except in the Bondo district hospital were Hans installed some high efficiency solar collectors, which provide electricity to a CRP measurer (accute phase protein than can give an indication to infection or inflammation), a Hb measurer (aneamia), some light and the charging of our notebook batteries.
I attached a picture of the clinic and the village. (can't upload sjit, the connection could use some laxate) The cottage where Esther and I reside at the current moment is very basic, no electricity and no running water, holes in the ground to drop the occasional brown (depending on the food) message. I am used to these situations but what I truly miss is the fact that there is no running river in which you could take a nice shower. This is the big difference compared to my stay in South America. Fortunately for me the rain season in Tanzania means rain, so the shower problem is solved, although I am still waiting for a rain shower in the evening. We collect rainwater and use that to take improvised showers, we filter the same rainwater for intake.
The word in Bongo is…
That I am here, an object of major interest. No quite white, but not quite black, long whiskers (bakkebaarden) and a cap. In the first few days, the children were fascinated by my presence but now they are adjusting to it, I start to miss the attention already.
Our Job in Bondo
Here in Bondo, we provide basic free healthcare to children under the age of 5. At the same time we treat them for malaria, and measure some parameters from the children. Like the previously mentioned CRP, Hb, bloodslides and plasma. The children in the program, receive pills which contain micronutrients. These micronutrients are believed to have an positive effect on the 'resistance' against malaria infections in children under the age of five. Of course we use appropriate controls in this double-blinded trial in other words; we don’t know which supplements contain the actual micronutrients. Every time a child gets malaria it visits our clinic.
All kinds of kiddo’s pass by. Children with an accute episode, in which fevers reach temperatures above 42 degrees Celsius. Children, which would have been classified as deadly sick in the Netherlands but are playing around. No wonder the spleen (milt: important in the recognition of the bad guys), of the average child is at least three to four times as big as mine. Theirs is working extra hours while mine is still working on the cold I had three weeks ago. Theirs wouldn't even get out of bed for that cold.
It is hard to describe the things I coop with, but I am feeling ok with it. And Esther and Jacobien speak quite some Swahili which saves us a lot of trouble and gets the account of good will from all the locals. But at the same time it is a double edged sword. My swahili is not improving that fast. But then again, languages were never my strongest point. Some of the people in the clinic speak English as well.
I like it here....
My current job
Yesterday (Thursday) we started collecting blood from the children. The blood can give us a lot of information on the health of the kid, and if his situation has been improving over time. A child gets bitten by a malaria carrying mosquito at least two times a night in these high endemic areas. This means that during our trial they will get malaria on several time points. Every time they get treated against malaria we can take measurements. On two times during the trail we collect blood. During the baseline (start) and somewhere near the end which is approaching. My job in this is to analyze the immunological parameters. The number and what kinds of white blood cells (the soldiers to combat the infection) do these kids have. And what kind of weaponry do these white blood cells use to combat the infection. This is not easy, because on several occasions these kids are infected with different bad guys, sometimes, with different types (strains/clones) of malaria. That’s why I am going to screen for multiplicity of infections in the blood but also in the feces (bacterial). When I get back in the Netherlands I’ll to reproduce representing data in-vitro (in lab conditions, in a petry-dish). As some of you know malaria is a nasty disease. It is transmitted by a bloodsucking mosquito’s the parasites enter the liver within 30 minutes after the initial mosquito bite. The parasites remain dormant in the liver for a while. At least, the patient won’t notice any symptoms. After this dormant phase it moves on to red blood cells, where it multiplies and multiplies until the red blood cell explodes. The parasites consumes and convert substances in the red cell into a new substance which the body considers toxic. After explosion, a tremendous amount of parasites as well as these toxic substances make their exit. The thing is that all the infected blood cells (which could be over 7%) do this trick at the same time. Triggering our immune system in battle mode in a ways that can result in high fevers, anemia and a fast death. I want to see if I can simulate this situation in the lab, so I can see how our soldiers really react, more detailed measurements can be made this way, but the downside is that a lab model is very far from the real thing. These last experiments are going to be performed in Wageningen. At this current moment I help in the clinic, mainly with the lab diagnostics but Hans encouraged me to participate in the clinical stuff. Extracting blood by finger pricks and examining for malaria, measuring weight. I really like this part of the job. I know the molecular stuff in detail, but now I am learning to relate this to clinical observations. As I said before, I am learning a lot.
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