Here I am again, hotter than ever! en

By MaDLiVe on Friday 10 October 2008 11:58 - Comments (5)
Category: Tanzania, Views: 4.942

According to nerd terms I’ve been offline way to long, sorry for that. But the reason for this is most apparent; the 3G/GPRS support in this area sucks big time ;)

But before we go to the most recent happenings in my life I would like to thank you guys for all the supportive and nice e-mails, indeed this is an urgent request to sent me moreeeeeee

I write the majority of articles beforehand. So now and then I have access to the www and I put all the written material online. For example now I am in Tanga, where the have a dail in connection. So in betwen the shopping for food I update you guys

I try to use the original date stamps, corresponding to the date of the event. So double check if you have already read ‘zhe’ stuff. Don’t mind the spelling mistakes, due to a lack of time I write things down, and don’t always double check mistakes. If you have the time to rephrase stuff please do so :+

So the first few day were awesome, and I don’t mean that in an always positive, ‘ow, I am so freaky happy, I am going to give away free hugs’, kind of positive. There were and will be eye openers which don’t show me anything new, the only thing that differences is that I am granted to see and experience them with my own wicked senses.

Check out the most recent posts and pictures!

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Collect my blood, don't screw up ourfield trial! en

By MaDLiVe on Friday 10 October 2008 11:54 - Comments (1)
Category: Tanzania, Views: 2.673

Collect my Blood
We started with the collection at 0700, and got assistance from two very skilled nurses.
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First of I have to admit that my body is having serious problems with the lack of caffeine, especially in the morning. Sometimes we get up around 0500, and work till 1900. Long days…

Anyway, collection was performed on nine children from one specific area, I helped separating the samples (divide blood, into plasma and the rest) and did some malaria essays to check if the children were infected. This was something I wanted to know because I need this data to know on which samples I will be able to do a infected red blood cell extraction. The remainder of the blood was taken to Korogwe. Hans made the drive and asked if I could join him. Because there were not too many patients in the clinic I decided to join him. Korogwe, has a hospital with a new brand new laboratory, with several research teams from different countries occupying it. There are only females working in the lab, at least that is what I noticed.

They have showers, nice rooms, and actually it is quite nice (especially some of the lady’s, one was wearing a white dress, almost transparent :+). We analyzed blood profiles and prepared the plasma for long term storage. The cool thing about Korogwe is that there all the people there are doing incredible research, all in the area of tropical infectious diseases. Hans knows all these people and always introduces me to them (he knows where my interests are pointing to). Today we met someone whom was asked to perform a big vaccination trail (cholera) on behalf of the WHO on Zanzibar. His trials includes only some geographic regions at this moment but might expand to the whole population (1.5mil.). He joked, at least, I think he was, that he was looking for people like me (multidisciplinairy).

I also met Mayke, a PhD. student who offered to help me with establishing a good protocol for isolating and appropriate storing of my infected red blood cells. Afterwards Hans delivered me back to Bondo clinic, but before that we made a stop at a nice restaurant to get a cold coke and had a few nice chats about the Academic world. Which is no different than the real world.

A few challenges are coming up. How am I going to collect the infected red blood cells, hibernate the parasites long enough, and store these goods till I get back in the Netherlands (these kinds of experiments require fancy labs). Well enough stuff to think about this weekend.

To make a long story short, I have been helping in the clinic these last days and will do so until upcoming Sunday. Then Hans and I will go to Moshi, where they have ‘advanced’ lab facilities. The main focus there will lay in the isolation of these white blood cells from blood, which will be collected in the Bondo field hospital and transported to me the same day (almost 750km of travelling a day). Next to that I will do a few other things on which we will come back later.

It is a shame I have to leave on Sunday, because I like the clinical work, but fact is I am not a medic. This way, I can connect clinical work with scientific work, and that is the area I want to end up in. Hans already told me I can come back as soon as the blood collection is completed. And I probably will do so. Maybe I can locate myself in Korogwe for a few weeks, depending on the arrangements Hans can make. This will greatly reduce the traveling time for the blood samples and will improve the quality. I am really glad that I decided to come here. There is no thesis project that could replace the unique experiences I am gaining here and this is an conclusion I already made within the first week. And let’s face it, these fancy lab techniques I can always master them in at least a month after all I am a smart kid ;)

The African or other way of doing a proper job
As I mentioned in previous chapters, the children in our program receive food supplements. It is of utter importance that they get these supplements every day, on a empty stomach. That’s why the supplements are administered by a so called health administrator. This is a guy who has the responsibility within a certain area to administer these medicines and check if the children have any symptoms of fever. In that case, the health administrator directs mother and child to the clinic (the furthest locations are 12.5km from our clinic). They get paid for this job, and according to local standards quite decent as well. We don’t leave the job to the mothers because they might 'neglect' these kinds of routines, and it makes it harder to monitor errors in administration.


To check if the health administrators do their job we perform so called spot checks. We go to a certain spot, unannounced to check if the health administrator is doing his job. Last week we noticed that one health administrator was handing the pills out to the mothers. So we could never confirm if the child actually got the supplements. This could lead to major flaws in the whole study and is therefore unacceptable. That’s why the health administrators have to report in now every day, and have to bring the pill strips. It sounds like a harsh measure but apparently it has to be this way. The downside is, that the team had more administration to comply with and we have to perform more health checks (so get up early…)

Wednesday morning (morning is 0500) we woke up to do a so called spot check, except for the truly beautiful sunset, we say to our great pleasure that our health worker was doing a great job.


Check out the pictures. I will try to update you from fancy Moshi on a more regular bases. I have internet at my disposal at any given moment.

Cheers mates luv ya all,
Ammer

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Bondo, medical district center en

By MaDLiVe on Thursday 9 October 2008 12:01 - Comments (0)
Category: Tanzania, Views: 4.510

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.

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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.

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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.

Karibu (welcome) en

By MaDLiVe on Friday 3 October 2008 10:38 - Comments (0)
Category: Tanzania, Views: 1.745

The use of a Barf sensor

As you might remember I left the Netherlands on Thursday the 2nd of October. My last post on this log carries the timestamp of 1800, an hour later I was on my way to Dar Es Salaam. Still doubting to make the ride to Muhesa in one long run. The first few hours of the flight were pretty ok, I had 3 seats reserved for me alone, no hot chicks filled the seats next to me (bummer) but in exchange I got a very modern LCD tv (7") with touch screen controls. They had a bunch of recent movies, and tv series onboard. I watched one episode of the office US and spent most of my time reading some papers. So in a attempt to keep this episode of my story interesting I skip my hilarious dinner and conversation with a MIWNLTF. As soon as I planned to go in to coma mode, some old dude in front of me starts barfing. No, this wasn’t a small barf, he decided to barf trough the whole aisle. He probably ate some wrong sjit, but my barf detector concluded different. This dude had too much to drink. Well to conclude the plain episode. My barf sensor kept screaming, ‘don’t sleeeeeeeeeeeeeeeeeeeeeeep Amrish, stay Awaaaakeeee, cause barf means danger and you don’t wanna be stabbed by an angry oger do ya!?’, and so I did, awake, before I knew it was morning.

The Anal cavity search, to do or not to do

There comes a moment during every airplane flight that the plane is going to hit the ground. This can happen in several ways. Well our way was the proper way for the critics, that means: on several wheels and on the correct airfield/strip. I made my exit, not to speedy of course, did not want to draw any attention, you know me by now. Because I already arranged a VISA I could move past all the people who were waiting in line. So after customs, I made my exit. But apparently I did not pay any attention to the guard screaming at me, at least not in time. Well I did pay attention when he reached for his very impressive bullet launching machine. I excused myself, for not paying attention, and told him I was very tired. He asked me f0r what reasons I was visiting Tanzania. ‘Study’, I said while exchanging mutually cold expressions. Having no doubt about it, I reached for my improvised letter (bulletfast!!) which approved and explained my luggage content (40 to 60% diagnostic equipment, and some nice impressive stamps from all kinds of important persons). What happened after this is quite boring. But no anal cavity search and no scooping through my luggage. Phew, I will return with vials of red stuff in my luggage, fingers crossed for the same course of things during the trip to the Netherlands.

Kabari Ndugu

I was in Tanzania! My taxi was already waiting for me. Hans arranged that Chief, my driver would come to the airfield and pick me up. I must say that this was very convenient, I was tired, and cashless. The ride to Dar center was around 30 minutes and it was a typical sight. Slumbs on the outer zones were the word poverty was widely known. It is not different then from the books with the pictures begging for attention, how coldhearted it may sound, that is how it was. In Dar center I exchanged some cash and got a Tanzanian sim card (4 euro’s for a simcard and a sjitload of credit) I decided to go straight to Muhesa and meet up with Hans. This would mean another long ride with the bus, but afterwards the traveling would stop for a while. How wrong I could have been ;)

If you are a stupid dickhead, you will get ripped off

The bus ride was taking forever, I am never going to complain about the NS, I swear. Next to that I was an interesting object of interest, but you know me, quite used to this kind of stuff. So I put up my cool face (sunglasses and cool smile) and tried to get some sleep. Didn’t happen. The bus driver woke me up before we left. He wanted me to pay some extra cash for my bag, which was in the luggage container. To be exact he wanted me to pay double. My logic told me that he was ripping me off. But logic works in mysterious ways especially when it comes to my logic , I decided to ignore logic. Cause the double of 4 euro for a trip of this extent was still affordable and still that much of me was saying that I would not win the discussion, not only because the guy and his friends were looking really grim but mainly because I only could understand the words ‘pay another 7k Tanz shilling’. I always make it a custom to learn some words of the native language if I visit a country, but because of my irregular and busy scheme in the period before I left, learning Swahili was completely neglected. The bus ride itself sucked ass don’t blame me for being honest, but I did get a nice impression of the landscape.

Karibu, here is your first case of malaria

Somewhere around Tanga I decided to call Hans, he was close by, actually I just passed him at a famous t-intersection (Moshi, Tanga). He was waiting for a sick child that he would drive to Korogwe hospital. I asked the driver to stop and to unload my bag. Hans picked me up and we went to the rendezvous point. We picked up a sick child, who had just had a malaria episode and came in with aneamia (bloedarmoede) and respiratory distress. Under young children malaria knows how to create massacre’s. Child mortality rates under the age of 5 years go up to 30% in high endemic areas. Hans who is an all rounder (but mainly a very skilled epidemiologist) decided to drop the kid at the hospital, although he did not share the conclusions of the dokter who made this decision. The kid is alright by the way. A step further on the road towards immunity against malaria.
After meeting some personal at the lab connected to this hospital, we went to the Bondo Chakenai field hospital. Our base of operation. No electricity, no running water but a shitload of people who require medical attention. Here I met Esther, a student in medicine at Nijmegen University who was stationed here for already 5 weeks.

Hans decided, that I had to go to bed. Which wasn't a bad advice. Before he would drop me off in the field he thought I should get a good rest and meal at his place in Muhesa. Not a bad advice, not at all. At this point I was awake for more than 38 hours. Taking in account that the upcoming weeks would bring a lot of hard work, and that my body had to adjust to the climate I knew I had to take care of myself. So after dinner, meeting Hans his wife, Jacobien, I went to bed to wake up the next afternoon.

Take it easy

Instead of moving on the next day, Hans advised me to take an extra day off, just, dive into the literature’, he said. I tried, truly I did. But ended up with playing with Sam, the very active and energizing offspring of Hans and Jacobien. Well at least I adjusted, to the climate, and the red sand which is full of iron. Ironically enough, both plants and people lack the same iron, which the ground holds so dearly.

On Sunday I left for Bondo. The field clinic, representing Africa in almost all the known stereotype images. Poverty, disease, hardship, but a lot of happy friendly and warm people. Finally leaving some room in my bag for air, I stacked all my lab equipment at Hans his place, because we wouldn’t be needing this in the upcoming weeks.

A Day at the Airport(s) en

By MaDLiVe on Thursday 2 October 2008 14:11 - Comments (9)
Category: Tanzania, Views: 4.380

Well , well, today I am leaving for warm Tanzania. A long travel awaits but the first part is done, getting in to the airport (Amsterdam). No long goodbye's just a tremendous lack of sleep and the prospect that my hand baggage is too big, heavy and waiting to be bounced of the airplane. If so I will leave some sweaters and books behind.

You know the weather prospects for the Netherlands? I do, and you know what, HAHA!

As a good nerd should, I am sitting in the KPN lounge surfing the web, at the same time I found this a nice occasion to update this site. Coffee, is getting cold, just the way I like it.

So yesterday I started packing, as it seems I started way to late, what else is new right. I finished packing at 0330, Fortunately I was able to sleep till 1000 in the morning, leaving my parents in the mess, consisting of clothes, aftershave, books and rushing ourselves to the airport where we arrived way to early (that's why I am typing this sjizzle. Sorry mum! Ask Dimi to clean ;)

40% of my primary luggage consists of DNA extraction material and PCR tubes + enzymes. Reason enough to get myself an extra handbag. I never had to leave behind so much clothes, books and articles but I figured out that you can by clothes in Tanzania (no sjit sherlock). The articles are stored in a digital format, and I have 3 backups. I forgot to tell you guys, that 2 days ago I almost lost my whole collection of articles which I collected over a year. Fortunately I got them back, without the filenames but, at least they are back (hail to recovery fix!). That was a much for much stress I must admit.

Hans, my supervisor, called yesterday with a request to get some extra material from the lab in Nijmegen, but unfortunately I already was in Amsterdam, well if I wasn't I had to mention that my bag was already locked and loaded.
The thing I hope for is that the airport dudes in London will spare me...I hate extended searches for crap, and I don't look forward to explaining why I have all this stuff in my luggage. On Monday, the secretary from the chair group and I made up a 'formal' letter. Signing it with the digital autographs from 2 professors and filling it up with impressive stamps. Hope that it is impressive enough. But apparently my color gives reason extra caution, that’s just the way it is. I tried to paint myself white, but it didn't work out, bummer! As emergency measure I shaved (and yeah that was needed), and put a lot of gel in my hair, now looking like the black brother of Wolverine. Damn, I look sexy....

So what is the plan for today/tomorrow. In less then a hour I will fly to London. Four hours later I will fly to Dar Es Salaam. I will arrive there in the morning, still leaving open, the option to spend one day in Dar Es Salaam, and recharge my battery, or just making the trip (if the bus schedules allow it) to Tanga in one drive.

Haven't decided what to do in the plane, reading a book, sleep all the way.

I hope the person sitting next to me is a really hot girl. Don't know when I will come online again, might be in a few hours, or not.

Cheers mates,
Ammer

Ps. A really hot girl just passed by.

[1636, Londen]
Pps. Ow my god, Free internet in a lounge. How cool. That is what makes the Netherlands sucky sometimes, you have to pay (a not moderate amount) for every, what in my opinion, should be free services. At Schiphol they charged me 12 euro's for 90 minutes ;) Well it allowed me to do some overdue work.

Ppps. No hot chick accompanying me during my flight towards London, just a guy who really liked talking, about his life. Almost missed my flight, note to self: Departure time isn't the same as boarding time...

Pppps, No anal cavity search yet, thumbs up! :D

Pppps. The burger which I am consuming now, is like totally awesome and the waitress is hot, in a cute kind of way. No Irish, red, ordered one, got a Stout….first time for everything