Inside a dark wooden hut, 20+ kilometers from the nearest muddy road, UK medical student Hannah Russell and several others in white lab coats labour over ‘buckets of poo’. They filter each faecal sample through a mesh, collected from 50 Malagasy village children, smear it onto a microscope slide, and start counting the eggs. It’s a smelly job, but incense and Tiger Balm under their noses helps to offset the offensive smell. ‘Blame it on the Weatherman’ plays on a small battery-powered speaker nearby. “It’s not a very glamorous job,” Hannah laughs.
There are 50 samples of urine as well, but these are much easier to test for schistosomiasis, more commonly known as bilharzia, a parasitic worm that can enter one’s body via infected water. Like a pregnancy test, a few drops of urine onto a strip will produce an answer, and the answers from the 2015 Madagascar Medical Expedition (Madex) were astonishing. After testing 399 children from six remote villages in the Marolambo district, one of Madagascar’s most remote regions, the team of doctors and medical students from the University of Manchester found an overall bilharzia prevalence of 94%, an exceptionally high number. As well, they recorded extremely high egg count levels, well over the World Health Organization’s threshold for ‘intense’ infection. If left untreated, it can cause serious organ damage and even death.
In June of 2016 the team of five from the UK returned to Madagascar, having first visited in 2015, to continue with more research, education, and treatment of the disease. This time they flew with MAF Madagascar to and from the Marolambo airstrip that MAF built and paved many years ago on a mountain ridge above the Nosivolo River. In 2015, the research team came from the capital to Marolambo by public transport. They didn’t know they could fly. It was a brutal four days on extremely rough, muddy roads.
“The road was absolutely terrible,” Hannah describes. “It was like nothing I’d ever seen.” It was pitch black on the fourth night when they reached a section where three trucks, stuck in the mud, completely blocked the road. “There was no option but to get out and walk the final section for about 20 kilometers. We’d been traveling all day. We hadn’t eaten. We had all our equipment. It was raining. We trekked through the darkness with a head-torch, just seeing a few meters ahead. It was so muddy! Eventually we arrived in Marolambo and we were all absolutely exhausted.”
Some time after arriving, they learned of MAF’s flights, and have flown to this remote region since.
“To be able to go back to Tana in about 45 minutes was just amazing,” Hannah says, remembering what that first flight was like after taking the road. “This year the weather was so bad that it was taking 10 days to get from Mahanoro (two days travel from the capital) to Marolambo on the roads. If we had arrived and planned to go via the road, it would have completely ruined the expedition. This year we couldn’t have done it without MAF.”
The 2016 expedition expanded the research to look at how the disease is affecting the health of the population using questionnaires, tests for anaemia and malaria, cardiovascular assessments, and checking for liver damage using a small portable ultrasound scanner. Three research days were spent in each village, after which the team packed up and trekked to the next village along the river, often taking an entire day that included river crossings over slippery foot-bridges made of planks and sticks with no hand-holds. Although it’s the dry season, it had rained for two weeks prior to their arrival, and continued through much of trip.
Each of the three research days consisted of a similar routine.
“Education on schistosomiasis and hand hygiene preceded the study,” Dr. Stephen Spencer describes, beginning with day one. “We then divided the school into several ‘stations’ through which the fifty children (aged 5-14) would rotate through. Daniel, Zo, Emmanuel, Elodie and Dr Alain completed the questionnaires with each child (assessing the impact of schistosomiasis in their daily life), James and Corty measured each child’s height and weight, Hannah performed ultrasonography, and Steph and I took blood tests for anaemia and malaria.
“We had hoped to run through 25 children each day but the first day had gone much quicker than planned; we had only 19 children left for day two meaning extra time for faecal and urine analysis!
“Our third and last day involved treating every child in the village for schistosomiasis via ‘mass drug administration’ as advised by the WHO.”
Approximately 9000 doses of the drug treatment were flown in by MAF. Most of the data collected will be analyzed as the team returns to the UK.