Saturday, February 24, 2007

MalariaGirl gets malaria!

I've been back from Kenya for about 10 days and am getting the second installment of my blog for my blog done - it was strategically delayed due to the news. :)
One, I got sick - more below. Two, due to bureaucratic snags in Kenya, it looks like we won't get to run this study after all, which is disappointing, but after the difficulties we've run into with essentially every step, I think anything else I try to do later will seem easy in comparison. :)

This is the clinic at the district hospital where we planned to run our study - this is where all the kids come for their vaccine and sick visits.
I stopped at another clinic and took a peek at what the microscopist was looking at - in this case, a blood smear absolutely chock full of malaria parasites. They look like a little ring with a darker dot to one side. There were probably 100 little rings in every microscope field. The child it belonged to was pretty sick.

So, I am typically very bad about taking my malaria medicine. I can just never remember every day. I usually take doxycycline, which can be hard on your stomach if not taken with food, and can't be taken at night before you go to bed if you've forgotten all day unless you want esophageal ulcers. This time, I took malarone, which has the fewest side effects of any malaria prevention medicine - it's great! Any I remembered to take it every day! Well, 12 days after I got to Kenya (hardly even long enough for it to incubate), I was training our staff and just didn't feel good - stomach stuff and felt weak. I talked to one of my Kenyan colleagues and we decided it was just a little viral bug, but I asked him to pick up malaria treatment at the pharmacy that evening for me. The next day I felt much better. At noon, I was eating with friends, I felt my hand go numb and looked down and saw that my nails were blue - like when it's freezing outside - only it was 85-90 degrees outside! I started getting chilly, then I started getting goosebumps, then I started a real teeth chattering shiver, at which point my friends (my friend Meredith, whose office is 2 doors down from me in Atlanta, was there that week) said I looked pale and mottled and marched me to the lab, where Martin, a Kenyan microscopist who has been doing nothing but look at blood smears for 40 years, did my smear. He didn't find anything on the first slide, but told us he wanted to repeat it in 1-2 hrs. By that point, I had stopped shivering, but my temperature had shot up and I felt horrible. Meredith arranged for a car to take us back to the hotel, and did a blood slide in the car when we got back to the hotel and sent it back to the lab with the driver. By this point, I had some ibuprofen in my system and was starting to feel slightly better - and my temperature was 102.7! So I laid there and waited. We called the lab an hour later - and they said they had found one little sad looking parasite on my smear, but were very excited, and the director of the lab and two guys came over to get venous blood to run some more tests on. I made them do another smear, too, as I knew people back in Atlanta would be skeptical - there were 2 on that smear! My first smear is below - didn't come out very well. The parasite is the darker round dot in the upper left hand - you can't really see the ring.

So I started taking the treatment that my colleague had fortuitously purchased the day before, and felt a good bit better the next morning. My branch director, Larry (in the last installment) came to check on me. I felt good enough to go into work that afternoon, though I rested over the weekend. My stomach still hurt for a couple days, and my appetite didn't really come back for a week, although Meredith persistently dragged me to go eat something. She's so good!

Points this experience really brought home to me:
*I had malaria several times as a child, but I don't remember the bone-rattling chill - something to be reckoned with.
*Malaria is not a big deal if you have access to rapid diagnosis (I had the best imaginable - even in the US it might have taken a couple days) and treatment. The reason it still kills a million people (mostly young children) every year is because they don't have access to the same - whether they live too far from the nearest clinic, or they can't afford the treatment (cost me $6)...or if you're a dumb American (no offense) and you sit at home and don't see a doctor for a week with fever after you've traveled to a malarious area .... or your health care provider doesn't think of and test for malaria... (but there are only a handful of those every year - 7 in 2005 to be precise)
*You can still get malaria after taking prophylaxis (although this is extremely rare - they are testing my blood for drug levels to see if I don't properly absorb malarone), although this is NOT an excuse not to take it. You just have to know it can happen. Because I was taking prophylaxis, there were very few parasites on my smear and they looked atypical (although clearly enough to make me feel really yucky!!), which could have made diagnosis tricky.

Anyway, glad to be back and feeling back to 100%!

Thursday, February 08, 2007

Kisumu, Kenya

Hi from Kisumu! I'm here to set up for a clinical trial - we are testing three different antimalaria regimens (all approved drugs) in children with malaria. We are still trying to get the protocol through the approval process, but in the meantime are out here making sure our data collection system, lab supplies, personnel hiring and training, and study site are ready to go the minute we get approval.
Below are "the team": Meghna (in the middle) grew up in Tanzania and has worked in Kisumu before. She is Atlanta-based and is supervising me on this project. She was absolutely fabulous to travel with (even 5 months pregnant), completely in her element here, and great to work with. On the right in Frank, who is Kenyan and the study coordinator for the main trial that ours is a part of - Frank is incredible, totally organized, and one of those people who makes things happen, plus he's really nice! Chris, on the right, is the study coordinator for Meghna's and my study - also incredibly terrific. We have worked so well together over the past few weeks - he's a very hard worker, and totally on the ball.
Here we are in the clinic room of Bondo District Hospital that we will use for registering and examining the children in our study, planning clinic flow.

So, I haven't gotten out on any wild adventures yet, but it's fun to sit by Lake Victoria, only sometimes you wouldn't necessarily realize you're by a lake! Several years ago, water hyacinth was introduced to Lake Victoria, according to local tradition, by a British woman. Since then, it has practically taken over much of the lake in huge mats, and according to Frank, "looks like a football pitch" (soccer field). The green "field" in the background of this picture is actually part of the lake. It has resisted both mechanical and biological (special beetle that eats water hyacinth) attempts at control.

Close-up of water hyacinth - apparently the mats get so thick you can walk on them. It seems maybe they are not all bad, even though the fishing industry has tanked. Formerly, the Nile Perch (another introduced species) was decimating the Lake Victoria cichlids (colorful little fish, often found in pet stores, many species found only in Lake Victoria). Since the introduction of water hyacinth, the cichlids are making a comeback. Another ecologist had predicted that Lake Victoria would be "dead" due to industrial waste in a decade, but the water hyacinth seems to play a role in re-oxygenating the water and keeping it healthy. :) Oh, the tangled web we weave!

Back to people - this is Mary Hamel, the malaria branch chief here in Kenya (and the Kenya-based primary investigator of the study I'm working on - there are many cooks in this kitchen) and her daughter Yala (named after a river here). It has been fun to get to know the CDC community here - they often all go out to the same place to eat, usually a place where all the kids can run around together and then adults can socialize in peace. Reminds me a little of my growing up. Yala is a lot of fun - very high energy, needs constant stimulation - I love grabbing her and going for a walk, picking flowers, touching the hippo signs at Kiboko (hippo in KiSwahili) Bay.

Me by Lake Victoria - can actually see some Lake in this picture!

Sunset over the lake

Some EIS officers work a lot with their supervisors - not so much in the malaria branch. My predecessor crossed paths in the field with his supervisor once - by accident. I don't think I will ever cross paths outside Atlanta with my primary supervisor, Rob, but my secondary supervisor is the CDC Atlanta Malaria Branch chief (Larry Slutsker), and he was here for an unrelated visit, so I had to get documentation that I had been in the field with one of my supervisors once. :) Below are Larry and I. He just finished a 4 year stint being director of the field station here and just loves Kisumu.