Entomology, chemical ecology, evidence-based environmentalism and science in general. I like big bugs and I cannot lie.

Monday, 1 June 2009

Sprogs and swabs

On Thursday I finally got to start the work I'd come here to do -
taking samples from the eyes of kids with and without trachoma. The
first step was to actually find some kids with an active trachoma
infection, and to this end Shivonne (the doctor volunteering with the
project, who is the one actually poking the kids in the eye), The
Professor and I drove out to screen some local villages. On the way we
picked up our fieldworker, who is the spitting image of Samuel L
Jackson and so that's what I'm going to call him from now on. This
bloke is incredible; he's been working on the trachoma project for
some time and is able to identify Muscids in the dark and identify the
signs of trachoma from 500 metres. I exaggerate slightly but
certainly he should be the one getting the PhD, not me.

The children were summoned, lined up and the Samuel L turned the upper
eyelid inside out and checked for visible signs of infection. This
isn't painful but it is quite an unpleasant sensation and although the
kids didn't enjoy having it done to them very much they thought
watching it happen to others was brilliant entertainment. Some of the
older boys, unbidden, took it upon themselves to capture their
screaming peers and drag their sacrificial victims to the examining
stool. Some kids fought all the way, some looked resigned, some seemed
to enjoy the attention, some bawled as soon as they looked at us and
one little girls stamped up to the stool, crossed her arms and scowled
at Samuel L through the whole procedure before stomping off again with
a "hmmmph!".

Some of the kids struggled so much they had to be held down, which
made me feel rather uncomfortable. There's a rather different
attitude to discipline here - in Britain a crying child undergoing a
procedure like this would be comforted, here they were physically
restrained and often thumped or hit with switches if they cried, which
apart from being unpleasant to watch was rather counterproductive as
it just made them squirm and fight more. Usually it was the mothers
who held the children down, but in one village the Alkalo or headman
took on the task and performed it with a gentleness that I found very
moving, soothing instead of chiding and gently stroking the children's
eyelids closed with his thumb once they were done.

When not being sampled the kids were great fun, scared at first of the
white people but quickly gaining courage. One little girl in
particular stands out in my memory; four or five, shy at first, when I
smiled at her she came up to me and held out her hand. I shook it
gravely and she beamed, then started dragging other children forward
to shake my hand. As we left she shouted what sounded like "Send me
email!", and as neither Samuel L or our driver knew of anything in a
local language that sounded like that I can only assume it's what she
said. I doubt she could read or write, there was no electricity let
alone a computer in her village and as I have discovered internet
cafes are incredibly scarce here, but someone muct have taught her
that phrase and she wanted to stay in touch.

As we pulled out of the last village I saw two boys playing at doctors
trying to turn each others' eyelids inside out.

Having identified suitable clusters of trachoma, we returned the next
day to actually take the tear samples and the swabs that would tell us
whether the children had an active trachoma infection. (The symptoms
of trachoma can ake a while to develop and so can lag behind the
presence of the bacterium, and may persist once the infection has
cleared, so what you see on the childrens' eyelids may not correspond
to what you see with a PCR test for the presence of C.trachomatis
DNA). Shivonne took swabs by rubbing a cotton bud on the inside of
the eyelid and stciking another cotton bud up the children's nostrils
- I was amused to note that some of the dirty little perverts seemed
to rather enjoy this step. After the procedure was completed the
children got a "mintie", a boiled sweet, and it was amazing to see how
a child who had been crying inconsolably a second earlier suddenly
quietened down when a twist of luridly coloured cellophane was
deposited in their mitt.

Next to one village The Professor spotted a rocky outcrop rising a
good thirty metres into the air, unusual in a country that's mostly as
flat as me in a bikini. He asked the local villagers about it with
rather unsatisfying results ("What do you call that?" "A hill.") and
was informed that some missionaries had once climbed it, in a way that
suggested that this was only one of the crazy things missionaries did.
Not wishing to be beaten by missionaries he immediately decided that
we should do the same.

By this point in the day I had a thumping headache (usually we found a
place to sit in the shade for sampling, but something had gone wrong
in thelast village and we'd spent the afternoon sitting in full sun)
and couldn't think of anything less appealing than scrambling thirty
metres up baking rocks, but The Professor is a very singleminded man
and I don't think anything less than a stampede of hippos would have
stopped him. I reached the top feeling pretty awful and had to sit
for a few minutes with my head between my knees. Then I looked up and
the climb was suddenly worth it - the view was amazing with lush
swampland to the south soaking into the river Gambia and stately palms
rising above the dusty plains to the north, and the the thatched roofs
of villages we had visited dotted all around is.

Coming back down I snagged the back of my shirt on a rock and Samuel L
had to free me. He then decided it would be helpful to hold the back
of my shirt up and out of the way all the way down, so we came of the
hill like a slightly surreal bridal procession.

We set out again the next day and repeated the sampling operation.
More villages, more children, more screaming and smiles, resistance
and resignation. In the last village we met the Gambia's answer to
Richmond's pushy mothers. In Britain this woman would have been the
first to fake Christianity, move in with her sister to get into the
catchment area, anything to get her son into the right school. Here
she was determined that he should be included in our study. She dug
out his clinic card and kept trying to give it to me, and even went as
far as lifting poor little MOhammed onto the sampling bench ahead of
the other children we'd picked - Samuel L would then argue with her
until she took him away to make space for our sampling subject, then
she'd try it again when we changed child. Pushiness works -
eventually we included Mohammed in the control group just to give
Samuel L a quiet life. I took a picture of Mohammed, which I'll
upload when I get somewhere with a good enough connection. I'm
surprised she didn't ask me to print it out and frame it.

Coming back The Professor treated us to lunch at a small shack
restaurant next to the Kerouan bus garage, or rather treated everyone
else as I had no idea how coeliac-compatible the rich, spicy-smelling
stews were and declined. It was pleasant sitting in the shade under a
tree by the garage, even if the diesel fumes were occasionally a
little overpowering, and though the food smelled wonderful I was
really too hot to feel hungry and so didn't feel I was missing out.
In fact as I watched a pair of grubby small boys washing their hands
in the uncovered water bowl used for cooking I was suddenly glad I
hadn't eaten anything.

We have a few more vilages to sample, and then start the fly work on Monday.

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