Bamako Day 7 (02/07/09)

Last night I had nightmares about slide reading. How sad is that?

This morning we headed up to the lab to meet Agnes and then went to the visit the drug resistance lab. We spoke with the researches in that lab about the work they do, which mostly focus around PCR (a method of DNA replication that allows you to identify different characteristics of the parasite). There they can determine is a parasite sample taken from the field is drug resistant and which mutations it has. They are also assessing the effectiveness of IPTc (intermittent preventative therapy for children), which means giving children curative doses of antimalrials (in this cause they were comparing sulfadoxine paramethamine (SP) with an artesinate comination therapy (ACT)) at given intervals ( I think it was every 2.5 months) during the transmission season. They're hoping this will help counter some of the damaging effects of getting several bouts of malaria per season (children here typically get clinical malaria 2-3 times per season), such as anemia and missed school days. However, there is the risk that this will as cause a delay in the amount of time it takes children to develope aquired immunity to malaria (typically it's acquired between age 5 and 10). Tekate v(who is the head of the lab while the director Djimde is away) invited us to have coffee in the "lounge" and talk some more. When I had heard about IPT before I was concerned that it would just shift the disease burden to an older age group, but Tekate made a good point: when a baby is sick it can't tell anyone, their mother or caregiver has to be paying attention, but when a child is older, say 5 or 6 they can tell their parents that they are sick and potentially get the attention and treatment they need sooner. I was very excited because I was able to ask several questions in french (though I'm sure they has plenty of grammatical errors) and Tekate understood. :)

At 11 Agnes came to take us to the immunology lab. This lab turned out to be scarcely more than an office with a fumehood and some instruments. The lab belonged to Boubacar Traore and his medical research student. He was very nice and explained to use the things they focus on, mainly analyzing samples from vaccine trials to check for antibody response and cell mediated immunity. Right now the lab is in a bit of a lull becasue they're waiting for samples from the vaccine trial that is wrapping up. After we had finished talking to Boubacar his student escorted us back to the guest house. Liz wasn't feeling well so she went to take a nap.

After lunch Liz still wasn't feeling better so she stayed at the guest house to rest while I went back to the lab. When I got to the lab two of the techs were watching "Kangaroo Jack" in french. I attended a journal club in the afternoon, though it's not like a journal club in the US where someone presents a reserach article, here it was research students presented their data and getting feedback before having to present their thesis to graduate (though the people presenting already had doctorates, they were going fro 2nd degress, which seems fairly common here). There were 3 presentations. The first was a well done study comparing treatments for schistosomiasis (another parasitic infection common in Africa). His presentation aws in french, but I was able to read the slides and keep up. The next presentation wasn't as good, though I'm not sure if this was due to the presenter or the fact that his data wasn't complete. He presented his study on the effect of Vitamin A and zinc supplementation on Malaria morbidity (from what I've read about it, this treament seems to have mixed results, helping in some studies and having no effect in others). He didn't have much data yet because the study isn't over, however his presentation was in english and many of the tables he has were sort of awkwardly presented, hopefully they'll improve with the feedback. The third presentation wasn't by a research student but by one of the doctors on how to use scientific databases. The presentation was fairly short, though many of the older doctors there seemed confused (not surprisinly so as the genetics databases are complex). During the lecture I began to discover some interesting trends in Malian speech. People tend to talk very softly (and they like to joke about how Nigerians are very loud and rude), but when asking a question making a statement then tend to be rather longwinded. The soft speaking gives me some trouble as I still have a difficult time figuring out what they're saying, which is made harder when I can't hear them well.

After the journal club Agnes came back to the guest house with me to check on Liz. She had just woken up and though she was feeling a little better she still wasn't great and Agnes suggested doing a rapid malaria test just to be sure. Agnes went up to the lab to get the supplies and when she came back she had me do the test. Thus Liz was my first patient. I think I did well with the finger stick and was able to get enough blood for the rapid test, but it was a little difficult to get a good drop of blood on the slide to make a good smear, but all in all I think I did well. And bonus, Liz doesn't have malaria (Mahamado Thera had mentioned before that there was come resistance to mefloquine, the drug that Liz is taking).

We've had a pretty quiet night, eating dinner, doing a crossword and just vegging out. Tomorrow we'll visit a lab that was on the schedule for this afternoon. Bon soir.