Emily Cotter is a second-year medical student at George Washington University in Washington DC. This summer, through Global Network founding collaborator Helen Keller International, Emily worked on NTDs in Sierra Leone. Below is part 3 of her 4-part series detailing her experiences.
Sierra Leone pulled off its first national preventive chemotherapy campaign for schistosomiasis this summer and luckily my internship coincided with the timing of this event. I was able to spend a week and a half supervising the prophylactic chemotherapy (PCT, aka mass drug administration) program with the HKI program coordinator for NTDs, Mustapha Sonnie. This event was a huge undertaking: surveillance for schisto was done throughout SL and any district that had a prevalence of schistosomiasis (either mansoni or haematobium) greater than 10% was included in this drug treatment program. This turned out to be planning treatment for more than 640,000 children! Funding for this program came from USAID’s Neglected Tropical Disease program, with the funding passed through RTI (Research Triangle Institute) and HKI on its way to the Ministry of Health and Sanitation.
It was fascinating to see the implementation of such a large-scale public health campaign! Sierra Leone has previously implemented PCT campaigns for other diseases such as onchocerciasis, lymphatic filariasis and soil-transmitted helminths using an approach called Community-Directed Treatment with Ivermectin. This approach uses community-based drug distributors who are trained volunteers that distribute ivermectin and albendazole in their communities. The PCT campaign for schistosomiasis did not use these volunteers; instead, the Ministry of Health and Sanitation trained the peripheral health unit staff to distribute praziquantel using a height-pole for accurate dosing. Mebendazole was also given to children during this campaign so children were simultaneously treated for soil-transmitted helminths and schistosomiasis. Praziquantel needs to be given with food so funding was also distributed to provide a meal at school before children were given the medications.
Mustapha and I supervised the treatment program in the Kenema district of Sierra Leone, an area in the southern part of the country close to the border with Liberia. Some of the chiefdoms in this district had severe schistosomiasis problems with more than half the children infected with the worm. Many children had mild side effects (symptoms like nausea, vomiting and diarrhea) from the praziquantel and mebendazole, which scared other parents who then wanted their kids to abstain from participating in the program. We spent a lot of time with a local radio station going on-air to answer questions from the community and educate parents about why it was important for their children to be treated for schistosomiasis and the soil-transmitted helminths. We also had a member from the Pharmacy Board of Sierra Leone with us to monitor side effects of the drugs and reassure community members of the safety and efficacy of these products. 
Amazingly, most of the schools we visited did a great job with this treatment campaign. Aside from a couple of exceptions, the peripheral health unit staff all received adequate amounts of praziquantel and mebendazole for the schools in their area; were accurately using the dose-pole to dispense the right amount of praziquantel; at times trekked through some difficult terrain to treat children in hard-to-reach areas of the country; and ensured the children were fed before being treated. The school-feeding aspect of this program was no small feat: the money earmarked for school feeding was passed through many players – from the national-level Ministry of Health to district-level Focal Points for NTDs, community-level peripheral health unit staff, then finally head teachers – leaving many opportunities for corruption. I was very impressed to observe that the money had reached its target destination in most cases as I witnessed hundreds of children being fed and treated for schistosomiasis and soil-transmitted helminths during my week and a half in Kenema.
good article as usual!