Seth Hoffman, pre-med student at Cornell University and author of our student summer series, updates us on what was accomplished during his time in Nangapanda, Indonesia. He also gives some insight on what he’s learned from his experience thus far, and provides what’s to come in his next public health adventures (and blog post).
By: Seth Hoffman
My time in Nangapanda is quickly drawing to a close and the adventure has left me with so much to think about. In several days my younger brother Ben and I will fly to Sumba, Indonesia to work on a project at the Eijkman Institute. Since I have been in Nangapanda, I’ve learned so much. However, I think the most rewarding experience has been directly interacting with patients while performing physical exams during population studies. On most weekdays we have continued to wake at 5:00 AM to travel to local residences to take blood and stool samples, and measure height and weight, blood pressure, and skin fold. The physical exam also includes a questionnaire to determine general health, and whether or not the patient has any indications of malaria and/or helminth infection. In order to garner the correct information from our patients, we have to be attentive, aware, awake (hard to do when it’s still dark out), and present a positive attitude…oh and 
did I mention you have to know how to speak Indonesian? The population studies have allowed me to develop a relatively quick grasp of Indonesian language and I now have the great ability of being able to haggle with ojek (hitchhiking with motorcycles for a small fee) and bemo (local bus service) drivers. And let me tell you, a bemo ride is quite the exploit. For the equivalent of $0.50 USD you can squeeze into a car made for max 9 people, but experience reveals it can easily carry 18 people.
In recent weeks Ben, Mike, and my main focus has been on resolving the issue of medical waste disposal at our facility in Nangapanda. At the moment, all the waste is thrown outside the back door and is simply burned in a pile. We have spent a considerable amount of time attempting to find a solution to this problem–we concluded the best method of consolidating the waste (having broken glass slides with blood smears on them exposed on the ground directly next to a preschool where children roam barefoot does not sound safe) and effectively disposing it is to construct a physically sound medical waste incinerator. We went through a number of designs (i.e. a concrete pit, oil drum incinerator) before we settled on a 1.2 meter tall brick/concrete structure with a fire pit at 
the base and an area for waste separated by a metal grate above it. In order to prevent noxious fumes from being inhaled by the local village population and entering the facility, we constructed the incinerator with a 1 meter tall chimney. We also dug a 2 meter deep pit for the disposal of the incinerated ash, and are in the process of fencing off the area, erecting warning signs, and writing a standard operating procedure for the incinerator so that anybody can learn to use or troubleshoot it.
As mentioned before, Ben and I will be heading to a division of the Eijkman Institute in Sumba to work on a project to investigate the efficacy of a new rapid test for G6PD deficiency. The inherited sex-linked deficiency of G6PD is associated with greater protection against Plasmodium falciparum malaria, but increased risk of oxidant hemolysis (rupture of blood cells). This is of concern because the main drug used to treat P. ovale and P. vivax malarias is Primaquine, which is an oxidant and therefore can cause hemolysis in G6PD deficient patients. The development of an effective rapid stick test for G6PD would be extremely beneficial in order to prevent the dosage of Primaquine to a person who would be harmfully affected by it. The study involves 10 days of hard, thumping work with an aim to test 1,000 people with the new rapid G6PD test. We will also conduct rapid diagnostic tests for malaria on all study participants and treat all those who are positive for malaria.
On a slightly different note Mike, Ben, and I were invited to a going away party for several nuns during which the head nun made the request that we sing some songs. It made for quite an interesting experience to say the least. As a band we have been really busy writing music, and I have found that I have quite a knack for slide guitar.
Talk to you all very soon! Peace. – Seth
Seth Hoffman is a pre-med student at Cornell University, majoring in Anthropology and minoring in Global Health. He has worked for a number of years on identifying olfactory genes of Anopheles mosquitoes involved in mate and host seeking, and has published on his work in the scientific literature. He is a singer and guitarist for the band Nigeria.
