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 1 of her 4-part series detailing her experiences.

I began my summer project in Sierra Leone with sweltering heat, a light microscope and stool samples.  I had no idea what to expect when I agreed to come to Sierra Leone to work with Helen Keller International (HKI) on a neglected tropical disease (NTD) internship: when planning my project with the HKI Country Director in Sierra Leone we agreed that flexibility would be paramount.  I was looking forward to being spontaneous when it came to projects – it was going to be a welcome break from the routine and scheduled life of my first year of medical school.  Even still, contributing to schistosomiasis and soil-transmitted helminth surveillance through stool sample microscopy had not been anything I’d anticipated!  However, here I was at Fourah Bay College sweating in my white lab coat, crossing my fingers for a slight breeze while bent over a generator-powered microscope looking at Schistosoma mansoni eggs in stool samples.

Helen Keller International is an international non-governmental organization dedicated to preventing blindness and promoting the sight and even the lives of the world’s most vulnerable people.  The organization does some great work in Sierra Leone in the field of nutrition, especially related to vitamin A supplementation and malnutrition prevention.  HKI began its work in NTD control with the prevention of onchocerciasis and trachoma, two NTDs that can lead to blindness.  The NTD program has expanded to include schistosomiasis and the soil-transmitted helminths ascaris, trichuris and hookworm.  The HKI office in Freetown, Sierra Leone is small: there is one country director, a program coordinator for NTDs, a program coordinator for nutrition, some administrative staff and a few interns who recently received their undergraduate degrees from Fourah Bay College.  I worked with these interns for a good portion of the summer, assisting them with their schistosomiasis and soil-transmitted helminth prevalence and intensity research.

The laboratory at Fourah Bay College (FBC) was unlike any other that I have seen.  FBC is the oldest university in West Africa and used to be a premier institution.  Currently it is isolated at the top of a large hill of Freetown, making the commute difficult but providing spectacular views of the city. There’s very little electrical power in most areas of Sierra Leone and the college is no different.  We had to run a generator to provide energy for the one microscope that HKI uses for NTD surveillance; the lab did not have any other functioning microscopes when I first arrived.  Unfortunately, the generator broke down a few times so we were unable to work for a few days (there’s that flexibility issue).  There is no running water in the lab and all the reagents were mixed by hand.  Nonetheless, HKI interns and some undergraduate students from FBC had previously analyzed hundreds of stool samples from children in various chiefdoms (smaller sections of the 13 districts of Sierra Leone).

I was able to assist in finishing the microscopy for the last 100 or so samples, recording the type and number of helminth eggs found in the stool.  Our results informed HKI and the Ministry of Health and Sanitation of the prevalence and intensity of helminth infection in certain areas of the country; these data were used to target mass de-worming campaigns in areas of need.  Sadly, there are many areas in need of preventive chemotherapy with anti-helminthic drugs and we continually saw slides peppered with S. mansoni eggs.  I was also depressed by a slide from a child who had more than 80 ascaris eggs in the one gram of stool; I could only imagine what his or her belly would have looked like with this high worm burden.