From Michigan to Malawi: zikomo kwambiri!

Hello everyone (muli bwanji!) My name is Sarah S. Bassiouni and I am uploading this post from the University of Michigan School of Public Health in Ann Arbor, Michigan, on the eve of the first day of classes. During the past three and a half months, I worked with the Blantyre Malaria Project, in Malawi, Sub-Saharan Africa for my 2015 summer research internship.

My approximate flight route to Blantyre, Malawi, via Chicago O'Hare, London Heathrow, and Johannesburg OR Tambo, and Blantyre Chileka International Airports.

My approximate flight route to Blantyre, Malawi, via Chicago O’Hare, London Heathrow, and Johannesburg OR Tambo, and Blantyre Chileka International Airports.

For the vast majority of my time in Malawi, I was unable to post about my experiences because of internet connections that refused to upload text and/or photos! Better now than never though.

Me (Sarah S Bassiouni) conducting a lab assay (for my fellow scientists: direct sandwich enzyme-linked immunosorbent assay) on site in Blantyre, Malawi.

Here I’m conducting a lab assay (direct sandwich enzyme-linked immunosorbent assay) on site in the ICEMR Molecular and Genomics Core Laboratory in Blantyre, Malawi.

Quick recap for those unfamiliar with my project: my project was a proof-of-concept of “Molecular determination of Plasmodium falciparum infection in Anopheles mosquitoes.” Deciphered: Plasmodium falciparum is one of the causative agents of malaria, and the one that causes the most mortality worldwide, with the highest burden amongst children under the age of 5 who live in sub-Saharan Africa. According to the World Health Organization, in 2013, more than 580,000 deaths from malaria were reported with 97 countries detecting ongoing malaria transmission.  Additionally, more than 3.2 billion individuals worldwide are at risk for contracting Plasmodium infection. It’s important to note that P. falciparum is transmitted via the bite of the Anopheles mosquito, which is often a target of public health interventions using insecticide-treated nets and indoor residual spraying.

Myself (second from right) and Blessings, a field team member (far right), explaining how a CDC mosquito light trap operates to two local women before installing it in their houses for one of the ongoing Blantyre Malaria Project studies.

Blessings, a field team member (far right) and I (second from right), explaining how a CDC mosquito light trap operates to two local women before installing it in their houses for one of the ongoing Blantyre Malaria Project studies.

Previous work has identified individual Plasmodium parasites in human blood samples. What my project was attempting to establish was, can we identify individual Plasmodium parasites in a mosquito blood meal and if so, what is the limit of detection? If we could, future studies could determine direct transmission patterns between humans infected with Plasmodium and infected mosquitoes, allowing for identification of potential human reservoirs and better target anti-malarial treatment strategies.

Anopheles mosquitoes to which I had fed cultured <i>Plasmodium</I> parasites in whole blood, ready for me to dissect out the abdomen for DNA extraction and genotyping.

Anopheles mosquitoes to which I had fed cultured Plasmodium parasites in whole blood, ready for me to dissect out the abdomen for DNA extraction and genotyping.

As my departure date approached, I had been asked with increasing frequency how I feel about going home; my reply has always included the word “bittersweet.” And that’s what this is. Bitter because I have so enjoyed my time in Malawi and was so sad to leave. Sweet because (1) I am eager to return and share my experiences with family, friends, and colleagues and (2) to begin the next chapter so that I can apply what I’ve learned to reduce the burden of parasitic diseases worldwide. This means that my final days in Malawi were approximately bitter; not consumed by the bite of farewell but not entirely lacking it.

My fellow labbies, from left: Godfrey, Alex, Andrew, Chifundo, and me, standing at the entrance of the University of Malawi College of Medicine. The ICEMR Molecular and Genomics Core Lab where we all worked is housed in the Biochemistry Building of the College.

My fellow labbies, from left: Godfrey, Alex, Andrew, Chifundo, and me, standing at the entrance of the University of Malawi College of Medicine. The ICEMR Molecular and Genomics Core Lab where I worked for three and a half months is housed in the Biochemistry Building of the College.

The people of Malawi have, to a one, been some of the kindest and loveliest people I have met. It has been an honor to live in and learn from Malawians during these past three and a half months. In addition, I was consistently awed by the physical geography surrounding us each day. The harsh sounds of rush hour traffic bookended by the sweet quietude of the evenings and early mornings. The bubbly rhythm and rolling sounds of Chichewa surrounding me in lab as I cultured parasites and ran qPCR plates.

Here I am presenting my journal club article.

Here I am presenting my journal club article on whether implementing insecticide treated nets and indoor residual spraying is more effective than one alone; presented at the Malcolm E. Molyneaux Learning Center of the Malawi-Liverpool Wellcome Trust.

And now I would like to thank all who helped me along this amazing journey. Without further ado, zikomo kwambiri (thank you very much) to:

Dr. Mark Wilson, my UMSPH internship advisor. Thank you so much for presenting me with the golden nugget of this opportunity when I approached you in the Fall 2014 term about potential research and allowing me to follow through with it. I will be forever indebted to you.

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Conducting field work at a local primary school in the Chikhwawa district. I assisted the nurse and team member conducting surveys in collecting blood specimens, to be further tested, and in running and reading malaria rapid diagnostic tests (with associated anti-malarial treatment for children whose tested positive) on schoolchildren. In less than one day, we collected specimens from over 90 children–zikomo!!

Dr. Karl Seydel, my-on site advisor and mentor. Learning from your infinite wisdom, knowledge, advice, and guidance both in lab and shadowing in the malaria ward were invaluable. Observing your work as a physician-scientist juggling the demands of each side were a masterclass. Your generosity with your time in teaching me techniques, answering my questions, and encouraging my persistence to keep going and digging for the next set of answers make it difficult for me to find the words to express my gratitude to you.

Dr. Terrie Taylor and Dr. Gretchen Birbeck: the kindness and passion you both had in teaching me about your work while I shadowed you both in the ward helped me to see the immediate individual toll cerebral malaria takes on children and their families, but also to consider and work towards preventing the long-term and population wide ramifications of this disease. The lessons that I learned from each of your trailblazing work and approach to battling this disease will stay with me forever.

Karl Seydel and colleague Terrie Taylor with a patient in Malawi, where MSU has been helping people with malaria for 28 years. Photo by Jim Peck. 

A photo taken by Jim Peck (MSU) of Dr. Terrie Taylor (L) and Dr. Karl Seydel as they care for a young patient at the Malaria Ward. (Clicking on the image will take you to Dr. Taylor’s website).

The wonderful staff of the ICEMR Molecular Core and Genomics Lab. Jimmy, Godfrey, Syze, Alex, Andrew, Trancizeo, Rachel, Gertrude, Chifundo, Joseph. You have all been so fantastic to me and helped to make my days in lab both enjoyable and educational. Your cheerfulness, kindness, and generous sharing of your knowledge to me epitomized the generous spirit and character of Malawians. I have learned so much from you all and I will carry that on. Zikomo kwambiri for our impromptu Chichewa (Malawian language) lessons in addition to my primary scientific work. Your laughter and great stories added a lovely variety to my long days in lab.

Just a sampling of the many, many 1.5mL Eppendorf tubes I labelled while completing this project.

Just a sampling of the many, many 1.5mL Eppendorf tubes I labelled while completing this project.

A day in the life: a snapshot of my parasite cultures (I cultured P.falciparum parasites nearly every day for two and a half months.)

A day in the life: P. falciparum parasites in culture flasks in the biosafety hood (I cultured two different strains for nearly two and a half months.)

The Malaria Alert Centre entomology gurus. Dr. Themba Mzilahowa, Martin, Jomo, Justin, Chifundo, Annie, Angie, Bydon, Oscar. Zikomo for taking me on a mosquito crash course: from membrane feeding through dissections. My mdzudzu (mosquito) project would not have worked without your help! I thank you from the bottom of my heart for all of your help.

The great Entomology Lab team at the Malaria Alert Centre. (L-R: Anna, Justin, Dr. Themba Me, Jomo, and Chifundo)

The great Entomology Lab team at the Malaria Alert Centre. (L-R: Annie, Justin, Dr. Thembazilahowa, Me, Jomo, and Chifundo)

Photo on my second-to-last day of the Transect Study Field Team (L-R: Blessings, staff, myself, Chigo, and Ammon).
Photo on my second-to-last day of the Transect Study Field Team (L-R: Blessings, staff, me, Chigo, Ammon).

The School-based and Transect study fieldwork teams. Moses, Peter, Chifundo, Bright, Ammon, Chigo, Blessings, George, and others. Zikomo kwambiri for letting me participate in the collection, as well as learn firsthand the many opportunities and challenges inherent in conducting surveys and collecting samples in the field.

The administrative staff at the Malaria Alert Centre. Nelson, Sam, Chisomo, and others. Thank you so much for your help in making my transition to live and work at the BMP swift and painless.

My farewell lunch at Superior Halaal Food Market with many whom I worked with at the ICEMR lab (L-R: me, Alex, Oscar, Chifundo, Trancizeo, Andrew, Rachel, Godfrey, and Gertrude).

My farewell lunch with many whom I worked with at the ICEMR lab (L-R: me, Alex, Oscar, Chifundo, Trancizeo, Andrew, Rachel, Godfrey, and Gertrude).

While running my final qPCR plate, Alex took this photo of me next to my total combined data and samples in lab (less than two hours before my departing flight!)

While running my final qPCR plate, Alex took this photo of me next to my the physical summation of my three and a half months of research (on my last day, less than two hours before my departing flight!)

The clinical officers and nurses at the High Risk Malaria Ward. Alice, Elizabeth, Monica, Joyce. Zikomo kwambiri for your endless patience in answering my many questions about the patients, their families, and their conditions and teaching me as I shadowed you.

The many people I’ve met along the way while exploring the bountiful beauty of Malawi and Zambia, many of whom have become excellent friends: Nicole, Brandi, Anna, Sandra, Joann, Mirjam, Tamiwe, Sarah M, Miriam, Jenna, Andrea, Sarah E, Sarah H, Pooja, Jaya, Peter, Ben (the MPHer), Ben (the physio), Rob, Mahallia, Naomi, Jenn, Suli, Rachel, 2015 Sapitwa Sleepover crew (Gordon, Lemorah, Mary Crystal, Rosie, Stephen, Lutz, Gregor, the boys), 2015 Three Peaks stalworts (48 km, 12.5 hrs later, still standing tall), 2015 South Luangwa Safari (Hannah, Marden, Lillian, Menno, Alex), Sam, James, Juliette, Memory, and countless others. You come from all over the world (Australia, Germany, Britain, New Zealand, the Netherlands) and our adventures climbing the highest mountain in Malawi, trekking the surrounding mountains in one day and seeing the sparkling splendor of Lake Malawi made some of the best memories I had.

Here I am on the first day of our three-day hike up to the summit of Mount Mulanje. A hard and fast hike but still smiling!

Here I am on the first day of our three-day hike up to the Sapitwa Peak, the summit of Mount Mulanje. A hard and fast hike but still smiling!

Summiting Mount Mulanje, the tallest mountain in Malawi, with the 2015 Sapitwa Sleepover crew (I'm at the bottom, far left).

Summiting Mount Mulanje, the tallest mountain in Malawi, with the 2015 Sapitwa Sleepover crew (I’m at the bottom, far left).

View looking down from near the summit of Mount Mulanje.

View from near the summit of Mount Mulanje.

I captured this photo of a herd of elephants crossing a sandbank at South Luangwa National Park in Zambia.

I captured this photo of a herd of elephants crossing a sandbank at South Luangwa National Park in Zambia.

Stripes galore! These two zebras grazing made for a photo I couldn't resist taking while in South Luangwa National Park in Zambia.

Stripes galore! These two zebras grazing made for a photo I couldn’t resist taking while in South Luangwa National Park in Zambia.

Sunset overlooking Lake Malawi, the

Sunset overlooking Lake Malawi, the “lake of stars.”

And last, but certainly not least (if anything, the most). Thank you, thank you, thank you to the patients and their families on the High Risk Malaria Ward at Queen Elizabeth Central Hospital. Your lessons in courage and enduring love in the face of cerebral malaria’s malicious specter were beyond inspiring. I will never forget the honor you granted me when you allowed me into your world to observe and learn. I will take this knowledge and work tirelessly to communicate it to others. I will carry your message with me wherever I go to help you alleviate and end the suffering that continues. Zikomo.

A mother holds the hand of her son as he receives treatment while a patient in the High Risk Malaria Ward at Queen Elizabeth Central Hospital in Blantyre, Malawi. (Before I took the photo, I received verbal permission from the mother to document this moment.)

A mother holds the hand of her son as he receives treatment while a patient in the High Risk Malaria Ward at Queen Elizabeth Central Hospital in Blantyre, Malawi. (Before I took the photo, I received verbal permission from the mother to document this moment.)

For whoever reads this, if you would like to learn more about how to contribute, please see this flyer from MSU to contribute and/or please send queries to:

 Christopher Surian
Director of Development
MSU College of Osteopathic Medicine
965 Fee Hall Road, Room A310
East Lansing, MI 48824
christopher.surian@hc.msu.edu
517-355-8355

I took this photo of sunset from Sapitwa Peak at Mount Mulanje. By doing what you can and learning more about cerebral malaria, you can be part of a brighter and healthier future for millions of children. Zikomo!

I took this photo of the sunrise from Sapitwa Peak on Mount Mulanje. By doing what you can and learning more about malaria, you can be part of a brighter and healthier future for millions of children. Zikomo!


Sarah S. Bassiouni, B.S., PBT(ASCP), is an MPH Candidate and Dean’s Scholar in the Hospital and Molecular Epidemiology Track at the University of Michigan School of Public Health.  She received funding from the UMSPH Office of Global Health and from the Mary Sue and Kenneth Coleman Global Experience Fund; because of these generous gifts, she was able to conduct molecular epidemiology malaria research in Malawi during Summer 2015.

You can read more of Sarah’s work here and here.

3 thoughts on “From Michigan to Malawi: zikomo kwambiri!

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