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.
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.
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.
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.
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.
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.
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.
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.
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.
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 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.
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.
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.
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:
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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.