IGHI Student Challenges Competition: Diagnosing Schistosomiasis: My Journey so Far…

Gabrielle for articleGabrielle Prager, Winner of IGHI’s 2013 Student Challenges Competition guides us through her journey throughout the contest and the next steps for her research project.

This is the problem:  In 2011, 243 million people required treatment for schistosomiasis. 28.1 million were reported to have received that treatment. Schistosomiasis is a neglected tropical disease.  What is it? It is a blood dwelling fluke. How is it treated? Mass Drug Administration with Praziquantel has been the mainstay of most treatment programmes. Uganda was the first country in Africa to initiate a national control programme coordinated by the Ministry of Health with technical and financial support from the Schistosomiasis Control Initiative (SCI). The SCI have been involved in the mapping, monitoring and evaluation of schistosomiasis.  Within two years Uganda saw a decrease in prevalence and infection intensity. As Mass Drug Administration continues, infection intensities and prevalence decreases and areas of lower infection intensities and prevalence begin to be targeted. In lower intensity areas, better diagnostic tools are required. Finding a better diagnostic tool is the beginning of my story.

Gabrielle with childDr. Charlotte Gower works closely with Dr. Poppy Lamberton in the Department of Infectious Disease Epidemiology and they have been involved in tackling this neglected tropical disease for a number of years. Dr. Gower has been investigating the identification and development of new diagnostic tools, in particular loop-mediated isothermal amplification or LAMP. LAMP is an isothermal DNA amplification technique, which allows amplification in less than an hour at a single temperature, which decreases the need for complex and expensive lab equipment. Dr. Lamberton’s fieldwork took her to Uganda to monitor infection and examine drug resistance. I had the good fortune of working with both these extraordinary women.

gabrielle 2I was one of four Imperial College Global Health BSc students who joined Dr. Lamberton for five weeks in the field in Uganda. I travelled from London and was collected by Fiddi, from Uganda’s Vector Control Division, at the airport. We had never met him before but he had no trouble identifying us at four in the morning in the Kampala International airport. From the airport we made stops to pick up supplies, were taken to his house for a bite to eat, and then drove four hours to reach our base in the Mayuge district near Lake Victoria. For the next five weeks I would collect urine, stool and blood samples from primary school students in the region in order to compare different diagnostic methods for S. mansoni. I became aware of the impact that schistosomiasis has on the long term well being of these children, their health, education, ability to work and quality of life.

I travelled to three schools twice to collect samples and compare them after treatment with Praziquantel. (It’s important to note that last year Merck pledged to increase their donation of Praziquantel from 25 million to 250 million tablets a year.) The children were friendly and excited to see us – partly because it meant time off from their normal school routine.

gabrielle 3The work we did in the field made it apparent that the existing diagnostic tests, while good, were not good enough and a third diagnostic tool was required to resolve discordant results. A more sensitive field test, which would be accurate in areas of low intensity infection, would be highly desirable.

I returned from Uganda with the samples and began the laboratory work extracting the DNA from the stool samples and testing them using LAMP. LAMP has been shown to be successful with other infections and Dr. Gower has been exploring its use in the diagnosis of S. mansoni. Dr. Gower guided me through the process of the DNA extraction and amplification in the lab and left me to work with more than 600 samples we had brought back from Uganda. It became clear to me that if the LAMP diagnostic tool could be made field applicable then the benefits could be enormous.

Having gathered my results and reviewed them with Dr. Gower I began to consider whether the Institute of Global Health Innovation Student Challenges Competition might be the right platform for me to try and gain funding for further research so I could determine whether LAMP might be used in field conditions. In my view, the IGHI Challenge is a way to make ideas real – to test theory, to put into practice the work you are doing. Imperial College is a world leader because of these kinds of opportunities. It was something I wanted to be part of. With the encouragement of Dr. Gower I began to prepare my presentation and compare the results of LAMP with the existing diagnostic techniques available.  I prepared a presentation, which Dr. Gower reviewed. Having a world expert as your advisor is no bad thing.

The actual process of the competition was straightforward and I was delighted to have been shortlisted after the submission of my written proposal. Preparation for the presentation was more time intensive than I had expected. I rehearsed my oral presentation repeatedly trying to make sure that I was able to get through the information required within the requisite amount of time – ten minutes. Everyone had assured me that the judges wouldn’t be too rigid on the presentation time; as long as I was close it would be okay. I was nervous to be presenting to such a distinguished panel of judges, Sir Thomas Hughes-Hallett, Dame Ruth Carnall, Professor Dame Julia Higgins, professors and my peers.

gabrielle 4I was extremely honoured to have Dr. Gower come and listen to my presentation. I had been informed that I was the first of the shortlisted finalists to present and just before I began the chairman of the judging panel, Sir Thomas Hughes-Hallett, reminded the competitors that he would be ruthless about time and that we would be asked to stop precisely on ten minutes.  The admonition did nothing to calm me down. Months of work. Ten minutes.

gabrielle 5I began. As I worked through the presentation slides I began to feel the comfort of preparation and the ten minutes flew by. I felt I had done as well as I could have – whatever happened next I felt extremely proud to have been a finalist. I listened with interest to the other projects and thought that all of them were innovative, strong ideas, which would no doubt produce benefits. I think everyone involved felt the same sense of pride to have made it to the final presentations. The actual announcement was a blur. Obviously I was excited. Dr. Gower, I think, was extremely happy for me but quickly brought me down to earth as she explained the choices I would have to make as I continue my research.  I’m still evaluating those choices and considering how to best use the prize money to achieve my goal.

I can’t thank the IGHI enough for giving me this opportunity.

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