Right now I am sitting in mud hut in a small village supervising the field work that is happening today.  We are collecting urine and stool, which is quite a strange procedure. The baby that I’m with today is only 7 months old.  How can you collect urine from a child that small, you ask?  Well, we have a bag with adhesive on it that sticks around the child’s genitals. The bag hangs and collects any urine the child excretes for 5 hours, while a field officer periodically uses a tube from the bag to siphon off the urine into a jar.  Stool is scooped from a diaper and then taken to the lab, where it is processed for Kato-Katz. One problem has been that most of the mothers have never seen a disposable diaper, and need to be taught to attach it properly. Part of my never ending battle as lab manager is to ensure that everything is very sterile and that we don’t have stool or urine contaminating all of our surfaces when the samples are processed in the lab.  There is a very real risk of contracting worms from these samples, and I do not want any inside of me! While the young babies that we are looking at now usually do not have so many worms, the school aged children sometimes have awful infections.  Don’t worry, every child that we take a stool sample from receives a deworming pill.

The problem of parasites is so persistent here! I was having a conversation with Wekesa, a lab technician who is very knowledgeable about parasites, and he was asking me which parasitic diseases we have in the United States.  He was actually very surprised by how few we have – the main diseases that exist in both places are giardia and pinworm (probably the most benign of the wide range of parasitic infections available here). For many diseases, such as malaria and hookworm, I explained that we used to have it, but do not anymore. Wekesa was encouraged by this, and vowed that Kenya would also eliminate these diseases.  I hope so!  Because we experience so few of these infections in the United States it is very easy to underestimate the damage that they do.  Sometimes it seems like a waste to pour money into these “neglected tropical diseases” that only exist in secluded corners of the world that most of us rarely consider.  But when you visit a community and see the distended bellies on malnourished children everywhere and you realize the enormous impact that intestinal parasites have had on so many people in that place, you cannot deny that this is truly neglect.  Malaria is not a neglected disease – it is one of the “big three” tropical diseases that receive large numbers of donor dollars along with AIDS and TB. However I feel more and more surrounded by the hopelessness that people feel facing malaria, and wonder what the solution is. What I do know is that we cannot think that what we are doing is enough for malaria or the wide range of neglected tropical diseases that exist here.  Not only does malaria have a high mortality rate (especially in young children), Tim and I have met mothers who have miscarried at 8 months and children and adults who have suffered brain damage from acute malaria.  Just last week one of my lab techs was less talkative than usual, and I asked him what was wrong.  He pulled some pills out of his pocket to show me, and simply said “malaria.”  When Tim and I worked in Tanzania one of our workers also had malaria, so this was unfortunately familiar to me.  The costs of malaria are so high – the mortality, the morbidity, the productive time lost for families that are already scraping to get by. And despite everyone’s efforts, just today I saw – not for the first time – a mosquito net being used as a chicken coop.

As I sit in this boma monitoring the child’s urine bag, I feel face to face with these problems in a very real way.  I’m reading a report from the WHO that says 46% of deaths in the African region are children under 15 years old.  In high-income countries, that number is just 1%. The child in this house has a fever and horrendous cough, and when we suggested to the mother that she should take the child to the doctor she shrugged, saying that she doesn’t have the resources. She seems like a caring mother, but she kisses her baby and sits holding her, waiting to see what happens. At another home I was in recently, a pregnant mother holding her firstborn told us that she had given birth in the hospital.  After some further questioning we realized that she had clearly given birth at home, and the baby had never seen a doctor or received any vaccinations because the mother couldn’t afford the 100 shillings ($1.20) that it cost to see a doctor.  At a year old, she looked clearly underweight and we couldn’t even coax a smile.

Sometimes it feels discouraging to “just” do research when there are so many challenges facing the people around you.  However I am also confident that this is a good place to be and good work to be doing.  Water, Sanitation, and Hygiene have long been shown to have an impact on diarrheal disease and health of children, but there is currently a lack of studies evaluating interventions in these areas.  This study is an enormous undertaking that will hopefully provide information to help governments and organizations evaluate which interventions are most beneficial and cost effective, so that the projects that are implemented can have a real impact.  I am excited to be a part of this and I think that this work is very important – but still sometimes I want to throw in the towel and give all the money, all the interventions to the one sweet family that I meet with the adorable child with diarrhea.