Can I have some of your blood?
Using the map provided to me by the project coordinator, myself and another team member in matching blue and yellow t-shirts hike up a dirt road to the lone house sitting at the top of a hill. After yelling to alert its residents, the door is opened by a hesitant homeowner. We give him our spiel which basically ends with, “Can we have some blood?”
Well, we actually state that bit way more eloquently, but I know that’s how it often sounds to the receiver.
Modern medicine is a thing of beauty. I am fortunate enough to have access to it when and where I need it. As a public health professional, there are many areas that I can focus on, from mental health to policy. I currently choose to focus on epidemiology which helps others have access to the care they need for illnesses that affect the masses.
Epidemiologists focus on the 5W’s (Who, What, Where, When, and Why) and the 1H (How) regarding disease and health events. My current project focuses on leptospirosis, which is a disease transmitted by mammals (livestock, dogs, rodents) that pass the Leptospira bacteria through their urine.
Humans may pick up the bacteria by contacting contaminated fresh water (rivers, lakes, pools, etc.), floodwater, wastewater, or when taking care of contaminated animals. The bacteria thrives in hot and humid climates, which makes it easier to spread in those locations. And easier to spread especially after a storm that causes flooding.
As with any disease, response to exposure varies, from having no symptoms, to experiencing flu-like illnesses, to experiencing liver and kidney failure which may lead to death.
The good news is that there is an antibiotic that can clear up the bacteria in just a few days, just as long as the illness is caught early enough. The problem in the community we are surveying is that there is no screening currently performed for the disease.
If it truly is a problem here as we’ve suspected since the three cases identified after the severe storms in 2017, then we have to gather the evidence to drive public health initiatives and improve health care and medical professional awareness regarding the disease.
So, as part of “Team Lepto”, I have been traveling in teams of two’s or three’s to assigned blocks geographically identified by census and randomly selecting households for the survey. Essentially, we end up as unexpected visitors requesting answers to questions, a few a bit personal, along with a sample of blood.
As you can imagine, there have been challenges. Because we are sampling early in the day for safety reasons, many people are unavailable. They are at school or work, or maybe just out running errands. Many agree that our “golden hour” is probably between 4-6 pm. But still, that means six hours of work that may prove very difficult to reap reward.
Other people pretend not to hear you in hopes that you would go away. But because our efforts are meant to benefit them as well, we often juggle how long is too long to pester someone.
For the people that answer, that’s when the real salesmanship starts. They are always skeptical of our presence and needs (unless they’ve heard or seen the ads). We have to display our credentials. We have to convince them that we are not saying that they are diseased or filthy. We have to show them how important their participation is in the project, how it will benefit them and the rest of the community. But we cannot be too pushy or too demanding. The potential backlash will hurt the project in ways that I am sure we cannot afford.
Photo by Myriams Fotos on Pixabay
And even if the individuals are willing to participate once hearing more about the project, at least 50% startle when we get to the part about the blood. “My blood? Where…here? Not a chance.” One man scoffed as he stated, “I’ll answer your questions, but you’re not getting my DNA.” At least half of those can be cajoled into participating, once they know it is the best possible way to help them, their family, community, and even help save someone else. We let them know that we would absolutely not ask for their blood unless it was something that was truly needed.
Because of the range of symptoms, it is difficult to know for sure if someone has ever been exposed to leptospirosis. For this project, because local screening for it is not completed, we need to gather samples community-wide to figure out a few things. We need to know how prevalent the disease is here and have to determine the risk factors associated with the illness.
In other words, we need to know who is affected, what animals and freshwater sources may be contaminated, where the affected populations and sources of contamination are, when people may have most likely been exposed, how they were exposed (i.e. the type of activities that put them in contact with any source of contamination), and why some people picked it up but others didn’t.
This Lepto survey is a month-long project that is almost near the end. With this final week to go for the field work, we are on track to have the samples we need to fully evaluate the disease in this community. We are doing pretty well by having such an unusual request being fulfilled more times than expected. I am hopeful for ongoing success as we strive to get ahead of this disease and potentially save lives.
Originally published on vfranceeditorial.com on March 25, 2019.
Can I have some of your blood?
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