Parnika Mukherjee (HUB)

Published October 2019 

Established in 1802, the Institute of Tropical Medicine at Charite University Medicine Berlin has a long-standing history of cooperation with partners in low-income countries around the globe. Research at the institute focuses on prevailing health problems in these countries, with particular emphasis on malaria and other parasitic diseases. One essential part of this effort is the active contribution to recruitment and follow-up procedures among patients and populations living in endemic countries. For an ongoing malaria project, two PhD students and one medical doctoral student traveled to Butare, Rwanda from March to June 2018 during the peak transmission season.

The current field study on malaria in the Huye district of southern Rwanda was organized and executed in cooperation with the National University of Rwanda, the University Teaching Hospital of Butare, the Kabutare district hospital as well as the rural Sovu primary health center, and it consisted of three core parts: clinical and molecular surveillance of artemisinin resistance, current clinical manifestation, and effects of protective host polymorphisms.

Rwanda is unique among African countries in many ways. Following the 1994 genocide, it has experienced ongoing economic growth, it receives substantial developmental aid, its way of life is peaceful, the country is remarkably clean (e.g., ban of plastic bags), and it is one of the safest countries worldwide. There is an obligatory health insurance system in place, and the health system seeks its equal on the African continent.

Public insurance and a sophisticated health system allow even people on the countryside to have access to medical services. Health workers are sent out to rural communities to educate and treat the people. The next contact point are rural health centers spread out all over the country, mainly run by nurses. More severe cases are transferred to the district hospitals and, if need be, further on to one of four reference hospitals.

Building on this structure, the project was integrated in the health system to collect less severe malaria cases at the primary health center and more severe cases at the district hospital. However, due to unexpectedly few malaria patients at the district hospital, the rural health center became the pivotal recruitment point of the study. The health center team was very cooperative and allowed us to use their rooms to set up our equipment to the best of our demands. Patients with fever or a history of fever within the last 48 h were screened with a rapid malaria test recommended by the World Health Organization (WHO). Malaria-positive patients were informed about the study and invited to participate. Once patients had signed the informed consent and were included in the study, a nurse started examining the patients and a blood sample was collected. Haemoglobin and glucose concentrations, as well as parasitemia were checked on-site, and patients were sent to the medical doctor for final diagnosis and treatment.

To ensure treatment success, patients were asked to return after three days for a quick check-up of parasitemia by microscope. Further work, e.g. in vitro cultures with respect to artemisinin resistance or sample processing, was facilitated by the laboratory of the University Teaching Hospital of Butare.

Recruitment has been surprisingly slow due to low numbers of malaria patients. This may be due to a late onset of the rainy season and recent governmental activities, i.e. insecticide spraying.

In conclusion, working in a new country always takes a bit of time and adjustment to the local culture and way of life but our Rwandan partners made it easy for us. The work has been a truly unique experience and even though you see the scars of 1994 everywhere and in everybody, it was moving to see new and the old generations, processing these events while creating a better future with an impressively strong will to move on.