Brutal brucellosis
Philip MacMillan took
part in a research project in Tanzania funded by the UK government's
Department for International Development. He shares his experiences
Brucellosis is
a bacterial disease that can pass from farm animals to people. In
livestock, it induces abortion and reduced milk production, and in people
it causes a serious acute illness, featuring endocarditis and arthritis,
which may progress to cause permanent disability. Brucellosis occurs in
almost all developing countries and can have disastrous implications for
rural communities.
Initiation
While working as a laboratory technician during the
university vacation, I became aware of the Tanzanian project run in
collaboration with Glasgow and Edinburgh Universities. I contacted a senior
researcher from Edinburgh who was overseeing the project, explained my
medical background, and expressed my interest. At the laboratory I had been
involved in testing blood samples sent from Tanzania and so had the
relevant skills. I had also contacted other people in the United Kingdom
and in Tanzania involved with the project to find out as much as I could
and so was also able to show that I had a thorough understanding of the
nature of the work. I explained that I would love to help with fieldwork in
Tanzania and that I could fund myself. My offer was gladly accepted.
My research project took me to Tanzania to investigate
the impact of brucellosis on human and livestock health with the ultimate
aim of devising effective measures for controlling the disease. I joined
two Tanzanian postgraduate students, one a doctor and the other a vet, in
the Karatu district in central Tanzania, as they embarked on the
case-control part of the study. We needed to select human and livestock
controls to compare with previously identified infected cases. We blood
tested humans and livestock using a simple technique, called the Rose
Bengal plate test, that gives clear results within minutes. We chose people
randomly from households across the district and collected information
about cultural and dietary habits with questionnaires.
Typical day
Most of our work was done in remote locations at
altitudes exceeding 1800 m. We stayed in basic family run guesthouses and
ate anywhere that was available, which usually meant small village bars.
The day began at 4 15 am, when, bleary eyed, I would clamber into the Land
Rover to travel to our selected village. On arrival, we were given film
star status—children and adults alike ran out to welcome us. The
village chief would then come to greet us and ask us to sign the village
guest book.
With the help of a villager and a random numbers table
(a table of computer generated random numbers that helps with random sample
selection) we would select a household for sampling.
Manoeuvring the Land Rover over the rugged terrain to
get to households was difficult and often hair raising. I have a vivid
memory of finding ourselves perched awkwardly on the edge of 30 m drop,
seemingly with no way out. On another occasion our anticipated visit
spurred one man into spending his whole day digging a 300 m long road for
our Land Rover to deliver us directly to his door.
We would then test every animal (cow, goat, and sheep)
and every person (adult or child) within the household for Brucella. This could be an
arduous and physically draining task, with some herds 50-60 strong. My
previous experience of taking blood had been restricted to friends at
medical school. Now, here I was with a long queue of nervous looking
Tanzanians and herds of goats and sheep. I was first shown how to take
blood from sheep and goats and then allowed to have a go under supervision
until I was competent to continue alone. The researching doctor was very
happy to supervise as I took blood from humans also.
Testing positive
Socially, brucellosis has a big impact. Life as a
small scale farmer in rural Tanzania is demanding. Families rely on their
animals as a source of food and they are considered a mark of status, so
they must be well maintained. Keeping them well fed involves walking them
for miles each day to graze them; if this is not achieved the family will
suffer. One man showed great delight at testing positive. He was unable to
cope with the rigours of daily life, feeling tired, feverish, and with
excruciating joint pain. The family had accused him of being lazy but he
was unable to explain why he could not meet their demands.
Telling someone they had tested positive for Brucella was a sensitive issue
and had to be dealt with carefully. Communities in Tanzania have varying
attitudes towards illness and so we could never predict how the news would
be taken. We told people about their condition privately, giving them the
option to tell others should they wish. We also reassured them that the
disease could be treated effectively and gave them advice on the best
treatment options. Given the language barrier in many of the small rural
communities visited I was only able to observe as advice was offered.
Simple hygiene
During visits we discussed general health issues with
each family, hoping they would then pass on information to their friends.
Many people that we met had not had formal education and had minimal
understanding of simple hygiene. What started as a low-key discussion with
a handful of family members, often turned into a large scale-debate with
villagers flocking from afar to listen. As a team we felt extremely valued.
The project has now almost reached completion and final
conclusions are being drawn. As expected the work has shown substantial
geographical variations in the prevalence of brucellosis among animals and
people rural communities in Tanzania. Commonly, where animal infection
rates are high, so too are those in humans. Education into the safe
handling of potentially infected animal products for human consumption is
required to minimise the spread of brucellosis from animals to people.
Furthermore, it is important that pastoralists are made aware of the key
signs of brucellosis in their animals such that they can act to minimise
the spread among their herds.
For further information visit www.dfid.gov.uk.
PICTURE CREDIT: PUBLIC HEALTH IMAGE LIBRARY
Philip MacMillan, third year medical student, University of Bristol
Email: pm1939@bris.ac.uk
Competing interests: None declared.
studentBMJ 2005;13:265-308 July ISSN 0966-6494
