WEEK 5 IN MWANZA (The Medical Research Begins!)

A SUMMARY OF WEEK 5 HIGHLIGHTS (if you're too lazy to read the whole post):
-We have packaging and label design for it. Now, we have found a company to print the label onto the packages!!! Once that’s all done we can expand our selling market!
-Joke’s clinical trial has begun!! 150 HIV+ women, half taking probiotic yoghurt, half taking non-probiotic yoghurt, for 30 days, everyday, 125 mL servings. On the first and last day a simple blood test with a finger prick (to calculate viral load) and then vaginal samples with a pipette (to test for Bacterial Vaginosis, condition which makes women more susceptible to STIs, and the transmission of HIV from mother to child). We advertised by putting up posters and distributing pamphlets around Mabatini and at Sekou-Toure hospital. (Seeking women >18, HIV+, taking ARVs, no allergies to milk etc.)

On Monday we went to NIMR (National Institute of Medical Research, Mwanza) to get our lab space arranged for Joke’s trial which was set to start on Saturday. We finally got the chance to speak with Dr. Changalucha (Senior Scientist in NIMR). I stopped in the hall to look at the research posters, many of them describing works in rural areas of Tanzania, studies dealing with access to antiretroviral treatment. Most of them were carried out by the London School of Hygiene and Tropical Medicine (Jamie, a past intern, is actually doing her Masters there, and working as a nutritionist in Malawi at the moment).
Later that afternoon, we went to various stationary and printing companies in town (there are SO many little hole-in-the-wall shops that do printing and photocopying. We looked at a couple shops that carried sticker-type labels on sheets that we could stick into a printer and imprint the Fiti-brand label. We have the final label designed on the computer and put on USB, or “flash” as they call it here.

On Tuesday morning we returned to NIMR to talk with George, the lab-tech, after receiving the heads up from Dr. Changalucha to go ahead with the work we requested space for. We were shown some of the lab equipment and I felt as though we had gone back in time, the lab was not heavily equipped with supplies like in Canada. The autocalve machine (for sterilizing, through application of high heat and pressure) was ANCIENT (It looked to be from pre-historic times compared to the one I had used at Lawson Research Centre back in London). They had a fridge and two incubators (kept at 37°C) that we have access to use for storage of yoghurt samples and agar plates. Later that afternoon, the final company we tried turned out to give us the best deal as long as we printed in mass amounts! This company was originally going to print us water-proof labels (much better than the paper ones we were looking into), but then once we described the packaging, they informed us we could print the label directly on the plastic surface of the bags! Packaging has been a huge hurdle the mamas needed to overcome, so we were very pleased with the results of the day!! Joke dropped off the posters and pamphlets she had printed outlining her trial and we told her we would put them up in the yoghurt kitchen the next day to advertise for patients.

On Wednesday morning we walked to the kitchen to count the number of packages we had. The labeling company told us we could get a much cheaper price if we printed out 5,000 bags, for example. Turns out we have over 10,000 bags! Of course, when I went to pull the box out from under a pile of old file folders and papers, a couple mice scurried away (terrified me!!) and when we opened up the box it was infested by ants and what looked like cockroach (hey, I didn’t look to closely at it!). There were probably about 1,000 bags that were ruined, shredded and chewed through by mice (they’ve been sitting in an open box in a neglected corner of the kitchen for some time now, when they thought the sealer was broken…) We dumped the contents of the bag outside, and luckily there was a large lag, completely sealed that had untouched packs of plastic bags, each containing 100 packages, so it made it easy to count. Now we know we can get a cheap deal for the labeling, so we’re ecstatic!
Later that afternoon we went to the local market to re-stock on fruits and vegetables. One vendor we were purchasing cucumbers from proposed to me haha, and although I rejected his offer, he gave me an extra cucumber and a green pepper free of charge (only to be eaten by me, I was informed by Esther haha). Then, Joke picked us up to go try out an aerobics class at Family Fitness. It turned out to be a small, mirrored room, humid with the stench of sweat. We paid for a step class, which I am terrible at because it’s all about coordination and following the pattern of motions of the instructor, but he was going soo quickly and I always found myself unsynchronized with everyone else! Once we got home we bought “chips” (like an omelet with fried potatoes in it) from the street vendor.

On Thursday we stopped by the kitchen to collect samples of “probiotic” and “nonprobiotic” yoghurt to be tested. We arrived at NIMR with a big suitcase full of lab materials, including an endless supply of plates, a micropipette, agar and MRS broth powder, an anaerobic chamber and anaerobic packets that release carbon dioxide etc. Lots of nerdy things, really…It turned out to be a long day at the lab, as we had to make a large number of agar plates to last the entire length of the trial (For quality control three times a week). We ran into a few problems, like the weigh scale not working, but we worked around it by walking over to another part of the lab to do our measurements. After mixing the agar solution according to the recipe, we needed to keep it in the autoclave machine, and then cool it. The actual process of diluting the yoghurt samples and plating was really quick and then they were placed in an incubator in an anaerobic chamber.

On Friday, when I returned to NIMR to check on the plates, there was bacterial growth on both plates! Yikes! This isn’t what was supposed to happen. The non-probiotic sample should not have indicated any presence of GR-1, if it was in fact probiotic. We decided that there was evidently a slip-up in the procedure, so we decided that on Saturday the women would have their tests, but not be given yoghurt, until a new batch was made that would could test just to be sure to not have faulty data. We will have to delay and start distribution on Tuesday now, just to be safe!

On Saturday we went to Sekou-Toure Hospital early in the morning to help out Joke. We had cake and sodas for the patients enduring the long waits, because there was only one nurse and one doctor to perform the tests. There was also another woman who was helping the women fill in applications and sign consent forms. The patients received 3000 Tsh for that day (the tests are a little invasive, so we figured they need some incentive to come in), and they will generally receive 2000 Tsh for each time they come to pick up yoghurt, to cover traveling costs. In the end, there were 35 women who showed up for the initial tests. A few men also showed up, even though it clearly specified “women” on the posters, and unfortunately they had to be turned away. They all brought little cards with their medical histories, and I noticed they also displayed CD4 counts. More women are set to come on Monday for more tests, and some women who had initially signed up did not show up today so hopefully they will come in on Monday. The study is called a “30-day trial”, but it is expected to last a few months because not all patients start consuming yoghurt at the scheduled start date, and there will be more and more women joining in the future.

On Sunday we headed to the kitchen to oversee the entire process of making yoghurt and ensuring that the “non-probiotic” yoghurt truly is non-probiotic this time. We think that last time it was contaminated wither by using the same spoon to stir both containers, or by inoculating the new milk with a spoonful of probiotic yoghurt as a “starter culture”. After boiling the milk and stirring constantly, it was separated into to separate containers and placed in a cold-water bath. After cooling, the probiotic milk was added to one container, and Mara Milk (local yoghurt that we purchased at the convenience store) was added and then it was sealed and placed in a warm water bath to be incubated.
After this was finished at midday, we went home and headed straight to Talapia for Major’s (Joke’s boyfriend’s) birthday celebrations on the boat! For lunch, there was a whole goat roasting on a spit over hot coals, potato salad and a salad with a tomato and red onion base, EVERYTHING eaten with our hands. Joke also made some amazing breads in her bread-maker and banana muffins! Some of the guys had a couple fishing rods out, trying to catch some fish, but the attempts were unsuccessful haha. We ended up getting stuck in the eye of a storm, and the waves started getting choppier and the rain poured down in sheets, while we tried covering up with a gigantic orange tarp. Just as we started rolling back the tarp, thinking the rains had stopped, a new bout of showers would fall from the sky haha. It was a really fun outting, even if we were freezing, our lips were purpled and teeth chattering, in our clothes soggy and sticking to our skins.

Random/Misc/Hilarity:
-I had to buy some shampoo/conditioner, and I noticed some at Zagaluu, the convenience store across the street from us. The packaging looked to be Dove, but once you looked closer at the translations it says things like “for sexy, slippery hair need lots of drinking water”…"For god filled hair colr"..."water water is smooth smooth, soft and soft, and bright bright". Interesting translation hahah.
-We noticed a man at NIMR and also man in Mlango Moja (the area we live in) walking on his hands (with flip flops on) and dragging his feet; it looked like a strenuous effort to lug his crippled body down the street, and I thought in Canada this man would without a doubt be in a wheel-chair.
-We’ve started cooking our own ugali (using maize and cassava flour), a staple in Tanzanian meals. It’s rolled up into a ball with the hands and dipped into a sauce with okra, tomato, and onions. It’s delicious!!
-Whenever we wear our African-print Kangas, everyone compliments us “ume pendeza!!”…and they say we look like “African women” haha. Esther never wears Kangas and wears more modern, city clothes. She says that only “Mamas” wear the Kangas and Kitanges (similar to sarongs).