Jaimie's Journey... In Tanzania

Tutaonana Tanzania!

2008-08-21T09:14:00.004+02:00

Slowly-slowly all of our participants are finishing the study and leaving us! Like the participants, on Sunday I leave Mwanza for the second time.

This week we are entering data like crazy and trying to wrap up all of the loose pieces of the study. We are so thankful to have close to 100% follow-up. Despite the sometimes fishy-tasting yogurt. All participants were happy to be involved and happy to drink the yogurt. We'll cross our fingers for positive results.

It is a strange feeling leaving Mwanza again, especially since I have been wrapped up in the study and haven't had enough time to reflect and say goodbye to all of the people I want to. It's such a short time to come here and a lot of specific work, which meant I was very focused for 2 and a half months. Lots of fun times along the way though, with our roommates and friends in Mwanza.

I will post a more detailed blog about the end of my time here when I return to Canada... right now I have some serious pipetting, data entry, and receipts submission to do!

Thank you for following my blog and I look forward to seeing all of you soon.

Jaimie

The Yogurt Champ Finishes

2008-08-06T15:39:00.001+02:00

Our yogurt study champion waits patiently outside of our office for us to open up the 170 locks we keep on the door to prevent people from stealing the microscope from 1867. So he waits there in his suit (the same one as the one he was wearing the day he started four weeks ago) as I stumble with my keys and he says he will be sad to finish the study. I looked at my favourite man and thought how sad I will be too for him to finish. Certain messages get lost in translation between English and Kiswahili, but I really enjoy the challenge of the language barrier. I also enjoy the satisfaction of realizing that after minutes of crazy hand gestures and broken Swahili, that my message was understood. I think that is one of the reasons I really love working with this group, because every day it is a challenge even to communicate, but nothing feels better than connecting with the participants even with this barrier. So his message that he was sad got through to me and I responded back to him and he nodded his head as if he understood. Then I finally got the locks undone and we continued with Baba’s follow-up visit.

One of my messages, though, did get a little bit confused, but luckily there was a room full of translators to laugh hysterically with me at how funny the mistake was. I asked a participant in Swahili if she was able to come back in two days to get her yogurt..... for some strange reason I don’t know she said “no I haven’t had diarrhea yet”. Hahaha it was a pretty funny mistake, but knowing me I probably did ask her by accident about her diarrhea.

We have another participant who makes us laugh quite hard. He has very blood shot eyes and his voice is so deep it’s almost a growl. Each participant has a green cardstock record of their yogurt-pick-up, and initially we would write their randomized code of the type of yogurt they receive (either 980 or 055) on the front of their card. We decided after about the 40^th participant that we would write it on the back of the card to prevent any potential bias during the follow-up interviews. So for the 40 participants with a number on the front, we had to cover those numbers with flowery stickers. He thought the sticker was a gift, so in a way I kind of agreed it was a gift as I covered his number, and he asked for more. So I gave him a few more, and by the end of the visit, the perimeter of his card was filled with stickers and the other participants wondered why he was lucky enough to get so many! This morning Ruben asked him “How was your sleep?”. He responded, “well, when I woke up the sun was still there, and then I looked and the sky was still there, so.... it was good”. Another time when I love finding out what someone says in another language. I will also be sad when he finishes.

As you can probably tell from these stories, we began our follow-up visits last Saturday, which means these participants have already consumed the yogurt for four weeks and we are taking their blood and filling out questionnaires to see the effect of the yogurt. We finished 11/12 of the scheduled follow-up visits, and we hunted down the 12^th person who will come tomorrow for her visit. We have a good system for hunting people down now! We don’t want to miss anyone. So this is what we’ll be busy with for the next four weeks as the participants all finish their four week period of yogurt consumption. We will be finished totally on the 23^rd, and then I leave on the 28^th for Canada. We haven’t had any major problems with the study and it is going very smoothly. We have a very good system now where I have certain things that I’m responsible for and so does Ruben and at the end of the day we discuss anything else that needs to be done or improved. Tomorrow night we plan to have our research team over for dinner again to celebrate their amazing hard work.

My Dad asked me if I’ve been able to see or do anything outside of Mwanza. I answered not really because we spend Monday to Saturday at work and there isn’t much time on Sunday to travel anywhere. So I thought about that question heavily after and about all of the things I have seen and done. Last weekend we went to Tunza lodge, which is a nice place right on Lake Victoria. After we swam with the crocodiles and went wake boarding, we went out on the boat to a very cool rock penninsula. It was very quiet and beautiful and we just climbed around, watched the fishermen and the amazing handmade sailboats go by.

This past weekend we were invited to a wedding at a Catholic Church here in Mwanza. We went with our little apartment unit (Ruben, me, Sabrina, Jessica and Osama) and our new friend Emma, who is a really cool Masters student from Ryerson and York. She is working at Kivulini for August. The wedding was our friend Jenny, who works at NIMR, and Joey who is originally from Mwanza. It was quite a beautiful ceremony – very cool choir! Later that night, I almost forgot to mention that Emma and I were totally on the brink of death when a pack of angry dogs came after us... with only maybe 0.1 seconds to spare, I jumped in the car and slammed the door and Emma ran in her gate to be protected by the guard who arms himself with a bow and arrow. Heavy stuff, I know.

This past weekend we went on another little adventure to Saa Nane game reserve in Mwanza with me, Ruben, Pendo (our house lady) and her son Abu. The nature and the surroundings were really cool, but somehow I got the sense Pendo didn’t really enjoy it as much as we did. I get that sense because she kept telling us there was nothing to see except trees and rocks! Haha. Pendo is so honest. It was so cool to see her talking to people and just walking through a huge crowd and greeting everyone. She also has very special relationships with all of her kids – she is very assertive and directive, but at the same time she has very light and nice conversations with them. She explained to Abu a lot about the animals at Saa Nane and her theory about why Lake Victoria will never run out of fish. Many times Pendo’s children come and help her work on the weekends when they’re not in school. They are all very polite and interesting kids and I really like when they’re around. At Saa Nane we were a little bit on edge most of the time, though, because when we approached the empty lion cage we realized the door was open. We found out later it was in Dar es Salaam for the weekend (?). We spent the time wondering if the lion was lingering in the bushes somewhere. We climbed up the steep rocks again to find yet another beautiful look-out to Lake Victoria. On the way down, I think I may have been a little nervous for the trek because my feet were very sweaty, so I had to take off my shoes and climb bare foot. It was a little scary, but we managed to make it down safely. After that trek we joined Pendo and Abu and, no joke, a monkey for lunch. The monkey was so human-like I could hardly believe it – he was accepting food right from our hands, he started eating off a spoon, chewing and handling food like a human, and finally he felt so comfortable he sat down and sprung a small leak below him and scared himself a little bit.

This week we are continuing with our follow-up visits and planning seminars we will hold soon at NIMR and with the mamas. Jessica is leaving this weekend, sadly. I will miss her brownies, caramel corn, chocolate sauce, funny stories and recaps and excellent organizational skills!

Again, I hope everyone is having a wonderful summer. I miss everyone at home and I’m looking forward to seeing you soon.

Jaimie

Photo Journal to go with the coming post

2008-08-06T12:22:00.014+02:00

Ruben and a happy yogurt client

Enjoying some yogurt in the clinic

Monkey and Pendo enjoying their lunch

Sharing our meal with the monkey

Me with Pendo and her son Abu on the way to Saa Nane game reserve

Jenny and Joey's Wedding -- and the Beautiful Choir

Osama the intellect

We lifted the rock so we could have a place to sit

Beautiful handmade sailboat

Rock Peninsula

Climbing with bare feet and horrible climbing clothes

Learning some clinical skills on a Friday night...

“The yogurt is good... until it explodes”

2008-07-20T13:21:00.015+02:00

The man who was dressed up in best suit is our biggest supporter of the yogurt. He just loves it. In fact, many mornings he sees me getting out of the taxi with 30L of yogurt and stops right in his tracks to help me into the clinic. He talks about how the yogurt makes him stronger and gives him more energy to do his work, but there was one day he didn’t feel as enthusiastic about the yogurt. “The lid slowly rose as I went to take my yogurt, and all of a sudden the cap popped off and there was yogurt everywhere. I wasn’t able to take that one”. He told Ruben. He apologized to our yogurt champ and tried to assure him that it wouldn’t happen again. Many of the participants don’t have a fridge to use to keep the yogurt, which makes it a challenge having 80 people pick up their yogurt every day from this small clinic. There are some participants who have what is called a “Barafu” which is a hole in the ground attached to cool ground water. This acts as a “pseudo fridge” for many of the participants, but we only give yogurt for about 3 days and then they come back for a fresh stock. Hopefully their Barafus aren’t coated with exploded yogurt.

Me and Dr. Butamanya

This week we reached participant 84! Our sample size was 80, but we quickly realized that we wouldn’t be limited by the number of people available to participate. This is our last week of screening and after that it’s just baseline, yogurt distribution and follow-up visits. We also didn’t expect so many people to be eligible to participate (ie: a CD4 count more than 200). This is really a great thing that their CD4 counts relatively high. Nothing hurts more than telling a participant he or she is not eligible because his or her CD4 count is below 200, which is one of the major diagnostic tests for AIDS. Ruben has the responsibility to tell them they are not eligible and he gives them a letter to give to their doctor, while I stand by the yogurt fridge with a watermelon in my throat. I am blown away about how positive people are in general, but mostly the ones who participate in the study. We really had to modify the quality of life questionnaire for this study from the one I used in Canada because people’s perception of what is a poor quality of life is pretty astounding. Someone may come in with severe opportunistic infection and still come to get their yogurt and when asked how they are, they will still tell you “very well thank you, and you?” I also like how during the informed consent process we will have sometimes 10 people in the office, and it doesn’t cross anyone’s mind that it would be strange to share a seat with a stranger or perhaps sit on their lap. Sometimes people will stroke my leg on the public bus, probably without realizing they are touching anyone. The level of tolerance of a lot of things is very different here than it is in Canada. That is one of the main cultural differences I have noticed and that perhaps is a whole other issue I could explain another time.

I mentioned in my last post that Mama Karoko, our research nurse, gets a little tired and falls asleep from time to time. This week’s story is perhaps a story that will make me laugh for the rest of my life. Tuesday morning is always very stressful and busy for us because we have both screening and baseline visits. This was a quiet part of the day close to the end and there was only one participant going through the informed consent process. I was facing the window doing my normal task of washing yogurt cups and listening to Mama Karoko give her animated talk. Today the talk was a little bit slower and less animated than it usually is, and then the room became very quiet. Ruben came over and he was laughing pretty hard and motioned for me to turn around and look at Mama Karoko. Her head was nearly at her belly button, the letter of information still in her hand, and the participant quietly waiting until Mama Karoko woke up. I nearly hit the floor laughing as Mama Karoko was startled out of her little nap. When she woke up, she too laughed pretty hard and kind of embarrassed said “Thank you Ruben, Thank you Jaimie” because neither of us could hold in our roaring laughs. That night when I told the story to my roommates, it took me about 10 minutes to get the words out because I was laughing so hard. Ahhh a little comedic relief from a sometimes stressful project. Thank you Mama Karoko.

Part of our research team (me, Ruben, Mama Karoko) at Sekou Toure Canteen

Preparing probiotics at NIMR

Last weekend we had a thank you party at the New Mwanza hotel for some of the folks who help us with the research study: Mama “zzz” Karoko, Flora (other research nurse), Judith (research assistant who helps us with the baseline questionnaires and yogurt distribution), Oswald (lab technician at NIMR), Simon (microbiologist at NIMR), and of course our wonderful roommates who are awesome supporters of the project. It was a really nice time and good way to show our appreciation for all of their hard work. Mama Karoko showed us some of her sweet dance moves and then we called it a night.
I love working at the clinic, and coordinating this research project in Mwanza is really a dream come true for me. Every day I think I wouldn’t rather be anywhere else than working with these participants. I am happy, though, when we can go on other adventures in Mwanza. Even riding on the back of Ruben’s bike has been adventurous for me – sometimes I laugh so hard I lose strength and almost fall of the bike. The locals think it’s funny too. It’s an efficient way to get to and from the clinic though. Yesterday I went on an adventure of a lifetime with Ruben as we both felt like slaves to the research project and needed a little bit of a break in the evening. We went to Nygezi, which is a little village on the outskirts of Mwanza and is right on Lake Victoria. We walked along the shore in kind of swampy farm land, and I thought if I will ever get attacked by a crocodile – now’s the time. The farmers along the water were very kind to stop and talk to us, and we asked questions about the area and their life and they asked us questions about ours. We stopped at one family’s house. They received money from a friend of Ruben’s to build a shelter for their chickens, but the handy guy (fundi) ran away with the money and there was no chicken house to be seen. We talked about our countries, what language my “tribe” speaks (English) and the cataracts in the grandmother’s eyes. We headed back on a long walk along the shore and finally reached a beautiful place that is under construction to be a beach resort. It was covered in beautiful green grass, palm trees and the land swirled around huge Mwanza rocks. We saw an amazing sunset and met a very nice Tanzanian couple who drove us back to the main road to catch a bus back to town. It was dark at that corner, and believe me, strange things happen at night, including a man who appeared to be having a seizure on the ground. We took the dala dala bus (which on the inside was a lot like a coffin with a black velvet studded and mirrored ceiling) back to town and found a taxi to take us to another remote part of Mwanza for dinner. Here we were in Nyakato for a dinner in a small shed with just one woman cooking rice and meat or rice and beans and tea with milk, a candle, one table and her six kids. We enjoyed rice and beef, two teas with milk and paid our $1.50 for the whole bill. One of the daughters, Ebenezer, very shyly came over to sit with us. She, like Mama Karoko, must have been a little bit tired as her head started bobbing and landed suddenly on my shoulder for a little snooze. Her mother explained the meaning of her name Ebenezer as someone who brought a lot of calmness and peace to her life when she was going through some difficult times – her protector. After all of that, we ended off the night by challenging some local pool heroes a game of pool – I’m pretty sure we embarrassed ourselves pretty badly, so we very quickly found another kind person to drive us to the closest road to get a taxi home. Adventure complete. It was very cool to go find adventure like that and talk to locals about their lives and ours.

Today I’m preparing for another busy week and helping with another nutrition project that is going on in Mwanza, where 50 people with HIV will be given nutritious meals every day (including probiotic yogurt) for 3 months. This is a program through Catholic Relief Services, and the WHE team got involved to help plan and evaluate the program. So I am using good old ESHA nutrition software to analyze the menu, and some program planning and evaluation guides that I got from other students in the MScFN program – thanks guys!

Thank you to everyone for reading my blog and sending me messages. I appreciate your support and I look forward to hearing more from you!

I will most likely post every other week as it is hard for me to use the internet regularly. So in two weeks, my next post will come!

Tutaonana Badaaye!

Jaimie

"Yogurt is Good... Like Education"

2008-07-08T17:35:00.003+02:00

Week 1 and 2 in Mwanza

Hello everyone! I apologize for taking so long to post my blog. Life including the trial began as soon as I stepped off the airplane! Luckily, my bags arrived safely and didn’t have any problems carrying my 80lb bag of supplies into Tanzania. My mom and I worked very creatively at the airport to switch around my luggage so it would actually be allowed on the plane. We located the problem very quickly – a 10lb bag of jujubes and a 3lb bag of golf balls that were left over from a previous trip. So – adventure number 1 was at the airport!

I arrived in Dar es Salaam to meet Sabrina who took a different flight and arrived in Dar about 4 hours earlier than me. Ali, the WHE coordinator’s uncle very kindly picked us up from the airport and brought us to a nice little hotel for the evening. The next morning we left for Mwanza. It was such a strange phenomenon coming back to Tanzania and speaking Swahili – it was like I never stopped speaking the language because it came back so easily. It was also so nice to see everyone I was friends with two years ago! Life hasn’t changed very much in Mwanza – many of the same people are in their same roles as when I was here the first time, which I think is a very nice thing. People here are extremely friendly and it actually amazes me how people will drop what they’re doing or leave work just to talk or to give us company while we walk somewhere. They live life very “presently” without a lot of dreaming about what’s next, which is what I find myself doing a lot in Canada. I am so happy to be back here because I have had two years to reflect about my experience and really appreciate it as well as learn much more about Tanzania, the culture and about certain diseases that plague this country. I feel much more confident and capable this time around, which makes it much easier for me to appreciate my life in Mwanza.

In the first week we were very busy with meetings and a seminar that we held for the partners involved in this research – three people from the analytical lab at NIMR, Dr. Changalucha, Mama Robert from Shaloom Care Centre (who has been excellent in sending many eligible patients our way), Mama Koroko (one of the research nurses on the team) and Osama and Sabrina. We discussed the protocol at the meeting with a very detailed section on the Nuremburg code and ethical research! Snooze fest 2008. I asked Ruben whether or not it was my voice or the material that lulled Mama Karoko to sleep J. It was funny to look up and realize she was having a nice nap. It was quite an energetic session by the end though! Everyone asked some great questions which helped us to correct a few “bugs” in the study.

Moving my supplies into the lab at NIMR -- full suitcase!

The Virutubisho trial or “Micronutrient Supplemented Probiotic Yogurt trial” is going extraordinarily well so far. Last week, Ruben and I had meetings with everyone involved in the study – Dr. Changalucha at NIMR, Dr. Butamanya at Sekou Toure and we started recruitment on Monday, where the potential participants read through the letter of information and consent document with the research nurse, and have their blood collected to check that their CD4 count is above 200. Saturday we had our very first baseline visit and it went very well – we enrolled 12 patients that day. Good news! People aren’t as perturbed by the yellow yogurt here as people are in Canada!! Not one person looked scared when we “revealed” the yogurt, and some people even said “It’s good…. Like education”! I love how languages don’t always perfectly translate – makes me laugh. One participant arrived in his very best suit to the baseline visit and was so pleased to have his first cup of yogurt, I could tell he enjoyed it because he was saving a little bit for later on his lips. Then, later that night he called up Ruben to say he was feeling better already. I hope everyday that these participants do benefit from the yogurt because they are so committed to coming to receive the yogurt and answer the questionnaires.

Mama Karoko working her magic while teaching the letter of information and consent doc

Although we spend roughly 50 hours a week in the clinic/lab, I have still had a chance to enjoy life outside of the clinic in Mwanza. Last weekend we went to a beautiful place called “Dancing Rock”, which is a beautiful view of Mwanza and Lake Victoria. This weekend we visited a number of friends’ homes up in the rocky oasis of Mwanza. “Team Yogurt” was invited to our friend Salame’s (Tara and Stephanie – she gives you big “hello!”s by the way) home in the Isamilo area of Mwanza. It was quite the trek and I felt like I was on the “Bat” ride at Wonderland when we were on the bus there, but it was completely worth it. She has everything she needs on her property – two goats, a number of avocado plants, mango trees, maize, lemon grass, chickens, a dog, two adopted children and a beautiful little home. In the corner of her small home (which is about 400 square feet) she is storing stones for the base of her new home that she plans to build once she has saved enough money. After a beautiful dinner she led us home down a very rocky and treacherous plummet down the isamilo hill in the dark. It was quite the adventure.

Visiting Ali's Family Home

I could talk all night about how cool it is to visit the homes of Tanzanians – but I would love to explain it to you one day in person. It’s very strange how it feels like a different world until the conversation is translated in English. Then I realize that we are all fundamentally the same and talk about similar things when visitors are there and treat our family members the same and care the same way about our lives. There are always cultural differences, but I realize now more than ever how much the same we are and it’s such a cool feeling.

Pret the cat's going away party -- the WHE team Ruben, Me, Jessica, Sabrina & Osama

I hope everyone is enjoying their summer and I look forward to hearing from you!!

Jaimie

Countdown Begins, 5.....

2008-06-17T05:31:00.003+02:00

I am busily getting all of my materials prepared for the study and for my life in Mwanza. My suitcase is already full and I have another 20 or so kg to pack! A little creativity and some compromise and perhaps a little extra cash for overweight charges and there I'll be in Mwanza with my yogurt cups and nutrients ready to roll.

Jenny and I had fun on our first Duathlon! We got a little over enthusiastic after we finished thinking of all the places in the world we could do our next Duathlon. That may be a lofty goal as we were very obviously amateurs.... forgetting to wear helmets while biking, forgetting to take helmet OFF while running, bikes made for comfort and not for speed (may as well had some streamers and a basket), a lovely shoe full'o'blood and of course huge smiles on our faces the entire time :) I think everyone should try it!

Thank you again for looking at my blog -- the next time I write it will be in Mwanza, TZ!

Jaimie

14 Days and Counting...

2008-06-06T12:56:00.008+02:00

Yogurt Label we Used in Canada

I would like to thank everyone for all of your kind messages on e-mail and blog. I really appreciate all of the support and encouragement.
At the moment I am working in a hospital in St. Thomas, ON as part of my internship to be a Registered Dietitian. Any time I mention this project, I immediately get a few questions. I know many of you reading my blog know the answers to many of these questions, however, I thought I would post some answers to the frequently asked questions I get.

Just a little background first...

Diarrhea and subsequent nutrient mal-absorption is the major nutritional complication of the HIV population. About 50% of all people with HIV will develop diarrhea at sometime during the clinical course of their disease (Cello, 1997). Death from AIDS is often associated with wasting and malnutrition more than it is from opportunistic infections (Keusch and Thea, 1993), thus nutritional interventions play a powerful part in the management of HIV. Most of the diarrhea is caused by some sort of “enteropathogen” or a nasty bug that effects the Gatrointestinal tract. Diarrhea can also be caused by certain nutrient deficiencies – zinc deficiency, for example, has been shown to increase the incidence of diarrhea, especially in children. As though that weren’t enough, diarrhea actually causes nutrient malabsorption, especially certain blood proteins (albumin) that carry many important nutrients in the blood (like zinc) and as a result, people living with HIV are left with a vicious cycle of diarrhea and nutrient malabsorption. Benchley, et.al. (2006) describes this is a little bit more eloquently than I just have, he and his colleagues suggest that “injury to the immune component of the GI mucosal surface [mainly from diarrhea], along with damage to the intestinal epithelial microsurface with its antimicrobial functions, may affect systemic immune activation during the chronic phase of HIV infection through the increased translocation of luminal microbial products” In a nutshell, a leaky gut causing bad bugs to leak out into the system, which stimulates the immune system and causes infection.

SO, after my long and winded description of HIV, diarrhea and malnutrition, here we go with the answers to the questions.

1) Why probiotics? What do they do?

Basically, probiotics, or healthy bacteria/yeast, help to maintain the integrity of the intestine during chronic HIV infections by reducing the impact of pathogens [Reid,et.al. 2003], stimulating the immune function of the gut, and with certain strains (L.rhamnosus GR-1), preventing or reducing the incidence of diarrhea all together.
So what does that mean? Less diarrhea = less water/nutrient loss = better nutritional status = better immune system = happy camper

2) How much do the patients have to eat to benefit?
In other studies [Anukam, et.al. 2008], reduced diarrhea and a stimulated immune system was seen after 4 weeks of consuming 100mls of probiotic yogurt per day. In our case, we will be using about 125g.

3) Is there refrigeration in Tanzania? How do you keep the yogurt cold?
There are refrigerators run by electricity in the yogurt kitchen. Usually there are rolling power outages, which causes a little bit of a problem with the fridges. What normally happens is the yogurt is incubated until about 5PM and subsequently put in the fridge over night when the power is back on. For the study, we will have a special fridge for the study yogurt.
If the yogurt is not refrigerated, for example the study participants get their yogurt every other day and most likely will not keep it cold, the acidic nature of the yogurt prevents the growth of harmful bacteria, especially if it is unrefrigerated for only a short time, like one day. Dr. Hekmat did a study by inoculating her yogurt with E-coli. She found that these strains of E-coli didn’t even survive in the fermented milk and at the end of the shelf-life it was undetectable. So in a nut-shell, the yogurt won’t make anyone sick if it’s unrefrigerated for a day or two!
If you have any other questions about the study or the yogurt please feel free to write me an e-mail!

Enjoying some PBY
I am just enjoying my last two weeks in Canada. Next week my friend Jenny and I are trying our first Duathlon, which is biking and running. Should be hilarious : )

Tutaonana Badaaye!

Jaimie

34 days and counting...

2008-05-19T21:54:00.010+02:00

Thanks for visiting my blog! This is my second time travelling to Tanzania with the Western Heads East project and I'm very excited to write about my 10 weeks in Mwanza. Mwanza is one of my favourite places in the world, and it is difficult to describe in words, but I hope to accurately share with you what it is like to live and work there. I studied Stephen Lewis in the fall, and some pages of his book "Race Against Time" literally made my eyes well up with tears and made me want to pick up and work in Africa. I remember reading Lewis saying

“When people are dying by the thousands everyday, unnecessarily, when we’ve had this horrendous pandemic unfold for two decades while the world stands by and watches – you’ll do anything in your power to move the process,” says Lewis of pushing the Canadian government forward to provide assistance for the fight against AIDS in Africa “I don’t care what it takes. All I know is that every time I got to Africa, I am shaken to the core”.

That's how I felt.

Moving to Africa mid-semester was not exactly a realistic thought, but now I have the chance to live out those thoughts and use the knowledge and skills I have gained as a student in Food and Nutritional Sciences. I am thankful for the students, staff and faculty at Brescia, Western and Lawson Health Research Institute who have listened to my ideas and thoughts and allowed me to work with them to develop this meaningful research project.

Just a little synopsis of what I will be busy with in Mwanza:

Last summer (2007), I was asked to work as a graduate student on a team to develop a micronutrient-supplemented probiotic yogurt that tastes very similar to regular yogurt found in grocery stores. After some yogurt that looked like orange play-do and tasted like rotten beef, we finally came an acceptable product. We worked with the nutrient formula to make it even more acceptable and at the end of the summer, we developed our "keeper", which tastes and looks like regular yogurt.

In the fall of 2007, we implemented a successful clinical trial in London, ON with participants who are HIV positive. The participants all enjoyed the yogurt (although I'm sure they were glad not to see a strawberry yogurt for at least a couple of weeks after the study finished) and the study provided some interesting results.

Now we're taking the idea east with a similar trial in Mwanza. I will be working alongside Ruben Hummelen, who has been working on another very important HIV-probiotics trial in Mwanza for the past year. The primary aim of his study is to test the effect of combined treatment of bacterial vaginosis with probiotics (Lactobacillus rhamnosus GR-1 & L. reuteri RC-14) and metronidazole (an antibiotic) on HIV-1 shedding. Ruben, along with Tara Koyama and Stephanie Irvine worked very hard to submit our ethics protocol to the Medical Research Coordinating Committee (MRCC) in Tanzania, which is where we hope to receive ethics approval from.

At the end of June we will begin recruiting the participants from Sekou Toure Regional Hospital's Care and Treatment Centre for people with HIV.

80 people with HIV will be consuming one of two types of the yogurt
-- either micronutrient + Lactobacillus rhamnosus GR-1 (probiotic) OR micronutrient + Lactobacillus delbrueckii/Streptococcus thermophilus (standard yogurt cultures) (120g) every day for 4 weeks.

We hope to see positive changes in the immune system and bowel health.

In addition, I will assist the other interns (Jessica, Osama and Sabrina) with other Western Heads East projects. I really look forward to seeing the Yogurt Mamas again!

I would especially like to thank both of my supervisors, Dr. Gregor Reid and Dr. Sharareh Hekmat, for leading me to this opportunity and making it happen.

I will be in Mwanza for a total of 10 weeks (June 24-August 29) so it will really be a whirlwind and hopefully [relatively] smooth adventure. I leave Toronto on June 22 at 4:30 PM and I arrive in Mwanza on June 24 at 10:30AM (3:30AM our time). I will update you as soon as I have access to a computer.

I hope everyone has a wonderful summer and I look forward to hearing your stories while I'm away!

Jaimie