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Schistosomiasis Teaches Lessons the Hard Way

  • Gideon Abraham, 10, has big plans for when he grows up. The Nigerian boy needs to stay healthy for his dreams to come true.

  • Because schistosomiasis—a parasitic infection that damages internal organs—mainly affects children, the government’s strategy is to distribute treatment through schools.

  • Gideon (center) and his brother Odenaka, 12, and sister Blessing, 7, moved into the area too late for school-based mass drug administration.

  • School Headmaster Paul Nnamchi measures Gideon to determine the proper dose of praziquantel to control schistosomiasis.

  • A single annual dose of donated praziquantel is sufficient keep the tropical parasitic infection under control.

  • Gideon swallows his praziquantel tablets. The frightening blood in his urine should clear up within a couple of days.

  • Nnamchi, a volunteer drug distributor for the Ministry of Health, keeps detailed treatment records for all the children under his care.

  • Brothers Odenaka and Gideon, along with their peers, are free to pursue their goals without schistosomiasis slowing them down. (All photos: The Carter Center/ R. McDowall)

It’s challenging enough to be the new kid in school. It’s even harder when something scary happens and you don’t know why.

Ten-year-old Gideon Abraham and his brother Odenaka, 12, and sister Blessing, 7, had come to live with their grandmother in Amagunze, Enugu state, Nigeria, in the middle of the school year. They are bright children, and getting in sync with their new school’s lessons was the easy part. Gideon wants to fly airplanes when he grows up — and perhaps become president of Nigeria.

One morning, he was alarmed to discover that his urine had turned blood red. He didn’t tell anyone; he just got dressed and walked to school, a half-mile up the rust-colored dirt road.

This went on for a week. Finally, because it wasn’t going away, Gideon went to his teacher while all the other children were outside during recess. The wide-eyed boy leaned in and quietly told her, “I’m scared.” The teacher asked him why. “My urine is red,” he whispered.

The teacher gently took Gideon by the hand and walked him past a row of mango trees to the office of headmaster Paul Nnamchi, who quickly realized what was causing Gideon’s problem: schistosomiasis.  He knew this because in addition to his educational duties, Nnamchi is a community-directed drug distributor for the state Ministry of Health. The ministry partners with The Carter Center to train volunteers like Nnamchi to administer treatments for schistosomiasis and several other neglected tropical diseases.

Schistosomiasis is a parasitic infection that can cause bleeding in the urinary tract. Left untreated, it can seriously damage internal organs, causing anemia, stunted growth, chronic pain, higher susceptibility to other infections (such as malaria), and sometimes premature death. The parasites utilize tiny snails as an alternative host in addition to humans. The snails live in still or slow-moving untreated water and release a form of the schistosomiasis parasite that enter through the skin of humans who walk or swim through the water. The snails in turn get infected when people urinate or defecate into water, depositing schistosomiasis eggs. A shallow, snail-infested stream crosses the road Gideon’s new school is on; children and adults wade through it every day.

“We can treat schistosomiasis with a donated medicine called praziquantel, and keep it under control,” said Dr. Frank Richards, director of the Carter Center’s schistosomiasis, river blindness, and lymphatic filariasis programs. “But right now we can’t get rid of it altogether. People can get reinfected every time they go into the water — and they have to go into the water in the normal course of their daily lives.”

Nigeria is the most endemic country for schistosomiasis, with approximately 20 million people — mostly children — needing treatment. Since 1999, The Carter Center has assisted the Nigeria Ministry of Health in providing six endemic states with health education and praziquantel (donated by Merck KGaA through the World Health Organization) to treat schistosomiasis.

An infected person’s parasite load can be knocked down with a single annual dose of praziquantel, Richards said. Because schistosomiasis mainly affects children, the government’s strategy is to distribute the drug through schools. On one designated day, all the students are lined up after lunch and their height is measured to determine the appropriate dosage. They swallow the tablets and return to the playground or classroom.

“The children are happy, the teachers are happy, I am happy; the parents too,” Nnamchi said. “The whole community is happy with this.”

Unfortunately, Gideon and his siblings fell through the cracks of that generally effective system. Before they moved, they lived in an area that was free of schistosomiasis, so no treatments were given there. They came to Amagunze after the school’s treatment day, so they missed out on being medicated.

Several Carter Center staff members happened to be visiting Gideon’s school the day his problem came to light. Teachers discovered 10 more children — including Gideon’s brother and sister — who had missed treatment for various reasons. With the Carter Center staffers looking on, Nnamchi measured all 11 and carefully counted out praziquantel tablets. 

“The drug kills the parasites almost immediately,” said Adamu Sallau, a director in the Carter Center’s Enugu office. Gideon’s urine could be expected to clear up within 48 hours.

The pilot license and the presidency may take just a bit longer than that.

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