Team:MADRID UCM/Human Practices

Human Practices Page I – iGem Madrid

HUMAN PRACTICES

context

1 What's up

Our human practices span the multidimensional problematic of water-related diseases, trying to maximize our positive impact on the planet through a responsible, informed, respectful and effective intervention. We must listen to the world in order to understand it and act accordingly.

Our values

Our project engages with the hottest topics of today’s international agenda, the Sustainable Development Goals, stressing particularly the 3rd (good health and well-being) and the 6th (clean water and sanitation). We agree with the ideology of the SDGs, and wish to partake in this worldwide shared plan to ensure peace and prosperity for the people and the planet, in present and future times. Our desire is to work together with groups across the spectrum to reach this goal.

Following this logic, we are not only thinking about the most immediate outputs of our intervention. AEGIS’ project will provide local communities with access to an easy-to-use and easy-to-get technology that may be further improved in the future by local researchers and technical specialists. Therefore, while helping to fight against cholera outbreaks, we will be encouraging the technical development of rural areas within their economic and material limits, actively participating in their empowerment and, consequently, linking to the 10th SDG (reducing inequality within and among countries).

2 Context

Problem

Cholera outbreaks are a major public-health concern for developing countries. The microbial contamination of water used domestically makes dealing with the prevalence of this disease difficult, as this is the direct trigger of the outbreaks that wreak havoc on local communities. In our project, we have focused our efforts in the African country of Cameroon, which has a sadly long history of cholera epidemics.

Many causes of this have been repeatedly identified by a number of research initiatives, but there is one that stands out because of its urgency: the rapid urbanisation that comes with exponential population growth.

The constant establishment of new urban settlements is often done without any governmental control, resulting in informal constructions that follow no regulation on issues like waste management [1]. This situation is a hazard for the consumption of non-treated water that is traditionally used in most of these areas, as well-water, consumed by the majority of the population, is contaminated by household refuse [2]. Water that a couple of decades ago was safe has now become dangerous, and it is not likely that this will get any better.

And most susceptible to water-related diseases like cholera are those in poverty, who cannot afford treated pipe or bottled water. This, combined with the lack of infrastructure for sanitation or potabilization, creates great health risks.

But the damage caused by cholera covers a wider area than just the health sphere: cholera outbreaks make populations dependent on foreign help and medicines, condemning them to the use of sensing methods that are expensive or ineffective, and that are provided by outsiders. This dependence is a harsh strike to the autonomy and self-development of those populations.

Measures implemented / in process

National and international organizations have been dealing with this problem for a long time, as the various prevention campaigns implemented by the WHO and its Global Task Force on Cholera Control show. The Ministry of Public Health of Cameroon in 2016 unveiled the National Health Development Plan, a four-year project that aims, among other objectives, to improve the quality and the scope of the Cameroonian healthcare system [3]. This document also provides a wide array of demographic and sociological data that is very useful for understanding the challenge of cholera.

But, despite all the resources invested in this enterprise, the incidence of cholera outbreaks continues to be an issue [4]. It is worth asking why.

Studies carried out in this context have revealed one crucial point: social characteristics are not generally considered in the design of public-health strategies [5]. Quantitative and qualitative analysis of a wide amount of data reveal the inadequate integration of socio-cultural factors into cholera-prevention strategies [6]. These researches point out the direct relationship between the existence of cholera risk factors and community vulnerability, showing that social attitudes and beliefs are the bridge linking these two concepts. Hence, the failure to address the worldview, the traditional ways of behaviour and the social features of local communities is holding up the effective implementation of cholera-prevention initiatives.

What is needed?

Early detection of the presence of cholera in household drinking water is crucial in the fight against the spread of the disease, allowing quick responses and so helping to control outbreaks. There is plenty of academic evidence that supports this, leaving the necessity of finding an early detection and warning system beyond any doubt [7] [8].

Most cholera cases with a fatal outcome take place outside hospital, revealing the need for proper medical care that is currently not reachable for a large percentage of the population. This lack is related to factors like the limited geographical access to health facilities and the low resources and supplies that are available to CTCs (Cholera Treatment Centres). There is an urgency to strengthen case management and to ensure adequate supplies with a special focus on rural areas [9] [4].

Simplified laboratory and epidemiological methodologies can improve the feasibility of cholera surveillance in rural and resource-constrained areas, facilitating early case detection and rapid response implementation [10]. Therefore, an easy-to-use tool that can effectively identify the presence of cholera in samples with reduced overall costs is more than a mere technological upgrade: it is an urgent need that could save many lives.

But this cannot come alone: to ensure the good implementation of any initiative it is essential to integrate sociocultural factors with well-equipped labs for diagnosis.

What can we do? - Solution

As cholera’s problems are not only physical but also socio-political, so must the solutions be. When thinking about the challenges we need to address, it is important to not only see the immediate health impact of the disease, but also to try to get a holistic picture of all its aspects. Questions such as how local communities understand and deal with cholera, and what implications this may have (related to the sickness itself, but also to patients, communities, families, external agencies, and governments), must be answered to bring some light to the matter.

The goal of this global approach to the problem of cholera is, in the end, the development of efficient, effective and respectful technologies that will, in the end, have a positive impact on the societal level.

Our solution to the cholera issue is multidimensional, approaching the problem from different sides and directly addressing the needs voiced by local experts:

We employ a revolutionary technology for biosensing: aptamers as a solution for the problem of low resources. Our technology is cheap, resilient (temperature-wise) and easy to produce and scale - a perfect mix for the target areas.LAMP was carried out using regular E. Coli lab strains (standard for this kind of use, and entailing no risk) as a practical example, but it is possible to reproduce the technique with other kinds of pathogens.

We have developed a system to allow our project to progress from cholera to other diseases. This system is based on the robotization of a protocol for the development of new sensor molecules (aptamers). These new molecules can be included in the models of the final sensors in order to make them applicable to other diseases. And this can be done with little investment, allowing local labs to work on their own, avoiding dependency on foreign resources.

We have acquired a proper understanding of the project by working on the ground with local communities. This involves listening to them and joining our forces with theirs to succeed in our task. An aptamer is only a molecule and can be shaped into many kinds of sensors, so we went to Cameroon to understand what is the optimum shape for the kind that we are building*. We believe that fieldwork, involving collecting feedback and cultural impressions about the disease and society in general, is the perfect way to address the daily fight against cholera that some groups face.

All this said, we consider it important to value local knowledge. Populations in areas most affected by cholera outbreaks have been struggling with the matter for many years, in which time they have acquired their own insights into it. Their first-hand experience has provided them with strategies and homemade methodologies to cope with the problem on a domestic level, which has helped us to make our project more efficient and effective, by avoiding the disconnection from the social features of the populations that makes other initiatives fail.

Our project allows a reduced reaction time, which results in the quicker public warnings that are essential for preventing outbreaks. In addition, the early detection will allow small rural clinics and CTCs to provide better treatment for their patients, reducing fatality in many cases.

Problems are never single-factored, and nor are their solutions. This is why we have adopted this strategy and why it is the basis of our project. It is time to work together.

Reflection upon the solution

Having reached this point, we should stop for a second. Just a minute, to breathe. It is tempting to go wild and get lost in the infinite possibilities of present and future applications that our project has. And this is completely fair; after all, we are presenting a potentially great solution to a major worldwide problem.

But many projects are like ours, and the international arena of development is full of great solutions and life-changing initiatives. So, let’s put a bit of perspective in here.

We absolutely believe in the utility of the AEGIS Project. We are proud to have invested so much of ourselves in it and we are pleased with the results. But we are also aware of the scope of the solution that we are proposing. What we bring is mainly a patch - an urgent resource that will save many people’s lives, yes, but a patch. Cholera and other water diseases will not be solved by patches and detection. They will be solved when each individual has guaranteed access to safe water for domestic consumption. And this can only be done by providing every human settlement with adequate infrastructure to ensure the potabilization and treatment of their water, together with the observance of urban regulations about waste management.

The effective end of cholera is beyond our action range. But this does not mean that we cannot do our bit to get there. Our contribution will be the dam that contains the disease until a definitive solution is forthcoming. And this is definitely something to be proud of.

References

[1] (2010). 3ème rapport RGPH ( Recensement Général de la Population et de l’Habitat).
[2] E. T. Epule, C. Peng, M. W. Mirielle, and N. M. Mafany, "Well water quality and public health implications: the case of four neighbourhoods of the City of Douala Cameroon.," Global Journal of Health Science, vol. 3, no. 75, 2, 2011.
[3] (August 2016). National Health Development Plan (NHDP) 2016-2020.
[4] F. N. Djouma, J. Ateudjieu, M. Ram, A. K. Debes, and D. A. Sack, "Factors Associated with Fatal Outcomes following Cholera-Like Syndrome in Far North Region of Cameroon: A Community-Based Survey," American Journal of Tropical Medicine and Hygiene, vol. 95, no. 6, pp. 1287-1291, Dec 2016, doi: 10.4269/ajtmh.16-0300.
[5] A. Ndah and S. Ngoran, "Liaising Water Resources Consumption, Urban Sanitation and Cholera Epidemics in Douala, Cameroon: A Community Vulnerability Assessment," 2015.
[6] P. Amaah, "Quantitative and qualitative analysis of the knowledge, attitudes and social representations of cholera in the extreme northern region of Cameroon: the case of Maroua I, Maroua Ii And Mokolo," (in eng), The Pan African Medical Journal, vol. 17, p. 253, 2014, doi: 10.11604/pamj.2014.17.253.2799.
[7] L. D. Djomassi, B. D. Gessner, G. O. Andze, and G. A. E. Mballa, "National Surveillance Data on the Epidemiology of Cholera in Cameroon," Journal of Infectious Diseases, vol. 208, pp. S92-S97, Nov 2013, doi: 10.1093/infdis/jit197.
[8] E. J. CARTWRIGHT, PATEL, M. K., MBOPI-KEOU, F. X., AYERS, T., HAENKE, B., WAGENAAR, B. H., … QUICK, R., "Recurrent epidemic cholera with high mortality in Cameroon: persistent challenges 40 years into the seventh pandemic," Epidemiology and Infection, vol. 141, no. 10, pp. 2083-2093, 2013, doi: doi:10.1017/S0950268812002932.
[9] M. C. Ngwa et al., "Cholera public health surveillance in the Republic of Cameroon-opportunities and challenges," (in eng), The Pan African Medical Journal, vol. 24, 2016, doi: 10.11604/pamj.2016.24.222.8045.
[10] A. K. Debes et al., "Clinical and Environmental Surveillance for Vibrio cholerae in Resource Constrained Areas: Application During a 1-Year Surveillance in the Far North Region of Cameroon," Text 2016/03/02 2016, doi: doi:10.4269/ajtmh.15-0496.

fieldwork

3 Fieldwork

Why fieldwork?

We care about the world. That is why we want our project to have a positive impact on society, and the only way of doing this is by gathering knowledge about what is really needed and wanted by the people we work with, and developing our technology according to this. We believe in scientific research connected with local communities, always keeping the focus on sustainability and with the aim of solving the big and the small problems of the world.

But how can we address this complex and global challenge from our position as individuals? After all, trying to apprehend every dimension of the needs of low-resource areas seems, at the least, slightly unrealistic. To cope with this we have adopted a field-based methodology, using a particular case study to tackle a more general problem.

Going to the field is the way we chose to avoid the purely academic perspective that could give a biased impression of reality. Also, it is not easy to find completely up-to-date papers, so observing the evolution that has taken place has been a useful methodology for thinking about future challenges. Combining scientific papers with on-the-ground work provided us with the understanding we were aiming for - one that could make our project real and applicable.

Being in the field allowed us to talk face-to-face with the people who will make direct use of our technology - our most important stakeholders. They gave us a new, non-official perspective on the cholera situation in Cameroon, the “dark side” that is not usually mentioned in papers: people are often not well familiarized with water-related diseases because they “simply don’t have drinkable water” (in the words of one local clinic).

As such, specific knowledge of the cholera situation in Cameroon allowed us to develop a technology that could be useful for all areas lacking in means and infrastructure (not only in African countries, but all rural communities with difficulties in accessibility).

How?

Addressing local expertise to shape our technology means a win-win relationship with the communities we work in, allowing us to go directly to the point, saving on time-consuming trial-and-error approaches and reducing the risk of rejection or resistance. Our efforts are aimed at avoiding an imposed top-down procedure, which has been the cause of failure of many development initiatives and has been proved to be problematic and victimizing - at best.

To carry out this research, we have considered local understandings of the cholera disease, and all the implications this has. This has meant investigating conceptions of the sickness itself (whether it is associated with dirtiness, poverty, ex-colonial empires, a curse etc.), but also gathering information about the sick people, their reactions, and their relationship with their families and the rest of the community, in addition to addressing the institutional and governmental dimension of the problem and the role that ‘outsiders’ (development cooperation agencies, foreign helpers) play here.

Why Cameroon?

One of the main reasons why Cameroon stood out as a good place to carry out our research was the historical recurrence of cholera epidemics there. The seventh pandemic of cholera reached West Africa in 1970, and has persisted as a public-health problem in some areas since that time [1]. Cameroon has historically experienced recurrent cholera epidemics with high mortality rates, which have been the focus of many international organizations and institutional initiatives.

As the problem is a long way from being completely solved [2], Cameroon seemed to include all the elements that we want to take into account when designing our project.

Our initial intention was to situate the main part of our research in the northern part of the country, in Garoua. The far north of Cameroon is a rural, low-resources and arid area, which made it one of our paradigmatic target areas. But once we arrived in Cameroon we realized that, despite the academic and developmental focus on cholera in the northern rural areas, the same problem lies under the surface in more urban zones, like Douala or the capital city Yaoundé. Therefore, we decided to reconsider our interests and stay in Yaoundé for fieldwork, working as guests of the African Institute of Open Science & Hardware by being part of their programme of Open Residences (http://africaosh.com/aiosh/open-residencies/.)

Residence African Institute of Open Hardware and Science

‘Africa Open Science & Hardware’ (Africa OSH) (http://africaosh.com/) is a grassroots effort to bring together researchers, technologists, hacker hobbyists, educators, government officials, and start-up innovators from around the world. Their goal is to create a conversation and set of actions on OSH, both among African actors and between them and the international community, to develop OSH principles and practices appropriate to their context. After running two editions of the Africa OSH Summit, an event bringing into practice these ideas, they took another step forward in their community-development strategy: launching the African Institute of Open Science & Hardware, with its main campus in Yaoundé, Cameroon.

The mission of the Institute is to meet current research and training needs in the field of Open Science. This is part of the contextualisation of the Global Open Science Hardware Roadmap, which lays out recommendations for making open hardware ubiquitous in science by 2025.

The African Institute of Open Science & Hardware hosted a number of residencies from June to July 2019. Based at Mboa Lab in Yaoundé, Cameroon, they offered us the opportunity to organize one of those residences (http://africaosh.com/aiosh/open-residencies/cholera-aptasensors/) which also allowed us to execute our fieldwork research in a local open lab.

How does it fit into our project?

Our stay in Yaoundé gave us the opportunity to work elbow to elbow with a local lab (Mboa Lab http://www.mboalab.africa/), which was one of the major goals of our fieldwork planning. Thanks to the Cholera AptaSensors residence, we were able to try out with them the most promising detection methodologies that currently exist. Following the workshops we gathered feedback, including it in the design of the new technology that we aim to develop through the AEGIS Project.

Moreover, we were able to experience what it is like to work in a small local lab, where the lack of economic resources forces every investment to be carefully considered and measured in advance. Apart from this, the poor quality of urban infrastructure (such as electricity and piping systems) brings a number of challenges that we must consider in order to maximize the practical utility of the technology that we are presenting.

Fieldwork process

Besides the Open Residence, which allowed us to cover the purely scientific investigation, our team carried out other activities during our time in Cameroon. An important part of our research is on the social challenges that come with cholera, and the best way to address those is by using the tools that social sciences provide us. These tools are, principally, semi-structured interviews, participant observation, informal chats and life stories, all accomplished with a culture-sensitive perspective.

We travelled around the surroundings of Yaoundé, focusing on the villages of the suburbs. There we visited medical facilities, paying special attention to details such as prevention-campaign posters, the geographic situation of the clinics and the amount of staff working there. All of this gave us a fairly good idea of the main points where we should concentrate our efforts to develop our project: lack of electric power, scarcity of staff with high technical skills and, in some cases, difficulties in moving from the clinics to a bigger city hospital.

Interviews (formal, semi-structured and informal) were one of our main sources of socio-cultural information. We managed to talk with a number of very diverse actors, concentrating our interest on science-related workers, but also including the opinions and worldviews of other people in the community. By this we were able to complement and, on occasions, correct our initial ideas, adapting them to the Cameroonian reality.

Fieldwork conclusions

Having finished the stay, we found ourselves with a large amount of data of all kinds. Fieldwork does not end with the flight back; once at home, we thoroughly analyzed and interpreted this raw information to produce a set of important conclusions. These conclusions have permitted us to modify our perspectives and translate them into a context-sensitive technology.

They can be summarized as follows:

The existence of acting protocols in case of the arrival of a patient with cholera symptoms does not decrease the need for a rapid and reliable diagnosis of the disease. Identification is essential for implementing public-health measures aimed at prevention, and for guaranteeing correct treatment of patients (with respect to the correct choice of medicines, urgency of the case, etc.)

The main cause of the prevalence of water-borne diseases is the lack of potabilization infrastructure. A regular check of the water sanitation in traditionally used sources could avoid the spread of infections.

The rapid-detection methods that are currently used are not completely effective for the prevention or early diagnosis of the disease. This is because of factors such as a high percentage of false positive results, the need for infrastructure and technical knowledge that only big labs can afford, and the fragility of these tools in storage.

Prevention campaigns are regularly implemented but do not always obtain the expected results. This occurs due to human mistakes, as the measures that they promote are based on the behaviour of individual citizens and on household water treatment.

Our project should focus on providing small clinics and CTCs with our technology rather than producing kits for domestic use, as we originally intended. Individual sale of this technology would come with the same problem affecting bottled water: that the poorest population groups cannot afford to spend their resources on it.

It is essential to work in collaboration with the Cameroonian government, as they are the ones with the capacity to cover the widest area and to access the most remote places. The inclusion of our project within the National Health Development Plan [3] framework would ensure its continuity into the future, which would boost its efficiency.

Moreover, the effectiveness of public-health campaigns is limited by time constraints, as they must keep up with cholera outbreaks themselves. The decision-times involved in putting out public warnings reduce their effectiveness.

And while it is not the most relevant factor, there is a tendency to undervalue the risks of non-treated water. Local populations experience feelings of rejection against institutional measures, rooted in their socio-historical context. It is important not to forget the post-colonial status of Cameroon, the consequences of which have a dramatic impact on popular faith in governments and, especially, in initiatives promoted by foreign-white agents).

In addition to gathering the knowledge that has helped make our project effective, this time in Cameroon has opened our eyes to the reality of what a developing country really is. Although people there have to face difficulties that Westerners would find hard to imagine, they are not helpless victims. They are qualified professionals who seek to keep on going, to work and improve their quality of life - just as we do in other parts of the world.

Our work in Africa has shown us that our project is viable. It is possible to save lives and make the world fairer for everyone. So, let’s get to it!

References

[1] E. J. CARTWRIGHT, PATEL, M. K., MBOPI-KEOU, F. X., AYERS, T., HAENKE, B., WAGENAAR, B. H., … QUICK, R., "Recurrent epidemic cholera with high mortality in Cameroon: persistent challenges 40 years into the seventh pandemic," Epidemiology and Infection, vol. 141, no. 10, pp. 2083-2093, 2013, doi: doi:10.1017/S0950268812002932.
[2] M. C. Ngwa et al., "Cholera public health surveillance in the Republic of Cameroon-opportunities and challenges," (in eng), The Pan African Medical Journal, vol. 24, 2016, doi: 10.11604/pamj.2016.24.222.8045.
[3] (August 2016). National Health Development Plan (NHDP) 2016-2020.

stakeholders

4 Stakeholders

A solid Human Practices should show the effect that a project aims to have in the world and how the world has influenced the design and implementation of the project. To achieve this, it is key to consider and incorporate feedback and views from stakeholders. But who are these stakeholders?

To identify the various actors to consult during the project-development process, we followed both direct and indirect implication rationales. This means that we chose the stakeholders based on their level of involvement with the cholera problem and, secondarily, their relationship with the health system. This covered a wide array of possible actors, but such breadth is not necessarily a bad thing. Water-related diseases affect the whole population; and what is more, the most vulnerable groups are the most forgotten ones in the implementation of most prevention measures. We wanted to avoid this problem by trying to make our stakeholders as possible, preferring local experts and using the demographic and sociological tools that the Cameroonian government releases to the public.

Who are they?

Academics: our project is strongly based on academic papers, from the preliminary research through to the analysis of the gathered data. But apart from the papers themselves, we wanted to interview and gain close contact with authors and researchers in order to gather more specific qualitative data.

The main purpose of getting in touch with members of the academy (who are still local citizens of Cameroon) was the certainty that we could trust their expertise. As a group, they dedicate their professional lives to gaining a deeper understanding of the world, so their perspective was highly valuable for achieving our objectives.

We were fortunate enough to have Thomas Hervé Mboa Nkoudou as the prime actor in this category. Mr. Mboa was one of the main supervisors of our host, Africa Institute of Open Science and Hardware, and the creator and coordinator of the Mboalab. A graduate in Biochemistry, Educational Sciences and Public Communication, Mr. Mboa provided us with a privileged insight of the historical and postcolonial situation of the Republic of Cameroon, and of how this relates to the scientific development of the country. He currently offers seminars and symposiums in many universities and international congresses, so we are incredibly grateful to have been able to count on his expertise and feedback on our project. We have incorporated many of his views into the project, and used them to shape our future plans.

Scientists and lab workers: we want our technology to be produced and updated in local labs, and for this we needed the feedback of the people who would be in charge of it. Scientists and lab workers such as Stéphane Fadanka and Lenshina Agbor were essential stakeholders in the development of the project. Together with us, they were in charge of carrying out the detection workshops, and they also helped inform our future trajectory.

Thanks to them, we were also able to learn how a local community lab is set up and launched, with all the obstacles and challenges that come along with it. They taught us the different tips and tricks to help to cope with these problems, saving us a lot of trial-and-error time. This priceless advice allowed us to take a realistic and on-the-ground approach to the situation of technical resources.

Health workers: in the course of our fieldwork we made several visits to local health clinics, in order to understand the experience of health workers in diagnosing and treating cholera. Those responsible for the proper functioning of the clinics are important stakeholders, as they are the people having direct contact with the population. In the clinics, we saw their main problems: lack of equipment and difficult access and transport to the main hospitals, which limit the attention and care that they can deliver to their patients.

Villages in rural areas usually only have access to this kind of health facility, so these are the first barrier between outbreaks and epidemics. Taking into account their supply needs and specific storage situation is indispensable for creating an efficient sensing technology with a real practical use.

Technicians: we were lucky to also count on the invaluable help of technicians at one of the biggest labs in the country. Through interviews, we were able to see which sensing technologies they are currently using, and which of them are identified as the most promising ones.

We confirmed that some leading technologies are already being implemented in these large and well-equipped labs, with good results. Therefore, the problem is not a lack of knowledge or technical ability in a general sense, but the difficulty for these methodologies to reach the most poor and isolated areas of the country on time.

This group of actors led us to think about the convenience of focusing our implementation protocols on small clinics, as they are the ones that most need a technology like ours.

Non-science-related people: when addressing a health-related problem, it is important not to forget that the final recipients of our technology are the people. Taking into account their opinions, worldviews and life perspectives is what makes a project more than a simple technical tool; it becomes a part of people’s daily lives, assimilated and used. This is what we want for the AEGIS Project.

To achieve this understanding of the realities of the population, we prepared a set of questions to ask members of the local community. Their answers, and the experiences and thoughts they shared with us, were the perfect complement to the sociological and statistical data that we gathered in advance.

Cameroonian people are aware of the risks that come with a cholera outbreak. A number of stories of fear and rejection of people with cholera symptoms showed that clearly. But they still need to live their lives, and that means that they have to prioritize some expenses over others. This translates into the limited usefulness of domestic cholera sensing kits for water, as long as they cost money. We found here another reason to focus on the clinical use of our kits.

And we must keep in mind the colonial history of Cameroon, which is the cause of a general mistrust of governmental or institutional measures and of “white” medicine. Even though it is considered a “bad” attitude, it is important to keep in mind that this attitude does exist, and the only way to cope with it is by introducing our project through local scientists and national labs, which can make people feel safer.

A fact that is easy to overlook is that many of the recommended prevention measures centre their approach on household-level behaviour and hygiene practices. Although this is reasonable, it overlooks that some of these acts are easily forgotten through human error, as they may not be easy to include in a daily routine. The collective memory of wells and water pits being safe is still powerful, and can lead people to undervalue the danger that exists nowadays. Considering these factors when designing an implementation protocol is crucial to make it properly work.

Centre Pasteur du Cameroun (CPC): http://www.pasteur-yaounde.org/index.php/fr/ This centre is a technical institute belonging to the Ministry of Public Health of Cameroon, a hospital establishment with financial autonomy and legal personhood. Created in Yaoundé in 1959, it has since set up two more annex branches: one in Garoua and one in Douala.

The CPC is a member of the International Network of Pasteur Institutes (RIIP) and shares their principal mission of fighting against infectious diseases. To achieve this, the Centre Pasteur addresses four objectives: service delivery, public health, research and training. Each one of these objectives aims to increase scientific expertise, and the work of the CPC is framed within the national initiatives for poverty reduction and improvement of the health system.

We received an invitation to interview one of the heads of this institute, which provided us with some useful information on the matter. She informed us that the impact of cholera varies from one region to another, being more pressing in the northern part of the country. We talked also about the protocols that the CPC has for coping with cholera outbreaks and ways to improve them (again, a quick diagnosis seems to be the key to success), and she gave us some information about the diagnosis of cholera and other diseases that they carry out in the centre.

Ministry of Public Health, Republic of Cameroon: we have touched on the need to establish a partnership relation with the Cameroonian institutions throughout the presentation of our project. Our studies have led us to believe that this is the best way to achieve the level of impact that we aim to have. The Ministry of Public Health represents a key stakeholder in making AEGIS a real project, as it is they who will enable us to bring it to the field.

We have produced a proposal for implementing our project in Cameroonian society. This proposal draws on the final conclusions of our research and translates them into concrete actions to be put into practice by the relevant government departments. The proposal places our project in the National Health Development Plan [1], as the perfect institutional framework.

We want our project to be managed by local organizations. By this, we will avoid bringing in another top-down, unrealistic idea, instead boosting an initiative that we expect to grow more and more. We want our project to be central to improvements in science and healthcare.

World Health Organization, NGOs and other foreign institutions: while our stress has always been on local initiatives and expertise, it is important to mention other relevant institutional stakeholders. They have been the ones most strongly encouraging the release of prevention campaigns and, in the case of the WHO, provide medical care during outbreaks. Their experience and support are therefore necessary for the fight against cholera and other similar diseases.

We have contacted experts at GTFCC (Global Task Force for Cholera Control) and Epicentre (who provides scientific assessment to Médecins Sans Frontières) and they have advised us about the best way to carry out our research. We believe that it is important to include them in our implementation plans , aiming to make our technology useful for them as well. Supplying their CTCs (Cholera Treatment Centres) with our detection kits could reduce mortality on a large scale and help to control the spread of the disease. This also extends to a wide range of organizations with the same purposes; cholera is a multi-dimensional challenge, and only by working together can we stop it.

References

[1] (August 2016). National Health Development Plan (NHDP) 2016-2020.

actions

5 Actions

Workshops

The work of our team in Cameroon was possible thanks to the hospitality of the African Institute of Open Science and Hardware. Our stay was arranged as part of the Open Residences programme that this organization hosts, offering us the opportunity of carrying out one residence: the Cholera AptaSensors Residence.

Our Open Residence took place in the Mboa Lab, a bio-hackerspace located on the outskirts of Yaoundé. The idea of this laboratory is to provide a free hub for experimentation where students and others with no access to bigger facilities can develop their scientific interests. The Mboa Lab follows the open-access philosophy, encouraging citizen science and shared knowledge, and hence was the ideal location for us to undertake our activities. Those attending our workshops were educated people - local scientists and lab workers - which proved valuable in gaining feedback on our main project.

The whole event lasted two weeks, which due to logistical and material requirements we divided into two parts: a first week of familiarization with the place, and a second in which we developed a series of workshops.

The first week’s activities were focused on getting to know the work already being developed in the lab and accustoming ourselves to the local working strategies and conditions. We learned about the operation of technical equipment, which showed us how things can work even in a low-resource environment, and we collaborated on different ongoing projects such as the set-up of an agitator.

In the second week we ran several workshops:

The main activity was a LAMP (Loop Mediated Isothermal Amplification) workshop. LAMP is the most promising detection technique currently applied in detection of infectious diseases. It is based on the identification of the genetic material (DNA) of the organism that one seeks to detect. This workshop consisted of several sessions with different objectives. The first was a theoretical introduction based on preparation of the reactants to be used in the subsequent sessions, the second approached the method through different visualization options, and two final sessions were focused on validation of the method, employing the conditions judged optimal in the previous tests.

LAMP was carried out using regular E. Coli lab strains (standard for this kind of use, and entailing no risk) as a practical example, but it is possible to reproduce the technique with other kinds of pathogens.

We also ran another workshop consisting of building DIY spectrophotometers. After a brief introduction, we assembled and welded the components to set the device up. The next step was testing its functioning by calibration with food coloring, using the spectrophotometer to determine the amount of food coloring existing in some commercial candies. It is important to point out that the use of a spectrophotometer is required for most activities that are performed in laboratories, in the routine measurements of many parameters used to specifically determine water contamination.

A third workshop involved assembling a mini-module able to function as an incubator for the growth of microorganisms. The final product was settled in the Mboa Lab together with the rest of the DIY equipment, allowing to be used further.

Throughout the course of the Open Residence, we also supported and helped to shape a collaboration proposal between the Mboa Lab and the Medicine Faculty of one of the most important universities of the country (UCAC Cameroon). This proposal will result in the formation of two working groups composed of students and staff of the UCAC, who will continue the development of a sensing technology based on LAMP. This activity will be performed in the Mboa Lab facilities, and will draw on the knowledge our iGEM team has been generating regarding aptamers and their application to biosensing at the end of the competition. Therefore, one of the outcomes of the Open Residence was that we established a three-way collaboration with local researchers by transferring our research to these groups, who will continue the investigation and comparison between technologies.

To carry out this research, we have considered local understandings of the cholera disease, and all the implications this has. This has meant investigating conceptions of the sickness itself (whether it is associated with dirtiness, poverty, ex-colonial empires, a curse etc.), but also gathering information about the sick people, their reactions, and their relationship with their families and the rest of the community, in addition to addressing the institutional and governmental dimension of the problem and the role that ‘outsiders’ (development cooperation agencies, foreign helpers) play here.

Proposal for the ministry of public health - Republic of Cameroon

References

[1] M. Chengedzai, "Barriers to public supply chain management strategy implementation: an exploratory diagnosis," Problems and Perspectives in Management, vol. 14, no. 3, pp. 256-265, 2016, doi: 10.21511/ppm.14(3-1).2016.12.
[2] J. Vleugels, M. Greuter, Y. Hazewinkel, V. Coupé, and E. Dekker, "Implementation of an optical diagnosis strategy saves costs and does not impair clinical outcomes of a fecal immunochemical test-based colorectal cancer screening program," vol. 5, no. 12, pp. E1197-E1207, 2017, doi: 10.1055/s-0043-113565.