Dossier: Parasites Cryo: (ITM’s version of Frozen) Monet and molecular epidemiology
Parasite hunter from the Amazone to Antwerp
Institute of Tropical Medicine, Antwerp | PÂł | No. 2 - February 2016
nl
Colophon
Editorial
responsible publisher Bruno Gryseels
Dear reader,
editor in chief Roeland Scholtalbers editorial coordination Eline Van Meervenne editorial committee Ildikó Bokros Nathalie Brouwers Nadia Ehlinger Stefan De Pauw Alexandra Hörlberger Roeland Scholtalbers Mieke Stevens Nico Van Aerde Eline Van Meervenne Marc Vandenbruaene Gert Van der Auwera Luc Verhelst Daphné Vleeschouwer Maria Zolfo layout & photography Stefan De Pauw translations Serv-U contact communicatie@itg.be +32 (0)3 247 07 29
Parasites are everywhere and large numbers spread through our intestines, lungs, muscles, brains, liver, skin and bloodstream. Animals and plants are not immune to parasites either. Parasites even live in other parasites. The word itself originated in ancient Greece and is used to describe a person who lives at the expense of another, a sponger. And that is exactly what parasites do and what ITM researchers are so fascinated by. Just the thought of it would make a normal person wince, but it makes the hearts of our researchers beat faster. In this second issue of the ITM magazine P³, you will meet a Mediterranean parasite hunter in Antwerp, you will get to know the creepy crawlies you may find on your plate, and learn about penguins and malaria. You will get an glimpse of the frozen memory of the Institute and will be introduced to an unwelcome guest from South America. And did you know what Monet and molecular epidemiology have in common? Besides this issue’s main theme, the current P³ introduces Anne Chapelle, managing director of the Antwerp BVBA 32 fashion house and the latest member of our Board of Directors. She shares a bit of history with ITM. Patrick Reyntiens talks about his experience living with HIV for 30 years. A Vietnamese student tells about the challenges international students face in Antwerp. In addition, this P³ will take you back in time, to show you how the clinic for colonials and sailors became a polyclinic. On behalf of the entire editorial staff, I wish you pleasant reading. We welcome your questions, comments and suggestions via communicatie@itg.be. Sincerely, Roeland Schotalbers Editor in chief
*P³ - ITM’s essence captured in one letter Our innovative and interdisciplinary research focuses on Pathogens (Department of Biomedical Sciences), Patients (Department of Clinical Sciences) and Populations (Department of Public Health). ITM researchers improve our understanding of tropical diseases, and develop better methods for their diagnosis, treatment and prevention. Others study the organisation and management of health care and disease control in regions where means are limited, but needs are huge. We also focus on the health of animals and the diseases they spread to humans.
4 The ITM number
5 Dossier: Parasites
6 Parasite hunting: from the Amazon to Antwerp
12 Monet and molecular epidemiology
14 Parasites on your plate
20 1987- From clinic to outpatient clinic
23 The bookshelf
8 Cryo: (ITM’s version of Frozen)
11 Are penguins dosed with malaria pills?
16 Leishmania: a complex globetrotter
18 Ha's high five
24 Portrait: Patrick Reyntiens
26 ITM and I: Anne Chapelle
Š The contents of this publication may not be reproduced in whole or in part without the express consent of the publisher. Images in this report were taken with full understanding, participation and permission of the people portrayed. The images truthfully represent the depicted situation and are used to improve public understanding of our work.
the itm number
of all malaria cases occur in Africa, but some patients returning from risk areas get a malaria diagnosis in Belgium.
Nearly
In 2015 ITM confirmed
cases. (*) Over the past year ITM saw a slight decrease in the number of cases. This could be a result of a slow-down of the malaria transmission rate in some regions, but may also be related to a lower number of travellers to West Africa because of the Ebola outbreak.
Twentyone patients were admitted to the University Hospital Ant足werp, the majority of them were people who visited Africa.
dossier
Parasites “Parasites are an odd and exceedingly diverse assortment of life forms that defy generalisation: essentially their actions define them. The word parasite was first applied to humans, used to describe people who live by taking from others. The self-serving activities of such people are damaging to their hosts, whose resources they deplete. A parasite in the biological sense is similar: a parasite lives on, or in, another species, getting everything it needs from its host. In keeping with the cultural view that a parasite is a despicable creature, the strictest biological view holds that parasites damage their hosts. Curiously, however, the word parasite isn’t used consistently to describe all life forms that live in this way. Bacteria, fungi, and viruses that multiply in the tissues of other species are traditionally excluded. Tiny predators, such as mosquitos, are excluded as well because they feed on, but don’t live on, their hosts. In a medical sense, at least, parasites include protozoa, worms and certain things with legs, such as mites and insects – but only those that must spend at least part of their lives in or on the tissues of other living things.” From Rosmary Drisdelle, 2010. Parasites : tales of humanity’s most unwelcome guests
Parasite hunting: from the Amazon to Antwerp (via Papua)
Alexandra Hörlberger
Head of ITM’s Unit of Malariology Anna Rosanas is no lab rat. Originally from Catalunya, Spain, the dedicated scientist sees life through both the microscopic lens of a molecular biologist, with a background in genetics and the bird’s eye view of an epidemiologist. Although an avid lab researcher, Anna wanted to experience science in a more personal way, which is why, after finishing a PhD on the role of ParaHox genes in the development of diabetes in 2005, she decided to take a break to reflect on the next step and travel around South America. Some intense months of traveling ushered in a switch from “evo-devo” (evolutionary development) to malaria research starting a postdoc at the University of São Paulo and later moving to the Hospital of Tropical Medicine in Manaus. In collaboration with the Brazilian National Malaria Control Programme, Anna was given the opportunity to work with riverine communities at the very heart of the Amazon region.
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Following this intrepid period Anna moved on to continue her field work at the Institute of Medical Research in Madung, Papau New Guinea. Together with a medical doctor, she coordinated a field study in a remote part of the Sepik region where 80% of the population live without running water or electricity in small subsistence farming communities. The study monitored 500 children over a 12-month period, followed by an additional year of molecular analysis of the findings. Another three captivating years were spent in this “amazing country of extremes”, as head of the Molecular and Epidemiology Unit.
Having also had two children during “Malaria has a ment Agency DGD, the projects are this sojourn, Anna now faced a tur throughout South Ameri current annual dappled ning point in her life as a researcher ca, West Africa, Southeast Asia incidence of and mother. After five years, it was and Europe (Peru, Mozambique, a time for a change and new chalBurkina Faso, The Gambia, Vietaround 250 lenges. Her decision brought her Papua New Guinea and Spain). million malaria nam, and her young family to Antwerp With a current annual incidence of cases worldwide around 250 million malaria cases where she was recruited as head of the Unit of Malariology at ITM. The worldwide and a death toll of more and a death move entailed both a culture and half a million people, the idea toll of up to one than temperature shock and took some is to eliminate and ultimately eradimillion.” getting used to. Now three years cate this lethal parasite. If funding is down the line, Anna leads an ensustained and does not decrease due thusiastic team of nine malaria researchers who to an over-optimistic interpretation of reduction in reliably meet at 11 a.m. every Friday morning to disease, Anna believes the elimination of malaria give each other an update on their work. Pursuing to be an attainable feat. her passion with a great team of good people is Anna’s driving force. She enjoys sharing scientific Her goals for the future are to continue enjoying curiosity and enthusing about the work at hand, what she does, to maintain the excitement in her not to mention the deep sense of satisfaction she work, to remain flexible and not to get bogged down gets from seeing the impact of her valuable projects. by life. Antwerp has become home – it is small enough to be easily navigable and large enough to The Unit of Malariology covers three main thematic offer the infrastructure and perks of a big city. Plus, areas: drug resistance, transmission, and invasion it is family friendly. However, the climate remains a mechanisms, with studies both in the lab and in bone of contention, she smiles with a shrug. the field. Partly funded by the Belgian Develop-
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Cryo
(ITM’s version of Frozen)
Roeland Scholtalbers
The word cryobiology is derived from the Greek words kryos, “cold”, bios, “life” and logos “science”. Cryobiology studies the impact of ultra-low temperatures (-196 °C) on living structures. Thus, cells, tissues, organs and even living organisms can be kept in liquid nitrogen for years and brought back to life at a later stage. The ITM cryobank stores more than 60,000 isolates of human and animal pathogens - invaluable material for use in research in Antwerp and elsewhere.
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photo story Per week approximately 400 litres of nitrogen are used to lull pathogen species from around the world into deep sleep under the watchful eye of Jeroen Swiers. Plasmodium, Trypanosoma, Leishmania and Theileria protozoa come and go in his white-orange containers. Besides the culprits behind parasitic infectious diseases such as malaria, sleeping sickness and the cattle disease theileriosis, other regulars are HIV virus samples and lesser-known pathogens.
The collection of Trypanosoma and Leishmania strains in the cryobank is unique in size as well as in diversity and is an important reference research facility. ITM also houses the largest publicly accessible collection of tuberculosis samples. But it is Jeroen and his colleagues who provide the culture medium used by the Unit of Mycobacteriology for growing TB strains.
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photo story
Jeroen Swiers has seen a great number of samples over the past 10 years. “Usually they come in small batches, but once I received 10 000 HIV samples from Uganda for analysis by the Unit of Immunology. I was hard pushed to find storage room.” Jeroen is meticulous in his work as guardian of the Institute’s frozen memory. Every sample is put into liquid nitrogen following a standard procedure and strict labelling, and taken out when scientists need it for research into new diagnostics and treatments.
“We always store one sample of each particular pathogen collection in a separate container in case the rest of the batch gets damaged or spoiled, through thawing for example. We can then rebuild the strain on the basis of this remaining vial. A question of spreading the risk,” says Swiers. Every day Jeroen Swiers and his colleagues from the Unit of Applied Technology and Production work closely with virologists, bacteriologists and parasitologists from various scientific units, because in ITM’s cryobank the institute meets at microlevel. “I feel that I make a small contribution to research that changes people’s lives for the better.”
Jeroen Swiers – the iceman After graduating as a medical laboratory techni cian, Jeroen Swiers joined ITM in 2006. While studying, he spent some time as a trainee in ITM’s clinical laboratory and became interested in exotic pathogens. As coordinator of cryobiolo gy, kitchen laboratory and sterilization he deals almost exclusively with the frozen memory of ITM. Jeroen is attached to “his” collection, but is too cold blooded to call it a passion. Occasionally he gets burned by the -196 °C nitrogen even though he wears heavy-duty blue gloves. And he does not fear winter, because over the years his bare hands have become used to cold weather.
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fun fact
© ZOO Antwerpen
Does the Antwerp ZOO dose its penguins with malaria pills? Marc Vandenbruaene
The childlike amazement of Eva Hemelaer, social nurse at the ITM-STI-HIV consultation, was the inspiration for this piece. She sent me an email on 2 July 2015 and told me about her visit to Antwerp Zoo and how much she had enjoyed a chat with the person feeding the black-footed penguins. She was surprised to learn that this species receives antimalarial treatment. It puzzled her and she wondered: is malaria a threat to zoo animals? Veterinarian and former ITM colleague Francis Vercammen confirms that the Antwerp penguins and those in Planckendael are dosed with anti-malaria pills during the mosquito season (April to November). Avian malaria does indeed exist and is a pathogen belonging to a strain of Plasmodium relictum and Plasmodium elongatum. These micro-organisms are transmitted by the Culex mosquito - the ordinary Belgian house mosquito.
“Without anti-malaria pills all black-footed and Humboldt penguins would probably die as they build up no natural resistance. With malaria pills death from malaria can usually be prevented.” Once a week all penguins get a combination treatment of chloroquine and primaquine. The capsules are inserted under the gills of a fish and each penguin gets the “preventive” fish from the keeper. Of course, all this involves a bit of administration. Each bird is assigned a number to make sure that they all get their dose. Some penguins permanently live in an enclosed space where the temperature ranges from 7 to 10 °C and where the mosquitoes cannot establish themselves. These birds do not get the anti-malaria pills. Only penguins that live outdoors receive preventive treatment. Canaries, birds of prey and other birds are equally prone to infection with the Plasmodium strains, but they usually do not present symptoms of the disease. 11 | P³
Monet and molecular epidemiology
Mieke Stevens
From 10-13 May 2016 leading scientists will come to ITM for the 13th edition of MEEGID, a top congress series on Molecular Epidemiology and Evolutionary Genetics of Infectious diseases. This is quite a mouthful, but luckily Prof. JeanClaude Dujardin is willing to paint us the picture, literally. The MEEGID congress series and its companion journal, Infection, Genetics and Evolution represent a unique forum for cross-fertilisation between molecular epidemiology, evolutionary genetics and infectious diseases. Molecular epidemiology is both the “molecular”, the use of the techniques of molecular biology, and the “epidemiology”, the study of the distribution and determinants of disease occurrence in populations. “You could say that molecular biologists and epi demiologists have problems with their eyesight,” says Prof. Dujardin, who heads ITM’s Department of Biomedical Sciences. “Take this painting by Monet for example. Molecular biologists will look at it in such detail that the overall image is lost-all they will see is a collection of pixels. Molecular biology
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Epidemiology
Moleculair epidemiology
Conversely, epidemiologists look at infectious di seases from a distance and see a blurred image of the painting. Bringing both molecular biology and epidemiology together in molecular epidemiology results in the creation of an image that is close to reality.”
The relationship between patients and hosts completes the picture of this multidisciplinary approach. The severity of disease symptoms is among others determined by the host’s immune response, while the variety of symptoms can also help our basic understanding of the interaction between pathogen and host.
But the MEEGID congress is about more than crea ting a Monet painting of reality. The uniqueness of this platform is that it also introduces evolutionary genetics into the mix. “You will see a lot of trees during the congress.” These computer-generated tree-like structures allow scientists to identify the pathogen and in particular the evolutionary relationship between the pathogens that have been isolated from patients with a particular disease. How does this help to combat infectious diseases? “If we find a homogenous group of pathogens that can be linked to specific disease symptoms, we can target them for the development of sensitive diagnostics or treatments. Another example is that we can use phylogenetic trees to map where certain pathogen groups are found, explaining why patients in a certain region are prone to the development of severe disease whereas in other areas this pathogen doesn’t cause severe disease,” Dujardin concludes.
MEEGID XIII
13th International Conference on Molecular Epidemiology and Evolutionary Genetics of Infectious Diseases Antwerp, 10-13 May 2016 www.meegidconference.com Monet painting: courtesy of www.claudemonetgallery.org
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Parasites on your plate Two million people die each year as a result of foodborne and waterborne diseases caused by bacteria, parasites, viruses and chemical substances. How safe is your food? ITM houses the Belgian national reference laboratory for trichinellosis and plays an important role in detecting this roundworm that can cause serious health problems. Eline Van Meervenne
December 2014. Christmas holidays are coming and restaurants and bars are packed. Sixteen Fle mish people become unwell and even have to be hospitalised after eating a cut of wild boar in three separate restaurants in the provinces of Limburg and Antwerp. Scientists from ITM investigate the meat and patient fluid samples, and conclude that the patients have been infected with the Trichinella parasite through contaminated meat. Infection occurs commonly in animals such as domestic pigs, horses and wild boars. These animals rarely present symptoms. Trichinellosis in humans is mainly caused by eating insufficiently cooked meat. Symptoms can include severe gastroenteritis, muscle pain and swellings. Severe cases can even be fatal. The wild boar meat is examined in the national reference laboratory of ITM. ITM hosts the national reference laboratory for trichinellosis funded by the Federal Agency for the Safety of the Food Chain. If there are suspected cases, such as those in December 2014, our scientists investigate the contaminated meat by literally mincing and digesting it. The parasite will show up under the microscope in the resulting paste. ITM’s reference laboratory not only provides advice but also ensures that other laboratories investigating trichinellosis apply the correct procedures.
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“Diseases caused by food contaminated with parasites are becoming more common.”
“In the old days, trichinellosis regularly occurred in the West, and the EU Member States were subsequently required to designate a reference laboratory,” says Prof. Pierre Dorny, Head of the Unit of Veterinary Helminthology. “Today the Trichinella parasite is rare in our regions because pig food is strictly controlled and cases are mainly due to the consumption of game. In other parts of the world, such as South America and South East Asia, trichi nellosis is far more common. Pigs roam around freely, there are very few regulations about animal sustenance and the meat is often undercooked,” according to Prof. Dorny.
Trichinella is not the only parasite that is spread through our food. For decades, ITM has carried out research in the tropics on various tapeworms and flatworms. “Diseases caused by food contaminated with parasites are becoming more common. This, among other things, is a result of the globalisation of our food supply, population growth in risk areas and changes in culinary habits. They can also be detected more quickly because we have more efficient diagnostic tests and better communication. Therefore drawing attention to these diseases is not a luxury but a necessity,” concludes Dorny.
The wild boar meat is examined in the national reference laboratory of ITM.
The meat is minced and artificially digested. The parasites are detected in the sediment.
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Leishmania
a complex globetrotter The World Health Organization estimates that there are 1.3 million new cases of leishmaniasis each year, resulting in twenty to thirty thousand deaths. There are different forms of the disease, ranging from non-lethal skin lesions to the fatal kala-azar variant. They are all caused by the Leishmania parasite, and are transmitted through the bites of infected female sandflies. Leishmaniasis is endemic in 98 countries across Asia, Africa, Latin America and Europe. ITM not only actively fights this disease through its numerous projects involved in the diagnosis, treatment, prevention and epidemiology of leishmaniasis, but our clinic also detects about twenty cases each year. One of these was Philip, a soldier who brought the parasite home from South America. Gert Van der Auwera
About a month after Lieutenant “Leishmaniasis my leg. Doctors from the military Philip D. (26) from Essen came in Neder-over-Heembeek is endemic in 98 hospital back from an overseas training, he decided to send a sample to ITM for countries across analysis. The verdict: a Leishmania noticed a small blister on his lower left leg. Philip is over two metres tall, guyanensis infection - one of the Asia, Africa, strikingly handsome, and passionate species responsible for the Latin America twenty about his army experiences.” The disease.” and Europe.” blister was not much larger than a centimetre, and not that uncommon The cutaneous form which Philip after a mission in the jungle where fell victim to is just one of the many hygienic standards leave a lot to be desired.” An types of leishmaniasis, and the most benign. The abrasion made him forget about the bump until the damage is limited to a local lesion at the site of inscab that had formed over it fell off and revealed fection but can sometimes develop into ulcerative an open wound the size of a teaspoon, bleeding lesions, such as in Philip’s case. In some unusual profusely. “When the lesion got larger and began cases the disease leads to the total destruction of to fester, the army doctor and I suspected that there the mucous membranes of the mouth and nose, was more to it,” Philip explains. “This was ten weeks and causes severe facial disfigurement. In the most after my return to Belgium. Shortly afterwards serious form, visceral leishmaniasis or kala-azar, small red bumps showed up in other places on the parasite embeds itself in the bone marrow, liver P³ | 16
and spleen. The type of Leishmania that develops depends on the individual’s immune response to infection and the exact species that has caused the infection. “In most cases nothing happens, and the skin lesions heal themselves,” says ITM’s Dr. Jan Clerinx. “Each year, ITM diagnoses between 15 and 20 cases, one to five of which turn out to be visceral leishmaniasis. Cutaneous leishmaniasis is the most common form. The patients are mostly tourists, expats and soldiers who have stayed in risk areas for longer periods, and immigrants from endemic regions. They are of all ages and we cannot pinpoint an area where people are significantly more or less likely to become infected, although in recent months we have seen more cases coming from Syria,” says Dr. Marjan Van Esbroeck of ITM’s clinical laboratory. Philip does not know when he was bitten. “I was in the Amazon rain forest for over two months, where humidity is almost 100% and temperatures fluctuate between 28 °C at night and above 40 °C during the day. We were often forced to swim, which washes off any insect repellent. Although you sleep under a mosquito net, you fall prey to so many insects that the bite of a sand fly does not really stand out among the rest. At one point I got heat rash, and my skin was covered in red spots and purulent blisters.” He adds that all army clothing is usually impregnated with insecticide. “During our
training we had to wear castoffs from the French army which meant that all preventive efforts were more or less in vain of course.” “It is important to start a specific treatment in good time,” says Dr. Clerinx. According to Dr. Pierre Buffet of the Hôpital de la Pitié-Salpêtrière in Paris, 80% of the cutaneous leishmaniasis patients are cured within three months, the rest after some additional treatments. Philip’s infection disappeared after three intravenous injections. “Within two weeks the wound began to heal and the skin was restored. A five to eight-centimetre wafer-thin scar is still visible. The smaller lesions on my leg have disappeared.” What remains are his “red friends”, as Philip calls them. He even seems a little proud of them. “I had heard of leishmaniasis,” concludes Philip, “but not before we left for training. The locals told us about it, so we knew there were sand flies. And although our army doctors know a lot about Africa, the army is mainly active in Central and West Africa. These are not the known hotspots of Leishmania transmission. I do not know if any other colleagues have become infected, but if my story can contri bute to improved knowledge and awareness of the disease, I am happy to have it widely published.”
“It is important to start a specific treatment in good time.”
What a cute sandfly having a sip.
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the list Alexandra Hörlberger
Five challenges of a Vietnamese student in Antwerp.
Ha’s High Five
Remarkable young public health professional Ha Dinh Thu from northern Vietnam reflects on the five biggest challenges she faces as an international student studying abroad. She is currently enrolled in the one-year Master of Public Health degree programme and is the youngest of the 39 students. Ha began preparing for her one-year stay in Belgium three years ago when pregnant with her first child. “I tried to make her as independent as possible from the moment she was born,” she says of her now two-year-old daughter, “so that she would bond more with her father and they would be OK while I was away.” Pursuing a master’s degree abroad as a young, married female professional with a toddler is not common where Ha is from. She and her husband have a mutually supportive, modern relationship that has enabled her to follow her dream and overcome other obstacles that she encounters along the way.
1. Language barrier On arriving in Antwerp, the language barrier was the biggest challenge Ha faced. “English is a foreign language in Vietnam. Before I came to Antwerp I tried to study British and American English, but that didn’t prepare me enough for my classmates’ P³ | 18
colourful accents and jargon we use in class. Plus,” she adds, “there is the added challenge of Dutch and not being able to understand the labels in supermarkets and signs on the roads!”
2. Cultural differences The cultural differences are huge but locals are very forthcoming and happy to help when they detect a foreigner in need. “I once got lost and couldn’t find my way back,” Ha chuckles. “I was standing in the middle of the street turning around in circles scanning for street signs, obviously looking very confused when a local came up and asked if I nee ded help.” Another mortifying learning experience ensued at the check-out of a supermarket when Ha happily accepted the plastic bag handed to her by the cashier. Oblivious of the growing queue and patiently-waiting cashier, Ha carefully packed her shopping. “I had no idea that you had to pay for plastic bags,’ she cringes. “I felt so embarrassed!”
3. Homesickness
5. Converting euros
Homesickness is a burden that paralyses Ha with sadness at times. “I miss my daughter and husband terribly,” she says wistfully. “Sometimes I sit for hours watching videos of our family. It was parti cularly hard for me when my daughter fell ill and I couldn’t be there for her.”
On a more practical note, Ha shakes her head. “I have given up converting euros into my currency,” she laughs, “and I found this!” She triumphantly holds up a circular plastic object that fits neatly into the palm of her hand. It is a coin holder, which allows Ha to make sense of the confusingly similar assortment of cent and euro coins.
4. Time difference Additionally, the six-hour time difference makes communicating hard. “When class is over for the day my husband and daughter are already asleep,” Ha shrugs,” so we generally only Skype on weekends.”
“Life is not easy at first,” Ha concludes. “The course is very demanding in addition to the challenge of acclimatising to a new place and culture.” But there is hope! “ITM staff are wonderfully supportive and we can communicate very openly with our teachers.” Good preparation is the key to successful studies abroad, Ha stresses. “And don’t forget your umbrella,” she adds quickly, “for it can rain any time in Belgium!”
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<< rewind
1987 - from Clinic for Colonials and Sailors to outpatient clinic Eline Van Meervenne
Medical services are one of ITM's core activities, next to education and research. Every year our doctors in the polyclinic carry out more than 35,000 consultations for travel health, HIV and sexually Transmitted Infections (STI). Until 1987 the clinic had a number of beds and even an operating theatre. Let’s take a trip through the history of ITM’s clinic. In 1931 the School of Tropical Disease became the Prince Leopold Institute of Tropical Medicine and moved from Brussels to Antwerp. The “Clinic for Colonials and Sailors’ was set up at the same time and was part of the Institute. In November 1933 the clinic opened its doors to patients from the colonies and the navy, who not only went there to see a doctor but could also be hospitalised on the premises. The clinic had a number of dormitories and rooms, an operating theatre, a laboratory and an X-ray facility. The first year saw 126 admissions and on average doctors performed 12 consultations a day.
The war During World War II the clinic’s activity was rather low key. There were few returning colonials and shipping was reduced. In May 1940 the clinic and its staff operated as a Red Cross relief hospital. In 1945 some parts of the clinic were refurbished in order to take in the many victims of the air strikes on Antwerp. After the war the clinic resumed its normal activities. In 1951 the number of consultations rose from 10 to 34 per day in just two years. The clinic got an extension, a head nurse was appointed, a new operating table was installed and the sterilisation equipment was updated.
Nurses, 1948.
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<< rewind
Relaxation room for patients
Travel medicine and HIV/STI In the late ‘60s, more and more people travelled to overseas destinations and this brought a rise in the number of consultations for vaccinations and advice. In 1975 our doctors regularly gave informative lectures and successfully published our first travel health booklet. In 1980 Prof. Peter Piot paved the way for STI consultations. The clinic was familiar with these infections because returning sailors not only consul ted for tropical diseases but also for these kinds of infections. The STI consultations were very popular both because of the excellent care administered but also because of the respect for the privacy of the patients. The fact that the gay community had such confidence in our clinic gave ITM a key role during the HIV / AIDS epidemic, which started in the early 1980s. First class room
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<< rewind
Farewell to the Clinic
Financial difficulties 1976 saw concern about the clinic’s financial si tuation. As a result of rocketing costs, the clinic accumulated losses. There were fewer patients due to the advent of efficient and short treatments which could just as well be administered at home. The problems started piling up: too few beds were occupied and the hospital lacked certain equipment which meant that patients who needed specialised treatments were referred to other hospitals. The final blow was dealt in 1986 when the government decided to close or merge all clinics with fewer than 90 beds. A year later, in 1987, a Ward of Tropical Medicine was set up at Antwerp University Hospital (UZA) and led by ITM staff. The clinic’s beds were transferred to this new unit.
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The transition from a small hospital to an outpatient clinic did not always go smoothly. Marina Cloetens has worked as a nurse at ITM for over thirty years and looks back at the turbulent period of 1986 - 1987. “We worked in a close-knit team of about 15 nurses and shared joy and sorrow with each other and our patients. The discontinuation of the hospital had a major impact on our activities. Only four nurses remained in the ITM clinic while the others were transferred to the ITM unit in the UZA. I stayed here and started working to a fixed timetable instead of in shifts. Although I saw this as a positive change, I missed the care of and the contact with the patients,” says Marina. “When the news was announced, we organised a number of protests. For example we made an obituary of our beloved clinic and marched along in a funeral procession. But the decision stood. Fortunately we got a say in the reorganisation of our work in the outpatient clinic. One thing I really appreciate is that we are able to organise our own tasks. And we regularly get together with our “old” team and reminisce about the past. Even to this day I have contact with my former colleagues,” concludes Marina.
the bookshelf
Patrick Reyntiens and Guido van der Groen are two prominent figures of the ITM community who each wrote a book recently in which they reveal their own remarkable story. Both books were presented at the Institute. Patrick Reyntiens
Guido van der Groen
Dancing in a vacuum - living with HIV
In the wake of Ebola
Twenty-five years ago, Patrick Reyntiens was diag nosed with HIV at ITM. His life literally hung in the balance but he recovered and decided to tell his story about living with HIV in Belgium. His objective was to convince the thousands of other seropositive patients that there is life after an HIV/ AIDS diagnosis. The book deals with issues such as his chronic illness and the many obstacles, challenges and ordeals he had to overcome as a result of his infection. It is an inspiring story of how to address the HIV-related stigma and discrimination effectively and how to open a dialogue on this matter.
In the mid-70s former ITM professor Guido van der Groen examined a thermos flask containing the blood of a deceased Belgian missionary nun. That put him and his colleague Peter Piot on the trail of a new virus: Ebola. With the recent devastating outbreak in West Africa still fresh in our minds, van der Groen revives his old enemy and ‘mistress’ forty years later. The book gives a thrilling insight into the research of a renowned scientist and also into a number of dangerous viruses that are lurking just around the corner.
A full portrait of Patrick Reyntiens can be found on page 22.
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portrait
Patrick Reyntiens 30 years living with HIV Eline Van Meervenne
On a hot summer’s day in 1985, Patrick Reyntiens was diagnosed as HIV positive at the Institute of Tropical Medicine. He felt like he had just been given a death sentence. At the time, AIDS was a mysterious disease that killed millions of people worldwide. Now, 30 years later, Patrick works as an expert at Sensoa. He lives with his longterm partner and is a stepfather of two nearly adult children. Because he had been feeling generally unwell for a while, Patrick consulted his family doctor. The doctor explained that Patrick’s condition was a result of reduced resistance. Eventually ITM diagnosed Patrick to be HIV positive. “I couldn’t believe it. I had just turned 21 years old and the world was at my feet. Suddenly I was being told that I was terminally ill and could even die. It came like a bolt from out of the blue,” says Patrick. P³ | 24
The diagnosis After the diagnosis, Patrick visited ITM every Wednesday for treatment. “There was very little information available on HIV in the 80s. The comprehensive multidisciplinary care that exists today, such as appointments with a social nurse or a psychologist, was unheard of. Yet at ITM all this was already in place. Doctors and nurses helped me through the hard times and were there for me if I needed to talk. It was real patient-centred care avant la lettre. They fully understood the needs of people like me. I often participated in ITM’s cli nical studies, to help fight this mysterious disease together. It certainly was a memorable time and I have built up a special bond with some of the doctors and nurses,” says Patrick. “When I told my family they showed great understanding. My parents knew I was gay and offered me their full support. The main worry of my family and friends was that I might die. They were certainly
portrait
not afraid of me infecting them. Today that sounds weird but at the time very little was known about AIDS. Even I was scared sometimes. My sister had just had a baby and I was afraid to hold it for fear that something would go wrong and I would infect it,” says Patrick.
stand up for my rights and not let people walk all over me. As seropositive people we are patients but we also have to take matters in our own hands. We have fought together, for example, to obtain faster testing of antiretroviral drugs. We have contributed to the policy on HIV care.
HIV activism
Nowadays, living with HIV in Belgium is more comfortable than say 20 years ago, but our struggle is not over. People living with HIV in countries such as Ukraine and Russia face quite a challenge. They do not benefit from the same follow-up and treatment that we have here. But even in Belgium, social stigma still exists. We have come a long way, but it’s so important that we continue to fight for our rights."
Patrick did not get a favourable reception everywhere though. Just before his diagnosis, he got a job with a large company in Antwerp. However, shortly after having informed the HR department of his HIV status, he was fired supposedly because of a restructuring. “It was very upsetting,” Patrick remembers. "I was used to people not reacting in the same understanding manner when you tell them you have AIDS, but this was a big blow. I felt terrible for weeks but it taught me that I had to
More information on living with HIV: www.levenmethiv.be
Patrick with Sensoa colleagues during the presentation of his book
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itm and i
Anne Chapelle Anne Chapelle manages the Antwerp fashion house BVBA 32. She attended the ITM postgraduate course in 1980-1981 and became a member of the Board of Governors in 2015.
© Frederik Beyens
I caught my first glimpse of ITM sitting on the tram. The majestic building and the mysteries of research ... I promised myself: “someday this is where I’ll study.” After I graduated as a nurse I saw my chance and took it. The course was a real eye opener, both in content and in my contact with the other students. For the first time I was expected to work independently. I feel a great nostalgia just thinking about the hours spent in the video room and garden, and the rolls of wallpaper I needed for the entomology course. I went to Buto, Zaire, where I assisted Prof. Groe nen. We took care of all the patients, but mainly dedicated ourselves to the study of leprosy and tuberculosis. We collected data to map the status and distribution of these diseases. TB patients die quickly and all were diagnosed with Kaposi’s disease. We systematically took biopsies and sent them to Prof. Stefaan Pattyn and Prof. Peter Piot in Antwerp for further analysis.
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Soon afterwards I became ill with what turned out to be encephalitis and was repatriated to Belgium. Prof. Eyckmans followed my case closely. I was so relieved when I was able to leave the hospital a few weeks later, fully recovered. But I will never forget the lumbar punctures. Following that experience I returned to Africa on regular medical missions. Nowadays I frequently travel there on business. ITM is a driving force in global health, and the spread of globalisation will make its role increa singly important. The ability of viruses to mutate quickly, their so-called drift and shift, makes ITM’s research and development programmes more crucial than ever. As a member of the Board of Governors, I am ho noured to be able to contribute to and help with the design of new opportunities. The Institute ranks as one of the best in the world and has been a milestone in my intellectual development. It taught me how to work efficiently and how to carry out in-depth micro/macro research. Although today I apply these skills in a completely different setting, the techniques are basically the same.
announcements
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A broad overview of the history and achievements in the field of Ebola, 40 years after its discovery.
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An excellent opportunity to exchange thoughts with key players in the field!
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For more information and registration, check the website www.Filovirus2016.com.
SAVE THE DATE
For the very first time, ITM will organise the European Congress on Tropical Medicine and International Health (ECTMIH2017). The 10th edition of the conference will take place at the Flanders Meeting and Convention Center (Antwerp Zoo) from 17 to 20 October 2017. Main themes for the nearly 2000 participants: migration, climate & ecological change, innovation & technology, complex adaptive systems. The congress is supported by Because Health, universities, NGOs and private institutions. More information to follow in the course of 2016. Join us in Antwerp!
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Calendar 24-25
March
Health 2.0: Are we ready to go digital? (Egmont Palace Brussels)
10-13
May
MEEGID XIII conference (ITM, Antwerp)
26
May
Knowledge for Growth life sciences conference (ICC Gent)
8-9
July
Bringing Evidence into Public Health Policy (Bengaluru, India)
12-15
September
ITM Colloquium â&#x20AC;&#x153;Ebola: 40 years after Yambukuâ&#x20AC;? (ITM, Antwerp)
14-18
November
Emerging Voices for Global Health (Vancouver, Canada)
Keep in touch
We welcome your questions, remarks and suggestions at communicatie@itg.be. We also take orders for paper copies of P3.
Read P3 online at www.itg.be/magazine
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