In November 2019, the Onchocerciasis Elimination Mapping (OEM) project expanded to Mozambique, making this the largest river blindness mapping under the project to date. It is also the first time the neglected tropical disease (NTD) river blindness has been surveyed in Mozambique using modern techniques, which will help assess the prevalence of the disease in the country. Knowing which areas to target in the country is vital in helping to eliminate the disease.
Clécio and Silvia were paired together during a three-day OEM training that took place in Nampula, Mozambique, before the official surveys began. And they have since become good friends. But what inspired both Clécio and Silvia to take part in the project?
Clécio, a biologist who works for the ministry of health in Mozambique, says: “I have a lot of experience working with other NTDs. Being involved in this project is going to be very valuable and give me more experience in my career.
“Before the project existed in Mozambique, I was talking with my ministry of health colleagues about whether we could start a new mapping project for river blindness. My colleague, Rassul Nala, the principal investigator for OEM Mozambique, helped develop the project and asked me if I would like to get involved.”
Silvia, who works in advocacy, learned about the project from a friend who was going to be involved, and asked if she would be interested in joining too.
“I accepted the invitation because it gives me more experience and something new I can learn about. Maybe, as time goes on, I could share my experiences and teach other people about the project and what I have learned,” says Silvia.
Silvia and Clécio are just two of the 25 surveyors that make up Mozambique’s OEM screening team. Teams are usually made up of sets of two people: a recorder and a laboratory technician.
The laboratory technician conducts blood tests by pricking the finger for blood and applying this to special filter paper, which will be sent to the laboratory for results. The recorder collects the participants’ personal data using ESPEN Collect, a secure mobile application which records GPS data and uses barcodes to link participants and their test results.
“During the surveys I will be a laboratory technician and collect the dry blood spot samples,” explains Clécio.
“And I will be a recorder during the project,” adds Silvia. “I will have lots of responsibility because I need to ensure I collect information that is clear and complete.”
Silvia also explains her favourite part of the training: “I love learning about what to do when we are in the field. For example, how to interact and explain to the community why this project is so important.”
Having a scientific background and experience working in NTDs at the ministry of health, Clécio believes OEM is an important project for the country: “If we achieve our targets then we can help many people. Because of this mapping we will know what steps to take next… If Mozambique is found to have a prevalence of river blindness we will know where it is and can follow it up with treatment.
“I think it is important for Mozambique to eliminate river blindness as it will contribute to the development of the country. I feel that I am making a difference and am happy to be part of this project,” Clécio adds.
After two days of classroom training and one day of community-based training, the OEM Mozambique survey teams are ready to start mapping. Half of the screening team travelled to Tete province and the other half went to Zambezia province. Clécio and Silvia are part of the team to conduct surveys across Zambezia, which shares a border with Malawi.
The surveys in Zambezia began in areas across Morrumbala district, a community largely made up of farmers.
The journey to some of the communities in Morrumbala district can often be long and treacherous. Some of the communities are very remote with giant pot holes along the long dirt roads, which can make for a very bumpy drive.
Thankfully, on the second day of surveys, Clécio and Silvia’s community is only a 45-minute drive from where they are based. Once in the field the pair meet with their community guide, Albino Jomuoio, who helps them get permission from the community leader to carry out the surveys and then talks with the community members to help them understand the importance of the project.
Albino walks through the community with Clécio and Silvia, taking them from house to house to find participants to take part in the survey. In order to see evidence of the disease, the survey requires adult participants over the age of 20 who have lived in the community for at least 10 years. Clécio and Silvia then gather permission slips and describe the survey process to each participant. Before finishing for the day, Clécio and Silvia have screened 50 participants.
Albino recognises the importance of the project, and even took part in the survey himself: “I was happy to take part in the survey because it is important for the health of each person and the community. I know people who have experienced blindness, and although personally I am not blind, one of my eyes is not okay.”
Going house to house can be long and tiring, especially under the Mozambican sun. Thankfully, most households had been informed that surveys would be taking place and were told to work near their homes for the day.
“I am happy because since we started doing the surveys, we have found people who understand the need for this work. My experience in the field has been very good; I have been learning a lot. Initially, I thought it was going to be a lot of pressure, but I think we are succeeding,” explains Silvia.
Clécio adds: “The only challenge I have felt is the house-to-house approach, because I am more used to gathering the entire community in one central place. This is my first time going house to house and it can be tiring, as we are walking long distances and sometimes the weather conditions are not favourable.
“I will feel satisfied once we have completed all the surveys. It will feel like the mission has been accomplished.”