S...l...o...w...

I'm discovering that something strange happens in this region during the summertime.

Things....slow.....down...... Almost to a standstill (not that things move particularly quickly during the rest of the year, but that's a whole separate issue and conversation). And people think you're nuts if you imply that they shouldn't.

The reason? Simple. The heat. It's just too hot to do anything.

I suppose it's the same reasoning that's used to explain why we Southerners speak and move a little slower than the rest of the country, but in this region of the world, this excuse takes on an entirely new meaning. It really is unbearably hot. And so people don't work or shop or gather socially until the sun goes down. I now understand why the Egyptian population is pretty much nocturnal. It didn't make since during the winter months, but now it does. Quite simply, it's just too miserable and unbearable to be outside during the day.

The heat as certainly taken its toll on our work. Even though I've stayed just as busy as ever in the office, my work outside the U.S. Naval compound has pretty much been stopped dead in its tracks. No trainings for laboratory or hospital staff. No sample collection. No assessments of new facilities. No travel to meet and develop new collaborations. And there's practically no one in the office. Apparently everyone saves their vacation time for the summer and uses it to escape from the heat for two, three, four weeks at a time.

The Djiboutians "strongly suggested" in May that we not return to their country until September at the earliest. The Ghanaians haven't stressed the issue as much as other countries, but it's pretty obvious that things will move more smoothly after a couple more months. And here in Egypt, people look at me like I'm crazy if I try to set a timeline for anything to happen between now and October.

Up until now, the heat as been the primary factor in all of this, but I'm afraid another factor is approaching that will slow things even more. Ramadan, the Islamic holy month of fasting, in which Muslims refrain from eating, drinking and smoking from sunrise until sunset, will begin in late August. The Ramadan fast isn't like the version of fasting that most of us claim during Lent, when we give up chocolate or sweets or television; Ramadan is true fasting - not a morsel of food, not a drop of water, not a single cigarette (which I expect to be a huge deal here, where every single man chain smokes from sun up til sun down) - every day for a month from sun up til sun down. As much as things have slowed down over the past couple months due to the summer heat, I expect the few things that are still moving forward to grind to a complete stop when Ramadan begins.

Slaughterhouse samples

(WARNING: There are some graphic pictures in this post that may offend or nauseate some of you. On the scale of pictures that I could have posted, they aren't so bad, but I still feel like I should give a warning.)

I can proudly say that I have survived two weeks of working in an Egyptian slaughterhouse (first mentioned in this post). The study that we're doing in the slaughterhouses in Egypt is designed as a risk assessment, to see what diseases are being carried by the animals and insects in the slaughterhouses and determine whether the employees who work in the slaughterhouses may be at risk for catching some of these diseases. (For those of you in the medical field, we're specifically interested in Rift Valley Fever, West Nile virus, Crimean-Congo Hemorrhagic Fever, Q-fever, Brucella spp., Leptospira spp. and two sandfly fevers.)

We decided to collect three different types of samples to analyze in our laboratories for these diseases: (1) blood samples from slaughtered animals, (2) ectoparasite collection (ticks, lice, biting flies, etc.) from slaughtered animals, and (3) insect collection (mosquitoes, flies, etc.) using light traps and sticky traps. I recruited a team from NAMRU-3 (mostly made up of vector biologists, laboratory staff and summer interns) to help with sample collection, and we spent four long days at the slaughterhouse. Slaughtering begins at 2:00 or 3:00 a.m. every day, so we had to be at the site by 4:00 a.m. and we worked most days until 9:30 a.m. I suppose that's not too many hours, but it's a lot of time to spend in a dark, smelly, bloody, hectic Egyptian slaughterhouse.

NAMRU-3 study team

As I mentioned, the first component of the sample collection was to take blood samples from slaughtered animals. In four days we collected blood specimens from over 500 animals, including cattle, buffalo, sheep and camels. To avoid any stigma or controversy, we decided to collect blood samples after the animals were killed rather than before, lest one of the butchers think we were using needles to inject the animals with something. By collecting the blood after slaughter, we were able to avoid using needles at all.

In Egypt, as throughout the Middle East, animals are slaughtered according to halal methods to meet religious requirements that forbid such things as the consumption of blood or of meat from an animal that has been strangled, beaten or gored. Animals are therefore killed by having their throats slit with a sharp knife (in all reality, their throats are cut all the way through to the spine so the animals are practically beheaded). Since the animals bleed for qutie some time after they are killed, it was rather easy for us to step in and collect blood directly from the jugular vein while the animal was laying on the ground after slaughter.

Inside the nicest area of the Muneeb abattoir

The second component of the study involved a group of vector biologists from our team. After we collected blood from each animal, the vector biologists checked the animal's body for ecoparasites like ticks, lice and biting flies. This was truly a messy job, to comb over each slaughtered animal's body searching for tiny little bugs and then removing each critter with a pair of tweezers and placing it in a tube. I was really impressed at how many ectoparasites they actually found.

Vector biologists examining an animal for ectoparasites

The third component of the project also involved collecting vectors, though in a less messy way. By examining the animals, we were able to collect insects that attach themselves to animals for a longer time period, but we were also interested in the insects that attach themselves for just a short period of time - insects like mosquitoes and flies. The vector biologists used two types of traps to collect these vectors. The first type of traps are called CDC light traps. The second type of traps are sticky traps, which look like a piece of cardboard covered in a stucky substance, attached to a stick and stuck in the ground. Both types of traps were set all around the slaughterhouse grounds.

Vector biologists setting CDC light traps

Vector biologists setting sticky traps

Clearly sample collection for this project wasn't a clean job, nor an easy one. It wasn't a pleasant thing to do; it didn't happen in a pleasant location; it didn't happen at a pleasant time of day (those of you who know me well can only imagine how excited I was to set my alarm clock for 2:30 a.m. every morning that we had to go out to the slaughterhouse); it didn't smell pleasant; in fact, there was nothing pleasant about it, except for one thing, and thankfully, that was one huge thing. My study team for this project was absolutely incredible. They were so great to work with, and I mean that in the very, very best way possible. Each person was meticulous and diligent with the work, followed direction without question and, somehow, in this environment, maintained a positive attitude, made jokes, smiled and laughed throughout the days. It was truly a pleasure to work with each and everyone of them and somehow it almost makes me look forward to the next time we have to go out and do this!

NAMRU-3 study team

NAMRU-3 study team

Comino

I decided to spend my last night on a little island on the north side of Malta. The island is called Comino, and it's home to the Blue Lagoon, which is a breathtaking site!
Unfortunately the lagoon had pretty much been taken over with European university students on summer vacation when I was there, so I spent most of my time on the other side of the tiny island, where my hotel was located. I'm not usually one to hang around the hotel, but I loved laying on the beach in the sun in the peaceful quiet.

H1N1 in Malta

All the newspapers I’ve seen in shops today have a huge headline that reads “4 cases of swine flu in Malta.”

Even now, I’m sitting in a small café in Valletta, and a woman, who is obviously a friend of the owner of the café, walked in and said “they have just taken my son to the hospital to be tested for the swine flu.”

Try as I may, I just can’t get away from it!

Castille Hotel

I do love the little hotel where I've been staying in Valletta. It's nothing too fancy, but the owners are so kind and it's in a great location. Plus breakfast is served on the roof and gives a terrific view of the city!