P³ | #9 Autumn - Winter 2019

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#9 2019




COLOPHON Responsible Publisher Marc-Alain Widdowson Editor-in-Chief Roeland Scholtalbers Editorial Coordination Ildikó Bokros Editorial Committee Roeland Scholtalbers Nico Van Aerde Eline Van Meervenne Catie Young Layout Toech communicatiebureau Photography Astrid Bultijnck, Jessica Hilltout, Jan Jacobs Translations Serv-U *P³ - ITM’s essence captured in one letter We work to improve health worldwide by conducting and applying science. Our innovative and interdisciplinary work 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.

Contact communicatie@itg.be +32 (0)3 247 07 29

#9 2019


Dear Reader, The autumn edition of P3 takes a closer look at the Salmonella research of PhD student Lisette Kalonji. Salmonella is a bacterial infection that is a growing health problem in Lisette’s home country, the Democratic Republic of Congo. There is no clear picture of the scale and impact of the disease and Lisette is trying her best to change this. This August, Marc-Alain Widdowson became the new director of ITM. P3 offer its readers a chance to get to know him better. We explain the world of falsified, sub-standard and poor-quality medicines and how ITM has devoted itself to prioritising universal access to quality-assured medicines. You’ll also meet an ITM staff member suffering from bike fever and see some great pictures of our new high-security laboratory. We give a sneak preview of an upcoming TV documentary about our activities. And what is the link between a fire officer-on-watch and ITM? Dimitri Vercammen fills you in on that in ‘ITM and I’. Last but not least, we introduce you to “GeoSentinel”, a worldwide clinician-based communication and data collection network which monitors travel-related illnesses. Enjoy the read. The Editorial Committee



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© 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. # TABLE OF CONTENTS



14,699 calls to the ITM travel phone in 2018 For many globetrotters, the ‘Tropical Institute’ is the obvious point of reference both before and after the trip. Today our travel clinic provides medical travel advice to tourists, business travellers and migrants, both at ITM itself as well as over the phone and internet. Every year the travel phone processes more than 10,000 calls, and in 2018 that was a record number of 14,699.

For questions before or after your travels, call 0902 88 0 88 between 9-12am and 1-5pm on weekdays (€1 per minute). Remember that a phone call can’t replace personalised travel advice obtained during a consultation.

DRIVEN BY INVASIVE SALMONELLA ELINE VAN MEERVENNE With a cheerful smile, Lisette Kalonji opens the door to the laboratory. “I spend many hours here,” she says. The 34-year-old doctoral student carries out research into invasive Salmonella at ITM and at the National Institute for Biomedical Research (INRB) in Kinshasa, Congo. She usually works in Kinshasa, but once a year she joins her colleagues in Antwerp.

“From a very early age I was fascinated by science,” she muses. “It became a passion and I went on to study medicine at university. During my studies I undertook an internship at the neonatal unit the University Hospital of Kinshasa [UHK]. We were hit by a bacterial outbreak and several babies died as a result. It was the first time I was confronted by the consequences of such an outbreak in such a fragile setting and it had a big impact on me. I had so many questions afterwards: how could this happen? How could we avoid this? It motivated me to carry on my research because research pushes you to look at the core of a problem. I find that interesting and it made me feel really useful.”



Lisette and her colleagues in the DRC Lisette continues: “after my studies I specialised in microbiology. That’s how I got to know Prof Octavie at UHK and INRB and later on Prof Jan Jacobs at ITM. What followed were doctoral studies on invasive Salmonella in DR Congo.”

Lisette is doing her joint INRB/ITM PhD through a scholarship financed by the Belgian Development Cooperation and since 2018 she is also registered as a PhD student at KU Leuven. She comes to Antwerp once a year.

A major cause of bloodstream infections in Congo with a high mortality rate, Salmonella is a very relevant topic. Although the disease is recognised as a genuine public health problem, there is no clear picture of the incidence and the distribution of invasive Salmonella serotypes like Salmonella non-Typhi. For this particular serotype also, little is known about its reservoir and its transmission. In addition, antibiotic resistance against it is increasing.

“My laboratory skills and knowledge as a researcher are being strengthened through the INRB/ITM collaboration. With the knowledge I obtain, I am able to improve working conditions in my own country. I train my colleagues and we adapt our procedures when it is necessary. In Belgium I concentrate on my publications and can discuss easily with my promoter Prof Jan Jacobs,” she continues. “Antwerp to me is a small, cosy and quiet city. I love wandering in the wonderful ITM gardens.”

“In my country Salmonella is a big problem and its control is still a long way off,” adds Lisette. “There are few reliable data about where the disease occurs, how it’s caused and the way it spreads. I want to change that through my doctoral studies. With reliable data we can make the government aware of the impact of Salmonella, so they can take more effective measures.”

When asked about her ambitions, Lisette’s answer is determined. “I want to continue doing research. My dream is to help develop vaccines and medicines ­because they help save so many lives. Even when I was a little girl, I wanted to discover a vaccine against HIV. I would like to pursue this childhood dream,” she says with that smile again.


From a very early age I was fascinated by science. It became a passion.



“I LOOK FORWARD TO CYCLING AND COLD WEATHER” ROELAND SCHOLTALBERS New ITM Director Marc-Alain Widdowson swapped Nairobi for Antwerp last August. He shares his first thoughts about joining the Institute and moving to a moderate sea climate with P3. Born in France, and raised between the United Kingdom and France, Marc-Alain Widdowson was instilled with an international outlook very early on. Widdowson later studied anthropology and veterinary medicine at the University of Cambridge. He also completed an MSc Communicable Disease Epidemiology at the London School of Hygiene and Tropical Medicine. His career took him around the world, starting as a wildlife epidemiologist for the UK Department for International Development in Zimbabwe. “That involved fun things, like darting buffaloes from helicopters,” Widdowson says smilingly. A next adventure saw him chasing and capturing vampire bats in Bolivia. His career took a more mainstream public health turn when he moved to Utrecht, where he worked for RIVM, the Dutch National Institute for Public Health as a European Program for Intervention Epidemiology Training Fellow. After two

years in the Netherlands, Widdowson crossed the Atlantic to join the US Centers for Disease Control and Prevention (CDC) where he has worked for the past 18 years. “In Atlanta, I studied enteric viruses, influenza and Ebola. Four years ago, I moved to Nairobi to lead a group working on a wide range of projects in research and capacity building.” The experience as Director of the Division of Global Health Protection at CDC-Kenya turned out to be a stepping-stone for Widdowson’s new role as ITM Director. “I have grown into my managerial role, in ways that I didn’t even expect. While working at ITM will be different in many ways, the scope and breadth of scientific programme management is similar, though much bigger,” Widdowson explains. “Leading an organisation like ITM is simply an exciting opportunity. It has a truly international environment and a tremendous reputation. As I have shared the news of my move to ITM, people I have known for years have told me enthusiastically about the courses they followed in Antwerp, or their collaborations with ITM researchers. That says a lot about the positive contribution the Institute makes through teaching, research and capacity building throughout the world.”

Going forward, Widdowson sees both continuity and change, strengthening the Institute’s core activities and responding to health trends. “We don’t want to stray from what we are good at. We will keep strengthening the work that has built ITM’s strong reputation over the years and especially look to expand partnerships. At the same time, we need to monitor health trends and adapt to emerging issues. We have seen tremendous progress in global public health, like in childhood mortality for example, but it’s not only good news. Think of the emergence of antibiotic resistance, or the spread of vectors capable of spreading disease.”

Leading an organisation like ITM is simply an exciting opportunity. It has a truly international environment and a tremendous reputation.

Moving from Nairobi to Antwerp also implies a significant change in daily routines. “I look forward to doing lots of cycling and to the cold weather. I miss the changing of the seasons and getting on my bike to go to the shops, which I couldn’t really do - either in Nairobi or Atlanta. Mountain biking is a passion of mine, so I will look for Belgium’s hilly parts in my time off. My family and I are eager to explore the country and life in Europe. My wife and two youngest daughters will move to Antwerp with me, while my eldest daughter will start university in the UK.” 9

Dr Raffaella Ravinetto

FOR POTENTIAL SIDE EFFECTS, READ THE PATIENT INFORMATION LEAFLET! ILDIKÓ BOKROS Imagine falling ill with a bacterial infection for which the doctor prescribes antibiotics. You buy the medicine in the pharmacy, start taking it, and in about a week you feel better again. Now imagine you live in Kinshasa, Democratic Republic of the Congo. You get the same prescription, go to the pharmacy, take your meds… But you don’t recover. The doctor accuses you of not taking the antibiotics correctly or of selling pills to someone else. You did neither – unbeknownst to you, what you have swallowed were poor-quality medicines, with insufficient active ingredients.

parts of the world may have a one in three chance of getting a medicine which will be at best ineffective, at worst, cause even greater harm, or even death.” So what allows for such a prevalence of poor-quality medicines? On the one hand, the national regulatory bodies in LMICs often lack the resources to properly check the quality of medicines that are imported, manufactured, or distributed in their country. Secondly, the international pharmaceutical market – similarly to other markets – has become increasingly complicated and globalised in the

“Such is a common scenario in many low- and middle-income countries [LMICs],” says Dr Raffaella Ravinetto, a pharmaceutical expert at ITM. “According to the latest estimates of the World Health Organization [WHO], on average 10.5% of medicines are of poor-quality in LMICs, and in some countries the number can be much higher. For instance, a study conducted with ITM researchers in the Kinshasa area found a staggering 27%. In other words: patients living in these 11

pharmacies in a low-income country past decades, which poses serious challenges for tracking the supply chains of medicines. After a long period of neglect, these global developments have increasingly raised concerns for many actors in the humanitarian, development and health sectors. Some donors of humanitarian and development programmes want to ensure that funds are not used for purchasing substandard medicines that could be detrimental to people’s health. These donors, like the Global Fund, ECHO (the European Commission’s Humanitarian Aid directorate), or the Belgian Development Cooperation and others developed their own policies to ensure that medicines used with their funds were quality assured. Sadly, in reality, there is not always a mechanism in place to do that beyond medicines for HIV, malaria and tuberculosis.

The cause of quality-assured medicines has been gaining political momentum in Belgium and beyond. In 2017, as a result of joint efforts by the Belgian Development Cooperation, ITM and various Belgian implementers such as Memisa and the Damien Foundation, Belgium became the first country in the world to officially make a commitment to adopt a stringent pharmaceutical quality assurance policy. Catherine Dujardin, Global Health Officer at the Belgian Development Cooperation: “Belgium has committed to purchase good-quality medicines in humanitarian and development programmes. The commitment was drafted together with Belgian implementers and ITM who provided significant input to make the document concrete and compliant with what already exists on the global level. We hope other countries will follow suit.”

ITM and the Belgian Development Cooperation have devoted themselves to prioritising universal access to quality-assured medicines over a decade ago. The QUAMED network was launched by ITM with Belgian Development Cooperation support in 2010 to improve the quality of medicines in LMICs via a network of non-profit organisations and national procurement agencies that supply medicines in or for these countries. QUAMED, now an independent entity, organises missions for humanitarian and development agencies to audit manufacturers and distributors according to international standards as well as running trainings on medicine quality issues. In addition, QUAMED closely cooperates

contaminated IV fluid

with ITM for research, advocacy, and policy development. Daniel Berman, board member of QUAMED explains their working mechanism with an example: “In Bangladesh where there are extensive humanitarian programmes, NGO partners of QUAMED ask to help with deciding which medicines to buy. QUAMED sends in experts to examine the local market including producers and procurement centres and by means of a very rigorous process, grades them, so NGOs know which drugs are safe to purchase. There is no black and white answer, but we provide the best possible information and assessment based on the standards of the WHO.�

substandard paracetamol pills 13

Berman envisions, in the long term, a type of ‘seal of approval’ system, which could steer the business to buying medicines from the best producers. A universal certification system could be of interest to manufacturers and procurement centres and could positively shape the market.

It’s proven by now that poor-quality antimalarials have contributed to the resistance to malaria-drugs. Others share his sentiment in the humanitarian and development world. Various organisations such as Médecins Sans Frontières (MSF), ECHO, or the US Pharmacopoeias (USP) developed their own assessment systems, but a global one is lacking. In 2001, the Prequalification of Medicines Programme (PQP) was initiated at WHO to facilitate access to medicines that meet unified international standards of quality, safety and efficacy for HIV/AIDS, malaria and tuberculosis. Dr Deus Mubangizi, the head of the PQP team welcomes the idea to expand the scope of prequalification: “At this moment only 26% of the 194 UN-member countries have the capacity to enforce adequate quality assurance systems for pharmaceuticals. We work to strengthen these regulatory systems but we also need an international, harmonised quality assurance system, which can facilitate free movement of products for emergencies and also for routine use. Especially in

global emergencies the different systems may become a barrier.” What is the most pressing issue today? According to Dr Ravinetto, poor-quality medicines not only represent a threat for individual and public health by causing therapeutic failure, including deaths, or direct toxicity, but they contribute to the emergence of resistance, and erode trust in health systems. “It’s proven by now that poor-quality antimalarials have contributed to the resistance to malaria-drugs. If we don’t act fast, the global effect of the poor-quality antibiotics can be colossal.” To further advocate for quality-assured medicines, ITM has joined the global #MedsWeCanTrust campaign to raise awareness of the scope and impact of the problem and inspire collective worldwide action.

WHAT’S IN A NAME? FALSIFIED, SUBSTANDARD OR POOR-QUALITY MEDICINES The turn of the century saw some highly publicised cases such as the contaminated cough syrup in Panama that caused hundreds of deaths, or the many cases of under-dosed malaria medicines detected in many low-income settings. In the first case we are talking about falsification – industrial diethylene glycol was put in the syrup instead of glycerine, whether on purpose or by negligence. In the second case, these were substandard products: bad manufacturing practices were the probable cause, but bad storage practices were also perhaps a factor. The term ‘falsified medicines’ implies criminal activity, where manufacturers or distributors have falsified a product on purpose. Repressive measures may help fight these kinds of ‘medicines’, but they will do little to stop

the circulation of ‘substandard medicines’. Substandard medicines are of poor-quality despite being produced by licensed manufacturers and approved by the national regulators. Fighting them requires sustained capacity strengthening of national regulators, improved surveillance on international supply chains, and increased awareness of purchasers including international donors. Substandard implies that the medicine was ‘part of the system’, yet it caused therapeutic failure or toxicity. The failure may be due to a great variety of factors, such as insufficient amount of active ingredient, presence of unwanted impurities, lack of sterility, or inadequate ways of storage or transport. In our text falsified and substandard medicines are brought together under the wording ‘poor quality’. 15

KEEPING WATCH OVER DISEASE OUTBREAKS ROELAND SCHOLTALBERS GeoSentinel is a worldwide clinicianbased communication and data collection network for the surveillance of travel-related disease. P3 caught its principal investigator, frequent traveller Professor David Hamer, during a trip to Belgium. We meet Professor Hamer in ITM’s stately Room Broden. He works at Boston University and Tufts University in the United States. It is the day before the PhD defence of Dr Ralph Huits. Hamer is one of the jury members. ITM’s Professor Emmanuel Bottieau, one of the promoters of Dr Huits, is also present. The three work together in the context of the GeoSentinel Surveillance Network. The International Society of Travel Medicine (ISTM) initiated GeoSentinel in 1995 with support from the US Centers for Disease Control (CDC). “The initiative resulted from discussions around ever-increasing scientific understanding and growing awareness of the threat of emerging infectious diseases. The idea behind GeoSentinel is that the diagnostic evaluation of returning travellers can signal disease outbreaks elsewhere in the world,” says Hamer. Today, GeoSentinel has 70 sites in 30 countries worldwide. The network conducts surveillance, to which member

sites contribute, by submitting data to a central site after each post-travel consultation. These data are used to track geographic and temporal trends in clinical syndromes and infectious diseases among travellers and migrants. Hamer: “We have recently added interesting sites like Seoul, Hong Kong, and French Guiana, a unique site where our local partners see lots of cross-border migration. For our sentinel function, it is good to have a wide variety of places.”

Sharing data to raise awareness about new outbreaks works.

Sharing data to raise awareness about new outbreaks works. Like in 2018, for example, when one of the GeoSentinel sites reported a patient with yellow fever who had been to Manaus, Brazil. “We knew that yellow fever existed there. But then another case surfaced, from São Paolo. And another three patients who had travelled to Ilha Grande, a beautiful island off the coast of Rio de Janeiro,” Hamer explains. “This was not marked as yellow fever territory, so at the time you wouldn’t recommend a vaccination to somebody only visiting Rio and Ilha Grande.”

After collecting a few additional cases, GeoSentinel published a series of ten patients, eight of whom had travelled to Ilha Grande. “Sadly, four young travellers died from yellow fever, a disease that is so easily vaccinated against.” GeoSentinel fed that information to the Brazilian government, to the CDC, the European CDC and World Health Organization, so that the yellow fever map and vaccination recommendations could be updated. ITM also rang the GeoSentinel alarm bell on several occasions, most recently when a group of Belgian travellers from South Africa returned with schistosomiasis (a worm infection) in 2017. They had

stayed in what was advertised as a schistosomiasis-free lodge. Nevertheless, all 34 exposed travellers were infected while swimming in a nearby river. Professor Hamer concludes: “It’s great for GeoSentinel to have ITM on board, because its clinical services see a large number of returning travellers. The quality of diagnostics is excellent, which means we get very accurate diagnoses. I hope ITM will also lead on some of the network’s new studies in the near future.”

From left to right: Ralph Huits, David Hamer and Emmanuel Bottieau 17


ITM’S NEW HIGH-SECURITY LAB In October 2018 ITM inaugurated a new high-security laboratory to carry out advanced research into tuberculosis (TB). This lab is a so-called “BSL3” lab, which stands for biosafety level 3. Biosecurity cabinets and a negative pressure room were installed to ensure safe handling of risk group 3 pathogens, like Mycobacterium tuberculosis strains. These safety measures protect the technicians and stop the spread of infectious organisms outside the laboratory in case of an incident. Every year the Institute investigates thousands of TB samples sent to Antwerp from all over the world for confirmation and extensive analyses. ITM is also host to the world’s largest public collection of TB and other mycobacteria strains, an important tool for research into new diagnostics and development of medicines. This is especially crucial because, due to antibiotic resistance, multi-drug-resistant TB rates are on the rise. The new premises also act as back-up allowing maintenance of present BSL3 laboratories and ensuring continuity for the analyses of highly pathogenic bacteria, viruses and parasites. The expansion and upgrade of this facility was funded by the National Lottery.




BACK TO THE FIRST ITM COLLOQUIUM ABROAD CATIE YOUNG ITM’s substantial research on mycobacteria has been long, varied and repeatedly recognised internationally. With its international colloquium in 2005 for the first time being hosted abroad in Benin, ITM highlighted the collective work on the two bacteria causing tuberculosis (TB) and Buruli ulcer in Africa. The event, held in the coastal city of Cotonou, is remembered as a joyous reunion that deepened cooperation between the South and the North marking a time of intensive output from ITM’s mycobacteriology team.

ITM has been organising its annual scientific colloquia since 1959, but for 46 years they always took place in Antwerp.

In 2005 for the first time it went abroad, a tradition which has continued every other year since. The colloquium, ‘Improving Case Management and Control of Tuberculosis and Buruli Ulcer in Africa’ ran from 5-7 December 2005 and was supported by the Belgian Development Cooperation. Attendees enjoyed sessions of international experts exploring medical and public health topics as well as visiting hospitals and dispensaries in Benin on the front line of the diseases. “The colloquium was a unique opportunity for my team to discover the work done in Africa first hand and to forge closer relationships with our partners,” remembers Professor Emeritus Françoise Portaels, then head of the Unit of Mycobacteriology and main organiser of the event. “Attendees were able to discover and contribute towards the many important findings and achievements we were attaining collectively and it allowed us to secure close international ties that would go on to spark many PhD’s, deepen research efforts and build significant capacity in our partner organisations.” Highlights of this period of intense activity in the area of Buruli ulcer, together with partners included: national disease programmes, populations and health

care workers education, correct laboratory diagnosis, better treatments, and better understanding of epidemiology and pathogenesis. This also encompassed many ‘firsts’ for the Institute: »» The first report on the susceptibility of Mycobacterium ulcerans to the antibiotic clarithromycin. The combination of rifampicin and clarithromycin is presently the WHO recommended treatment »» The discovery of M. ulcerans in aquatic insects, identifying them as potential vectors »» The isolation of this mycobacterium from the environment Around the turn of the century, ITM’s Unit of Mycobacteriology had also started hosting two worldwide reference laboratories; as WHO Supranational Reference Laboratory Network for Tuberculosis Drug Resistance and WHO Collaborating Centre for the Diagnosis and surveillance of Mycobacterium ulcerans Infection. “Working mainly with partners from Benin and the Democratic Republic of the

Congo, and in close collaboration with other colleagues from the US and Europe, this time saw us investing our resources into the study of multiple aspects of Buruli ulcer and TB fuelled by our work as reference labs,” says Prof Portaels. “The colloquium and our activites of this time laid the groundwork for our partners in Benin Laboratoire de Référence de Mycobactéries in Cotonou to become itself, in 2017, a WHO TB Supranational Reference Laboratory. TB and Buruli ulcer samples used to be sent to Antwerp for confirmation. Over the years with their excellent and motivated staff and the building of stable and modern infrastructures the team in Benin has gradually taken over this task with our partnership being central to this,” she adds. The Antwerp-Cotonou collaboration has been supported throughout the years by the Belgian Development Cooperation, via ITM’s capacity building programme enabling partners to take charge of their own scientific and medical capacity.




BIKE FEVER CATIE YOUNG Laurent Bevolaina Ratsarahery has caught a fever. It’s one that sees him leave his home in Wezemaal to fly through the Belgian countryside on an average of three hours and forty minutes almost every working day. It requires a two-wheeled carbon apparatus, nylon clothing, water and lots and lots of snacks.

As anybody, he didn’t catch the fever intentionally. It snuck up on him and now it looks like it’s here to stay, as does his life in Belgium as an ITM financial and administrative manager. Originally from Madagascar, Laurent is a father of a 16-year-old daughter called Janna. So how did the fever start? His local bike shop announced a sale and he bought a racing bike for recreation. Next, to get to

work, he bought a hybrid bike, but it got stolen at the nearby train station so he was forced to take his racing bike. But he didn’t want to leave this bike, even more precious than the last, at the station in case of theft. Keeping his precious racer safe, he rode it to the office. This was when he worked in Brussels – a 39km ride one way and the same back again. It was hard, but his condition improved and he could no longer imagine taking the train to work. Now that he’s changed jobs he rides the 51.48km he needs to get to ITM and covers the same distance to get home at the end of the day. So we can safely diagnose Laurent with ‘bike fever’ – a particular addiction-like activity that causes ecstatic meditative states of wellbeing. Further biomarkers of the illness are: love of biking magazines; courses on bike maintenance; owning four bikes and more biking than ‘normal’ work clothes; and the need for a route performance app called ‘Strava’. Like any fever, though, it can cause you to waste away and black out (yes, this has happened to Laurent once), so now we talk about food – snacks and constant other nourishment activities. Waking at 6 am, he starts with a juice before he heads off after preparing his food for the day. This consists of: »» At least three ‘boterhammen’ (sandwiches), one chocolate, one jam, one honey, all eaten on the bike on his way to work »» Taking half of what he prepared the evening before for lunch: • 1.5kg Madagascar style brown rice cooked with onions, garlic, ginger

• • • •

and dried leaves imported from Madagascar (if he eats white rice he needs to double this), 500g of protein – usually fish or chicken, A fresh salad of tomato, carrot and cucumber, A protein bar and a couple of bananas for the ride home, A bowl of muesli and yoghurt eaten once arriving at home to give him the strength to eat the rest of the rice and meat and prepare his food for the next day.

Interestingly, eating and exercising while getting places isn’t a new habit for Laurent. When little, he remembers that his mother used to give him his bus fare but he would keep it and walk 45 minutes so that he could buy fresh lychees, guavas and mangoes for the road instead. Another consistent aspect about Laurent is his strong but calm tenacity. When he arrived in Belgium he expected to speak French, an official language of Madagascar and one in which he gained his Masters of Science and Economics. But they didn’t speak it in Antwerp! Not letting this get in his way he studied Dutch in Leuven and then took on a Master of International Management and Development at the University of Antwerp. Then came the bike fever and then ITM – which he loves for the kind colleagues and interesting work. Thanks Laurent for the inspiration, may the biking fever continue with lots and lots of snacks!





“We find your Institute really fascinating and would like to make a documentary series about your activities.” With these words, producers from the production company Geronimo approached ITM’s Communication Unit two years ago. The four episodes of this documentary series required more than 100 days of filming and four overseas trips. They highlight several major health challenges and ITM’s contribution to finding solutions. The series will be screened by Flemish broadcaster VRT this autumn or in spring next year. Here we give you a preview of the series and turn the spotlights on the countries and the ITM partners that star in the programme.

Adam Hendy, a former ITM researcher, went to work in Brazil soon after his PhD at ITM. Deep in the Amazon forest, high up in the trees, he searches for mosquitoes that can transmit viral diseases and tries to map the life cycle of these insects as accurately as possible. The filmmakers also looked at the link with Zika, a virus transmitted by mosquitoes. They talked to mothers who were infected with Zika during their pregnancy and the serious consequences for their children. 2. DR CONGO Ebola, sleeping sickness and resistant bacteria: the film crew concentrated on these topics during their stay in DR Congo. Together with local health workers they went in search for new cases of sleeping sickness in Bandundu, a port town on the east bank of the Congo River. Via this large-scale project ITM, together with local and international partners, is trying to eliminate the disease in this vast African country. Also extensively covered in the series are the history of Ebola and the many years of cooperation with the Congolese partner, Institut Nationale de Recherche Biomédical (INRB), in response to this viral disease. ITM researcher Anne-Sophie explains resistant typhoid fever.



Coffee and sesame seeds are the most important Ethiopian export products and are harvested immediately after the wet season on big farms. Tens of thousands of seasonal workers leave their homes in the mountains to work in the low lying sesame fields during harvest time. The working conditions are often far from ideal, and the workers run an increased risk of getting leishmaniasis, a parasitic disease spread by the bite of the sand fly. The film crew follows Prof Johan van Griensven and his Ethiopian colleague Dr Ermias Diro who study leishmaniasis in this region. ITM researcher Temmy Sunyoto organises group discussions with seasonal workers to assess their access to healthcare, and other issues.

ITM anthropologist Prof Koen Peeters investigates how malaria affects the Raglai population in Vietnam, an ethnic minority that primarily lives in the forest. Malaria is common in their villages. Together with Koen, the team looks at the main reasons why malaria in these villages is so difficult to control in these villages. Prof Anna Rosanas and her Vietnamese colleagues from the national malaria programme show how they tackle resistant malaria.



© Brandweer Zone Antwerpen

I am already looking forward to exchanging “crisis ideas” and an even closer working relationship in the future.


DIMI VERCAMMEN I met the members of the ITM crisis management team through my emergency planning work for the Antwerp Fire Brigade. I am an officer-on-watch, a job I try to perform as professionally and creatively as possible. It’s my responsibility to ensure the smooth cooperation between firefighters and other emergency services during an intervention. Crisis management is of particular interest to me and my connection with ITM is a direct result of this interest. Tropical medicine has an aura of mystery about it for citizens and emergency services. I was therefore very happy that I had the chance to get to know the workings of the Institute. ITM’s Head of Prevention Service, Kathleen Anthonis, gave me a guided tour of the buildings and more information about all the safety aspects. She also explained the “myths” surrounding biological risks at ITM. Yet these were not the only issues I needed to reflect upon. Firefighting in historic buildings is a peculiar challenge. I was truly impressed by the available expertise and especially by ITM’s considerable efforts on (fire) safety. There is no doubt that the Institute considers fire safety and the safety of its employees of paramount importance. A lot of effort has already been made to ensure the safety and well-being of ITM

staff. The request to sit together and examine safety issues related to students, employees and direct neighbours is clear proof of the commitment of ITM’s crisis management team. In November last year our pleasant cooperation resulted in a crisis drill with the different emergency services such as the fire brigade, the medical services, the police, but also ITM’s own crisis communication team. Such exercises confront all parties with a scenario fraught with hypothetical questions: “Should we extinguish the fire? How shall we do it? Who to evacuate? Which streets should we close off? What are the risks for our employees? How do we communicate about a fire at ITM to the neighbours?” We were faced with a whole range of questions which meant that this was an informative and enlightening exercise for each of us. I am already looking forward to exchanging ‘crisis ideas’ and an even closer working relationship in the future. # ITM & I 27

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www.travelhealth.be Stay up-to-date wherever you go New website & app – coming in the fall of 2019


ONE PLANET. ONE HEALTH. ONE FUTURE. Since 1959, the Colloquium is ITM’s yearly flagship scientific conference, funded by the Belgian Development Cooperation. Every other year the Colloquium takes place in a partner country of ITM. This year the Colloquium is taking place in Antwerp on 9 and 10 October. For this 60th edition, we will be connecting the dots between some of the most pressing issues facing the tropical medicine and international health community. Experts from all corners of the world will come together to address the current challenges of global health, with a specific focus on migration, climate change and innovation. 9 - 10 October 2019 Antwerp, Zuiderkroon colloquium2019.itg.be



Opening of academic year

16-20 Sep

ECTMIH 2019 – Liverpool, UK

9-10 Oct

Connecting the dots 60th ITM Colloquium

15-16 Oct

Be-cause health conference – Taking the urban turn

22 Nov

Flemish Science Day

YOUR THOUGHTS COUNT! If you have questions, remarks or suggestions or to place orders for paper copies of P³, please contact communicatie@itg.be


Read P3 online at www.itg.be/magazine


www.itg.be @ ITGITMAntwerp @ @ITMantwerp / @TropischITG @ www.itg.be/update

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