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Dossier: Bacteria Ebola, 40 years after Yambuku Three hidden ITM gems

Pioneer Armand Van Deun deals

A blow to resistant tuberculosis Institute of Tropical Medicine, Antwerp | PÂł | No. 3 - September 2016


Colophon

Editorial

publisher-in-charge 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 and Wilkens C.S. contact communicatie@itg.be +32 (0)3 247 07 29

Bacteria are tiny living beings. They are single-cell organisms, usually a few micrometers in length. These microorganisms are all around us; in the air, the soil, and water, and in and on plants and animals, including us. There are good and bad bacteria. Some of them are even ugly. The good bacteria help us digest our food and fight invading microbes. The bad ones challenge our immune system and make us sick, while the ugly ones even put our lives at risk. Bacteria are smart creatures, they adapt to the antibiotics we have developed to beat them. Some bacteria are resistant to one type of drug, while others no longer react to several types of medication. These multi-resistant bacteria raise fears about a future without effective antibiotics, in which ordinary infections could become life-threatening again. While this is a global problem, there is a particular urgency in some developing countries. We know that using drugs for the right purpose, in the right doses and for the right amount of time is crucial to avoid resistance, but this is far from self-evident in many emerging economies. In this issue of P³ you will read more about on ITM’s work on bacteria. We pay tribute to the man whose pioneering work has improved the odds for patients with multidrug resistant tuberculosis. You will also meet the multidisciplinary team of our new Bacterial Infections in the Tropics (BIT) project. But there is room for much more on bacteria and other topics as well. We take a look at the giant paintings of Allard l’Olivier that adorn ITM’s main building, read about the extraordinary career of Mr. Travel Health and shed light on some of the Institute’s hidden gems. We wish you all happy reading. The Editorial Committee

*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

10

A blow to resistant TB

12

15 doden

Tuberculose 1,5 Antibiotic resistance here and in the South

Ackermans & van Haaren fellowships

Hiv/aids 1,2

8 The Bangladesh regimen

versus

16 gevallen

18 1930 - The paintings of Allard l’Olivier

22

Malaria 0,4

Portrait: Fons Van Gompel

2

Ebola, 40 years after Yambuku

miljoen

Has syphilis been conquered? Not in Africa!

Dossier: Bacteria

6

miljoen

The ITM number

5

24

Three hidden ITM gems

26 ITM and I: Bharathi Ghanasyam

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.

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the itm number

The ITM loves bicycles.

No less than 53% of the staff, or 230 employees, cycle to work regularly or on a daily basis.

8x

Together, they cover a distance of 322,182 km per year, which is equivalent to cycling eight times around the world.


dossier

Bacteria

“I know you think of yourselves as human beings but I think of you as 99% bacterial.� Bonnie Bassler, molecular biologist TED Talk 2009, nearly two million views


Pioneer Armand Van Deun deals

a blow to resistant tuberculosis Roeland Scholtalbers

Very few scientists have the opportunity to make a dramatic improvement in the chances of survival of thousands of patients all over the world. ITM researcher Dr. Armand Van Deun is one such scientist. In May 2016, the World Health Organization (WHO) approved a combination therapy developed by Van Deun as a standard treatment for multi-drug-resistant tuberculosis (MDR-TB).

T

he newly approved treatment ensures faster cure for a higher number of patients. When he started working on this health challenge 20 years ago, the disease was thought to be untreatable. Each year nine million people all over the world develop tuberculosis and one and a half million do not survive the infection caused by the mycobacte­rium M. tuberculosis. The biggest threat in the fight against tuberculosis is the growing epidemic of a multi-drug-resistant strain of the disease. In 2014, approximately 450,000 cases of the disease were resistant to the most common medication. Anyone affected by multi-drug-resistant tuberculosis (MDR-TB) will be subjected to almost two years of treatment, including second-line drugs with toxic P³ | 6

side effects. For example, one in three patients will become deaf as a result of the treatment. On average, only half of the MDR-TB patients survive. After spending time in Tanzania and Rwanda, Dr. Van Deun arrived at a Bangladeshi project of The Damien Foundation in 1994. As a young doctor, with a diploma in tropical medicine and laboratory medicine, he had already acquired some experience in treating tuberculosis and leprosy in Africa. “There were very few cases of resistant TB at the time and people told me that the disease was untreatable. That was indeed true at the time, but a few dedicated nurses and I were unwilling to accept this,” reflects Armand Van Deun.


dossier The directors of The Damien Foundation were sceptical, but Dr. Van Deun and his colleagues went in search of the right combination, dosage and timing of medicines for a better treatment. Thanks to the devaluation of the American dollar compared to the European currencies, the scientists received unexpected spending room to continue their pro­ject. The development of a new treatment regimen is effectively a race against the clock, because it is not known when resistance will develop. Resistance to medicines occurs as a result of incorrect and uncontrolled use, which is a growing problem particularly in the emerging economies of the Southern hemisphere.

The scientists confirmed these excellent results in a subsequent study in 2014. Despite the increa­ sing severe resistance to second-line drugs, the scientists achieved a positive result in roughly 85% of the cases. A smaller study in Niger also confirmed the results of the shorter treatment. This life-saving plan is currently being tested in Ethiopia, Vietnam and South Africa, all countries with a higher number of HIV/TB co-infections compared to Bangladesh. A study by The Union in eight French-speaking African countries is also using the new treatment regimen.

Between 1996 and 2008, all patient samples from Bangladesh were examined at ITM in Antwerp for resistance to medication. Dr. Van Deun has worked in ITM’s Unit of Mycobacteriology since 1999, which runs a WHO reference laboratory for mycobacteria (TB, Buruli ulcer, leprosy). “Based on the data from thousands of laboratory tests, we were gradually able to define our treatment,” explains Dr. Van Deun. Experiments carried out in the laboratory of Prof. Françoise Portaels suggested to him that he should add clofazimine to the treatment. “At the time, this product was not recognised by the WHO and in the short term it also did not appear to be effective. However, we had data to suggest that it did become effective after several weeks and that this effect would last for the duration of the treatment. This was later confirmed.” In 2006, the ‘Bangladesh regimen’ became a fact, based on seven existing medicines, with gatifloxacin leading the anti-bacterial troops. The treatment lasts less than nine months, instead of the 18 to 24 months recommended by the WHO. In 2010, Dr. Van Deun and his colleagues reported that this treatment increased the success rate from 65% to 88% for MDR-TB patients in Bangladesh. In contrast to the WHO regimen, this new treatment causes virtually no resistance if the treatment happens to fail. In addition, the shorter treatment is also a lot cheaper.

On 12 May 2016, the WHO announced amended international guidelines for MDR-TB, based on the regimen first put together by Armand Van Deun in 1996. “We have demonstrated that multi-drug-resistant tuberculosis has now become a treatable disease. However, we should combine available medicines optimally in order to avoid further resistance. This means that the rules for use need to be observed all over the world. Newly developed TB medication will also remain effective for a longer period if used correctly.”

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infographics

Multi-drug-resistant tuberculosis the Bangladesh regimen

There were 9.6 million new TB cases in 2014. That represents about

87% of the Belgian po­pulation. deaths

TB 1.5

versus

cases

214 malaria

million

million

HIV/AIDS 1.2

malaria 0.4

9.6 TB 2 HIV/AIDS TB is the world’s

top killing infectious disease.

(Source: WHO; all 2014 data, except for malaria, 2015 data).

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infographics

People cured

of treatment per patient 800

Months

20

Total cost

the treatment

80%

USD

Duration

not finishing People

15%

50% 9

6%

250

new old

new old*

new old

new old

*Approximately. Cost varies according to drugs utilised.

The breakthrough:

a treatment of 9 months instead of 20 months, with a lower cost per patient, a higher succes rate and more people finishing the treatment.

TB MDR XDR Success 0%

Lost 29%

Failed 54%

Died 90%

100%

TB: tuberculosis | MDR: multi-drug-resistant tuberculosis | XDR: extensively drug-resistant tuberculosis

Unfortunately,

more resistance means more deaths. This was computed from the outcomes for cohorts in several countries in the WHO data.

infographics Š Pierre Massat - www.mavromatika.com | sources: ITM, Statbel, WHO

9 | PÂł


dossier

Has syphilis been conquered?

Not in Africa! Marc Geenen

Penicillin has gotten the better of syphilis almost everywhere, but not in Africa. That might be partly due to more connected sexual networks, ITM professor Chris Kenyon suggests. Meanwhile the disease is on the rise again in Europe. From America with love

Three stages

What do you do if you despise a disease? Just say you got it from the enemy. In 16th century, European people were so ashamed of syphilis. The English coined it the ‘French pox’. Russians named syphilis the ‘Polish disease’ and the Polish on their turn called it the ‘German disease’. They all erred. Syphilis probably originated thousands of years earlier in America, as we now know from DNA-research.

Syphilis is a very contagious, sexually transmitted disease (STD) caused by the spirochaete bacte­ rium Treponema pallidum. The STD can be treated efficiently with penicillin. Without the antibiotic, syphilis develops in three stages. It often begins with a so-called ‘chancre’: a well-defined painless ulce­ ration. If situated in the vagina, rectum or throat, the ulcer may be inconspicuous.

So maybe it were the conquistadores who brought syphilis from the New World, apart from gold? Not exactly. The disease had very probably made victims in Europe long before Cortés and others returned, possibly already in ancient Rome. However, the explorers did import a variant of the bac­ terium that Americans had already developed some resistance against, unlike Europeans. That explains the syphilis peak at the end of the 15th century. The affliction would remain rampant for five centuries among people from all walks of life: Paul Gauguin, Henry VIII, Friedrich Nietzsche, Franz Schubert, Toulouse-Lautrec, … all were infected with syphilis.

With second stage syphilis, the bacteria spread through the blood and the patient may develop a rash, a fever, a headache, bone pain or hair loss. Only years later, stage three begins when syphilis damages the central nervous system. Eventually also the heart and main blood vessels may be affected. In Belgium, the third stage is hardly ever reached anymore. Luckily so, because the damage is irreversible.

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dossier

Until recently six percent of the pregnant women in southern Africa had syphilis World-wide syphilis has been on the decline, but not so much in Africa. Nearly all countries, where five percent or more of the pregnant women have syphilis, are situated south of the Sahara. Together with his colleagues ITM-based researcher Prof. Dr. Chris Kenyon has been looking for an explanation. In May 2016 he published an article on the subject in PLOS Neglected Tropical Diseases magazine. Prof. Kenyon used data on syphilis from routine testing of pregnant women since 1918. In most of the countries studied, the number of pregnant women with syphilis had already decreased to less than 1% before the advent of penicillin. In Southern and Eastern Africa, on the other hand, the prevalence remained about 6%, 50 years after the introduction of the antibiotic. Prof. Kenyon suggests that during the 1990s and in the year 2008, syphilis rates dropped very sharply in a number of countries where the disease was still prevalent, during the height of the AIDS epide­ mic. That is partly due to the syndromic approach to treating STDs (i.e. better antibiotic policies) and changes in sexual behaviour. A further crucial factor how­ever was that sexual networks were shattered when scores of people died of AIDS. Despite

a fall in syphilis rates in Africa following the AIDS epidemic, the number of pregnant women with syphilis was still significantly higher in Sub-Saharan Africa in the 1990s and in the year 2008. The scientists also investigated whether there were any links between the prevalence of syphilis and factors such as access to effective detection and treatment, health care spending and gross domestic product per capita. No such links were found. The only clear correlation was with the geographic location: i.e. Sub-Saharan Africa. In previous papers, the researchers demonstrated a strong correlation between syphilis, herpes simplex virus - 2, and HIV prevalence. In other words, syphilis and herpes rates from before the HIV epi­ demic predicted which countries would go on to ex­perience severe HIV epidemics. “More work needs to be done into what common risk factors enable the three STDs to spread more easily. Because herpes is an incurable condition it is implausible that differing treatment capabilities are responsible. The available evidence suggests that densely interconnected sexual networks are a more plausible explanation.” accor­ding to Prof. Kenyon.

More new cases in Europe Meanwhile new data from the European Centre for Disease Prevention and Control (ECDC) show that the number of syphilis cases in Europe is on the rise again. In Belgium 1,238 new cases were reported in 2014, versus 778 in 2012. “People are less afraid of HIV and so there is more risky behavior, especially among men who have sex with men. Safe sex remains the key message”, Prof. Kenyon warns. Relatively speaking the increase is limited. Belgium has 1 new case of syphilis per 10,000 inhabitants, whereas some countries in Southern Africa are being confronted with more than five cases per 100 inhabitants.

Prof. Dr. Chris Kenyon

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dossier

Tackling antibiotic resistance here and in the South Marc Geenen

Climate change and religious terror dominate the media but the danger of multi-resistant bacteria is at least as big. The World Health Organization warns against the increasing global resistance to bacteria such as Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus. The financing by Baillet Latour Fund allows ITM to focus on a curse that we brought upon ourselves.

Where do we stand today? People need bacteria to maintain a healthy intestinal or gut flora, but contact with the wrong bacteria or bacterial imbalance can cause illness. When that happens we may have no other choice than to take a course of antibiotics. The treatment has saved countless lives since World War II. Yet antibiotics have a major drawback as excessive, inappropriate and poorly timed use may cause bacteria to become drug resistant. Antibiotic resistance has thus become a major threat which, if truth be told, we saw coming a decade ago. Some bacteria have even become multi-resistant. In Belgium about 2,600 people die each year from infections with bacteria that are resistant to antibiotics. A large percentage of victims are elderly people or hospital patients whose immune system is weakened. The resistance of pneumococcus to erythromycin has increased from 3% to 35% between 1985 and 1999. The situation is not as bad in Western countries, where antibiotics are available on prescription only and barrier controls are put in place for patients with resistant bacteria. The South does not usually have the resources to control resistance and antibiotics are sold over the PÂł | 12

counter. People use them in ever greater numbers and fast-growing economies provide them with the means to do so. The consequences are frightening. In the Cambodian capital Phnom Penh half of Escherichia coli infections are multi-resistant and reserve antibiotics are often too expensive or unavailable.

The ITM BIT team Research into this issue goes beyond microbiology or genetics because of the social and cultural factors involved. Sometimes people (in the South as well as in the North) will do almost anything to get antibiotics and it is often difficult to convince patients that they should continue taking the drug even if their complaints have disappeared. Antibiotic resistance can only be controlled through a multidisciplinary approach. ITM has exactly the kind of versatile team needed. It is called BIT, which stands for Bacterial Infections in the Tropics. Bacteriologists, specialists in tropical laboratory medicine and medical anthropologists collaborate with partners in Cambodia, Burkina Faso, Ecuador, Peru, the Democratic Republic of Congo and Rwanda.


dossier

Two examples. Together with the Government of Flanders and Ghent University, BIT works on a new Salmonella test. Worldwide 20 million people suffer from typhoid fever and an even larger number from other Salmonella infections. The procedure to detect salmonellosis takes several days, is laborious and complex and misses many cases. As a result, antibiotics are often administered based on guesswork. Many people die an avoidable death and antibiotic resistance is growing. A reliable, rapid test would make a huge difference. In Burkina Faso, BIT investigates how rural hospitals use antibiotics in patients with fever and how to set up a stewardship programme for antibiotics and keep it operational.

The Baillet Latour Fund The BIT team is indebted to Count Alfred de Baillet Latour, Director of the Artois Breweries, who created the fund in the 70’s to encourage achievements in the field of health, education, culture and sport. With the 1.35 million euro awarded to the ITM, three scientists are able to carry out research on antibiotics until 2020. Pharmacologist Stijn Deborggraeve set up a new bacteriological research lab, internist Judy Cox researches antibiotic use and resistance in low-resource settings, while anthropologist Koen Peeters examines the influence of sociocultural factors in this field.

Stijn Deborggraeve and PhD researcher Pablo González Andrade are demonstrating a rapid diagnostic test detecting multiresistant bacteria at the Universidad de las Fuerzas Armadas, Ecuador. © Jan Jacobs

13 | P³


dossier The importance of their work cannot be overestimated. Without effective drugs against bacterial infections, health care will recede to 19th century standards. Belgians and others in the West still take far too many antibiotics, even indirectly through meat consumption. But in Asia and Africa the em­ ergence of resistance is a major cause for concern. If people in the tropics have a fever, malaria is often the default diagnosis. They get prescribed a range of broad-spectrum antibiotics to ensure that all infections are covered. Or they will buy their mi­ racle drug without prescription even if that means they have to go hungry. “Millions of people face the

choice between completing a course of antibiotics or putting food on the table,” says ITM Director Prof. Dr. Bruno Gryseels. We must tackle this pro­ blem together with the partners from the South, not only for the benefit of the local population but also out of self-interest. Globalisation, migration and tourism, including medical tourism, are exposing Europeans to infections on which antibiotics very soon will have no grip. “The support of the fund allows us to study and address the specific conditions in the South. This is badly needed because multidrug-resistant bacteria know no borders,” according to Prof. Dr. Gryseels.

ITM introduces a pilot course on antibiotic resistance ITM has antibiotic resistance high on its agenda. It’s a subject of intensive research, and with the launch of the pilot course ‘Hospital-Based Interventions to Contain Antibiotic Resistance’ it is now also part of its academic curriculum. Health professionals from across the world gain greater expertise regarding antibiotic resistance and its containment at hospital level in low-resource settings. Antibiotic resistance can only be controlled on a multidisciplinary level and this approach is reflected in this pilot. Doctors, lab technicians, etc. share their ideas and draw up plans in work groups and through discussions. “I have come to understand how to communicate in a diverse group and how to draw up a clear plan. Not only did I acquire theoretical knowledge but I also sharpened my people and organisational skills,” says participant Abera Bulti from Ethiopia.

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Ackermans & van Haaren scholarships Over the years, the Ackermans & van Haaren Group has provided ITM with over € 450,000 of funding channeled into a scholarship fund. Both European and non-European students can apply for the scholarship.

P

harmacist Ariadna Nebot Giralt illustrates how important these scholarships are for European students. Following numerous years in the field working for NGOs and local institutions in low and middle income countries like Morocco and Bolivia, Ariadna wanted to deepen her knowledge and further her career by doing an international Master in Public Health (MPH). Like many Europeans who embark on a career in international development, Ariadna had to use her own resources to gain field experience, by doing voluntary and local work. “The paradox is of course that, as you gain more operational knowledge in the field, the savings needed to do an MPH dwindle,” Ariadna explains, “That’s why fellowships offered to European participants are increasingly necessary to assure an international and diverse MPH, including

highly experienced European participants in addition to their colleagues from the South.” Ariadna’s master thesis tackled quality assurance of medicines used in low and middle income coun­ tries. She analysed the compliance of several wholesalers to the WHO quality assurance standards. Her thesis allowed her to start working at ITM afterwards and she is still employed at the Department of Public Health today. In addition to eight PhD students, Ariadna is one of the more than 36 master students who have since 2004 benefitted from an Ackermans & van Haaren scholarship to partially cover their tuition fees. These scholarships effectively support career development in the framework of international solidarity. 15 | P³


Ebola, 40 years after Yambuku: contagious research

Ann Van Gyseghem

The 58th ITM Colloquium joins forces with the 8th International Symposium on Filoviruses this year to offer Antwerp a big Ebola conference from 12 to 15 September 2016. This event unites some of the most prominent pioneers who laid the foundations for the discovery of Ebola with the people who are battling the virus in the field and in research centres across the world today.

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T

he wide spectrum of discussed topics takes a comprehensive look at the future of Ebola, building on what was handed over to us by these pioneers.

Let’s go back in time to 1976: in the former Zaire, the region of Yambuku experienced the very first large-scale outbreak of an undefined virus, transmitted through personal contact and contaminated needles in hospitals. In about two months’ time, a few hundred people got infected and almost nine out of ten died of this disease. Jean-Jacques Muyembe, a local ITM partner, Peter Piot and Guido van der Groen were some of the first on the spot to help determine the origin, the progression and the possible treatment of the (until then) unknown virus, which would later be named after the river Ebola. The Ebola virus causes high haemorrhagic fever. The patient can suffer nausea, various kinds of pain, diarrhoea and inexplicable internal and external bleeding in a few days’ time. If left untreated, it can lead to a painful death within eight to ten days. The presumed natural carrier of the virus is a fruit bat, but it can be transmitted from animal to animal, from animal to human and from human to human. The virus is not extremely contagious because transmission can only occur through direct contact with blood or bodily fluids. However, the tiniest splatter of blood or bodily fluids is enough to transmit the infection, making it very dangerous, and causing doctors, nurses and family members extreme difficulty and stress when dealing with Ebola patients. Since the first big outbreak in Zaire, new Ebola cases have emerged in more than 30 locations in the last 40 years, with varying mortality rates. In 2014, the entire world witnessed the biggest and

deadliest Ebola outbreak ever in West Africa, with occasional recurrences up to this date, which have cost over 11,000 lives. But Ebola research is contagious, too. Since 2014, an entire international community of researchers, doctors, nurses, patient organisations, NGOs and pharmaceutical companies is investigating the different aspects of the disease. They are all looking for new solutions for improved diagnosis, treatment and prevention, aftercare and social guidance during Ebola outbreaks, which are exactly the aspects that come together at our Colloquium. The historical perspective of our pioneers and the general overview of the World Health Organisation (WHO) lead us to an exciting debate with the contemporary Ebola crusaders and brothers in arms. Together with Jean-Jacques Muyembe, Peter Piot and recent survivors of Ebola, the European Commission, the WHO, MSF, Johnson & Johnson and ITM, along with many others, address the central issue of this Colloquium: what are the lessons learnt from these Ebola outbreaks and will the world have an adequate response if a new outbreak is to occur in the near future, possibly on an international scale? This pressing issue is the guiding principle for the Ebola research of the future, for diagnostics, epidemiology, vaccine development, as well as for the treatment of patients and relations with survivors of the disease; viewpoints which are all to be taken into account during the conference. By unifying the entire Ebola community, the past and the present, and by transmitting the acquired knowledge, ITM hopes to contribute to an improved preparedness and, maybe one day, the defeat of this murdering disease. 58th ITM Colloquium/8th International Symposium on Filoviruses: www.filovirus2016.com.

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<< rewind

1930 - The paintings of Allard l’Olivier Eline Van Meervenne

Anyone who has ever visited ITM has been fascinated by the exquisite paintings that adorn the staircase and hallway of the main building. The artist, Fernand Allard l’Olivier, was part of the so-called Africanist movement. He travelled several times to the former Belgian Congo and became enthralled by its culture. What he saw, became an obvious inspiration for his works.

The Congo rapidly captivated Belgian artists in the 19th century and incited them to make their way to the colony. Their work resulted in the socalled “Africanist” movement. These artists, rather than visualising the benefits of Western civilisation, depicted the otherness of African society through an unprejudiced representation of daily life in the colonies. Fernand Allard l’Olivier was born in Tournai in 1883 and part of the group of Africanist artists, active in the later years of this movement (first half of the 20th century). His paintings illustrate the rich culture of African tribes. He portrayed scenes from everyday life and often made life-size portraits of people wearing traditional dress, complete with jewelry, weapons and native hairstyle. Allard l’Olivier made his first voyage to the Belgian Congo in 1928. He was commissioned by the Belgian government to create a series of paintings, to be shown at the World Exhibition in Antwerp in 1930. He travelled through the country by train and even transformed a carriage into a residence and studio so he could more easily transport his artists’ materials throughout the country. He organised a

P³ | 18

first exhibition of his works in Elisabethville (now Lubumbashi) and in Brussels. His sketches were sold in no time.

World’s Expo He sent twelve sketches to the colonial administration, a mix of portraits and scenery. They were the basis for his contribution to the 1930 World Expo. The scenes show the course of a day on Lake Kivu. The day starts at sunrise in Bukavu and ends with the boat mooring in the Bay of Bobendana at sunset. We meanwhile get to admire fields in full bloom, a procession of safari porters and dancing by native tribes. After the World Expo, the works were donated to ITM. Allard l’Olivier died in the Congo in 1933 during a boating accident. He took a sailing trip in the tow boat Flandre to paint the local scenery. On the way back, he hit his head and fell into the muddy water. His body was recovered in Yanonge only three days later. His death caused great consternation in colonial circles.


<< rewind

19 | P³


<< rewind

The paintings in the Institute The works of Allard l’Olivier adorn the hallways of ITM’s main building and the outpatient clinic. In 1990 a visitor remarked that at the 1930 World Expo 24 paintings had been exhibited. But nobody knew where the remaining works had gone. A number of ITM staff went in search of these paintings and found three of them in the attic. After being stored away for more than 50 years, they were carefully restored and added to the collection.

P³ | 20


advertisement

Support ITM and get your own Allard Do you and your housemates or colleagues wish to enjoy this wonderful legacy in the comfort of your own home or office? In the framework of its fundraising, ITM offers high quality prints of four paintings of Allard l’Olivier for sale:

Chef agriculteur, Kivu

Femme Mutusi

Femme indigène, Kivu

Femme au léopard

Size: print 65 x 48 cm, image 53 x 44 cm.

Interested? Visit www.itg.be/allard/en for more information.

21 | P³


portrait

Fons Van Gompel

Mr. Travel Health Alexandra Hörlberger

A magnetic personality with Mick Jagger looks, Fons Van Gompel recently retired after having devoted 30 intensive years to ITM in the field of travel medicine. Van Gompel looks back at his impressive career and explains why, as a trained internist and specialist in nuclear medicine he opted for tropical medicine instead, what he is most proud of, why he sees himself as a captain of a ship and how he now enjoys the small things in life.

B

y 1985 Fons Van Gompel had numerous medical qualifications under his belt inclu­ ding internal medicine specialising in gastroenterology, nuclear medicine and geriatrics. However, instead of remaining on a predictable career path, a twist of fate attracted him to ITM where he completed the Diploma in Tropical Medicine. After a brief professional sojourn at ITM’s policlinic, Van Gompel left for what was then Zaire, where he volunteered at a hospital and spent some months backpacking. These months in the field (Zaire, Rwanda, Kenya and Tanzania) were an en­ riching experience and an intimate encounter with tropical diseases such as malaria and scabies. With P³ | 22

no specific career path in mind, Van Gompel returned to ITM’s policlinic and took on more and more tasks. He began teaching courses in tropical medicine and established himself as an expert in the emerging subject of travel medicine, which indeed he helped to create. A tireless medical detective, he enjoyed preparing his students for confrontations with forgotten diseases and thrived on team investigations. “It can only be anthrax,” he recalls telling a colleague when faced with the puzzling lesions a tourist presented with on her return from Africa, where she had come into contact with a hippo that in fact had died of anthrax, it later transpired.


portrait One would not expect Fons Van Gompel to reply “the appreciation of patients, students and colleagues” when asked what he is most proud of, based on the many, many milestones in his career, culminating in his recent award of Officer in the Order of the Crown by royal decree. By 1995 he was professor in tropical pathology and head physician of ITM’s medical services by 2000, not to mention co-founder and president of the Belgian Scientific Study Group on Travel Medicine. Whilst recognition moves Van Gompel the most, having established travel medicine to the extent that it really placed ITM on the world map is also something he is proud of. When pondering what kind of a boss Fons was, he replies that he wasn’t. He sees himself as more of a leader or captain of a ship who together with his crew was able to do great things. Criticism and feedback he views as opportunities to learn. With

a smile and shrug he admits that despite the team focus he does remain a perfectionist and control freak and he perhaps should have delegated more, considering his multi-faceted career of late: Fons occupied four high-level positions simultaneously (doctor, teacher, national expert and chief physician) in the last fifteen years. Now that he has the time, Fons channels his effervescent passion towards the small things in life. He and his wife now enjoy the good life exploring Europe in their camper van, gardening or making music. Fons is a talented flutist and doting grandfather of four. He is relieved to now have a drastically shorter to-do list and feels that the time has come for a new captain. “Do it your way,” he smiles. “Just as I had the freedom to do. Give it a try!” He leaves ITM in a happy way with a dose of nostalgia. “I will keep fine memories of you, and I would like you to keep fine memories of me.”

Dr. Livingstone, I presume?

23 | P³


the list

Ildikó Bokros

Part of ITM is housed in two magnificent, protected monuments: an iconic Art Deco building and a seventeenth century monastery. As most old buildings, both conceal many secrets within their walls. However, ITM’s other, less historic sites also hide some gems. Let us introduce you to three of them. A quiet place The Capuchin nuns acquired the former Carthusian monastery in 1834 and adapted it to suit their own needs. They installed a dormitory, a textile workshop, a laundry and a sacramental bread bakery. This former monastery has become the Campus Rochus. The nuns also had a “Lourdes grotto” in the garden and that has been kept. It is colloquially referred to as the “smoking cave” by some of the ITM staff who uses it as a place to talk or to spend a quiet moment. In 1858 a peasant girl named Bernadette Soubirous from Lourdes (France) saw apparitions of a belle dame, who introduced herself as the Virgin Mary. The apparitions and subsequent healings

at the grotto of Massabielle gave fresh impetus to Catholic devotion. The famous Lourdes grotto was replicated more or less true to the original in hundreds of places. It consists of a large cavity on ground level with a niche on the top right side that holds the statue of Mary. A photograph held by the City of Antwerp archives shows that the Campus Rochus grotto originally stood next to the chapel (now Aula Janssens), in the middle of the garden. Afterwards it was moved to the outer wall.

The log Karibu, ITM’s cafeteria and student dormitory, opened its doors in 2013. Although it looks slightly less grand than the Art Deco main building, never­ theless, it houses a very peculiar object. Have you ever noticed a small tree trunk hanging on the wall and wondered what it could be? This secret will now be revealed. When construction work on Karibu began in 2011, archeologists discovered some unexpected objects dating from the Middle Ages. During the excavations, they found what appeared to be a cobblestone

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the list

road. However, it was lying three meters below ground level and it was bordered by vertically and horizontally arranged logs, both at the side and at the end. This palisade and the traces of water found on the bottom suggested a scaffolding or a pontoon bridge. Further research indicated it must have been a watering place for animals, which at the time probably laid just below street level and was accessible via a slope. The site was located between the third and fourth city walls in the 15th century. As the logs were in prime condition, the archeologists took samples, one of which, part of a tree trunk was freeze-dried for preservation. It is now a jewel on the walls of Karibu. (Some of the cobblestones were also preserved and used in the inner courtyard of Karibu.)

Behind this waterfall there used to be ventilators sucking in fresh air which was subsequently filtered, heated, humidified, reheated and finally sent to the patientsâ&#x20AC;&#x2122; rooms through a large pipe. The stale air was collected near the ceilings and expelled through vents in the attic. This air conditioning system is no longer in use but has been taken over by a modern installation. Moreover, ITM has no longer any wards, patients are hospitalised at Antwerp University Hospital. The only thing remaining is the fountain, which was renovated 15 years ago. It still works. Special thanks to Nico Van Aerde and Peter Van Eyndhoven for their valuable contributions.

Avant-la-lettre-airco The grandiose main building has a quite ingeniously constructed secret. Some of it is actually visible to all visitors who enter the travel clinic through the garden: a fountain. On its top three bronze frogs spit water into a marble basin. When full, the water spills over to the next level and from there to the lowest level creating a waterfall effect in the process.

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itm and i

Bharathi Ghanasyam

I am an Indian journalist specialising in development and health issues. A lot of my reporting focuses on tuberculosis, a plight for too many people in my country. I was overjoyed when I heard I was selected as ITM’s Journalist-in-residence.

The Journalist-in-residence programme itself is uniquely structured. Unlike other bursaries, which I have won and delivered on, it does not expect anything in return. The programme empowers one with knowledge, even while giving you the flexibility to set your own pace and select your areas of interest. And to me that is the biggest motivator. My world has opened up because of my stay at ITM, my perspectives and understanding of public health are now stronger and more robust. Spending a few weeks in Antwerp helped me to reduce the great gap that sometimes exists between people who generate knowledge and those who (like me) translate that knowledge to larger audiences. I now have the basic understanding of how to translate complex information into layman’s language - something I was always doing, but will henceforth do with greater conviction.

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My field trips were great experiences in themselves. Take the visit to the Arendonk asylum centre with the TB screening van of the Flemish Association for Respiratory Health Care and Tuberculosis Control (VRTG), where refugees were arriving in droves. Or the visit to Damien Foundation in Brussels to learn about their work and the trip to KIT in Amsterdam to hear Hans Rosling speak - there is no more I could ask for. But the many days spent in company of ITM’s pas­ sionate staff meant most to me. I have had the op­portunity to interact freely with some great minds, committed individuals and persons with formidable expertise in their chosen subjects. To name only some would be injustice to the others and naming all would make this piece very long. The sincerity of purpose with which people come to work every day, the results they produce, which translates to


itm and i

better health for the most disadvantaged across the world - ITM stands out for all this and more. I saw excitement in the eyes of the lady in the laboratory when she found a good sample of TB under her microscope, despite the fact she’s been doing this job for over two decades. This tells me she still finds her job stimulating. The smile I see on the face of the person one first sees in any institution - the receptionist - it tells me she loves her workplace and that’s a great indication of what her workplace gives her beyond remuneration. An exciting part of my tenure has been interacting with Dr. Armand Van Deun and his team, who have pioneered the nine-month treatment regimen for multi-drug-resistant TB. It’s like being a

part of history, especially in the light of the recent guidelines issued by WHO approving the regimen. Remuneration is an essential part of life – it helps lead lives of dignity. But work for a larger social good is what makes life worthwhile and by this yardstick, people who work at ITM stand head and shoulders above the multitudes who merely work for a living. It is a sobering thought that this piece might come across as one that is gushing in its tone and tenor and too effusive in its praise of ITM. But my firm belief is that we are a little too miserly when it comes to saying good things and too quick to point out flaws. I suppose if I think deeply, I could find a few flaws. But for that I would have to work really hard and I’m too lazy for that!

© Damian Foundation

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Calendar 12-15

SEP 2016

ITM Colloquium “Ebola: 40 years after Yambuku” (ITM, Antwerp)

19-23 SEP 2016

Distance/Blended Learning Workshop

6-7

OCT 2016

European One Health/EcoHealth Workshop

14-18

NOV 2016

Emerging Voices for Global Health (Vancouver, Canada)

27

NOV 2016

Science Day

16-20 OCT 2017

10th European Congress on Tropical Medicine & International Health

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

Institute of Tropical Medicine in Antwerp Foundation of Public Utility RPR 0410.057.701 | IBAN BE 38 2200 5311 1172 Nationalestraat 155 | 2000 Antwerp | Belgium Tel: +32 (0)3 247 66 66 Fax: +32 (0)3 216 14 31

P³ | issue 3 - Autumn 2016