P³ | Spring - Summer 2018

I TM M AG A Z I N E

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SPRING-SUMMER 2018

SAMPLE TO RESULTS WHY LIESELOTTE CNOPS CAN SMILE GEORGIA ON THEIR MIND

DOSSIER ALL THINGS DIAGNOSTIC

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YOUR THOUGHTS? Please take part in our P³ online survey! www.itg.be\survey

COLOPHON Responsible Publisher Bruno Gryseels Editor in Chief Roeland Scholtalbers

Editorial Coordination Eline Van Meervenne, Catie Young Editorial Committee Roeland Scholtalbers Mieke Stevens Nico Van Aerde Eline Van Meervenne Catie Young Maria Zolfo *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.

Layout Toech Reclamestudio Cover Image Jessica Hilltout

Translations Serv-U and Wilkens C.S. Contact communicatie@itg.be +32 (0)3 247 07 29

#6

SPRING-SUMMER 2018

Dear Reader, We all know what it is to be a patient – visiting the doctor’s white office with the smell of astringent alcohol; answering the obligatory questions; the touches on the right and left of the throat; a wooden stick in our mouth; if we’re unlucky some blood tests or an x-ray. Next step diagnosis. For us it seems benignly simple – it’s what doctors do – but for medical practitioners it’s far from that – it’s a puzzle that needs to be solved. It starts with getting to know you, the patient and your symptoms, and testing hypothesis through diagnostic testing and often via the treatments themselves.

With these images in mind, we would like to welcome you to the sixth edition of P3 and the wonderful world of diagnostic testing at ITM! Get to know the researcher who developed a series of ingenious sample-to-results tests that can help doctors pinpoint one tropical virus or hemorrhagic fever out of a range of such diseases using only one patient sample; meet our HIV reference laboratory head and read about her experience diagnosing the virus over the last 40 years and discover what our ‘Swab2Know’ outreach activities are doing to increase diagnosis in susceptible communities; learn about the challenges faced in low-resource settings on getting doctors to even trust and use their laboratories and what ITM is doing to help, especially in light of anti-microbial resistance.

Beyond diagnostics dossiers, see why two of our researchers have Georgia on their mind – even though it’s not exactly tropical; meet our new Public Health Department Head Marianne van der Sande in an exclusive interview and find out why a lately retired WHO Director still calls ITM home.

We hope you enjoy our latest edition and think of us the next time you tell your doctor you have a sore throat and aching muscles.

That said, good health to all into 2018!

Sincerely, The Editorial Committee

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DOSSIER: DIAGNOSTICS INTERVIEW: LIESELOTTE CNOPS DIAGNOSTICS IN THE TROPICS

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HIV - 40 YEARS OF DIAGNOSTICS TESTING GEORGIA ON THEIR MIND ECTMIH2017 – A PHOTO STORY REWIND – ABOUT THE CATT PORTRAIT: MARIANNE VAN DER SANDE HOW TO SURVIVE AS A JAPANESE EXPAT IN ANTWERP

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ITM AND I: DIRK ENGELS © 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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2,038,500 is the number of ‘card agglutination tests for trypanosomiasis’ or CATTs that ITM distributed across the world in 2017. CATT is a diagnostic test, developed

by ITM over 40 years ago, for sleeping sickness. ITM is the only producer in the world of the tests and has distributed close to 50 million CATTs over the years. Discover more of its history in our ‘Rewind’ section on page 22.

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DOSSIER DIAGNOSTICS

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For medical practitioners, making a diagnosis is often challenging and is a difficult aspect to learn and perfect during studies and beyond. Doctors have to weigh up a patient’s symptoms with their history, risk factors and their likelihood of having been in contact with certain diseases.

In early medicine and in resource-rich settings, before the microscope, thermometers, a stethoscope, this was all they had to go on but now, with the technological advances of the 20th and 21st centuries and a move toward evidence-based medicine, diagnosis has moved on to include a range of dependable tools making it an increasingly precise science that continues to evolve.

logical advance appear to have turned the emphasis of medical practice in the advanced countries towards numerous and sophisticated investigations. For a long time to come ours must be based on the older art of clinical examination…”

With this in mind please join us on an exploration of diagnostics at ITM and discover the researchers, stories and tests themselves, which have and are shaping the diagnostic landscape of tropical diseases particularly towards sharing knowledge and providing workable technology for partners in the South.

There is a different story, however, for medical practice in the South. In his prologue from ‘An Introduction to Clinical Diagnosis in the Tropics’ Professor A.O Falase, from the University of Ibadan in Nigeria, wrote in 1997, “Wealth and techno-

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IF YOU WANT SOMETHING YOU HAVE TO GO FOR IT! CATIE YOUNG Molecular biologist Lieselotte Cnops has developed many diagnostics tests for ITM over the last 10 years. Her latest being a series of innovative sample-toresults tests that provide analysis on a multitude of diseases in one go. P3 gets to know Lieselotte’s diligent drive for success.

Lieselotte Cnops, an up-and-coming Flemish researcher at the Department of Clinical Sciences, is a person who has worked very hard to achieve what she has achieved. Currently, this is a series of ingenious molecular diagnostic tests – including a number of fully automated sample-to-results tests in cassette form – for a wide range of tropical viral diseases. # Dossier 7

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“I have six brothers. Growing up, everything was a competition – when you’re riding your bike together it’s about peddling as fast as you can to beat the others; at the seaside it was about who’s the first to reach the water...They taught me to be tough.” This tenacity shines through in her past studies, throughout her career at ITM and in her family life, where she is the proud mother of two boys.

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Thinking back to her studies, although good at sciences, Lieselotte remembers the initial years of rote learning during her biology studies at university as a challenge.

“But with my Masters I found the interpretation and understanding part better,” she recalls. And she didn’t stop there; in 2006 she completed her PhD from the University of Leuven and continued on with postdoctoral research from 2006 to 2007.

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In 2008 she started at ITM. As a molecular biologist she has worked over the years on developing diagnostic tests for over 20 parasites, viruses, bacteria, and fungi.

In December 2014 she was the first person at ITM to be granted a postdoctoral innovation mandate given by the Flemish government’s then Institute for Innovation through Science and Technology (then IWT, now VLAIO). The mandate seeks to connect research with industry in the region. In Lieselotte’s case it was with Biocartis, a Flemish company specialising in molecular diagnostics.

“The end of 2014 was amazing,” Lieselotte explains. “The timing of my mandate defence was just at the time of the peak of the Ebola outbreak in West-Africa. I was part of the set-up team and worked in the ITM diagnostic lab for suspected Ebola patients in Belgium. The day of my defence happened to be on the same day we were expecting our first Ebola patient sample. I delivered my defence in Brussels and had to take off my high-heels to run to the train to get back to Antwerp. I was just in time, the sample arrived and we worked through the evening to deliver it. In the end the patient was Ebola free and I found out later that I got the mandate – so, a very positive end to an intense day!”

variety of medically important viruses transmitted by arthropod vectors (such as mosquitoes). Just as for her studies, however, she didn’t stop there. During the Ebola outbreak she also worked with her team and Biocartis to fast-track a test cassette for the detection of the Ebola virus and has also moved on to develop this cassette to include a number of other hemorraghic fevers such as yellow fever.

ITM is currently �eld testing these cassettes in low-resource settings. Lieselotte’s dream is to make them available worldwide, especially in endemic or epidemic regions where they are most needed.

The recent outbreaks of Ebola in West-Africa and of the Zika virus in Latin-America, clearly demonstrate the need and added value of such molecular tests that target multiple viruses in one go. To turn this dream into a reality, once ITM has completed the field evaluation of the tests, Lieselotte and a multidisciplinary team will look into ways of making the different cassettes available on the market.

The mandate is now complete and Lieselotte, together with her scientific collaborator Birgit De Smet, have successfully developed, under the supervision of virologist Kevin Ariën of the Department of Biomedical Sciences, a fully automated sample-to-result molecular diagnostic prototype test for the simultaneous detection and identification of a broad # Dossier 9 brochure-ok.indd 9

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WORK IN A CRISIS WHAT THE CASSETTE CAN BRING Lieselotte’s work with Biocartis and the outbreak of the Ebola virus coincided. On request from Biocartis they fast-tracked its development as a rapid diagnostic test for the Ebola virus. Tine Vermoesen and Saïd Abdellati were two intrepid ITM laboratory researchers who went to process samples in Guinea during the epidemic, unfortunately at that time the Biocartis cassette was still in the works. Their job there included three weeks of working with patient samples in a quarantined area and working into the night to process the high numbers of the samples coming in from rural areas.

“We had to do the end-to-end processing of the highly contagious samples in extraordinary conditions,” remembers Tine.

“Out of the 651 samples, 43% were positive.”

“With the rapid test that Lieselotte and her team have developed, we would only need to do the first part of the process – placing the sample into the cassette in a highly secure ‘glove box’. The hand-held cassette would then replace the following series of test procedures that normally take up a number of rooms,” explains Saïd. “With it, we would have had faster output and a lot less hands-on work - making it safer for us all.”

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DIAGNOSTICS IN THE SOUTH A MATTER OF (MIS)TRUST CATIE YOUNG As a part of the diagnostic puzzle a test is only as good as the health system surrounding it. To make a good diagnosis, treating physicians have to be skilled in recognising the patterns of symptoms and prevalence in their populations. To verify their estimations, they need to have an arsenal of diagnostic tests and they need to know the indications, interpretations and strengths and weaknesses of these diagnostic tests. They also have to trust both the technicians producing the results and the results themselves.

To ensure this in high-resource settings, medical students study laboratory practices. Doctors and the diagnostic testing laboratories also follow quality standards to ensure correct communication and understanding between them. In low-resource settings, however, this is far less common.

Doctors are more often sceptical of laboratory results for a variety of reasons. In

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the case of diagnosing bacterial infection and prescribing the right antibiotics it is a problem that is adding to the public health threat of antimicrobial resistance. It also leads to misdiagnosis with doctors mainly associating fever with malaria, leaving the bacterial infections undetected. Through projects with our Southern partners focusing on hospital patient care, antibiotic stewardship and quality management systems, ITM is working to change this.

Leading the way is ITM’s multidisciplinary Bacterial Infections in the Tropics (BIT) programme. It is dedicated to researching bacterial infections and their antibiotic resistance in low-resource settings.

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“What we see is that communication between the doctors and the laboratory is insufficient and even if the lab is there, it is often unexploited,” he says. “In low-resource settings microbiology labs are small; they often don’t have digital information systems; have the difficulties of stock rupture, power rupture, humidity, high temperatures, under-trained lab staff and a general lack in quality procedures. To this, you also need to add the cost of laboratory diagnosis and the reluctance of patients to sampling. This history makes doctors doubt lab results and refrain from the use of laboratory diagnostics.”

In May 2017, Jacobs co-authored an article ‘Implementation of quality management for clinical bacteriology in low-resource settings,’ published in Clinical Microbiology and Infection (Barbé B, et al). The research highlights how international programmes have strengthened reference laboratories

in the control of tuberculosis, malaria and HIV and recommends similarly strengthening clinical bacteriology quality systems to ensure best practices in addressing antimicrobial resistance.

“The research proves the answer to better exploitation of the labs has to be multidisciplinary and locally owned. It shows, the best work we can do is in focusing on local hospitals and helping management to bring their quality systems up to scratch with accredited programmes. This includes working with national regulatory bodies and reference labs,” says Jacobs.

Training of physicians and other hospital staff in good laboratory practices in clinical bacteriology is another critical ingredient in this work.

“By addressing the healthcare context in this way our projects look to increase quality standards and instate better working relationships. This should make for

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The research proves the answer to better exploitation of the labs has to be multidisciplinary and locally owned.

Prof. Jan Jacobs

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Issa Guiraud is verifying his research results in Antwerp with ITM’s Marjan Peeters

trustworthy results that doctors can use as pivotal tools in their diagnostic decision making. And in the case of bacterial infections this is good news as clinical lab results are crucial tools against antibiotic misuse.”

A SHINING EXAMPLE IN RURAL BURKINO FASO Meet Issa Guiraud, a PhD student who is studying antibiotic resistance in the community of Nanoro, Burkina Faso. A medical doctor, Guiraud works at the Clinical Research Unit of Nanoro (CRUN). This research centre was set up by another illustrious ITM alumnus, Halidou Tinto. Tinto began the clinic in 2008 with ten staff, it now has over 200.

Guiraud is an excellent example of how educating doctors in laboratory practices can help. “When I did my studies at the National University of Burkina Faso and we received the lab results I would look at them but with next to no understanding. Even

when you would go to the professors with the results they would tell you they weren’t right,” he says with a slightly embarrassed smile.

At CRUN this is di�erent – they have implemented quality systems and are training physicians on the labs and the value and dependability of their results. This is supported by a sound infrastructure with mains water and power (including a generator and a solar back-up system) that are necessary for the often temperamental bacterial cultures involved in diagnosing bacterial infection.

“I have worked in clinics and laboratories in Tanzania where they didn’t have confidence in the lab,” says Marjan Peeters, the microbiologist working with Giraud at the ITM reference lab in Belgium where he is verifying his research results. “CRUN is an exceptional local example. With its best practices it can have a lot of impact on other health clinics in its region.” # Dossier 13

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ITM AND HIV A NEAR 40-YEAR DIAGNOSTIC RELATIONSHIP When thinking diagnostics and ITM one area predominates – the extensive work done in diagnosing human immunode�ciency virus (HIV), since its discovery nearly 40 years ago. As a pivotal actor in HIV and AIDS research, including the Institute’s exposure of the African dimension of the disease, diagnostics have played a major part.

Up to last year, ITM was the only World Health Organization (WHO) HIV reference laboratory in the world. One third of the circa 30,000 HIV patients diagnosed in Belgium received their diagnosis in Antwerp and the Institute has evaluated hundreds of HIV tests for WHO and industry since the 1980s.

One researcher behind these years of testing is Katrien Fransen, Head of ITM’s HIV reference laboratory. Katrien started at ITM as a biology graduate in the 1980s.

After a period writing reports on natural sciences for government agencies, she was very pleased to become a part of a team where she could see direct results.

“We were very lucky to have Peter Piot so engaged in policy around HIV and AIDS starting in the 80s, it meant we could see how our work was impacting people and the public health environment. Helping

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patients through a very difficult situation in life has always been very fulfilling,” says Katrien.

When she started, Katrien produced the antigens for the diagnostic test – known as the ‘Western Blot’ – herself; one of the earliest tests available for detecting antibodies of the virus. “In the past, as a biologist coming from studying trees,” she recalls, “I just set to work on extracting the antigens in a security level 3 laboratory. Today it’s not possible – you have to go through strict exams to be able to work with HIV in the labs, things have changed!”

And this change is not only in the ways of working, HIV diagnostics have also evolved and continue to evolve.

“Today everything is about speed – rapid testing,” Katrien explains. “People can perform a first HIV test themselves at home after buying it from the pharmacy.”

But no matter the type of test used for this first serologic test – whether from an enzyme linked immunosorbent assay (ELISA), the Western Blot or a rapid diagnostic test – specimens testing reactive need to undergo another series of confirmation tests before the patient receives a final diagnosis that leads to treatment.

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Helping patients through a very di�cult situation in life has always been very ful�lling Katrien Fransen

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Choosing test combinations depends on the purpose of the testing and the prevalence of the disease in a given geographical area. WHO outlines a series of generic testing strategies for HIV. They give possible combinations using ELISAs, rapid tests or a combination of these. Testing algorithms describe the combination and sequence of specific HIV assays used within a given HIV testing strategy.

Along with these combinations, the specific diagnostic tool technicians choose changes regularly, for researchers and companies are always looking to produce the next generation of tests. That’s why Katrien and her team also provide quality testing of such new tools – reporting back

to WHO and providing analysis for the European quality registration label CE (conformité Européenne).

“Whatever certified assay is chosen, the important thing is that the results are as accurate as they can be in the given setting. Nobody wants misdiagnosis with such a disease – with all its social stigma and knock-on effects. Test results should only be shared with patients once we have undertaken the series of the serologic tests needed. Of course this is of utmost importance for us as a diagnostic team at ITM and it’s something we look to make our partners in resource-poor settings particularly aware of.”

SWAB2KNOW GOES EUROPEAN CATIE YOUNG Swab2Know is an ITM outreach programme for HIV using an oral �uid diagnostic swab test developed at the Institute. Starting in Belgium, it has since gained funding support of the European Commission and in 2017 has been rolled out in a further �ve countries across Europe. The programme is helping increase accessibility to diagnosis and care among the most susceptible.

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In arresting the spread of any infectious disease, knowledge and awareness are pivotal. Along with its clinical services, ITM is active in these areas for HIV. With its Swab2Know outreach and testing project starting in 2012 in Belgium, the Institute set out to reach the two most important European groups affected by the disease: men who have sex with men and subSaharan African migrants. With the initial project reaching its objectives well in 2014, the initiative continued with funding from

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the City of Antwerp and in 2017 expanded to five other European countries now under the auspices of the European Union project known as Euro HIV EDAT. Euro HIV EDAT looks to gain knowledge to improve HIV early diagnosis and treatment among vulnerable groups. It aims to increase the understanding of community based voluntary counselling and testing services and explores the use of innovative strategies based on new technologies in order to increase early HIV/STI diagnosis and treatment.

Swab2Know is such a community based testing service and therefore ITM received the coordinating role of the work package for surveying and piloting activities on innovative strategies and interventions.

“We started outreach activities for HIV and other sexually transmitted infections at ITM in 2007. Over the years we gained a lot of experience of how best to break down the barriers and increase diagnosis among susceptible groups,” explains Tom Platteau, sexologist and leader of the project at ITM. This experience included the development of the oral swab test by the ITM HIV reference laboratory, which grew out of a need for simplifying diagnosis as taking blood represented an access barrier for many.

Services then also developed to include a website where people could order tests online anonymously.

“These reiterations have provided a tried and tested outreach tool,” says Tom. “When we learned about the European project, we were happy to take on the

mandate of expanding Swab2Know well beyond Belgium,” adds Tom. Currently the Swab2Know website offers its anonymous HIV testing services to people in Belgium, Spain, Portugal, Denmark, Slovenia and Romania in local languages and in English. The European project is now successfully completed.

Each country is now responsible for their part of the website - ITM is continuing its Swab2Know efforts in Belgium.

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GEORGIA ON THEIR MIND

BRUNO MARCHAL AND ARIADNA NEBOT GIRALT CONTRIBUTE TO BETTER TB CARE IN GEORGIA

ROELAND SCHOLTALBERS Located at the crossroads of Eastern Europe and Western Asia, Georgia is a well-kept secret even to avid travelers.

Even less people would associate the country of nearly four million inhabitants with the Institute of Tropical Medicine, mainly because…well, it is not exactly tropical. Yet, ITM’s Bruno Marchal and Ariadna Nebot Giralt are engaging with Georgian health professionals and policy-makers to improve the care for tuberculosis (TB) patients.

TB is the world’s biggest infectious disease killer with nearly 1,5 million deaths per year. Most people affected by TB live in developing countries, but the disease is also common in countries that used to be part of the Soviet Union. Georgia has a high rate of new TB cases and treatment success rates are relatively low. Because of low adherence to treatment, more than one in ten TB patients are resistant to first line drugs.

“Georgia changed rapidly after the fall of the Iron Curtain,” explains Prof. Bruno Marchal, Head of the Health Systems Unit in ITM’s Department of Public Health. “The health system underwent a number of dramatic reforms, leading to a full-scale privatisation and deregulation of the health sector.” His colleague Ariadna Nebot Giralt adds, “Private-for-profit providers are responsible for most of the tuberculosis care and prevention. The long treatments that TB patients require are not necessarily a priority for them.”

In order to stimulate the private actors to better engage with TB care, Georgian policymakers have set their hopes on results-based financing (RBF). Georgian partner Curatio International Foundation decided to call in expertise to accompany this process. ITM, as well as the Queen Mar-

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garet University and the London School of Hygiene and Tropical Medicine from the UK, joined in for a 48-month research project. Results4TB will assist the government in developing a provider incentive payment scheme for TB. The project runs until 2021 and is funded by the UK Department of International Development, the Economic and Social Research Council, the Medical Research Council and the Wellcome Trust.

Bruno and Ariadna were asked to bring in their realist evaluation experience. “We help to gain a better insight into the policy process and the problems in TB care that need to be tackled. The strength of realist evaluation lies in developing a detailed and evolving hypothesis underlying the policy with the actors involved, comparing their views with the existing evidence,” says Bruno. “In the process, one starts to see that this is not a simple policy tackling a simple problem.”

Ariadna nods and pitches in: “We involved the policymakers in a detailed problem analysis, which made them see that RBF is only part of the solution. As a result, they broadened the policy to include other interventions, including in-service training and reorganising service delivery through task shifting, for example.”

It was a particular advantage that, unlike in many other cases, Bruno and Ariadna were involved from the very early stages to design the theory-informed intervention. They will also guide the overall design of the evaluation of the policy’s impact and cost, and of the mechanisms underlying it.

“Tracing the introduction of a new policy presents a number of challenges in itself,” Bruno concludes. “On top of that, what might seem like a straightforward policy actually intervenes in a complex health system. Results4TB will therefore also shed light on how realist evaluation fares in guiding complex interventions.” # ITM Story 19

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ECTMIH2017: WHEN ANTWERP TURNED TROPICAL The European Congress on Tropical Medicine and International Health (ECTMIH2017) took place in Antwerp, October last year. A biennial event, ITM organised this 10th edition together with its partners Be-cause Health and the Federation of European Societies for Tropical Medicine and International Health (FESTMIH). It was with pride that ITM and partners made Antwerp shine for the �rst time since the event’s inception.

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Here a taste of ECTMIH2017.

For the full story please see www.itg.be/ectmih

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<<REWIND

LETTING THE CATT OUT OF THE BAG ITM researchers developed the CATT – a diagnostic test for sleeping sickness – in 1978. Greeted with initial skepticism, it proved its e�cacy during an epidemic in the early 1990s becoming a welcome ally in the �ght against the disease over the last 40 years. The Antwerp Institute still produces and supplies the test to this day to countries and organisations in need.

As for many new things, when the CATT (an abbreviation for card agglutination test for human Trypanosomiasis) was first introduced health professionals were doubtful. Traditionally, clinical staff diagnosed sleeping sickness via its clinical symptoms such as fever, headaches, joint pain and mental disorders, and by the microscopic inspection of blood for the single cell parasites Trypanosoma brucei. However, in the late 1970s ITM Head of the Serology Unit Dr. Nestor van Meirvenne (far right in the group picture of his team) was convinced that alternative diagnostic methods could

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be more efficient. Together with his lab technician, Eddy Magnus, he developed the CATT providing a serodiagnosis of this debilitating and if untreated deadly disease, which would help in its control over the last 40 years in Africa.

Prof. Philippe Büscher, who is currently validating a new rapid test for sleeping sickness, remembers, “when I joined ITM in 1986 they were evaluating the test. The researchers had difficulties introducing it as the test detected infections in people who didn’t have any symptoms. Only when it became apparent that many more people than originally thought had the infection, did they start to get traction.”

It was during the epidemic of the 1990’s in Central Africa that the CATT was used in a large scale setting and it became accepted in the field as a key diagnostic instrument for sleeping sickness.

“Thanks to the CATT sleeping sickness in Africa was brought in check,” adds Büscher. “It allows the screening of 300

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to 400 people a day, to ensure treatment of the patients, to minimise transmission, and thus to bring an outbreak rapidly under control. Known cases were reported as around 40,000 in the 1990s — today reported new cases are down to 2,000. In this way the role of the CATT was very important in decreasing the prevalence of the disease very rapidly.”

As well as being a WHO Collaborating Centre for sleeping sickness, ITM is the only

producer of the CATT worldwide. Diane Jacquet and her team work on its production and continue to supply such clients as Médecins Sans Frontières, the World Health Organization, National Sleeping Sickness Control Programmes and the Drugs for Neglected Diseases initiative (DNDi). She has been head of the service for the last 10 years and her team have produced approximately 2,000,000 tests per year during that time.

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PORTRAIT MARIANNE VAN DER SANDE Dutch national Marianne van der Sande is the enthusiastic new head of ITM’s Public Health Department. P3 talked to her about working in sub-Saharan Africa and what energising public health at ITM means for her.

With her straight-talking demeanor, Marianne explains her excitement for her new job, “I’d been in my last job in the Netherlands for ten years, which I enjoyed very much, but when this came up I felt really enthusiastic about taking on something new which would also enable me to be connected to working with tropical countries again.” Marianne’s first taste of the tropics was at the start of her career. While working in hospitals in the Netherlands, she undertook missions with Médecins Sans Frontières in Sudan and Uganda. This led to four years as Medical Officer at the Sichili Mission Hospital Zambia, followed by 10 years as epidemiologist in The Gambia. Wanting to give her three children a European base for their schooling, her family returned to the Netherlands where she took up a position in public health.

From 2007 to mid-2017, Marianne was head of the Centre for Epidemiology and Surveillance (EPI) at the Dutch National Institute for Public Health and the Environment (RIVM). With her kids now happily on their own paths, Marianne felt it was the right time for a fresh perspective. “The field has changed a lot over the last 10

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“

As a smaller and more specialised Institute, a close connection between our departments provides an ideal situation for getting di�cult jobs done together. years but that is refreshing because I have things to learn and I’m interested to see how my current expertise in infectious diseases and public health can be useful again to the tropics.”

PEOPLE, NETWORKS AND INTIMATE SIZE The general mission of ITM’s public health department remains to ‘generate, disseminate and manage scientific knowledge relevant to public health in developing countries through research, postgraduate education and service delivery’. For Marianne, the key elements to fulfilling this mission are motivated capable people in strong global networks. She also sees ITM’s relatively small size as a competitive advantage in the global health arena.

“There are a lot of universities with global health institutes nowadays, so we need to make sure that our offering is differentiated. We can further strengthen the internal links between Public Health, Biomedical Sciences and Clinical Sciences. Universities have these departments too but they often each stand alone. As a smaller and more specialised Institute, a close connection between our departments provides an ideal situation for getting difficult jobs done together. Furthermore, a key competitive advantage for ITM are our unique long-standing collaborations in the South.

This can provide real added value,” Marianne says with conviction.

CONSOLIDATING ITM’S CONTRIBUTION TO GLOBAL HEALTH To build on this added value, the main external areas of impact Marianne would like her department to have over the next five to ten years include: making a visible contribution to global sustainable development goals and global health priorities; maintaining ITM’s position as a recognised and respected global partner in research, education and capacity building; contributing to improve health in low- and middle- income countries through the development, implementation and dissemination of appropriate, acceptable, innovative, effective and efficient interventions.

To make this a reality she “wants to keep building on our positive history”. This means continuing to focus on improving health through a multidisciplinary approach. This is already well reflected in the Department of Public Health team, made up of epidemiologists, as well as social and political scientists. In this she recognises the importance of motivation and dynamism within her team. “You need to ensure that colleagues feel respected in what they are doing and that they are acknowledged for their contributions – this allows people to feel energised. I know that if we can combine this with good work across departments and with our partners in the North and in the South, I think we’re going to do very well,” she adds with a smile. # Portrait 25

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HOW TO SURVIVE AS A JAPANESE EXPAT IN ANTWERP NICO VAN AERDE

FISH

Bioinformatician Hideo Imamura has been working at ITM for eight years, analysing data for molecular parasitology, veterinary protozoology and malariology projects. He is currently working on a project to detect the presence of the Leishmania parasite directly from a patient’s bone marrow instead of having to culture it in the laboratory.

‘Zeevishandel De Eendracht’ Hoogstraat 53 2000 Antwerp

According to our colleagues, Hideo also is an excellent sushi cook. Sushi is gaining popularity in Belgium, with many people trying to make it at home, so we thought we would pry loose some of his secrets on where to find the best ingredients. As an added bonus, Hideo also divulged where to find the best Japanese restaurants.

Like many Japanese, Hideo learned how to make sushi at home, watching his mom cook. He laughingly mentions that making sushi is not all that difficult, and that the instructions are actually displayed on most sushi vinegar bottles. The main difficulty is finding fresh ingredients.

Hideo buys fresh salmon and occasionally tuna in De Eendracht, which he considers the best fish store in Antwerp. Fresh tuna is not available year-round. Hideo insists that the use of liquid nitrogen to freeze fish instantly is the best way to obtain frozen fish.

SEAWEED Any store in Van Wesenbekestraat 2060 Antwerp The Van Wesenbekestraat is the beating heart of the Chinese community in Antwerp. The local stores carry many Asian ingredients, however, and certainly do not limit themselves to Chinese food. For seaweed, Hideo advises to shop around, as the prices vary wildly from store to store.

SUSHI VINEGAR ‘Seing Thai Supermarket’ Van Wesenbekestraat 28-32 2060 Antwerp Hideo has one address for sushi vinegar: the Thai grocery store in the Van Wezenbekestraat.

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SUSHI RICE ‘Tagawa’ Chaussée de Vleurgat, 119 1000 Brussels Sushi rice can be found in almost any local supermarket, but when Hideo wants to go the extra mile, he buys sushi rice from the Japanese-run Tagawa in Brussels. Hideo warns us that it can be expensive, with prices running twice as high as in Japan.

VEGETABLES AND SEEDS Any local store Cucumber, water cress and sesame seeds can be found in any local store. For smaller cucumbers, Hideo does return to the Van Wezenbekestraat.

NOTEWORTHY JAPANESE RESTAURANTS IN ANTWERP Let’s face it, we don’t always feel like cooking ourselves. Hideo made a list of Japanese restaurants he’s most likely to go to in Antwerp.

KIOKU Oude Vaartplaats 47 2000 Antwerp Kioku offers decent and well-priced Japanese and other oriental dishes.

MINATO Vlaamsekaai 61 2000 Antwerp

I RO HA Haarstraat 8 2000 Antwerp Hideo seems especially fond of this restaurant in the centre of Antwerp, serving a variety of traditional home-made dishes.

IZUMI Beeldhouwersstraat 44 2000 Antwerp Izumi is a more expensive restaurant but the dishes come well-recommended. The ingredients are brought over from Paris and the cooks have been trained in an exclusive cooking school. It’s a favorite lunch place of local business people.

Authentic Japanese food, not limited to sushi.

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Š World Health Organization

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ITM & I DIRK ENGELS Dirk Engels has recently retired from the World Health Organization where he was Director, Control of Neglected Tropical Diseases. Dirk talks of the common thread ITM has formed throughout his career.

public health in a practical way in my first roles in low resource settings. It was there that the realities of the field, hard work and my polyvalent ITM education met to shape my ability to create long-lasting local health programmes.

My passion for tropical medicine started at a very early age. It must have been the missionaries at my Belgian school and their stories of helping people abroad that awoke my initial curiosity. The interest stayed with me throughout my medical studies, which is when my relationship with ITM began. Many of my professors at university said that, as a good student, I should do another form of specialty. But the then director of the Institute Luc Eyckmans advised me that, if I was passionate about tropical medicine, it was what I needed to do. I’m very glad I followed his advice because it has helped me to shape a very fulfilling career in Neglected Tropical Diseases (NTDs).

I also have a personal attachment to ITM through my professional relationship with Bruno Gryseels. He introduced me to a job in Burundi, where I closely collaborated with him in the Netherlands, and he later hired me to work at ITM in 1997, where we set up the Master in Disease Control.

This experience brought me to my biggest step – working on a global scale for the fight against NTDs with the World Health Organization. Here I proudly contributed to establishing a practical road map for NTDs, and was able through the London Declaration of 2012 to forge informal alliances that have been invaluable in ensuring large scale public health programmes for NTDs that currently reach over a billion poor people. All this originated from ITM. I therefore consider it as my ‘home institution’ that has provided a common thread through my career.

The education I got in my Diploma of Tropical Medicine and Hygiene at ITM gave me a holistic view and has allowed me to tackle

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CALENDAR 22 April

Antwerp 10 Miles

27 May

Sound of Science Festival

9 Sep

Open Monument Day

25 Nov

Flanders Science Day

5-7 Dec

59th ITM Colloquium on Antibiotic Resistance, Cambodia

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