The weather has been strange today, hot and sunny and then cool and rainy. February tends to be the hottest month in Rwanda, but I was told this year has been very different – we can thank Global Warming for that.
Our activities today included capturing Don Warren, ND (My Dad ) on video to tell his story as it relates to the selenium HIV/AIDS trial, a lunch meeting, and getting the Selenium bottles from the warehouse to Kibugabuga Hospital.
I think you might be interested in knowing a bit about Selenium. Selenium is a trace mineral that is needed in our bodies to keep our immune system healthy. A Medical Geologist found that the countries that had the highest levels of HIV/AIDS were countries that had the lowest levels of selenium in soils. Selenium, when in the soil is absorbed by plants. As people consume food grown in these soils, they receive the needed trace mineral in their diet. However, if Selenium is lacking in the soils, like in Sub-Saharan Africa, people will be deficient of this needed mineral in their bodies, thereby weakening the immune system.
The Selenium Supplementation Clinical Trial is a double blind controlled study that will determine if this hypothesis (the relationship between Selenium and HIV/AIDS) has merit. HIV/AIDS, if you don’t know, is a virus that can be transmitted from person to person that attacks the immune system. The reason HIV (Human Immunodeficiency Virus) is so devastating is because it not only attacks the immune system, but the virus continues to multiply. A person can live a relatively normal life with HIV if they have a strong immune system, but when the immunity of a person is weakened a person with HIV will move to what is called AIDS (Acquired Immune Deficiency Syndrome).
People do not die from HIV but they will die of many diseases that attack the body when the immune system is depleted (AIDS), and their body is attacked with opportunistic infections that they can no longer fight.
Anyway, back to the Selenium Supplementation Trial. The clinical trial requires participants (300 total participants form 3 HIV/AIDS clinics in Kigali) who are HIV positive to start a regiment of selenium supplementation. Some will take Selenium and some will take a placebo and no one except that manufacturer knows who is getting what. This is what makes it a double blind study. Over the course of two years the clinics will conduct interviews and receive data that will include blood tests (CD4 count, viral load), quality of life, and general health. (I know you wonder about the ethics of this and to put your mind at ease this study has passed through the review boards of The Canadian College of Naturopathic Medicine, Wilford Laurie University and the Rwandan Ethics Review Committee.) Also, at the end of the study, each of the participants will be given Selenium for one year and no participant will go untreated when their CD4 count falls to a dangerous level. Just in case you were wondering?
Ok, so now I am talking a bit more technical, (don’t let me fool you that I am this smart, I have had to learn this stuff) so let me describe the CD4 count. Your immune system contains different types of cells that help protect the body from infection. One of these types of specialized cells are called the CD4 or T-cells. HIV attacks these types of cells and uses them to make more copies of HIV. And in doing so, HIV weakens the immune system, making it unable to protect the body from illness and infection.
Early in the course of the disease, the body can make more CD4 cells to replace the ones that have been destroyed by HIV. Eventually, the body can’t keep up and the number of functioning T-cells decreases. As more and more CD4 cells are destroyed, the immune system becomes more and more weakened. Eventually, the weakened immune system leaves the body at risk for infections. By measuring the CD4 count we can see if Selenium is helping protect the T-cells and therefore protecting the body from getting infections.
Seroyal, who manufactured these supplements, donated the Selenium for this Trial. To bring the Selenium into the country it had to be received and stored by a Rwandan Government Agency called CAMERWA that oversees all drugs and supplements that enter into the country. Jean Claude is a pharmacist and one of the co-investigators of the Rwandan Selenium Supplementation Trial (RSST), and is the commercial director of CAMERWA.
The Selenium will be stored at CAMERWA and will be distributed to the hospital and clinics from there.
Someone that you have not been introduced to as of yet is Heather Fay. Heather is a New Hampshire native, and is working with the RSST team in Rwanda as the Clinical Study Manager. She attended Johns Hopkins University in Baltimore, MD and received her Masters of Health Science in Epidemiology. She has experience living in Africa and experience with international public health. She is a great asset to the team.
Next week we will be doing some more “The Story of Water” work. We will be going to a sanitation and hygiene training at one of the new water pump sites. Clean water is only half of the issue of water born disease, proper hygiene and sanitation is the other side of this and it will be important to tell this part of the story.