This has been the busiest week of my stay which has now finally come to a close. I realised that I have a lot of things that I need to do before I leave and believe me you I have again forgotten to do many of them…

Monday:

We did some laboratory experiments - some usually take a whole day and I was able to appreciate what a sample of dead cells looked like on flow cytometry and how frozen samples sometimes behave, and will look out for that in the future. It looks like not much work but what usually takes time is labelling with the antibodies, incubating and especially for the antibodies which have no florochrome the process is long.

The new tram line has been opened and it leads to a very extraordinary version of the new city. I was able to visit the grand arena where gigs and comedies take place called the O2. It staggering in its beauty and I did plenty of sightseeing.

Tuesday:

We started off with a journal club and it was a good chance to see and be part of a journal club here. It is really different from the methods we use for this exercise. Here everyone gets at least 2 journals and chooses a recent paper form each and they discuss them - we were 8 people in attendance, so you can do the mathematics. You really get vast information in such a short period of time. In the afternoon we sat down to do all the flow cytometry analysis we have been doing and we worked on it till 5pm - it was a hard task.

Wednesday:

I gave a talk in the department concerning my Masters thesis and the work on Pediatric Immune Reconstitution Inflammatory Syndrome. We all enjoyed the session, which generated a fruitful discussion and we hope to form future collaborations so as to try and elucidate the immunopathogenesis and probably endeavour to get tighter and tighter. At the end of the presentation one of the doctors said that they had actually admitted an African lady intensive care unit that day with TB-IRIS!!! And she was fighting for her life.

I was able to visit the children’s hospital at Temple Street. I was given the tour by a paediatrician called Ronan who actually worked in Uganda at Joint Clinical Research Centre. It was a fantastic tour and I was able to see him recruiting study patients for his study and doing the consent and phlebotomy. He also showed me the Rotunda Maternity Hospital which is the second oldest in the world. 

I also attended the Christmas fair in Dublin near Connolly station and it was very lovely.

Thursday:

I had lot errands to run but I was still able to prepare some PBMCs - finally. Enda told me a postman had foreseen snowing by the end of this week and I was wondering and doubting his ability to predict snow and low and behold I saw my first snow shower in the evening.

Friday:

Today it is Friday – my last day. It is a beautiful morning with snow all over the place. At least I have been able to see snow! I have really partied this week. Every evening since Monday I have had a wonderful evening out with friends and colleagues. I have had a fantastic time and it has been a time well spent. I know we have started many collaborations. Bravo CDPC…Mwebare munonge nembendeza Nohiri nungi nomwaka musya murungi!!!!!!!!!!

The last week has passed by so quickly. It has been a very busy week, especially in the laboratory and training area.

Techniques and strategies in Molecular Medicine

I was also able to attend a spectacular training session at UCD’s Conway Institute, where I focused on several techniques and strategies. The training covered a vast array of scientific techniques and gave me much food for thought as to my future Ph.D studies, in which I intend to focus on infectious diseases and immunology; specifically, I hope to focus my research on immunopathogenesis of Pediatric TB-IRIS in HIV infected children on ART.

The techniques taught at the Conway Institute’s training session included: RNA detection and quantification, differential gene expression and overview of relevant methods, polymorphism association with disease, model organisms, DNA cloning strategies, transgenics and knockouts, RNA interference, determining protein, protein interactions in biology, protein expression and purification, mass spectrometry, expression proteomics, biochemical applications, immunodetection methods on cell and tissue extracts, cell imaging and sorting, flow cytometry, imaging using fluorescent/confocal microscopy, high content analysis of nanoparticle/cell interactions, stem cells-biology and applications.

The brilliant talks were given by specialists in these fields and the whole thing was quite fruitful. The keynote public lecture was on structure-based systems biology of insulin and IGF-I receptors signalling, by Prof Pierre de Meyts from Hagedorn Research Institute. You can imagine it was an intensive hectic two-day workshop!

Lab work with Enda

We have started working on the frozen HIV PBMC samples where we have to rapidly thaw them followed by counting the cells. It has not been easy as the samples kept in nitrogen can be disappointing, however the controls have not given us such trouble. Some of the samples (after thawing) showed insufficient cells and others showed that the cells were dead, which meant the sample was lost. However, we have learned that working with frozen samples is not usually as exciting and straightforward as with fresh samples. We also prepared fresh PBMCs and we shall be using them on Monday for full experiments. I will be looking forward to a busy last week!

CDPC workshops

I have managed to attend seminars this week so as you can gather it has been a busy one. The first seminar was on Phylogenetics and Justice: HIV infection at the Intersection of Science and Law. The first lecture featured Edwin Bernard (writer and activist with GNP+, IAS, NAM, NAT and UNAIDS), who gave a lecture entitled 'HIV Forensics: from the lab to the courtroom'. This was followed by a lecture from Stéphane Hué (University College London, Division of Infection and Immunity), whose lecture was entitled 'Investigating HIV transmission: a molecular approach'. These two lectures generated a lot of discussion, especially in terms of the gray areas of HIV- for example, if you infect another person with HIV this may be categorised as a crime and the law might need to intervene. However, I was of the opinion that this may result in drawbacks as far as positive advances made in HIV prevention are concerned, as it might become a source of stigma once again. It may also be very difficult to prove someone’s guilt in such an instance and would necessitate encroaching on and unnecessary exposure into private lives. I also saw that it may be practical in a few instances like ‘sugar mummies and daddies’ who entice young people with tokens and through these means, have cross-generational sex which usually results in unprotected exposure of these desperate youth who may contract HIV and/or other sexually transmitted diseases. However, in the usual instance it is cheaper and more practical to aim education at a wider audience so that one is empowered to make an informed and responsible decision as far as HIV transmission is concerned.

The final workshop this semester was on Saturday; the topic was “In Search of the Woman in the Body across Africa: Anthropological Perspectives on Gender, Health and Development”. This was held in John Hume Building, NUIM, and we had three female presenters who were all knowledgeable in their field. The main theme that came out of this workshop was the reasons why it more difficult to empower women in Africa and we realised that we need to understand the context of the culture one has been brought up in, the pressures of the demands it poses on her, education levels, religious beliefs and women’s own self-expectations.

Weekend:

I have really been busy summarising my stay in Ireland and also planning for another week that will be very exhausting as I still have a lot to do and complete. It has also given me a time to go slow and reflect on what I have learnt, what I will immediately utilise and what I will use later on but mainly share with other colleagues with the aim of improving our diagnostic investigations and more so research and then see how they can be replicated or transformed into better patient management, as that is my sole aim of research and studying.

I have also followed the finals of The X Factor - I have been an ardent watcher of the show over the weekend and watched the final episode which saw Joe as the winner. I wasn’t that thrilled as I really thought that Daniel and Stacy had and still had what it took. Joe is kind of predictable and same style and nothing strikingly knew – but, that is what the people voted for. We shall take it as that. It has been really very entertaining to watch an interesting show with surprises of aspiring stars with very minimal talent. It gave me a nice laugh from time to time.

On a good note am also looking forward to go home I really miss home and my family, my ward, my normal routine like nyama choma at car wash in Kigali, the happening times in Kampala and the warm friendly sun!

The 1st of December has been declared World AIDS Day, a day dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection. It is common to hold memorials to honor persons who have died from HIV/AIDS on this day. Government and health officials also observe the event, often in the form of speeches or forums on AIDS-related topics. Since 1995, the President of the United States has made an official proclamation to commemorate World AIDS Day. Governments of other nations have followed suit and have begun to issue similar announcements. This is when stakeholders of HIV/AIDS in different countries take stock to see how far we have gone in fighting HIV on all fronts and establishing what needs to be going  forward for the coming years.

On World AIDS Day this year, there were HIV updates in the headlines in Ireland stating that there has been a 20% rise in new infections compared to the previous year. This is not good for Ireland’s youth, who are sexually active with high risk behaviour and lack knowledge about HIV and STIs.

My day began when Neema arrived at my house at 7. 45am so that we would walk to the bus stop in Maynooth. Patsy Toland would collect us here to travel to Carlow to do another full day of Development Education workshops. We were collected, and off we went. We gave the usual HIV/AIDS quizzes to secondary school students. It came to my realisation that this time, some of the children actually had their facts, and this prompted me to ask them the source of their knowledge. It was really interesting to run workshops with such a group because it became more interactive; interestingly, they were more attentive and would ask questions spontaneously. I actually found out that their Bible teacher usually takes time to educate them as far as HIV is concerned on a regular basis, rather than the once a year, 30-minute talk which seems to be common in secondary schools and is easily forgotten.

The workshop culminated by raising the red ribbon for HIV to commemorate World AIDS day as a symbol of commitment to fight against AIDS.

I have had a really lovely time and memorable stay so far in Ireland and have tried to keep myself busy over the last few weeks. One of the best social activities of the recent past was going with Hayley to watch a  Canadian band called Great Lake Swimmers perform in Dublin – although the night rushed past very quickly and before I knew it I had to be on the last train to Maynooth.

Great Lake Swimmers in Dublin

The last week has rolled by really fast. At the beginning of the week I attended a two-day Irish Flow Cytometry Society conference which had a strong international presence. I had the pleasure of listening to the details of interesting scientific work which has been completed recently, and some of the presenters were students from Derek’s lab. The conference was at the National Science Gallery, Trinity College. Flow cytometry is one of the techniques I am doing at the moment. In my next blog I will write about the lab work in detail.

I also received the Young Investigators Award to enable me to travel to San Francisco in February to attend CROI 2010 (Conference on Retroviruses and Opportunistic Infections) where I will present an abstract from part of my research findings during my masters programme. The CROI is a large scientific gathering where renowned scientists present their work. This is a big achievement for me and I hope to meet colleagues in the area of pediatric infectious diseases and possibly form research collaborations with them.

School workshop

On Sunday evening, Neema (my Tanzanian counterpart) and I travelled to the countryside by train and went to Joseph Clowry’s house, where we spent the night. We planned our talks for outreach that evening and it was nice to sit in front of a traditional Irish fire trying to keep warm: this gave me a nostalgic feeling. We also spent time talking with Joseph about some of the ‘culture shock’ that we have felt when we arrived in Ireland and had a good long chat.

In the morning we woke up to the usual Irish rain and set off to the parish centre in Carlow where we were to hold the workshops. The group consisted of Patsy Toland (Self-Help Africa), Darren, Neema, Joseph and I. The workshops were on developmental education which is being slowly introduced in Irish schools, particularly through conducting workshops. This is a forum whereby Irish students are exposed to international issues such as human rights, war and conflict resolution, diseases and poverty. This particular day’s topics were: peace and conflict in Israel and Palestine, focus on development and HIV/AIDS. The children came from two secondary schools: Colaiste Lorcain and Knockdege College, a boys’ boarding school. Introductory remarks were given by Patsy, who spoke about the choices that are made daily and the possible impacts they have on developing countries.  For example, there are big factories in the world which, in some developing countries, have really failed to recognise the rights of their workers.

We were later divided into three groups to attend the three workshops for the whole day. My group was made up of Joseph, Neema and I. We began with the first group, and I gave the workshop assisted by Joseph. We started off by asking very simple questions, such as: what does HIV/AIDS stand for, how can you contract the infection? Do you think someone suffering from HIV infection is skinny? To be honest these children had no idea about HIV and some thought that HIV can be contracted by being bitten by a mosquito. This left me wondering how there can be such a lack of knowledge of one of the biggest pandemic diseases in history – one which is mainly fuelled by social circumstances, is difficult to prevent and is currently rising again - not in Africa this time, but in Europe! Will these children and many more like them make wise choices to keep themselves safe? I really think the education system needs to urgently incorporate such topics in order to strengthen their effort against new and unnecessary HIV infections, especially in light of the economic recession.  For a country that is at the forefront of providing support to Africa as far as HIV/AIDS issues are concerned, the least it can do is to educate its own young generation about the basics of HIV, as they are so vulnerable to contracting the virus through such a profound lack of knowledge.  I strongly believe that this lack of knowledge of a crippling and yet preventable disease should be urgently addressed because this is a fertile ground for fuelling a new and more deadly HIV upsurge. Globalisation, coupled with high sexual activity in the young generation (as we know in 2007 the age group with the highest transmission is 15 – 25 years), means many are bound to fall victims of HIV and thus suffer its devastating effects.

Given that the highest increase of HIV infections have been occurring in Eastern European countries, and with the open borders of the European Union, these unequipped teenagers will fall prey to HIV when it could have been prevented by education.

The other issue that I found really odd was the fact that secondary schools do not have collaborative interactive programmes - I was under the impression that they all work in isolation and I really see this as a source of immerse weakness as there is little opportunity for maximized youth interaction. Young children can teach each other better through debating clubs, games, such as soccer competitions, music and even social events between schools which can act as a platform for new friendships and academic excellence. Young children from different schools in the same area really need to interact and this would be fruitful if planned regularly.

I would like to congratulate the different groups and organisations of people who are involved in developmental education, and would like to see this change of knowledge acquisition amongst the Irish children. I hope that they are given support for their noble cause.

Derek’s Laboratory at Trinity College

I’ve had the privilege to study under Derek Doherty, an immunologist at St James Hospital, who has a rich diverse experience. It has been a productive week, crowned with attending the 12th IMM Conference in the Molecular Medicine Institute. I was introduced to Derek by Dr Noel Murphy about 3 weeks ago and I begun my training using flow cytometry immediately. I had always thought it to be a straightforward technique until I started doing it myself! It has transformed my knowledge and skills and also led me to realise that flow cytometry can be used in various ways to avail of information that can be utilised to enrich patient management and research. I am now ready to start on the formal research, where Derek’s group is interested in V gamma delta T-cells in HIV and Hepatitis B and the cytokines produced by this small T-cell population. Through this hands-on exposure, I will be utilising the experience to aid me in designing and streamlining my PHD proposal, and thus in the long term it will direct me on the academic journey I have always wanted.

8^th Nordic HIV Conference

The previous week, I attended the 8^th Nordic HIV conference at Croke Park Conference Centre – the home of Irish football. The theme was ‘Positive Living: Healthy Body, Healthy Mind’. It was a turning point in my medical career: I met with the Author of ‘Still standing the Irish story of HIV and Hope’ and it was wonderful to listen to an Irish view of coping with being an Irish HIV-positive mother with children to look after and to disclose to. It was lovely to meet such a brave woman. I also had the wonderful opportunity to listen to a beautifully delivered and eloquent speech concerning HIV, especially the stigma surrounding it from Her Excellence the President of the Republic of Ireland. She also spoke about breaking the barriers of stigma of HIV with respect to travel, and highlighted how President Obama was committed to lift the travel ban on HIV positive people. It is at this point that I learned that for all these years the USA, a major supporter of developing countries as far as HIV is concerned, actually also practices double standards. You could imagine how shocked I was to come to the reality of such marginalisation. This actually left me perplexed and this has led me to further believe that people living with HIV are the best advocates concerning their plight and all we can do is support their effort.

12^th IMM Conference

This was held at the Institute of Molecular Medicine at Trinity College where I listened to top researchers at Trinity, who are also top international researchers in their field, present their magnificent work. What I realised is that the intricate teams of researchers were made up of a diverse group: for example, collaboration involved students at Masters, Ph.D and post-doc level, as well as professors at the highest level, all working and collaborating with other related groups. What I would like to communicate to principle investigators in developing countries is that we need to learn to work together in a friendly manner and have a relationship which will allow us to develop great ideas. We also need to learn to appreciate the important position of students in this respect – for example, Masters students involved in research. I know many postgraduate students in Africa will share a similar experience whereby going through postgraduate studies has been stressful, and coupled with minimal or nonexistant guidance, this leads to the cultivation of a population of copper-bitten intellectuals, many of whom will themselves become academics in the future. You can stretch your imagination to establish the position of students who will happen to be under that particular individual taking into account their background training. But I hope that through these collaborations we see a new breed of professors and lecturers who love themselves and thus will easily work with others for the common good and for good research standards. What I have learnt from this is to be a good teacher. The State of the Art talk was delivered by Prof Esther Sternberg, Head of Neuroendocrine Immunology and Behaviour at National Institute of Mental Health, Bethesda, USA. She has written a book called ‘Healing Places: The Science of Place and Well Being’. This important and beautifully written book shows that contemporary medicine has made the same fundamental error about healing and shows how powerful situations and spaces can be in moving people from illness to health.

Kilkenny Castle

As usual I joined the International Students society of NUIM (which I belong to) to travel and visit the city of Kilkenny. I visited St Mary’s Cathedral, which was magnificent and imposing. It is a beautiful piece of art. I also visited the Dominican Black Abbey which is said to have been set in the heart of the ancient kingdom of Ossory. It is about 700 years old and has withstood difficult times.

I also visited the Cathedral Church of Saint Canice, which is also an old church built so beautifully set opposite the Kilkenny Castle on a distant hill.

I also went to the Christmas market which was bustling with happy Christmas shoppers carrying heavy bags. It was a peculiar sight for me because it was like Christmas was tomorrow.

Kilkenny Castle was my last stop visit of the day. It is such a magnificent and dramatic castle, standing in a strategic place and imposing itself over the whole city. It is on the banks of River Nore which runs through the city. It has existed for over 8 centuries and the original Anglo-Norman stone castle was built for William Marshal (the 4^th Earl of Pembroke) who actually opened the Dominican Black Abbey. In the 13^th century it became the residence of the powerful Butler family for the last 600 years. I just wondered how this family could stay in such a magnificent castle for such a long time with different changes of power during those unstable times. Looks like they always changed sides for their safety. We had a tour inside the castle and unfortunately I have no photos to share as photography is forbidden. This really again struck me that in such day and age photography is forbidden like you are on an American army base or embassy. Needless to say the interior was magnificent, done in a gothic style and lavishly furnished, portraying the elegance and style that changed with the fashion of the day. It is possibly still in my memory. Finally we made it back to watch the decisive match between Ireland and France for World Cup qualifications and we all know what happened at Croke Park.

Judy and Laura in Kilkenny