Tokomeza Kichocho!

Yesterday I learned that Zanzibarians don’t mess around when the second Vice President of Zanzibar (yes, there are more than one) comes to visit. The launch of ZEST has been building for months, and yesterday it culminated in dancing, singing, speeches and laughter. T-shirts and hats were even made just for the occasion.

Pemba is not a well-developed island, but its inhabitants are just as colorful and welcoming as the tropical environment. School children flooded into the Public Health Laboratory’s compound, filling the lawn with school uniforms and brightly patterned head scarves. There were more kids than adults, but the younger generation stands to benefit the most from knowledge spread about schisto, or kichocho.

When the Vice President first arrived, it was a remarkably quiet event. He shook the main players’ hands and took a tour of the newest building on the Public Health Lab’s campus after a brief unveiling and ribbon-cutting ceremony. A demonstration of ZEST’s activities was then given in the labs, complete with cups of urine, a microscope showing worm eggs and a dose pole.

The second Vice President reveals the new building's plaque upon arriving.

I’m not going to list all of the big names who attended, but there was great representation from each of the partners involved in the project, from WHO to the Schistosomiasis Control Initiative. The speeches delivered (those in English) were a mixture of history and praise for the partnerships that allowed ZEST to develop.

“The eyes of Africa are now on Zanzibar,” said David Rollinson of the Natural History Museum in London.

Zanzibar is indeed now under a magnifying glass. But why is elimination such a big deal for Zanzibar, and what will the program’s importance be concerning the future of schistosomiasis research and planning?

If schistosomiasis is eliminated in Zanzibar, it will be the first time the disease has been eliminated in Africa. Although other African countries have managed to substantially reduce prevalence, even to only a few cases per year, none have managed to interrupt transmission completely. The goal of ZEST is to eliminate schisto as a public health problem on both islands, followed by the interruption of transmission so that there are no more new cases. And since more than 90 percent of schisto cases are found in sub Saharan Africa, the elimination of the disease in Zanzibar would be a major step forward in determining how to do it elsewhere.

Zanzibar seems to be the perfect candidate for schisto elimination; it has already greatly reduced its burden of malaria and lymphatic filariasis, it has great support from local leaders, and it has a demonstrated ability to utilize partnerships in health improvement.

But the main point of the project is to determine what the next step should be after successfully sustaining control of schistosomiasis, says Daniel Colley, SCORE Secretariat Director. It’s not enough to eliminate the disease; researchers should be able to show how they did it. And while an entire country may not have the resources or ability to follow those guidelines, perhaps a district or smaller area can manage to rid itself of the burden and rebuild the community’s health.

A word of warning was issued, however. “Elimination does not mean that you can walk away,” said Colley. If the program does yield a model for others to follow, it’s important to remember that elimination won’t stick if surveillance and reporting aren’t kept up afterward.

ZEST will no doubt be a learning experience for those involved, both members of the public and researchers. But the success of that experience will depend upon continued collaboration, the acceptance and involvement of the community, and understanding what elimination really means in the long-term.