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Vital Signs

Student had 37 million reasons to do film project

By Kelley Meck

What does cinematography have to do with fighting illness? If you're second-year DMS student Aimee Peck, the answer is "Everything."

During the summer of 2007, Peck teamed up with award-winning filmmaker Aaron Edell, who happens to be her fiancé, to produce a documentary in Tanzania on a nasty tropical disease—African river blindness, also known as onchocerciasis.

Worms: The disease, which occurs near fast-flowing rivers, especially in remote African agricultural villages, is caused by the parasitic worm Onchocerca volvulus. Its larvae are spread by the bites of simulium black flies; the larvae live in nodules under the human skin and mature in about a year. A single adult gives birth each day to thousands of microscopic worms, called microfilariae. As the microfilariae travel beneath the skin and through the blood, they cause extreme itchiness and pain, skin lesions, inflammation, and seizures; over the years they canmigrate to the eyes, causing scarring and eventual blindness.

Drug: The 30-minute documentary, titled 37 Million and Counting, aims to raise awareness about efforts to treat the disease in the 37 million people worldwide infected with it. Since 1988, the pharmaceutical firm Merck and Company has been donating a drug called ivermectin to affected countries; the company intends to provide the drug as long as it's needed. It does not kill adult worms but keeps them from producing offspring and paralyzes the microfilariae.

Peck, right, chats with a district coordinator who wishes he had a four- wheel-drive truck to reach distant villages.

The microfilariae cause
extreme itchiness and pain
and skin lesions.

So patients need to take a dose once a year for up to 20 years, until the adult worms die. Peck filmed the documentary in Tanga, a region in northern Tanzania, where a community based treatment program has been successfully distributing ivermectin. "Right now, onchocerciasis is relatively well-controlled in Tanga," Peck says, even though "at least three districts in Tanga are onchocerciasis-endemic and 200,000

people have been identified as needing treatment."

Foot: The film highlights the heroism of people at all levels of the distribution chain—fromthe director of the national onchocerciasis clinical program; to regional and district coordinators; to village-level distributors, who travel on foot to car ry the drug to all infected individuals in their communities, including many who live miles from the nearest road. One district coordinator tells Peck he could do his job better if he had a four-wheel-drive truck instead of a motorbike. And a village distributor wishes he had rain boots to keep his feet dry during the rainy season, when he hikes for days on muddy paths. The distributors often leave their jobs, sometimes for weeks, to get the medicine to those who need it. "They're not working in their fields, so they're losing money," Peck says. Sometimes they can't afford to eat. "They have the bulk of the responsibility formaking the programa success, and yet they're doing it on an empty stomach."

Blind: But if the distribution system were to fail for even a single year, the microfilariae would survive and people's symptoms would return. Prior to the 1988 program, in areas where the disease was endemic, up to 60% of the population was infected and up to 10% of those infected were blind. Now, the blindness rate has fallen to less than 1%. DMS was "instrumental in getting me the support I needed to make this project happen," says Peck, who expects that the film will be ready for release sometime in early 2008.

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