Ologies with Alie Ward - Bilharziology (BLOOD FLUKES) with Anouk N. Gouvras

Episode Date: January 19, 2021

A LOST EPISODE! Three years in the making, this interview features vials of vile creatures, worm drama, febrile hallucinations, spooning, and unfortunate snacks. It has waited a long time to meet you, so let’s get weird, take a trip back to summer of 2017 -- before Ologies existed -- and unearth one of the very first, never-before-heard interviews. Alie absolutely bungles her way through a chat with Dr. Anouk Gouvras, a London-based parasitologist studying the flatworms that cause schistosomiasis. Consider this an awkward baby photo of Ologies: before the show had any format or structure, and before your host learned how to properly use sound equipment. Stay tuned for a surprise ending to the conversation, and then follow Dr. Gouvras on Twitter and tell her you’re glad to finally get an introduction. Follow Dr. Anouk Gouvras at Twitter.com/SciAnouk Sponsor links: www.alieward.com/ologies-sponsors A donation went to the The Global Schistosomiasis Alliance: eliminateschisto.org More links and info at alieward.com/ologies/bilharziology Become a patron of Ologies for as little as a buck a month: www.Patreon.com/ologies OlogiesMerch.com has hats, shirts, pins, totes! Follow twitter.com/ologies or instagram.com/ologies Follow twitter.com/AlieWard or instagram.com/AlieWard Sound editing by Jarrett Sleeper of MindJam Media & Steven Ray Morris Theme song by Nick ThorburnSupport the show: http://Patreon.com/ologies

Oh hey, it's the ghost of podcasts past. Allie Ward, I am bringing you an early lost episode from 2017 for today, 2021. I never ever ever thought I'd air this one. This one was dead to me. It has been sealed tightly in a vault for three and a half years in shame. It's one of the very, very first interviews I ever did for ology is before the podcast even really existed, before there was like a format, before I figured my shit out, before any pandemics, and definitely before I knew how to use sound recording equipment. And so I need to warn you, if this is your very, very first episode of ologies you're ever listening to, please go away, just stop, just put a pin in this episode, turn around, pick another episode. Okay,

ologites, people who have been around long enough to know all my secrets and call me dad, this one's for you. This episode, again, dead and gone. Every time I thought about this interview, I cringe. And even like now, I literally got like tingles at my spine, and I shuttered 100% honest. Okay, so here's what happened. It was June 2017, before I ever released the first ologies episode, I went to London for work and I packed all my audio equipment just for this interview. And I met up at the Natural History Museum of London for an interview about parasitology. I did the mic check, not realizing that the two handheld microphones were picking up nothing. And instead, it was just the little built-in mic capturing us talking. Now, we're able to sweeten

the sound, make it work a little bit. But before I tell you the rest, just a really quick thanks to all the folks on Patreon, patreon.com, such ologies. Thank you, everyone, to everyone who rates and subscribes, especially people who write reviews, such as this one from, hi, my name is, who listens while boiling coyote bones in a lab, they say. And they wrote, I'm truly in tears thinking about how ologies has filled my heart and brain with excitement and joy while living some of my darkest days of this year. Thank you, hi, my name is, please don't make me cry. So the topic is bilharziology. And you're like, the fuck is that? Okay, so bilharzia are types of parasitic worms. And bilharzia comes from the name of the guy who first identified these

old critters, a German dude named Theodore Bilharz, like really the world's first bilharziologist. And because I was not great at interviewing yet, the questions are all over the place. We talk about parasites, but mostly bilharzia, which cause schistosomiasis. So I checked bilharziology, bam, one Google result. This word has been used one time before in a typewriter written 1960 World Health Organization report in regard to bilharziologists or scientists who study the disease caused by blood flukes. It's on. So this ologist has likely completely forgotten that they sat down for a 2017 interview for a podcast that didn't exist yet. But in her email agreeing to do it, she promised, I will bring you some lovely slash nasty specimens and that she did. So she is

communications and program manager for the global schistosomiasis alliance. And her background is in tropical diseases and biomedical research. She did a postdoc at the Natural History Museum, where she still does research. So curl up, put on your skinny jeans from four years ago, I still wear mine and get ready to ingest some lost episode vintage baby ologies banter about curly worms, vials of vile creatures, snails, flatworm drama, febrile delirium, spooning, outmoded gender roles, historical weight loss pills, unfortunate snacks, and some new therapies with parasite researcher and bilharziologist Dr. Anu Guvres. Well, we're recording, but again, we're caught all this out. You want to test your levels?

Okay. Not entirely sure what to say, but it's good. Your level looks good. As it turns out, her levels were not good. Anu Guvres. Got it. Also in 2017, I hadn't yet started asking the guest pronouns, but I checked in her Twitter bio says she her. So currently, I am the communications and program manager for a organization called the Global Schistosomiasis Alliance, and that is going to require some explaining. So I'm based at the museum, but it's actually an independent body that looks at a particular parasite and a particular parasitic disease called Schistosomiasis that infects 250 million people worldwide, particularly in sub-Saharan Africa. And it's

caused by a parasitic worm called Schistosoma or Schistosomes, which we have some samples of here. I know we're looking at jars in front of us and it looks like there's just squiggles, evil squiggles, evil white squiggles in the bottom of them. Yeah, they are evil white squiggles. What is the name Schistosoma? Where does that come from? Schistosoma, I think it comes to describe the actual body of these worms. So they're quite unusual looking in that they they look round like round worms, but they actually are flat worms that are curved in or the males are they're flat and curved in and they create this little groove. And the female worm who is round sits in that groove. And it's sort of almost like a sort of split body. There's another stage,

their larval stage, which also has a split tail. So that also is like a schist. So a schist is a split. So Schista, split, soma, body. And though there are over 25 recognized species, only a small handful infect humans. And the size varies depending on the species. But in their tiny jars in front of us, they look like short, errant threads picked off a cotton sweater. Now under a microscope, the paired couples looked kind of like a pink green bean, slightly a jar, and acting as a hammock for another much smaller pink green bean, which is just nestled in a sexy patriarchal groove that scientists call a gynecophoric canal. They're the couple engaged in uncomfortable PDA at a dinner party too close. What are the ladies doing curved up in that? So they're very traditional

lifestyle. They pair up male and female and they actually reside in the blood system of mammals. And the male is strong and muscular and he holds on to the vein wall and feeds the female, protects the female and the female just sits there and produces eggs. She just sits in this grove that he's made for her, produces eggs. That's all she does. That's so atomic family. Yes. That's way so traditional. How come these ladies aren't like getting out? They have been documented cases of evidence that they do swap partners, but the females actually cannot produce eggs and become quite stunted if they're not paired up with males. So they clearly, they have to actually exist paired up with a male in order to be able to feed themselves adequately. So yeah, it's quite

interesting. That's not very empowering. No, it's not empowering at all. So I was wondering how they pick mates in the dark sticky tunnels of our blood vessels. And luckily I found a 2009 international journal of parasitology paper titled The Sex Lives of Parasites Investigating the Mating System and Mechanisms of Sexual Selection of the Human Pathogen Schistosoma mansoni. And it had everything I never knew I wanted. Okay, first off, they are mostly monogamous. Wait, mostly your soulmate lives in your body. Now in this study, it was observed that the guys could stuff their groove with multiple ladies and only actually mate with one of them. Well, the other ones are just crammed in there, like kind of sister worms,

wondering if they should have frozen some larva. Now, does this mean that there are shy worms with no one to nap in their sex canal? Well, the study continues that, quote, male body size was positively related to reproductive success. So wow, worms. I thought you were above it. But worm gossip is not over yet. So sometimes long term pairs get a divorce, and the lady squirms out of the dude because there's another mate less related to her. So she's like, thank you so much for all the nutrients that you suck from this person. But I got a piece because that guy is not my cousin like you are. And I wish you nothing but the best. Please do not text me. Now hopefully, another mate will come along and catch their eye

or whatever. They don't particularly have eyes or anything like that. So living in the blood system, it's all done by chemical cues. So they're just sniffing out. Yeah. So okay, now they are flatworms. Yes. So they're they're trematodes or flatworms. So sort of like the liver fluke. But the liver fluke lives in the liver. Whereas in schistosomes are blood flukes. They live in the blood system of mammals, including humans. And also birds actually get some schistosomes that affect birds. Not the same ones though. Different species. So even the evil squiggly worms I've got in tubes right here. We've got a couple, we have three different species that infect cattle in front of us. And then this one here is the species that infects humans. It's called schistosome mancini.

And it causes a disease called intestinal schistosomiasis, which can be found in a variety of countries, but mainly in Sub-Saharan African countries and also in Brazil. And it's quite nasty. It can cause quite severe organ damage. But it's a very gradual disease. So it builds up over time and people get more and more infected. They get more and more damage to their organs. And so they get infected when they're maybe children. And then by the time they're the age of 30, they have lots of complications, organ complications like they could potentially have the swollen liver and damaged liver. So their liver isn't functioning properly. And it could lead to liver failure. But they can also get damage in the lungs, damage in the spleen, lots of

complications that way. Another similar species, schistosomia hematobium, causes urogenital schistosomiasis. Oh, that sounds painful. And that is very painful, very nasty, and can lead to bladder cancer, kidney failure. So it can cause sterility, can potentially increase HIV transmission, and it's quite nasty. So how did you get, what did you study? How did you get involved in schistosomia? In parasites and schistosomia? Yeah, because you're a parasitologist. Yes, right. Yeah, I'm a parasitologist. I didn't start off as a parasitologist. So I always liked animals as a kid. And I always liked the marine sort of environment. So I first started doing marine zoology, studying animals of the sea. But we also had some general biology lectures. And it was in

one of those that we started learning about parasitic infections. And it wasn't schistosomes, it was a different parasite that we were learning about, one that's transmitted by insect bites. And I found it so fascinating that suddenly decided that maybe I would pursue that a little bit more. And I started going to the parasite based lab sessions that they had. I then decided to do my masters in parasites and the biology and control of parasites at the Liverpool School of Tropical Medicine. So yes, she got a bachelor's of science at the University of Wales and a master's at the Liverpool School of Tropical Medicine and Hygiene, and then her PhD from Imperial College London in the Department of Infectious Disease Epidemiology. Now, did she always have an aptitude

for bilharziology? Was it in her blood, proverbially? What was your gateway parasite? What was the one from insects? Yeah, it was, I think it must have been trypanosomiasis, not the long word. All these parasites have long words. Yeah. But it's also known as Shagas disease. It occurs in South America. And it's really nasty. I've heard of this. They're transmitted by these big kissing bugs or assassin bugs they're also called. And they can cause a lot of damage to people and gradually make them very, very ill. Again, these are all sort of gradual diseases, but Shagas can be very fatal. Did Darwin possibly have that? Yes, he did actually. There is this sort of myth that he even collected the insect that bit him and it's in our collections. No. I wouldn't say

that it's absolutely certain. It is an insect, one of these assassin bugs that he collected. Now, whether it's the one that bit him, I don't know. But yeah. And so, did he die from it? Or did he suffer from from Shagas disease? It's a good question, actually. I think he did suffer from it, but I don't know if that is, I don't think he died from it, but might be wrong. I remember a story of him being so excited about collecting bugs that he ran out of hands. And so he put one in his mouth. Oh, no. Okay, so I fact checked this. And aside from unraveling the mysteries of evolution, Darwin was also that friend you had who's always trying to figure out why they were sick. And this dude was out there on boats trying to collect creatures while also barfing

after every meal. He had CVS, which is not a disorder of elongated cash register receipts, but rather cyclic vomiting syndrome. Oh, poor dude, as well as ailments that modern day physicians looking back suspect were each pylori bacteria, which causes ulcers and yes, Shagas disease, which may have led to heart problems that led to his death. Now, given the poor Chuck was prone to fits of upchuck, it is no wonder he penned my most favorite journal snippet in 1861 quote, I am very poorly today, and very stupid. And I hate everybody and everything. That is some relatable content. Okay, now back to schistosomes. So that was that kind of interesting. Yeah, that learning about how the control of this bug was controlling the disease

in South America. And so what is it about? I mean, this is maybe a stupid question, but what is different from just being infected with, say, a bacteria versus a parasite? Like, when does something become parasitic? Ah, that's a really good question. And so, you know, loads of people who will argue that, you know, maybe bacteria are also parasites and things like or viruses, but really parasites, I mean, they tend to be things like malaria. So it's like a protozoan, which is malaria, malaria is a protozoan, it's a sort of simple cell cellular organism that lives in the blood. But then you can get other parasites that are like these schistosome worms, which are clearly much more complicated, much bigger multicellular organisms. They have

evolved very, a very specific survival strategy, if you want. Parasite, it's more of a life strategy than a particular type of organism. So it very much has to do with anything that lives in or on another organism, taking nutrients and benefiting from that, but to the detriment of the host. So there will always be a host parasite relationship. Now, that's why it's sort of some people argue that bacteria are similar to that. There are a lot of free living bacteria and bacteria might may or may not cause you damage. So part of being a parasite is the effect that it has on the host. And dictionaries define a parasite as something that lives off a host, quote, without making a useful or adequate return. So they're not just the ones who don't chip in on the big dinner bill,

but they never chip in, like you can rely on them to not be reliable to chip in. Yes, there's also an interesting relationship between the parasite and the host in that it's not in the parasite's interest to kill you outright, to kill the host outright. It wants the host to survive as long as possible, so that it can reproduce. So it's not an immediate killer, like some some other infections like anthrax, for example, will want the body to go straight back into the earth. So it'll kill straight away. Anthrax, by the by, is a thrash metal band from the 80s, whose name was chosen because one of the members read about a spore-releasing bacterium of the same name that, if weaponized and inhaled, kills 85 to 90% of patients who

don't get treatment. So the band said they liked the name anthrax because it sounded sufficiently evil. And now I agree with them. Whereas in a parasite, once actually the host to survive as long as possible, so they can continue to reproduce and continue to send its offspring out there in whichever way it does, whether it's through another insect carrying its offspring off, or whether the offspring come out, in the case of schistosomes with stool and urine entering the environment, there are different ways that parasites can transmit and continue their life cycle. Do you ever, like over the upslide, the strategies of parasites to like psychological things in your life? Are you ever like,

did you ever roommate where you were like, I'm not taking my nutrients? Like, do you ever, does that ever go into your psychology? Um, no, I don't think so. I don't, I tend to not really think of parasites in terms of humans. But I think potentially some things I might in terms of, yeah, maybe in terms of, sort of relationships, particularly when it comes to what parasites and hosts do, which is an evolutionary arms race, based on what's called the Red Queen Hypothesis. The Red Queen Hypothesis comes from, it's Lewis Carroll, in where you have to run as fast as you can in order to stay in the same place. So the parasite is constantly finding ways to infect the host. The host is constantly trying to find ways to prevent parasitic infections. So they,

they constantly have this, this battle where every time the host finds another way to stop infections or to stop the parasite from spreading, the parasite will find another way to get past that hurdle. So they're both running as fast as they can to stay in the same place with the Red Queen Hypothesis. And now you can see in a lot of things and how the world works that we are constantly doing that. It's such a drama, isn't it? Who would have thought that vials of these tiny, curvil words could cause such drama? Who would have thought, Ali? Maybe the 250 million people globally who have schistosomiasis, or maybe the scientists who have dedicated their lives to finding treatments and cures. But yes, lady who has never risked these parasitic flatworms,

spooning and boning in your lifeblood, they do cause drama. Yeah, I might be slightly, being slightly focusing on the negative aspects of parasites. There are, believe it or not, some positive aspects of them as well. So you can use them in positive ways. How can you use them in positive ways? Okay, to give an example, I think our museum curator, for example, she sometimes gets called in with live animals that have been confiscated from, from people who have brought them into the country, or different countries. The people who have confiscated these animals, they don't know if the animal has come from the wild, or if it has indeed, as has been claimed by the paperwork by the person bringing it in, being bred domestically and therefore can be

traded. Are we talking like baby tigers or squirrels? Well, not baby tigers, but chameleons, for example. Okay. Like Madagascan chameleons, which people can have as a pet if they're bred domestically, but you can't collect them from the wild. And if you look at the parasites that live inside them, you can tell pretty quickly, if it's a parasite that only exists in the wild in Madagascan, you know that chameleon couldn't possibly have been bred domestically. It was abducted. So it was abducted. It wasn't, you know, a real bred, domestically bred chameleon, because there's no way they could have picked up those parasites anywhere else. So that is one aspect, for example. There's also another aspect where

you get parasites that can control insects that damage crops. So that's another thing that you can potentially use parasites for. I'm still not convinced that the forensic science of chameleon parasites is a good thing. Chameleon doesn't like it, but our trafficking can control it. Yeah, again, you'll get really nasty parasites, and you'll get parasites that aren't so nasty. So maybe the chameleon's like, I don't like the parasite, but it's not completely messing up my life. So okay, again, this was an early interview, and we're talking about chameleon parasites right now, which then led me down a rabbit hole reading a 2007 news article about a guy from Croatia who vacationed in Thailand. He was caught in customs with a wriggling suitcase that authorities

discovered was filled with 175 chameleons. So let's not do that humans. But one thing we can do is donate to a charity of the geologists choosing. And this episode was so long ago, the benefit of your episode being on a shelf for three and a half years is now in honor of Dr. Kuvras, we're sending a donation to the global schistosomiasis alliance, which is an alliance of partners working together to accelerate the progress toward schistosomiasis control and elimination. And you can find out more at eliminate shisto.org that link is in the show notes. And that was made possible by sponsors of the show we may hear about now. Okay, back to the blood flukes. Let's learn about the asses of the hour, Bilharzia. And no,

there are not patreon questions because at the time I did not know what I was doing. And if you don't believe me, you just wait to see how this episode ends. Okay, onward. Another thing that happens to these parasites, particularly things like worms, intestinal worms or blood flukes, they are incredible at manipulating the host immune system. So they will find ways to dampen the host response so that the host immune system doesn't attack them. And that can have a secondary effect in that you won't get allergic reactions quite so strong. So they have been linked like worms have been linked to potentially dampening down the effect of like, belt syndrome, Crohn's disease, asthma and eczema, yeah, that kind of autoimmune stuff. So there does seem to be like

a link between where you got a lot of parasitic worms, you have less of these allergies, but areas where like here, where you don't have any of these worms, a lot more people are suffering from autoimmune disease. And people are doing a lot of research looking at what it is exactly in the parasite worm that is dampening down this immune system. And is there a way of making it into a safe medicine for people to take? I would not advise people to go and infect themselves with worms. The risk of getting complications, even if it's just one worm, can be quite severe, particularly also for pregnancy, it can be quite dangerous as well. So yeah, don't try to infect yourself with worms. I wouldn't say go and infect yourself with worms. I know that there are people

who will do that. Yeah, there were tapeworms were used as a diet aid and like, yeah, exactly that as well. I remember seeing an old ad from like the 20s where take one of these tapeworms. And then the tapeworms will just gobble up your food for you. Yeah. Yeah. I mean, do you hear stories? I actually know a girl who had some bad sushi and ended up with like a legit tapeworm. Do people come to you because they know they're like, oh, we're gonna have to choose deals with parasites? I don't think I have had that once or twice ages ago, emails saying like, oh, my God, I think I have this parasite. What should I do? We're not allowed, we're not medic doctors, we're not allowed to, you know, tell them what you should go and take this. It's not,

we're not trained that way. We'll give advice about, okay, there's the, you know, the London Hospital of Tropical Medicine, go there, tell them where you've been, and they'll treat you. And they have a walk-in clinic for people who've just come back from travelling. But you do get cases as well where it will be a museum staff member, and we've actually got a specimen from a museum staff member who got infected with a worm. Please tell me everything. And after he took the treatment and like pooped it out, he cleaned it, he cleaned it and brought it in and we've got it preserved in some alcohol. He really took his work home with it. I mean, that's very generous of him to know that it's like straight out of your body.

Yeah, nice, nice collection there. Well, have you gotten to do any fieldwork at all? Yeah, I do. For my previous job at the museum, so I was a postdoctoral researcher on a particular project on schistosomes. But for that project, which I did for five years, I travelled every year to a Sub-Saharan African country, Tanzania, to do fieldwork. And before and for my PhD as well, I travelled to different African countries to do fieldwork there. And that was definitely an attraction for me in terms of parasitology as a discipline. You can, if you're a field parasitologist like I am, you get to travel to lots of different countries and experience different cultures. But also whilst you're doing that, you get to help with a particular health

problem in that country. And your research can feed into how that country and how the ministry of health is dealing with that particular disease. I like the application side, how you can apply this parasite knowledge in the health area. Remember, lost episode of baby zygotologies, I still haven't even asked about schistosomiasis really. So let's actually get into it. Give me a really brief rundown of schistosomiasis. And from what I understand, and I learned this in seventh grade that still haunted me. Still, they were drills into the foot? Where does this work? Yeah, how does it work? So yeah, it's got a complicated life cycle. It's got a two host life cycle. So the human or the mammal is the main host where the male and females pair up

and they produce eggs. The eggs come out into the blood system, but then they pierce the barrier between the blood system and the urinary tract or the intestinal tract, depending which species they are. The eggs come out with urine and stool when a person goes to the bathroom. And in a lot of the areas where schistomiasis occur, there are no infrastructure for toilets and sewage, things like that. So people will defecate and urinate outdoors and often will go and wash themselves in a river. And that's how the eggs enter the river. And it's when they are in water that they will hatch out. And these larval stages, little baby schistosomes will come out of the eggs and will start swimming around in the water. And they're actually looking for a very specific snail

species to infect. That is so complicated. You got this snail species when when they find them, they go inside and they are able to multiply thousands of times inside the snail. Then they'll come out of the snail. And when somebody goes to wash themselves or their clothes or their dishes in that water body, this next stage that comes out of the snail will locate them again using chemical cues will locate the human and pierce the skin. So it might be the foot, but it could be any other part of the body. And they have these, they'll go down like a hair follicle. And then they have these little enzymes that they'll release, which will break down the skin and they can just snip in into the blood system under the skin. And that's when they'll, you know, travel around the

body getting bigger and bigger. And then finally pair up with their opposite sex and produce kids. What selfish little assholes. Yeah. Why the snail? Why this particular snail? Is the snail like, why am I involved? Yeah, absolutely. Poor snail as well. A lot of control programs also look at controlling the snail. So the snail gets killed off in order to prevent the parasite. Okay, so the schistosomes are boning in your blood vessels. And then the female blurbs out some eggs, which are called muricidia, which sounds like a beachy town outside of San Diego. But those eggs get into snail tissue. The snail releases circaria, which is a larval form that looks like an egg with a forked tail. It's kind of like a tiny swimming IUD. But while they're

still looking for a snail, those little baby eggs are watching the clock just scrambling. These larval stages, they can't feed. So they don't survive very long in the water, maybe 24 hours, and they get weaker and weaker. So they'll start getting desperate towards the end, and they'll try to infect anything, any snail species. But once they do that, they won't be able to overcome that other snail species immune system. So they won't, they'll die inside the snail. Whereas in this particular species, they have evolved to adapt to that immune system, and they can overrun it basically and just get away with using the snail as a big sex party. Well, not quite. It's clonal. It's not sex. That's not correct.

Pairings, you got breakups, spooning with your cousin. Someone get these worms at TLC show. Oh my god. So okay, how do you do fieldwork and not worry about these little dudes getting infected? Well, because I'm an expert in schistosomes, I know how to avoid getting infected with schistosomes. Other parasites is another matter, but schistosomes, at least, I can, I can avoid getting them. So what we do when we do fieldwork, we do two types of fieldwork, we do one where we collect the snail. And that's where, where most likely to get infected. So collecting the snail involves going into the water body. And we wear like, you know, fishermen have these big huge waders. So we wear these waders. And depending how deep the water is, we'll either

wear like wellies or waders that come up to your thighs or sometimes even chest waders. And you go in there with a like net, special nets, and you scoop around amongst all the like vegetation and marshy habitats and pull out the loads of different snails. And you got to pick out the snails that you know are the ones that can't get infected. And then another type of fieldwork, which is worse, is that I go into schools. And this is working with local research institutes or ministries of health and ministries of education. So I'll go into schools and I'll ask like 100 kids to provide school samples or urinary samples. And then I'll filter out the eggs in those infected kids. It's just quite gruesome work. It's not very glamorous. Do you have to,

do you have to keep them numbered or? Yeah, they all have to have IDs. I shouldn't like have access that all the kids data is pretty protected. These IDs, we can link that to what's the parasite species that we collected from this child. And then here at the museum, we do a lot of parasite DNA work. So we can link that parasite DNA to that infection from that area. And it's actually quite useful because we work alongside treatment programs. Anywhere we go where we do our research, anybody who's infected will get treated. So any school we go to to collect from infected children, those kids will then get treated afterwards by either the National Control Program or by various NGOs that we work with that will treat children.

That's an incentive. Yeah. So at least I know those kids are being treated, which is great. The thing is that they'll go back in the water and get infected again. So something that we do is we monitor how the parasite might genetically might be changing with ongoing treatment programs is, you know, I told you about this evolutionary arms race or one of the sort of selective selection pressures we're putting is that we're treating lots of people with this drug and it's our only drug. And the parasite might start resisting, you know, getting resistance or being less sensitive to this drug in which case we've got a massive problem because it's the only drug we have and it's currently being donated

free. We don't want that drug to not work anymore. So you've really got to monitor what's going on. How does it work as it is? This is one of the embarrassing stories of research. Nobody knows. It was originally developed as a malaria treatment. But when they were testing it out, they said, well, it clearly doesn't stop malaria, but something's going on with schistosomiasis. So that's how they worked out that it does kill the schistosome worms, but only the adult schistosome worms, not the younger stages. And they think it's got something to do with the worms calcium channels that disrupts them. And then the worm just sort of withers away and dies. But it's an accident and they're still

trying to work out the exact mechanism. Loads of people are spending years researching this aspect. And yet that is still being investigated. And the drug has been given out for free by its maker, Merck, which just crossed the one billionth free tablets line, which has estimated to have treated 400 million since 2007, but still 200,000 people every year globally die from this parasite. But I was looking for recent news on it. And in the Journal of Ethnopharmacology last week, there was an article citing the antiparasitic effects of red propolis, which is bee spit mixed with their beeswax and tree resins. So do I need an ethnopharmacology episode? Yes, I do. Now, as we're talking about eggs and poo and willowy white worms, I just need you to know

that I took a break to get a snack while researching this. And this week, I was so on top of my snack game that I pre made some chia puddings. But I'm now sitting here eating some globby mush that contains a constellation of slimy chia seeds that look like eggs and also threads of shredded coconut that look like worms. And I just I need to tell you in context, it is not awesome. Okay, my sludge aside, back to research on therapies, which kind of has its own set of complications. So you try to use maybe like hamsters, which isn't doesn't work very well and isn't very nice as well. But there's no way of keeping that parasite life cycle without having a host there. So it makes researching these sort of things a lot harder to do both from a financial

point of view, but also regulation point of view as well. Yeah, like, hey, do you want to sign up for this study? We're going to give you? Yeah, you stuff may or may not work. Exactly. Very difficult to get that through like ethical approval or that kind of thing. Like you get a gift card to Starbucks and a donut and people are like, no, I'm not doing that. Anook says that she's working on neglected tropical diseases, which despite affecting one billion people annually get very little funding and attention for all of the infuriating and heartbreaking reasons that you would suspect. Quite a lot of the time because the the people they infect tend to be poor and in poor communities and also because they're not immediate killers,

like malaria is, for example, for children, it can kill kids pretty quickly. Whereas in things like schistosomes that it builds up gradually and it just means the person is sick for a very long time. And that will affect their physical growth, but also their cognitive ability and it will then impact on their economic ability. And eventually it'll lead to being quite or causing quite a restraint on health systems that are already pretty weak in these poor communities. So it's like a gradual thing that happens with these neglected tropical diseases, but they're not like, they're not sexy. That's the problem. They're not really sexy as a topic. So that's why they're called neglected. What kind of impact do you think

your your particular work has had? So they're different. It's a good question. There's sort of different streams of impacts that our research can have. So one of them is that all the research we do, the child gets treated or the person gets treated afterwards. So that's one impact. And that's great. And it could be that in those areas, they wouldn't get treated. So that's one impact. An impact of the actual research that we do is that we're able to inform local governments and local ministries of health of what snail species they're dealing with, where that snail is predominantly found, and how best they could potentially control the snail. Also, we train local researchers

on this parasite, how to identify this parasite and how to study it. They also store wild collected specimens for further research, like to see if a vaccine will work on it. And I was like, wait, these six are alive? And no, they're not alive. They are very dead. But having dead ones on hand or rather, I guess, in the vials is helpful because what you can do is because a lot of these things are tested out on laboratory strains. And laboratory strains do not reflect the diversity of the parasite in the field. So you'll develop this great vaccine based on a particular part of the DNA of this parasite, lab strain parasite. Yeah, this is great. This is going to work. And then you'll test it out

in the field and it doesn't work at all. Because that part of the DNA is only a small fraction of the population that's actually out there. So you can actually use these collections of the museum to look at how diverse field specimens are and get a better indication, a better idea of how effective your vaccine is going to be if at all, as well as looking at museum does a lot on evolution and looking at how parasites adapt to changing environments, for example. And that's all done with DNA work. And that's the big thing about parasites is that they do adapt. Yeah, very, very good at adapting. It's scary, actually. Okay. And here's a whopper of a question I asked three years before a global pandemic.

Are you kind of a germaphobe at all because of your work? Are you less of a germaphobe? I think I'm less of a germaphobe. No, I wouldn't say I'm less of a germaphobe. I take precautions. So I get vaccinated. I love vaccinations. I have all of them. They're available, I'll get it. And I'll definitely be careful in terms of wearing gloves and wearing wellies and protecting myself. I have a bit more of a like, well, you know. When you're on the train, are you like, are you more or less likely to hold on to a rail on the tube? I'll hold on to a rail. I'll just wash my hands before I eat or before I touch my eyes, for example. Ah, such simple times when you could just gab face to face with a worm expert

and also just leave your house. There are times when I've gotten sick. Everybody that does fieldwork will get the stomach bug at some stage or another and it's not fun. Most travelers get it. I think I've had malaria as well, which wasn't a good experience. Do not recommend it. Definitely get lots of insect repellent. Did you have fever hallucinations? Yeah, yes. It was, so I was, I was doing my PhD and I had, I was working in Kenya and I remember the fieldwork was really intense and we take preventative antimalarials to prevent us from getting malaria. But I think what happened was that the fieldwork was so intense, I forgot to take the pill and if you forget it, you are not covered particularly well that day. It's got a

very short half-life and I remember that I was bitten by a lot of mosquitoes as well because I didn't have time to reapply insect repellent, you know. But I didn't think about it. I thought, oh, I've been to Africa loads of times, I've got it, it'll be fine. And then when I came, I came back to the UK, I stayed for a week and then I went to West Africa to Niger and the day I arrived, I started feeling quite feverish. I thought, oh, I've got the flu. So annoying. I've got to do fieldwork. It started getting progressively worse. I then had to let the teams go out to the school and I stayed behind in this, you see in this building that used to be a hospital but the money had stopped so it was just an empty building that was near the villages

where we were and we were in the middle of nowhere. So I stayed behind there and kind of like slept on the ground and hallucinated a bit and had people just felt so weak. I wasn't quite aware but the teams were getting really worried about me and we, I think we left the site early. But I already started feeling better. So I thought, oh, it must have been one of those bugs that I got and I'm sure it's all going to be fine now. And the teams were thinking, oh, it looks like, particularly this team leader, she's like, oh, it looks like malaria but she's out, she's only just come from the UK. She can't possibly have malaria and I of course didn't tell her that I was in Kenya two weeks before. She eventually, because I started feeling better,

which is a cycle malaria happens in cycles. You hallucinate, get the fever, then you're a bit better and then you get it even worse. I was better for a while and said, no, I'm fine. Let's continue. Went to the next place in the middle of nowhere and suddenly started getting worse, but really bad. And I couldn't really get up. That's when she, this lady asked me, maybe in Africa recently. She told her, yeah, I was in Kenya without totally wearing insect repellent or taking all of the anti-ballerials. Why? She gave me a look like I am going to kill you. Yeah, for you. And malaria has a two week period for it to develop in your body before you show symptoms. So she, she immediately, they took a blood smear from me and looked under

the microscope and apparently it was full of malaria parasites and they were too scared. They were scared I was going to freak out. So they didn't tell me and they, and I was hallucinating anyway. I was out of it. So I wouldn't have really known good hallucinations like cool ones or very weird ones, just mixed up. But I couldn't cry. I wasn't sure when it was day and when it was night. And then I think that I'd got up and done something. But in fact, I hadn't just that kind of stuff. I just still lying down and I thought I'd got up and I don't know, got a drink of water. But in fact, I hadn't moved, you know, that kind of thing. She put me immediately on treatment and just told me, just take these pills.

I just took the pills and I started getting better. And that's when they told me you have malaria. And apparently I went, Oh, cool. Are you serious? Because I knew that once you've diagnosed it, you're out of the danger zone. And it's also that thing of knowing what you have when you know that it's not going to kill you. You feel literally relieved. I think I said it in French, though, because I was in Wow. Oh my God. So did you ask to save the blood smear? Oh, no, I didn't. I wish I had, but I didn't. And we were in a hospital out in the middle of nowhere. And they didn't really have a lot of facilities. So I think they probably just, you know, cleaned the slide.

Yeah. How often do you do that where you have a microscope and you're like, oh, I might as well just look in here and see some of my like my own stuff. No. No, really, I think that was probably the only time. Really? I did that. She effectively saved my life. And that is where my batteries died. So we continue talking for another 20 minutes without me realizing that my batteries had just croaked mid conversation. So this is where our episode concludes, just with a lesson to travel across continents and oceans for answers, asking smart people simple questions, and also learn how to use your sound equipment before

doing so. But also, I want you to know the lesson here, no failure is as bad as you think it is. I mean, here we are. I thought this episode would never ever be heard. But here we are. I decided, you know what, let's just share this nugget of vintage geologies. I have plenty of episodes banged, but just having this one on this shelf has been gnawing at me for too long. So you can follow intrepid bilharziologist Dr. Anouk Guveris on Twitter at Psi Anouk and find more links to her work at alleyward.com slash ologies slash bilharziology. Yes, there is a link to that in the show notes. And we are at ologies on Instagram and Twitter. I am at alleyward on Instagram and Twitter. So please do say hello there. If you listen to

the end of the episode to last week's secret, there is more info on that secret on my Instagram at alleyward. So do say hi. Merch is available at alleyward.com. Thank you, Shannon Feltis and Bonnie Dutch of the Comedy Podcast. You are that for managing that. Thank you, Erin Talbert for admitting the big huge group of listeners on the ologies podcast Facebook page. Thank you to every single patron at patreon.com slash ologies for making the show possible. Thank you, Emily White and all the transcribers for making transcripts available. Caleb Patton bleeps them and transcripts and bleeped versions are on the website for free. The link is in the show notes. Thank you to Noel Tillworth for doing so much scheduling and various life-saving.

And of course, to assistant editor and chief executive cheerleader, Jared Sleeper, who has taken up quarantine workouts every morning at 9 a.m. Pacific on Twitch. So you can find him via my Instagram and just sweat along. Occasionally, I do walk by with a coffee and a doc and of course, to the grooviest worm in the tube, Stephen Ray Morris for helping us patch this together each week. And the theme song is by Nick Thorburn. And if you like it, you should check out his band Islands. They're a good band. He also did the theme song for cereal, which is nuts, right? Cereal with an S, not a C. Now, if you stick around to the end of the episode, you know, I tell you a secret. And this week, it is a life hack from old dad Ward. I realized this this week

and I'm too excited about it. But if your shower is vexed by soap scum, it is very gratifying to clean it with the edge of razor blade. You just glide the razor edge across it and all the gross stuff just peels off in curls. And if you're like, wow, I actually have never had a lazy month or two where I ate a lot of spiced cakes and bald watching Christmas movies and watched government buildings being breached. So I don't have soap scum. I'm really happy for you about that. And I will actually take your life hacks if you want to give them to me. Okay, be safe out there. Remember, chin up. Masks on. We got this. Bye bye.