Doctor, There’s a Snake in My Poop

Here is a nice review of Ascaris, the most common Helminth affecting humans. It is most common in tropical and subtropical areas, but I have encountered this guy in the midwest.


Case history:
A mother brought her 5 year old son into his pediatrician with a “snake” that she found in his stool. Otherwise, the patient was completely asymptomatic.

Specimen sent for ID:



Ascaris is the most common Helminth affecting humans. It is also the largest of the roundworms (nematodes), growing up to 35 cm in length. There are several species of Ascaris however only A. lumbricoides affects humans.

Ascaris occurs in areas with poor sanitation, hygiene and solid waste practices. Worldwide it is most common in tropical and subtropical areas.

Transmission & Life Cycle
Ascaris is transmitted through the fecal-oral route, and is therefore most prevalent in areas with poor sanitation and waste practices. Transmission occurs when an uninfected person swallows a fertilized egg which was originally passed through the stool of an infected person.

The adult male and female forms live in the small intestine. The female passes…

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What is old is new again, claypot refrigeration

While traveling from Cap Haitian to Borgne, we were talking about how the roads were more pothole than pavement. One of my colleagues brought up how the lack of infrastructure affected local economy and food security. Farmers could grow their crops, but often their produce would rot before getting to market.

Upon returning Stateside, I read about how communities in Africa were using claypot refrigeration to prolong the life of food in resource limited environments.

Enter the Zeer Pot!


The Zeer pot is a pretty simple but efficient tool that can be used anywhere it is warm. It takes advantage of the cooling properties of condensation. Essentially it is two pots with clay sand between them. The evaporation that builds up on the outer pot cools the inner pot. The inner pot is where you store your perishables to keep them from spoiling.


How to make a Zeer pot:

Where it works best:
Hot and relatively dry places (humidity decreases condensation)
Ideally should have good air movement to promote cooling/condensation

1 Large clay pot- porous
2 Smaller clay pot- can be non porous to prevent water from leaking in.
Sand or Loose Dirt
Wet Cloth

1. Fill a layer of sand over the bottom of the large pot until you can easily rest the inner container towards the top of the pot.
2. Then fill sand in between the two pots.
3. Pour water into the sand filling
4. Place perishables in inner pot and cover with wet cloth

Note: You can fill the space with non-drinkable water but make sure to wash perishables before consuming.

Other benefits besides increasing shelf life of food (which is huge both for eating or selling as a cash crop).
1. The building of these pots can stimulate the economy- i.e. woman’s collective making and selling pots to local farmers.
2. Improved diet/nutrition
3. Can be used to store meds that need to be refrigerated
4. Decrease use of generators/electricity for modern refrigerators.

The Solar Powered Flashlight, It’s no longer an oxymoron

When I was working in Haiti, I had the unfortunate opportunity to care for an elderly woman that had sustained second and third degree burns over most of her body. She had been walking in her home when her dress had caught fire from the oil lamp that was illuminating the room. She ended up passing away overnight. I spoke to my local colleagues and they told me that this was not uncommon in the rural part of Haiti I was working in.

Upon returning to the US, I was driving in my car when I heard about this innovation called the solar power flashlight.


So what are the potential benefits of the solar power flashlight in resource limited environments.

1. Health Impact

Injury prevention- As noted above in the story above, the solar power flashlight is a great way to reduce injuries from burns as it allows for a light source that is affordable and low cost. It also provides safety for those traveling/working in the dark.

Reduce healthcare costs- in many countries with inadequate infrastructure these lights can help reduce energy expenditure associated with running generators.

2. Economic impact

Cost of oil- up to half of impoverished families’ income goes towards purchasing kerosene. Imagine what they could do with doubling their expendable income.

Business opportunity- Consider empowering communities by helping them set up their own sustainable business to sell this tool. Why just buy and donate, when you can help a community build a sustainable business model that will bring funds back into the community.

Consider partnering with One Million Lights to bring BOGO Lights to the community you work with.

Should you routinely deworm children if working in a region with a high rate of parasite infection

jpegThe debate as to whether or not we should be devoting time and resources towards routine deworming is still out. However, a recent cochrane review (systematic review of the medical literature) would suggest that it has little benefit in terms of overall nutrition, hemoglobin level, and missed school days.

So what should where should we be focusing our resources if we want to improve overall pediatric health and reduce the worm burden. Just like with most interventions, primary prevention is the cheapest. Since this is primarily a sanitation issue, it makes sense to focus our efforts on the following:

1. Improved sanitation through building toilets and encouraging their use to decrease the spread of worms. This also has the benefit of reducing other fecal-oral transmitted illnesses.

2. Spend money on clothing, specifically soled shoes/slippers. Also, provides additional safety/podiatric injury prevention. You can even consider empowering a community by helping locals build an industry around this. Check out the link to follow a discussion on the pros and cons of microlending.

3. If you are concerned about anemia in pediatric populations, consider iron supplementation. This systematic review suggests that mass iron supplementation is cheaper and more effective than routine deworming.

Well that is my tip for today. What are your experiences with deworming and will these reviews change your practice plan? Let me know in the comments section.