The Unsung Hero of Neglected Tropical Diseases: Interview with Narcis Kabatereine

To reach Dr. Narcis Kabatereine’s office at the Vector Control Division (VCD) of Uganda’s Ministry of Health in Kampala, you must first walk through a room full of lab technicians who are studiously looking down microscopes. The atmosphere of quiet diligence is set by the softly spoken Dr. Kabatereine (Image 1) himself, a 56-year-old entomologist, who takes great pride in having trained this cadre of hard-working technicians. When I first meet him, he shows me photos on the bulletin board behind his desk of the young technicians who have died of AIDS— a sobering reminder of the country’s death toll. ‘‘AIDS hit Uganda hard,’’ he says. ‘‘At one point, every night we were going to a vigil for someone who died.’’ Dr. Kabatereine manages the ministry’s Bilharzia and Worm Control Programme and chairs the Neglected Tropical Disease (NTD) Secretariat in the VCD. Without fanfare, he has steadily built a career as both an academic and a highly trusted technical expert whose advice on tropical disease control is greatly in demand across Africa. Rwanda, Mozambique, Tanzania, and southern Sudan have all called on him to help guide their NTD control efforts. Dr. Simon Brooker of KEMRI/Wellcome Trust in Nairobi, Kenya, calls him ‘‘the unsung hero of NTDs.’’ Dr. Kabatereine’s office gives a snapshot of his wide-ranging research, consultancies, and advocacy. There are files and papers everywhere. A box on the shelf is labeled ‘‘10% Kato Katz Slides,’’ used in the diagnosis of schistosomiasis. His bulletin board is plastered with newspaper clippings—one striking headline reads ‘‘Bilharzia Threatens Hundreds in Uganda.’’ There’s a calendar from the Carter Center. And there are photos on almost every inch of his walls, including one of his PhD graduation ceremony on March 28, 2001, at the Danish Bilharziasis Laboratory (DBL) in Copenhagen. As a child, he says, ‘‘I just loved insects, wondering how the social insects managed to work together—bees, termites and ants.’’ He followed his fascination at Makerere University in Kampala, where, for his bachelor’s degree in zoology and botany, he did a dissertation in entomology while at the same time gaining a diploma in education. During his degree, he says, ‘‘my interest in insects increased when I realized that many were vectors of disease.’’ That realization led him to join the VCD in 1980. At that time, he says, there were documents showing that schistosomiasis was a problem in north western Uganda ‘‘but no one was working on it.’’ In 1982, he did a 4-month course at the DBL called ‘‘Fresh water snails of Africa and schistosomiasis control.’’ He later did a master’s degree in medical entomology at Nairobi University in Kenya, with a focus on tsetse flies and trypanosomiasis control. But when it came to choosing a topic for his doctorate, he says, he chose ‘‘snails and schistosomiasis, a disease that was then more neglected than trypanosomiasis.’’ Throughout this time, he was becoming steadily more senior at the VCD, eventually becoming the division’s Principal Entomologist in 2007. He was devoting much of his life to understanding and controlling Uganda’s enormous burden of schistosomiasis and intestinal worms. His studies included the epidemiology of these parasitic diseases in Kampala, and the transmission of S.mansoni both in North Western Uganda and in a remote fishing community on Lake Albert. I ask him to tell me which of his many achievements gives him the greatest pride. ‘‘I managed to map out the magnitude of the problem due to schistosomiasis and soil transmitted helminthiasis in Uganda,’’ he says, ‘‘and initiated a national control programme for the diseases.’’ He also succeeded in including these neglected conditions in the country’s Health Sector Strategic Plan. He is proud of having convinced the government and external donors that mass drug administration (MDA) to control these worms was necessary. Through Uganda’s MDA campaign, he says, ‘‘we have successfully reduced morbidity due to schistosomiasis and soil transmitted helminthiasis.’’ Since the late stages of schistosomiasis are deadly, he believes the campaign has also saved many lives. ‘‘Appearances with Narcis can be deceptive,’’ says Dr. Brooker. ‘‘To some who do not know him well, he seems happy and grateful to have donors interested in NTD control in Uganda. With time, you realize that long before donors arrived, he had identified what was required to develop an effective and sustainable helminth control programme in Uganda. He then strategically set about to put those pieces in place, identifying which collaborators could support each area.’’