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Next day I was invited in for some training on how to operate the PEG. I'd been given no information, actually, about what we were going to have to do to manage it, once it was there. Anyway I went in that morning, and I was given I think ten minutes to be shown how it worked. And a nurse who spoke very little English came to show me, and she put a syringe of, of, of water through the PEG with such speed, and I think for a daughter to suddenly see a mother being fed through a tube in the stomach with such aggressiveness, I mean that bit in itself is difficult. But the kind of just callousness of it all, just shocked me beyond belief. And I remember walking out of that hospital and phoning my sister in floods of tears saying to her, 'We have to manage this every day. Mum's not going to be able to do this for herself, you know, no-one has told me that we're going to have to flush this thing through every single day now.' And I was just, blown away by that, really'The other'You didn't get any other training after that,No.That was it?No, that was it. Yeah.You didn't get any written information on it?No, I had got hold of a booklet which has information, really, that's good for people who know how to use it, but actually not helpful for somebody who's just picking up on it. It doesn't have any pictures, and actually pictures of course are the easiest thing to follow if one's uncertain. I felt that really they needed somebody like me to write it for them, because they're never going to know what it's like to learn to do it, or what you have to overcome psychologically in order to get round to using it. And I think that's quite difficult. And I think also that there are questions that you have like, 'Well, where do you get the equipment?' and you know, 'How often do you throw away a syringe?', and you know, 'Is it safe just to keep it open in the bathroom?' or you know, 'Could I poison my mother?', or - you know, these questions which may seem really silly or elementary are the things that one really worries about. It's like having a new piece of machinery which actually is going to be crucial to your very existence and you don't know how to turn it on [laughs]. It gives you a huge amount of fear. And I worried enormously about that.You said that psychologically you had to ', Mm.Can you tell me a bit about that?Yeah, I think the role of your mother in your life is to kind of nurture you and feed you, and that kind of intimacy is one that's mother to daughter, and suddenly there's a switch which is untimely. It's not as if your mother had lost her faculty or anything like that where your mother's life depends upon your care. And that not just that you're not actually putting food in her mouth, it's through a hole in her stomach and for me the kind of connection between the umbilical cord and the PEG tube, you know, it's there, and that seemed like a very difficult line to cross. I think my mother also had an immense amount of dignity and suddenly I was playing a physical role. And I think again that's quite a tricky line to cross, no matter how close your relationship is. You know, I think there are some things that one wishes, one hopes to keep separate, and that wasn't going to be possible. And I think also for her, again there was this business of, 'I'm not going to be able to manage this myself for long.' So it was having to contemplate again the business of failing.

Schistosomiasis, also known as bilharzia is a parasitic disease causedby several species of trematodes, parasitic worm of the genus Schistosoma.Urinary bilharzia is caused by the Schistosoma haematobium, and the Snailsfrom the genus Bulinus serve as the intermediate host between mammalianhosts. It is common in tropical and subtropical regions, especially incommunities with very little or no access to safe drinking water and goodsanitation; people involved in routine agricultural, domestic, occupational,and recreational activities which expose them to contaminated watercontaining the infected snails. When children come into contact with acontaminated water source, the parasitic larvae easily penetrate throughtheir skin and further mature within organ tissues. Schistosomiasis is achronic disease.

Three primary schools in Sinazongwe district were sampled byconvenient sampling and these were: Mwezya primary, Sinakasikiliprimary and Maamba private. 542 urine samples were collected from allthree schools; 208 from Mwezya primary school, 184 from Sinakasikiliprimary school and 150 from Maamba private school. The urine sampleswere collected from pupils in labeled, sterile, wide mouthed, screw cappedplastic containers and the pupils were given an instruction to depositmidstream and terminal urine. The urine collection was done betweenthe hours of 10.00 and 14.00 as this is the period in which the femaleschistosome worm lays its eggs. The samples collected were then processedand examined in the laboratory at Maamba Hospital which is 20 km fromMwezya primary school, 15 km from Sinakasikili primary school and 1 kmfrom Maamba private school.During the processing of the urine samples,10 ml of the urine in each labeled, sterile, wide mouthed, screw cappedplastic container was placed in a test tube and spun in a centrifuge at 3000revolutions per minute (3000 RPM) for 3 minutes. After centrifugation, the supernatant was decanted, leaving the sediment at the base of the test tube.The sediment, which has a high concentration of the substances containedin the urine was then placed on a glass slide, covered with a cover-slipand examined under a light microscope at 40x objective for the presenceof Schistosoma haematobium ova; taking note of the number per sampleexamined.

Snail survey was carried out along 3 streams that are near the selectedschools; Siamaambo stream which is near Mwezya primary school,Kanzinze stream which is near Sinakasikili primary school and anotherstream also called Kanzinze which is near Maamba private school. 1 km ofeach stream was surveyed. The length of each investigated area was dividedinto 10 stations, each station covering 100 m. 10 scoops were conductedat each station using a dip net, and the snails were placed in containers,1 container per station. The dip net was passed through the water andvegetation at intervals along the shore-lines and sometimes on the upperlayer of mud. Snails collected were sorted out according to species; andthe number of Bulinus globosus snails collected were counted and furtherexamined to detect cercaria; this was done by putting the snails in test tubeswith water, 1 snail in each test tube and then exposed them to a light source(bulb) for two hours. After two hours of exposure to light, the water in thetest tube was examined for the presence of cercaria using a magnifying lens.Siamaambo stream in Sinazongwe district, one of the water sources nearSinakasikili primary school. Left-researcher scooping snails on the edgesof the river using a dip net; Right- wide mouthed screw capped containersused for sample collection (Figures 3 and 4). 041b061a72


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