Cerni Tolu (54), in complete laboratory attire, in the Napu laboratory, where he dedicates a significant portion of his days examining schistosomiasis. (WHO/Fieni Aprilia)
Dressed in a protective vest and equipped with complete field gear, Cerni Tolu, a researcher at the Wuasa community health centre, carefully extracts microscopic snails from a small plastic container. With a gesture, he showcases the tiny creatures resting on his palm. "These used to be everywhere," he said, his gaze sweeping over the expanse of a small creek and the surrounding land. Nestled in the heart of Napu Valley in the Poso District of Central Sulawesi, the picturesque landscape harbors a hidden menace – schistosomiasis, more commonly known as snail fever.
Tiny freshwater snails, barely visible to the human eye, can carry a
parasitic worm causing snail fever. (WHO/Fieni Aprilia)
Schistosomiasis stems from a parasitic worm called Schistosoma japonicum, which resides in freshwater snails. The snails carrying these worms are found exclusively in 28 villages in Central Sulawesi, specifically in Poso (Bada and Napu highlands) and Sigi districts (Lindu highland). Snail fever poses a persistent threat to the health of the 22 000 individuals residing in Poso and Sigi Districts. Indonesia is the last country in the South-East Asia Region working towards eliminating schistosomiasis as a public health issue.
Cerni, the 54-year-old Napu native with over three decades of experience in schistosomiasis, reflects on the enduring impact of this parasitic disease on the local community as he pockets the snails and rides his trusty motorcycle back to the laboratory in Wuasa village. The village's livelihood has been at risk for years, prompting community-based measures such as reworking the land, drying it out, and regular molluscicide spraying. In the schistosomiasis laboratory, Cerni quickly geared up in his lab suit before placing the snail samples under the microscope.
Nasir, a district health office staff, sprays the host snail areas twice a year with niclosamide to eliminate snails. The focus areas are surrounded by water seepage and long grass, requiring thorough cleaning
and trimming before spraying. (WHO/Fieni Aprilia)
Cerni also works with the community to support screening and treatment. "There are instances where no one shows up when we go to collect stool samples. Achieving the 80% target typically requires about a month in each village," he noted. Cerni suspects that people's reluctance to be tested or undergo treatments is often influenced by weariness. He shared the story of an individual who never received a positive schistosomiasis result in ten years and grew bored of the annual test. However, most of the residents, especially those who are often infected, find the treatments and test routines helpful and approach them with a positive attitude. Moreover, the mass drug administration (MDA) programme has consistently been received in a good light by the community – everyone, whether tested negative or positive, would come together to take the drug, courtesy of WHO.
Cerni Tolu analyzes human stool samples which are collected on a yearly basis.
(WHO/Fieni Aprilia)
Discovered under the microscope: the egg of Schistosoma japonicum in a stool sample,
confirming a parasitic infection. (WHO/Fieni Aprilia)
As the sun is starting to set, Cerni packs away his microscopes and laboratory tools. Active in the field since 1989, collecting samples, conducting checkups, and performing lab tests with two other colleagues and some volunteers, he emphatically asserted, "As a native of this village, I can't say that I’m tired of these routines." Underscoring his dedication to eliminating schistosomiasis, he emphasized the critical role of all members of the village to address this issue collectively. WHO works with communities such as Cerni’s, along with local and national authorities, to move Indonesia closer to the goal of eliminating schistosomiasis once and for all.
The five-hectare land is one of the snail host focus areas. Originally a swamp, several farmers have grouped together to transform the patch into productive ponds, gardens, and fields. The combined efforts of the community bring about agricultural opportunities while protecting the village against snails. (WHO/Fieni Aprilia)
Written by Fieni Aprilia, Digital Communications Officer, WHO Indonesia. Photos credits: WHO/Fieni Aprilia