Guest blog post by Jessie Seiler from Stomping Out Malaria in Africa
World Malaria Day is today, April 25, which means that Christmas has come in the springtime for those of us working to fight this disease. From Atlanta to Maputo, D.C. to Dakar, New York City to Phnom Penh, we’re looking around at the work being done to end malaria in our lifetimes and realizing that we’ve got a lot to celebrate. I have been lucky enough to spend the last several years watching as the fight against malaria changes, first in a small African village and now as a part of a major initiative to wipe out malaria, and so today is a day of happy memories and joyous expectation for me. Here’s why.
Before I came to the West African country of Senegal as a Peace Corps Volunteer, I didn’t know anything about malaria. During a brief but intense training period, experienced volunteers, Senegalese educators, and local community health workers showered us with the basic information about the disease: it’s characterized by high, cyclical fevers, horrible headaches, and vomiting. A child dies of malaria every minute. Malaria costs Africa $12 billion dollars every year. It’s particularly dangerous for pregnant women and children under the age of 5, which makes malaria seem almost consciously vicious.
And the real kicker? The crazy thing? The fact that fills me simultaneously with rage and hope? Malaria is entirely preventable and treatable. In fact, it was eradicated from the United States – completely wiped out – in 1951.
When I first started to understand these facts about malaria, I was filled with anger. It seemed like a tragedy. I couldn’t learn from the story, just mourn over it. But during the next two years of living and working in a tiny Senegalese village called Ndiago, I realized that we are living in a time of great hope and excitement. New technologies, growing awareness and intelligence, and a fresh zeal to eradicate malaria convince me that we’re about to see the disease’s hold on humanity ended, once and for all.
When I arrived in Ndiago, I started hearing about malaria’s impact on the community there. Everyone in the village of 300 reported having had a recent battle with malaria, or sibuuru, as it’s called in Wolof. But I quickly learned that when the community members said sibuuru, they really meant any malady characterized by headache, fever, and fatigue.
I was amazed. I knew that malaria was a big problem in this part of Senegal, but the people who were suffering from it didn’t have enough information about the disease to tell it apart from the aftermath of a long, hot day of working in the fields. No wonder getting rid of malaria seemed like such an imposing task: we were fighting blind.
In the beginning, I wasn’t much use myself. The first health talk I ever gave in village was about malaria, and it went horribly. Each family in Ndiago sent two women to hear me talk about the signs and symptoms of malaria and to watch me make neem lotion, a mosquito repellent made of cheap or naturally occurring ingredients that are easily available in rural Senegal.
It was a bust.
Having just been installed in the village about two weeks beforehand, I barely spoke enough of the local language, Wolof, to keep myself out of trouble, let alone talk about a complicated disease like malaria. I had made neem lotion before, during our brief but intense time in training, but never before a curious audience, and never by myself. As I poured in the shavings of a bar of soap, which melt in the neem leaf-infused boiling water, an exasperated lady in the front row of the crowd shuffled up to me. Grabbing the large spoon out of my hand and shooing me from the pot, she rolled up her flowing sleeves and started stirring powerfully. Apparently, I needed to be taught how to stir. Watching the soap dissolve, I wondered what exactly I was going to be doing in this village for the next two years. I couldn’t be trusted with the simplest of daily tasks, so it didn’t seem possible that I would be much of a community health educator.
Luckily, and to my eternal wonder and joy, humans get better at things as they go along. I spent two years learning Wolof, getting to know the 300 people who chose to share their village with me, and found out more and more about malaria and the role it plays in the lives of the Senegalese people.
Together, the community taught me what it was, what the members valued, what they wanted from their lives and from each other. They taught me how they saw malaria, what they thought of this threat to their lives, what they knew to do when they got sick. They helped me understand why they couldn’t pay the $4 to buy a mosquito net, even though they knew that sleeping underneath one every night would protect them from being bitten by the mosquitos that spread malaria. They talked about being too scared to go to the health post to seek treatment for a suspected case of malaria when their infant sons and daughters became ill, even though they knew the disease was so dangerous. They surprised me with their knowledge and resources, and saddened me with their matter-of-fact statements about their perceptions of the limitations on their lives.
Over the first two years of my time here, the people of the village turned every idea about public health I had on its head. Not only did I have to learn how to stir a pot of melting soap slivers, I had to start at the absolute beginning when it came to figuring out how health care and malaria prevention education should work. But it was exciting, because as I was learning more about malaria and how to fight it, so was my community. So was the world.
There is a health post in Ndiago, a small hospital with one nurse and a couple of trained community health workers. That’s where the people of Ndiago and the surrounding villages go when they’re seriously ill. But the hospital had no quick and easy way of testing for malaria, so anyone who came in with symptoms that looked like they could be caused by malaria were treated for it. It was an expensive system, but it was the best thing to be done. Better to catch every case of malaria and treat many people for a disease they didn’t have than to let even one patient die when a treatment was available.
The advent of Rapid Diagnostic Tests (RDTs), which came to Ndiago about the time I was getting settled in there, changed everything. With a simple prick of a patient’s finger and a little drop of blood, the nurse could diagnose malaria immediately and start treatment with the appropriate drugs. Not only did the costs associated with malaria in the community begin to drop, but also people became better at recognizing malaria. They knew they could be tested for it, immediately receive treatment, and immediately start to feel better. Now that the people of Ndiago could put a label on their experience, the disease stopped being a mysterious and unpredictable force. These RDTs are becoming more and more widely available everywhere in Africa. For me, for the community of Ndiago, and for the people working to fight malaria all over the world, their presence means that the disease is starting to feel like a more manageable, weaker enemy.
Watching the people of Ndiago get better access to diagnosis and treatment was one thing, but we needed something more. Mosquito nets have long been an important part of malaria control programs across the world, but now we’ve got a super weapon of sorts: nets treated with a long-lasting insecticide. Not only do these nets provide a physical barrier between a sleeper and a mosquito, but they also take out any mosquitos that land and rest on them. Basically, they’re mosquito traps baited by sleeping children.
NGOs, the Senegalese National Malaria Control Program, and other major players all have been pushing these nets for some time now, but the programs of distribution were not coordinated or thorough. Sometimes, distribution campaigns were aimed at pregnant women and children under the age of 5, who are at the greatest risk of dying from malaria. So when these groups were given free nets, other naturally assumed that they were being skipped over because they weren’t at risk. Men and older children continued to get malaria regularly, and so the disease continued to thrive in communities across Senegal even though there were more nets on the ground and in use.
Realizing that there was a better way, a handful of Peace Corps Volunteers joined forces with the local health structure and pioneered what’s now become the standard practice for a distribution: universal coverage of mosquito nets, paired with a comprehensive system of anti-malaria education for the people receiving nets. The nets are designed to last up to five years, and the knowledge about malaria, its symptoms and how to prevent it, will last a lifetime. Instead of giving out nets to pregnant women alone, the new campaign trains health workers to take a census of every sleeping space in the village, whether it’s a bed or a mat on the ground. Those health workers are also charged with talking to families about the symptoms of malaria, what makes it different from other diseases, and how communities can protect themselves from it. Sibuuru is no longer a mystery disease that sneaks children away. We know malaria now, and we know how to fight it.
Today in Senegal, local and international partners have covered or are covering 12 of the 14 administrative regions in the country. Malaria rates are dropping everywhere, and the excitement is growing. An ambitious but realistic program in northern Senegal, where malaria rates are already very low, even aims to stop the transmission of the disease by the end of 2013 using SMS technology and rapid diagnosis and treatment protocols.
All of these amazing changes in the ways we fight malaria make me think of my own progress. I started out knowing very little, like the community of Ndiago. But the more I learned, the more the people of Ndiago learned, and the more the international community learned, the better we became at fighting malaria. This fight is an example of what I love about humanity: we try something, we learn, we improve, and we try again. We’re getting better at this every day, smarter and more committed. It’s an adventure, and it means that malaria is no match for us.
Keep an eye on the people of Ndiago, of Senegal, and of all the other communities that have been ravaged by malaria for so long. You’re going to be amazed by the next few years. Together, we’re going to end malaria. Celebrate with us today, on World Malaria Day, and tomorrow, maybe start thinking about what we should do next.