Malaria

I’ve just finished reading an article in my friend’s National Geographic about malaria. The article, titled Bedlam in the Blood: Malaria, explains the plethora of problems that have prevented malaria from being eradicated. Currently there is more malaria in the world than there has ever been, yet the United States and Europe have eradicated it. This is thought to be one of the significant reasons that malaria is still an issue in the developing world. The west dealt with it and has no interest in continuing to address the issue because they have no interest anymore. In the U.S. malaria was killed off by DDT, a chemical very harmful to the environment, so using this strategy again has been turned down by the environmental community. My concerns with this issue lie a little deeper than western interest in eradication.

Only in the past few years has malaria captured the full attention of aid agencies and donors. The World Health Organization has made malaria reduction a chief priority. Bill Gates, who has called malaria “the worst thing on the planet,” has donated hundreds of millions of dollars to the effort through the Bill and Melinda Gates foundation. The Bush Administration has pledged 1.2 billion dollars. Funds devoted to malaria have doubled since 2003. The idea is to disable the disease by combining virtually every known malaria-fighting technique, from ancient (Chinese herbal medicines) to the old (bed nets) to the ultramodern (multidrug cocktails). At the same time, malaria researchers are pursuing a long-sought, elusive goal: a vaccine that would curb the disease for good.

I really think all of this aid and interest in the disease is wonderful, but I am right here on the ground and I do not see a large need for all of that money, I don’t even see where that money is going. We had a campaign in December which the Gates Foundation funded. The event made available measles and polio vaccines, and we gave vitamin A tablets to infants and pregnant women, also the first 500 hundred children to come through received a double mosquito net. This was just for my village the availability of mosquito nets varied throughout the country. Regardless, the population of my village is roughly at 5,000, so even if 500 hundred children are now sleeping under mosquito nets, 4,500 other people do not have that opportunity. Mosquito nets are not altogether expensive, but when you have a choice of buying food for your family or a mosquito net you’d probably choose food. Another volunteer said people in her village do not even think that Malaria is caused by mosquito bites. You cannot fight that kind of problem with money.

As a Peace Corps volunteer we do smaller projects to educate people about the ways that they can protect themselves. One of our big activities is building soak pits. A soak pit is a large underground pit, usually a few meters deep and a few meters diameter, nearly filled with a diverse range of fist- to head-sized rocks. The pit is covered with hay or straw and mounded with soil. The purpose of the rocks is to give it structural support (so one can still walk or drive one’s motorcycle over the top of it) while leaving lots of empty space to absorb grey water. Typically, these are built just outside of the walls of a concession and a pipe extends out of the dwelling to lead water to the upper center of the pit. Pits may be square rectangular or circular and a typical construction is shown in Figure 9.5.

Figure 9.5 Soak pit

Soak pits prevent excess water from pooling and creating breeding areas for mosquitoes. They are not too expensive to build and they address a problem that no organizations seem to see as an issue. The biggest problem with soak pits is that they only address a small part of the problem. In villages mosquitoes are less of a problem, except during rainy season, but in areas where there is an excess of stagnant water, malaria is continually an issue. In my regional capital, we are in currently in the hottest driest season of the year, I rarely see mosquitoes in the villages, even those on the river, but in the cities, open sewers are constantly filled with stagnant water. The waste water from people’s latrines, like dirty water from their showers, along with human waste are washed directly into these sewers. If you walk by them the smell is intoxicating. These sewers also cause significant problems to the potable water in the region, but that’s another issue.

The point is medication and sleeping under mosquito nets doesn’t even begin to address the problem. Even volunteers and visitors who are taking their malaria medication properly have gotten malaria. The prophylactics are not foolproof and do not ultimately solve problems for natives because these drugs are too expensive for them to buy. Taking mephloquin for my whole life would be a dreaded existence anyway. The malaria parasite evolved a resistance to chloroquin, a formerly used prophylactic. There are larger problems that we see on the ground that large organizations are missing. While it would be fabulous to find a vaccine, people are dying today and prevention is as easy as cleaning up the streets and educating EVERYONE about how to prevent it. One of the greatest advantages to cleaning up stagnant water reservoirs in cities and large villages is that it solves a lot of other problems. Suddenly raw sewage doesn’t make the entire place smell putrid and drinking water is cleaner. Obviously this doesn’t solve all of the problems of malaria, but getting people to change their habits is much much more difficult than to clean up after them.

One of the most frustrating things about development is that fixing a problem usually has strings attached or requires twenty other things to be fixed as well. Malaria, I think is simpler in that no matter how hard you try to prevent it no one can keep away mosquitoes permanently, so eventually it would be most effective to eradicate it. Right now, however, sending mosquito nets across the world and hoping they get to the right people is not enough. Stopping stagnant water problems isn’t going to solve the problem either.

I was texting with a friend in America and lamenting on the conflicting relationship Malians have with the rain. The rain is good, it brings fresh water, it brings life. They cannot grow crops without it, they can’t live without it. Rainy season makes their lives easier, they can go to the stream (a dry river bed the rest of the year), to fetch water, do laundry and wash dishes, even take showers, they do not even have to water their crops. With all these great things, however, the rain brings with it horrible problems. One, of course is Malaria, but many other parasites live in tropical water, schistosomiasis, Guinea worm, giardia, dysentery, and cholera. There is no such thing as potable water in Mali. Everything that is safe for me to drink is filtered or boiled or treated. One thing I’ve learned about Africa is that nothing ever comes in moderation; one rain storm can wipe out a newly paved road, tear down a mud house, and turn dirt roads into swamps. Why not just try and stop the rain?

Development is a slow boat, let me tell you, and watching it on the village and local level, it’s even slower. My village built a pre-school where children are even singing songs in English (whether they know it or not), yet my host-brother made his 12 year old daughter get married a few weeks ago. Little by little, is something we say a lot here, because that’s how everything happens, but most of the time it feels like we’re falling backwards. The few intelligent or motivated people ready to do some real work do not have the community backing that they need to actually make a difference. People are reluctant to look to the future because they are struggling so much now.

The organization where I work did training for the midwives in the region. My supervisor had just attended an HIV/AIDS training in the capital and wanted to share, right away, what he had learned. He is one of those motivated people. I went to the training and found that what they were learning was too far beyond what they need right now. The women spent three days (and I’m sure were given per-diem, about $15.00 a day, on top of the $50 a day to rent the facility and $100 a day to provide food and refreshments) learning about counseling HIV positive patients. As far as I know and as far as my homologue knows (she attended), there is not a single person in my village who is HIV positive, and if there is, they certainly aren’t coming in to be counseled. The HIV rate in Mali is relatively low and insignificant in relation to other problems. HIV in the villages is much much lower than the rates in more urban areas. So, why are organizations spending money to train people to do something they are unlikely to ever do? I feel that this money would be better spent teaching these women about how to educate people in the villages about HIV and encouraging people to get tested, AND then once people start to come to the health centers with a need for counseling, train the women to counsel. There are more important and more significant topics that need to be addressed in health centers like how to do proper pre-natal consultations, teaching about family planning and birth control, education regarding sexually transmitted diseases, etc.

Don’t worry I talked to my supervisor about this and explained to him my concerns. I’ve never been one to keep my mouth shut. What am I doing to help? Well, little by little (donni donni in Bambara), I am addressing these issues. However, I think it would be better to convince people who have money to do the small project Peace Corps Volunteers do, in a lot of places.

Now it’s time to shower and get a days’ worth of grime off my skin. I wonder what’s swimming in my bath water tonight!