Was It Ever a Problem in the US?

Malaria.  You’ve no doubt heard of the disease, and you’re probably aware that you have zero chance of contracting it in the US.  It seems like it’s been that way forever.  But scientists didn’t even discover that mosquitos transmitted the disease until 1897. The disease wasn’t eliminated in the US until 1951.  Not to mention the strategy used to eliminate malaria in the US during the 1940’s almost killed off the mascot of America, endangered human life, and gave birth to the modern environmentalist movement.  DDT, bald eagles, Silent Spring, or Rachel Carson ring a bell?

While the disease is nonexistent in the developed world, malaria remains a major health concern for countries of the developing world.  The World Health Organization (WHO) estimated that in 2010, there were about 219 million malaria cases and 660,000 malaria deaths.  WHO estimates that 90% of all malaria deaths occurred in the Sub-Saharan Africa, mostly among children under five years of age.  Obviously the mass utilization of dangerous pesticides to neutralize mosquito populations was ruled out after the discovery that chemicals like DDT are incredibly harmful to humans, bald eagles, and the world in general.

So how can residents of the developing world avoid contracting malaria? The simplest and most effective method is to sleep under an impregnable mosquito net.  For a variety of reasons, however, it is extremely difficult to convince people in the developing world to sleep under mosquito nets.  Last month, I conducted a door to door survey in my village and saw /heard the most common reasons: 

·         People don’t know that mosquitoes spread malaria

While the source of malaria is taught in primary schools of Burkina Faso, there are still children and adults in my community who don’t know that mosquitoes spread malaria.  While these individuals were a minority, it was still worrisome to realize that a father of four children in my village did not attribute malaria to mosquitoes.

·         People don’t believe that malaria is a serious illness

It is seen as a common disease that people rarely die from.  People believe that traditional medicine can cure the illness.  Other people buy easily available “street drugs” that vendors claim can cure the disease.  Others know that the community health clinic has drugs that cure malaria, therefore see little reason to protect themselves.

·         People don’t own mosquito nets

Mosquito nets cost money (usually around $5-$7 per net).  While that may seem like a steal, most families in village survive on less than $2 per day. Families tend to have 6-10 members.  WHO recommends at least one mosquito net for every two family members.

·         People own mosquito nets, but they are poorly maintained or not used properly

Mosquito nets are difficult and annoying to set up in the proper manner. During hot season most villagers (including myself) sleep outside because the inside of their houses remain too hot.  Setting up a mosquito net outside requires some sort of frame, such as four sticks or two chairs, which many villagers won’t go through the trouble of setting up.  Some people own mosquito nets, but there are tears or holes through which mosquitos can enter, making the nets almost useless.

·         People rely on the government or outside organizations to give them mosquito nets instead of buying nets themselves

About every two years, the Burkina Faso government, partnered with various organizations such as USAID, organizes a mass mosquito net distribution.  Families (are supposed to) receive one mosquito net for every two family members.  However, this solution has its own problems.  Mosquito net distributions are useless if people don’t know how to use the nets or are unwilling to.  The net distributions also foster and expectation that mosquito nets should be free instead of purchased.

 

For example, we were told in person by Dr. Patrice Combary, the National Coordinator of the Fight Against Malaria, that the next mosquito net distribution was to take place in June 2013. As of now, not a single volunteer has any idea when or how the distribution is going to take place.  However, the staff at the community health clinics in my village have been telling patients who ask that there is a national mosquito net distribution in June.  It seems unlikely that a villager is going to purchase a mosquito net if they think they can get one for free in the near future. Clearly this makes any malaria education work that I do difficult and frustrating.

I like to imagine that convincing Burkinabe wear helmets while riding motos involves many of the same challenges as convincing Burkinabe to sleep under mosquito nets.  From an American perspective, it makes complete sense to sleep under a net and avoid a dangerous illness such as malaria, just as it makes complete sense to wear a helmet while riding a dangerous vehicle such as a motorcycle.  However, most Burkinabe don’t wear helmets while riding motos.  Most have friends or family that have gotten in accidents, some of them more serious than others, but it seems rare that people die in these accidents.  Helmets cost a considerable amount of money.  Wearing a helmet is uncomfortable.  A vast majority of Burkinabe understand the basic science behind why a helmet protects your health/life.  But even if an outside organization bought helmets for everyone in village who owned a moto, they still wouldn’t wear them.

My job is to attempt to convince people in village to acquire/use “helmets” to protect themselves, as well as their children (yes, helmetless children as young as five are frequent passengers on motos in Burkina, as well as babies tied to their moto driving mothers’ backs).  Luckily it’s not my job to convince Burkinabe to wear motorcycle helmets, as it is widely considered impossible.  So I guess relatively speaking, the task of convincing people to sleep under mosquito nets is easy.

But how to go about said convincement? One method is a door to door survey/campaign.  I conducted one in my village at the beginning of May to get an idea of how many families actually had enough bed nets for the members of their family and what condition they were in.  The results were pretty alarming.  My village lies in a region that is permanently at high risk for malaria, with cases numbering over 200 per month during the rainy season.   Yet less than 50% of the villagers slept under impregnable mosquito nets.  Most families had a few mosquito nets, but many were in various states of disrepair (not exactly “impregnable”).  The survey was pretty disheartening as it revealed the sheer scope of the problem in my village.  And I haven’t even done surveys in the villages that are farther in the bush, where results are likely to be even more alarming.   However, the survey did allow me to meet a lot of new people and it was one of the first things I did that felt like actual “health work.”

I also recently set up a discussion/debate with students of the primary school regarding malaria with the help of my village counterpart Ibrahim.  We asked a group of about 100 kids questions about how malaria is transmitted, how they can avoid getting it, what the symptoms of malaria are, and what they should do if they think they have it.  A soccer ball served as the “right to speak,” which encouraged kids to participate and helped maintain law and order amidst the anarchy of 100 primary school kids.  The head nurse and assistant nurse of my health clinic participated, as did the director of the school.  Of course it was all in local language so I didn’t understand a majority of what was taking place, but most primary school kids cannot express themselves in French and the goal was for the kids to understand and participate.

Anyhow, it felt good to finally start working on some projects.  Hopefully I can make an impact, however small, before I’m done here.  I’m still trying to figure out whether to lie or tell the truth when Burkinabe ask me if malaria was ever a problem in the US.