Tuesday, April 2, 2013

Malaria: 101

One of the most prominent health issues facing the community that I live within (and most of Zambia & Africa) is Malaria. The malaria that is carried by the female Anopheles mosquito here in Zambia is called Plasmodium Falciparum. This is the most deadly strain of malaria, and it's ravashing villages across Africa. The plasmodium parasite has been a critical global health challenge for thousands of years. The World Health Organization estimates that, in the year 2005 alone, malaria infected 500 million people and killed over 1 million. 90% of these deaths occured in Sub-Saharan Africa, where I am currently living, and most of them were of children under 5.

When John F. Kennedy first challenged students at the University of Michigan to serve their country in the cause of peace by working and living in a developing country back in 1960 and Peace Corps was formed, they outlined three programmatic areas for PC volunteers to work under. These were: education, food security, and malaria. Malaria has killed more humans than any disease in the history of the world, and has been an important part of Peace Corps education and prevention since the very beginning.
Combating malaria in this area is being funded by a number of NGO's, businesses, host country institutions, government organizations, and global aids. In 2009, President Barack Obama created the Global Health Initiative (GHI), to coordinate all activities of US Govt organizations working with foreign health issues. As a Peace Corps Volunteer in Sub-Saharan Africa, I work to integrate with the Presidents Malaria Initiative, the National Institutes for Health, the Centers for Disease Control and Prevention (CDC), and the United States Agency for International Development (USAID). In 2011, Peace Corps launched a new initiative with these partners- Stomping Out Malaria in Africa, or STOMP. This is a large part of my job.

Stomp is currently being carried out in 19 countries in Africa, wherever Peace Corps is serving. In Zambia, malaria is the most significant health problem. It is endemic in all 9 provinces and all 72 districts of Zambia, and 100% of the population of 13 million people are at risk of malaria. While the incidences have declined in recent years, there are still communities and people suffering everyday from a preventable disease. This year, Peace Corps Zambia has joined together with all of the other Peace Corps Africa countries to "Stomp Out Malaria in Africa" in our lifetime. There are over 3,000 volunteers across the continent who, just like me, are working to bring this number to zero. World Malaria Day is April 25th, but I'll be working with my clinic, local health volunteers, and community members throughout the entire month of April on many different Malaria projects.

I've created some flip charts (flip charts is such a Peace Corps thing!) to assist me in teaching the locals about malaria. Whenever I draw anything up in my village, all the villagers come and want to see, and they ask me what it says. The ones that can (sort of) read English, like to show off by reading the posters aloud and explaining them to those who can't read or understand English. This gives me an opportunity to talk to the adults in my village about Malaria and other health topics, but it's not enough. In my catchment area, I have 7 Neighborhoods. Each neighborhood is composed of a number of villages, and each neighborhood has a Health Committee of volunteers. I will be biking out to each of these neighborhoods this month, anywhere from 5km-30km away from my hut, and meeting with the Neighborhood Health Committees, and training all of them to train others about malaria. I will be talking to pregnant women about malaria and pregnancy every Tues and Fri when they come into the clinic and see me for Ante-Natal care. I will be visiting the 3 schools in my area and reading a story about malaria, along with doing different activities and games with each of the classes, with the translation help of their Head Masters. I'll be working with the school drama groups to create a skit about malaria for National Malaria Day. I'm also in the process of creating a 'wall of fame' at my clinic with photos I've taken of villagers and their correctly hung mosquito nets. (This ones a bit tricky, because 1. Not many people actually hang their mosquito nets up, and 2. Going into someones bedroom, especially with a camera, is taboo here. ) I've taken a few, however, and Zambians love having their pictures taken and shown to people, so I'm hoping that patients at the clinic will see the photo wall and wish to be on it as well. I'm hoping this will encourage more people to go home and hang up their mosquito nets.  
PCV Morgans' host mom, father, and new baby brother, Nathan under their family net
On April 25th, National Malaria Day, my clinic will hold a program under our huge oak tree at the school grounds. The last time I attended one of these was for Mental Health Day, and that was about a week into my service. It was attended by a significant number of people, the Chief, the Village Headman, and Government Health Workers from town. Womens groups sang and preformed dances, youth clubs did short skits, and presentations were given in a mix of Tumbuka and English. They tell me this one will be the same, except I get to be the one up front teaching everyone. I'm really excited about this, and kind of nervous, because it will be my first big teaching experience here. Since I alone seem to be a sort of spectacle here, I'm thinking this will draw a larger crowd. It should be fun; I have trivia questions for them, a net hanging demonstration, a possible net hanging relay, and a little jig called the Malaria Stomp. April's going to be a busy month!

Here in Zambia, there are four initiatives taken against malaria that I'm to promote and educate on. One is Indoor Residual Spraying, which is done once or twice a year. Workers come out to the villages and go to every hut and spray their walls and grass ceilings with a poison that's supposed to kill mosquitos. Mosquitos land to rest and digest on the upper 3rd of anterior walls, so that's why IRS is used. Another intervention is Fancidar, which is an intermittent preventative treatment drug taken by pregnant women during their 2nd and 3rd trimester. They are also, of course, encouraged to sleep under a mosquito net every night, and are given a free net when they first attend Ante-Natal care. Pregnant women are a high risk group because any immunity that the women have built up against malaria is stripped away when their body comes into an immune-suppressed state as to not attack the fetus during pregnancy. The malaria causing parasite loves the placenta because of all the nutrients. When it attacks the placenta, it keeps blood and oxygen from reaching the fetus, which can cause brain damage, miscarriage, premature delivery, and still births. The 3rd intervention is Artemisinin-based Combination Therapy, which is a drug called Coartem here, and that's what is taken when someone has tested positive for malaria. Coartem is extremely expensive to make (and it's made in New York) and the body can build up resistance to it if it's taken a lot. This is obviously something we don't want people to have to take, which means we don't want people to be continuously getting sick with malaria, so the final intervention is the most important and most obvious to me: sleeping under an Insecticide Treated Mosquito Net every night. If we can get 80% of the community sleeping under a mosquito net and using them properly, something called the "community effect" will be created, and it will drastically decrease the number of malarial incidences, as well as greatly reduce the number of mosquitos in that area. This will lead to less absences from school, less deaths, more time to work in the fields, and save a ton of money. Malaria costs Africa something like 13 billion dollars a year!
Members of my Neighborhood Health Committee, Kasuku NHC. The shirts say "Malaria is a Killer Disease!" :)
I know I wasn't concerned about malaria when I was in America. Of course not, because I was concerned with what was going on around me and I didn't know how big of an issue it is here. And I'm sure many other Americans are in the same boat I was. Malaria is the #1 killer in Africa! Before coming here, I thought it was AIDs. But, globally, there are around 750,000 deaths from malaria per year, and 90% of those deaths occur here in Africa! Most of those deaths are children under 5, because they aren't able to communicate their symptoms and they don't have any immunity to the parasite. I believe that every child deserves a 5th birthday, so that's why I'm working to Stomp Out Malaria in Zambia.

“Much of the progress against malaria in Zambia has been made possible by the United States, particularly the President’s Malaria Initiative (PMI)…and President Sata’s first public reception honored the work of the U.S. Peace Corps and USAID for their continued work in malaria control.”  -Michael Gerson, Washington Post, April 2012.



  1. Caitlin,

    Thanks for taking the time to share your malaria work with us. It is an incredibly important issue and Zambia and the Peace Corps are lucky to have you working on it. As an RPCV myself I look back fondly to those days of hopping on a bike and heading off to a nearby village to do a health talk. Know that you are making a difference.

    Matt McLaughlin
    Program Manager
    Peace Corps
    Stomping Out Malaria in Africa

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