World Malaria Day!

The World Health Organization explains that "Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected Anopheles mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells. Symptoms of malaria include fever, headache, and vomiting, and usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs." Malaria is particularly lethal small children and pregnant women, and while there isn't a vaccine there are extremely effective treatments available, and people can avoid mosquito bites by using insect repellent and sleeping under Long-Lasting Insecticide-treated Nets (LLINs). 

Malaria is an enormous problem in Senegal, and, unfortunately, the region of Kédougou has some of the highest malaria rates around. Thanks to Universal Coverage programs and increased access to Rapid Diagnostic Tests (RDTs), many more people are sleeping under LLINs (at least during rainy season) to avoid malaria and getting effective treatment if they are infected. There are PCVs doing amazing malaria eradication work across Senegal, and you can click here to read the fantastic post that my friend Annē wrote about an ongoing anti-malaria project in the Kédougou region.

Diamé and I in 2012

Like many, many people I know, my little host sister Diamé came down with malaria last year. Thankfully, my host family lives within walking distance of a health structure, understands the importance of early treatment, and has the means to pay the small consultation fee to see the nurse to get malaria medication, which is free. It's never fun to see a sick kid, but as far as children-with-malaria-scenarios go, Diamé's played out pretty ideally - in the evening Diamé's mom saw she was listless and feverish, the next morning she took her in for an RDT, came home with a pack of Coartem (the locally available brand of malaria medication) and before long Diamé was back to normal. All too often, people put off seeking treatment, and by the time they get to a health structure they're so sick that they need more intravenous medication and fluids, which are expensive and can require hospitalization. 

Early treatment is great, but prevention is even better, and I'm really hopeful that this year Diamé won't get malaria at all. In addition to upcoming Universal Coverage follow-up bed-net distributions, there are plans to a implement seasonal malaria chemoprevention (preemptive treatment) program for all children under the age of 10 living in high transmission zones. It's an ambitious approach, but it has the potential to have a truly enormous impact on malaria in Kédougou. 

I don't want these kids to get malaria. 

I'm excited about seasonal malaria chemoprevention because it's a way to help break the cycle of malaria transmission  Anopheles mosquitoes become infected with Plasmodium when they bite a person who is carrying the malaria parasite; the mosquito becomes infected and then passes the parasite on to the next person it bites. If kids are on chemoprevention it means that they'll be protected from malaria, and they'll also avoid being carriers, which will help to reduce transmission rates and protect the entire community. Additionally, as someone who's been on preventative malaria medication of one kind or another for the last two years, it's really good to know that my little host brothers and sisters will be given a chance to benefit from the same kind of protection that I had during my service. They deserve at least that much. 

If you'd like to know more about malaria and the work that's being done to eradicate it, please take a look at Stomp Out Malaria, or check out what the CDC or the Bill & Melinda Gates Foundation have to say about the fight against malaria. 

Malarone!

One of the very first things that happened when I arrived in Senegal was that I started taking anti-malarial medication. People who grow up in areas where malaria is endemic can acquire some degree of resistance to malaria infections, but PCVs definitely don't have any sort of immunity. While there are a places in northern Senegal where malaria is practically non-existent (mosquitoes can't live without water and it's the desert up there) it exists on an epic scale down here in Kedougou, particularly during the rapidly approaching rainy season. 

The go-to malaria prevention drugs in West Africa are doxycycline (doxy, as we call it)and mefloquine (AKA Mephaquin, Lariam). Doxy is an antibiotic, sometimes prescribed to people in America for acne. You have to take it every day and it has mostly mild side effects, like upsetting your stomach and making you more sensitive to the sun, but most PCVs here tolerate it well and for a few it's even helped keep their complexions clear. However, due to an allergic reaction I once had to a medication in the same -cycline family of drugs the Med Office (quite rightly) decided that it was off-limits for me and I was put on mefloquine. 

Mefloquine (one of the generic versions of the much-maligned Lariam) is made of a chemical that disrupts the development of malaria parasites. It doesn't tend to upset your stomach, you only have to take it once a week, and, like doxy, it's pretty cheap. However, in some people it can cause things like extremely vivid dreams, insomnia, anxiety and/or depression. More rarely it can cause hallucinations, odd behavior, and self-destructive thoughts. My first few months on Mefloquine I had bizarre, incredibly vivid dreams (all of Peace Corps in a strange pageant at an Under-the-Sea-themed middle school formal; being menaced by lazy, helmeted urban dinosaurs, etc etc) but that was pretty much it and I didn't mind. 

Then, as the weeks went by, I started getting weirder. Slowly, like the proverbial frog, I went on with my life as a tight, angsty knot began lacing itself around my sternum. Back in America I wasn't exactly an carefree ray of twenty-four-hour sunshine, but I also didn't get all squirrely about making eye contact with my neighbors. It took awhile for me to decide that the anxiety I was feeling wasn't justified (from scary transport to aggravating cat-callers,  there are so many anxiety-making things here) but eventually I listened to other PCVs and gave Med call. It didn't take long for them to decide that I shouldn't be taking mefloquine anymore and (because my -cycline allergy ruled out taking doxy) they set about getting authorization from the Washington, D.C. Medical Office to switch me to Malarone. 

The most valuable thing in my hut. 

They needed official permission from D.C. because Malarone costs a lot of money. The Cadillac of Chloroquine-resistant malaria prohylaxsis medications, it's known for having almost no side-effects, and also for being crazy expensive. Because it's a generic drug Mefloquine is pretty cheap (I think brand-name Lariam can be more expensive) and an entire month's worth of doxy only costs about $10 USD, but Malarone costs about $5 USD per pill, or about $185 USD per month. That's considerable, particularly at a time when budgets are getting slashed left and right. In any case, they sent me a bottle of Malarone, I stopped taking Mefloquine, and after a couple weeks the big ball of anxiety in my chest started to loosen. It took a couple more months for me to really feel like I was getting back to normal, but it happened eventually and life is much better now. There are still plenty of stressful things (student loans, rainy season transport, project funding, garage weirdos, government paperwork...) but they no longer feel like they're consuming me, and I have a new appreciation for what people who struggle with serious anxiety issues have to deal with. 

Also, I was sitting in my hut the other day and realized that the bottle of Malarone I was holding probably cost about five hundred dollars, making it the most expensive thing currently in my possession, worth more than my netbook and my iPod put together.

World Malaria Day

So. Malaria. Basically, a person gets malaria from the bite of a mosquito infected with Plasmodium parasites. The parasites get into the bloodstream, mess up the red blood cells, and start making the person all feverish and then really, really sick. If another uninfected mosquito bites that sick person then that mosquito becomes infected and can pass on  Plasmodium parasites to the next person it bites. 

Image thanks to iayork.com

Only female Anopheles mosquitoes can infect humans with the Plasmodium parasites that cause malaria. (Italics because it's the Latin name,not because I'm trying to be extra emphatic.) There are different strains of Plasmodium parasites, some more dangerous than others, and here in Senegal we have mostly Plasmodium falciparum, which is pretty much the worst kind. You can avoid getting malaria by taking prophylactic medications like doxycycline, mephloquine (Lariam), or atovaquone (Malarone). If, for whatever reason, these medications aren't an option you can reduce your chances of getting malaria by using insect repellent, sleeping under a bed net, and getting rid of standing water and other mosquito breeding grounds. 

If you do get malaria there are effective, affordable treatments available, even in places with  chloroquine-resistant malaria, like Senegal. Our Health Center is usually well-stocked with government- and NGO-subsidized Malaria Rapid Tests and Coartem medication packs, especially during rainy season, when most malaria cases happen. Here are photos of the Coartem for adults that Peace Corps gave me (but which I will hopefully never need because I'm good about taking my prophylaxis) and also of a pack of Coartem for children that's available at the Health Center. 

This past Wednesday was World Malaria Day, and people all around the world did activities and held events to acknowledge the damage caused by malaria and to raise awareness of how to prevent malaria. In Salémata, my village, Wednesday was also when our Health Center has its monthly vaccination and growth monitoring activities. We didn't do anything huge because it was already a pretty busy day, but we did have an informal causerie discussion with the mothers who had brought their babies to be weighed and vaccinated and who were just hanging out, waiting for the nurse to call them up. Adama Dioulde Diallo, one of the women who does community outreach  Salémata, used  my little set of info cards to give little presentations on how to properly use and care for Long-Lasting Insecticide-Treated Nets (LLINs) and we talked about setting up a bednet care-and-repair activity sometime soon.  

Adama Dioulde Diallo

If you like maps and are interested in learning a little more about malaria, please check out the CDC's fantastic Interactive Malaria Map. It's neat. 

More Notes on Camp

The radio show This American Life has an excellent episode called Notes on Camp, and it's totally work a listen.

Here are a few more photos from youth camp:

Tatiana running a Marketing activity for selling
 locally made bug repellent and the weekly village market.

Host Sisters: Mariama Gaulo and Adama

Eric & I, exhausted from teaching First Aid. 

Also, doorways here tend to be really low, and everyone hits their heads pretty frequently. One evening Patrick, one of my Peace Corps neighbors, hit his head one time too many (he had a couple scrapes on his scalp that were actually bleeding a little bit) and went and got his bike helmet. That night was also spaghetti night, and they ran out of utensils at dinner (usually we'd get spoons to eat with) so some of us wound up eating with our hands. It was a total mess, and also almost pants-wettingly funny. Almost.

Patrick, Meghan, & Tatiana

Meghan and me, eating spaghetti with our hands

Tatiana and Patrick on Spaghetti Night

You can tell who sat where by how much pasta
 was left on the floor afterwards. (Those are my toes.)

All in all, I'm lucky to be in a region with such awesome and entertaining people; even when things got hectic and confusing (which happens a lot when cultures and schedules and languages collide) we still managed to have a lot of fun.

Also, just for the record, my summer camp, Camp Unalayee, is still the best summer camp of all time.

Work Stuff: Baseline Survey and Potential Work Projects

Before I begin working on any projects in my village I have to do a Baseline Survey and lay out an Action Plan for my service. There are three main neighborhoods in Salémata and the Quartier Mosqué, my neighborhood, has approximately 61 family compounds. So far I've  taken my survey questionnaire around to almost all the compounds in my neighborhood and a few in the other two neighborhoods, and people have been really helpful and receptive. I did my survey in Pulaar, and I asked things like how many people live on the compound, where they get water, if there's a latrine, and about the communities health challenges and resources. I'm currently setting up an Excel spreadsheet and getting ready to enter in all that data -- sometimes life in Africa exactly as exciting as life in any office in America.

Once I get all my baseline data organized and sorted out I'll have a better idea of what projects I'll propose in my Action Plan, but here are a few things I could work on that people I interviewed suggested:

Latrines: It's nice to have a toilet, even if it's a pit toilet, and many people here do not. Diarrheal diseases, like amoebic dysentery, are a major cause of suffering and death here, and a lack of latrines contributes heavily to that problem.

Malaria: Malaria is still a huge problem here and I'll definitely be working on finding ways to reduce malaria in my village. Having a training on making neem lotion, and to teach others to make it, There are Long-Lasting Insecticide-treated Nets, indoor spraying,

Reproductive Health: From basic human anatomy to ways to prevent infections to reliable family planning options, there's a need for accurate information about reproductive health, especially for young people. There are many people who have a lot of good knowledge about health, but here's also a lot of misinformation out there - for instance, I've had several people tell me that pregnant women shouldn't eat foods rich in vitamins because it will make the baby too big and cause difficulties during childbirth, which is both untrue and potentially very harmful to mothers and children.

Nutrition: From underweight babies to iodine deficiency, there are a lot of food and nutrition issues in my area. Promoting moringa gardens, use of iodized salt, and having workshops on basic nutrition and how to make simple enriched porridges to help malnourished kids recuperate are a few examples of potential projects.

Here's some more info on the Preventative Health work that Peace Corps Volunteers do in Senegal:

• Malaria
• Preventing HIV with Youth Theater
• Community Latrine Projects
• Moringa

Delorian Dreams

Just for the record, the preventative malaria medication that I'm taking does indeed cause surreal dreams. Not nightmares, just weirdly vivid dreams that I would probably confuse with reality except for that they've all been ridiculous.

All my Lariam dreams so far have taken place entirely at night, even the one that I had during my afternoon nap. For instance, last night in my dream I remembered that I forgot my toothbrush and some notebooks, so I ran home to California get them. I tried to hop a flight back, but San Francisco International Airport was being remodeled to look like a Japanese restaurant from the 70s, so it was really hard to find the right elevator... and so on like that.