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. 

Maternal and Child Health Training: The Last of the Work Stuff

In March the maternal and child health training for "Neighborhood Aunts"that we've been trying to get off the ground for months actually happened, and despite some communications difficulties (the cell phone network went down for a week and a half) it went really well. “Neighborhood Aunts” are women who have been selected by their villages to serve as point people for disseminating important health information and encouraging healthy behaviors. Because they live and work in the community they are ideally placed to serve as health resources and can encourage healthy behaviors, such as attending pre-natal visits and seeking early treatment for malaria. 

For the most part, the midwives would lead a discussion or lecture, and then the women would break into small groups to practice leading health talks and having conversations about a given topic. Then, one by one, they would practice leading a health talk with the whole group, and the midwives would add or correct things as needed. The training was based on the "Neighborhood Aunt" curriculum laid out by the Senegalese Ministry of Health, and the schedule went like this:

Day One

·        Orientation and discussion of roles

·        The importance of advocating for ante-natal care

·        Pre-natal visits, attended births, post-natal visits, and miscarriage

·        Family planning and reproductive health

Day Two

·        The importance of advocating for child health (0-5 Years)

·        Vaccinations, seeking early treatment for illness and injuries

·        Community mobilization methods, implicating community leaders

·        Creating and managing community health funds

           

Day Three

·        Planning, implementation, following up, and reporting activities

·        The importance of the "Neighborhood Aunt"

·        Evaluation and distribution of monthly activity reporting forms

·        Review and closure

There were also group discussion about why maternal health is important, and the participating women spoke frankly and passionately about how women are often undervalued or seen as replaceable, and how that needs to change. They had the chance to ask all sorts of questions, talk about the reasons that people in their communities wait until the last minute to seek medical care, to discuss why some people are opposed to family planning, and to reaffirm the importance of having "Neighborhood Aunts" in a village.

The Community Center where the training was held is also where local youth can take vocational courses for trades like tailoring and catering, so the lunch and coffee break prep for our training also served as a practicum for a group of catering students. It was really fun to hang out during lunch and coffee breaks, both because the people serving the food were intent on showing off their skills and because all of the women were so obviously delighted at being served a fancy lunch that they didn't have to make from scratch themselves. I think it made them feel important, which made the training feel more important, too.

Once the chairs were rented, the radio announcements made, and the lunches all paid for, my main role was just to sit in the back of the room, taking pictures, occasionally holding fussy babies, and nodding approvingly whenever anyone looked over at me. About half the participants came from other villages, took three whole days out their lives, to attend the training, and it was great to see most of them really enjoying the training, asking good questions and taking their role very seriously. Best of all, the midwives were really pleased, and after the training wrapped up they talked and talked about how to best implicate the newly-qualified "Neighborhood Aunts" in their attended birth and pre-natal visit promotion activities. 

Latrines: A Very Good Thing

During my baseline survey, many of the 62 family compounds I interviewed talked about wanting a latrine. There were some pre-existing latrines in the area, but many of them weren't very sturdy and were susceptible to collapse, particularly during the rainy season.

A partially collapsed latrine

Two years ago the Catholic Mission of Salémata held a training for a group of village masons that covered ideal pit dimensions, durable latrine designs, how to mold a concrete latrine cap, and installing ventilation pipes. So, there was obviously a high level of community interest and available skilled masons, but the high cost and inconvenience of obtaining building materials meant that very few families had actually installed a latrine, and of course, without latrines people are forced to practice outdoor defecation, which contributes to the spread of dysentery and other diarrheal diseases.

All of this led me to write a Peace Corps Partnership Project grant proposal, and with an incredible amount of support from my friends and family in America it was quickly funded. Once I had the means, it was time to go back to the hardware stores in Kédougou where I’d gotten quotes, order the materials and arrange to have them transported the 80k (50 Miles) on a rough, unpaved road out to Salémata. Ordering the supplies was painless, but withdrawing the money from my account turned out to take almost five hours of waiting at the bank. With help from my host family and neighbors we spread the word about the project requirements and held meetings to make a list of participants and a plan for how people would pay their contributions, compensate the masons, and verify that the work had been done. Once all the supplies actually arrived (there were some truck problems and some inadequate stock problems, so it took a couple tries to get everything delivered and ready to go) participants paid their contribution and got checked off on the Chief’s list, and then came in pairs to collect their cement and materials.

Once the latrine building got underway I walked around with the head of the village Sanitation Committee to check in and see how things were going. We chatted with people about the project, talked about different ways to make covers for the hole, and made sure to work the many benefits of hand-washing with soap into the conversation. People were really positive and it was a huge relief to see that the whole thing had worked – latrines were built, awareness was raised, progress was made.

Some of the latrines are totally done and in use, but there are a few people who still need to put up the crintin privacy fencing. Now that hot season is upon us the Bassari craftsmen are starting to show up to the weekly lumo market with sheets of crintin, stools, beds, tables and chairs made from something that everyone calls bamboo, so hopefully the rest of the latrines will be screen in and operational in the next few weeks.

Working on this project has been a fantastic experience. As one of my neighbors said, “Adama, this is a very good thing for Salémata. Your work is good and now we have a latrine in our household. It will be a good thing and the people will see the latrines and remember you. Whenever I look at our latrine I will think of you.” As flattering as that is, this project wouldn't have happened (or would have been much, much more difficult) if people hadn't already been interested in latrines, if there hadn't been trained masons on hand, if my family and friends in America hadn't put on such a successful fundraiser, or if the chief and Sanitation Committee hadn't be willing to do the lion’s share of the accounting and explaining and distribution of supplies, and I’m grateful to everyone who contributed time, energy, and support to the project.