Malungo

Right now Ebola is a media sensation and for a good reason. People are dying and there's not really a cure. One good thing is that Ebola is a relatively hard disease to get as it requires direct contact with bodily fluids. But I don't want to write about Ebola. I want to write about Malawi and what I work on here that's maybe not such a media sensation but its a huge part of my life and the lives of those around me. 

In Malawi we don't have Ebola yet. But we have other things. Here my life goes like this: every night as I lay down to go to sleep, I also tuck in an insecticide treated bed net called a LLIN around my bed and under the mattress. Every hotel I visit also has these hanging from the ceiling. Everywhere you go they are there. The "why" is this: in Malawi many people die from malaria (malungo in Chichewa) each year and WHO estimates "around 1 million" die around the globe every year. Children under 5 years are especially vulnerable and Malaria is the #1 reason for out-patient visits, hospitalizations and deaths in under 5 children. Malaria costs governments and donors millions of dollars each year. And yet it gets less media, funding, and attention than other public health issues such as HIV/AIDS.

The reason we sleep under nets is because malaria is spread through a certain female mosquito called the Anopheles and she only bites from dusk to dawn. So basically through the night. Bed nets act as barriers blocking the mosquito from getting to your body. Malaria itself is actually a parasite that mosquitoes carry in their saliva that gets into a persons bloodstream, reproduce in the liver and then burst out and attack red blood cells. It kills through severe anemia, by spreading to the brain, causing high fever, organ failure, and dehydration. Malaria is curable through several lines and types of treatment. But the problem here in Malawi is malaria needs to be treated fast- the recommendation is within 24 hours of symptoms. And sometimes the drugs required are out of stock at clinics and health centers. Sometimes the medicine is around but oral rehydration packets are not.

So we teach people to sleep under nets. And to wear long sleeves at night and keep standing water to a minimum as this is where mosquitoes breed. We also encourage people to go for testing as soon as they have symptoms. In 2010 only 22% of children under 5 got diagnosed within the first 24 hours. The goal by 2015 is 50%. There can be several reasons for this delay though. For example, if the symptoms occur on a Friday, most health centers don't open again until Monday and Monday is a busy day with long lines. Some people also live very far from health centers. Others are so accustomed to malaria being a part of their life that they don't take it as a very serious thing anymore. When we do test for malaria we do so by taking blood samples. You can look for the parasite under a microscope or just do a quick rapid test for antibodies taking about 15 minutes. 

Pregnant women are also highly vulnerable to malaria. In Malawi, only 49% of pregnant women as of 2010 were sleeping under a net. This is scary as malaria can cause spontaneous abortions, low birth weight and growth retardation in babies, anemia, and other problems. Women here have to take a drug during pregnancy that tries to prevent malaria- a prophylaxis. People like myself who are not immune at all to malaria also take a prophylaxis to prevent ourselves from getting malaria. The goal by next year is that 80% of pregnant women are sleeping under a net and getting 3 doses of their prophylaxis at antenatal clinics. 

^^Photo: Nets hung over bed mats at the guardian shelter at the clinic

As of 2013, 90% of cases of malaria occurred in Sub-Saharan Africa. It's a problem that's killing people but one that can also be prevented and solved. Behavior change is one of the largest obstacles to that change- getting people to understand how serious malaria is and then take action against it. As I write this, one lady is sitting outside the health center vomiting from malaria. Another child is in the observation room with an IV. Another young boy has severe anemia from malaria and needs immediate attention. All our resources and energy are today focused on malaria.

So what have we done as a community and health center about it? A few things. To start, in our Guardian Shelter where expectant mothers stay until it is their time to deliver we've hung bed nets and reed mats down so the women can sleep there safely and more comfortably. We've painted 2 murals about malaria prevention and treatment at 2 different health centers. I teach about malaria in my Life Skills class and do activities with the youth after school raising awareness. I help in the malaria testing room and have worked to improve the data entry and analysis process so reporting is more accurate. I encourage all our workers to follow proper infection prevention (IP), data entry, and diagnosis protocols. We've had a soccer tournament with drums, drama, and teaching to show people about proper bed net usage. We also started a program called House Calls for Health where we visit homes doing malaria surveys along with nutrition and teach people about malaria and proper net usage and also explaining the importance of going to the Health Center when sick. We teach about malaria at the health center to different groups during health talks. We have invited people to wash and repair ripped bed nets. We also installed screens on the windows of the maternity ward. I encourage friends to sleep under nets and go for testing and to not just buy malaria drugs at the store without having a test first. Because the more drugs we take to treat malaria without actually having malaria, the more drug resistance we cause. All of these interventions and programs are just trying to encourage behavior change.

The problem sounds big and it is but strides are being made. And malaria can be eliminated. Did you know the United States, Canada and parts of Europe use to have malaria? But they were able to eliminate it and Malawi can too. It is possible. But until then we use nets, take prophylaxis, minimize standing water, put on insect repellant, wear socks, and take rapid tests each time we feel ill or have a fever. This is a little about one of my biggest projects here in Malawi. Thanks for reading!

^^Photos: Malaria murals at the clinic. Neighbors washing and cleaning their mosquito nets. Informational posters created to post at the health centre.