Reflecting on the first 48 hours of Peace Corps, I remember a whirlwind of packing, introductions, buses, airports, and flights. Eventually, we found ourselves in a conference room in Lusaka where the medical officer gave a bottle of medicine. “Take one, pass it on”. We all gulped down what I found out to be Malarone, one of the three prophylactic medications we must take to prevent malaria.
I generally knew about malaria – that it’s a disease contracted from mosquitoes – but didn’t learn the specifics until we came to Zambia.
Even though our primary project is promoting small scale aquaculture, our secondary projects vary wildly. Malaria is a high priority in our village. The parasite is so common that people speak nonchalantly about contacting malaria. Actually, “malelya” is interchangeable with a general feeling of sickness, so when we greet people and they say they have malaria, we have to question further whether it’s mosquito malaria or just a cold. Often (and thankfully) they’re just feeling unwell, but the fact that people use the term to mean a general sickness makes eradicating malaria even more difficult. Still, I’ve found that people are rather unconcerned about malaria. Yet I know of so many confirmed cases just in the past few weeks including the head teacher, headman, fish farming counterpart and his son, and ironically, our malaria counterpart and his wife. This was in dry season, so I am afraid what will happen during rainy season. I can see directly how malaria affects people’s lives, so we are committed to doing malaria programming in our village.
The Basics of Malaria
Malaria is transmitted from human to human via a parasite in a mosquito’s saliva, specifically a pregnant female Anopheles mosquito. The parasite enters the liver and multiplies until it bursts into the bloodstream. It is then that one experiences symptoms, typically 7-30 days after being bitten. Symptoms include fever, chills, vomitting, diarrhea, body pains, and headache. One way to test if you have malaria is with a rapid diagnostic self-test in which you take a blood sample to measure the proteins in your blood. However, a more accurate microscopy test would be done in a clinic. Once confirmed, you would be prescribed three rounds of Coartem, which kills the parasite in the liver and bloodstream. If left untreated, which unfortunately often happens because clinics are usually far distances away, the illness can progress to cerebral malaria, possibly causing coma and long-term effects.
There are a lot of myths surrounding malaria, such as:
- You can get malaria from eating raw mangoes or drinking dirty water.
- You can only get malaria in the rainy season.
- Only pregnant women should sleep under a bed net.
- You could become immune from malaria.
These misconceptions and a lack of access to healthcare are some reasons why malaria persists. The government’s efforts to control malaria include a country-wide bed net distribution and Indoor Residual Spraying. Even though most people received bed nets, unfortunately they are misused, not used at all, or sold. Most people won’t go out of their way to buy a bed net because they are expensive and money is usually tight; food and school fees take priority. The government is unlikely to do another bed net distribution, so the effect is a short-term one. While we PCVs lack the resources to do such programs we are armed with knowledge to do education programs for a longer-term solution.
Kasama/Mungwi Malaria Bike Tour
One volunteer and a counterpart can only do so much, so we combined forces and put on events to reach a larger audience. Eight volunteers in our area bicycled 99km to three villages to do malaria education and programs. The first site was ours, so people rode 1-8 hours to our village on a Sunday morning in the absolute hottest month of the year. We rested the first day and I introduced them to some of our friends in the village. It also happened to be the day of the first big rains after a dry spell of five months, so with that comes an infestation of inswa (flying termites) fluttering around the house. It wasn’t the most pleasant experience, but it certainly was memorable. Instead of pitching tents out in the rain, everyone snuggled up in our house for a classic slumber party!
The next morning, we started the program at 8. The students hauled desks outside and performed songs and dances to kickstart the event. The volunteers introduced themselves, I gave a little speech, and we taught the symptoms song that goes to the tune of “Head Shoulders Knees and Toes”. They always get a kick out of the second verse.
Mpepo umutwe ukukalipa ukukalipa (x2)
Mpepo umutwe ukukalipa ukukalipa
Fever, headache, body pain, body pain
Fever, headache, body pain, body pain.
Then, the students split into groups of three. It was originally supposed to be small groups of 6th and 7th graders, but the head teacher insisted that ALL students participate. So it was a bit hectic controlling about 200 little ones, but it all worked out in the end. The PCVs and counterparts did such a wonderful job at keeping the energy up! Meanwhile, I played manager by keeping track of time, taking attendance, and managing all of the adults who came by.
The activities were all hands-on games to teach about malaria prevention using analogies. For example, they played Sharks and Minnows, except the sharks were mosquitoes with malaria and the minnows were people. After playing the games, there was a lesson and a summary of the takeaways. Namely:
- Malaria is preventable
- The most effective and cheapest way to prevent malaria is to sleep under a bed net every night and use it properly (tuck it under your mattress, close any holes, don’t let your body touch any part of it, don’t use it for other things like fishing nets)
- You must go to the clinic if you experience symptoms in order to get tested and receive treatment.
- You must finish the full course of treatment, even if you feel better, in order to kill all of the parasites.
- You should protect yourself not only for your own well-being, but to protect your family and community. If you get malaria, then it can be transmitted to people you love.
After the games, we reconvened again and did a little skit on human transmission. Some older people are casual about getting malaria as it is so common. They think they’ve built immunity and can sleep it off, so they might not take the initiative to protect themselves. In doing so, however, they’re putting their families and community in danger because malaria is transmitted from human to human via mosquitoes.
The final activity was a demonstration showing how malaria affects the fetus in pregnancy. Every month, some staff from the nearest clinic (13km away) comes to our village for the Under-5 clinic. Mothers bring their children for measurements, immunizations, and education. It’s a chaotic event but a good opportunity to interact with women and teach topics like nutrition and hygiene. Amber and Martin did a superb job!
After our site, we rode about three hours (well, we took a long break in town to eat and relax!) to Thomas’s site. It’s amazing how sites vary from village to village. The idyllic atmosphere has fantastic sunset views over his host father’s fish ponds and green rolling hills. You can relax in the shade of the mango tree and enjoy the silence. Our site, on the other hand, is on school property and near churches and the shops, so we are always hearing kids, the school bell, yelling goats, music, and drums. The activity is nice, but sometimes you just want peace and quiet. Since October 24 was Independence Day, the school was closed for a program, so we took a rest day by the river. Reminded me of my favorite spot in Gwangju!
Well rested, we did a program at the school the next afternoon with similar games. Immediately after, we hopped on our bikes and rode for about two hours in the afternoon sun, mostly uphill, to the final site, Amber’s. Needless to stay, we were wiped out from the week’s activities, heat, and bike riding, but I still managed to muster the energy to play with her sweet pup, Nsansa, prepare and eat dinner, and bathe. I quickly knocked out in her comfy living room just after dark.
The following morning, we split into groups of four and did bed net checks. Grayce and I visited a few households, introduced ourselves, asked some questions, and went into their homes to check their bed nets. I was surprised to learn that many people did not sleep under a net, but was even more shocked that they had bed nets still in the package. In 2017, there was a mass distribution of insecticide-treated nets across Zambia. One net for every two people should have been distributed, but unfortunately some people missed out on the distribution day. Anyway, we politely asked if we could hang their nets up over the sleeping areas. One family quickly agreed and even helped us, but another household was reluctant to use the net because they felt it would be too hot under the net. After some convincing, they finally agreed. Hopefully they are still sleeping under the net today!
In the afternoon, we did the transmission skit and played some games with some curious and sweet kids. Amber also talked about IRS (Indoor Residual Spraying to kill mosquitoes in the house to prevent transmission) which was about to happen in the village. We answered some questions, somehow found energy to do energizers, and wrapped it up! Then we pedaled a quick 14km to town where I celebrated with an obligatory ice cream cone. Not having refrigeration at home, the littlest pleasures are miracles.
Overall, the bike tour was a success! We had a wonderful team of volunteers, a variety of activities, and a decent pace to travel 99km throughout the week. I think the attendees took away knowledge from the events, but there’s still following up to be done. Change doesn’t happen overnight with one lesson – education, leading by example, and continuing the conversation are essential for behavior change, ultimately leading to controlling malaria. When less people contract malaria, more people can work, go to school, and generally live healthier lives.