Malaria Month

While Hallmark promotes holidays such as Grandparent’s Day and National Kitten Day in the US, people on the African Continent recognize such events as Tuberculosis Day and Malaria Month.  This week we “celebrated” Tuberculosis Day in Nicoadala.  The top executives of the province and the hospital opened the event by reading long and formal proclamations followed by political promises to improve care for patients, their families and the general public.  A theatre performance by a group of activists picked up the pace using a humorous skit to remind people about simple tips for prevention and treatment.

Any attempt to provide health education is useful here.  Clear and repeated messages are sorely needed to counter the misinformation, myths and lack of information.  In a culture where many people are uneducated and rely on the customs of their ancestors and local healers, health care improvement is an on-going challenge.

Peace Corps addresses health issues, like Malaria, by encouraging all volunteers to gear up their activities to  “Stomp Out Malaria”, a popular program in Africa working towards the eradication of this disease.  April is designated as Malaria Awareness Month.  The idea is that with an increased effort the world at large, and our communities in particular, can focus with renewed interest and energy and make a serious impact towards eradicating, or at least preventing malaria.

“Stomp Out Malaria” involves volunteers holding seminars and trainings in their communities, facilitating events for mosquito net distribution, and using social media to share websites and information.  The real trick, though, is to inspire behavior change.  Raising awareness and providing education are only the first steps, and usually the easiest and most fun. This is the fanfare, the horn-blowing and throwing of confetti, the marching in proverbial and actual parades, waving in the by-standers to join the festivities.  But initiating behavior change, and measuring this behavior change, is crucial for long-lasting and effective progress.

And, the behavior change is asking that the population practice new or different actions, actions not always consistent with the culture.  We all know that change can be an obstacle in our lives.  It can induce feelings of fear and doubt in the suggested action, in the messenger and even in our selves.   Attempting to change behavior is no small feat in any circumstance, and particularly a looming undertaking for a Peace Corps Volunteer serving in a foreign country.

And, the thing is, as is the case with Malaria, as Americans, we know the disease can be eradicated.  Malaria existed in the US up until 1951.  So teaching prevention methods, while extremely important in this setting, feels like throwing that one starfish back into the sea.  Undoubtedly it is essential to that starfish, or the person sick with the disease, but it doesn’t address our continued inability, or unwillingness, to eradicate Malaria.

Meanwhile Peace Corps Volunteers and other health workers try to educate people about malaria.  We encourage people to remove stagnant water from their yards and to cover any water tanks or buckets.   We suggest that they cut up or bury old tires and trash, places where mosquitos breed and produce eggs.  We demonstrate the proper usage of mosquito nets and plead that they use them nightly, the time when the mosquitos are most active.  We ask that they not use the nets for fishing or to cover and protect their crops.  We try to show the cost of the illness, how losing time in the garden and needing to purchase additional foods for a healthy recovery are more expensive than it is to simply purchase a net.

Yet, this all goes back to the issue of behavior change.   Understanding that stagnant and still water is a risk is difficult to comprehend when the dangers of microscopic-sized organisms cannot be seen.  Covering basins of water requires having a cover and instituting a new habit.   Burying or burning trash is an additional effort.  Here there is no community provision for trash removal. 

And, trash is the by-product of a purchased item, something that while common place today was once a status symbol.  If we believe that almost all of our actions are based on financial platforms, as I purport, then discarding the wrappers of processed foods in one’s yard was proof of one’s social and economic standing.  Now, it is simply a learned behavior, and a result of not having any other option, to throw the trash in the yard.

And if a mosquito net can bring in fish which could be sold, or to yield more plants from the garden, a portion to be sold in the market, isn’t this a financially sensible choice?  The alternative is to protect from a bug that may or may not bite or infect.  And, if it does, there is medicine at a cost of only five metacais, as compared to one hundred metacais for the purchase of a net.

Malaria Month Brochure

All of these are factors to contend with when educating people here about malaria.  The behavior change, I am convinced, is best addressed on the financial level, by comparing the higher cost of illness to the affordable cost of prevention.  It is time also to convince our funders, the world over, that their combined donations to treat this disease would best be spent to eradicate Malaria once and for all.  That is a behavior change we could easily measure.