Before coming to Cameroon, I knew very little about malaria.
All I knew was from my undergraduate public health classes, as well as from
previous visits to doctors before traveling. I knew it was a disease
transmitted by mosquitoes that primarily affects individuals in tropical and
sub-tropical climates, and that it kills a disproportionate number of people in
African countries every year. And that was pretty much it. Little did I know
that years later, malaria would be the primary focus of my life for a whole
month—and likely two years more—during my Peace Corps service.
I became
fascinated with malaria the first day we started talking about it during PST.
Obviously, from the start we were told certain things about malaria, like the
importance of taking our prophylaxis and sleeping under a bed net every night
to prevent it. However, I’ve always been interested in the why of things like this, the biological mechanisms behind things
(okay yeah so I’m a bit of a science nerd), and so it wasn’t until our malaria
unit in PST that I really became interested in the disease.
Here, we
learned that the disease malaria is caused by a parasite called Plasmodium. Though there are several
types of Plasmodium that cause the
disease, the most deadly—and commonly found in sub-Saharan Africa—is known as Plasmodium falciparum. The disease is
transferred by the bite of a female Anopheles mosquito that is infected with
the parasite. This specific mosquito prefers warm environments, and only bites
between the hours of around 8pm and 4am. Our trainer explained that this is why
bed nets are such an effective method of preventing malaria—because the
mosquito that transmits the parasite comes out during the night when most
people are asleep, if you just cover yourself with a bed net during that time,
you’re less likely to get bitten. This
was the ‘why’ I had been looking for!
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| A properly hung bed net |
Next, we
learned about the transmission cycle and manifestation of the disease. Here, we
learned that after the infected mosquito bites someone, the parasite enters the
body and stays in the liver. The parasite can stay dormant in the liver for
anywhere between one and four weeks. During this time, the infected person does
not experience any symptoms, and is not contagious (i.e. cannot transmit the
parasite to another mosquito, which is how the disease is spread from person to
person). Then, the parasite leaves the liver and begins infecting red blood
cells, which it uses as sites of reproduction. After 2-3 days, the red blood
cells explode, releasing new parasites into the blood stream, where they begin
infecting other red blood cells. When these red blood cells explode, toxins are
released into the body, which cause the first telltale symptoms of malaria:
high fever and severe headaches. Because so many red blood cells are destroyed
during this process, it is common for people with malaria to become anemic very
quickly. At around the same time that the parasites begin infecting red blood
cells, other parasites become capable of being transmitted to other mosquitoes,
which starts the transmission cycle all over again. Because the symptoms occur
with the spread of the disease from the liver to the red blood cells, there is
very little time between a person becoming symptomatic and becoming capable of
transmitting the disease to another mosquito, and eventually another person.
This is why immediate treatment is so important for those diagnosed with
malaria!
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| A great graphic to help better understand the malaria transmission cycle |
Besides the
scientific stuff, we learned the real-life effects that malaria can have on
individuals, families, nations, and continents. Here we learned that malaria is
the cause of 660,000 deaths each year, 90% of which occur in sub-Saharan
Africa. We also learned that every minute, a child dies due to malaria, and
that malaria is the primary cause of missed days of school among students in
Africa, with approximately 10 million days of school being missed each year due
to the disease. We also learned that malaria is the primary cause of
morbidity—the number of people living with an illness—and mortality—the number of
people who die due to an illness—amongst vulnerable populations in Cameroon.
These groups include children under age 5, pregnant women, and people living
with HIV. The malaria morbidity rate is 52% amongst children under the age of 5
and 38% amongst pregnant women. In Cameroon, malaria is the primary cause of
hospitalizations and of consultations at health centers, as well as the primary
cause of child mortality. Here, a child dies every four hours from malaria.
Now I’m
sure to many of you, malaria seems like a foreign thing that you will never
have to confront in your whole life. Which for some of you may actually be the
case. However, what some of you may not know is that malaria is not just a
problem in sub-Saharan Africa. It is a problem all over the world, and at one
time, was a problem in nearly every country, including—you guessed it—the good
ol’ United States of America. Yup, that’s right—malaria wasn’t eradicated from
the United States until 1951. This means that some of your grandparents—or maybe
even your parents—had or knew someone who had malaria while living in the US. Between
1946 and 1951, malaria was eradicated from most of the world, except in
sub-Saharan Africa. Why is that? Unfortunately, though the global efforts to
defeat malaria were strong and united, they for the most part completely
ignored sub-Saharan Africa. This is likely a major explanation for why malaria
has not been eradicated from this region yet, despite the fact that it has been
eradicated from many other parts of the world.
So at this
point, some of you may be thinking, “well maybe it’s just impossible to
eradicate malaria from that region!” While that may be an easy way to get out
of caring about the problem, it’s actually not true! After the world finally
started paying attention to and addressing malaria in sub-Saharan Africa, by
2008, malaria deaths in 10 sub-Saharan African countries fell by more than 50%. So yes, though there may
be more challenges in addressing malaria in these populations, completely
eradicating it is by no means impossible. Those of us doing malaria work just
need to keep pushing, and keep forcing the world to pay attention to the
problem. Though malaria may not seem as scary or exciting to the world as the
Ebola crisis, it’s a terrifying reality for millions of people in sub-Saharan Africa, and it needs to be
addressed just as ferociously as the Ebola crisis was.
So, what am
I doing to address the problem in my community? I’m glad you asked! Over the
past month or so, I’ve been working with the chief of my health center to plan
a project to address malaria prevention in my community and those surrounding
it. When I come back from this gardening training I’ve been at—something I
promise I’ll write about later! —we’re gonna really get the ball rolling. Once
I get back, we will have a peer educator training for 10 community members that
have already been trained by Plan Cameroon as Community Health Agents (Agents
de Santé Communautaire, or ASC in francophone regions). Here, we will introduce
the goal and steps of our project, as well as teach them more in-depth
information about malaria, prevention, and the economic losses caused by
malaria in our community and around the world. After finishing the
training—including the distribution of some handy PC-certified certificates—we
will begin the next phase of the project. Here, the ASCs will be assigned zones
within our village, where they will be responsible for going door-to-door and
performing surveys with community members. These surveys are designed to gauge
community members’ knowledge of malaria basics, measure their usage of
preventative measures, and scout out houses where bed nets are missing or have
not been hung up yet. After finishing the surveys, the ASCs will begin the
third part of the project. Here, they will go back to their zones, and continue
going door-to-door. This time, however, they will assist people in hanging up
their nets, and ensuring that every house they visit has an appropriate number
of nets hung up for the number of people living there. After helping with net
installation, they will talk to community members about malaria, including
information about transmission, prevention, vulnerable populations, and the
costs and losses for families and the community due to malaria. Finally, a
month later, the ASCs will initiate the final step of the project. Here, they
will go back to their zones for a final time with the same survey as used in
the beginning. They will ask the same questions to ensure that community
members have retained the information given to them, and will check in on
families to see how their bed net usage is going. Though this project hasn’t
started yet, I’m feeling really excited about it, and am sincerely hoping that
it will create some positive change in my community. I’ll be sure to keep you
updated with the project when it’s finished!
Feeling
inspired by my post and are just itching (no pun intended) to do something
yourself? Awesome! If you’re looking for ways to get involved in the fight
against malaria, I have a few ideas for you. First, check out some cool
organizations with malaria eradication as their primary goal, such as Stomp Out
Malaria and Roll Back Malaria. If you have a few extra dollars lying around,
maybe even make a donation to one of these organizations, or see if there’s a
way you can donate bed nets or something more specific. Next, go public! Post a
Facebook status about how you donated to one of these organizations, or with a
cool fact you learned about malaria from me or anywhere else. If you’re mentioning
one of these orgs, be sure to tag them so other people can visit their pages!
Talk to your weird aunt at your next family party about malaria and its impact
on the world—heck, it may even help you avoid that awkward conversation of why
you’re still single or why you don’t care that it might be hard to find a “real
job” with a degree in Art History. No matter what you do, MAKE THE WORLD KNOW
that malaria is still a major problem, and that it’s not going to go away
unless we all work together to fight it. Keep fightin the bite, my friends, and
let me know if you ever wanna chat more about malaria!
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| The official logo for #StompOutMalaria, a malaria initiative powered by Peace Corps volunteers in various African countries |
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