Uganda Bites Back! Malaria Education Through VHT Training

Written by Kristina Sandfoss

PCV Kendra Smith is based in a rural village in Kiruhura District in Southwestern Uganda. Uganda Bites Back, a project Kendra created, coordinates two-day malaria workshops for Village Health Teams (VHT) comprised of local volunteers that assist with distributing health education, skills and assessments to community members.

The goals of the project are to train the VHT Coordinators on malaria education and prevention, specifically mosquito net repair, care and maintenance, to increase community knowledge of malaria, malaria prevention and to encourage behavior change around proper bed net use.

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Kendra is passionate about the fight against malaria and this passion is what pushed her to create Uganda Bites Back . Earlier this year, Kendra conducted a baseline survey to better understand what community members knew about bed net usage; the results confirmed the need for bed nets in the homes and education on their proper use.  Kendra says “I know behavior change is one of the hardest parts of a society to effect, but a difference cannot be made if nothing is ever tried”.

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Kendra’s efforts are supported with a grant from the Pollination Project. The grant will fund supplies for each training and materials for net repair. The Pollination Project is a US based vegan organization that makes $1000 seed grants to individuals committed to making change happen every day of the year. The organization has supported 18 projects in Uganda that range from students becoming conservation advocates and community leaders to gender based violence workshops training community activists to malaria and other health education activities
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Follow along with Kendra’s project on her blog http://ksmithpcv.blogspot.com/
For more information on The Pollination Project visit http://thepollinationproject.org/

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Gambia Weekly Awesome: Introducing Mpahoreh Sillah

IMG_1916Mpahoreh Sillah, born 12 April 1986 in Sabi, a rural Sarahule village in the Upper River Region of The Gambia in West Africa has been instrumental in the fight against malaria thanks in part to the Stomp Out Malaria initiative. As a trained nurse, employed with MRC, he is passionate about two things: health education and football or soccer as we know it.

He became interested in health at an early age. A product of the Education system founded in Sabi under Future in Our Hands he was a leader in a very active Peer Health Club and mentored by teachers who encouraged him to follow his dreams. Working in health programs for the MRC he completed a two year nurse training program in 2013. When PCV Elizabeth Livingston was assigned to Sabi the stars aligned and two people who share a love of two things were introduced. As a PCV there is nothing more powerful than having community leadership at the center of any initiative and as Mpahoreh will attest, if you do what you love it isn’t work it’s destiny.

Mpahoreh is looking for opportunities to continue his education in health but always with the goal of returning to his home community, to be a part of giving back: “I want to be a part of the development and growth in Sabi.”

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Gambia Weekly Awesome: A Volunteer’s Narrative of Football Tournament Meets Health Fair

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It’s 8 am the Friday morning of Sabi’s Stomp out Malaria Soccer tournament, and all participants are actively waiting for the weekend to begin. They are assembled, quiet, feet tapping against their metal desks, adorned in both soccer cleats and bitik flip flops. There is an anticipation in the air, and the Peace Corps volunteers attending are sitting in the corner and watching Gambian counterparts begin the day. The counterparts start by quieting the boys, explaining what is to happen over the next 3 days and we all just sit in the background and watch.

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The concept of the weekend began with a clear identification of a West African passion: Soccer, and a West African health issue: Malaria. My wonderful friend Elizabeth, an avid soccer fan, and advocate for Malaria thought of an ingenious way to combine the two: use an existing soccer tournament as a platform for teaching about one of the most prominent health issues in this part of the world. She found an incredible counterpart named MPa, someone we all would be so lucky to work with throughout our service. He assembled a team of Gambians to lead the weekend, and Elizabeth did what is perhaps the most difficult but most effective thing we could do as volunteers: stand in the background and allow magic to happen so that our host country national counterparts can take the spotlight.

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I have never seen Gambians take such initiative, teach so effectively or be so passionate about something. As with all things here, things were late, and imperfect but with the imperfection came this understanding that the people running the program had never been given the trust or opportunity to educate like this before.

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Friday and Saturday were devoted to allowing the counterpart team teach the kids about Malaria, have the kids do a pre-test and use the Grassroots Soccer curriculum as a way and method to make the learning fun. The afternoons were devoted to the soccer tournament. On Sunday, Elizabeth and fellow PCV Jess, created a Malaria health fair which had the kids rotate rooms to learn about all aspects of Malaria: prevention, proper bed net use and malaria transmission. It was genius.

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There was a small army of Peace Corps volunteers there to help, but the beauty was that we barely needed to do anything. As the people who were translating our lessons for us took over and began to teach themselves, we were able to relax and just make sure things ran smoothly. I mentioned a quote in my last blog, or a mindset that I think we all should have as Peace Corps volunteers: “Go with the people. Live with them. Learn from them. Love them. Start with what they know. Build with what they have. But with the best leaders, when the work is done, the task accomplished, the people will say ‘we have done this ourselves.’”

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This was the beauty of the program. It will have an impact, I am sure. But it is nothing compared to the empowerment effect. When Elizabeth returned to village after the weekend, the boys on the soccer teams were still partying, the women still chattering, and I bet this will continue. Not because it was a Peace Corps program, but because it was theirs.

To Empower” was originally published on Musings from Under a Mango Tree
Photo credit: Beth Eanelli, PCV

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Gambia Weekly Awesome: Football Tournament Meets Health Fair

The boys of Sabi village in the Upper River Region sat in anticipation to start a three day program to stomp out malaria, organized by PCV Elizabeth Livingston. The idea to combine Grassroots Soccer, a football tournament and a malaria health fair all became a reality a few weeks ago. Elizabeth found Mpahoreh Sillah, a counterpart that any volunteer would be lucky to have in their service. He took the initiative, selected and trained coaches from the Sabi Football Association. Elizabeth and her counterpart made the decision to teach everything in Serehule, the language spoken in Sabi, and include all boys in the community, not just those who attend school. This made the program even more special because it is a rare opportunity for out-of-school kids to get to participate in an educational program like this.

Friday and Saturday mornings were dedicated to learning the four lessons from the Grassroots program, two each day. Taught by Elizabeth’s wonderful counterpart and the coaches that he trained, the students learned about proper bet net use and care, prevention and treatment, and facts and myths about malaria. In the afternoons, the 8 teams played the first rounds of the football tournament.

The final day of the program brought the semi final and final games of the tournament. Full of excitement the boys went back to school for the malaria health fair. They rotated through 4 stations being taught by PCVs and Gambian counterparts to reinforce the lessons taught the previous two days. The idea is that this health fair will be expanded to many schools throughout the Upper River Region, in the near future.

It was a beautiful thing to watch. About 15 PCVs came to help out for the weekend to find that there wasn’t really that much work to do because the Gambian counterparts had taken charge of everything. It was the epitome of Peace Corps picture perfect program.

Written by: Rachel Popik, Education Volunteer, Malaria Task Force Member

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63rd ASTMH: Accelerating to Zero

What impresses me the most about walking the halls of the ASTMH is the breadth of the research on display. From the most minute details of the parasite’s surface proteins to the challenge of getting drugs to millions of people in mass screen and treat (MSAT) campaigns, malaria is being looked at from every angle.

If there was a single thread that ran through the sessions I attended today it was that malaria is not a homogeneous problem. It differs country to country, region to region, town to town and now research is revealing that in many places malaria rates are clustered even within the same town. Intuitive this should be obvious – mosquitoes need a water source to breed and it stands to reason that malaria rates would be highest near that water source – and yet a population based bio-medical approach treats everyone’s risk as being equal. It’s not.

Fascinating work is being done in Zambia to map the occurrence of malaria at the household level and identify determinants of risk. In Namibia and Kenya mobile phones are being used to map mobile populations in real time to identify risks of malaria importation from one region to another. And Dr. Adam Bennett, who has presented at our Boot Camps introduced the concept of “hotpops” or hot populations – groups that are occupationally or behaviorally at higher risk for malaria, i.e. artisanal gold miners.

One way to address these populations may be to take a page out of the HIV book. Over the last 30 years ministries of health have been forced by the HIV/AIDS epidemic to break out of their clinical comfort zone and embrace innovative peer outreach models to reach high risk populations. Similar approaches may help malariologists identify and intervene with high risk (often underserved) populations as we try to push to zero.

And pushing to zero is on everyone’s mind. From mass drug administration to MSAT to vaccines and transgenic mosquitos the research community is filling its toolbox for the final push. I ended the day at a reception hosted by Malaria No More and the University of California San Fransisco’s Malaria Elimination Initiative. Looking around the room as the various speakers exhorted us to redouble our efforts I saw young brilliant researchers from around the world, public health professionals dealing with the disease day in and day out and a cadre of people who have been in public health long enough to be jaded. And it’s the hopefulness I saw in that last group that lifted my spirits.

PMI’s Bernard Nahlen brought it home to me when he talked about the sea change he’s seen in the tools available. When Bill Gates announced a commitment to elimination on the part of the Gate Foundation in 2007, it was roundly understood as an aspirational but unrealistic goal. No one thinks that any more – it’s an inevitability. The only question is how quickly can we do it – and every bit of speed we can muster is another child that doesn’t have to die.

As Nahlen pointed out, the city of New Orleans was itself quite malarious. With concerted public health effort that era is behind us. We can walk down Bourbon street without worrying about the mosquitos. We can enjoy New Orleans jazz from a balcony restaurant steeped in the tradition of the south. And we’re on the path to that day when Africa will be similar – one will be able to sit at a sidewalk cafe in Dakar or Accra or Lilongwe, listen to their distinctive musical heritages and give no thought to malaria at all. Zero.

written by Matt McLaughlin, Program Manager
Stomping out Malaria in Africa

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Day One of the 63rd ASTMH

Program Manager for Stomping out Malaria in Africa Matt McLaughlin with  RPCVs Anne Linn and  Karin Nordstrom along with Senegalese Regional Chief of Medicine Dr. Youssoupha Ndiaye in front of their PECADOM+ Research Poster

Program Manager for Stomping out Malaria in Africa Matt McLaughlin with RPCVs Anne Linn and Karin Nordstrom and Senegalese Regional Chief of Medicine Dr. Youssoupha Ndiaye presenting their PECADOM+ Research Poster

Bill Gates’ words from last night’s keynote hung in the air as the first full day of sessions began. Malaria elimination is achievable. That theme was hammered home in the morning session presenting the second Global Malaria Action Plan (GMAP2). The targets of GMAP2 are substantial, a 40%, 75% and 90% reduction in 2020, 2025 and 2030 respectively in both malaria mortality and morbidity. All of these measured against a 2040 baseline. To achieve these results we’ll need a roughly 70% increase in resources, but it as the head of the WHO Global Malaria Group noted, “We think these are realistic, not aspirational targets.”

Across the backdrop of high level malaria planning Peace Corps had something to offer. RPCVs Anne Linn and Karin Nordstrom along with Senegalese Regional Chief of Medicine Dr. Youssoupha Ndiaye presented their research on PECADOM+. Researchers from around the world stopped by their poster presentation to learn about the proactive community treatment model.

Now is a great time to be a Peace Corps Volunteer. The power of the Internet is creating linkages that allow great projects like PECADOM+ to spread rapidly. As I walked through the exhibition halls, my phone buzzed in my pocket with an email from Togo where they’re doing their first PECADOM+ pilot. Even in an area of substantially higher prevalence than where it was first piloted in Sengal they’re seeing strong preliminary results.

In the coming days I’ll be evangelizing PECADOM+ with anyone who will listen. I’ll also be on the lookout for the next great Peace Corps pilot project. I already have an inkling of what that might be… In the GMAP2 presentation hidden amongst a slew of slides on the biomedical and chemical approaches was a slide on environmental modification – clearing clogged drainage ditches, screening houses etc. Household screening is simple, easy and may have a substantial impact. I’m looking forward to exploring this with Volunteers.

written by Matt McLaughlin, Program Manager
Stomping out Malaria in Africa

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Botswana Weekly Awesome: Bringing Sexy Back to Malaria Prevention

It can be extremely challenging to implement and mobilize community members to take action against malaria in Botswana, particularly when HIV/AIDS epidemic is a much bigger battle. Only 50% of the population technically resides within malaria-endemic areas and  less than 100 malaria-related deaths are reported annually. Botswana’s overwhelming successes in malaria control in the past decade also propagate the notion that malaria is a “thing of the past”, further attributing to the disinterests in on-going malaria interventions. Despite recent malaria outbreaks across the country, including in non-endemic areas, the immediate threat of resurgence correlating to decrease in community uptake of malaria prevention strategies and the relevance of HIV-malaria co-infection, malaria remains unperceived by the general public as a threat.

Sadly, this perception of malaria is not only held by community members, but also shared by some Peace Corps Volunteers. The community’s attitude towards malaria can also quickly erode away any PCV’s initial enthusiasm for the topic. It’s a reality that raises a very serious question for the Botswana Stomp Team: If we can’t get our own volunteers to care about malaria, how can we expect to lead our community members by example?

If we wanted PCVs to become as informed and as passionate about malaria as we are, then something had to be done to reduce the  gap between our malaria training and theirs. While Stomp Coordinator Volunteers were educated and empowered with all the necessary information and tools to become experts in the area of malaria, as well as to become equally passionate about eradicating malaria from Africa in our lifetime, at an intensive boot camp… our volunteers were asked to copy resources off of a USB key to learn about malaria in their own spare time. Information was unregulated and overloaded: files upon files of resources accumulated overtime, passed down from generations of Botswana Stomp Coordinators, all arranged in no particular order and without any commentary on their significance.

Our solution was to overhaul the USB system and to come up with a brand new malaria toolkit that was comprehensive, up-to-date, and sexy. The toolkit comprises of (i) a handbook, a complete guide to malaria based on everything that we know and all the resources that we have, and (ii) necessary items required in successful bed net demonstrations, such as needles and threads, all neatly packaged in recycled Peace Corps Medical kits. While this is no substitute for a boot camp, we still sincerely hope that it will allow PCVs to be better informed and more confident on the subject of malaria, as well as to increase the likelihood of malaria-related activities to be immediately implemented at PCVs’ sites.

PC Botswana Malaria Tool Kit: We know you want one!

PC Botswana Malaria Tool Kit: We know you want one!

We are piloting our toolkits on our newest intake group, Bots 15, having just recently distributed the kits at PST earlier in October. An electronic copy of the handbook can be accessed here via dropbox.

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Botswana Weekly Awesome: Hacking the Chobe Sun to Complete Tablet-based Surveys

QuickTapSurvey (App) powered Tablet for speedy data collection.

written by Kim True, Bots 14

Before the heavy rain season, between November and January each year, District Health Management Teams (DHMT) offer free Indoor Residual Spraying (IRS) to households living in malaria-endemic regions of Botswana. The Ministry of Health credits IRS as the key intervention in vector control resulting in a consistent decline in malaria cases over the past decade. In 2013, there was far less IRS coverage and now Botswana is facing an immediate threat of resurgence of malaria cases. The Northwestern District of Chobe was once the leader in IRS uptake, consistently achieving over 90% coverage, but in the 2013-2014 transmission season they only achieved 60% coverage. The village of Kasane and Kazungula, the two most heavily populated residential areas in the district, barely made it above 50% coverage…

… and why is that?

“I’ve heard complaints about skin irritations from IRS.”
“You see, people are refusing to open up their homes for the IRS spray men!”

“What do you mean? No one even came to my house!”

Each time the Chobe DHMT sat down to discuss the way forward, the conversation failed to bring conclusive reasons behind the decline in community uptake of IRS. A consensus was reached that they needed to conduct a household survey prior to the launch of the November 2014 IRS campaign.

The Chobe sun is intense and the thought of a door-to-door survey in 45 degrees Celsius temperatures almost seemed inhumane. The survey had to happen but we needed to modernize the slow pace paper-based surveys in order to collect more data in a shorter period of time. I created a survey using tablet technology which sped up the process immensely.

Over the course of two weeks, 111 households were surveyed (50-Kasane, 61-Kazungula) by me and a community health worker. We asked about community members’ perceptions, experiences and utilization of malaria intervention strategies, including bed net usage and IRS. While the health worker asked survey questions, gave an overview health talk and answered malaria-related questions participants may had, I recorded information on my iPad. Tablet-based data collection, as opposed to paper surveys typically used by the DHMT, enabled data to be recorded in a time and resource-efficient manner, a feature that is extremely crucial for conducting household surveys in the midst of the Sub-Saharan summer.

QuickTapSurvey (App) powered Tablet for speedy data collection.

QuickTapSurvey (App) powered Tablet for speedy data collection.

Information gathered on IRS from the survey conducted in Kasane and Kazungula:

  • Despite frequent complaints about skin irritations associated with IRS, only 2% of participants who received IRS last year expressed dissatisfaction with their service.
  • Of participants who did not receive IRS last year, 16% stated concerns over preexisting respiratory-related issues (asthma and sinus infections) and 27% stated disinterest in IRS.
  • 14% of all survey participants were unaware of the benefits of IRS and/or how IRS contributes to malaria prevention.
  • 59% of all survey participants expressed need for specific time/days of the week in order for a household member to be present for the IRS team to enter their homes.

Information gathered from the survey has been used to make necessary changes to the designs of the Chobe DHMT’s malaria intervention strategies and efforts, including IRS schedule and procedures for management of missed opportunities and improved education to address gaps in knowledge on health implications of IRS and  health volunteers will address common misconceptions during the district-wide door-to-door sensitization campaign.

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Health Education Officer, Thebe Lesole, conducting a household survey on malaria in Kgaphamadi Ward, Kasane

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Botswana Weekly Awesome: How do you eat an elephant?

Why, piece by piece of course. The idea of creating an accurate and detailed map can be overwhelming. The necessity of capturing each and every building, house, shop, road, school, footpath seems like an elephant of a task. But maps are important; they are a visual representation of our world, which allows us to see it clearly which in turn assists in analyzing and understanding our surroundings. In fact, community mapping is one of the PACA (Participatory Analysis for Community Action) tools Peace Corps recommends in getting to know the site we have been assigned. When I first arrived my site, a small village located in Chobe Forest Reserve an enclave within the greater Chobe National Park (nicknamed “Land of the Giants” for its’ large elephant population) without really realizing it I was constantly drawing maps.

I had girls at the local Junior Secondary School draw maps and realized that the one thing all their maps had in common was the football field and the school. Together we discussed where they spent the majority of their time and whether or not they felt that these spaces were safe and welcoming.

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After follow-up visits with TB patients and home based care clients, the Health Education Assistants had me help them draw a map of the village to keep track of these patients. When a representative from Thuso Rehabilitation Centre visited the village, they pulled out a map that was so confusing and distorted that we had to draw a new one to direct them to patients. But, at best, the maps we created were the roughest sketches of the reality on the ground and lacked impartiality.

Then, in February I had the privilege to attend the Stomp Out Malaria Boot Camp and learned about OpenStreetMap.org; an open source website that crowd-sources community mapping, it’s the perfect intersection of technology and PACA tool. I was enthralled. When I got back to Botswana, with a million things on my plate, I tucked the mapping technology into the back of my mind.

Life moved along, and I was invited to represent the Peace Corps at the National Malaria Conference. We heard from experts from the World Health Organization, Center for Disease Control, and Roll Back Malaria and one of the messages that was repeated by all these organizations was that mapping was the way forward. That in a country, such as Botswana targeted strategic interventions are vital and that maps can provide this information. Then we heard from people at the national, district and community levels and they chimed back about the lack of capacity and tools that they had for mapping.

I remembered Open Street Map. It was the perfect solution. And after talking with my community counterparts and showing them the tool, they were just as excited as I was about its possibilities. I made a video asking friends and family back home to support our mapping efforts with their powerful Internet. And with support from the Peace Corps Office of Innovation; maps, beautiful detailed maps started to come to life. My community and I marveled as we watched the map develop and then added our own local knowledge. I taught people how to name government buildings, schools, how to mark shops and bars and most excitingly was able to show them their own houses and yards on the map.

Before: Map made at Clinic to track patients

Before: Map made at Clinic to track patients

After: Open Street Map

After: Open Street Map

We have a way to go before all the villages in the district are mapped (in fact we’re working on mapping Satau now http://tasks.hotosm.org/project/712 and could still use your help). We are only starting to play with all the possibilities the map offers. But today, the Village Development Committee and I hung up the map on their wall, I have a meeting tomorrow with the Kgosi (chief) about the map, and the day after tomorrow I have a meeting with the Environmental Education Officer about how we can use the maps in an upcoming Indoor Residual Spraying Campaign. And the potential cascades from there.

Here, in the Land of the Giants, we know that elephant meat is “very nice and tastes like Zebra” and that to solve any problem we all have to work together and “eat it” piece by piece or in this case house by house. And for everyone back home who has taken a bite, we thank you. Re a leboga.

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Botswana Weekly Awesome: Stomp it Out Music Video Pt 2 – PCV Chad’s Wish

By Chad Anderson

PCV Chad Anderson worked with local artists to create this vibrant, and catchy malaria music video. Below he writes about his experiences; from learning about malaria, to his transition from Mali to Botswana, and finally the process of creating the music video. Chad, closed-out his service, but his music video continues to inspire us to sing, dance and stomp out malaria.

Before I arrived in Mali, West Africa, as a Peace Corps Volunteer (PCV) I knew next to nothing about malaria. Malaria? That’s some exotic disease that other people on other continents get; something that I might hear about, and remember only vaguely, from a church campaign or fundraiser. Nothing that had anything to do with me or people I knew.

That soon changed after I moved to my site in Mali and I attended my first local funeral and learned that the person had died of malaria. I didn’t know people were still dying from malaria. Especially since the Peace Corps had supplied me and my fellow volunteers with nets and mosquito repellants. Very soon after I learned of another death from malaria, this time the young man was around my own age. It hit me really hard. I couldn’t stop thinking about the unfairness of it all: Here I am taking pills that will help prevent malaria, but the people in my village didn’t have anything—medicine or nets. The realization almost made me depressed and hurt my heart, especially when I realized that every time I went to the local clinic where I was volunteering, someone one was being treated for malaria. I think a turning point for me was when a child of one of the nurses got sick with malaria. Although he pulled through, I had many sleepless nights worrying about him. And the others. It was almost as if a decision had been made for me: Nothing was more important than working on malaria projects.

I started thinking and talking to others about possible projects that I could do focused on malaria. But suddenly my time in Mali was cut short by a government coup. Peace Corps evacuated us, but luckily I was accepted as a PCV in Botswana. I learned that HIV/AIDS, not malaria, was the focus on Peace Corps efforts in Botswana (which still has the second highest infection rate in the world). I was happy to still be a PCV, but saddened at leaving my malaria projects behind.

But soon after being placed in a small village in northern Botswana, I learned that my village, as well as many other areas in the country, were still considered high risk for malaria. My passion to do something to reduce the impact of malaria was rekindled. I often sat at the local clinic, meeting staff and patients, asking questions, and wondering how I might help. And then, in a quiet moment, I remembered! In Mali, I had heard local artists on the radio one night, reminding people to use their nets. Why not here in Botswana? Why not work with local artists here to design an educational video that both entertains and educates people? Why not?

I reached out to a local artist I had met and he thought the idea was great. It also fit for him because he wanted to give something back to not only Botswana but to all of Africa.

We threw around different ideas: maybe a parody on a popular song but with the lyrics changed to focus on malaria education? Maybe an original song? A few months after our initial conversation we met and the artist said he’d talked to friends and colleagues in the studio and they wanted to make their own beats. So they got started! I supplied some statistics that could be incorporated in the lyrics (originally written with fellow PCV and Stomp Coordinator Jessica Hall). In one week, the song was written.

But now, it was to be more than a song; we were going to write and produce a music video! I really wanted the video shot in my village because so many members of community had been in my classes where I talked about malaria. People were very interested; this was particularly gratifying to me because these are the people who are affected by malaria. They wanted to be a part of the video. My passion became their passion, just as their needs had become the focal point of all my volunteer work.

People got involved and we shot the video, and then a documentary about making the video, but focusing on what people had learned about malaria and what they wanted others in Africa to know about it.

Our goal was to showcase it at the first- ever All Volunteer Conference (February 2014) where Peace Corps was celebrating 10 years in Botswana. Not only did I and everyone involved in this receive warm and outstanding support from other PCVs, but the National Malaria Coordinator Mma Mosweunyane also attended, and spoke warmly about the video and documentary. She now wants the video shown on television in Botswana.

This project has been a dream come true. It has taken time, patience, and many hours of work not just from me, but from all involved. This work will always have a special place in my heart because of all the people I’ve met who died from malaria. I was hit especially hard the night of the premier showing for Peace Corps when I learned that my host family in Mali had lost a son—my host brother—from malaria. My heart felt truly broken, almost as if I had let him down.

My wish for this video is very simple: I want it to help educate people; I want malaria to be prevented and eradicated. I want no one else in Africa or anywhere to die from malaria.

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