The 2nd Race Against Malaria in Botswana

Botswana Peace Corps Volunteers dressed up as mosquitos at the RAM2 event

The sight of parked commercial trucks stretched for miles along the main road in Kazungula is not an unfamiliar sight. A border town located adjacent to Zambia and Zimbabwe, Kazungula serves as the gateway for cargo trucks to transport goods from South Africa up the African continent as far as the Democratic Republic of Congo. These trucks wait in line for their turn at the weighbridge or to board the ferry to cross the river anywhere between hours to days.

However, this time the long line of vehicles that was slowly gathering at 6 am on the morning of April 21st was something entirely different. Rather than normal sight of massive trucks brimming with goods, it was a convoy of vehicles plastered with colorful stickers, proudly displaying the flags of many countries and appropriately the lead vehicle was a truck- a massive, low bed truck decorated in blue carnival flags with a group of people on board with banners in their hands.

RAM2 Sticker

This was RAM 2: the 2nd Race Against Malaria, a multi-country initiative, and the convoy was about to embark on a 12 km parade towards a malaria event that was being held in the township of Kasane before departing for Namibia to continue their tour throughout the southern African region.

In partnership with Roll-Back Malaria (RBM), countries in Southern Africa Development Community (SADC) organized a campaign, which consists of convoys of national malaria teams driving all the way from Lilongwe, Malawi (April 14) to Odnjiva, Angola (April 25). This is the second time the race has been held in hopes of strengthening existing cross-border collaborations among southern Africa countries in malaria control and elimination efforts, as well as promoting malaria awareness among local communities along the way.

The RAM2 convoy, which consisted of stakeholders from countries including South Africa, Zimbabwe, Malawi, Cuba, and Switzerland, arrived in Botswana on Sunday April 20th. The Botswana Ministry of Health and all local government agencies in the Chobe District organized a short half-day community event on malaria in the township Kasane, as well as a malaria-testing booth for truck drivers at the Kazungula border the following day.

As the agenda of the malaria event on the 21st was severely time-restricted, Peace Corps Volunteers on the event team assisted the organizers in strengthening the advocacy aspect of the event, incorporating new innovative and appealing ways to urge community members to attend the event that was taking place on a public holiday. The Peace Corps Volunteers came up with the idea of leading the parade with a “float” in addition to the standard microphone announcements, as well as to dress up in mosquito costumes.

Botswana Peace Corps and Red Cross Volunteers aboard the RAM 2's Malaria Float

Botswana Peace Corps and Red Cross Volunteers aboard the RAM 2′s Malaria Float

The theme of the float was written on the banner that stated, “O ishireletsa jang mo malaria?” which translates to, “how are you protecting yourself from malaria?” A crowd of Botswana Red Cross Peer Educators held signs with anti-malaria messages and dressed up in conical bed nets. The four participating Peace Corps Volunteers were dressed up as mosquitos and loudly greeted every individual who came across the float as it moved. At the event, the mosquitos walked around with their signs and used their costume as conversation starters with event attendees.

Botswana Peace Corps Volunteers dressed up as mosquitos at the RAM2 event

Botswana Peace Corps Volunteers dressed up as mosquitos at the RAM2 event

The community event consisted of entertainment embedded with malaria-messages and QA sessions with prizes took place following speeches from prominent figures, including the Botswana Minister of Health, the representative from the World Health Organization, the local headsman of the Kasane township, and the leading representative of the SADC Military Health Services. Despite the event being held on a public holiday, it attracted a large crowd and the community members were extremely engaged with the on-going activities.

The RAM 2 convoy departed for Namibia on the same day, and it was safe to say that the turn up in Botswana did not disappoint. Perhaps if the four female anopheleses could properly learn how to dance like the dance troupe that performed that day, the crowd would’ve been even bigger.

Posted in BAMM, BAMM Blog Roll, Botswana

Sierra Leone: Behavior Change Communication Malaria Training

By: Elijah Filip

Earlier this April, the STOMP team put together a behavior change workshop here in Sierra Leone. The training lasted four days and presented a number of theories on how volunteers can affect behavioral change within their communities. While working through the theoretical, we simultaneously applied these theories to designing malaria projects within a small group of three volunteers. The idea was to use these projects, created within the context of these behavior change theories, to implement lasting change within our individual communities.

We started the training by focusing on the socio-ecological model. We used this model as a starting point as it shows who has the biggest impact on molding our beliefs and opinions. As volunteers, we sit somewhat outside of many community members sphere of influence. In order to address this, we spent a good amount of time discussing the impact that care groups – or a small group of committed individuals – can have in changing behavior. If you can convince one person to change their behavior and then discuss this change with their neighbors, you can engender a much greater impact than simply attempting to convince a large audience. Using this model as the basis, we went on to discuss Doer/Non Doer analysis and the key determinants of behavior change. With this framework, we analyzed the ways in which we can determine the root causes of the behavior we are attempting to change. We rounded out the sessions with a discussion of how one is to effectively monitor an ongoing project and evaluate it at its conclusion.

During and after these theory sessions, we worked within our small groups to implement these ideas into a project that we could take back to our communities and implement. The project that our team devised involved starting a care group of 10 community members where we would emphasize the importance of malaria prevention though economic terms. Malarial prevention is a rather abstract concept. In order to concretize it we wanted to focus on how preventing malaria directly results in better economic outcomes as you/your family can work more and thus generate more income. After this training, we would ask the 10 members to come up with three names of people they can talk to about what they have learned. Each member would then be supplied three short surveys to fill out when they go to discuss malaria with their three community members. Upon returning these surveys, they would be rewarded and given three more of the exact same surveys which they would fill out a week later with the same three community members they had previously talked to. These would then be returned and evaluated in comparison to the first surveys to determine if their discussion with their community members has a lasting impact.

We have yet to actually implement this plan within our communities but hope to do so within in the coming months. Overall, the training was great as its structure allowed us to directly and immediately practice the theories and concepts we were discussion.  In addition, I’m sure that the ideas we worked through will be extremely helpful in contextualizing future secondary projects, regardless if they involve malarial prevention or not. Hopefully this is something that we as a STOMP team here in Sierra Leone can continue to do and improve upon each year as we continue on our quest to eradicate endemic malaria throughout Sierra Leone.

Posted in BAMM, BAMM Blog Roll, Sierra Leone

Sierra Leone: On that Health Fair Day

By: Michael Gibbs

One thing that gets Peace Corps Volunteers really excited is the opportunity to cooperate for large-scale projects.  There’s a lot we can do in our community, but as only a single individual it can be hard to influence others.  The chance to operate en masse, combining our sheer star power as a horde of whites with our individual persuasive skills, has a far greater impact.  As a band of brothers with similar goals, we can magnify our impact by working together with a small group.

There’s a certain collegiality on such occasions, as we few, we happy few, try to simplify complicated messages to a large group.  A few weeks back one such situation arose in a nearby town when Lindsey, the local PCV, organized a district-wide health fair.  Groups of PCVs came to work on an array of booths, each with a distinct healthy living element.  One booth had a condom demonstration, another talked about food security and a balanced diet, another held forth on water and sanitation (WASH—the “h” might be for “health”), yet another had microscopes (showing, among other things, the bacteria in swamp water so that in their flowing cups and buckets the participants would freshly remember the WASH lessons), and one focused on malaria.

I wasn’t officially assigned to any one committee—my main secondary assignment is literary—but I spent most of my time with the malaria gang.  More importantly, the two students I brought with me also helped out with malaria.  The two I brought were Alhaji Bangura and Yusuf Fofana, and I would not wish for one student more.  Both are in SSS3 Arts, two of the best I’ve taught here, and they had a dual job.  Towards the end of the day they went on stage to conduct a Q&A session on malaria knowledge, and before then they had to visit all the booths to get all the lessons the other PCVs were teaching.

For the latter task I helped them throughout the day.  We went to each booth together so they could listen and ask questions, and afterward I would question them to see if they’d gotten the gist.  By and large they had, and though I expected that all would be forgot, they remembered with advantages what health feats they were taught that day.  Even when I quizzed them weeks later, they still remembered how to use ash as an alternative to soap, how to balance different foods in plasas, and the risks of open defecation.

For the former task, conducting a game show before the assembled student body, I had lent them my malaria information book and vetted their questions in advance.  The contestants—SSS students from Lindsey’s school—had been well prepared by a malaria booth that included a bed net demonstration, quite a few handouts and diagrams, and concluded (after my kids’ Q&A) with a giant mosquito piñata.  They were asked an escalating series of questions about malaria, ranging from the simple (“do mangoes give you malaria?”) to the rather complex (“define ‘endophilic’ and why it makes Anapholes mosquitoes dangerous?”).  When the contestants made a mistake, which wasn’t often, Alhaji and Yusuf would give the correct necessary and explain the error.

With a final injunction that this story the good student should teach his parents, so that the information would diffuse to decision-makers in families, my students left the stage.  They had held forth on a complicated, challenging topic for close to twenty minutes.  They had done so in a role (teacher), format (game show), and setting (different school in a different town) that was foreign, and had performed admirably.

From a Peace Corps perspective, the best part was working with so many volunteers and seeing their unique educational style.  Some were quiet, some constantly joked but slipped in information, some stuck to the facts, and some spent more time asking questions than answering them.  Seeing how different students responded to these approaches, and trying them out for myself in an unfamiliar crowd, was good practice for my own development as a teacher.

From the perspective of a mentor for Alhaji and Yusuf, they showed that just a few students could win a great share of honor.  In unfamiliar territory, talking about a subject they are by no means experts on, they held the crowd’s interest and managed to reinforce some important points about malaria transmission and treatment.  They not only checked students for being right or wrong, but also helped tease out more ideas by expounding on partially-correct answers.

The last step, which so far has only been done informally—we haven’t had regular school since the health fair—is for them to explain their presentation and what they learned to their fellow students.  Once school kicks into gear, the final advantage of a multi-PCV event will be displayed.  With sources from all around Bombali district—and some farther afield—Alhaji and Yusuf will have experience with different presentation styles and a variety of public health issues.  When they discuss malaria prevention and treatment in the coming weeks, I’m curious to see how they present the topic and deal with their classmates’ questions.  They learned the material well, and it will be fascinating to see how they choose to spread that knowledge.

 

Posted in BAMM, BAMM Blog Roll, Sierra Leone

The Power of Soccer to Fight Malaria

PCV Morgan leads an energizer at her Grassroot Soccer camp in Lesotho.
PCV Morgan leads an energizer at her Grassroot Soccer camp in Lesotho.

PCV Morgan gets kids excited to learn by leading an energizer at her Grassroot Soccer camp in Lesotho.

My favorite part of the village was the soccer pitch. During my Peace Corps service, I came to see how much of life in rural South Africa was uncertain and challenging – but that dusty field was, unfailingly, a place of hope. Kids opened up on the field; they became bold, confident in their abilities, and empowered by the strong bonds they’d formed with their teammates and coaches. It was wonderful to see, and as I joined them in kicking around the soccer balls they diligently made from plastic bags, I’d wonder how I could inspire that same passion in the life skills clubs I ran at the local schools.

Thankfully I didn’t have to figure that out alone: I got in touch with Grassroot Soccer (GRS), an organization that uses soccer to inspire youth in the fight against HIV and malaria. It was founded in 2002 by four professional soccer players in Zimbabwe who’d witnessed their communities devastated by disease. They recognized the power that soccer has to bring people together, and realized they had a unique platform and opportunity to inspire young people. Some athletes use their influence to sell shoes; they decided to promote health.

Grassroot Soccer programs work by using fun activities and sports-based metaphors to illustrate key messages in an accessible way that’s different from school. One of GRS’s key tenets is that learning is not a spectator sport. Engaging kids in active learning helps them grasp complicated topics that can sail in one ear and out the other in a classroom setting, and using soccer as a hook gets them excited and passionate about participating.

“Learning is not a spectator sport.”

Running a GRS program was such a positive experience that I extended my service to spend a third year supporting the GRS/Peace Corps partnership. One highlight of that has been working with the amazing PCVs implementing GRS malaria-prevention programs in their host countries.

The first PCVs to implement Grassroot Soccer programs, back in 2011, lived in communities where HIV was one of the most pressing health problems. But as the partnership grew, GRS started working with PCVs whose primary projects involved malaria education. This seemed like an opportunity to take the lessons learned about fighting HIV through the power of soccer, and apply them to malaria prevention.

A grassroot Soccer team poses under a mosquito net. (From Burkina Faso PCV Todd B.)

A Grassroot Soccer team poses under a mosquito net during SKILLZ Malaria Practice 1. (Courtesy of Burkina Faso PCV Todd B.)

In 2013, Grassroot Soccer and Stomping Out Malaria did just that, developing SKILLZ Malaria: a program with four one-hour-long sessions addressing topics like bed net usage, facts and myths about malaria, the importance of visiting clinics and adherence to medication, and identifying risky situations. The program has spread through word-of-mouth, GRS trainings, and via the STOMP Boot Camps, which members of the Grassroot Soccer team are often lucky enough to attend.

The Malaria Team has been instrumental in bringing GRS to their host countries. To date, 870 PCVs have reached more than 18,000 youth across 42 countries with Grassroot Soccer programs. Most of these Volunteers use the HIV-focused curriculum, but as the program grows (especially in West Africa) it’s exciting to see more and more PCVs report back to us about their completed SKILLZ Malaria interventions.

We have even seen Grassroot Soccer programs continuing after PCVs leave. A key part of the program is empowering counterparts; the founders of GRS understood that kids learn best from people they respect and identify with – not just soccer stars, but also local role models. Grassroot Soccer emphasizes the importance of finding and empowering these men and women to take the lead in running the program. It has been incredible to see Volunteers use GRS to unlock the potential of their local counterparts.

Grassroot Soccer is a strong model for how PCVs can transform local passions into educational opportunities. I’d encourage all PCVs to think outside the box when implementing malaria-education programs – what makes people hopeful and inspired in your community? Whether it’s soccer or something else, use it!

Volunteers who are interested in the SKILLZ Malaria program should get in touch with us, we’re happy to welcome you onto our team.

For more information about how you can implement a Grassroot Soccer program in your community, get in contact with Kelsey and the rest of the GRS ‘Peace Corps SKILLZ’ Team: pcskillz@grassrootsoccer.org

Posted in BAMM, BAMM Blog Roll

Sierra Leone: The Last Mile, Part II

By:  Michael Gibbs

When you hear about “last mile” problems in public health, it generally references the distribution of medicine down to the local service providers.  The problem is often framed in terms of government policy and infrastructure, something to be addressed from the top down.  Yet in the context of malaria, that last mile is really the physical mile from clinics to people’s houses and the mental mile between what they believe about malaria and what they actually do.

The biggest problem with malaria at this point is not knowledge.  A surprising number of people in this country know quite a bit about the disease.  The rub lies in translating those words into deeds.  For every person who says malaria is spread by mangoes or beer, there are another six or seven who know that mosquitoes cause it.  The public health work isn’t just getting that last holdout to understand parasite vectors; the real struggle is getting those six or seven to protect themselves, because even the well-informed don’t always take adequate precautions.

 The workshop I attended last week focused entirely on that issue.  What makes malaria control difficult compared to my other jobs here (especially literacy) is the focus on practice instead of knowledge.  Teaching someone how to read is not an hour-long deal.  They have to practice on their own, yes, but developing even basic reading skills requires months and months of effort with a dedicated teacher.  No one does a half-day session on reading and expects the entire audience to understand War and Peace, or even The Magic School Bus.  In contrast, a lesson on basic malaria prevention can cover how to use LLINs (long-lasting insecticide treated nets), clean the environment around the house, and obtain basic testing and treatment in a few hours.  Getting someone to apply all of that, though, requires a monumental change not only in how they manage their house but in how they see the fundamentals of health, destiny, and culture.

That exploratory process was our first objective at behavior change communication (BCC) malaria training.  What to an outsider might seem like a clear-cut issue—LLINs reduce the prevalence of malaria—is often hedged with a variety of small but sharp concerns.  What if nets don’t work?  What if I can’t get one?  What if God doesn’t want me to use one? (Common variation: “What if who gets malaria is in God’s control?”)  What if they make it too hot to sleep?  What if I forget to put it down most nights?  What if no one else is using them?  What if I don’t know how to use one?

 Each one of these concerns is perfectly understandable.  For many, the extent of their malaria knowledge boils down to someone saying, “Use a tent [local term for LLIN] and you won’t get malaria.”  They’ve never had anyone explain the whole process of disease transmission, or show them how to hang a net, or kept reminding them until it becomes second nature (think about how long it took you to learn to wash your hands), or heard all their neighbors talk about using them.

The upshot is that any public health campaign here has to start with surveys (generally called doer/non-doer studies and barrier analysis).  If the problem is access to nets then LLIN distribution by the Government of Sierra Leone is an effective way to cut malaria.  But if the problem is more personal, adding more nets to the mix is necessary but not sufficient—it has to be combined with a message that addresses the barriers.  If it’s religious you probably want imams and pastors talking about LLINs; if it’s skills-based, you probably want a workshop on how to set them up (actually several, with refreshers, to give people practice); and if it’s a style thing, teach them how to bluff (show off, in Krio) with the nets.

After such a campaign comes my favorite part in the health care system—collecting data, analyzing it, and making refinements.  I enjoy it primarily because it provides such scope for inventive design.

The BCC training was structured so that we spent four days in a group of three steadily refining proposals for a single activity.  One group focused on environmental cleaning, three on LLIN usage, and mine on testing.  Our goal was to design a program that would lead Sierra Leoneans, when they had a fever, to get tested for malaria (and then taking ACTs) instead of just assuming they had malaria (and taking whatever treatment they could find).  Based on pre-conference discussions with neighbors we figured that the main barriers were knowledge (most people in K Town don’t know about the tests), access (limited supply of RDTs), cues for action (nobody had a habit of getting tested), and belief in testing’s efficacy (a dearth of upbeat stories).

The first and last were ones we could directly address, the second was beyond Peace Corps’ ability to control, and the third was where we had fun.  We designed an information session PCVs could quickly and easily deliver to groups in common gathering spots (wells, football matches, court barre, market, etc.).  It would explain the components, costs, time required, and utility of RDTs and microscopy, hopefully addressing the first and fourth barriers.  For the cue to action, we decided to distribute at our information session big yellow vouchers offering free testing.  Since testing is supposed to be free to pregnant women and children under five, the groups we would target, the vouchers wouldn’t actually cost the clinic or hospital anything.  Instead, they would serve as a very visible reminder of the session, and hopefully also encourage people who felt ill to get tested.

They also would serve a second purpose: data collection.  Bringing in those vouchers would entitle each person to a cheap but visible prize (lollipop, sticker, temporary tattoos) so that everyone in town could see they were tested.  They would get their photos taken and placed in a hall of fame inside the clinic or hospital, giving them a chance to bluff in a public place.  Finally, they would be entered into a lottery for some large prize, similar to the way phone companies here attract customers.  All these gimmicks would serve one main purpose—get people tested.  In bringing in their vouchers, though, they would also provide us with an important dataset—the number of people we educated who altered their behavior.  Basically, it could help tell us if our project was effective.

Those of you still awake will note that, to be helpful, we’d also have to find a way to measure how many people we educated didn’t use their voucher to get tested.  Unfortunately, the best answer we could come up with was a survey, going door to door among those who didn’t turn their voucher in to ask if they’d had any malaria.  The problem is that surveys around here are known for skewing, so our data would be skewed (perhaps enough to make the results meaningless).*

Leaving aside that problem, our experimental program is ready to go.  We’d identified a need, estimated what the major barriers were, tried our best to focus on the salient issues, and checked it with the PC Salone malaria team and Sierra Leonean staff.  All that’s left is the field trial, something we’ll probably do during third term.  Definitely a good way to spend a week, and I look forward to applying the lessons both to malaria work and future literacy endeavors.

*If any of you can think of a way to avoid surveys and get accurate data on the treatment group that didn’t respond, please let me know.  For all you statisticians/public health campaign workers out there, it would be a huge help.

 

Posted in BAMM, BAMM Blog Roll, Sierra Leone

Sierra Leone: Malaria and Exponents!

Sierra Leone-Maile 3

By:  Maile Thayer

“I’m going to give all our students malaria,” I inform my colleague teachers as I leave the staffroom to go teach.

“What?!” they exclaim, aghast.  “Why?  How will you do that?  Don’t do it!”

I laugh and promise to explain after.  I enter the classroom and hold up a drawing of a mosquito.

“What is this?” I ask the class.  I hear gasps all around.

“A butterfly!”

“A bird!”

“A beast”

“A devilI!”

Finally, after a pause: “A mosquito!

“Correct!” I say.  “And not just any mosquito.  This mosquito carries malaria.”  I hold up a small red card and pin it to the mosquito.  I hear more gasps from the class.

“Who wants to volunteer to have malaria for this lesson?” I ask.  The class looks back at me, scared, confused, and silent.  One brave boy grins and raises his hand.

“Great!” I say.  “So let’s suppose Abu forgets to sleep under his bed net one night.  A mosquito with malaria comes, bites him, and gives him malaria.”  I take another red card and hand it to him.  I write on the board:

Day 0

Abu

“Then the next day, Abu forgets to sleep under his bed net again.  Another mosquito comes, bites him, and gets malaria from him.”  I pin another red card to the mosquito.  “Then the mosquito goes and bites someone else with no bed net, and gives him/her malaria, too.”  I nudge Abu.  He eagerly runs to the other students, grabs his horrified friend, and drags him to the front of the class.  I make the mosquito “bite” James too, and I hand him another red card.  I write on the board:

Day 1

Abu

James

“THEN,” I say dramatically, “the next day, both Abu and James forget to sleep under their bed nets.  A mosquito bites each of them, gets malaria, and then goes and bites another person with no bed net and gives him/her malaria, too.”  Abu and James each go and pick another friend from the class, and the mosquito “bites” each of them and gives them malaria and red cards too.  I write on the board:

Day 2

Abu

James

Abdulai

Umaro

“And then, sadly, the next day, none of these students sleep under a bed net AGAIN.  Mosquitoes bite each of them, get malaria, and then each bite another person not sleeping under a net.”  The four students scamper off and each pick another person to give malaria.  I write on the board:

Day 3

Abu

James

Abdulai

Umaro

Sorie

Mariama

Joseph

Simeon

The class is starting to smile and nod.

“And then the next day,” the class is saying this along with me now, “all eight of these students don’t sleep under a bed net.  Mosquitoes come, bite them, get malaria, then bite other people.”  The 8 students happily let the mosquito bite them, and they each pick another student from the class to give malaria.  I write on the board:

Day 4

Abu

James

Abdulai

Umaro

Sorie

Mariama

Joseph

Simeon

Isatu J

Susan

Aminata

Mohamed

Abdul

Kadiatu

Marie

Rugiatu

“Can anyone tell me how many people will have malaria the next day?” I ask, writing “Day 5” on the board.  After a pause, several students shout, “32!”

“Correct!”  I say.  “Does anyone see the pattern?  Remember, we learned about exponents yesterday.”  No one answers.

I write the number of students with malaria for each day.  Then, under Day 0 I write “20.”  Under Day 1 I write “21,”, under Day 2 I write “22,” etcetera.  The students chime in with the answers before I write them on the board.

“How many students will get malaria on day 6?” I asked. “Day 7?”  I call on two students to write the answers on the board.  The board now reads:

Day 0

Day 1

Day 2

Day 3

Day 4

Day 5

Abu

Abu

James

Abu

James

Abdulai

Umaro

Abu

James

Abdulai

Umaro

Sorie

Mariama

Joseph

Simeon

Abu

James

Abdulai

Umaro

Sorie

Mariama

Joseph

Simeon

Isatu J

Susan

Aminata

Mohamed

Abdul

Kadiatu

Marie

Rugiatu

1 person

2 people

4 people

8 people

16 people

32 people

20

21

22

23

24

25

 I turn to the class after they have all settled down, and ask, “How could all of these students have avoided getting malaria?”

The whole class shouts, “By sleeping under a bed net!”

“Good!” I say. “So what will all of you do every night?”

“Sleep under my bed net!!”

Maile Thayer’s JSS Class in Kamaranka, Bombali District, Sierra Leone.  Happily learning about exponents and why to use a bed net every night!

 

Posted in BAMM, BAMM Blog Roll, Sierra Leone

Sierra Leone PCV Eli Filip Blogs About Malaria

Sierra Leone-Eli Filip

By:  PCV Eli Filip

As a newly anointed member of STOMP, I recently attended my first official STOMP oriented activity. In February, one of our fellow volunteers, Lindsey, held a health fair in her community, Rokulan, aimed at bringing together the disparate health education committees throughout Peace Corps Sierra Leone. We were tasked with presenting information on our individual areas of specialty to the community members and schoolchildren who joined us for the district-wide fair. As members of STOMP, our booth naturally centered on malaria education and prevention.

C:\Users\Elijah\Desktop\Salone Things\Blog Posts\Resized Pictures\127. Stomp Sign.jpg

The banner we hung on the outside of our booth at the Bombali Health Fair.

Before the fair, my opinion of sensitization activities was mixed. While they always seemed well intentioned, my lack of hands-on experience in performing these activities made me question their efficacy, especially in the climate of widespread misconception about malaria present in Sierra Leone. However, my misinformed opinion was significantly altered during the health fair, which served as both an ample introduction to STOMP and the value of sensitization.

The moment that really drove home the impact that sensitizations can have came during the time I spent talking with one of the primary school children who showed up at our booth. Due to our booth being swarmed with students, we broke off into smaller, more managable groups. Here I met one particulaly enthusiastic primary student who, despite struggling with Krio –  Sierra Leone’s lingua franca – expressed an interest in the materials we were presenting and handing out. In our smaller group, I spent time working with him and others though a hodgepodge of Krio and Temne to acertain and then build upon their understanding of malaria and prevention best practices. Though younger than most of the students he did a great job of participating and working alongside the older children. While he seemed lost through the majority of the discussion, he brightened with understanding  toward the end of our discussion and quickly turned to one of his fellow primary students who looked just as lost to disiminate the information presented. After our discussion ended, he continued to hang around our booth acting as a sixth member of STOMP, harping on the importance of bed net usage and malaria prevention in Temne and his limited Krio to all who would listen.

C:\Users\Elijah\Desktop\Salone Things\Blog Posts\Resized Pictures\Blog Post 6\130. Rokulan Primary Student 2.jpg

The enthusiastic primary school student who, through two languages, learned about malaria treatment and prevention.

This is clearly a small example of the effect that sensitization can have. However, if every sensitization can have a similarly small effect, the combined effect of our efforts can profoundly shift detrimental cultural beliefs toward more health conscious opinions. I’m looking forward to working on more STOMP activities in the future where we will hopefully build upon this moment and continue drive home the importance of malaria education and prevention.

Posted in BAMM, BAMM Blog Roll, Sierra Leone

Sierra Leone: Malaria as a Way of Life, Part I

By:  Michael Gibbs

Don’t worry—this isn’t a blog post about me getting malaria.  Unfortunately, it is a blog post about those near and dear to me in this country—friends, neighbors, coworkers—who suffer from the disease.  In every class I’ve taught, in every social circle I’ve entered here, every single person I’ve asked has suffered from malaria at some point in their life.  Some may be mistaking their illness for something else, but with roughly one in four Sierra Leoneans suffering from malaria each year, many of my neighbors and closest friends know what ails them.

 I grew up in an epidemiology-loving household.  With a father who works in food and drug law, a brother fascinated by virology, and my own and my mom’s interest in health and public policy, I picked up a half-finished collage of medical knowledge at the dinner table.  Of the diseases we talked about, four stood out: Ebola, HIV/AIDS, TB, and malaria.  The first and second are known for their mortality, the third for its drug resistance, and the last for its sheer persistence.  Ebola, at least until recently, had never been found in this region; HIV and TB have mercifully low endemicity here; but in Salone malaria and its impact are ever-present.  People here get sick again and again, until the weeks lost to exhaustion take their place beside corruption, limited education, and poor infrastructure as costs of living.

What makes that acceptance particularly galling is that malaria is, if not completely avoidable, subject to some preventative measures.  As a Peace Corps Volunteer, I take malaria chemoprophylaxis (a reduced dose of malaria treatment medication) daily to ward off the disease.  Chemoprophylaxis, though, is expensive and impractical for subsistence farmers.  So is Indoor Residual Spraying, which requires substantial training and expensive chemicals.  That leaves two other preventative measures, long-lasting insecticide treated bed nets (LLINs) and environmental/larval control, and subsidized treatment (preferably artemisinin-combination therapy, or ACT) as upline Salone’s best options.

LLINs and larval control, while not panaceas, are effective at reducing the incidence of malaria.  Salone’s mosquitoes, although an ideal malaria vector in many ways (carry the most virulent strain, feed indoors, live indoors, prefer humans over other mammals), their peak biting time is generally in the middle of the night.  Most don’t emerge until sunset, and most have ceased biting by sunrise.  In other words, if you sleep under an LLIN, your chance of getting malaria goes way down.

 Controlling mosquito breeding is also a promising avenue of control.  During the dry season in Salone pretty much all standing water near houses is man-made (mostly jars of water drawn from a well or pump for cooking or bathing), and a simple cover makes it impossible for mosquitoes to breed.  The mosquitoes can still develop in the swamps, but at least that makes them fly a little farther (in some villages, a few miles) to find people.  Neither LLINs nor larval control provide perfect insurance, but at least they reduce the frequency.  From the community’s perspective LLINs are particularly important for people who are already sick; putting up a barrier means that mosquitoes can’t transmit their infection to others in the community.

After someone gets sick, there’s a pretty standard treatment regime that, regrettably, not too many folks here follow.  If you think you have malaria, you’re supposed to go to the nearest clinic/hospital and take either a rapid diagnostic test (RDT) or microscopy (the former is faster, the latter more specific), depending on which is available.  If you test positive, you get ACT for three days and then, malaria-free, you go back to everyday life.

 The actual malaria set-up, at least in upline areas, is more commonly as follows.  Many people don’t have an LLIN at all.  Of those who do, few have sufficient numbers to cover the entire family (families of six or seven can’t easily fit under a net made for two).  Those who are left out are often children, individuals who already suffer disproportionately from malaria (people in endemic areas build up some resistance, but it takes five or more years).  Many families who do have nets don’t use them correctly or at all (LLIN fishing nets and soccer goals are visible in most villages).  Then, once people get sick, they tend to assume every bout of fever and fatigue is malaria.  This could promote outsized malaria resistance if people took ACTs, except most folks go to the local pharmacy, native doctor, or bush (i.e., cutting presumed medicinal plants on their own) to get medicine.  For those who don’t have malaria the result is a mild (or, in the case of some traditional bush remedies, not-so-mild) placebo; for those with it, their body is often left to fight the disease unaided or with outdated medicine.  Malarial episodes last for a week or more, infected individuals are bitten by mosquitoes and so spread the disease, and malaria sometimes relapses weeks or months later.

 Of course, this bleak picture isn’t universal.  More and more people are realizing ACTs are the way to go, especially for children and pregnant women (who need them the most).  Years of antimalarial campaigning is paying off, as people are gradually starting to sleep under nets (or at least stop fishing with them).  Larval control and testing have been a little slower to catch on, possibly because the link between them and health is less obvious, possibly because more attention has been paid to LLINs and ACTs.

What remains perhaps the most challenging part of anti-malaria work is the feeling of complacency.  Malaria is a fact of life here, and has been for hundreds of years.  Dramatic personal encounters with malaria—the loss of a loved one, a particularly bad bout that makes you miss something important—can sometimes change the equation, but for most people malaria is merely mundane.  Ideas of how to change things are dismissed—“our treatment is cheaper/better/easier than ACTs,” “mangoes give you malaria,” “bed nets are too hot,” or, my personal favorite, “everyone gets malaria.”  (When I say I don’t, that’s often met with, “Well, whites are different.”  End of story.)  Maybe malaria cannot be eradicated by the tools we have today, but it can be reduced.  I know it pains each and every Peace Corps Volunteer when they hear those dismissals and at the same time see the cost malaria exacts on their communities.  The only thing worse than a problem, after all, is one with a palliative or cure in sight.

 

Posted in BAMM, BAMM Blog Roll, Sierra Leone

Stomp Salone at the Bombali Health Fair

By:  Maile Thayer

Maile (left) and Suzy (right) at the Bombali Health Fair answering questions and taking a survey, by show of hands, of who knew the answers to questions about malaria.

Maile (left) and Suzy (right) at the Bombali Health Fair answering questions and taking a survey, by show of hands, of who knew the answers to questions about malaria.

The weeks leading up to the Bombali Health Fair were just as busy as the day of the event itself.  I was running around trying to prepare activities for our malaria booth, and training some of my students to perform at the fair.  These preparations were just as valuable for malaria education as the fair itself; they prompted many questions and discussions from members of my community.  The students who were not chosen for the performance were envious, and kept sneaking over to watch us practice.  The performance consisted of a native dance and a comedy skit about the dangers of malaria in pregnancy.  Many students who came to watch us prepare asked questions about the skit, wanting to know about access to malaria medication and verifying the accuracy of our information about malaria.

At home, in Kamaranka, I made a banner for our booth, posters and flyers to advertise for the event, a malaria trivia quiz, and, most noticeable of all, a giant mosquito piñata.  The piñata prompted some really interesting conversations about malaria, from people of all ages.  I promised to make more for my community.  I filled it with Diamints (I chose these red mint candies to  resemble blood), and made the piñata itself out of cardboard, paper, pipe cleaners, paint, glue, tape, and, when the glue and tape ran out, pieces of fabric to hold it all together.  I explained the rules of how to “play” piñata, emphasizing that we should kill mosquitoes because they can give us malaria.  My other preparations triggered a lot of conversations about malaria too, but the piñata was so conspicuous and strange that people were drawn to it.

The Health Fair itself was also a huge success.  A PCV had organized the event at her school and invited each PCV in the district to come with two students.  The students had to visit each booth and take notes, and perform some sort of presentation about a health issue.  There were booths for Water, Sanitation and Hygiene, Food Security, Safe Sex, Germ Theory, and, of course, Stomping Out Malaria in Africa: Sierra Leone.  We hung the mosquito piñata in front of our booth.  In addition to the items I brought, our booth had several Peace Corps Malaria Handbooks we had written, handouts on statistics about malaria, and some “What’s wrong with this picture?” cards I had created previously.  Students crowded around our booth, looked at all the pictures, asked questions, answered questions, and generally learned a lot.  Some students who spent a long time at the booth answered questions of newcomers, using some of our handouts and pictures.  People were especially intrigued by the piñata, and some kept coming back to look at it.

Maile with her mosquito piñata.

Maile with her mosquito piñata.

Halfway through the day, I prepared my students for their performance.  My village, Kamaranka, is near the village where the fair took place, Rokulan, so I brought 10 students instead of 2.  They were the stars of the show!  They got up on stage and my counterpart drummed for their native dance and we directed them during the malaria in pregnancy skit.  Their performance was wonderful, eliciting much applause and laughter.  Afterwards, we brought the piñata onstage, explaining about malaria and why we need to prevent it (and kill mosquitoes) and then describing the rules for hitting the piñata.  It was a huge hit, but I feared for my life when the candy started pouring out.  I dove off the stage to escape bodily harm as small children rushed onto the stage to get at the candy.

On the way back to our village my students continued to talk excitedly about the fair.  When we reached, they boasted proudly to everyone that we had “won” the health fair.  And I suppose we did!

Posted in BAMM, BAMM Blog Roll, Sierra Leone

Hey Mosquitoes, Eat Dust: Bike Racing Against Malaria and HIV in Guinea

Forty-one athletes competed in the bike race, including three PCVs.

By Courtney Clark, Peace Corps Guinea

I will be honest – I have always been fairly skeptical of the myriad walks, runs, and marathons that American non-profits love to host. Sure, these events help organizations raise vast sums of money that support critically important research and programs. However, before I came to Peace Corps Guinea, I got annoyed every time my morning bus was full of new advertisements for the latest charity race and my Facebook feed was blasted with requests for donations from my runner friends. I realize how cynical this all makes me sound, but to the contrary, I have chosen to dedicate my life to the goal of social justice, and I care deeply about the success of the world’s nonprofits. It simply bothered me that so many charities seemingly lacked creativity and latched onto the walk/race model as a tried and true way to raise funds and awareness.

I realize just how wrong I was after working with my partner organization, a Guinean peer educator association called CECOJE, to host a bike race against malaria and HIV in the city of Labé. There is an excellent reason that so many nonprofits integrate sports events into their awareness and fundraising strategies – sporting events bring people together in a powerful, emotional way and are highly visible spectacles that can bring much needed awareness to unglamorous public health problems.

 PCV Courtney Clark, her counterpart Samba Camara and a representative from one of the event's sponsors discuss the importance of using bed nets to prevent malaria on a regional radio program.

PCV Courtney Clark, her counterpart Samba Camara and a representative from one of the event’s sponsors discuss the importance of using bed nets to prevent malaria on a regional radio program.

Our objectives for the race were three-fold; first, we wanted to prevent HIV by promoting condom use; second, we aimed to prevent malaria by encouraging bed-net use; and third, we wanted to build the capacity of the CECOJE’s peer educators by involving them in every aspect of the project’s planning and implementation. My fellow Guinea PCV Aaron Moritz and I wrote an HIV SPA grant and the CECOJE and I solicited community contributions from local businesses, NGOs and government officials. On March 2 we hosted the race and sensitized over 200 people at the closing ceremony and with a post-race malaria and HIV fair. We estimate that thousands more were reached through our radio spot, pre-race radio interview program and day-of live broadcasting. Fifteen CECOJE peer educators worked together to plan and implement the event. Eleven of them successfully completed a three day malaria Training of Trainers program hosted by Peace Corps in conjunction with the race.

While the Tour de Labé primarily fulfilled Peace Corps’ first goal by providing technical assistance to my partner organization, the presence of many PCVs made the event into a heartwarming Second Goal activity (Peace Corps’ Second Goal is to help promote a better understanding of Americans on the part of the peoples served). Eighteen volunteers assembled in Labé the weekend of the race, ready to help with sensitizations and to support the event in whatever way possible, and three even competed in the race. The CECOJE and I planned an HIV and malaria fair to be run by volunteers and held directly after the closing ceremony of the race. Volunteers split into teams to manage each of the fair’s activities, which included mosquito net washing demonstrations, condom use demonstrations, a malaria dream banner, photo ops under a mosquito net, HIV and malaria talks and trivia. During the announcement of the winners, my counterpart made a thoughtful and moving speech about the spirit of brotherhood, friendship, and sport that had brought together Guineans and Americans for the race. He was clearly excited and touched that three Americans had participated. He also thanked all of the volunteers profusely for our technical and material support and explained that we share the same objective: ensuring a healthy and prosperous future for youth all over the world. The event reinforced the Labé community’s goodwill toward Peace Corps.

After the race, Guinean peer educators and PCVs hosted a malaria and HIV awareness fair. Here Guinean children pose under a mosquito net for a photo while a PCV dressed as a mosquito explains how the net protects them from malaria.

After the race, Guinean peer educators and PCVs hosted a malaria and HIV awareness fair. Here Guinean children pose under a mosquito net for a photo while a PCV dressed as a mosquito explains how the net protects them from malaria.

Sport-based events like bike races, 5k/10k races and soccer matches are a fantastic way to mobilize Guinean communities and make malaria and HIV prevention exciting. Biking as a sport is a new concept in Guinea and so our race was fresh and novel to an urban population that is bombarded with invitations to events and sensitizations hosted by nonprofit organizations. These events also empower volunteers from every sector to get involved in malaria work, even those with no experience in malaria prevention, by making it easy and fun to participate. Peace Corps Guinea volunteers have big plans to continue using sports to promote malaria prevention through several upcoming Kick Out Malaria soccer matches and the Grassroots Soccer student malaria training program.

Posted in BAMM, BAMM Blog Roll, Guinea