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

Building the capacity of volunteers as malaria peer educators in Botswana!

Brianna and her counterpart in a bed net demonstration

After the first rain in November, Botswana suddenly transforms from fifty shades of ocher into glorious sceneries of lush green.  While rain restores life to a nation that is roughly 70% covered by the Kalahari Desert, it also introduces the risk of malaria outbreaks.

Botswana may be in its final stages of malaria eradication, but the disease remains a major health concern.  Malaria incidences are not limited to a few isolated cases, and rather present itself as significant outbreaks each rainy season.  Nonetheless, community awareness about malaria remains low, and overall there is inadequate understanding about the disease and prevention strategies.

When Brianna “Boo” Gehring, a Bots 12 clinic volunteer, first started malaria projects in her village, Etsha 13, she was surprised to find out how little her clinic staff knew about malaria. Despite being located in northwestern Botswana, a region that has the highest malaria endemicity in the country, due to its proximity to the Okavango Delta, some staff members were unaware of the role that mosquitoes play in the transmission of the disease.

Green Scorpion Volunteers leading a community health talk with a flip-book tool

Green Scorpion Volunteers leading a community health talk with a flip-book tool

Since then, Brianna has been working incredibly hard to change things.  Her approach was simple: to make malaria education personalized, immediate and realistic.  She believes that malaria prevention messages should be disseminated directly to an individual; where the audiences’ personal circumstances, means and resources can be taken into consideration and action taken immediately.

 “Personalizing malaria to one’s family meant changes were easy to make. On the spot, nets [could be] repaired and wastes removed. Small group discussions [also] meant that participants [could be ensured to] understand mosquitoes’ role in malaria.”

She wanted to focus on small changes that anyone could accomplish by limiting the scope of their responsibilities to their own household; with tasks such as ensuring that everyone sleeps under a bed net and that their compound is free of potential mosquito breeding grounds.

Last year, to commemorate World Malaria Day, Brianna organized a week-long campaign where health educators participated in a door-to-door campaign, which aimed to provide malaria education as well as on-site bed net repair services. Following the successes of her Malaria Week Campaign, Brianna made the activity continuous and sustainable over time by extending the responsibilities for community outreach to an existing group of volunteers called, Green Scorpions.

Green Scorpions is a short-term employment program through the Botswana government that employs a team of community-based volunteers to perform environment-related work, sanitation in particular.  In Etsha 13, Brianna is one of the trainers that provides training for the new groups of volunteers that come in each month. In addition to teaching them about important environmental health topics, such as recycling and water sanitation, Brianna also equips them with basic malaria knowledge.  In addition, they learn how a clean yard and proper water storage could combat malaria.  Most importantly, she builds their capacity as peer educators and potential resources for the community by including trainings on bed net usage and care, and the benefits of indoor residual spraying.

Brianna is COS-ing this coming June, and we would like to highlight her exceptional work and efforts against malaria!  We hope that others can learn from Brianna’s innovative intervention and view it as a motivation to look for opportunities to build capacity with local volunteers and support groups within their own villages. Together we can stomp out malaria.

Posted in BAMM, BAMM Blog Roll, Botswana

Students Take Lead in Malaria Education in Rwanda

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It was pouring rain as I arrived at my school 45-minutes before our day of malaria education. All the students were cooped up in their dorms or taking shelter in the cafeteria. We had a tight schedule ahead of us, and the rain was clearly going to be a huge obstacle. Even though the students were all on the school grounds, trying to get them moving would have been like trying to light a charcoal stove under that damp sky. As the starting time came and went, my fellow Peace Corps Volunteers and I were on the verge of panic and plan B’s. Although there was little we could do, I kept faith everything would come together in the end.

And at the last minute, it did.

It was the height of southwest Rwanda’s malaria season and students at E.S. Bugarama in the Rusizi District were taking charge in the fight against malaria. It was the second in a series of “Malaria Days,” put on by a team of PCVs to educate students about the gravity of malaria in Rwanda and how to prevent it.

Six volunteers worked with eight student facilitators to lead a variety of lessons, games and activities. Fifty-eight students participated in the Malaria Day, which included education in net care, transmission and the importance of early treatment. We also emphasized the local and regional burden of malaria.

Senior 5 student BYIRINGIRO KAYISHEMA Elie teaches a lesson on the malaria situation in Rwanda to a group of his peers at the E.S. Bugarama Malaria Day in Rusizi District, Rwanda on 15 February 2014.

Senior 5 student BYIRINGIRO KAYISHEMA Elie teaches a lesson on the malaria situation in Rwanda to a group of his peers at the E.S. Bugarama Malaria Day in Rusizi District, Rwanda on 15 February 2014.

 

As the host, the most important aspect for me was to get students to have a strong leadership role. It took a little extra work and planning beforehand, but on the day of the event it paid off. I chose eight students who had participated in previous malaria activities and trainings. First we reviewed lesson plans. Then, each student leader was paired with a PCV to help facilitate the lesson. The pairs were assigned to a classroom where they would teach their lesson to small groups of students. Every thirty minutes the small groups would rotate to the next classroom.

 Peace Corps volunteer Claire Brosnihan, left, and Senior 5 student NDIZEYE Jean d'Olive Jolie lead a game of "Malaria Jeopardy" at the E.S. Bugarama Malaria Day in Rusizi District on 15 February 2014.

Peace Corps volunteer Claire Brosnihan, left, and Senior 5 student NDIZEYE Jean d’Olive Jolie lead a game of “Malaria Jeopardy” at the E.S. Bugarama Malaria Day in Rusizi District on 15 February 2014.

 

Senior 5 student ATHERI Sandrine, top right, participates in a "true or false" game about malaria. Senior 5 student DUSHIMIMANA Salomo plays the same game, which is aimed at dispelling commonly held myths about malaria at the E.S. Bugarama Malaria Day in Rusizi District on 15 February 2014.

Senior 5 student ATHERI Sandrine, top right, participates in a “true or false” game about malaria. Senior 5 student DUSHIMIMANA Salomo, bottom right, plays the same game, which is aimed at dispelling commonly held myths about malaria at the E.S. Bugarama Malaria Day in Rusizi District on 15 February 2014.

By the second or third rotation, the student leaders, for the most part, were taking control of the classrooms, leaving the PCVs to kick back and watch the students learn without much effort. To me, it is so much more rewarding to see students learning from each other rather than from me.

Students at E.S. Bugarama participate in an activity that shows how different groups are at risk of malaria at the E.S. Bugarama Malaria Day in Rusizi District on 15 February 2014.

Students at E.S. Bugarama participate in an activity that shows how different groups are at risk of malaria at the E.S. Bugarama Malaria Day in Rusizi District on 15 February 2014.

The results from the post-test showed a 15.5% increase in students’ overall malaria knowledge This improvement was lower than I had hoped, but I was glad to have an idea of the concepts that students still had trouble understanding so we could improve for the next Malaria Day.

Senior 6 student  MUKAHIRWA Lucie leads an activity to show how everyone's dreams are connected, and why it will take a community-wide effort to eliminate malaria.

Senior 6 student MUKAHIRWA Lucie leads an activity to show how everyone’s dreams are connected, and why it will take a community-wide effort to eliminate malaria.

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Posted in BAMM, BAMM Blog Roll, Rwanda

Sierra Leone PCV Recounts First Experience Representing Stomp

Sierra Leone-Mary Nolin 1

Nalehjah! (Good Afternoon- Fulla)

Sierra Leone-Mary Nolin 1Good afternoon family and friends! To all of my New Englanders, I hope that you have dug yourself out from the snow. It feels like even the BBC here in Africa was talking about all the snow that you all were getting, it must have been one heck of a storm! I hope at least one of you will be making a snow man in my honor. This week I want to talk about joining the STOMP team and my experience participating in my first STOMP event.

First of all, what exactly is STOMP? STOMP Out Malaria is an initiative of Peace Corps aimed at making a difference for people in host communities by working to prevent malaria, educate, and support people who are afflicted or at risk from the disease across Africa. Currently, STOMP is operating in 23 countries in Sub-Saharan region.

Our own STOMP malaria team here in Sierra Leone is composed of five members. They are Mr. Dylan Hoover, Salone 2, Ms. Maile Thayer and Ms. Suzy Khachaturyan, Salone 3, my Salone 4 buddy, Eli Filip, and myself. Even though we are a small group, we do work!

For those of you that do not know, malaria is an infection disease caused by the parasite called Plasmodium. It is transmitted only by the female anopholes mosquito. There are four main types of malaria, plasmodium falciparumplasmodium vivaxplasmodium malariae, and plasmodium ovalePlasmodium falciparum is the most deadly. Currently, we have all four types of malaria here in Sierra Leone.  The UN estimates that 627,000 people die from malaria each year. 90% of those deaths happen in Africa and 77% of those deaths are from children under five. Just in 2012, malaria killed about 483,000 children under five years of age world wide. (If anyone wants to check my facts or read more, check out the WHO World Malaria Statistics Report 2013)

Just to give you a clearer picture of the malaria situation here in Sierra Leone specifically. Due to its ideal climate and geography, Sierra Leone is a high transmission country with 100% of the population at risk for contraction of the disease. In 2013, there were 1,537,322 reported cases of malaria and 2,170,759 suspected cases of malaria. There were 3,611 confirmed, reported malaria deaths in 2013. Although that number may seem small, that is only the number of reported deaths caused by malaria. In reality, a lot more people die from malaria. Many cases are just not reported or misdiagnosed. Needless to say, malaria has become a way of life here and one that I have seen first hand deeply affect communities here in Sierra Leone and specifically my site of Kabala.

Sierra Leone-Mary Nolin 2On February 6th, the Sierra Leone STOMP team made an appearance at the first annual Bombali Health Fair in Rokulan, Sierra Leone. The health fair was organized by a Salone 3 volunteer, Lindsey. She invited members of STOMP, Water and Sanitation (WAS), as well as Food Security and Sexual Health teams to present in a science fair/ round robin event. Every team had their own booth and students from Rokulan and surrounding schools, as well as community members, were invited to partake in discussion and demonstrations on their own accord and interest. Students from the host school of Rokulan, as well as neighboring Kamakwie, also performed skits and dances to demonstrate their own knowledge about malaria and further educate their communities.

I have to admit that I was very nervous at first to be talking about malaria on behalf of the STOMP team. However, thanks to our AWESOME malaria handbook, and the veteran company of Dylan, Maile, and Suzy, my fears quickly disappeared. Questions I had ranged from anything from “What is malaria?” to “What specific malaria medications can I get at my local pharmacy?” I feel that our STOMP team was well prepared, both in the knowledge about malaria and the Krio, the lingua franca, to answer most questions.

In addition, our malaria handbook, pictures about the malaria life cycle and its prevention, as well as a bed net were all on display. Having the visual aids were a great help. Even if the cute, little primary school children didn’t fully understand what we were saying to them about malaria, all I had to do was point to the bed net and ask, “Do you have one in your house?” I was happy to hear that most children said yes. When I asked them why should they sleep under it, many replied, “I sleep under it so I don’t get sick.”

Finally, in order to assess the comprehension of the material we presented, Maile created a short, multiple-choice quiz in poster form that we hung up in our booth. Not only was the quiz an evaluative tool for our STOMP team, it also opened the door to a lot of great discussion.

After students and community members had visited the respective booths over the course of the day, students from Rokulan and neighboring schools presented their skits and dances. The creativity and presentation of information, particularly from the students of Kamakwie, was amazing to watch. Maile, being the creative genius that she is, even made a pinata in the form of a mosquito! She stuffed it with sweets and during this time we let the students literally and figuratively fight malaria. If you think that breaking a pinata is crazy in the U.S., you haven’t see the chaos that ensued after our pinata was beat to death. About 60 students rushed the stage in a mad dash for the sweets! I was nervous that the stage was going to collapse at one point! Luckily, African children are tough and no one was hurt.

Overall, I think that my first experience in a STOMP event was a positive one and a highlight of my service so far. I think that what I like best about being on the STOMP team, and about having the types of conversations that I did with the people at the Bombali Health Fair, is that it makes me feel like I am actually making a difference.

Wi go si bak, (We will see each other again/ See you later- Krio)

Posted in BAMM, BAMM Blog Roll

In Sierra Leone, an Education Volunteer Navigates New Territory with a Net Campaign

All those present at the partner meeting. The man behind me (far left) is the Social Mobilization Coordinator, and the DMO is towards the right with a baseball cap and a plaid shirt.

By:  Suzy Khachaturyan

One of the coordinators explaining the logistics of the bed net campaign to stakeholders.

One of the coordinators explaining the logistics of the bed net campaign to stakeholders.

For the past few weeks I have had the privilege, particularly as an Education Volunteer, to take part in the micro-planning for the upcoming bed net campaign here in Sierra Leone. Being placed in my district’s headquarters town (Pujehun District, Southern Province) puts me very close to the government hospital and all that comes with it—the District Medical Officer (DMO), laboratory, nurses, administrators, and the District Health Management Team (DHMT). Once I expressed to the DMO my interest in helping with the campaign, he invited me to the initial planning meeting.

The first meeting consisted of mostly Community Health Workers (CHWs), along with district council representatives, campaign coordinators from Freetown, and the DMO. While at first very tedious, the meeting was interesting nonetheless. The main task at hand was to find out the population in each Peripheral Health Unit’s (PHU) range, including all the villages that depend upon it for medical services. These figures were compared to previous numbers from past censuses and DHS surveys, and discussions were had about which figures were most reliable. Once that was complete, the number of nets per PHU (maximum of 3 per household) was calculated, as well as the number of bails (40 bed nets per bail) per village, chiefdom, and for the whole district. The next assignment was for CHWs to present information on the net campaign, alongside a distribution coordinator from Freetown, to stakeholders in each chiefdom headquarters town/village.

At the stakeholder meeting for my chiefdom, which also took place in my town, the town chief, imam, and pastor were present along with nurses, hospital administrators, and a few others. The purpose of the meeting was to inform them all of the upcoming bed net distribution and to have their assurance and support for the safety of the nets after they arrive but before they are distributed. Net theft, I have been told, has been a challenge during past net distributions. Several of the stakeholders asked questions about the logistics of the distribution, and all assured the coordinators that the nets would be stored safely.

The town imam asking the coordinator assuring the campaign coordinator that the nets will be well-secured in Pujehun.

The town imam asking the coordinator assuring the campaign coordinator that the nets will be well-secured in Pujehun.

Next up was the meeting with partners. NGOs such as Save the Children UK, World Vision, Sierra Leone Red Cross, and more were in attendance. The meeting was intended to inform the various partners in town about the upcoming distribution and to express the challenges, both logistical and otherwise, that would be faced. As it turns out, roughly 3 whole chiefdoms out of the 12 in my district are only accessible by foot or canoe, with most villages between 5 and 10 miles from the nearest vehicle-accessible path. Since each bail of nets weighs 38 kilograms, and villages need upwards of several dozens of bails, the task at hand is an ENORMOUS challenge. At the end of the meeting the DMO, coordinators, and administrators asked those present to think about how they could contribute resources and/or manpower to help out. One pledge of 50 gallons of fuel was made, and the other partners said they would talk to their offices to see what they could offer.

All those present at the partner meeting. The man behind me (far left) is the Social Mobilization Coordinator, and the DMO is towards the right with a baseball cap and a plaid shirt.

All those present at the partner meeting. The man behind me (far left) is the Social Mobilization Coordinator, and the DMO is towards the right with a baseball cap and a plaid shirt.

All in all these experiences have been very valuable and interesting for me. Being exposed to a taste of the health field here has been rewarding, and I look forward to continue my involvement. Soon I will be helping the Social Mobilization Coordinator at the hospital as he plans and carries out the educational aspect of the distribution—educating people beforehand about malaria so they can come for bed nets, and doing a post-distribution bed net hanging campaign. Aside from the education component, I plan to volunteer my time for parts of the distribution, particularly in my chiefdom, and tag along on some far off excursions if given the opportunity. Needless to say, I will be in close contact with the hospital administrators, particularly the DMO and Social Mobilization Coordinator. This event will be challenging for all involved, but I am excited to get started!

Posted in BAMM, BAMM Blog Roll