Fighting Malaria by Foot: New medication helps thousands of kids

Deaths from malaria are still a huge problem in Senegal, especially in the muggy, humid regions of Kolda (my site) and Kédougou (another southern region). It’s especially poignant for me now, returning from a vacation in Morocco where we could sit out on the terraces enjoying the night air without fear of mosquitos. I’d never thought I’d refer to air as delicious, but it was.

But now I’ve plunged back into the midst of Senegal’s rainy season, and those little buggers are having a field day laying eggs and spawning more of their horrendous selves in the millions of puddles everywhere.

Each year, it’s inevitable that members of my host family will get malaria during the rainy season. Too many times, I’ve sat with someone in my host family as they’re bent over, clutching their head or stomach in pain from this disease – all from a tiny little parasite transmitted by mosquito bite. My host mom, my little sister (Rouby, age 9), and my brother (Omar, age 10) have all had malaria this year. It scares me every time, but luckily my family is educated enough to recognize the signs and go to the hospital right away for testing.

It’s not just a matter of sleeping under mosquito nets, though. If only it were that simple! Each evening, mosquitos come out as soon as the sun sets (around 8 PM). Let’s be honest: who is going to shut themselves indoors, in bed under their mosquito net, at that time? Nobody. The days are so sweltering hot that the cooler evenings come as a blessing, a time in the day to finally relax in the breeze, drink tea and chat. Even if they did want to go inside, most Senegalese homes are very open to the air, with simple grating at windows and curtains as doors. “Going inside” doesn't really mean escaping the mosquitos.

Each night as I sit outside around the big shared bowl, eating dinner with the family, I get attacked by so many mosquitos I can barely concentrate on my food (or my Pulaar – pretty sure the things I’m saying stop making sense around that time). Thankfully, I’m protected by antimalarial medication, Malarone, which I take daily.

But Senegalese people don’t have that luxury. Antimalarial medications are not intended for lifetime use, and no approved vaccine currently exists for malaria (though several are currently being tested). Health workers tell the population to sleep under mosquito nets and clean up stagnant water, but that just reduces the risk – it won’t eliminate the disease. What we really need is the method that eliminated malaria as a threat in the US: a massive insecticide (DDT) spraying campaign across the entire country. And that’s definitely not something Senegal has the means or capacity to do.

(In case you’re wondering, malaria was still a problem in the States by the end of WWII. When the war ended, one of the first tasks of the new Center for Disease Control was to eliminate malaria as a major public health problem. Starting in 1947, DDT was sprayed in homes across the 13 southeastern states where malaria was reported prevalent. By 1949, this intense spraying of homes, along with extensive drainage, removal of mosquito breeding sites, and occasional spraying from aircrafts resulted in “total elimination” of malaria transmission in the US, CDC says.)

Senegal is nowhere near that stage. However, now there is a new hope! And it’s brought by the simplest of methods: feet. Hundreds of feet, walking and walking, delivering a new medication.

The New Strategy

Starting during last year’s rainy season, Senegal’s Ministry of Health (in partnership with USAID and others) started administering a seasonal antimalarial medicine to kids under age 10 in the Kédougou region. Similar to what women in Senegal are given during pregnancy (Intermittent Preventive Treatment / IPT), this method of preventative treatment for children is now referred to as "Seasonal Malaria Chemoprevention" (SMC).

SMC consists of a 3-day dosage of two drugs – Amodiaquine and a combo Sulfadoxine-Pyrimethamine (SP) pill. If the pills are taken correctly over the 3 days, the child is protected from malaria for a month. The whole thing is repeated again over the next two months, giving these kids a total of 3 months protection from malaria. This covers the worst of the rainy season.

The test round in Kédougou apparently was a success: fewer cases of malaria were recorded during that rainy season than in previous years. This year, they’ve extended the campaign to hit three more regions in Senegal (Sédhiou, Kolda, and Tambacounda). When the program arrived in Kolda this August, I got to be part of it!

I know, it's just like Where's Waldo. I blend in so well. 

French for "seasonal malaria chemoprevention for children age 3 months to 10 years"

This past weekend I spent three days walking around my quartier in Kolda doing house-to-house administrations of the medicine. We trudged around in our sandals carrying our paperwork and packs of pills, knocking on doors and invading people’s homes to explain the importance of the medicine, gather up the kids, and administer it right then and there.

We had to temper our explanations to the audience: some spoke only Wolof or Pulaar, some spoke French, some were educated and many were not. It’s pretty hard to explain what “seasonal malaria chemoprevention” is to anyone, let alone an uneducated individual who only speaks Pulaar, which has only one word for any kind of medicine (“lekki”). But we did our best, describing it as a kind of seasonal vaccine. We told them we’ll be returning in September and October to administer the medication again.

It was exhausting work, though it felt good to be physically doing something for my community that would tangibly improve their health! In the Western world, a campaign like this would never work, for many obvious reasons. But in Senegal, communities and families are very open, functioning on trust and hospitality. As long as you call out “Asalaam Alekuum” and greet everyone, you can walk right into someone’s house or compound (a big open space with several huts or buildings). This is culturally acceptable. People don’t get annoyed at you for invading their space or taking up their time – both of those things are Western concepts. Catch them in the middle of lunch? No problem, they’ll just invite you to join them. Time is fluid here, and space and belongings are open and shared.

Most importantly, door-to-door health campaigns in Senegal are the only way to guarantee that almost every child is covered. And it’s effective. People with limited means don’t travel far from their homes, so you can usually find all the children there. As a foreign “toubab” alone I would have inspired suspicion handing out medication, but I was part of a team of health workers (“relais”) from our local Health Post, all members of the community known and trusted by their neighbors.

(Actually, I’m finding that people kind of know me too, after a year living in this community! It’s nice to be recognized – much trickier in a big town like this than in a village. I’ve worked with the same team in the past for door-to-door Vitamin A supplements, polio/measles/yellow fever vaccines, and mosquito net distribution.)

My partner’s name was Youssouf Mané (“Bobo”), a local health relay and soccer coach and all-around awesome guy. Considering his size, it’s a bit unclear why he is called “Bobo,” which means baby... But no matter, it’s just gives me more ammunition for teasing. Senegalese culture is all about teasing. If you can take it and dish it back out, you’re golden.

The Dream Team (me & Bobo)

Bobo and I have worked together before and we make a good team: we alternate explaining in French or Pulaar (me) or Wolof (him) depending on the family. I fill out the paperwork, and he administers the medications. We also joke around a lot – gotta have fun somehow during these long, hot days.

At the end of the three days, Bobo and I alone had administered medication to 67 households and close to 200 children. In total, our team of health workers in Sikilo Ouest (about 50 volunteers) covered 2387 households during the campaign, with over 4400 children now protected from malaria. Not bad, for 50 pairs of feet!

 

Kolda is so green and beautiful in the rainy season!

The Faces of Change

Apologies for my long absence from this blog! I’ve been working my tail off here in Senegal with some big new projects (will explain soon), as well as gallivanting around Spain and Morocco (also to be explained soon). For now, though, I want to sincerely thank everyone who contributed to the Michele Sylvester Scholarship (MSS) Program that I fundraised for and blogged about a few months back!

I am happy to inform you that with your help, I raised all the money needed to offer scholarships to 9 girls from my neighborhood middle school, CM Sikilo Ouest. The school administration nominated these girls for their academic record, motivation and financial need, with teachers submitting a recommendation for each student. Each of the girls wrote me an essay about their future plans and their thoughts on the role of women in Senegalese society (you should see some of the things these smartypants wrote!). Finally, I conducted a personal interview with each candidate. 

Two of the girls I already knew, since they had attended our Youth Empowerment Camp back in March. The others proved to be just as smart and motivated – and sweet or spunky (depending on the girl). I approved each recommendation and sent their complete applications on to SeneGAD, our Peace Corps gender and development group handling the final approvals and scholarship distributions. If all goes well, the girls will be receiving their scholarships at the start of the new school year this October.

Thanks to all my lovely donors, these awesome young ladies can now afford another year of education without putting a strain on their families’ resources. Girls dropping out of school to work at home or get married remains a huge problem in Senegal (and Kolda in particular), so every little bit of motivation helps! Many of them come from big families with only one parent present or working – usually the father, with the mother fulfilling the traditional housewife role. Some are facing other difficulties as well. In addition to their studies, each of these girls also helps with household tasks every day (cleaning, sweeping, laundry, cooking, washing dishes). Still, they’ve all managed to stay on top of things and have some of the best grades in their class.

Here are the faces / stories of the girls your donations helped support!

Tacko Ndiaye

1.  Tacko Ndiaye
Age 13, Class 6ième (6th Grade)

Though she was shy at first, once I got Tacko talking it was obvious she’s a very bright, ambitious girl with a sense of humor. She is interested in a variety of subjects at school, not just one thing – she likes science, history, reading, languages, you name it. When I asked her about her future goals, she said she wanted to be “President of Senegal” or work in foreign policy! It’s great that she believes she can aim high no matter the circumstances. I am positive that she’ll go far. Her essay made it clear she already is a strong advocate for girl’s education and women’s rights, and she even has ideas for national policy changes. In addition, Tacko’s parents are divorced and currently her mother is the only one supporting her financially, since her father’s contract ended and he’s out of work. She lives with her parents and two brothers. When I asked what she contributes to the family, she responded, “L’amour!” (Love!) 

Mariama Baldé

2.  Mariama Baldé 
Age 12, Class 5ième (7th Grade)

The youngest of the scholarship recipients, Mariama is facing very difficult circumstances in life, but she’s extremely hardworking. She tells me she can see herself in the future either as a doctor with her own clinic or as a French teacher. Regardless, she wants to achieve success in life and help her mother out – a very selfless goal, considering her mother left her and lives in Guinea Bissau with a new husband, sending no money back to support Mariama at all. With her father dead, Mariama’s only source of support is her uncle – she lives with him and his (very big) family. I actually know and work with her uncle, Thierno Diamanka, a very respected and caring Marabout, and I know this scholarship will help them out.

Maimouna Gano

3.  Maïmouna Gano
Age 14, Class 5ième (7th Grade)

Maïmouna has two dreams, both of which involve helping women and the underprivileged: she wants to become either a gynecologist (to help reduce maternal mortality rates, she says), or a lawyer supporting human rights. She is very adamantly against early marriage, and her parents agree with her on this, thankfully! Maïmouna lives with her parents and 6 brothers and sisters. Her family seems to be having money problems, since her mother is a housewife and doesn’t work, and her father was a taxi driver, but his car has broken down.

Saoudiatou Akapo

4.  Saoudiatou Akapo
Age 14, Class 5ième (7th Grade)

Saoudiatou was one of the 4 students selected from this school to attend our Kolda Youth Empowerment Camp this past March, so I knew her already when we did the scholarship interview. She seems shy at first but is actually quite the opposite – little Miss Socialite! She is very intelligent (she has the highest grades of all the MSS girls), with opinions on women’s rights and education fostered and supported by her father, whom I also know. He is a radio journalist and a single parent supporting 7 children. This is obviously a pretty difficult situation, but he seems like a great dad. Saoudiatou loves science and wants to become either an ophthalmologist or engineer some day.

Marie Thérèse Diédhiou

5.  Marie Thérèse Diédhiou
Age 13, Class 5ième (7th Grade)

Marie Thérèse is a motivated student who has both achieved good grades and participated in extracurricular activities. She’s a strong believer in talking to people in her community about keeping girls in school. Later in life she wants to become a doctor. She lives with her parents and 4 siblings. Her family’s money situation seems a little tight, since her father is retired military living off a pension. Her mother doesn’t work – only her older sister is currently earning money for the family as a teacher in Velingara (another city a few hours away from Kolda). Her sister’s success has been an inspiration for her to work hard in school.

Rayhanatou Diallo

6. Rayhanatou Diallo
Age 16, Class 4ième (8th Grade)

Rayhanatou seems like a hard-working girl. She wants to become a policewoman or a doctor (gynecologist). She believes that women should not be delegated so many household tasks in Senegalese society and should have more time to pursue academic interests. Like many of my MSS girls, her mother is a housewife and does not earn money for the family. Her father operates a boutique (small shop) to support his family of 10 (his wife and 9 kids, including Rayhanatou).

Aissatou Diallo

7.  Aissatou Diallo
Age 14, Class 4ième (8th Grade)

Aissatou suffers from a vision problem that requires special glasses unavailable in Senegal, though her family is currently trying to obtain them from the US. This makes studying a little difficult for her, but nonetheless she is ambitious and hardworking. She wants to become either an engineer or a sage femme (midwife / gynecologist) some day. She is against early marriage and plans to complete her schooling and get a job to help support her father, who is the sole breadwinner in the family (mother is a housewife).

Bayelaou Diallo

8.  Bayelaou Diallo
Age 15, Class 4ième (8th Grade)

Bayelaou is an extremely sweet, respectful girl, quick to smile. I know her from her participation in our Youth Empowerment Camp. She was great in camp – very engaged and dynamic. She learns quickly. She tells me she wants to become a doctor / gynecologist some day, but she realized this is a difficult field and she’s a little nervous about succeeding. (I know she will, though.) In her family, her dad works at a boutique, but her mother doesn’t work, which means money is occasionally tight for her and her 9 brothers and sisters. Bayelaou is passionate about achieving success and helping other women in Kolda, and she has some great ideas for how to help women climb out of poverty.

Mbadé Amy Ndour

9.  Mbadé Amy Ndour
Age 13, Class 6ième (6th Grade)

Mbadé Amy was difficult to track down – she seems like a very busy girl (lots of studying and other activities)! Her family is definitely having some financial problems, and she told me that sometimes when they can’t afford rent, they have to leave their house and stay with relatives. Her father is the only one working in the family, as a carpenter. Regardless of these difficulties, Mbadé Amy works hard in school and hopes to become a sage femme or lawyer some day.