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!

Senegal’s Child Beggars

I believe in facing your fears.  As it turns out, my biggest challenge and personal fear in Senegal comes in a very small package: talibé, the children begging in the streets of Senegal's towns and cities.

Thrusting their skinny hands in your face through the windows of cars, surrounding you in a mob of shrill voices shouting “toubab” and demanding money, or just tiredly muttering Quranic verses as they hold out their yellow bowls, these (often barefoot) children in tattered clothes flood the streets of nearly every major city in Senegal.

As soon as they notice me and my white skin, which they equate with money, the kids rush over and glue themselves to my side like barnacles.  Ever since my first week in Senegal, they have by turns made me sad (who could do this to little kids?), driven me crazy with irritation (stop following me, just leave me alone), sparked me to anger (they need to get out of my face), made me nervous (am I going to look stupid if I don’t have a good Pulaar response?), and – a rising tide under it all – stirred deep feelings of guilt.

Why guilt?  Because my first exposures to them, during my first few months in Senegal, elicited an instinctively adverse reaction.  I didn’t know how to handle these kids, so they became my nightmare.  If I saw a pack of them, I tried to avoid the group.  They were caked in dust and dirt, staring at me out of infected eyes, heads sometimes covered in sores.  Overwhelming, because I didn’t know what I could possibly do.  There are so many. 

So I unconsciously started doing what many Senegalese do: tossing them a few smiles (or coins) and going about my day, forgetting.  Eventually, talibé become a predictable daily occurrence, almost like potholes in a road well traveled: you know they’re going to be there, you know you have to avoid them or navigate the bump, so you get it over with quickly and move on. 

Many people here don’t give talibé a second thought, except to dismiss them as obligations (for the giving of alms) or irritations.  One documentary film has labeled them “the least favored children of Senegal.”

There are an estimated half a million talibé in Senegal. Approximately 50,000 of those children are sent out begging or "subjected to conditions akin to slavery," according to Human Rights Watch.

Students Who Beg

The strange reality is: these kids are actually students.  In Senegal, children as young as five years old can be sent off by their families to become talibé, living and studying for as many as 11 years under a Quranic teacher (marabout) at his school (daara), often in conditions of extreme poverty. 

Talibé spend their days memorizing the Quran and begging for alms in the streets.  In many cases, they receive no meals from the marabout, so they must go out begging up to three times a day if they want to eat.

Talibé studying the Quran

A talibé entering his room

The ascetic nature of this type of education has traditionally been considered a way of teaching humility, as well as a rite of passage for boys into adulthood.  However, the system has become twisted in so many ways that it’s almost impossible to imagine how to begin untangling it.  Kids suffer and often their families never know. 

Unfortunately, poor families often see daaras as an escape – a way to lift the burden of financial support by sending their child away for a good cause.  (Parents have told me, “If we can’t pay for his public school fees anyway, why not send him to get a free education? Anyway, it’s good to learn the Quran.”)  Many talibé end up living in cities far from their original villages or towns, and sometimes families lose touch with their child for years.  A number of talibé in Senegal actually come from neighboring countries such as Mali, Guinea or Guinea-Bissau.

Human Rights Violations

Over the past few years in Senegal, reports have emerged of some marabouts exploiting talibé to grow rich off their earnings, while the boys lived in slavery-like conditions.  Many are forced to beg and punished if they fail to bring in their daily quota of food or money to their Marabout.  Several have reported being chained or beaten as punishment. 

In 2010, Human Rights Watch reported on the physical and sexual abuse some talibé experience, and seven Marabouts were arrested that year.  Anti-Slavery International wrote another report in 2011 highlighting the hardships these boys face and urging the Senegalese government to protect these children’s rights. 

Legislation banning “forced child begging” was actually passed in 2005.  But the tradition of Quranic education runs deep in Senegal, and the influence of marabouts and Islamic leaders stretches far.  In the end, they found a loophole for the talibé system: “soliciting alms” is not “begging,” they said. And so it continues.

(Please note that not all marabouts perpetuate harmful practices; many do care about their students and treat them well, but are simply stuck in poverty.)

Check out this video by Human Rights Watch for more info on the daara system:
https://www.youtube.com/watch?time_continue=2&v=qIigeLgtves.

Talibé In My Town

For me, after moving to my permanent site (Kolda, a regional capital in south Senegal), the talibé issue suddenly became personal and immediate.  My service here in Senegal has been all about helping wherever I can, finding those small cracks I can fill, facing my fears and trying to overcome my flaws.  I realized that I might be uncomfortable with talibé (and the whole daara system itself), but that was no reason to push the issue aside.  There are enough people doing that.

So I chose to confront my discomfort. 

Since I was placed in a small city and not in a village, I interact with talibé every single day.  They seem to appear around every street corner!  After my first month living in Kolda, I started forcing myself to stop and talk to the talibé, even with my limited Pulaar.  Giving out money is a tricky issue, since you’re also perpetuating the system in a way (this article - "Keep the Change" - argues against giving).  But once in a while, just to make a kid happy, I’ll give some extra food or a piece of candy.  They have so few bright spots in their days.  And they really do walk around barefoot, on dirty streets sprinkled with animal manure and broken glass (to name a few things).

Eventually, I started visiting daaras in Kolda with a Senegalese counterpart, introducing myself to the marabouts (which is still pretty intimidating) and researching how many talibé studied or lived there, the health conditions, their sleeping situations, etc.  So far, I have visited 18 daaras – and there are many left to visit.  Even the official local Inspector in charge of daaras and Arabic schools didn’t know how many existed in Kolda, and he’d never heard of several that I’d visited. 

The conditions I’ve witnessed are pretty dismal: bare rooms where boys sleep on the concrete floor, maybe on a mat if they’re lucky.  Usually there are not enough mosquito nets for all the children, making them highly susceptible to malaria.  The boys wear the same clothes every day.  With a few exceptions, most daaras here in Kolda teach the boys only the Quran and nothing else – so they never learn how to read and write, and never learn French (unlike their peers in public schools).  This severely limits their opportunities for the future. 

Marabout showing me where the talibés sleep

Talibé asleep in the room he shares with many other boys

Marabout laughing with his kids

Older talibés in their room

Group of talibés showing me their room

My Projects

Since no recent Peace Corps volunteer in Kolda that I know of has yet worked with talibé, I’ve decided to tackle what was originally a fear of mine and make talibé my primary focus for projects over the next two years.  After all, who cares if it makes me uncomfortable?  Here is a need, and I can address it, at least in some small ways.  So I’m going to try.

Recently I was elected to the board of SeneGAD, our Gender and Development group in PC Senegal, as Talibé Coordinator – so there’s my start.  In addition to my personal projects, I will also be acting as a resource for other PCVs interested in working with talibé. 

Here are some of the projects I plan to do in Kolda:

• Verify that they get enough mosquito nets during the upcoming national distribution 
• Health talks (causeries) on nutrition, malaria, hygiene and hand washing, diseases, etc.
• “Men As Partners” event, which sends a male Senegalese representative from Peace Corps to talk to the boys about their future, sex ed and reproductive health, violence, etc.
• Conference / event to advocate daara "modernization," as it is referred to in Senegal (improving conditions in daaras; teaching talibé a trade or sending them to French school, in addition to their Quranic studies) 
• French / alphabetization / literacy lessons with the kids

With the daara system so deeply entrenched in Senegalese society, I don’t know how long it will take for things to change in Senegal.  But I do know that I can try to help these boys that live in Kolda, even if it’s just to expand horizons a little or improve their health on a basic level.  I can try to help Habibu, that smart little talibé that hangs out downtown and knows me by name. 

After all, these are human beings we’re talking about.  Senegal’s future.  What’s more important than that?  So stay tuned for future stories!  In the mean time…

PLEASE DONATE:

If you’re interested in helping me reach out to the talibé, please support the work I’m doing by clicking on the “DONATE” PayPal button at the top of this website.  I am collecting donations to purchase these simple items for my health causeries:

• Bars of soap (25-50¢ per bar, depending on size) – Just $10 can buy 20-40 bars, enough for 1 daara! 
• Hand washing stations – bucket and pouring kettle ($4-6)
• Powder laundry soap (“Omo” – 10-50¢ per packet, depending on size)
• Bleach (“Eau de Javel” – $1 per bottle)

At this time, I only plan to distribute a few simple hygienic items to each daara, to go along with my health lessons.  This way I can help talibs practice what I teach, but will avoid creating dependency through large gifts.

DAARA DRIVE:

If you would like to support my work with talibé by donating items yourself, feel free to mail things like secondhand clothing, shoes (flip flops are great), light blankets or sheets, balls, marbles, simple games like checkers, etc.!  I am starting this drive now, but will not be distributing items until later in my service.  The idea is to establish a good relationship with the daaras first, conducting educational activities and events, so that handouts aren’t expected.  Ultimately, I will distribute the items to the daaras that I have formed the best relationships with. 

Mail items to:

PCV Lauren Seibert

Corps de la Paix

B.P. 26

Kolda, Senegal