This past weekend I ran some trainings for the leaders of girls groups, with the main goal being to equip the women with basic knowledge of our girls group program and how to be a good facilitator, as well as with basic (sexual) health information so that they can hopefully begin to effectively lead girls groups in their own communities. I was super excited for the weekend to finally be realized, as I believed that it would be the first of many important steps in actually building some inchoate vestiges of sustainability into Peace Corps Moz’s girls group program. And even within the midst of a few unanticipated and utterly demoralizing logistical trials (one being that a Peace Corps staff member had suggested to me the location, which inadvertently ended up being a venue primarily used by men and their prostitutes: perhaps not the best place to lead a conference with women you are hoping will be positive role-models for young girls), I do honestly believe that we in part reached our goal. One of the women commented, “I have learned so much, which I will guard in my heart and in my mind so that I can help our girls and the future of women in Mozambique.” She wins.
A last minute programming addition was the catalyst from which our last day was finally able to be what I had envisioned that the training could be: a bunch of women dancing and singing, certificate in hand, pumped to go home and get the ball rolling. In honor of April being World Malaria Month, and April 25 being World Malaria Day, we decided to incorporate some malaria information and games into the otherwise heavily anti-HIV focused campaign of the conference. In sub-saharan Africa, every two minutes, 3 children under the age of 5 die of malaria. Malaria is the number one killer of children under 5 in Mozambique specifically, as 142 of every 1000 children do not make it to celebrate their fifth birthday, and 42% of these deaths are linked to malaria. Malaria is the number one cause of death for all ages here as well, accounting for 29% of all deaths in Mozambique, while HIV/AIDS comes in at “only” 27%. I have been unable to find the exact number of people who die from malaria each year in Mozambique, but these statistics are staggering enough. HIV/AIDS gets all the attention, though malaria is a much more deadly peril. Though all provinces of Mozambique are considered to have high malaria threats, the northern part of the country, where I live, is most affected. And unlike its more legendary killing counterpart, HIV/AIDS, it is preventable and treatable, as well as more realistically eradicated. The game we played at the conference dealt with this first aspect of malaria: prevention. The rains came late this year, and therefore malaria is still a threat at this time of year, with the big mud puddles serving as breeding grounds for hoards of mosquitoes. Therefore, one area of prevention is to get rid of standing water around the house. Also, properly hung and utilized mosquito nets over every sleeping area, using naturally found and grown bug repellents (lemongrass, etc), and cutting down overgrown weeds are methods of prevention. The winners of our prevention-game each won a medically treated bed net as a prize. Aside from the lack of knowledge about or the plain neglect of adherence to simple preventative measures, I believe, in my admittedly inexpert opinion, that the number one contributing factor to the malaria epidemic in Mozambique is how “malaria” has become synonymous for “sick.” A far too frequent conversation here:
Me: Where is so-and-so today?
Person A: Oh, he is out sick with malaria.
Me: Did he do a malaria test at the hospital?
Person A: No.
Me: Then perhaps he doesn’t actually malaria, and perhaps just has the flu. He should go to the hospital and get a malaria test.
Person A: look of disbelief on face
By equating “malaria” with “sick,” the scariness and realness of the disease becomes less influential, because people are constantly overcoming and living through bouts of assumed “malaria.” The great threat that malaria does play will never be realized and taken to heart until this myth that all flu-like symptoms implicate malaria has begun to dissipate. Not only do constant real malaria infections regularly keep people at home and absent from school or work, only adding to the lower productivity of many aspects of society here, but to be honest, people are systematically dying by something that is easily cured with medication. Even when someone is rightfully diagnosed by means of a malaria test at the hospital, it is quite common for the hospital to then be out of stock of Coartem, the anti-malarial drug, (and quite often, the hospital has run out of the diagnostic tests) leaving people understandably less inclined to return to the hospital and wait for hours in line for their malaria test the next time they are sick.
As Peace Corps Volunteers, it is beaten into us during training the importance of adhering to our malaria-prophylaxis daily or weekly regimen. I have probably lost half the volume of the hair on my head as a side effect of my weekly malaria-prophylaxis pill over the last 19 months (not to mention the vivid dreams and occasional mid-sleep hallucination of rats climbing all over my mosquito net), but at least I am protected. We are given bed nets and a constant supply of bug repellent. We have both the rapid malaria test as well as the anti-malarial drug easily available in our Peace Corps issued med kits. I don’t even know a single PCV who has ever even had malaria. And yet our counterparts, students, friends, neighbors, etc all remain at an extremely heightened risk every day. Our school year is only 4 months young and already, 2 students have passed away. All I know is that they were sick, and then the school posted a notice on the front gate, ambiguously informing us of their passing. Though it is incredibly rare for someone to have their neighborhood-gossip-chain cause of death actually be “malaria,” due to the already explained misconceptions regarding this particular disease, I can’t be sure that malaria was not the principal cause, and I am statistically inclined to say that it was. The average lifespan in Mozambique is about half that in the US, and dealing with death is an overly routine experience. Yes, malaria’s more famous mortal counterpart HIV/AIDS, with its assumed link to sexual promiscuity and all that accompanies this fact, is also a massive player in this circuit, but malaria must start to be seen as on the same level, as it attacks the most vulnerable: children under 5 and pregnant women.
Bet nets are the most eminent means of prevention. The previous ideal for net distribution was one per household, which leaves the children, who often sleep on reed mats on the floor and have also not yet developed any semblance of immunity against the disease, wholly unprotected. Now, the suggestion is one net per sleeping area (most people don’t have beds), but they are expensive and even if received for free, often end up being sold in the market the next day as a vehicle for easy cash used for something deemed more important. People also are often uninformed as to proper use of the nets, occasionally using them as blankets or not knowing how to hang them up. It seems for the first time that the more attention is being paid and more funds allocated to prevent the biggest killer in Africa, as it rightfully should.