I woke up in a start from a nightmare. Walter White, the anti-hero of the twisted show Breaking Bad, was attacking me in my sleep. His lower jaw was missing and he had decided to swallow a bunch of gasoline in order to be a human flame thrower in a suicidal attack. I can still visualize his terrifying face coming at me shooting flames from the mouth even though I had this dream 4 months ago. Dreams have become a bit more interesting since I started taking the malaria prophylaxis Mefloquine. Since I live in an endemic malaria zone (just like most of Africa) I am required to take a malaria prophylaxis throughout my two years here. One side effect is vivid dreams. After taking the pill once a week I had some pretty good dreams. Now my dreams are less memorable as my body adjusts to the medicine. But still, according to Wikipedia, “mefloquine is associated with […] higher rates of neurological and psychiatric symptoms.” Great!
Malaria is one of the many preventable communicable diseases that still plagues the tropics, especially Africa. Currently there are about 250 million worldwide clinical cases of malaria a year. Of all those cases, malaria kills around a million people, give or take a hundred thousand. 90% of these deaths are in Africa. No one really knows the exact number since Malaria effects so many rural and underrepresented communities.
It affects the people of Abi Adi too. Malaria ranks in the top ten health concerns of both the local health center and the hospital. Last year it was the leading cause of out-patient services in the Central Zone of Tigray. And yet people here often report that Malaria is not a big deal in Abi Adi or that it is only a seasonal issue. Over the past few months I conducted house to house visits to ask about health concerns. People kept telling me that malaria is not a problem for them. However, the numbers from EVERYWHERE (local, regional, national, and international) all disagree. This misunderstanding needs to be resolved and one tool in this fight is World Malaria Awareness Day.
Everyone’s favorite president, George Dub, and the World Health Organization were behind the first World Malaria Day as he explains in his book Decision Points, “On April 25, 2007, Laura and I hosted America’s first-ever Malaria Awareness Day in the Rose Garden.” This was partially to promote Bush’s 2005 President’s Malaria Initiative that allocated $1.2 billion to fight malaria in 15 countries over 5 years. The motives behind this benevolent initiative, like most things Bush did, are debatable. Was it a plan to divert international attention from Afghanistan and Iraq, was it just the right thing to do, or was it to protect American national security? Bush writes: “Our national security was tied directly to human suffering. Societies mired in poverty and disease foster hopelessness. And hopelessness leaves people ripe for recruitment by terrorists and extremists.” Regardless of the motives or your opinions, Bush’s administration started a huge malaria program and helped promote an international awareness day for something that unquestionably needs more attention and awareness. So thanks boss!
We were told by Peace Corps management that we should try to promote World Malaria Day in our communities. I wasn’t really sure how to do this. Since I’m still pretty new in town, I don’t yet have a captive audience (like one school I work with) and don’t feel confident enough to organize a town parade or something big. My colleagues at the health office seemed apathetic about it and no one, including me, wanted to take the initiative to organize something complicated and intimidating. World Malaria Day arrived, and all I had managed to do was write a few paragraphs for a public health letter that we distribute to various offices in town. I felt like a failure; I let George W down.
Then an unexpected opportunity presented itself at the teacher’s college. I went to the college on Thursday night (Malaria Day) to watch and critique an Anti-HIV club’s skit they were polishing for a performance the following day. It turns out there was some sort of big event planned for the next day, and they invited me and my counterpart Tuha, to return the next day to discuss Malaria. I found my audience.
I didn’t really know what the program was. It sounded like some sort of school wide assembly so I prepared a speech. It was a really boring, but informative, speech about malaria transmission, prevention, and treatment. It fit in my 10 minutes of allocated time and served my purpose. Tuha and I arrived at the college and the program finally started almost 2 hours late (typical). It turns out the program was a talent show complete with poems, dancing, singing, and skits. After each act, teachers sitting at the judge’s table offered critiques, American Idol style, in front of the crowd of 400 or so college kids. The audience loved the brutal critiques of their friends and peers. The atmosphere was fun, rowdy, and energetic and I realized my boring speech was not going to cut it. Luckily my epiphany came a few minutes before going on stage so I had time to figure out a rough plan with Tuha before we took the stage.
We went on stage and he translated and explained some key points in Tigrigna while I ran around the stage with a big cardboard mosquito infecting people. I think we made it pretty clear that you should use a bed net – every night! We held their attention throughout, and the kids loved it. Hopefully they learned something. I’m just thankful that I changed my plan at the last minute. One more example of expecting the unexpected as a Peace Corps Volunteer; have a plan B, C, and D.
Bed nets are all over. They are distributed for free every few years by the government. Unfortunately these bed nets are often not used, or worse, used incorrectly holding hay down from the wind or keeping sheep out of gardens. When used properly, or at all, bed nets prevent you from being bitten by an infected mosquito carrying malaria. Mosquitos don’t inherently carry malaria; they must first bite another human infected with malaria. Therefore using a bed net also prevents infected people from spreading the disease to their friends, family, and neighbors. You actually get malaria from your neighbor, the mosquito is just the way you get it (the disease vector). This is just another example of a ridiculously complicated relationship between 3 organisms (humans, female anopheles mosquitos, and plasmodium protozoa). This microscopic organism is using humans to breed and mosquitos to spread. How that evolution worked out blows my mind. But at least my mind isn’t being blown by a stroke from cerebral malaria (plasmodium.falciparum) thanks to my bed net and Mefloquine – and all the fun dreams that come with it.