One of the hardest things about telling people about malaria in Abi Adi is the follow through. I tell people to use a bed net, every night, all the time, even in the dry season, yet if someone actually wants a bed net I have nowhere to send them. Abi Adi is out of bed nets.
Abi Adi is in a malaria zone and malaria is a problem here as indicated by pretty much every official report available. So far in the 8 months of the Ethiopian Calendar year 2006, we’ve had 6951 total examinations, and 814 confirmed cases of plasmodium.falciparum and plasmodium.vivax at the Abi Adi Health Center alone. This doesn’t include the hospital’s numbers. So this month I’ve been talking to my friends and students about malaria, since it is malaria awareness month after all. I explain how malaria is only transmitted by mosquitoes, but it requires human hosts to breed and spread. Using a bed net not only protects you, but also it protects your neighbors by lowering everyone’s risk.
However, I feel like a big hypocrite because when I’m asked where to actually get a bed net, I stutter. My colleagues at the town Health Office can’t even tell me. I asked around and everyone had ideas on where to procure a new bed net:
“Well you see, there are limitations, you can only get a bed net if you are a newcomer to the town.”
“I think you can buy a new bed net in the shops around the traffic circle.”
“They have bed nets at the health center but only for children.”
“They will come to distribute bed nets during the rainy season.”
But, if you walk around town, or the countryside, you will see bed nets. As I wrote last year, bed nets are everywhere in Abi Adi. They are distributed for free by the government every few years. The last one of these handouts was a few years ago as far as I can tell. No one knows when the next one will be, but bed nets are here now. They are just in the wrong places.
Since they are distributed for free, it is difficult to make sure they are being used properly. People find other uses for this strong, durable, and large piece of fabric. It’s used to hold down hay from wind storms. It’s used as a sheet to create shade. It’s cut into strips and braided into strong rope used to pull stubborn donkeys or to secure a load of firewood. To be fair, these bed nets do have a finite lifespan and maybe some of these ‘misuses’ are legitimate efforts at thriftiness. But I kind of doubt it.
Maybe bed nets shouldn’t be free…? Maybe people should be able to buy them if they want them. This way only people who find them valuable would use them for their intended purpose. Well, unless they were cheaper than rope, tarp, or other comparable materials. What is the value of a bed net anyway? This World Bank sponsored study of Tembien, Tigray, Ethiopia tried to answer that question back in the 1990s. But maybe if they weren’t free, people would completely ignore them and we would have a huge malaria epidemic on our hands. Regardless of the answer to that question, it seems to me that you should be able to buy a bed net if you want one.
A few days ago I was talking about malaria with one of my friends in town. Sara runs a little cafe on my street and sells tea and coffee all day every day from her cafe that is also her house. She takes care of her 2 year old son who can be found playing with other neighborhood kids when he’s not sleeping. I asked if she has a bed net. She said no but that she wanted one. I said I would try to find her one because children under 5 are considered vulnerable for malaria and are given priority for bed net use. For the next few days I tried to find a bed net in Abi Adi. I asked the health office staff at my office, I asked at the health center, and I went shopping in town. But I couldn’t find one. I couldn’t even find one to buy if I wanted to.
How can I go around telling people to use a bed net when you can’t even get one if you want one? I don’t know… I suppose people who do have a bed net, or who will get one in the next government hand out, need to be reminded of their true value and that they shouldn’t shred their next bed net into donkey guide ropes. People need to be reminded that bed nets are one of the most important tools in the fight against malaria, a disease which is responsible for around a million deaths a year worldwide. One million preventable deaths a year.
Luckily one of my PCV friends donated her bed net to my house since her site is in the highlands and is ‘relatively’ free of malaria. I keep it as a spare and let guests use it when they come to stay at my house. I gave that net to Sara so that she can use it for herself and her 2 year old son. It’s not a sustainable solution. What happens if someone else wants a bed net? What happens in a year when I’m not here to give someone else, equally deserving, a bed net? Again, I don’t know the answer to these questions. But I do know that it’s something… It’s an answer, however small, to one of these questions.
<< Edit Jan 25, 2015: Check out this NY Times article about misusing bednets for fishing in Africa and the ensuing ecological consequences. >>
Read more about the US Peace Corp’s fight on malaria here: Stomp Out Malaria
Read more about the work done by Ethiopia PCV here on our official website: pcethiopia.org