Malaria World Day is April 25

As a Peace Corps Health Extension Worker in Tanzania, to educate on the topic of Malaria is of utmost importance given that it is endemic in this country and to some extent, the continent of Africa, namely Sub-Sahara. Malaria is curable if treated promptly; but mostly, it is preventable…and this is where we come in to educate the host national communities the gravity of the consequence if precautions are not properly exercised.

In 2008, there were 247 million cases of malaria and nearly one million deaths – mostly among children living in Africa. In Africa a child dies every 45 seconds of Malaria, the disease accounts for 20% of all childhood death.

Malaria statistics in Tanzania:

•       Malaria kills 750,000 people annually.

•        90% of those deaths are in Africa.

•        Most of those are children. (80% under the age of 5)

•       1 in 12 children die before their 5^th birthday

•       14 to 18 million cases of malaria are reported each year

•       This accounts for over 40% of all outpatient cases

First and foremost, what is malaria? For those living in countries with temperate climates where this problem is less prevalent or virtually a non-issue, malaria like other tropical diseases: leprosy, cholera, scabies, Dengue and other hard to pronounce names ending with either –asis or -osis may be completely unfamiliar and a total mystery to many. To some, the word malaria may conjure exotic images of daring adventurers on expeditions wearing khaki colored safari clothes glistening in sweat on the verge of death in a tent staked out next to a river by a jungle in a tropical locale. There may be a romantic notion only because you’ve probably seen the leading man or woman in an epic movie heroically dying of malaria. In truth, there is nothing sexy about malaria because it can kill and mostly it happens in Sub-Sahara Africa. Let’s get the boring dry stuff out of the way. Malaria is a tropical disease where the infected female pregnant Anopheles mosquito injects its saliva containing the parasite, Plasmodium Falciparum. Five species of Plasmodium can infect and be transmitted by humans. The vast majority of deaths are caused by P. falciparum and P. vivax, while P. ovale and P. malariae cause a generally milder form of malaria that is rarely fatal. The zoonotic species P. knowlesi, prevalent in Southeast Asia, causes malaria in Macque monkeys but can also cause severe infections in humans. The deadliest is the Falciparum and this strain is of concern in Tanzania. This infected pregnant female Anopheles mosquito bites a human and feed off its blood. Malaria has a complex life cycle. Infected female mosquitoes inject malaria sporozoites when they bite, and the sporozoites are carried quickly through the bloodstream to the liver where they rapidly infect liver cells. Without causing symptoms, these sporozoites undergo a radical change and multiply furiously for the next 4-5 days. Tens of thousands of asexual stage merozoites are released from each infected liver cell, each of which rapidly target and invade a red blood cell. Every few days, the merozoites multiply ten-fold and burst out to infect other red blood cells. This cyclic and massive increase in parasite burden gives rise to the clinical disease we recognize as malaria. Because of their large numbers, these parasites can cause particular damage to the nervous system, liver, and kidney. Death may result if not treated. In the absence of immunity or drug treatment, death can occur within hours of noticeable symptoms. If death does not occur and infection continues, some of the parasites further differentiate into a form that is infectious for mosquitoes, thus permitting the life cycle to continue. Inside the mosquito, the parasite matures until it reaches the sexual stage where it can again infect a human host when the mosquito takes her next blood meal, 10 to 14 or more days later.

At the village level, the scientific process of transmission is not so much discussed as its biology is complicated and moreover, awareness and education is primarily focused on prevention, testing and treatment. Stomping Out Malaria in Africa is a Peace Corps initiative that uses strategic partnerships, targeted training Volunteers and intelligent use of information technology to support the local malaria prevention efforts of over 3,000 Volunteers in sub-Saharan Africa. As Health Extension Volunteers, we have a responsibility to get the information to the community not because the locals are ignorant of malaria, but we are to remind them of all the necessary ways of prevention, the importance of proper testing at a medical facility and not self diagnosis which results in self treatment which is dangerous and irresponsible, inform pregnant mothers the need to be on malaria prevention drugs, and equally important is dispelling myths and misconception of how malaria is contracted. In a culture that is heavily ingrained in beliefs, it can be challenging to suddenly inform people that sleeping under a mosquito net does not cause impotence, skin infection or slow death and consumption of green mangoes, the change of environment, sun, sorcerers, and dirty water does not cause malaria.

People tend to be attached to their beliefs and behavioral change can be difficult. One simple and effective way of malaria prevention is to sleep under a treated mosquito net since the infected mosquito feeds from evening until dusk. The change of attitude to take action may take a while, but at least they are informed, aware, and educated. The rest is the motivation that they have witnessed loved ones die from this disease that can be prevented with honest effort. Malaria also has dire economical consequences as students are absent from school, employees missing work, and productivity and production in jobs are down hence finances suffer greatly. Malaria can decrease gross domestic product by as much as 1.3% in countries with high disease rates.

In my village located in the cool Southern Highlands where malaria cases are low, it is not to be discounted that malaria education is not necessary or there is no urgency to educate. Contrary, education should be immediate as they may be less aware than those living in areas where malaria is prevalent.  Additionally, they may be less immune which is another danger. If a villager starts to display symptoms of malaria, but due to the lack of malaria knowledge, he may not know he has contracted malaria and will bypass testing and will self treat with inappropriate drugs. I teach school students, pregnant mothers at the village health dispensary and train teachers and other community members about malaria awareness so they will continue to spread the gospel of effective prevention and testing of malaria. April 25 is World Malaria Day and I will be concentrating my efforts on malaria education for the entire month with a weekly plan of different activities using interactive games for participation, sharing a children’s educational radio program with characters telling stores about malaria, and hands on activities. Getting kids to understand malaria and creating excitement about what they have learn can impact not only themselves but their families and peers as hopefully the students will proudly share what they have learned with others.

For more information go to: stompoutmalaria.org

 Students have a base knowledge on malaria; nevertheless, further education is needed to dispel myths, explain transmission process, remind them the importance of various prevention methods and the need to test if one suspects having contracted malaria

 Teaching secondary school students about malaria transmission, prevention, testing and treatment

The 6 Months Mark

April 3, 2013

Time passes like sand through fingers and an obvious milestone has been remarked. Already, half a year has passed since I left my family, my home, and the comfort of easy living. I have no problem temporarily forgoing all the easily accessible amenities to live in a developing country where poverty abounds and more intensified in rural villages. The following are 13 things that continue to still either fascinate or challenge me.

1.     My first notable positive experience is the honesty of the Tanzanians. Although they are economically challenged; from my experience, they are trustworthy people. Relationship between people is an important aspect of Tanzanian life and culture; therefore, they strive for smooth relationship dynamic. Unlike the developed world, individuality and ego are not concepts one aspires or is even in the radar of their conscious awareness. Needless to say, crime and bad-intentioned people exist in every corner of the globe and some Peace Corps Volunteers may disagree given the fact in the past month, there have been numerous accounts of thievery and robbing. These acts of crime have been boldly committed in broad daylight, among a big group of people and even in hotel rooms. Even being in the presence of a crowd, being out in the daytime and locking your hotel room is still not bullet proof guarantee that you are safe from crime of opportunities. I am almost always alone, I travel alone, I like being alone, I want to be alone and I need to be alone. I would be the perfect target given I am a single woman… alone. I’ve positioned myself in situations where “technically” one would consider it a bad idea; but my unfailing intuition has thus far served me well as my encounters with strangers in said questionable scenarios have only been godsends to me. I am in daily gratitude for my safety and well-being. Time and time again, regardless of which continent I am in, human beings are inherently good. People for the most part do what is right and kindness usually prevails. What I find noteworthy is that they are in no great hurry to be paid for their services or goods. It is always they who remind me of my due change and even money has been returned or questioned when I have either overpaid or have already paid.

2.     I hesitate to shake people’s hands as they are usually always moist and it feels somewhat greasy and sweaty. I will assume the perpetual griminess of the right hand because they eat with their hands instead of utensils and hand washing with soap is not readily practiced. There is no hot running water in villages because there is no plumbing and sometimes no electricity. Before eating, a jug of water is slowly poured over the hands. In truth, this is just wetting the hands. Soap is not common to use when washing hands. I recall back during Peace Corps Pre-Service Training, our first hands-on practice was teaching primary school students the importance of hand washing with soap. I understand why. A common practice we take for granted in developing nations is something here in Africa that still needs to be taught and reminded. In Tanzania, many health problems amongst children and adults are all related to the lack of proper personal hygiene practice causing diarrhea, parasitic worm, skin and eye infection, and respiratory tract infection.

3.     I find it extremely heartwarming that a stranger will always welcome you to their home with the greeting of “karibu” which means welcome. There is no sense of needing privacy or is making appointments necessary prior to a guest’s arrival. Their hospitality is truly genuine. If you happen to visit during meal times, food will be offered. The hospitality of the Tanzanians is admirable. I am always touched when I hear karibu from Tanzanians. This is their welcoming you to their country, region, village, home, shop, restaurant, and etc.

4.     An unsavory sight is watching men and women pick their noses. A finger is shoved in the nostril and the digging commences. This act should be reserved in private and not performed in public; however, the locals have no qualms picking their noses in front of people, as this is culturally acceptable and commonly seen.

5.     The villagers appear content and satisfy with their life and hard work. I have yet to hear complaint, woes, sob stories, and emotional guilt trips to the perceived rich white person for solicitation of sympathy and monetary aid. I would even say they might seem more at peace than their white counterpart in that they seem to be completely accepting of their situation. When there is no attachment or expectation to anything, usually one does not suffer.

6.     I am fascinated by the harmonious evenness of their skin color. Unlike their pale counterparts with facial discoloring of redness, brown/age spots, dark bags, and other skin issues…the African skin looks like a canvas of perfectly coated paint of dark chocolate or black coffee. At night or in photographs, their darkness recedes and only the white of their eyes and teeth glimmer.

7.     I am even more fascinated with their hair capillary. The African hair is a “S” type of hair. If you take a strand of their hair and put it under a microscope, the shape of the capillary is a “S” shape. This is type #4: kinky hair. The African population who has not been intermixed with other races all has the same hair texture. There is no variety like Caucasian hair where colors and textures come in an assortment. If you let the natural African hair grow out, it becomes an Afro. This Afro can become big like a helmet because of the tight curls, as there is no weight so there is no length to be weighed down. The hairstyles that one can create from this hair texture are amazing. The braiding and the patterns created are visually interesting. Sometimes, hair extensions are added for thickness and length. I have also seen pieces of sisal in different shapes, colors and patterns being sewed into the hair for further ornamentation. The creativity of the hair plaiting is fun to look at.

8.     The body odor of people, regardless of race and culture, is something I struggle to overcome. Like the hassle of hand washing, it’s an assessment of the living condition of an undeveloped area where hygiene and sanitation is still in the dark ages. If I were to analyze why unpleasant body odor is prevalent, here would be my take. Africa is hot and the majority of people are laborers and farmers, which means physical activity to the max under the harsh sun. Sweat translates to eventual bacteria growth, which produces stench as an assault to the nose. There is no plumbing in villages and water need to be obtained from wells, stream, river or if the village is fortunate enough to have a tap water system where you can collect water from a running spigot. Regardless of the water source, you need to fetch the water in a bucket and carry it back home. It’s labor intensive. In “colder areas”, bathing is not that appealing given the perceived unnecessary need to bathe daily. To buy soap costs money and if you bathe everyday, the soap runs out quickly. Shampoo is not readily available for purchase. If you find it in a big town, it’s expensive. Tanzanians wash their hair with bar soap, the same soap they use to wash the body. I’ve asked a teacher in my village approximately on average, how often do people bathe. He answered not everyday. He said once a week or when you know you’ll be meeting someone important the next day. Given that almost every single person farms in my village, I’m baffled with the idea of the once a week bathing routine. When I enter a church, a classroom, a public transportation or even an individual coming to my home... I am greeted with obnoxious body odor that makes me want to start a mass distribution of soap as a community service even if it’s self serving…namely to spare my own nose. In the seldom occasion I smell perfume or cologne on someone, I become indebted and want to thank them for making me smell something pretty and feel that there is hope. I suppose if I carry Tiger Balm everywhere I go, I could somehow manage this problem by swiping a glop under my nose whenever I’m attacked by foul body odor. I write a lot about body odor because I fortunately or unfortunately, have a keen sense of smell where the living and working condition of the population exacerbates this “problem”. My problem.

9.     I am visually disturbed when I see tons of flies swarming around food market, food stalls, and street eateries. Even in my own house, I don’t understand why but I have tons of fruit flies in my kitchen. I struggle to find a safe good place to store my food, as I have no refrigerator.  I am fastidious with cleanliness, yet these sons of the bitches won’t go away.

10. My body is constantly in a perpetual state of itchiness. I scratch daily and have scabs and red bumps from insect bites and God knows what else is eating me alive. I’ve yet been “itch free” since I have been in country. This unrelenting bodily itch problem is enough at times to make me want to leave the damn country and return to my sterile home in America.

11. I am most fascinated by the booty of the African women. Their fanny is famous and for good reason. When I was living in Paris, France, I designed and made a wedding gown for a client. This bride-to-be was of African ethnicity. I will never forget figuring out how to cut and sew the dress so that it would fit her very high and protruded posterior. Fortunately, I was successful but I recall the fear of the dress not properly fitted being the style was very form fitting. The African booty is magnificent. It rivals Mt. Kilimanjaro in its grandiosity. For men who like big butts…karibu Tanzania! For those with a penchant for daintier bottoms, I would suggest Southeast Asia where women are like lotus flowers…petite and delicate as are their butts.

12. If I can learn to shake my booty like a Tanzanian woman, I feel that my 27 months of Peace Corps service would have been completely worthwhile and mission successfully accomplished. Being of Asian descent with a voluptuously challenged butt, I don’t know if I will ever shake my flat fanny like the Tanzanians. I’ve yet to inquire and research if it’s actually a technique of dancing and specific movements or their muscle power enabling them to perform such a feat. Or both. Their Gluteus Maximus are designed to shake, rattle and roll. I am convinced it is in their genes. I have witnessed very small girls dance where their little child butts are merely a miniature version of an adult woman. I was blown away and nothing will persuade me to believe that they do not have the “DNA Dance” gene in their booty.

13. Lastly, although I am living without conveniences…(okay, I have a hotplate I cook on if I have electricity and sketchy internet), living condition is unattractive, simple tasks and chores can be arduous, unpleasant sensation of constant physical discomfort from the environment, traveling from point A to point B is unquestionably tiresome, and the pressure to successfully teach and train people and complete community development projects can feel heavy…but despite all obstacles, I feel very much as peace. I take each day one day at a time. Each morning upon waking, I start to give all my energy and dedication to what I am doing. When you live alone and in isolation, experiences feel more intense, thus one is more present and aware of him/herself. I relish my solitude, which enables me to concentrate on work. To be useful in life and have the privilege to work is a gift bestowed on us.