"When you're weary, feeling small..."
*****
What’s the highest fever you’ve ever had?
How long have you had the flu without any sort of medical intervention besides Tylenol?
Have you ever vomited your way through a migraine?
Were you lucky enough to be born in a place where the nearest health facility takes less than two hours to walk to (because there’s no way you can afford a bicycle)?
I’ve been asking myself some variations on those questions in the last few weeks. Only my answers were all pretty positive as compared to the people I’ve been working with. Even though I’ve had malaria, I’m fortunate enough to have had access to medical care (both physical proximity and financially) and have been able to treat it fairly quickly and effectively.
I was lucky enough to work with the CDC and a host of other agencies (Ghanaian and American) when I got back from home leave on a project that sounded…kind of boring at first. The official title of the study is: Prevalence of Plasmodium falciparum parasistaemia and anaemia in children under five years of age at baseline and following annual vs. biannual indoor residual spraying (IRS) in Bunkpurugu-Yunyoo district, northern Ghana.
For short: AP3, the third phase of this 6-phase study and the first one conducted after the spraying actually took place.
The basic goal of this study is to test whether the IRS is having any effect on the malaria levels in this district. IRS is reported to do well in reducing the mosquito populations in malaria-endemic regions, but no study has been done in Ghana. What we found was interesting, but I’ll keep that to myself since this isn’t actually a debate on whether or not it’s working.
My real point is that of the 2,000 children under five we tested in 71 communities, 70% of them tested positive for malaria parasites. SEVENTY. PERCENT. Of children under five. If you take out the children less than six months (who have a certain level of holdover resistance from their mothers), the number would’ve been more like 90-95%. This is the dry season savannah, too, not the deep, dark jungles where all sorts of creepy-crawlies exist.
I remember when I was getting over malaria. I was sitting on the sidewalk at the sub-office, just zoned out, practically staring at the sun. I was still so cold and couldn’t stop shaking. When I could string a thought or two together, I remember thinking “How in the world can a little baby suffer through what I just did?”
The places we went to, I didn’t even know existed. It was about a fifty-man show and only three of us were Americans, most were Ghanaians who were originally from that area. They still had no idea where we were going. We had GPS and were doing mapping for later surveys, we had our 4x4 trucks and were moving right along, plowing through corn and millet at the insistence of neighbors that the place we were looking for was “just up the road” (which was really a place in the farm where they decided to leave out a row of crops for their bicycles). I don’t know how many huts we passed or almost hit because the millet was so high you couldn’t tell there was a home there. We drove into villages where I know the kids had never seen A) a vehicle and B) a white person. They scattered like mice, peeking out from trees because no matter how afraid they were, it couldn’t overpower their curiosity. Houses separated by their crops, they emerged from the corn in single-file lines, the oldest leading the way, making sure the road was safe for their younger brothers and sisters to see the visitors.
The other PCV and I were assigned as supervisors - we bounced through fields and visited a few teams in the field every day, checked over the information for quality control and general encouragement. It was hard work. The teams consisted of an interviewer, a lab technician and a prescriber. While the interviewer was asking the mother questions, the tech and prescriber were working together to test the child for malaria and dispense the correct treatment. In quite a few cases we came across kids who were literally on death’s door and we took the trucks and rushed them to the hospital.
A kid like Jonas who was dry heaving because he’d been vomiting for two days and had nothing left to come up - all he needed was some ORS, but it had progressed to the point that he had to be put on IV fluids for 24 hours. His mother brought him back to our headquarters, smiling and showing off how well he was doing. She walked four miles out of her way to thank us for taking care of him.
Kids like Biduk, a twin who, at one year and five months weighs 5.1Kg while her twin brother Biduki weighs 10.2Kg, can be taken to the clinic, put on fluids, treated for malnutrition and malaria and, in a few weeks go back home. Right into the same environment we pulled her from - an alcoholic and depressed father who has fathered 6 children with her mother, two of which had already died and a mother who is trying her best, but literally has no options.
I think that was the hardest part. Going through and treating these kids for whatever it was that they had knowing that we’re not really taking care of the disease, just the symptoms. What caused them to have malaria or vomiting or chronic diarrhea last week is still there and it’s only a matter of time before it strikes again. It’s like trying to climb up a muddy hill - you make it to one embedded rock and you can hold on for a little while, but you have go up or slide back down, you can’t stay there forever.
When people throw out suggestions on how to solve problems in the developing world, it’s like they think some simple solution will take care of everything. But if it were so simple, don’t you think it would’ve been taken care of already?
The key is education.
Great. Who’s going to teach?
Hire more teachers.
And how will you get them to stay in an area that they’ve never lived, is practically impassable by road, has no electricity or running water, no food items to buy other than what you’ve grown with your own hands (which, if they’re teaching full-time like they should be, they won’t have time to grow)? On top of all that, they’re not from that area, so have no idea about the culture and local language.
Hire local people then.
Who have gotten their education how? There aren’t any schools, remember? If you’re lucky enough to get out, just like in America - you don’t come back.
…Well, build more clinics so they can at least have better health.
Who will work in those clinics and how will they get there if the roads are all but washed out riverbeds - complete with boulders the size of VW Beetles?
Hire people that are from that area, so they won’t mind living out there.
Same situation as the teachers, but sometimes even worse. Nurses are educated and have a different idea of how medicine should be administered. Local people often see clinics as the last resort for one reason or the other (they don’t like the nurse, the clinics never have medication, the clinics cost more money than the local healer and because there are no diagnostic testing capabilities, nurses can only take their best guess on ailments - and their guesses aren’t always right), and bring their children or themselves in when it’s too late. Nurses aren’t the most sympathetic in these cases because that person has basically been brought to them to die and, in their words “What then are we supposed to do?”
It’s such a circular problem that it hurts my head to think about. There’s no one good answer.
What’s the highest fever you’ve ever had?
How long have you had the flu without any sort of medical intervention besides Tylenol?
Have you ever vomited your way through a migraine?
Were you lucky enough to be born in a place where the nearest health facility takes less than two hours to walk to (because there’s no way you can afford a bicycle)?
I’ve been asking myself some variations on those questions in the last few weeks. Only my answers were all pretty positive as compared to the people I’ve been working with. Even though I’ve had malaria, I’m fortunate enough to have had access to medical care (both physical proximity and financially) and have been able to treat it fairly quickly and effectively.
I was lucky enough to work with the CDC and a host of other agencies (Ghanaian and American) when I got back from home leave on a project that sounded…kind of boring at first. The official title of the study is: Prevalence of Plasmodium falciparum parasistaemia and anaemia in children under five years of age at baseline and following annual vs. biannual indoor residual spraying (IRS) in Bunkpurugu-Yunyoo district, northern Ghana.
For short: AP3, the third phase of this 6-phase study and the first one conducted after the spraying actually took place.
The basic goal of this study is to test whether the IRS is having any effect on the malaria levels in this district. IRS is reported to do well in reducing the mosquito populations in malaria-endemic regions, but no study has been done in Ghana. What we found was interesting, but I’ll keep that to myself since this isn’t actually a debate on whether or not it’s working.
My real point is that of the 2,000 children under five we tested in 71 communities, 70% of them tested positive for malaria parasites. SEVENTY. PERCENT. Of children under five. If you take out the children less than six months (who have a certain level of holdover resistance from their mothers), the number would’ve been more like 90-95%. This is the dry season savannah, too, not the deep, dark jungles where all sorts of creepy-crawlies exist.
I remember when I was getting over malaria. I was sitting on the sidewalk at the sub-office, just zoned out, practically staring at the sun. I was still so cold and couldn’t stop shaking. When I could string a thought or two together, I remember thinking “How in the world can a little baby suffer through what I just did?”
The places we went to, I didn’t even know existed. It was about a fifty-man show and only three of us were Americans, most were Ghanaians who were originally from that area. They still had no idea where we were going. We had GPS and were doing mapping for later surveys, we had our 4x4 trucks and were moving right along, plowing through corn and millet at the insistence of neighbors that the place we were looking for was “just up the road” (which was really a place in the farm where they decided to leave out a row of crops for their bicycles). I don’t know how many huts we passed or almost hit because the millet was so high you couldn’t tell there was a home there. We drove into villages where I know the kids had never seen A) a vehicle and B) a white person. They scattered like mice, peeking out from trees because no matter how afraid they were, it couldn’t overpower their curiosity. Houses separated by their crops, they emerged from the corn in single-file lines, the oldest leading the way, making sure the road was safe for their younger brothers and sisters to see the visitors.
The other PCV and I were assigned as supervisors - we bounced through fields and visited a few teams in the field every day, checked over the information for quality control and general encouragement. It was hard work. The teams consisted of an interviewer, a lab technician and a prescriber. While the interviewer was asking the mother questions, the tech and prescriber were working together to test the child for malaria and dispense the correct treatment. In quite a few cases we came across kids who were literally on death’s door and we took the trucks and rushed them to the hospital.
A kid like Jonas who was dry heaving because he’d been vomiting for two days and had nothing left to come up - all he needed was some ORS, but it had progressed to the point that he had to be put on IV fluids for 24 hours. His mother brought him back to our headquarters, smiling and showing off how well he was doing. She walked four miles out of her way to thank us for taking care of him.
Kids like Biduk, a twin who, at one year and five months weighs 5.1Kg while her twin brother Biduki weighs 10.2Kg, can be taken to the clinic, put on fluids, treated for malnutrition and malaria and, in a few weeks go back home. Right into the same environment we pulled her from - an alcoholic and depressed father who has fathered 6 children with her mother, two of which had already died and a mother who is trying her best, but literally has no options.
I think that was the hardest part. Going through and treating these kids for whatever it was that they had knowing that we’re not really taking care of the disease, just the symptoms. What caused them to have malaria or vomiting or chronic diarrhea last week is still there and it’s only a matter of time before it strikes again. It’s like trying to climb up a muddy hill - you make it to one embedded rock and you can hold on for a little while, but you have go up or slide back down, you can’t stay there forever.
When people throw out suggestions on how to solve problems in the developing world, it’s like they think some simple solution will take care of everything. But if it were so simple, don’t you think it would’ve been taken care of already?
The key is education.
Great. Who’s going to teach?
Hire more teachers.
And how will you get them to stay in an area that they’ve never lived, is practically impassable by road, has no electricity or running water, no food items to buy other than what you’ve grown with your own hands (which, if they’re teaching full-time like they should be, they won’t have time to grow)? On top of all that, they’re not from that area, so have no idea about the culture and local language.
Hire local people then.
Who have gotten their education how? There aren’t any schools, remember? If you’re lucky enough to get out, just like in America - you don’t come back.
…Well, build more clinics so they can at least have better health.
Who will work in those clinics and how will they get there if the roads are all but washed out riverbeds - complete with boulders the size of VW Beetles?
Hire people that are from that area, so they won’t mind living out there.
Same situation as the teachers, but sometimes even worse. Nurses are educated and have a different idea of how medicine should be administered. Local people often see clinics as the last resort for one reason or the other (they don’t like the nurse, the clinics never have medication, the clinics cost more money than the local healer and because there are no diagnostic testing capabilities, nurses can only take their best guess on ailments - and their guesses aren’t always right), and bring their children or themselves in when it’s too late. Nurses aren’t the most sympathetic in these cases because that person has basically been brought to them to die and, in their words “What then are we supposed to do?”
It’s such a circular problem that it hurts my head to think about. There’s no one good answer.