Malawi's march on malaria
Some villages in Malawi are striving, mainly through education, to eradicate the deadly disease, writes DR SAM McMANUS
‘DO YOU have malaria in your country?”
“So what do your people die of?”
“Well, many people die from heart problems.”
“Why, what’s wrong with their hearts?”
“They damage them by smoking, and em . . . eating too much.”
Manyoni studies my face to see if I’m joking. When he realises I’m serious his face creases and he laughs.
We are walking along a dust road towards Kaphuka, a village in central Malawi. Manyoni is bringing me to meet Jameson whom he calls his brother. This could mean that he is his brother, a cousin, a friend, or just someone with whom he grew up, familial relations in these villages are fluid and all-encompassing.
We find Jameson sitting in the shade of a baobab tree. It is near midday and uncomfortably warm in the sun. He is taking a break from building a small hut to house himself, his wife, two daughters and a grandson. The mudbricks he has made lie drying in the sun. As we talk he picks one up and hands it to me.
Pressed into the drying mud I see the flattened form of a mosquito. By its palps, two appendages either side of its proboscis, I can make out that it is an anopheles, the malaria bearer.
Malaria is woven into daily life in Malawi. “Malungo”, the word for malaria in Checheyan, the local language, is also used for any kind of fever. I ask Jameson when was the last time he had malungo. “Last month, and before then, the month before, and before then, the month before that,” he answers. He tells me that it usually takes him three to four days to get over a bout of the disease. I quickly work out that one-tenth of his life is spent in a malarial fever. This is common to most people in Malawi.
The disease has a significant effect on the economy of malarious countries such as Malawi. Research by the economist and Nobel Laureate Jeffrey Sachs showed that economic growth of malarious countries was 1.3 per cent less than their non-malarious neighbours when other factors were accounted for.
Put simply, he showed that malaria causes poverty. Sachs gives the example of Haiti, significantly poorer than its neighbours and the only country in the region to have malaria. If this is true, the eradication of malaria will go a long way to raising people out of poverty.
As we sit talking, Jameson’s grandson stands observing us. He is quiet and watchful, unlike the other children I have met who have been smiling and laughing. He looks undernourished, his clothes are rags and dried mud is smeared on his skin.
Before we leave I crouch down beside him and take his hand to try to engage him. I can see his ribs, and, extending below the margin of his rib cage I can see the shadow of his spleen. Even in an emaciated child this is not normal. It’s likely that he has, like his grandfather, been contracting malaria regularly.
I ask his grandfather what age he is. “Eight,” he replies. The child is lucky not to have succumbed to the disease before his fifth birthday. Last year nearly a million people died of the parasite, the vast majority children under five. His chances are much better now that he is a little older, but the malaria has taken its toll. He is very small for his age.
The village of Chawantha, which I visit the next day, is an example of how, in the past five years, huge strides have been made in the battle against the disease. It is set among green plains, accessed by a 40km uneven dirt road. As I arrive I hear the swell of multi-harmony singing drifting across the fields. From a stone building in the centre of the village the singers come swaying and singing in unison, children around their legs, clapping their hands in time. It is a welcome song and a joyful scene.
The village has been battling malaria for the past 10 years through the force of education. The villagers have been taught about the transmission of malaria, the importance of bed nets, how to recognise the symptoms in their children and what to do when they occur. Local female volunteers have responsibility for teaching people about the early signs of malaria and monitoring the use of bed nets. It is a simple project but, as group village head Chawantha, the local chief, tells me, it has had a huge effect.
“Before we started, it was difficult to get any work done in the village. Every day there was a funeral, and in our culture, everyone has to attend the funerals.”
I ask him how they dealt with malaria prior to the programme
“We thought it was caused by witchcraft, we didn’t realise it was the mosquito giving it to us. Our witchdoctors would give us herbs when the malungo came, or, when pregnant women got it, they would tighten strings around their bellies to expel the fever.”
I ask the collected throng if anyone has lost a family member to malaria. A young woman called Katherine Bhri stands and begins to speak confidently.
“My child died in 2002. She had a fever one night, I just gave her some paracetamol because I didn’t know then that I should have gone to hospital. She slept that day and when I checked on her in the evening she was dead.”
“What age was she?”
“Two and a half.”
She says it without sorrow. Things have changed in the village. It is unlikely any more of her children will die of the disease.
I ask Chief Chawantha what difficulties they had in changing people’s behaviour.
“At first we thought the nets were decreasing our libidos.”
“Why would that be?” I ask.
“Before the nets the villagers were woken during the night by mosquito bites and as they were awake anyway . . . well . . . ” he looks knowingly at me, cocking his head to the side, the Malawian version of a nudge and a wink, and begins to giggle.
Other, more serious obstacles remain. People now know that when a fever comes that they have to go to hospital to get the anti-malarial drug Lumefantrine and Artemether or “LA”; that pregnant women need two doses of a malaria prophylactic in their first trimester; and that bed nets are necessary. However, the hospital is 24km away on an uneven dirt road; the only mode of transport, if it is available, is a bicycle and the hospital is often without any medications or bed nets.
Nevertheless, Chief Chawantha proudly tells me that because of what they are doing, they have not had to stop work for any funerals recently. In this village at least, the battle is being won.
In the fading light, the leader of the women holds her fingers in the air and they begin, singing and dancing in a circle. It is an educational song:
“This is what malaria does, it takes your child away, so when they have a fever get panadol and LA, pregnant women in your first trimester get your drugs in the hospital, sister.”
Dr Sam McManus is a writer and medical doctor. Marcelo Biglia is a freelance photographer. They travelled to Malawi with the support of the Simon Cumbers Media Fund.