What image flashes across your mind when you hear the word, malaria? For me, it is the image of a feverish child being brought to the Community Health Worker in my village for diagnosis and treatment. After a week at Malaria Boot Camp, I see diagrams of mosquito and parasite lifecycles, prevention strategies, and treatment algorithms. Here, my ignorance of malaria is quickly being shed and replaced with firm knowledge.
We all know that malaria is a big deal. Malaria is such a big deal that it directly affects five of the eight Millennium Development Goals- obviously improving child and maternal health, and combating infectious diseases, but also ending poverty and hunger, achieving universal education, and creating global partnerships. Pregnant women and children under five are the most vulnerable groups. Most child deaths in the world are caused by malaria in Africa.
In Rwanda, we don’t always perceive malaria as a big deal. Recently, we’ve seen a significant decline in malaria cases, from 1.5 million to 663,785 between 2005 and 2010. The prevalence rate is low relative to other African countries, with only 2.6% of children under five and 1.4% of women suffering from malaria. Malaria is only endemic in the low plains of the eastern and southern regions of the country because of elevation and temperature limitations.
Malaria may not be as prominent in Rwanda as other African nations, but that is due to improvements in key prevention activities, such as distribution and use of insecticide-treated bed nets. The bed net ownership rate improved from 15% to 82% between 2005 and 2010, while net usage rate in children under five increased from 13% to 70% and from 17% to 72% in pregnant women. In Rwanda, with a population of 11,689,696, approximately 1.9 million children and 460,000 pregnant women are at risk of malaria each year. Despite the overall reduction in malaria, there are still a lot of people at risk in Rwanda.
Someone may look at the data and think, “If malaria statistics in Rwanda are so low, why are we focusing on malaria there? Aren’t there other, more important things we can focus on, such as HIV/AIDS?” It is important to share our successes in malaria, but also note that their sustainment depends upon the continuation of our malaria efforts. Besides, we are no longer just trying to reduce malaria, but eliminate it.
Rwanda learned that lesson the hard way. In 2009, Rwanda saw an upsurge in cases of malaria from 772,197 to 1,322,622 between 2008 and 2009, primarily as a result of a decrease in bed net coverage to less than 25% due to a lag in net replacement. From this experience, we learned that any abatement of our focus, no matter how small, would have grave consequences for malaria. We learned that reducing, and eventually eradicating, malaria requires us to keep working on prevention and control regardless of the improvements made.
Let’s look at this yet another way. It took Rwanda a long time to get to the level of malaria sustainment the country has achieved today. The National Malaria Control Program began working hard to prevent and control malaria in 2005. That means Rwanda has already been in an eight-year long battle against malaria. Any withdraw of our strong front means we will have to spend more time, money, and resources to regain those small steps overtime.
Peace Corps Volunteers have a unique role in this global battle for malaria eradication. PCVs work at the local level in remote parts of the country where people at the greatest risk of malaria reside. We understand the communities we work in and the problem of “The Last Mile.” We employ the strategy of targeting one person at a time, for a long time, for lasting change in our communities. Where we work and how we work brings a different perspective than most partners to the malaria battling table.
It is difficult to understand the current situation in Rwanda without the ability to compare it to other countries. At boot camp, we brought together 20 volunteers from 10 countries. The most invaluable knowledge gained has been learning what PCVS are doing in other countries across Africa to reduce malaria. Rwanda’s malaria statistics may be impressive, but PCVs in Rwanda are doing few malaria projects. Learning about the great things taking place in other countries has made me realize our potential, what we CAN do, with a little exposure and direction.
One of the major goals of Stomp Out Malaria is to build a worldwide network of malaria professionals, comprised of peers in the field and operating at a local level. Now, a new image flashes across my mind when I think of malaria. Now, I see a crusade of Peace Corps Volunteers working to “stomp out malaria” in their communities in Rwanda.