Greetings all and bienvenue en Guinée! My name is Megan Townsend and I’m a public health volunteer working in a coastal village in the Basse Côte region of Guinea. My community is a lively village of nearly 40,000 inhabitants scattered over 18 sub-districts. The village is very close to the ocean and exudes a lovely “beachy” vibe. Ocean fishing, rice cultivation, and palm oil production are the main economic activities. The community is dominated by the Susu culture, which as I have experienced it, is characterized by warmth, hospitality, directness, sass, and practicality. Tempers and voices can rise quickly here but are always diffused by a quick joke and a smile.In my capacity as a public health volunteer, I have spent quite a bit of time at the community health center. The center, which supervises three other rural health posts, is responsible for the care of the nearly 40,000 residents of the sub-prefecture. The center is staffed by one doctor, three nurses, one pharmacist, and six midwives. Spend any time at a Guinean health center and it will be hard not to notice the burden of malaria. As such my first three months with the health center were colored by various daily encounters with malaria. Before my pre-service training in Dubreka, Guinea, I had never met anyone who had had malaria. As training went on, I quickly met many people who had malaria about as often we in the United States have common colds. I remember being flabbergasted when my little host sister, Fatim, came down with malaria while I was in training. Suddenly malaria was something real and tangible for me, realized in my host sister’s suffering. I’d had countless theoretical encounters with the burden of malaria in sub-Saharan Africa in various academic settings. But after Fatim’s bout with malaria, my concern with malaria was no long theoretical–things had gotten personal.
The staff at my health center is well-versed in the care of malaria patients, and we usually have the appropriate drugs for treating both children and adults. We don’t always have the drug distributed to pregnant women to prevent malaria during pregnancy, but women can normally find it in private pharmacies. Life is hard in the village, but everyone in the health center is working to make it better in whatever way they can.
Working to ease the burden of malaria in the community takes the form of health education for Monsieur Sedouba Soumah, the volunteer health educator for our health center. Mr. Soumah, a long time resident of the community, is a member of a community health committee. This committee has its origins in community training sessions given by UNICEF several years ago. The health committee was originally designed with the purpose of providing a sort of health insurance to pregnant women in order to combat maternal and infant mortality. After the government of Guinea declared all care related to pregnancy and birth free to Guinean citizens, the committee’s responsibilities became less defined, but Mr. Sedouba Soumah’s role as community educator survived the transition. Mr. Soumah said he remained active because (roughly translated) “This is my home. When you do good things for your community, good things come back to you.”
As part of his responsibilities, Mr. Soumah has given health lessons at the health center once a week for the past three years. Mr. Soumah, whose work is completely voluntary, usually gives his lessons on Saturday mornings, the busiest time at the health center. Saturday is market day and more than 1,000 people pour out of the outlying districts to buy and sell their wares in the market located near the health center. Most people try to combine their trips to the village market with their trips to the health center, and as such, the health center can have as many as forty women waiting at one time to see either the pre-natal nurse or the vaccination agent. Since Saturday is such a busy time at the health center, it is the perfect time and place for a health lesson.
When I first arrived in village, I was thrilled to discover health lessons already being taught. As a health educator myself, I found it incredibly valuable to see how Mr. Soumah worked with his audience and targeted his message. Mr. Soumah clearly had the know-how, confidence, and presentation skills necessary to convey health messages. He was, however, working with essentially nothing but his own charisma and previously acquired knowledge. As part of my first project, I began working with my health center to “amp up” our Saturday presentations. For our first initiative, we formalized the schedule for lessons, making sure there would a lesson given every Saturday without interruption. Mr. Soumah and I developed a lesson plan and created visual aids. Very few of the women in our community are literate, so we decided to convey our message using only images. Our malaria lessons have been given entirely in Susu, the local language of the village, and each lasted about thirty minutes. We’ve given the presentation four times thus far, and we’re encouraged by the engagement of our audience.
Our lesson on malaria was just the first of what will be many initiatives to fight malaria in the village. I’m encouraged by how seriously our health center staff views malaria and their role in alleviating the burden. There is a great deal of knowledge about malaria prevention and treatment in my community, and I’m very excited to tap into the village’s characteristic energy and passion as I expand my projects concerning malaria. We’ve added annotated photos of our presentation images below. We welcome comments and questions! STOMP ON!
In the first image, a mosquito bites a person already ill with malaria. In the second image, the mosquito is shown as having acquired the malaria parasite in the blood it took from the sick person. In the third image, the mosquito is shown biting a second, healthy person. In the fourth image, the formerly healthy second person is shown reclining on a bamboo mat, clearly ill herself now. And thus, the cycle continues as indicated by the pink arrows. The explanation of the process is simplified, but it provides enough basic information to make the essentials of malarial transmission clear to an illiterate audience.
Our presentation detailed five ways in which a person can avoid malaria.
1. Eliminate standing water. As mosquitoes breed in clear standing water, one way to control the mosquito population is to eliminate stagnant water around living spaces. This was illustrated using a puddle of water, drawn full of mosquitoes.
2. Cover buckets of water. Mosquitoes can breed in uncovered water left around the house. Covering buckets of water can help prevent this, as illustrated.
3. Wear protective clothing at night. Mosquitoes are very active in the twilight hours, the same hours when many people sit outside talking and visiting with others. Wearing protective clothing, such as long sleeves/pants can help minimize mosquito bites.
4. Seek treatment if you or your children are ill. People who have been treated for malaria do not transmit malaria if they are bitten later by another mosquito. The medicines given to fight malaria lower the levels of parasite in the blood, making the person less likely to transmit malaria to another if bitten again. We chose to illustrate this point with an image of a vial of quinine, the medicine used in Guinea to treat severe cases of malaria. This yellow vial is readily recognizable to those who have been treated for malaria before.
5. Sleep under a mosquito net. Mosquitoes are most active at night, and people are most vulnerable to mosquito bites while they are sleeping. Mosquito nets are perhaps the most important way in which people can avoid malaria, and thus was heavily emphasized in our presentation. Illustrated is a person sleeping under a mosquito net, an image that was readily recognized by our audience.