Health Volunteers Stomp It Out at IST

This October in the town of Musanze, in the shadows of Rwanda’s volcanoes (pictured above), 21 health volunteers participated in a ten-day in-service training and counterpart workshop. These volunteers, nicknamed Health 4, are currently living in 11 of Rwanda’s 30 districts, working closely with health center staff to address the needs of their communities.

The group had a specific request for their malaria training at IST: to learn more about the global malaria burden, malaria in Rwanda, and specific ways PCVs can get involved with malaria outreach in their communities. Rwanda’s malaria volunteers developed a presentation addressing these topics, including an introduction to the many resources available to PCVs through Stomping Out Malaria in Africa and the malaria messages being promoted by the Ministry of Health and the National Malaria Control Program.

In addition to these topics, we covered the basics of what Peace Corps Volunteers need to know about the science and history of malaria. Using the Focus In Train Up Curriculum, we introduced the volunteers to transmission, effects, response, diagnosis, treatment, and prevention, and facilitated a discussion of what PCV communities should understand about malaria.

The IST covered a wide variety of other health topics, including family planning, workplace integration, nutrition, adult learning, and cooperatives. At the end of IST, the volunteers were joined by 38 selected health center counterparts for a three day workshop on behavior change communications and project design and management. We malaria volunteers helped facilitate these workshops, helping the PCV-counterpart teams to develop project and activity plans.

The PCVs were well prepared for this IST. During their first three months at site, they conducted Community Health Assessments to learn more about health practices in their communities, from the prevalence of malnutrition to the availability of HIV/AIDS testing and counseling services. As part of this assessment, the PCVs learned more about malaria practices at their sites, including availability of malaria testing and treatments and insecticide-treated nets; the history of IRS sprayings; net usage and care practices; and community perceptions of malaria.

In our discussions, we learned that several PCVs had seen IRS sprayings at their sites. One mentioned a stock of nets at her health center waiting for the next universal coverage campaign. Another is planning to incorporate malaria lessons into her health club as one of her first activities. We hope that this IST gave the PCVs the knowledge and the materials necessary to begin implementing malaria projects at their sites. We are looking forward to seeing the good work they will do, and hope we can continue to assist them.

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Camp GLOW

Filling the Gap in Malaria Prevention Education: The Role of Education Volunteers

Education Volunteers Teach About Malaria in the Classroom

Education Volunteers Teach About Malaria in the Classroom

Getting Education Volunteers on the malaria bandwagon can be a difficult task. They give us a quizzical look before questioning, “Malaria? Isn’t that a health issue? What does that have to do with education? With us?” In truth, malaria has a lot to do with education.

Here in Rwanda, Peace Corps was invited by the Government of Rwanda to work in two sectors- health and education. It’s easy to get Health Volunteers on the bandwagon. Their work in health centers and with Community Health Workers is directly linked to malaria. These are the primary actors in the decentralized implementation of malaria control interventions in the community. Health Volunteers in Rwanda support their activities, including those of malaria prevention and treatment.

Education Volunteers are a bit more difficult to convince of their role. They not so directly involved in malaria activities, making the link between their work and malaria a little more difficult to establish. But, the role of Education Volunteers in malaria control should not be overlooked.

First, malaria causes a significant education burden. Malaria in childhood can lead to impaired cognitive development and is the leading cause of school age absenteeism in Africa. As a result, malaria can greatly hinder a country’s efforts towards development and our ability to achieve the first goal of Peace Corps: to help the people of interested countries meet their need for trained men and women.

Education Volunteers fill a gap that is usually left in malaria prevention education. Health Volunteers and their Community Health Worker counterparts target families, mostly mothers, with key health messages and behaviors. But what messages and behaviors are being promoted to youth in the period before having families? The answer is, not many.

Peace Corps Volunteers manage health clubs

In Rwanda, most students attend boarding schools outside of their communities. As a result, they are away from the influence of their families and responsible for their own choices concerning health. Their schools become their new communities; their peers their sources of influence. What would happen if their environments were malaria-friendly, and their friends informed peer educators?

I would assume that malaria among students in secondary schools would reduce. I would even venture that attendance rates and test scores would increase. Further, empowered youth would return to communities and share their values with families during school breaks, encouraging them to adopt the similar behaviors. The impact would be substantial.

Who will be responsible for engendering change in schools? Education Volunteers work as teachers and are in an ideal position to implement the types of activities that would produce the desired results. What activities am I referring to? Classroom lessons, health clubs, and youth camps are a few examples. I’m sure you can use your imagination to brainstorm more.

Rwanda’s Malaria Volunteers attended a Pre-Service Training for the new group of Education trainees. Our goal was to reject this commonly-held view of the traditional role of Education Volunteers, and inspire a new understanding of the link between education and malaria. Through our presentation, we empowered them to take on a new role in the name of malaria prevention.

First Group of Education Trainees Receive Malaria Training

 

 

On Monday, October 15th, Rwanda’s malaria volunteers visited the Education 4 training class at their training center in the district of Kamonyi, an hour outside the capital of Kigali. We met the 34 trainees the week after their site visits and saw them full of enthusiasm and ideas for the rest of their service. As proof of their spirit, they were not deterred by the rainstorm that nearly drowned out all the voices in the room during our lesson, thanks to the metal roof at the training center.

Before our lesson, we asked the trainees to try to gauge the perception of malaria in their communities, either at their new sites or with their host families in Kamonyi, by observing people’s practices related to, and asking their opinions on, malaria transmission and prevention. We began our presentation by asking the future volunteers to share what they had learned. A few discovered that their host family members knew that malaria was an illness caused by the bite of a mosquito. Some noted that their families had nets but never used them, and others reported that their families used their nets every night.

We gave a brief introduction to the history and global scope of malaria, and discussed the science of transmission and different areas of prevention and intervention. We introduced the trainees to PMI, Stomping Out Malaria, and Rwanda’s key initiatives. Importantly, they learned that malaria work is not just for health volunteers! At the end of the lesson, we asked the trainees to list some ways that they and other education volunteers could become invoved with malaria work at their sites. Their enthusiastic responses included doing malaria lessons during their classroom teaching time or with English clubs and labs, and getting involved with malaria activities at GLOW and BE camps and clubs.

We also provided the trainees with two guides: one to introduce them to Stomp and malaria in Rwanda, and one to help them incorporate informal malaria assessments into their first three months at site. We encouraged them to assess the burden of malaria at their sites in greater detail than they did during their site visits, to help them make informed decisions in integrating malaria into their services. At their IST, we will provide them with lesson plans and other resources specific to education volunteers. These are the first trainees in Rwanda’s education sector to receive an introduction to Stomping Out Malaria in Africa.

We are excited to expand our initiative and welcome these trainees to Stomp! They will swear in during the first week of December.

Anna Winters from Akros Presenting at the First Malaria Forum

The First Step of the Elimination Marathon at the First Malaria Forum in Rwanda

Rwanda held its First Rwanda Malaria Forum on the theme, “Towards Malaria Pre-Elimination: How to Sustain Achievements and Get to Zero Malaria Deaths in Rwanda,” from the 26-28 September at the Serena Hotel in Kigali.  Rwanda is currently working to control malaria and towards pre-elimination by 2017. The objective of the forum was “to review, align, and coordinate strategies according to the current malaria situation and articulate tangible actions that will be taken to accelerate the process on how to get to zero death due to malaria” (RMOPDD, 2012). Over the course of three days, officials from the Rwandan Ministry of Health and local partners listened to presentations by malaria professionals from organizations and countries around the world. Topics of discussion included prevention, case management, epidemiological surveillance and M&E, and cross-border collaboration.

Rwanda has achieved significant reductions in the burden of malaria, especially in the last two years. Between 2005 and 2010, malaria incidence decreased by 96%, morbidity declined by 87%, mortality fell 74%, and slide positivity rate was reduced by 71%. However, gains are fragile. Rwanda experienced a nationwide upsurge in malaria cases when the failure to replace long-lasting insecticide-treated bed nets in 2009 led to a decline in effective universal coverage. Further, Rwanda’s malaria profile is still very uneven. 40% of the malaria burden is concentrated in one district, while 10 districts retain 80% of the burden. Eight of the 10 high-burden districts are located on the border with neighboring countries. Rwanda faces the challenge of controlling malaria in the context of cross-border movement and importation of malaria.

The global history of malaria response has experienced three distinct phases. In light of the success with eradicating other illnesses, the international community turned to malaria. Yet efforts with malaria eradication failed and the international community settled on the less ambitious goal of control. Recently, the global community has been challenged to finally eliminate this old scourge. Unlike eradication, which is a permanent reduction on a global scale of a specific agent, such as a parasite, elimination is defined as “interruption in a defined geographical area of local mosquito-borne malaria transmission, i.e. zero incidence of locally-contracted cases” (WHO, 2010). Elimination requires continued measures to prevent re-establishment of transmission, and the use of the phrase “towards elimination” implies a series of steps to reach it. There is a conceptual and programmatic shift that occurs as countries move from control to elimination: approaches expand from country to regional; interventions are replaced by cross-border initiatives and change from universal to focal; the focus on commodities procurement and management shifts to systems strengthening, particularly of information and M&E systems; cases are classified as imported, no longer autochthonous; and detection becomes active instead of passive.

As we know, malaria elimination requires time and commitment. Rwanda can learn a lesson from Morocco, a country that took more than 50 years with many lapses to finally achieve elimination. Many countries have experienced a plateau as commitment stalls and focus shifts in response to progress. To build upon a previous challenge made by Melinda Gates in 2007, I urge volunteers and partners to re-motivate themselves to continue the fight against malaria,  not only through challenging times when movement stalls, but perhaps more importantly, when momentum wanes as countries progress towards elimination. Peace Corps Volunteers have demonstrated their unique role and understanding of the last mile; perhaps we have a new last mile where we can establish ourselves as countries near the finish line towards elimination. Sustained gains and continued effort is how elimination will be achieved. Peace Corps Volunteers- continue to be a voice of encouragement and example of determination in the marathon towards elimination. In the aftermath of the First Malaria Forum in Rwanda, we eagerly await the release of the Malaria Strategic Plan for the period 2012 to 2017, a document that will define the malaria field in Rwanda and determine the direction of our efforts.

Rwanda’s Malaria Volunteers Attend Camp BE in Kinazi, Southern Province

During the school break in Rwanda, youth freed from their daily lessons cram buses and flood back into villages to visit home. But there is no rest for the weary. During break, Peace Corps Volunteers in education and health sectors in Rwanda team to organize regional youth camps. Camp GLOW (Girls Leading Our World) is a global Peace Corps initiative with the aim of encouraging leadership, empowerment, and development of young women around the world. Peace Corps Volunteers in Rwanda have more recently introduced Camp BE (Boys Excelling), focusing on specific issues that prevent young men from leading, developing, and allying with women to create a better future.

We returned from Boot Camp in Senegal after the planning for this round of camps was nearly complete and there was little room for last-minute incorporation of malaria. Just in case, we prepared a malaria lesson plan and activities that we distributed to Regional Camp Coordinators. We made arrangements to observe camps to learn more about them and how they operate, as well as improve opportunities for malaria outreach through them.

Our plan was to attend Camp BE at the Groupe Scholaire du Bon Pasteur in Kinazi, Ruhango in the southern province of Rwanda. Kinazi is known for its extreme heat and dryness. As a result, malaria is endemic to the area.  One day, I received a phone call from the Camp Coordinator asking us not only to observe, but participate, in the camp. “What would you like to do a lesson on?” he asked. I smiled. “How about malaria?” I suggested. We were in!

We traveled over dusty red dirt roads and green rolling hills to the camp site perched on a mountain overlooking a valley shrouded in clouds. Working with a Rwandan facilitator, we taught four sessions on malaria to 56 boys aged 14-18 in one day. Our goal was for each student to be able to explain how malaria is transmitted, how to prevent transmission, the signs and symptoms of malaria, where to go for treatment, and common malaria interventions and strategies by the end of the lesson.

Our lesson strategy was interactive. Activities in the lesson demanded student’s involvement and they were willing participants, exceeding requirement to ask insightful questions. We clapped for a skit that illustrated a mosquito biting a student suffering from malaria, then a healthy one, and explained how the healthy one would become sick. We laughed when students demonstrated fever, head and body aches, nausea, vomiting, and diarrhea; the signs and symptoms of malaria. We refuted some common malaria myths that exist in Rwanda, in particular that patients should be given ACT even if testing for malaria is negative, nets are dangerous to touch because of the insecticide, and cutting bushes and alcohol consumption prevent malaria. Students were very interested in learning about the history of malaria and why it predominantly affects poor countries in Africa, including Rwanda.

The most enlightening part of the lesson was when our Rwandan facilitator shared his experience with malaria. JMV is a teacher from a local secondary school who suffered a bad case of malaria. He admitted that he used to be too proud, believing that his immune system was strong and malaria could not affect him. One night about five months ago, a mosquito bit him as he slept without a net. He became very sick and endured severe headaches. Finally, he visited the hospital where the doctors told him that he suffered from malaria. “Now, I sleep under a mosquito net every night,” he concluded. He was a role model for the young boys, relating to their own perceptions of pride and strength to reinforce the importance of using a mosquito net. Before dismissing the class, we asked who planned to sleep under a mosquito net every night, and every student raised his hand.

At Camp BE in Kinazi, we witnessed how camps could be successful channels for malaria outreach to youth. Youth are a niche of Peace Corps Volunteers, as they are a cohort with which we tend to have great rapport. Our goal is to expand and incorporate malaria lessons and activities, and possibly bed net distributions, into future camps, hopefully all. Even though this round of camps is complete, we have more work to do preparing for the next, taking place during the long school break from November to December.

It wasn’t all malaria talk at Camp BE. We did get out of the classroom to interact with students in other activities, such as arts and crafts. The boys created soccer trophies and cars from paper mache; unfortunately no mosquitoes. In the fun, some of the paper mache even got on us! If we can’t appeal to their reason for using a mosquito net, perhaps a malaria monster can!

Welcoming New Volunteers

Rwanda’s newest group of health volunteers were sworn in on July 18th by US Ambassador David Koran during a ceremony at his Kigali home. After ten weeks of training in the district of Kamonyi, the volunteers have now moved to sites across Rwanda. They received a brief introduction to Stomp Out Malaria during their pre-service training and have been given the responsibility of assessing the state of malaria at their sites through their Community Health Assessments. They will receive further technical training from the Stomp team in October.

The volunteers are pictured above with Country Director Steve Miller and Ambassador Koran. Join us in welcoming them to the Peace Corps Rwanda family! The next group of trainees, in the education sector, will arrive in September.

Malaria PCVs

Shed It! Let’s Learn About Malaria!

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.