Malaria Think Tank Springs Into Action

Last week the newly formed Peace Corps Uganda Malaria Think Tank held its first meeting! Comprising the Think Tank are Malaria Team members Matt Boddie and Ashley Givan, as well as Community Health Volunteers Sarah Cornett, Kristina Sandfoss, and Chris Peterson.  The Think Tank had the opportunity to sit down with Country Director, Loucine Hayes;  Director of Programming and Training, Paul Sully; and Health Program Specialist, Cotious Tukashaba, to form a strategy that will engage Peace Corps Volunteers in all sectors to fight against malaria.

Capitalizing on the strength and innovation of other Volunteer groups within Peace Corps  Uganda, the Malaria Think Tank will collaborate with the Water and Sanitation for Health, Micro-finance, and Agricultural Think Tanks to exchange information, resources, and plan cross-cutting projects together.  The Think Tank will also work closely with the Technology Committee to make information more readily available to all Volunteers through the Peace Corps Uganda website.

Potential projects of the Malaria Think Tank include: regional malaria trainings, conducting a survey on net use and care at the household level, using Village Savings and Loans Associations as a platform for malaria education, utilizing mobile clinics to deliver education on nets, teaching tailors how to embroider decorative patterns onto nets, carrying out a study on how subsidized nets are adopted in a community, and researching treatment and pesticide resistance at a national level.

The Malaria Think Tank will meet again in January. However, members already communicate on a daily basis. They are enthusiastic about forming partnerships with civil society organizations, local governments, and international organizations.  But most importantly, they are very dedicated to ending malaria in Uganda through its best resource: Peace Corps Volunteers.

Hammock from Ngora

Income Generation Through Mosquito Net Hammocks

Aigi Mary-Immaculate and Obote Denis showing off the hand-sewn bags that each hammock comes with.

Finding employment is difficult for youth in Ngora parish, located in eastern Uganda. Many haven’t completed their schooling and do not have the financial means to do so. The Ngora Parish Harmack Company is a community based organization founded in February 2011 by PCV Matthew Boddie and his counterpart Denis Obote. The goal of the organization is to help students continue their education by providing life skills training and assisting with school fees. Among these trainings, the NPHC teaches business skills and the fundamentals of microfinance to local youth.

Boddie is currently working with NPHC on a project that teaches youth to produce various types of hammocks, including some with built-in mosquito nets, to sell to local Ugandans, tourists, and companies. In addition to learning invaluable technical skills, the youth also manage the company’s profits. Selling the hammocks to local clinics that face bed shortages, the project both addresses healthcare needs and creates a sustainable income-generating project.

The NPHC decided on the “Off the Ground, Under a Net”  initiative after realizing the number of children who sleep on the floor, without a mosquito net. It is their mission in Ngora to provide every youth, especially those under the ages of 5, with a bed and a net to sleep under. The organization is able to help these children by using left over material to make additional mosquito-net sewn hammocks and selling them at a reduced price.

To date, about 63% of the hammocks sales come from companies and tourists, and 37%  from locals. The NPHC is trying to market more to locals through sensitization campaigns about the foreign type of bed and malaria prevention.

NPHC staff work through the night to complete a large order for a Ugandan resort. Several companies within Uganda buy NPHC hammocks for re-selling.

Currently, the organization is run completely by the youth who were trained in its first year. The project has now received funding from the U.S. Embassy Small Grants Office  to scale up their project.  The grant will be enough to create a two-room building complete with sewing machines, computers, and solar power.  Once complete, the NPHC will start to teach the skills they have learned to other at-risk youth within the area.

To date, the NPHC has sold 473 hammocks. 7 kids have been sent off to a full years’ education, one of whom was able to purchase a laptop for his college education.  Once the scaling up is complete, NPHC is hoping to increase their production 5-fold.  Stay tuned, because the NPHC also hopes to start selling globally soon!

Gambia Updates: Stomp Annual Report

Nets

1)  Distributions where PC was the driving force behind the distribution taking place:

PCTG has not been the driving force behind a bed net distribution since the 2010 distribution in Upper River Region.  The distributions went well to the best of my knowledge, but there were leftover bed nets and reports were not filed, and everyone that worked out the project COSed without finishing it.  I think that PCVs also stole some of the nets.  The project ended on a bad note because no one thought about what would happen after they COSed.  I think that everyone learned a lot about distributions after that one.

The govt handed out roughly 750,000 bed nets last year.  PCVs are better used with surveys and making sure that the distributions run smoothly.

2) Distributions that PC helped with:

PCVs around the Gambia usually help their Community Health Nurses (CHNs) and other health extension staff with bed net distributions.  This also includes the any work prior to the distribution itself.

 

Internal Trainings

1) Health IST

June 2011

At the IST, there was a one-hour general introduction to the Stomp initiative and how PCVs can get involved.  I made a PowerPoint introducing the initiative.  (Katim and I were at Boot Camp during the Environment IST so we missed our chance.)

2) Education PST

July 2011

Introduction to the Stomp initiative and the importance of all PCVs, regardless of their sector, getting involved in malaria prevention and control.

3) Health and Environment PST (in collaboration with PC Senegal)

April 2012

Introduction to the Stomp initiative, etc.  I was not there for the presentation and I have not really spoken to Alex, but Senegal should have a good description of how things went.

PCV Participation in malaria at Post

PCTG currently has about 79 PCVs, and at this time I’d say roughly half are actively involved in malaria work.  Examples of work include: neem cream demonstrations, malaria murals, working with community health nurses and other health extension staff, one PCV works on the radio, and many PCVs do community sensitization.

There has been a big push lately for PCVs to do malaria, along with food security.  The health sector project framework pretty much consists of malaria and reproductive health, so malaria will now take center stage.

In general, collecting best practices, especially photos, has not been one of PCTG’s strong suits.  I’ll email you some great photos that we have.  (I am also going to get them up onto the website in the next couple of days.)

Growth of Post “malaria armies”

In the past few months the malaria team has added Alex.  She will potentially represent her region, URR, and also serve as the coordinator of the team.  She will still live in her village and continue to do her primary projects.

The team is also expected to grow in the next month or so.  Alex is doing a great job of talking with people and ‘recruiting’ them to join the team.  In the next few months I would guess that every region will have a representative.

Bright Spot Anecdotal Stories

We have a lot of PCVs that work really hard in The Gambia, but when I think of a really really hard worker, Stephanie Starch comes to mind.  She extremely involved with her community and has done a lot of work.  She lives in Jamally Ganyado, which is a Fula village in Central River Region with about 20 compounds.  She also works with the other communities in her Jamally district.  She has made neem cream.  She taught a lesson about money management and included a section explaining neem cream as an income generation.  With the help of a nearby PCV, Steph painted a mural of how to make neem cream.  She came to me to talk about a project that she had in mind and it turned out that she basically wanted to start a Care Group.   In two weeks she got her Care Group up and running.  She also is doing an awesome job of collecting best practices and then sharing that information with other PCVs.  (I’ll attach some photos of Steph’s work.)

Shawn Reed is also doing an awesome job in her community.  She lives in Batti Njole, CRR, in a small Wolof community.  She has a great women’s group, and she works with the women on a lot of health issues, including malaria.  Steph and Shawn together painted a health mural in Shawn’s village.

Key Partners

PCTG has only worked with NMCP.  We do not have any of the ‘big guns,’ but there are some other groups around that we need to visit.

Working with NMCP has been very interesting.  They are the experts, and honestly sometimes it is a bit of a challenge to work with them.  New ideas or projects have to be presented in a way that someone will not feel as if their toes were stepped on.  That is the impression that I get.  It’s all a hierarchy, PCTG has to be really careful about how they talk about new ideas.  Katim and I gave them an overview of Boot Camp I, as per their request, and we literally showed them and told them what we learned.  One of the higher-ups got made about the coupons.  He said that The Gambia uses them.  Long story short, he talked a lot, and we smiled as I thought about the fact that I have never really seen the coupons, and even if they do exist, some people have all of the bed nets and some people have none.  It’s safe to say that everyone has learned a lot working with NMCP.

 Looking forward

I drafted a project plan and framework for PCTG’s initiative.  The ‘task force’ and staff are meeting in the coming week to discuss and begin to finalize plans.  Alex is first coming up with a better name for the group, and networking with PCVs to create a malaria team.  Gabriel is going to continue working with NMCP.

Our goal is push the neem cream stencils and have PCVs do neem cream demos with the painting of the murals.  We are also beginning to collect best practices.  I also think that featuring PCVs on the Gambia page of the site will get people excited.  I have already told people that if they do something that I will put it online.  Who doesn’t get excited about that???

There are also talks in the future to develop a baseline survey, and implement the survey first in one region.

 

 

Uganda Malaria Update: Amanda Rodriquez

I spent my service living at the last matatu stop of an urban area.  What lay beyond were endless maze, cassava, bean and banana fields with mud-brick structures scattered here and there with swamp lands and dense jungle intermitted.  I worked with a Community Based Organization (CBO) and a health center teaching both community volunteers and also health professional staff outreach curriculum and implementation practices.  Malaria remains one of the greatest health issues in Uganda so it was only fitting that we spent significant time doing trainings and outreaches on malaria education and prevention.

Immaculate, the director of the CBO, was a small Ugandan woman who cared deeply for her community and wanted to see health prevail as much as possible.  She believed it was the responsibility of the community to fight for one another’s health.  We discussed endless initiatives we could take up, different health topics we could focus on and ways to present them.  It was malaria that sparked the greatest passion in Immaculate.  In a country where you hear of someone dying from malaria almost every week it wasn’t surprising this topic was something people wanted to talk about.  When World Malaria Day came around it seemed the perfect occasion to mark the day as a whole community and start our work on malaria education and prevention.

The months leading up to April 25 we divided into teams and spread out to convince others to support us and join efforts to host a community malaria health fair.  A local school agreed to create and sing a song about malaria, an NGO would provide a tent and chairs, a church would donate a sound system, the mosque gave a generator, a doctor would speak on the physical process of malaria on your body while a nurse would speak on prevention and treatment, and we as a CBO would do a drama.  We found an NGO from the capital who did malaria work and agreed to come and sell treated mosquito nets for a subsidized price.  Then it was just a few short weeks away and we did our best to spread the word.  Announcements were made in churches and mosques along with across the local announcement system.  We put posters up in the market, at the clinics and we all talked it up no matter where we went.

Since Immaculate wanted to include as many as possible and our community is the end of an urban area going into a rural area, it was decided a march would be a great way to gather and reach the most people.  With a handmade banner and donated primary school brass band, we marched from a rural post to the main soccer/football field in our town inviting people to join us.  After over an hour of marching we only had a handful of community members with us.  I was nervous this event was going to flop.  We had estimated we would reach around 150 – 200 people but at 2 pm, when our presentations were scheduled to begin, there seemed to be just 40 people or so.  So we waited.  Another hour later we had a few more people and decided to go ahead.  The speeches started, the songs were sung, the talks were given and in true African time people trickled in over the next several hours.  Our estimated 150 people grew to nearly 1000.  Over 800 mosquito nets were sold and throngs of people wanted to buy more.

With each mosquito net that was sold we collected as much information about the person as possible so that we could follow up with them in the future.  3 months, 6 months and 9 months out we sent teams to gather data on if people were still using these nets, how many cases of malaria they had had and where they went for treatment if they were infected.  There were times I entered a compound and found the net being used as fencing for a families chickens or a covering for their water pots to keep things from falling in.  But there were also times I found the net properly strung up around their beds and reports of no malaria in the last 3 months.

While our CBO covered many health topics we became known as the “malaria people” in surrounding villages.  We hosted another community-wide malaria fair the following year and continued to do follow-ups and outreaches. Immaculate lead with passion and inspired team members to be ready to talk about malaria at any time.  Malaria is still pervasive in our community and the country as a whole faces many challenges in eradicating it, but there are many people who are fighting to raise awareness and knowledge so that they can have a healthier community.

 

Malaria Prevention in Uganda

Uganda became active in the Stomping Out Malaria initiative in February of 2012. With 122 volunteers placed in every region of the country there is potential to create an effective malaria prevention plan. According to the Presidents Malaria Initiative (PMI), “Malaria is the leading cause of morbidity and mortality in Uganda accounting for 25-40 percent of outpatient visits to health facilities, 15-20 percent of all hospital admissions, and 9-14 percent of all hospital deaths. Nearly half of all inpatient deaths among children under 5 are attributed to malaria.” A World Health Organization (WHO) study states that only 10% of both children under 5 and pregnant women are currently sleeping under mosquito nets. This is a major factor in the 16% of children under 5 who die from malaria each year in Uganda.

Uganda is taking  major strides in the area of malaria intervention supported by CDC, PMI, USAID and now the Stomping Out Malaria Initiative.  The four areas of intervention to prevent and treat malaria include the use of insecticide-treated mosquito nets, indoor residual spraying (IRS), intermittent preventive treatment for pregnant women (IPTp) and proper diagnosis and treatment of complicated and uncomplicated malaria. Peace Corps volunteers in Uganda are actively involved with all four of these interventions.

In addition to these four areas, Peace Corps volunteers in Uganda are currently engaged in a wide range of behavior change activities including a bi-weekly radio show in Bushenyi.  The show addresses malaria prevention and treatment behavioral issues.  It airs during prime radio listening time, 8:30-9:00 pm, engaging listeners through question and answer sessions after an introduction to the behavior change topic.  This is an interactive radio show that encourages listeners to engage the topics, and prizes are rewarded for those callers and individuals who sent in messages via SMS for their participation.

An example of another interesting behavior change activity was a drama show that took place in Mittoma, Uganda.  The drama addressed good behaviors such as sleeping under a long lasting insecticide treated mosquito net (LLIN) every night in order to prevent malaria.  Also, early treatment seeking behavior is promoted throughout the drama alongside the illustration of the signs and symptoms of malaria.