Blog #12: Stomping Out Malaria in Madagascar!

Blog #12

Malaria is a huge problem today, despite our knowledge of how to prevent transmission. Just how bad is it? Roughly 1 child dies every 45 seconds from malaria (taken from the Nightwatch curriculum). Malaria is responsible for the fifth most deaths from infectious diseases worldwide, and second most in Africa. For my site in 2012, malaria was the diagnosis for 33% of all clinic visits. And that’s just for the people who actually make it all the way (sometimes over 30 km) to the clinic and get the test. There are also community health workers (CHWs) that have the materials to diagnose and treat the illness, but consistent reporting of their numbers is problematic. The point being, as bad as the numbers look, they are probably worse.

This situation, especially in Sub-Saharan Africa, has led to the creation of the President’s Malaria Initiative (PMI). This initiative is led by USAID and provides funding for projects to raise awareness of and encourage behavior change with respect to malaria transmission. Peace Corps works closely with this program, and has launched a program of its own, Stomping Out Malaria in Africa.

2013 logo

With all of this in mind, April has become “world malaria month” for many Peace Corps countries, including Madagascar. World Malaria Day is actually April 25th, and many people do events at least for this day. I decided with some local CHWs to plan out activities in two towns that I had worked in frequently for the water/sanitation project.

The first game the kids learned was malaria dodgeball. If a kid caught a ball from one of the 5 or so mosquitoes, they were said to have killed the mosquito. If they dodged the ball, they avoided contact by sleeping under a net. Simple enough. Next, they set up in 2 nets across an open space. On command, the kids would have to run to the opposite mosquito net and try not to be tagged by the mosquito. The kids’ favorite game, however, was the mosquito piñata.

Malaria dodgeball

Sharks and minnows, but mosquitoes and kids.

Making and breaking of the piñata. 

Practice what you preach...got him!

We also prepared a mural for the town of Mahasoa. The town of Antsirakaomby will get theirs probably in June, but were not able to get their sign ready in time for the month’s festivities.

This mural is about finished. It will be put up tomorrow in the town center with a roof and a stand, then the Peace Corps and USAID logos will be added underneath. Finally, a story that follows the pictures will be added.

There were a few skits to highlight 1) signs and symptoms, 2) the importance of everyone sleeping under a net every night, and 3) the problems that can arise when people use their nets for things other than malaria prevention, such as fishing.

Skit for the importance of everyone in the household--and community--sleeping under a net.

Poster for the campaign.

 

We also had some things targeted for the adults. Later on, we showed people various ways to hang their nets in their homes. Making the square nets into circle nets can help to increase the coverage, especially if people sleep on mats on the floor. Also pictured below is a net that slides on its two guiding strings so as not to be in the way during the day. Finally, there’s a net with a cloth border at the bottom, which is meant to strengthen the net to prevent against tearing due to constant tucking. Net repair and proper washing were important themes of the event as well.

Hanging and retrofitting nets.

Training for net care and repair.

If you stayed with me this far, thanks. I hope it was interesting.  If you want to learn more, visit stompoutmalaria.org or http://www.facebook.com/StompOutMalaria

Blog #11: Research and such.

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Blog #11

I’ll talk mostly about my research here. Well, we (we being myself and my advisors and a PhD student at USF who is very involved with Madagascar for his research) decided that it would be worthwhile to investigate the possibility of lead leaching significantly into the water drawn from Pitcher pumps. Lead can pose a serious problem for everyone, and is implicated in illnesses including neurological development issues, cardiovascular diseases, impaired renal function, hypertension, reproductive effects, and suspected carcinogenicity (WHO 2011^a,b). The risk is especially urgent for children under 5. Even the most stringent regulations to date have been recently linked to significant health impacts (WHO 2011^b).

These particular pumps are pretty simple suction pumps that are hammered into the ground after a sort of sludging method is used to remove the first few meters of sandy soil. It has been used to supply household level water for over 50 years in Madagascar with no subsidies. There are over 50 independent pump manufacturers just in the Tamatave area. This is really impressive for a self-supply market, and is the subject of some extensive research done by Mike MacCarthy at USF.

Anyway, Meghan Wahlstrom and I started our research in December to see what the water quality was like when varied across several factors: Meghan looked at microbial quality; I looked at quality with respect to heavy metals (lead).

Lead can leach from the solder and the well-screen, which contain different percentages of lead in the alloys. We still have the same problem in the US, but centralized water providers to prevent high lead levels by controlling water characteristics (Triantafyllido & Edwards 2012). The other place lead comes from is the check valves in the pump head, which is pure (more or less) lead harvested from old car batteries.

To keep things brief, I’ll say that lead leaching is significant in the pumps. We’d like to be able to suggest affordable ways for people to mitigate this threat. One proposed solution, for example, is to flush a certain amount of water from the pump before drawing for consumption. Another potential solution is to replace the lead check valves in the pump head with iron.

Mike and Meghan determining well depth with a local manufacturer and USF's research assistant Onnie.

Me looking at water quality with an instrument that totally looks like Ghostbusters.

Leaded components for the well screen.

Leaded components for the check valves. Molten lead is cooling in an indention in the sand to the left.

Substitute for the lead valve weights is iron.

The portable instrument that lets me see lead content using Anodic Stripping Voltammetry.

Actually running a sample.

Meghan getting her "just desserts" after a day of research. I credit PCV Sam Irwin with the terrible pun.

At this point, I’ve completed 2 trips to the east coast for data collection. I will make another trip in July for a final round of data collection, and to begin sharing pertinent results with stakeholders in whatever ways are feasible for such a short time. I think that part of the requirements for the MI program is to get our final thesis translated into the language of the host country for PC service. That’s one way to further share results. Anyway, that’s where things stand at the moment with research. It has been going well and seems to be a worthwhile project.

I should also note here that in between my 2 research trips a lot happened, one of which being that I was able to go home and see friends and family for the first time in a year and a half for Christmas. That was pretty great, and now I’m counting down from like 4 months before I’ll see people again.

Triantafyllido, S. & Edwards, M. (2012). Lead (Pb) in tap water and blood: Implications for lead exposure in the United States. Critical Reviews in Environmental Science and Technology. 42, 1297-1352

World Health Organization (WHO), (2011)^a. Drinking water quality guidelines, 3rd ed. Geneva: World Health Organization.

World Health Organization (WHO), (2011)^b. Lead in drinking-water: Background document for development of Guidelines for drinking-water quality Rev/1. Geneva: World Health Organization.

Blog #10: My Mid-Point Vacation

Blog #10

Man. I haven’t used this in quite a while. I’ve got a ton to update, so I’ll do it in a very summarized form in 2 entries.

First, I have to give a quick summary of Tricia’s trip here to Mada. We had been apart for just over a year, so when she got here in July 2012, it was a great way to divide our service. Anyway, she got in from her 30+ hours of flying, and I gave her a day to recuperate in the capital before we left to ride 20+ straight hours on a taxi brousse to get to the north. We visited the park that I saw in December of 2011 with my friends here in Mada first. After that, we visited one of my best friends here, Megan Grzybowski, at her site in Nosy Faly. Her site was amazing, and Tricia and I had a great time staying at a nice bungalow looking out at the beach. Unfortunately, we lost our pictures from this part of the trip… Next, we rode in a little speed boat a couple of hours across the water to Nosy Be, one of the coolest destinations I’ve been to here on the island. We totally indulged and had great French food and stayed right on a beautiful, relatively quite beach in Andilana.

After we made our way back down, we went straight to my banking town of Moramanga, then to my site. We stayed in site for a few days, did some work, hiked a bit and had a picnic, and then decided to go back west a couple of hours to visit the national park in Andasibe. Once we were finished with the park, we went to the east coast, to Foulpointe and Tamatave.

The last part of the trip was spending a few days in the capital, finding souvenirs for people, walking around, and taking a break from the constant traveling. We covered a lot of ground, but there was so much more I wanted to see with Tricia. Maybe we just have to come back a few years down the road, hire a driver and go for it.

Really I can’t write enough about how much this trip meant to us. It was exactly what we needed. Now the plan is actually for me to spend 2-3 months in Panama when I finish here in Mada. I’m looking forward to it beyond anything else.

There are a couple of photos below, but sadly, her camera was stolen on our trip. Her camera was a lot better than mine, so we only took a few photos with mine until hers was gone.

This is the Manda, one of the oldest forts in Mada, located in Foulpointe.

This is a view from the Rova, or queen's palace.You can see a great chunk of Tana below.

The Indri, or Babakoto, in Andasibe.

After vacation, it was back to work doing CLTS with these guys pictured below.

Flavien and Jeannot, local NGO partners. And that's local transportation...

A CHW and a community leader making a tippy-tap. The one on the right makes use of ash instead of soap.

Things were “normal” again all the way until December, which is when I finally started research for my thesis. I’ll write about that in the next one. Misaotra e!

Blog #9: Wait, there's stuff to do?

5/30/2012

So it’s been a while since I’ve updated because I’ve sort of fallen into a rhythm and there’s not been much to tell. But recently I’ve had some cool experiences, watching this big water project come into fruition, so I’ve decided to write a short blog.

Below I have a couple of action shots from being at my friend James’ site and teaching either about HIV/AIDS or water/sanitation depending on the age group.

Oh, and the Catholic church has lemurs out back...?

Below I’m doing a house-to-house interview about hygiene habits, sanitation and water use and purification techniques. At the end, I’ve been doing a summary of the three messages central to WASH education. It’s okay, but it’s pretty much unofficial for now. I don’t write responses or anything; we just talk. I’m hoping to build decent communication with the people in ambanivohitra (towns on the commune fringe, literally “below the big town”). Soon I’ll conduct real surveys and do some focus groups and hopefully will be able to figure out how well the Community-Led Total Sanitation (CLTS) approach is working toward affecting behavior change as part of this RANO HP project.

 

Town meeting for WASH education

I got to meet the Minister of Water for Madagascar, pictured below, as he came to explain some of the legal aspects of the water project, the contract to be signed with a service provider, and the role of government in oversight and regulation.

From left to right: CARE representative, Minister of Water, Director of Water for the Eastern Region, Deputy Mayor, and the guy making a talking point represents a Mada NGO called Voahary Salama.

Then I got to meet the head of water and sanitation for CARE International—not just for Mada, but the world. It’s pretty cool, and pretty unexpected, to be honest, to have the opportunity to meet some of the people that have come to my site. I count myself lucky in my Peace Corps assignment. In addition to seeing development work from the perspective of rural communities, I’m able to see how NGOs work and partner to do projects, which really interests me.

From left to right: Edmond the deputy mayor (and one of the town presidents, too), Jonathan (CARE Madagascar), Madame Vola (NGO SAF Moramanga), a community health worker, and Peter (CARE Int’l, based in Atlanta).

This is the mayor of my commune (right) and a representative from the private sector company Velo (left) signing the 10-year contract that will hopefully ensure sustainable, acceptable service of the new water systems for the people of the community.

Another general update for the country is a little less optimistic than things are going at site. There have been strikes in major country sectors, so far including teachers at schools and now doctors are starting too. There have also been a lot of political demonstrations in the capital, some of them escalating to riots and broken up by tear gas, etc. I don’t say this to worry people, but just to make them aware, because there is so little news coverage of it (even here in Mada), that things are tense away from the rural parts of the country. Anyway, I’m hoping it calms down, obviously. I’d like to finish my service here and all.

That’s all I have for now. Still figuring work and research out, but it’s coming along. My girlfriend Tricia comes to Mada in mid-July, which I’ve been looking forward to since I got here, and she’ll be here for a few weeks, so we’ll travel around. The next blog will be sometime afterward, and should at least have some good photos.

Blog #8: Cyclone Update

2/29/2012

So when I got back to site, my place didn’t look so great (a few photos below). The wreckage in my site was largely cleaned from the previous week, but the town was unmistakably changed. I had some new views because a ton of trees were gone. As for my house, part of my roof had been blown off, but my friend—the guard for the hospital—put up a half-decent temporary replacement within a day of when it happened which helped a little with damage control. Part of my wall toward the roof came apart and fell through my ceiling. So I was open to the elements, somewhat, as you can see below.

Fence definitely gone. All the lemons, avocados and a fruit called pocanel gone too.

Okay dirty. Dirty beats destroyed...

These concrete slabs and the ceiling material pretty much fell where I always sit. Unsettling…

Shouldn't be able to see any of this...

…and the most dangerous thing about cyclones? Flying hypodermic needles. That’s how you get the AIDS. Seriously not sure how that ended up there, though.

These guys fix everything.

Anyway, some good news: none of my stuff was actually ruined. All of my clothes were dirty and wet, but my pictures and nearly all of the papers and books were fine. Everything basically just needed to be cleaned. I got my place fixed up within a week.

Back to the bad news, the real impact of this natural disaster won’t be felt for a little while. People are repairing their houses and but this may be reimbursed from regional allotments to the communes. The real problem is that farmland and cash crops are pretty much all gone. So many banana and litchi trees are gone, and a ton of coffee too. The people in this commune get most of their money during the rice harvests in April-June, but apparently the rice fields are destroyed too. The cyclone just amplified existing problems with money and work shortage.

As far as I know, only a few people in my entire commune of ~13,000 people died during the cyclone. A huge issue, though, is that many of the roads to the main town were blocked, flooded, or destroyed, and anyone seeking medical attention probably could not get it. I’m always impressed by the people who come to the hospital to get their babies vaccinated regularly, etc., because the roads—or paths—are plenty difficult when completely dry.

Work-related, I’m interested to see how the three new water systems are holding up.  At this stage of the RANO HP project, any maintenance issues would have to be taken care of by the NGOs because the private sector has not begun their work in the commune and people have not started paying for their water. Budget constraints are always imminent, so the cyclone can’t be good news. What I heard is that one of the dams for the sources is down, but in general, everything else is fine. I wasn’t able to go and see anything in the time I was back, however, because the roads out to these places are still impassable, either flooded or washed out.

Some counterparts estimated that maybe 2% of the latrines that had been built were still standing. I’m not surprised by this number because nearly all of the latrines built are of ravin’ala, or leaves and sticks, and some are random scrap metal plus the leaves and sticks.  It's probably going to be more difficult to encourage sanitation coverage now that people have experienced a major setback. My hope is that they would be inspired to build a stronger, more durable version.

That’s it for now. I’m definitely okay, and I hope my community will be soon.

Blog #7: When it Rains, it Pours, Pt. 2: Cyclone Giovanna

2/19/2012

I was in Moramanga with my fellow “Atsinanana/Toamasina” PCVs for a regional meeting last weekend when we started to hear more news about the cyclone coming straight for Madagascar. At first, we weren’t really worried, and some people who live right on the coast said they were just going to go home. We learned a little later that it was a huge storm, a category 4 cyclone (hurricane in the Southern hemisphere that rotates the other way) and that it would hit somewhere between Tamatave and Vatomandry, basically ensuring that none of our sites would really be safe.

So we were told to get to the capital and stay at the PC transit house until the storm passed and we could find out the damage to our sites. When the storm passed over Tana, we didn’t really see much. A few trees and poles fell, and some very low-lying areas flooded, but the worst the PCVs suffered was about an hour of time when the generator outside ran out of fuel before actual power was restored to Tana (First-world problems!) The day after the worst of the storm, we were able to go around town and do things normally.

But for a few days we didn’t know anything about our sites because electricity and telecommunications were out on the east coast. Finally we started to get information. Corey, my friend near Vatomandry got a text saying her house, made of local materials, (i.e., sticks and leaves) was completely destroyed. Few people heard anything else before riding toward the coast in a car with Peace Corps to assess things. The doctor in my town, who is also my neighbor, called me once the cell phone network was back up, and the first thing he said was that my roof was gone because of the wind. My house, structurally, is probably fine other than the roof. If you look above, you’ll notice it’s concrete, which I am lucky as a PCV to have. Without a roof, though, it’s likely that I’ll come home to some ruined things. He said the town was hit pretty hard. I think that power has not been restored to Lohariandava yet because now the cell phones are dead.

So I head back to site tomorrow morning and I’ll start to assess the damage to my stuff and my house, and I’ll see how everyone in my town is doing. I have a place to sleep at my doctor’s house if mine is still flooded or whatever the case may be. I don’t regret evacuating like Peace Corps told me to do, but it definitely brings to mind the ways that I am still not as much a part of my community as is seemingly possible. If I get seriously ill, PC will send a helicopter to my site. If there’s a big tropical storm, I have somewhere to go stay until things are safe. If my site is really bad, and my house will take time to be repaired, I’ll be put up in a hotel somewhere or brought back to the capital.

Anyway, I’ll get updates out when I can, but I’m fine, and I’m not that worried about my “stuff”. I’m more worried about my community. I actually had a pretty decent time in Tana because I was able to talk to some of you and see some friends.

Here’s a picture of the cyclone right as it’s over Mada, showing how it’s basically the same size as the entire island.

As for other updates, I just had a great trip on the east coast with my counterpart Jonathan. The photos are all up on facebook finally, so I didn’t post them here. We basically saw some more water systems outside of my commune and were able to talk about work and research ideas.

That’s it for now. I’ll post soon-ish. I also am only posting the link to this thing today, very much later than these were actually written, so that buys me some time

Blog #6: IST and Christmas Vacation

1/10/2012

So I got back a little over a week ago from my first vacation here in Mada. Before that was In-Service Training (IST), which is like a three-month check-point from when you first get to site. It was awesome meeting up with everyone again, and it almost seemed like no time had passed. IST was typically 12 hours of sessions, so that was pretty mind-numbing. But just before the training and just after, we all got to hang out in Antananarivo, which was nice.

Then a large group of us started our trek north for vacation. We had a nightmare of a brousse ride because it kept breaking down and all. At one point, the driver pulled over and opened the radiator to cool the engine down. Just opened the radiator to the engine, which is actually inside the vehicle under the driver’s seat, so steam and hot water shot up to the roof while people were still sitting inside.

When we finally got to Ambanja, a place where many PCVs up north do their banking and hang out, we had a great time. We also went to the beach in Ankify. Later, we went to the National Park Ankarana for a couple of days and went hiking. The last place we went was Diego (or Antsiranana). In Diego, we even spent a day on an island off the coast where we were fed an enormous amount of fresh sea food and we could see all kinds of fish. I put a few photos up below, but will have a lot more up on facebook by the time it’s posted. Admittedly, that’s made this blog post a little lazy.

Beach in Ankify, reminds me of LOST

Hiking in the tsingy

Lemurs!

Huge Baobab!

On a boat to an island

As for site…

RANO HP is starting to count latrines in these different towns in my commune, where they’ve been promoting sanitation and proper construction for a long time now. It’s a little disheartening to see some of the examples (pictured below), and to realize just how low the sanitation coverage is, but that’s why there is still time left in the project life. There are also meetings going on with the private sector for companies with trained technicians and engineers who are bidding to work on the system after it is constructed. The idea is that the people receiving this new water infrastructure will have counters and will pay 1 Ariary (roughly 0.05 cents) for every liter of clean water consumed, the private sector will come out to collect and will provide maintenance services with that money. The people will be paying 1000 times less than they would for bottled water, which hopefully will be affordable and perceived as worthwhile.

Mpanentanas (health workers) and the community meeting about sanitation

This doesn't count as a latrine

This is a broken latrine...no impetus to fix it

For now, I’m going around with my friends here and looking at latrines, etc., and soon hope to figure out/refine some project and research ideas.

In a few days I will have been in Madagascar for a full six months. That makes no sense to me. I’ve really not been able to keep up with time ever since training. That’s probably a good thing? Well, maybe I’ll have something else soon, I’m thinking early March I’ll be in Tana.