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.

-->

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!