Xajee (Ha-GEE)

While it will, in all honesty, be many months to come before I have the language skills and village connections to start my own projects, I can say for certain that at some point I will be doing something related to Malaria (or xajee in Jaxanke/Malinke).  And so, as an introduction to that topic, I’d like to share a few things about malaria that you probably didn’t know in honor of World Malaria Day.

First, Malaria is one of the oldest diseases known to plague humankind.  Scientists have found the parasite in 30 million year old amber-preserved mosquitoes (Jurassic Park style) and, based on its plant-like organelles, they believe it to have evolved from a plant.  Hippocrates (yes, the same Hippocrates for which the Hippocratic oath is named) is believed to have authored some of the first written accounts of the disease circa 400 BC. His writings describe people ill with fever that oscillates predictably over the period of one or a few days. The fever strikes at night, accompanied by profuse sweating, splitting headaches, vomiting and agonizing muscle aches. It then retreats to near-normalcy, the sweating stops and the aches dissipate, for just long enough to make you think you are have recovered before it swiftly returns to conquer your body again. These are the classic febrile paroxysms that characterize the disease and distinguish it from a myriad of other febrile illnesses.

Second, Malaria is a parasitic disease caused by one of 5 species of protozoa from the genus Plasmodium (although we only have 3 in Senegal) and is transmitted to humans by the pregnant Anopheles mosquito.  This means that only female mosquitoes transmit the parasite (did you even know that mosquitoes had genders?).

Third, as many as 2.7 million people die every year from malaria.  Roughly 75% of these deaths are among African children alone.  This has an enormous impact on African communities as very year many parents have to watch their children die from a preventable disease and in African economies since these children never grow up to contribute to their family’s economic well-being and since malaria treatment and prevention consumes a lot of resources.

The reason that we don’t have malaria in the U.S. is NOT because we don’t have the mosquitoes able to carry it or because it just hasn’t ever crossed our borders.  In fact, Malaria was present in the U.S. endemically until the 1940s when the Centers for Disease Control and Prevention (CDC) were founded with the sole purpose of eliminating malaria as a public health issue.  They mounted a hugely successful campaign to destroy mosquito breeding grounds, spray insecticides, improve housing and educate the public. Their example proves that elimination of the disease is possible.

Lastly, while Malaria is certainly a more challenging issue to tackle in a tropical, resource-poor country such as Senegal, that does not mean that these places are fated to interminably suffer its consequences. It is true that the climate lends itself naturally to the proliferation of the mosquito vector and the parasite itself: excessive rainfall during the rainy season leads to pools of stagnant fresh water that are ideal for mosquitoes to breed in; mosquitoes actually mature faster, breed sooner and bite more frequently in hotter climates; and the parasite itself also reproduces faster in hotter climates, enabling it to be transmitted from one person to the next even faster.  It is also true that in resource-limited settings one must combat a long list of extra complications in attempting to control and eliminate the disease: poor health in the population as a whole as a result of malnutrition and other infectious diseases complicates the pathophysiological course of disease and leads to worse health outcomes; lack of education about the diseases contributes to lack of healthy behaviors that might otherwise help people to circumvent disease (long sleeves, dumping of standing water, use of bednets to sleep under at night); and lack of resources prevent people from investing in home or municipal infrastructure that might otherwise help protect people (screen doors, covered water/sewerage systems, etc.).  But these challenges are not unconquerable and a lot is being done to overcome them.

Senegal is a leader among sun-Saharan African nations for the huge strides it has made in malaria control and Peace Corps Senegal has been a major contributor in the effort. The Senegalese Ministry of Health now supports universal coverage of bednet wherein enough insecticide-treated bednets are distributed to every household for free to cover every sleeping space (distribution per sleeping space was a Peace Corp Volunteer’s idea).  The Anopheles mosquitoes tend to bite between dusk and dawn so protecting oneself from bites during these hours is extremely effective in preventing disease. Several districts in Senegal also practice Indoor Residual Spraying wherein insecticides are carefully sprayed on the inside walls of peoples’ homes to deter mosquitoes from entering at all.  In certain parts of the country, chemoprophylaxis campaigns have also been implemented wherein all children are treated for malaria twice a year, whether or not they have symptoms, in order to decrease parasite prevalence in the general population and thereby decrease transmission. For both the Indoor Residual Spraying and the chemoprophylaxis, Peace Corps volunteers have been instrumental in aiding census efforts during program planning to make sure that everyone who should be included is included as well as in program evaluation to conduct surveys to ascertain how effective the program was.  Furthermore, in Saraya (my village), my Peace Corps ancians put in place a new program that has since been adopted as region-wide protocol that pays community health workers to make weekly sweeps of their assigned neighborhoods.  The health workers test everyone with symptoms and provide treatment on the spot or otherwise refer people to a medical center for complicated cases.  All of these efforts are supported by education campaigns up the wazoo in mass media and in schools (many conducted on the radio or in schools by Peace Corps volunteers).

And the thing is, it’s working.

The northern regions of Senegal, while more arid and perhaps easier to control the disease in, have reached a “pre-elimination” phase wherein they have come so close to stopping transmission that they have to shift control tactics.  They are now trying to actively find and smother the last few cases of disease so that they might interrupt disease transmission for good. In southern Senegal we aren’t quite there yet but new interventions have been demonstrated to decrease parasite prevalence by around 15%.

So if we just keep plugging along...

Maybe, just maybe…

We can stomp out malaria in Senegal.

(Stomp Out Malaria is the name of Peace Corps’ malaria intervention strategy – to read more about it click here)