The Dream Stealer.

“Malaria is a dream stealer!”

Second day attending the Senegal Malaria Boot Camp. After two days of traveling, meeting 33 Peace Corps volunteers serving all over Africa, Bootcamp has begun!

Today has been extremely informational and educational. This afternoon, we had the opportunity to skype Dr. David Sullivan from Johns Hopkins University. His focus has been on infectious diseases and in particular a large focus on Malaria.

We began the discussion by defining “what is malaria?”

My fellow PCV ‘s answered with academic responses such as ” Malaria is a parasite driven disease with two vectors….”
Dr. David responded, “yes, but in reality Malaria is a dream stealer!”
He is right, malaria has been stealing dreams from children in sub-Saharan Africa for decades and continues at a rapid pace. Last year alone 1 million deaths mainly affecting children under 5 and pregnant women were caused by malaria.

Some background on Malaria in Africa:

There are 5 strains of malaria, the most common and lethal one being P. Falciparum. When considering Madagascar the entire island is at risk, with hot spots being the east coast due to the seasonal rain showers and humidity.

Symptoms:
Symptoms of Malaria are :
-cyclical fever
-large spleen
-chills
-anemia

Diagnosis:

Within these African countries there are several different diagnosis methods.
The first and gold standard being microscopic testing, with blood smear. This allows you to know quantitatively how much parasite or infection density parasite per micro liter is in that person.
The difficulty of microscopy are that it is time consuming ( 15-20 ) mins, requires trained experts to administer and use the equipment, and of requires the equipment.

The next diagnosis method and what I believe to be a huge innovation are RDT’s ( rapid diagnostic tests ). These tests come in small packages. The plastic test has a small location to place the blood droplet after you have pricked the patient and a small space for the buffer liquid to be placed. In ten minutes the results can be seen.
The advantages are that the RDT’s are sensitive, fast, simple to perform. Most importantly require no electricity.

The disadvantage is that the RDT’s do not test for P. Vivax a strain of malaria common in Tanzania and parts of East Africa.

Some fun statistics, “In 2012, 200 million RDT’s were given out most being given to Africa!”

On a community or village level, I have personally seen the benefits of using the RDT’s and the quick results being produced. Of course like everything there is not a 100% efficacy rate, there may be false negatives or damaged tests.

While speaking with Dr. David he brought up an interesting graph showing the effect that heat has on RDT’s. Imagine for a moment a box of 300 RDT’s coming to my village on the East Coast of Madagascar. The tests have travelled days even weeks, spending maybe hours in hot humid weather. The graph showed that hot weather reduces the efficacy of the tests. Therefore it is important to keep in mind that there may be some false negatives.

The larger issue in wanting to eliminate malaria in African countries is that individuals can be asymptomatic. These asymptomatic individuals can still transmit the disease.
I think to myself, well an active approach to this problem is to test all who have cyclical fevers or are showing signs or malaria. The problem is that asymptomatic individuals show absolutely no symptoms… What to do then?

Treatment:
The treatment for malaria is ACT. It is an artemisinin based drug which dissolved the heme killing the parasite. There are different drugs who treat malaria stage specific illness. Ex: liver stage, red blood cell stage.

I have found a backlash from my community in taking ACT due to the fact that the second day of taking the three pill treatment, the patient feels very weak. In Mahanoro people have steered away from taking the treatment to malaria because of the controversy behind the feeling and bodily reaction when taking the pills.
This year I need to focus on working with my Community Health Workers, to educate the community about the importance of taking this drug.

I am looking forward to doing more research and learning more about what is on the horizon for Malaria Initiatives and inventions in the future. I have heard of talks of:

-a vaccine against malaria arising
-lasers killing mosquitoes carrying P.falciparum ( look it up so cool!)
-and using saliva and urine for diagnosis instead of blood samples

Things are looking up. Malaria has received much attention in the news and researchers are working hard.

With the help of global actors, private investors and local governments I believe we will eradicate malaria in Africa in 15 years!
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