Written By: Camille Yameen
Photo credit: Camille Yameen. Saondra; Women’s care group, the President of the Fokontany; CHW, and Claurice; CHW show off their Malaria BCC tools inside the health hut.
No matter how often I do it, waking up at 5 a.m. never gets easier. As I laid in my bed, I could hear my village coming to life around me; people fetching water, others walking toward the market, mothers calling out to their children. The only thing that helped to pull me out of bed was that I had a Starbucks VIA instant coffee pack, courtesy of a recent care package, waiting for me. That, and that it was a sweep day. As I sat at my kitchen table nursing my coffee, I started mentally prepping myself for what the day held – going house to house with my community health workers in one of my fokontanies (cluster of surrounding villages) seven kilometers away, testing anyone with a fever for Malaria. Since we started PECADOM+ here back in December, this fokontany had been conducting weekly sweeps and had already treated 346 fevers, 143 of which were positive for Malaria. We’d been averaging 30 fevers a week, but I was crossing my fingers that the numbers had gone down. I swallowed the last bit of coffee and double checked the contents of my backpack: notebook, pen, water bottle, bananas, granola bars, toilet paper, rain jacket and umbrella. (Malaria season is sure to bring unpredictable weather. The sky cannot be trusted.)
Packed up, I headed out at 6:30 a.m. Walking to Miaranarivo is like navigating a military boot camp, but one I can’t take too seriously, or else I’d never make it. …through the candy cane forest, past the sea of swirly twirly gum drops…then I walked through the Lincoln Tunnel. This particular day started out sunny, but I watched as gray clouds rolled in like waves and knew it was only a matter of time before I’d be battling with the sky. I pushed myself up and down hills, walked down dirt roads ankle-deep in mud that swallowed my feet like quicksand, crossed chest-deep water by way of a fallen tree trunk as a makeshift bridge, through rice fields, using branches and bushes to keep my balance, (though I slipped numerous times), washed my legs as best I could in puddles, dug rocks out of my sandles and cringed as I felt blisters forming on my feet.
Arriving two hours later, I was already tired, but knew I still had hours of walking ahead of me. I found my CHW, Claurice, and we made our way to the toby (health hut), where he and the other CHW help to treat people with minor illnesses. Soaking wet, we all sat and discussed where the fevers were as Claurice packed his backpack with the Malaria tests, medicine, paperwork and gloves we’d need for the day. Saondra, the care group leader who finds the fevers first, told us we only had five reported fevers, mostly children. To my relief, the numbers had gone down, but we didn’t know the condition of each person.
Together, we headed back out in the rain, my hood up, Saondra’s hair wrapped in a cloth and Claurice’s coat protecting the supplies. We walked kilometer after kilometer, stopping at the houses with the fevers, Saondra calling out to let them know we had arrived. Once inside, the beginning felt routine: hands shaken, apologies for being muddy given, supplies arranged, illnesses inquired. But a temperature check and fingerprick later, nothing was routine. As we waited for the results of the test, I started asking questions about mosquito net usage: do you have a mosquito net? Who sleeps under the net? Can I see it? Are there holes on it? Do you know how to sew and repair the net?
The first few tests were negative, so they were referred to the hospital to consult the doctor. But then we tested a 12-year-old boy who was so weak, he could barely lift his arms over his head or speak. He was the first positive. Then came a mother who tested positive. We decided that if there was a positive, we’d go ahead and test all who share the mosquito net since Malaria is easily transmittable and they might not yet be showing symptoms. She brought her 18-month-old daughter with her and insisted that she had already been treated for Malaria a few weeks back and was healthy again. While she had already had Malaria once, we tested anyway and sure enough two lines appeared, signaling she tested positive again. Once we got to the final house, a mother came out with her 11-month-old twin boys and I felt my heart shift. No matter what, seeing sick children is not easy and one was so visibly ill, I knew he would test positive before the test was even completed. Once Claurice pricked his finger, he started crying and then his twin whipped his head around and, seeing his brother in distress, started crying too, tears the size of peanuts rolling down their cheeks. Two tests later, we had two wailing babies and two positives.
As we finished up and I headed the seven kilometers back through the obstacle course, I kept going over the cases in my head, visions of nets with holes, unprotected babies, sick mothers, finger pricks and used tests. I was haunted by all I had seen. I wished so deeply and so honestly that there was an easy fix. But there are just so many people, so many houses to go to, so many nets to repair and people without nets; it’s a daunting task for two CHW’s, one care worker, and one PCV. My work here and with my CHWs is far from done. The only thing I was positive about as I hiked back through mud and rain and blazing heat, tired and sweaty and dirty, is how important the Pecadom+ program is.