During the month of April, the newest group of volunteers in Guinea was among the most active in educating and protecting their communities against malaria. One standout was Public Health Volunteer Alexa Gudelsky, from Cincinatti, Ohio. “I wanted to be a PCV since high school, and I wanted to do health work, but I thought thought I’d be fighting HIV/AIDS. I didn’t realize how many people died from malaria. I thought it just made people sick for a week like the flu, I didn’t really know it killed people. Turns out I was wrong.” Despite a lack of knowledge about malaria before coming to Guinea, once she saw the impact of the disease in her community, Alexa became motivated to initiate over a dozen projects in her community and the surrounding villages. She launched her projects in April known in the Peace Corps community as “Malaria Month”. Her projects ranged from a supply chain analysis of her health center to murals and educational booths at her weekly market.
The health center in Alexa’s Basse Cote (lower coast) community is unusual in that it is a private (versus government-run public) health facility. The center is funded through an international NGO Medecins d’Afrique (Doctors of Africa) and run by a Guinean non-governmental organization, la Fraternité Medicale de Guinée. This support means that the health center in Alexa’s community has a more supported diagnostic capacity for identifying malaria cases than many health centers in the surrounding area. The clinic is equipped with a working microscope and a trained technician as well as rapid diagnostic tests (RDTs) which are used to diagnose suspected malaria cases. The clinic serves a population of about 700 people.
Alexa helps the health center staff to compile their monthly reports, so she already knew that there was a large number of reported malaria cases. One of Alexa’s most intriguing projects in April was the analysis she wrote of her health center. She found that her health center treated over 2,000 cases of malaria in 2012, an average of more than five people per day. At other sites, one might be tempted to blame part of this enormous caseload on misdiagnosis, but given the aforementioned reliable diagnostics at the health center, it is probable that this number is fairly accurate. Another interesting finding from Alexa’s study is that while Artemisinin Combination Therapy (ACTs) drugs are recommended for treating simple malaria cases, her health center is almost always out. Instead they prescribe quinine in pill form. Even for a well-funded health facility, it turns out that access to the necessary medication is can be quite challenging.
In addition to looking at medication and diagnostic capacity, Alexa sought to quantify the impact these 2,000 cases had on her community. In Guinea, a long-lasting insecticide-treated net (LLIN) can be purchased on the open market for about 40,000 Guinean francs (about $5.70), and will last about three years. However, most health structures do not have a sufficient stock of bednets, which should be free at any consultation. On the other hand, a course of treatment for one case of malaria can cost anywhere from 18,000fg ($2.50) to over 50,000fg ($7.10), depending on the severity and availability/cost of medication at the facility. Alexa calculated that last year, the people of her community spent over 50,300,000 guinean francs, or $7,185, on malaria treatment. This high cost reflects the low coverage of mosquito nets in her community.
Numbers are great, but how to make use of them? Her idea was to use the number has a motivator to encourage the adoption and maintenance of net usage. Says Alexa about her project, “I wanted to show my community in a very visual (and Guinean) way just how much money they are spending on malaria treatment. It’s a staggering number and often hard to visualize.”
Alexa decided to represent the cost in physical terms by following the example of a Peace Corps Volunteer Ben Gascoigne in Senegal, and relating it to the most tangible of subjects for Guineans: rice. Alexa purchased enough empty rice sacks to equal the number of full rice sacks that one could purchase with that money: 250 fifty-kilogram rice sacks. That would amount to about 27,700 pounds of rice! To put this into perspective, one sack of rice can feed an average Guinean family for anywhere from 3 weeks to a month. Alexa used the empty rice sacks she purchased to line her village’s soccer field and hosted a malaria-themed soccer match with a halftime educational show about malaria. As Alexa said, she wanted to “show everyone just where their money could have gone and how many mouths they could have filled.”
Alexa’s malaria month activities did not stop at that. She also worked with her nearest volunteer, Maren Lujan, to bike to neighboring villages to do malaria messages at their weekly markets. In Guinea, local markets are a weekly occurrence to purchase food and goods and socialize. Instead of selling produce like all the other market ladies, Alexa and Maren peddled malaria knowledge! They set up a mosquito net demonstration and created a malaria trivia game. The winners of the trivia received a prize of American candy. Alex and Maren reached over 1,000 people. To reach the majority of the population, they partnered with a friend, Banyugo, who translated their talks into the local language of Susu.
Alexa also created a malaria mural at her health centering of a mosquito net covering the country of Guinea saying “Guinea – giving a kick to malaria.” Lastly, Alexa worked to build pride in net ownership and usage by photographing community members with their properly-hung nets and posting those photos on the wall of her health center.
On April 25th, World Malaria Day, Alexa did malaria sensitizations at the local middle school and the university in her regional capital. She involved the student theater group in marketing a malaria message. The day also involved a malaria-themed soccer tournament with half-time activities focusing on promoting bednet usage.
Malaria Month is over now, but Alexa is excited to be supporting a large-scale bed net distribution campaign that will cover hers and 13 other prefectures in Guinea, distributing in total three million mosquito nets. She recently attended both regional and local trainings for this distribution campaign. As she says, “I’m excited for it, and although I’m nervous that there will be a lot of hiccoughs along the way, I’m excited because I’m going to be able to play a role in it! I’m eager to see real statistics after the campaign so we can measure what the impact is. The real challenge from there will be getting everyone to sleep under their nets. That’s where I come in! I’m looking forward to going out into the community and helping people to understand why it is important to sleep under their new nets.” It is clear that this is just a taste of the enormous impact that the work Alexa and the other new volunteers in Guinea will do to reduce the malaria burden in Guinea in the remaining two years of their service!