Malaria in Macha – Integral developmental aid in practice
31 Mar 2008
The development of Macha started over 100 years ago with the settlement of a missionary hospital. The first 2 missionaries died within 3 months after becoming ill and the third missionary almost left. Despite all the critics and second thoughts one can have on missionary projects in the previous centuries it is with these pioneers that Macha has started to grow to what it is today.
In 1997 the Macha malaria research institute was founded. Today we had a tour on the Macha site of this institute. Malaria is one of the main causes of death in Macha area. The research institute and the malaria institute at Macha (Miam) play a crucial role in research and reduction of malaria. And they are highly effective in their work. You can also read an article about MIAM’s activity in the February 2008 issue of Nature magazine (Nature 451, 1047-1049 (2008)).
We learned that there are over 30 different kind of mosquito’s in Macha area. Only two of them spread malaria. Not only with people, but also with other animals like dogs, goat, cows and even snakes. Though not very high tech in Western standards the research institute is on the leading edge of malaria research. It is here that a methodology is developed to test people for malaria without taking a blood sample. Now it is becoming more common to test people on malaria through urine or saliva. This is not only faster and cheaper. People now don’t have to fear for misuse of their blood. This might sound silly, but it is a real problem that people believe that the blood might be misused in spiritual ceremonies or evil spells.
Malaria has two forms, a non sexual one in the mosquito and a sexual one in the blood of humans. Up until now the focus of many research has been on the non sexual form that only exists in the mosquito. With the form in the mosquito t is also important to make a distinction between the part of the body where the malaria parasite lives. Only when in the mosquito’s head the parasite will infect when the mosquito bites.
In Macha also the sexual form is investigated. The reason for this is that a person can be carrier of malaria without becoming ill him/her self. When this is the case this person can infect other people. This means that when – for instance – a parent is infected as a carrier but not ill and the child gets bitten it can become ill. Then after treatment when the parent is bitten again and after that the child this cycle will repeat and repeat and repeat … Discovery of treatment of the sexual form ot the malaria parasite might lead to a major breakthrough in malaria treatment.
We had a meeting with Philip Thuma, M.D., Board Certified Pediatrician – and P.I. or coordinator for most studies conducted at the The Macha Malaria Research Institute. Philip has been working as a doctor in Zambia for many years, his father also was one of the leading doctors in Macha hospital. Malaria has gone down in Macha and the decrease is far above average compared to other rural areas in Zambia and South-West Africa. We asked doctor Thuma about the underlying causes or ‘secrets’ of this high performance and great success. We heard a story that convinced me that here we have to deal with a proven concept of an integral approach. I’ll try to share some things here, though the issues are far more complex than I can understand from the few conversationt I’ve had so far. The following lines are my personal thoughts and impressions; not quotations or opinions of dr. Thuma.
Dr. Thuma told us that one of the primary reasons for the big success in reducing malaria in Macha was the subscription of ‘the right medicine’. Talking with him we found out what the right medicine meant, and this was more than just the right pill. Relationship, trust, patience, perseverance and doing more than just only medical aid have played a very important role. One can cure malaria with medical aid, but prevention through hygiene and sanitation plays an important role in sustainable treatment of malaria. So one of the important projects of dr. Thuma has been the digging of water wells in villages. Education and especially maternal knowledge also play an important role in sustainable treatment of malaria in rural area. The better informed the mother is about malaria, malaria prevention and treatment, the better the results will be in reducing malaria.
We also spoke about bed nets and housing. Bed nets definately have an impact on the reduction of malaria, but I believe the impact is much lower than is said to be. Most people in rural area have housing that makes it very difficult to put a bed net in. There are too many people living in one house or the house is not suitable for other reasons. Besides that most people live outside and only sleep in their home. This means that the time that the mosquito is most active people are not in their home, but outside. But this doesn’t mean that bed nets should not be spread, every contribution matters. Because the mosquito bumps into the treated bed net it won’t survive long enough to spread malaria.
As I find out looking around and talking with many people in Macha a bigger impact reducing malaria is achieved by better housing. Tin roofs make the house warmer and because of that the mosquito won’t survive. It needs a cool spot to rest and sleep. Stone houses are more closed that the traditional or wooden homes and because of that the mosquito has more difficulties getting into the house.
A major cause for people to create better housing is economical growth. Therefore economical support and development of sustainable local economy contributes to reduction of malaria. And of other diseases.
Communication, transportation and communication facilities also play an important role in reducing malaria and other diseases. Dr Thuma has shown with his research and statistical measuring that running out of medicine has lead to a major growth of malaria in the area. Now, because of the airstrip and internet connection, it is possible to get medicine in time to Macha. That means, if there is sufficient supply in Lusaka.
So here you see the bigger picture, an integral approach for malaria prevention. As far as I understand it now. This is what these people here in Macha are working on. I believe this also goes for treatment of other issues like HIV/Aids or maternal health and the other UN Millennium Development Goals.
Jasper Bets is going to do research on the integral approaches in Macha. Hopefully this will lead to a case description that is useful for developmental aid in other rural areas in South-West Africa.
A hospital with qualified doctors and sufficient medicine is a solid base for sustainable treatment of malaria. The impact becomes exponential more effective when this is combined with proper education, sanitation measurements, economical growth, better housing, communication and transportation facilities.
It is not just one thing, but you have to look at the picture as a whole. This is what we call integral. Dr. Thuma called it ” to look at the roots of the tree”. In my interpretation of it: Some trees have 12 roots and then you have to work on all 12 issues and other trees have 9 or possibly 15. Here is where the local differentiation comes in. Every rural area has its own specific life conditions and in order to be successful and sustainable treatment must be adjusted to these life conditions. The integral approach is what makes the Macha case – accoridng to me – important for developmental aid in general. Dr. Thuma studied CHE and our website and as told us he was intrigued by our vision and work despite the fact that he didn’t understand it all. Well, here is a parallel with CHE and a solid basis for collaboration; mutual respect and trust. One has to build a relationship of respect and trust in order to become effective. Especially if you do not fully understand what the other is working on. This might sound easier than it is. It takes years, an open attitude and the desire to preserve the African culture.
Another important lesson we learned and that I’d like to share here is the factor of time and patience. Dr. Thuma, Janneke and Gert Jan van Stam are effective in their work because of the long term dedication they have given to this area. Local people and their leaders trust them because they have proven to be sincerely involved with the local community. For building up a relationship of trust one must not think in terms of years, but in terms of decades. Only after more than ten years of hard work, setbacks and many disappointments, the results show significant and sustainable improvement of malaria treatment, economical growth and improvement of life conditions.
A donor could take this in consideration funding projects in Africa. An interesting book to read is “African friends and money matters” by David Maranz. This book describes the differences between Western and African cultures and the mutual frustrations from non understanding.