25 Oct

A visit to the malaria heartland

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“Do you have malaria in your country?”

“no”

“so what do your people die of?”

“well, mostly heart problems”

“ why, what’s wrong with their hearts?”

“we damage them by smoking, and em…..eating too much”

Manyoni studies my face to see if I’m joking. When he realises I’m serious his face creases and he laughs. He finds the idea of people dying from over-indulgence hilarious

We are walking along a dust road towards kaphuka, a village in central Malawi. Manyoni is bringing me to meet Jameson whom he calls his brother. This could mean that he is his brother, a cousin, a friend, or just someone with whom he grew up . Familial relations in these villages are fluid and all-encompassing. We find Jameson sitting in the shade of a baobab tree. It is near midday and uncomfortably warm in the sun. He is taking a break from building a a small hut to house himself, his wife, two daughters and a grandson. It is half-built, the mudbricks to complete it lie drying in the sun. As we talk he picks one up and hands it to me. Pressed into the drying mud I see the flattened form of a mosquito. By its palps, two appendages either side of its proboscis, I can make out that it is an anopheles, the malaria bearer.

Malaria is woven into daily life in Malawi. The word ‘malungo’ in checheyan, the local language, means both malaria and, simply a fever. I ask Jameson when was the last time he had malungo. ‘Last month, and before then, the month before, and before then, the month before that ‘ he answers. He tells me that it usually takes him three to four days to get over a bout. I quickly work out that one tenth of his life is spent in a malarial fever.

The huge incidence of the disease has a significant knock-on effect on the economy of malarious countries such as Malawi. T.H. Weller, a nobel laureate in medicine, once said ‘a malarious community is an impoverished community’. The debate about the relationship between malaria and poverty is ongoing. A paper by the economist Jeffrey Sachs and John Luke Gallup showed that economic growth of malarious countries was 1.3% less then their non-malarious neighbours when other factors were accounted for. Put simply they showed that rather then poverty causing malaria, malaria causes poverty. Sachs and Gallup are sure that it is no coincidence that malarial countries are the poorest in the world, giving the example of Haiti, significantly poorer than its neigbours and the only country in the region to have malaria. If this is true, the eradication of malaria will go a long way to raising people out of poverty.

Throughout our conversation Jameson’s son stands observing us. He is quiet and watchful, unlike the other children I have met here who have been smiling and laughing. He looks undernourished , his clothes are rags and dried mud is smeared on his skin. Before we leave I crouch down beside him and take his hand to try to engage him, to make him smile. I can see his ribs, and, extending below the margin of his rib cage i can see the shadow of his spleen. Even in an emaciated child this is not normal. It’s likely that he has, like his father, been contracting malaria regularly. I ask his father what age he is. “eight” he replies. The child is lucky not to have succumbed to the disease before his fifth birthday. Last year nearly a million people died of the parasite, the vast majority children under five. His chances are much better now that he is a little older, but the malaria has taken its toll. He is very small for his age.

The next day I visit Chawantha, a village set amongst green plains, accessed by a forty kilometre uneven dirt road. As I arrive I hear the swell of multi-harmony singing. From a stone building in the centre of the village the singers come swaying and singing in unison, children around their legs, clapping their hands in time. It is a welcome song and a joyful scene.

The village has been battling malaria for the past ten years by the force of education. Through a scheme provided by an ecumenical church group, funded by US Aid, the villagers of Chawantha and the surrounding region have been taught about the transmission of malaria, the importance of bed nets, how to recognise the symptoms in their children and what to do when they occur. Local female volunteers have responsibility for teaching people about the early signs of malaria and monitoring the use of bednets. It is a simple project but, as Group Village Head Chamwantha, the local chief, tells me, it has had a huge effect.

“ before we started, it was difficult to get any work done in the village. Everyday there was a funeral, and in our culture, everyone has to attend the funerals.”

I ask him how they dealt with malaria prior to the programme

“we thought it was caused by witchcraft, we didn’t realise it was the mosquito giving it to us. Our witchdoctors would give us herbs when the malungo came, or, when pregnant women got it, they would tighten strings around their bellies to expel the fever”

I ask the collected throng if anyone has lost a family member to malaria. A young woman called Katherine Bhri stands and begins to speak confidently. “my child died in 2002. She had a fever one night, I just gave her some paracetamol because I didn’t know then that I should have gone to hospital. She slept that day and when i checked on her in the evening she was dead”

“what age was she”

“two and a half”

She says it without sorrow or pity. Things have changed in the village. It is unlikely any more of her children will die of the disease.

I ask ChiefChawantha what difficulties they had in changing people’s behaviour.

“at first we thought the nets were decreasing our libidos”

I am perplexed. Why would that be? “before the nets the villagers were frequently woken during the night by mosquito bites and as they were awake anyway…. well….’ he looks knowingly at me, cocking his head to the side, the Malawian version of a nudge and a wink, and begins to giggle.

Other, more serious obstacles remain. People now know that when a fever comes that they have to go to hospital, that pregnant women need two doses of a malaria prophylactic in their first trimester and that bednets are necessary. But the hospital is 24 kilometres away on an uneven dirt road; the only mode of transport, if it is available, is a bicycle and the hospital is often without any medications or bednets.

Nevertheless Chief Chawantha proudly tells me that because of what they are doing, they have not had to stop work for any funerals recently. In the fading light, the leader of the women holds her fingers in the air and they begin, singing and dancing in a circle. It is an educational song:

“this is what malaria does, it takes your child away,

so when they have a fever get panadol and L.A

pregnant women in your first trimester

get your drugs in the hospital, sister”