A Co-Fellow Conversation: Perspectives on Eliminating Malaria
Stacey Naggiar and Chipasha Mwansa are 2016–2017 Global Health Corps fellows working to address malaria with PATH in Zambia. In honor of World Malaria Day, they interviewed each other to highlight their perspectives on malaria elimination.
A year ago, neither of us expected to have the word malaria in our job titles. And yet here we are, a Zambian and an American working for the NGO PATH, alongside the Zambian government, to take on the bold task of eliminating malaria.
Growing up worlds apart in Lusaka and New York, our experiences with malaria have been different, running the gamut from completely commonplace to totally foreign. Yet we both found our way to malaria eradication work through a similar belief that everyone has the right to access quality healthcare.
As Global Health Corps fellows, we entered into our roles with the Malaria Control and Elimination Partnership in Africa (MACEPA) project at PATH not fully aware of this unique moment in time for Zambia and malaria elimination. This World Malaria Day, the Zambia Ministry of Health has announced the National Strategic Plan to Eliminate Malaria by 2021. We are humbled by the opportunity to be part of the fight and to have a front row seat to history.
If a year went by without any of us getting malaria we would be surprised…
Stacey: Chips, my first question for you is… have you ever had malaria?
Chipasha: (laughs) Yes, more times than I can count. As far back as I can remember, malaria in my home was a very normal thing. If a year went by without any of us getting malaria we would be surprised and it’s something that would even invoke conversation if we didn’t suffer from malaria.
Stacey: Many of our readers might not understand what that’s like. Can you tell me a bit about what it’s like to have malaria?
Chipasha: I would have a fever and be throwing up, no appetite, no sense of taste, and a terrible headache. Even without going to a hospital or confirming what it was, we would all just know — “This is malaria.” I have taken chloroquine, quinine, Fansidar, and Coatrem, trying to find a medication that worked for me. Sometimes I would even have reactions. And malaria would do the rounds — if one person in the house had malaria, everyone would go through it. I took it as anyone would take any other disease like a flu or a cold. It was a part of my childhood and even into my early adulthood.
Stacey: When was the last time you had malaria?
Chipasha: I think the last time I had it was five years ago. And when I look at my community, it’s also become much less common in recent years. Even when you go to a health facility within Lusaka and say you think you have malaria they will ask if you traveled out of town. This shows that malaria in Lusaka is decreasing, though there are still imported cases in people coming from malaria-ridden districts. Prior to joining PATH, I really did not pay much attention to malaria but I recall hearing announcements on local media saying that Lusaka was declared malaria-free. It’s clear the malaria burden has significantly decreased across the country.
Stacey: Fast forward to the present day — tell me about your role as a malaria surveillance officer.
Without evidence from the field, we cannot know that we’re moving towards elimination. That’s what this job is all about.
Chipasha: My role as malaria surveillance officer is to analyze data that comes in from the field reports of community health workers and facility staff. These reports are used for decision making, so I follow up as needed to make sure everyone involved reports on time. I’m also involved in training community health workers in malaria case management, testing, and treatment. Without evidence from the field, we cannot know that we’re moving towards elimination. That’s what this job is all about.
Chipasha: Stacey, what about you, what does your role at PATH entail?
Stacey: My job is two-fold. One aspect of it involves working with teams like yours to develop training materials like videos and brochures to educate both community health workers and community members receiving malaria prevention services. The other role is to bring stories about progress against malaria to a larger Zambian audience and the world.
One thing I didn’t know before working on MACEPA is that when you reach low levels of malaria transmission, as Zambia has done in the Southern Province, it becomes more difficult to measure, see, and communicate success. That’s why I think it’s incredibly important to tell these stories. If we take our foot off the gas now, so close to the finish line, interest and funding to end malaria might stop and we could end up right back where we started. It’s a no-brainer that people should not suffer or die from a preventable disease.
Chipasha: Me too.
If we take our foot off the gas now, so close to the finish line, interest and funding to end malaria might stop and we could end up right back where we started. It’s a no-brainer that people should not suffer or die from a preventable disease.
Stacey: From where you sit, is elimination possible?
Chipasha: It is. We have evidence of eliminating malaria in some districts including Lusaka. All that’s needed now is concerted effort from all players working towards elimination. This includes community members themselves because one of the biggest challenges we’re up against is that people often don’t use the tools that are available, like sleeping under mosquito nets or allowing their homes to be sprayed. These particular challenges are behavioral, traditional, and cultural.
What about you, Stacey? From the work that you’ve been doing, taking part in village meetings, witnessing campaigns like mass drug administration and indoor residual spraying, do you think malaria elimination is possible?
The bottom line for me is always that malaria is preventable and curable… countries need to fix problems with much larger systems in order for malaria to be gone for good.
Stacey: For the same reasons you mentioned, yes, I think it’s possible. There was a time when malaria was endemic in the U.S. but I grew up not even knowing about malaria. Also, last year Sri Lanka was certified as malaria-free by the World Health Organization. The bottom line for me is always that malaria is preventable and curable. But we know that infectious disease is also influenced by poverty and poor education. So I think countries need to fix problems with much larger systems in order for malaria to be gone for good. That’s a huge and complicated task. I also worry that the investment we have seen from foreign countries is at risk given the current political climate. This means national governments, especially those heavily dependent on aid, need to increase their financial commitments to health budgets. It’s also an opportunity for the private sector to get involved. To sum it up, I’m concerned but yes, I do believe it’s possible.
Let’s switch gears. Looking back over the last nine months of the fellowship, what has most surprised you?
Chipasha: What has surprised me most has been the amount of work taking place behind the scenes. The community health workers who are doing a big part of this work are volunteers who don’t get paid. That just shows how committed people are to seeing malaria be eliminated. People have put earning an income aside to do this noble work. I hope they are not forgotten.
Stacey: I’ve also been blown away by the effort on the side of PATH and the Zambian government to train thousands of community health workers to find every last case of malaria. And by the community health workers themselves who have stepped up to make a change. It’s really powerful to see how much pride they have in learning these skills and serving as role models in their communities.
Chipasha: So Stace, what are you going to do after the fellowship?
Stacey: One thing at a time! I don’t know yet. You?
Chipasha: I don’t know yet either. But if we eliminate malaria, we can do anything.
To learn more about PATH’s malaria eradication efforts, check out this video.