GMin blog

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Our project is now complete. We’ve carried out our questionnaire, distributed the nets and made a deal with the Pujehun District Health Medical Team (DHMT) about how our project will run for the next three years. Yet, we realize that our reporting from Sahn has not been complete, nor have we uploaded a lot of pictures. Allow me to make up for that now.

We arrived to Sahn on July 13th after passing through Pujehun (a map of the Pujehun region, with Sahn Malen on it, can be found here) for our initial meeting with the DHMT we arrived in Sahn. Sahn has approximately 1.500 inhabitants, and is situated in the middle of the tropical rain forest. Fresh fruit is available aplenty, gorillas reside nearby and there are many rivers and rice fields around. Unfortunately, it is not only a paradise for humans, but also one for mosquitos.

We arrived at the guest house right next to the health facility, and we met up with the Sahn team. Aside from the four GMin people, the team was comprised of David’s two brothers, 12-year old Hopanda, one of David’s cousins, David’s dad, and a relative native to Sahn. After meeting everybody, we played football and called it a night early to rest before the first leg of the project.

The first leg of the project was the questionnaire. We split into three groups, each with translators and helpers. The questionnaire investigated fever cases in the household, the amount of mosquito nets possessed, treatment of malaria, and questions on a native malaria-treatment called Gbangba. It took two days to complete them for a bit more than 200 households, and we got quite a novel insight into life in Sahn.

For example: Their life is based on subsistence farming, some households had more than twenty inhabitants, none of them have electricity, very few are literate, women are not always dressed and everybody loves football! It was such a profoundly new experience to conduct these questionnaires that I will let the pictures speak for themselves.

After completing the questionnaire, which for example revealed that nearly everybody was affected by malaria (85% of all the households have had at least one episode of malaria within the last 2 weeks). 20 % of the population was under five and there were only 60 nets in total. We then continued with the distribution of the nets.

The distribution was initiated by a town meeting which was attended by 300-400 people, the paramount chief, the DHMT and all the elders of the town - everyone was dressed in their Sunday best. I was told that the speeches - which were in Mende - were great, at least there was a lot of clapping . We handed over ten footballs - one for each of the villages in the Chiefdom - and tools that can be used to clean around the houses and thus destroy the mosquitoes’ breeding places.

Morten at the town meeting

David speaking at the town meeting

The distribution thus started. The event we had been planning for nearly a year was now taking place. Finally!

We once again teamed up with our interpreters and we were helped by many friendly people from Sahn, who for example mastered the art of carrying nets on their heads (unlike me).

Yet, before the distribution started we were faced with a few dilemmas. First of all, people sleep together - this means allocating one for each will waste nets. Then, how many people do sleep together? (children sometimes sleep in bunches in the parlor). We could of course give one for each two household members, but we had to ensure total coverage. We decided that we would ask how many nets they would need, but then got some outrageous replies (like 13 nets for an 11 person household). At the same time, we wanted to avoid confrontation at all costs. Our project would not be successful if there was hostility between our team and the people whose situation we sought to improve, yet many other people could benefit from these excess nets and we didn’t want the nets to be sold nor used for other purposes. In the end, we agreed that being courteous with our questions yet firm with allocating the nets was the best way forward. Also, we decided not to contradict their own estimated need for nets. It worked: We almost always got sensible and honest replies. We really owe our translators and David’s other relatives a great deal for helping us carry out the project with such finesse; without them this project would not have been possible.

Team meeting

Mathias with his team

Again, it was such a peculiar and educative experience in a completely new setting - which I havn’t digested yet - so I’ll leave the photographic description to the pictures:

Finally, we left Sahn completely saturated with experiences. I bonded a lot with my translator, and we’ve made friends with the village. They opened up their homes for us and left us with nothing but a warm, personal impression. They also showed their gratitude in various ways, for instance by giving Jacob a hen.

Jacob’s hen

This is far from the last post on this blog, nor is it an account of what happened after the distribution finished, so I hope you’ll keep reading.

-Mathias

Being home is great. Being home with four guests in hospitable Sierra Leone is even greater. Showing Mathias, Morten, Gustav and Jacob my culture and translating lovely messages from family and friends is greatest.

Being a part of GMin which posses a million questions for the success of its project, compounded by the fact that I have to be a part of the group that also produces some of the required answers makes every one of my days longer than 24hrs. Each second presents a challenge whose end is interesting for me as well as for GMin.

Learning from the famous cliché “All work and no play makes jack a dull boy”, playing has been one of the better aspects of my stay here in Freetown, Bo and Sahn with the boys. Trying the different savory dishes prepared by my mother and other people and climbing up trees to pick fresh fruits have all made the “eradicate malaria” project by GMin an untypical one.

I welcome you all to read my blogposts on the Office of Career Services-Harvard University.

-David

I just updated some of our old blogposts with a bunch of pictures (okay, at least a few). The following posts have been updated:

• “Video killed the radio star” (just not in Sierra Leone)
• A day on the beach
• A bumpy ride to Bo
• World famous in Sahn Malen
• A little bit about Sahn

-Morten

Hi everybody,

In many ways Sierra Leone is a country in total contrast to the entire western world. In this blog post I will highlight some of these contrasts through what I’ve experienced for the past week. New updates, reflections and achievements concerning the project can likewise be found in the second half of this post.

I arrived in Freetown airport Friday evening a couple of hours delayed. Not very convenient as Ishiaka (my former roomy from RCN), his 1st year (Prince), and two uncles of his were waiting for me… They picked me up, we rushed to the ferry but were too late. One guy stayed behind with the car and the rest of us boarded after a couple of steps through the water. The ferry was packed!

It was not possible to see much of Freetown as it was dark, and there is no permanent electricity supply in Freetown. The ferry was quite cozy; there wasn’t much light, the temperature was tropic and the air was very humid. It’s the rainy season. From the center of the ferry a few hens jumped out of a bag and started crowing. No-one seemed to pay much attention.

The ferry entered the dark harbor solely guided by a lantern placed on land. We pushed through the crowds of people to disembark the same way as the cars, which seemed to be a bit tricky, but obviously not a problem here in Sierra Leone. We went into a little office by the harbor front and further into a little office with a sign saying “Ferry Manager” where another of Ishiaka’s uncles was sitting by his desk. The first thing he said was: “Welcome home”, just as many others I’ve met in my first hour in this very hospitable country. We Danes could learn a lot from this part of the mentality!

Later, we rode through the city, which seemed very busy even though there wasn’t much light. Driving through Freetown seems quite hazardous. A little bit like driving through the walking streets of Copenhagen in fourth gear on a Saturday night, with the horn honked almost constantly. We arrived to Ishiaka’s place where we got something to eat. Nice spicy food with fish, rice and potato leaves called “Crincrin”. There was light here. Prince left a bit later, and I went to bed early. We needed to get up at 4-5 am in order to catch the bus for Bo.

We got up at 6 am, and were late for the more comfortable public busses. We had the option of either waiting till Monday for the next bus or rush to a clay factory nearby to catch some smaller busses, which seemed like they were made of tin plates and soft-drink cans. I was told from beforehand that the road was rough, but I would never have imagined that it was in such a poor condition. To put the trip into a frame of reference it felt like being in the middle of a richter 7 scale earthquake. Nevertheless, the trip was a quite educative experience, and I especially enjoyed the stops we had to buy roasted corns and other foods.

Ishiaka and I arrived safely in Bo where Mathias, Morten and David where waiting, Jacob though had a hard time dealing with a throat infection… The day passed with more nice food, talking and a deeper introduction to Bo Town.

Over the weekend we mainly relaxed, visited family members as well as friends in Bo. One of David’s friends is running for parliament in the coming elections (first round will take place on the 11th of August). There is some rising tensions before the election, so far with a single violent episode in the east. Otherwise the situation seems calm, and it’s very unlikely that the situation will get unstable. We also spent some time on planning and discussing our next trip to Sahn Malen where the project is taking place. I had an idea about trying to investigate economical effects of the implementation of the nets, which some of the others were a bit skeptical about, mainly given the circumstances in the village and the lack of pre-planning. Of course I don’t know much about the scenery till I’ve been there. We might find a method of how such a research can be conducted. Another thing we’ve talked quite a bit about is how to create a reliable control group.

Our main objectives the next two days in Sahn are to ensure that the nets are properly installed, to help those who havn’t installed them yet and then to run some interviews… We will buy string and hooks for the nets tomorrow morning before catching the bus. They have told me that this road is even rougher than the one from Freetown. Oh no…

I’m going to bed now, need to get up early… Amu kpokoh (good night)…

Next morning, we got up early so that we could pack our stuff, eat breakfast and buy equipment to suspend the nets for those people who hadn’t done it yet. For many people it’s even a challenge to get hold of string and nails to hang up their nets. We were discussing back and forth what the best method of hanging up the nets would be, some thought it would be best to use nails, others that it would be better to use screws, as mud houses may be too fragile when hammering in the nails. We bought plenty of both screws, nails and string.

From Denmark I had brought some water-cleaners which look pretty similar to tea bags, and could be rather effective. However, the use of them is limited as they cannot clean all of the bacteria and chemicals which are commonly found in the fresh water here. So, before we left I bought a 12 pack of half-liter water bottles so that we would be able to take water samples from different locations around Sahn, Bo and Freetown. We will then get the samples analyzed either in Denmark or at a hospital up north which I’ll visit after the others have left Sierra Leone.

We got our stuff attached on top of the “bus”, which was something like a minor VW Transporter from the early 80s, only with home made seats etc. We were sitting 21 people inside, two persons were hanging on the back of the van, and three were sitting on the roof…on top of the 21 people’s luggage. It was even more painful than the ride from Freetown to Bo.

We arrived to the village four hours later, and started to plan for the next day. Our job this time was, as mentioned earlier, to ensure that people had suspended their nets, possibly to help them with it. We visited the health center to ask if they wished to have a representative with us around in the village, as well as to investigate a possible volunteer option, which, though, seemed not to be possible. At the health center we found detailed records of all malaria from two years back; such data is being recorded for all villages where the district health team is operating. That enables us to compare the next three years of records with the data from the past two years in Sahn, and likewise compare all the data with one or more “control villages” which may match the infrastructure of Sahn Malen’s. Hence, we’ll be able to evaluate the change in Sahn itself as well as an overall change in malaria cases by the implementation of the LLINs.

Additionally, we spent some time discussing a method of how to investigate an economical change for the village and in each household after the LLINs has been given. At first, the main challenge was that we couldn’t just ask people about their average income per day, week, month and so on, as they mainly were subsistence farmers, and don’t have the same system of money as we have. Furthermore, collecting such data from a “control” village would seem to be even more of a challenge as no preparations nor an official agreement had been made. The second thought was to count all mud houses and stone houses in a village, as stone houses are significantly more expensive, and it tend to be “richer” people living in these. Plus, such data would be more easily obtained from another village. The idea was dismissed after thorough discussion. This was partly because most people living in these houses have family members in the bigger cities which they depend on for remittances, as well as people often have other priorities than building a new house, such as sending their children to school, buying fishing nets etc. A useful method could have been to observe changes in the productive sector, but that would require we maintain the data collection for enough years ahead for children, from two different villages, to grow up, enter school, and graduate, which would be far beyond the scope of our project.

Next day, we finally went around to see the nets. We were followed by 30-40 kids either calling us “Pmui” (‘white man’ in Mende - the local language) or “Jacob”. Jacob seemed to have astounded this little society with his brilliant football skills… We figured that most houses already had put up their nets, which was a great relief. The ones who hadn’t yet, we either helped, or gave string, so they could do it themselves. We likewise figured that we needed neither nails nor screws to put up the nets, they could simply be tied to poles and planks in the houses’ structure.

When we came back I made a “Devil Stick” - out of two guawa fruits, some palm sticks, string and some leaves - for the kids who followed us around. A Devil Stick is basically a stick with a certain weight balance that enables it to be thrown and spun around two other sticks which you’ll hold in each of your hands. It was quite a success.

Some went playing football, and Jacob’s team lost.. HA!

We spent the most of Tuesday evening entering the data on our computers, evaluating the past days and extinguishing a fire in our generator which almost exploded.

We woke up at 5 am next morning to catch the “bus” back to Bo. We left the generator behind. The trip back was pretty fine and I got to hang outside the bus for a part of the tour, which was a lot of fun!

Now we are back in Bo, and are at the moment trying to plan the rest of our stay here in SL. Our project is almost finished, we only need a couple of more meetings. We’ll head for Freetown Wednesday.

So long for now…

- Gustav

LLINs - as they’re commonly abbreviated - is at the core of our project, so I figured I’d tell you a bit about them.

Treated with an insecticide which kill or repel mosquitoes for 3-4 years these nets are truly ‘long lasting’, and they can even be washed several times without any decrease in their efficiency. To put it in short, LLINs are superior mosquito nets.

You use the net during the night - the mosquitoes prime breeding time - where you sleep thus normally an easy victim, but with these super nets, a mosquito killer for years!

LLINs actually originates from ITNs (Insecticide-Treated Nets), a treated mosquito net that’s neither washable nor long lasting; they have to be re-treated every half year, what a mess..

The effect of using mosquito nets (no insecticide) to fight malaria, was already proven in 1914 with the building of the Panama Canal. At the first attempt in the late 1900th century more than 20.000 workers died, mainly due to malaria, and the project had to be stopped. At the second attempt in 1914, scientist had found that malaria is transmitted through mosquitoes, and a major effort was made to prevent the mosquitoes in reaching the workers; both through draining of swamps, but also, more importantly, through the use of mosquito nets. (You can read more about the Panama-intervention here).

Unicef, Red Cross and alike are currently distributing LLINs - through big centers - to pregnant woman and children under five; the two most vulnerable groups. An initiative that greatly cuts down on malaria among these two groups but not much on the disease in general.

Unlike Unicef and the others - that use LLINs as a way to protect specific target groups - we’re taking a more Panama-like approach, using the nets as a weapon against malaria. Something you can read more about here.

-Morten

I am aware that when you read this several days will have passed since I wrote it. None the less I feel compelled to share the following with you. We do not have any internet nor do our phones work here in Sahn, so we have not been able to upload anything since we left Freetown. So when you read this, we will be in Bo and have acces to a computer.

Sahn has a stunning location. It matches all my imaginations of a ‘Tropical African village’. There are big palm trees everywhere, and the environment is extremely fertile. Except for the mosquitos, there are many amusing and beautiful insects. David talked about a gorilla settlement a few miles down the road, and Morten has already seen a monkey. In some way it is a true fantasy oasis.

Most of the houses we visit are made of clay and bamboo (Until recently I thought bamboo only existed naturally in Asia) for walls and palm leaves for roofs. Wherever we go there are people cooking over open fire, and there are always loads of kids running around between the houses.

But everything sweet has a sour side. It is very sad to see the state the village itself is in.The village was nearly destroyed during the war, the biggest buildings are still ruins. I can’t stop thinking what the village would have looked like if the rebels hadn’t burned down all the buildings, and so abruptly reversed development.

In spite of this, many people have impressed me. Everyday I see people carrying gigantic items on their heads, be it a big log or a container with water. It looks really convenient though. You can carry a big load, and you have both hands free to use for other purposes. Perhaps I should introduce that carrying skill in Denmark.

Another thing I’ve come across that I find strange is some of the eating habits. Or maybe “strange” is a wrong word to use, maybe I should say surprising. For the most part we’ve eaten rice. Not that there is anything strange in eating rice, but it turns out that the rice which is a daily part of a sierra leoneans meal is imported from China. This means that it is  more rentable to grow rice in china for then to ship it to Freetown, for then again to drive it 7 hours through the country on bumpy gravel roads and sell it in Sahn, than it is for a local farmer to grow rice or another eatable wheat. In one of the worlds poorest countries, I find it odd to see that it is still cheaper to import rice from china. Go globalisation…

The chinese must do something right.

-Jacob

That is how I feel at the moment. We’ve been here for 3 days now, and already our names are known by most of the inhabitants of the village. Every time we walk through the village children yell our names and wave. It really is quite amazing. Especially Morten’s video camera and my photo camera attract a lot of attention - the children simply love seeing pictures of themselves.

Apart from that little personal anecdote, the project itself is going well. We had a meeting with the District Medical Officer (DMO) of Pujehun today, and we’ve started handing out the nets to the households. People are very grateful and it feels very good to make a difference for some people that are really in need. Before that, we spent two days conducting surveys to figure out, among other things, how many people who live in the different houses, and how many people that have been sick (fever) within the last two weeks. The numbers are mind-blowing. Of the 50 households I asked, at least 40 of them reported sick 1 family member sick in the last two weeks. In many cases fever is a symptom of Malaria.

On the same note, it’s worth mentioning that our youngest GMin team member Hopanda, a 12 year old boy who is a good friend of David, is having 40 degrees Celcius in fever - we are pretty sure it’s malaria, so even in our own team we are affected by the disease.

However, one thing is to provide the mosquito nets to the inhabitants, another thing is to create awareness about their importance and usage. We have therefore started a big soccer cup with the name “Kick Malaria Out of Sahn Malen”. Before each game Mathias and David make speech about the importance of using the mosquito nets every single night. A lot of people watch the games and people seem to be very interested in our message and listen when we speak.

I played my first match yesterday, and the fact that a white boy is playing football has not gone unnoticed. Even though I personally don’t think I played that well, a lot of people has come up to me today and said “Hey Jacob, the footballer, good playing yesterday”.

Tomorrow we are continuing the distribution of the nets. Though we have a bit to go, we expect to finish tomorrow.

-Jacob