Eradicate Malaria
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1) Research
This first phase can be boiled down to 3 parts: Research. Filter. Plan. Simple but very challenging.
First off all, we start running around like Sherlock Holmes going over both new and old ways to fight malaria. Village size. Climate factors. Prevalence and incidence of malaria. It all goes under the magnifying glass. After collecting and scrutinizing all available data we start the filtering process.
Like a press pot we filter the wanted from the unwanted. Separating the relevant from the irrelevant. It is tough but necessary as it gives us a "whiteboard overview" of where to go - which is exactly what the next step in the process is about.
Based on the fruits of the two previous steps, we are now ready to plan the project and outline it step-by-step. We make lists of people to contact. We prepare promotional events to teach people about malaria. We seek out the necessary funds. Essentially, we go over all the important parts of the project all the way from A to Z and then make a plan so we know the 'what, where, when and how' of each step.
All this running around like Sherlock Holmes, separating the relevant from the irrelevant and planning the project, finally adds up to a single blueprint of the entire project. With everything planned, we are now ready to take on malaria.
2) Connection
The second phase is about connecting with global and local organizations, medical teams, village chiefs and inhabitants. We can break this into 3 parts:
a) Knowledge-partners
Both global and local organizations go into this category. We discuss everything from the best general strategy to practical tips on putting up the nets. The bigger organizations have experience from working in a globalized environment, and they guide the planning of the macro-aspects of our project. Practical know-how is gathered from our Sierra Leonean team members, local NGOs and people in the local environment where we carry out the project. Once we're in Sierra Leone, we go from one meeting to the next and pick up a wealth of context-specific tips on how to handle all kinds of situations and on how to ensure the most effective method of distribution.
b) Intervention-partners
This part involves medical teams and, from time to time, local organizations. These are the partners who help us during the distribution and keep it alive for the next three years.
A good example of this is the local Pujehun District Health Management Team that is currently helping us with our '07 intervention. During the first 6 months of the project they visit the village every second week, and from then on every two months. They teach people how and why to use their anti-mosquito net along, along with information about medication and good practice in malaria prevention.
These partners are an integral part of our project.
c) Village-partners (and inhabitants)
Finally, there's what we call 'village-partners'. This can be the chief of the village who facilitates our project or a local business-owner. While cooperating with someone such as a village chief is vital to the project, it's only the first step. Connecting with the inhabitants of the village, who are responsible for carrying out the project each day, is much more important to us.
We go to great lengths to be welcome in the village. This is the alpha and omega of an effective intervention where the inhabitants keep the project alive long after we're gone.
3) Education
Imagine some strangers entered your town, knocked on your door and told you that each and every night you had to sleep under a bed net - an installation that might make a warm night considerably more uncomfortable. Which action is more likely, a) you choose to sleep under the net or b) you shut the door in their face?
Well, that's really the scenario the people we work with face. A simple hand-over along with a moralizing sermon does not make for an effective project. Rather, we let our local partners do the talking, and they emphasize why it's essential to use a bed net every night and explain how to install one properly.The distribution phase is thus used as a way of educating people about malaria, bed nets and the importance of regular use. To further this end, we also organize a wide range of events, ranging from town meetings hosted by village elders to a football cup where the local teams attract many of the younger members of the community. When we are not participating ourselves in the matches, we use the breaks in between the matches to inform people about malaria and the benefits of sleeping under a bed net.
"But wait," you might think, "you guys can't be in the village year-round, right?". Good thing you asked, because you're absolutely right - we can't be there all the time. Actually, the project doesn't truly start until we leave. That's why we work with local health teams to continuously educate and promote the use of nets. They stop by every other month throughout a 3 year period. This is great because it is not "some strangers" telling them what to do, it is someone they most likely already know.
This combination of education and promotion is crucial as it ensures that everyone uses their bed net. So far we're doing pretty good - 93% of all people covered in our '07 project still use their bednet.
4) Intervention
The intervention consists of 3 key components:
i) The Super Net
A special kind of super anti-mosquito bednet, known as Long Lasting Insecticide-treated Nets (LLINs), which protects people from mosquitoes while they sleep.
These nets are treated with an insecticide that effectively repels and even kills the mosquitoes in their blood-rush towards their sleeping victims. Even if the nets are washed this insecticide will last for 3+ years.
ii) The Inverted Cycle
In most places, nets are used as a protective measure only for under-five children and pregnant women as they are the most vulnerable groups. However, we use LLINs in a more comprehensive way and cover everyone in the village, we're going for 100% coverage.
The nature of malaria means a human can only get malaria from an already malaria infected mosquito. And a mosquito can only get malaria by sucking blood from a malaria infected human being. You see the cycle here? It is this self-reinforcing cycle we're trying to break.
Full coverage of everyone in the village significantly reduces the amount of people who will get malaria. Now, if fewer people have malaria in their blood, fewer mosquitoes will in turn acquire, develop and spread malaria. This leads to even fewer bouts of malaria. Cycle inverted.
iii) A Useful Gift: The House-to-House Distribution
Just like the 2 other components, this last one is quite work-intensive, but we have not come across a more effective method of distributing bed nets. The personal relationship is highly necessary.
Therefore we do a house-to-house distribution where we unpack the nets and hand them over to their new owners. Not only does this approach ensure that the nets reach the intended recipients, it also turns the distribution into an event.
The nature of a house-to-house distribution also takes the bednet from being "a free net" to being more like "a gift", which also spreads our sense of ownership of the project to our local partners. You'd think twice before selling that baseball cap your friend gave you last Christmas, right?
Finally, the House-to-House distribution is also a cultural exchange with room for smalltalk, meeting the entire family and learning about the local area. In short, a valuable opportunity to build friendships.
i, ii & iii tied together
Of course these 3 components are tightly woven together, so our intervention is "a (iii) house-to-house distribution of (i) LLINs that (ii) covers everyone in the entire village". It is our experience that the synergistic effect of combining these three components clearly exceeds their individual effects.
5) Evaluation
This phase is all about collecting and analyzing data, which is actually more exciting than it sounds because it's the indicator telling us whether or not our intervention was successful.
How many people still sleep under their bednet? How much did the prevalence of malaria drop? Compared to pre-intervention years, how many children died from malaria this year (if any)? Or the other way around: how many children do we save each year as a direct result of the intervention.
We do a survey regularly throughout a 3-year period (i.e. until the next intervention takes place) to compare to our baseline survey. This gives us all the data necessary to measure what works really well and what we should improve on in future interventions
Part of the Bigger Picture
Hopefully this page has given you a picture of how we go about fighting malaria and perhaps also a little insight into the way we work.
All 3 components of the intervention are quite work-heavy, and intense education throughout a 3 year period is nothing short of a mammoth task. Steps one, (research) two (connection) and five (survey) are of a different, but still work-heavy nature; we need to determine in advance what could work and what couldn't. Rinse and repeat.
We obviously believe strongly in this approach, but believing alone is not enough to carry out a project - funding plays a fundamental role too. Funding is part of the bigger picture, and you can learn all about it by clicking here.