Oftentimes when referring to global health crises around the globe, the circulating mindset whether in media or conversation is that if burdened communities knew how to protect themselves better, they would not suffer as extensively as they do. My time in Kigali, Rwanda taught me differently.
In the summer of 2018, I was given the unique opportunity to share malaria prevention strategies with 135 5th and 6th graders. Walking onto the campus property, I could feel the atmosphere around me stir as the students out on recess turned to identify the strangers in their vicinity. I walked as confidently as I could, making eye contact with some and initiating a warm smile as a friendly gesture. I honestly was not too sure what to expect – in fact, that was the purpose of the public health campaign: To identify what children at this particular school knew about malaria and to share the importance of implementing these tactics. Carrying out the campaign was ambitious in that I also hoped it would create a ripple effect through these children out to their families. The idea was that pupils would understand techniques that they could implement through an infographic poster and share it with their siblings and parents at home, possibly even keeping it their houses or hanging it on their walls.
When I got to each classroom, I was not short of surprised that every one of these 135 students already seemed to have a deep comprehension of how to protect themselves – poster or no poster. When asked for preliminaries on what they already knew, one-by-one they effortlessly spoke up on everything from cutting down bushes where mosquitoes may rest to spraying insecticide. They peered at each visual, excitedly raised their hands when called to describe what they interpreted them as, and seemingly almost 99% of the time hit the nail on the head.
Now among many things that this experience taught me, one of the most important ones was that just being aware of preventative strategies is not always enough. In a country where even little children knew how to protect themselves from malaria, why then were estimated mortalities in the thousands?1 Certainly it must be true that lacking preventative knowledge contributes to the persistence of diseases, but as the above experience shows, this is not always the case. Instead, I would argue, that there is a shift in the current needs of national communities from focusing on changing behaviors and spreading awareness at the community level, to focusing on implementing structural changes through government. That way, families need not worry about sleeping with an infected mosquito tonight or any other night.
Now, it seems that the lack of available resources and infrastructure are causing vector-borne diseases like malaria to spread, not a lack of personal preventative knowledge. For instance, while speaking to these children, I learned that most of them did not have window screens in place. Most people knew how to protect themselves, but most people were also unprotected by a measure that could hinder the invasion of disease-carrying insects into their houses. The scenario sounded contradictory. So what do we do about this divide between knowledge and resources? It seems that speaking to government workers and sharing how important it is to invest in preventative tools for the people of their provinces is the way to go. People know what to do, they just need the backing of policy makers, ministries of infrastructure, education, and more. Maybe, then, we should double our efforts to enter waiting rooms and offices, rather than solely classrooms and schools. Thankfully, strategies in place are already leading to the reduction of malaria incidence cases in Rwanda.2 Let’s do what we can – like installing window screens – to catalyze the process.
1. World Health Organization. (2018). Rwanda. World Health Organization International. https://www.who.int/malaria/publications/country-profiles/profile_rwa_en.pdf?ua=1.
2. Mbituyumuremyi, A, Kayumba, M. (2018). Rwanda registers declined malaria cases in 2018 – WHO report. Rwanda Biomedical Center. http://www.rbc.gov.rw/index.php?id=19&tx_ttnews%5Btt_news%5D=479&cHash=69a9e333926447b0150752dda7bb4398