For most part my colleagues Stella, Kabogo and I are often holed up in Malaria World, Nairobi office digging through hundreds of journals to pick out anything relevant to the “Malaria World”. Over the past weeks we have held discussions of what really happens out there, how is the war against malaria coming along? Are we loosing or winning?
The more we talked about it, the more we realized we didn’t know much about what really happens on the ground. What we see on paper is often quite impressive, but is that reflected out there? It was then unanimously agreed that we should head out and have a look.
We chose to visit a place called Mwea, better known for rice production in Kenya. As statistics show, this area is also popular for high malaria prevalence owing to the rice paddies. Its also located just two hours from Nairobi hence convenient for us, we could drive there and get back by evening.
A date is set and on the material day we begin our journey departing Nairobi at 6 am. After one and a half hours drive, we see the first rice paddies signaling our arrival at Mwea. We make a stop over to enjoy the expansive green and scenic view of the rice paddies. Rice happens to be my favorite dish and am glad I finally get to see where it comes from. We decide to have a chit chat with a man working on a rice pad right next to the tarmac.
He tells us he is not a local and only came here in search of a job as a casual worker in the rice fields. His daily wage is one dollar and a couple of cents. Asked about malaria, he said that, the disease is no longer a wonder in this part of the country as he has had it more times than he can count since he came to Mwea. He goes on to say he buys malaria drugs over the counter whenever he feels malaria symptoms, adding that even then he can only afford the cheap ones that go for ksh 40 which is $50cents.
He is however keen to note that many times when the disease comes knocking, it has found him penniless hence he can’t afford to go to hospital nor buy the drugs. During such times he puts on a brave face and hopes his immune system will put up a good fight. He reckons he is quite fortunate to be alive as a good number of his friends with whom he has worked in the rice fields have succumbed to the disease over the years.
Next to his pad is a lady tilling land under the scorching sun, by the vigor she does it you can almost tell her only hope and livelihood are beneath that soil. It turns out to be true as when we speak she tells us that what grows from that piece of land is what she depends on to feed her family for the rest of the year. She has three kids all of whom have already contracted malaria at least once since they were born. This, she adds, is the case with most families here; there isn’t a single family that hasn’t had a malaria case.
We then head to the local hospital, the Mwea Mission Hospital in the hope of getting more credible information and statistics. It takes us a good 15 minutes to the hospital a distance we are told costs 50cents of a dollar in public transport. This is the same amount that the cheapest malaria drug goes for over the counter.
We arrive at the hospital and head straight to the matron’s office where we find Sister Josephine Muthoni from Lady of Lourdes Missionaries.She is the hospital administrator, she grants us an interview and invites the resident doctor of the facility, Dr Njau to speak with us. According to her, the hospital had received and treated 4402 malaria cases in the year 2010 alone adding that in July of the same year they lost 19 patients which is the highest compared to other months. She attributed the month’s high mortality rate to the rice planting season. She says it is around July when rice farmers release water into the rice paddies hence escalating the breeding rate of the anopheles.
Dr Njau also points out that the main challenge they experience with malaria patients is that they come to hospital as a last resort. Most Mwea locals as mentioned earlier prefer to buy malaria drugs over the counter as opposed to going to hospital. The residents we spoke to complained of the high price of proper malaria treatment which costs anywhere between 85 to 100 dollars, an amount majority of them cannot raise, hence the reason they don’t go to hospital. They say the surplus they get from selling rice is committed to other basic needs such as paying school fees and buying food.
One would therefore think that preventive measures like nets would work better and be more effective in curbing malaria here. One Njoroge Macharia who works for a community based organization in Mwea begs to differ. He says while people are encouraged to hang nets in their sleeping quarters, most locals have no designated sleeping areas. Families here are poor, he says, they sleep in one room around the fireplace. According to him, families have one bed often reserved for the parents while the rest sleep on the floor on mats. Nets would therefore be hard to use in such sleeping arrangements.
The PSI, (Population Service International) regional coordinator Mr Wahome also points out that there is a difference between net ownership and net use as far as Mwea is concerned. His organization, which distributes nets and provides community capacity building has noted that not everyone who owns a net uses it, a situation that deals a blow in the fight against malaria in the region.
One thing that comes out clearly from our conversations with the residents of Mwea is that most cannot afford malaria treatment and their living conditions make it hard for them to employ preventive measures such as using nets. In other words, they can’t do much as far as malaria is concerned. One of the women we spoke to told us, “we are stuck to cultivating rice in the fields; we know the danger it poses but our hands are tied, rice is what feeds us, all the alternative means of making a livelihood have failed".
As we make our way out of Mwea we can only sympathize with the situation, that majority of people here are not only under constant threat of contracting malaria but also the fact that they can do nothing about it. When it comes calling it will most probably find them with no prevention and no treatment. All they can do is hope and pray that their immune system will put up a worthwhile resistance. While we are aware of the gains made in many other parts of the world, we can’t help arriving at the conclusion that malaria is winning in Mwea.