keatingr
Sep 22, 2011
Undergraduate / The Malaria Test: Essay for Research Fellowship Position in Development [2]
Dear All,
Thank you for this wonderful forum! All of you are all fantastic writers! I am just about to end my Peace Corps service and I am finding myself writing essay upon essay in preparation for school/job applications - and it isn't going well! If you could look over this I would be greatly appreciative!!!
Many Thanks,
keatingr
Prompt: a maximum 1,000-word essay about a current development issue and at least one proposed community-based development approach to help mitigate the problem. Be sure to include your best practices from your Peace Corps field experience, if appropriate to your, topic.
Handing the small, under-weight two-year old back to her mother, the clinic nurse turned to the beat-up, old register and wrote: malaria. They arrived at Lusuntha clinic on the eastern border of Zambia earlier that morning; the child spending her third day suffering from extreme diarrhea. Lethargic and miserable, she looked like she was on the verge of tears but her body, so extremely dehydrated, didn't have any left. The nurse turned to me and asked me to hand her a regimen of Coartem - the World Health Organization's "Essential Medicine" used to treat malaria. Throughout my Peace Corps service, I had gotten to know the family personally and saw members washing, playing and drawing water from the same low-lying stream that had become stagnate with the dry season. I knew malaria was a possibility, but so were a hundred others. It seemed to me that the nurse made her diagnosis too quickly, as if she knew what the child had before she even stepped into the room. But to be fair, it wasn't her fault: even if she wanted to test for malaria, the clinic didn't have testing kits - they ran out nearly three months earlier. She did the only thing she could: treat yet another suspected case.
In the remote villages of Zambia, malaria does not necessarily refer to the specific mosquito-borne disease. Malaria prevention and treatment have been so strongly integrated into the Zambian society that the word has taken on a catch-all meaning. Children, adults and even community health workers nowadays refer to malaria as anything that involves diarrhea, fever and body aches. Problem is: most diseases in rural Zambia involve diarrhea, fever and body aches. And when clinic staff diagnose (or patients self-diagnose) cases of malaria that aren't really malaria - the actual infection goes untreated and its potential severity and infectivity increase.
During the wet season, the recorded number of malaria cases rise dramatically. This makes sense: mosquitos carry the disease from person to person and they also breed in shallow pools of water. So: more water means more mosquitos and more mosquitos means more malaria. However, it isn't the only disease that finds opportunity in a wetter environment. First rains wash human excrement and other disease vectors from higher grounds into unprotected water sources - putting nearby villages at risk for cholera and other water borne diseases. Poorly ventilated homes and buildings become stagnate with mildew and moisture - increasing risk for pneumonia and other respiratory infections. And as the incidence of all communicable diseases rise, so does the chance for misdiagnosis.
Zambia receives significantly more donor support for medications than it does for testing kits, so clinics' medicinal supplies often outlast diagnostic. As a result, clinicians and nurses frequently have to rely on their own judgment to decide whether or not someone has malaria. In 2009, routine health data from the Ministry of Health demonstrated that roughly only one in three cases were actually tested and confirmed - the rest were diagnosed on a symptomatic basis. Bydon Tembo, the health officer in charge of the Lusuntha clinic, said he's aware that even he diagnoses many cases of malaria that may not be malaria at all. But, again, there's little he can do without the testing kits. Prescribing Coartem for a case that isn't actually malaria might make someone sick, but not giving the drug runs the risk of more advanced forms, such as the often fatal cerebral malaria. Bydon once admitted to me that he and his staff purposely err on the side of diagnosis; their feeling: why take the chance? They usually have plenty of Coartem - if they run out, they can easily buy the heavily subsidized medicine from the small shops surrounding the health center. And if the patient doesn't get better, they can always make a referral to the district hospital 16 kilometers away in town.
This strategy of treat-first-ask-questions-later may work well for those living close to clinics, but for the majority in rural Zambia - follow-up isn't so easy. Most clinic catchment areas can range anywhere from 12 to 30 kilometers in radius - epic distances for people who rely on their own feet as a primary means of transportation. To ask the sick and dehydrated to travel to the clinic for testing and drugs means a journey through a rough, hot, sometimes unbearable landscape. And if the drugs aren't effective, there may not be a second trip.
In the past, many NGO's have trained lay community health workers (CHWs) to provide simple home-based medical attention to those unable to access institutionalized health care. And while Zambia has established policy inclusive of the rural community health worker - rarely does the Ministry of Health provide the resources necessary to properly diagnosis and treat. Joseph Ngwila, a rural CHW that I worked closely with, said that even when he had Coartem to distribute, it never lasted long. Plenty of people came to him complaining of malaria, but beyond assessing for the basic symptoms there was no way to differentiate cases. And so, just like clinic staff, he typically gave it to anyone who looked the part.
During my service, Bydon Tembo and I collaborated with CHWs to conduct surveys on the prevalence of malaria-like symptoms. While the assessments themselves were informal, the findings were staggering: every family interviewed said that at least one child experienced malaria-like symptoms in the span of one month. Now integrated into their routine reporting process, CHWs keep tallies on the number of people that present malaria-like symptoms, submitting them quarterly to the clinic so an overall number can be determined. But until they are armed with testing-kits, it's an inexact process. While training clinic staff and CHWs on the methods of proper diagnosis and surveillance may help, funding must be increased for diagnostic methods so that the medication, and the response, can be better utilized.
As someone who has actually had malaria, I can attest to the miracle of Coartem. It worked perfectly; then again it worked perfectly because I had malaria, testing myself twice just to be sure. For the child at the clinic, the standard artemisinin treatment might have saved her life, but then again it might have made her sicker if the illness was, say, cholera or giardia. In the end the second guessing did not matter: we still didn't have the test. So, doing as I was told, I handed the nurse the medication, she recorded the visit and the mother and child began their long walk home.
Dear All,
Thank you for this wonderful forum! All of you are all fantastic writers! I am just about to end my Peace Corps service and I am finding myself writing essay upon essay in preparation for school/job applications - and it isn't going well! If you could look over this I would be greatly appreciative!!!
Many Thanks,
keatingr
Prompt: a maximum 1,000-word essay about a current development issue and at least one proposed community-based development approach to help mitigate the problem. Be sure to include your best practices from your Peace Corps field experience, if appropriate to your, topic.
Handing the small, under-weight two-year old back to her mother, the clinic nurse turned to the beat-up, old register and wrote: malaria. They arrived at Lusuntha clinic on the eastern border of Zambia earlier that morning; the child spending her third day suffering from extreme diarrhea. Lethargic and miserable, she looked like she was on the verge of tears but her body, so extremely dehydrated, didn't have any left. The nurse turned to me and asked me to hand her a regimen of Coartem - the World Health Organization's "Essential Medicine" used to treat malaria. Throughout my Peace Corps service, I had gotten to know the family personally and saw members washing, playing and drawing water from the same low-lying stream that had become stagnate with the dry season. I knew malaria was a possibility, but so were a hundred others. It seemed to me that the nurse made her diagnosis too quickly, as if she knew what the child had before she even stepped into the room. But to be fair, it wasn't her fault: even if she wanted to test for malaria, the clinic didn't have testing kits - they ran out nearly three months earlier. She did the only thing she could: treat yet another suspected case.
In the remote villages of Zambia, malaria does not necessarily refer to the specific mosquito-borne disease. Malaria prevention and treatment have been so strongly integrated into the Zambian society that the word has taken on a catch-all meaning. Children, adults and even community health workers nowadays refer to malaria as anything that involves diarrhea, fever and body aches. Problem is: most diseases in rural Zambia involve diarrhea, fever and body aches. And when clinic staff diagnose (or patients self-diagnose) cases of malaria that aren't really malaria - the actual infection goes untreated and its potential severity and infectivity increase.
During the wet season, the recorded number of malaria cases rise dramatically. This makes sense: mosquitos carry the disease from person to person and they also breed in shallow pools of water. So: more water means more mosquitos and more mosquitos means more malaria. However, it isn't the only disease that finds opportunity in a wetter environment. First rains wash human excrement and other disease vectors from higher grounds into unprotected water sources - putting nearby villages at risk for cholera and other water borne diseases. Poorly ventilated homes and buildings become stagnate with mildew and moisture - increasing risk for pneumonia and other respiratory infections. And as the incidence of all communicable diseases rise, so does the chance for misdiagnosis.
Zambia receives significantly more donor support for medications than it does for testing kits, so clinics' medicinal supplies often outlast diagnostic. As a result, clinicians and nurses frequently have to rely on their own judgment to decide whether or not someone has malaria. In 2009, routine health data from the Ministry of Health demonstrated that roughly only one in three cases were actually tested and confirmed - the rest were diagnosed on a symptomatic basis. Bydon Tembo, the health officer in charge of the Lusuntha clinic, said he's aware that even he diagnoses many cases of malaria that may not be malaria at all. But, again, there's little he can do without the testing kits. Prescribing Coartem for a case that isn't actually malaria might make someone sick, but not giving the drug runs the risk of more advanced forms, such as the often fatal cerebral malaria. Bydon once admitted to me that he and his staff purposely err on the side of diagnosis; their feeling: why take the chance? They usually have plenty of Coartem - if they run out, they can easily buy the heavily subsidized medicine from the small shops surrounding the health center. And if the patient doesn't get better, they can always make a referral to the district hospital 16 kilometers away in town.
This strategy of treat-first-ask-questions-later may work well for those living close to clinics, but for the majority in rural Zambia - follow-up isn't so easy. Most clinic catchment areas can range anywhere from 12 to 30 kilometers in radius - epic distances for people who rely on their own feet as a primary means of transportation. To ask the sick and dehydrated to travel to the clinic for testing and drugs means a journey through a rough, hot, sometimes unbearable landscape. And if the drugs aren't effective, there may not be a second trip.
In the past, many NGO's have trained lay community health workers (CHWs) to provide simple home-based medical attention to those unable to access institutionalized health care. And while Zambia has established policy inclusive of the rural community health worker - rarely does the Ministry of Health provide the resources necessary to properly diagnosis and treat. Joseph Ngwila, a rural CHW that I worked closely with, said that even when he had Coartem to distribute, it never lasted long. Plenty of people came to him complaining of malaria, but beyond assessing for the basic symptoms there was no way to differentiate cases. And so, just like clinic staff, he typically gave it to anyone who looked the part.
During my service, Bydon Tembo and I collaborated with CHWs to conduct surveys on the prevalence of malaria-like symptoms. While the assessments themselves were informal, the findings were staggering: every family interviewed said that at least one child experienced malaria-like symptoms in the span of one month. Now integrated into their routine reporting process, CHWs keep tallies on the number of people that present malaria-like symptoms, submitting them quarterly to the clinic so an overall number can be determined. But until they are armed with testing-kits, it's an inexact process. While training clinic staff and CHWs on the methods of proper diagnosis and surveillance may help, funding must be increased for diagnostic methods so that the medication, and the response, can be better utilized.
As someone who has actually had malaria, I can attest to the miracle of Coartem. It worked perfectly; then again it worked perfectly because I had malaria, testing myself twice just to be sure. For the child at the clinic, the standard artemisinin treatment might have saved her life, but then again it might have made her sicker if the illness was, say, cholera or giardia. In the end the second guessing did not matter: we still didn't have the test. So, doing as I was told, I handed the nurse the medication, she recorded the visit and the mother and child began their long walk home.