Well, I’ve just a few more days left of my Malawian adventure, so I thought it was worth writing an update. Just to recap, I’m here in Malawi running a small study in which health workers (known as health surveillance assistants, or HSAs) are collecting information on people in their communities who have symptoms of lymphatic filariasis, namely lymphoedema (swelling of body tissue, most frequently in the legs) and hydroceles (swelling of the scrotum – can be very large in size). As well we recording this information on paper forms, we’ve been exploring whether it’s possible for the HSAs to submit the information to a central database via text message. There’ve been a few little obstacles along the way, but overall things are going really well. We’re at the tail end of the ‘verification’ stage at the moment, where we’re visiting some of the people the HSAs have identified, and confirming whether or not they have the condition. So far we’ve visited around 45 villages, with around another 10 to go. Believe me, this has been no easy task. Unlike in the UK where we’re now all a little bit too used to popping an address into a satnav or our phones, then mindlessly following the directions we’re given, it’s pretty much impossible to do that here. There are three main reasons for this:
Despite my best efforts, I’m pretty certain that no map of the location of the villages in the area we’re working in exists. In planning our route, we’ve been completely reliant upon the HSAs’ knowledge of the area. There are a few hand-drawn maps knocking around on the walls of the health centres, but not all villages are represented.
- Roads are not as we know them. There are main roads running up and down the country, that despite the frequent potholes are pretty usable (and are tarmacked, which isn’t something that can be assumed in general), once you leave the main road things become chaotic very quickly. In rural areas, cars aren’t that common so the ‘roads’ are mostly used by bicycles or people walking, and often if you don’t know what you’re looking for are indistinguishable from the surrounding countryside. Plus, if it rains even a tiny bit, they very quickly become impassable as they turn into mudpools. Luckily,it’s been very dry in the area we’ve been working in! We have however has to exclude some villages from our survey, as you can only reach them by crossing a river in a boat, and the danger of crocodile attacks is too great for me to give it a go. I have however noted that even in the most rural areas you still get interrupted by the ringtone of a mobile phone.
Once you’ve successfully made your way to the village, it doesn’t quite stop there. The areas we’re working in don’t really have a proper address system. So, no house numbers, no street names. Many people write their name and their phone number on the outside wall of their house to indicate who lives there, but generally if you want to find a particular person you just have to ask someone to point you in the right direction.
So yes, the HSAs’ knowledge has been invaluable. This is certainly not a project that could have been undertaken without the cooperation of the community.
Unfortunately, the results of the study are top secret so I can’t give away any numbers, but it’s safe to say that the general message I’ll be going home with is that conditions relating to lymphatic filariasis are a big problem in this area, and it is a problem that needs to be addressed. In particular, there’s a shockingly large number of people with hydroceles in the area and as it’s a sensitive topic (and as such some men don’t want to identify themselves as having it), then I suspect that this problem is still being underestimated. The saddest part is that the condition is ‘curable’ via relatively minor surgery, and even though this surgery is free for men in Malawi, many can’t access it just because they can’t afford to travel to the hospital or take a day or two off work. At the moment, in the district we’re working in, the only place they can access surgery is at the district hospital, which for some of the cases identified is about 40km away down various quality roads. One way to tackle this problem is to run mobile hydrocele surgery ‘camps’ during which the surgery comes to them rather than they go to the surgery. Fingers crossed, the funds are found for this soon, as some of these people really need help.
During this trip, my eyes have seen so many things that I wish I could share with more people. When visiting these rural communities you’re faced with the juxtaposition of severe poverty alongside big smiling faces. I feel like I’ve been very disruptive, as as soon as the car drives into the villages, the kids all start to flock towards it, and once they spot a white person getting out of it, well, chaos ensues. I feel like I’m this great big shiny white beacon as I get spotted from so far away. And I’ve no idea how the message travels so quickly, but within a few minutes, more kids are seen in the distance running towards us, shouting excitedly ‘Azungu! Azungu!’ (white person). It’s nice to make so many people smile just by standing there. I get the odd English phrase shouted at me (ranging from ‘We love you’ to ‘What is your mass?’), but mostly they stare shyly. There’s an air of freedom around the kids in the villages, as they roam around in the droves, mostly unsupervised by adults, using their imaginations turn absolutely anything into a toy, yet I worry what the future holds for many of them. The cycle of poverty is hard to break. Family sizes are large in Malawi, and although primary school is free, secondary school is not, and sadly for many children, especially girls, this relatively small fee is enough to halt their education. And so, the cycle continues….. I don’t claim to know the intricacies of the problems faced by those living in rural Africa or how to solve them, but hopefully this work that we’re doing will have a teeny tiny positive impact on people’s lives a bit further down the line. I’ll let you know!