bed net bonnet, anyone?: a guest post by the good doctor

Hello All,

This is The Good Doctor here.  Many of you may not know me so let me introduce myself.  My name is Jean. I have a PhD in Molecular Biology and I’m finishing up my Masters of Public Health here in Ethiopia.  That’s right, I’m a good ol’ non-medical doctor (nMD) and I’m pretty much qualified to do absolutely nothing.  Hence my stint here in Ethiopia…

So I’m kinda into malaria.  It’s sort of my thing here.  I think my official title with Peace Corps is HIV/AIDS Community Counselor, but for some reason HIV is not my cup of tea. But malaria, come on, little parasites that live in your blood cells and are transmitted by blood sucking insects -  now we’re talking!  Nerd Alert, right here…I know.

Bad bed net installation.

My attempt to combat malaria in this country is assisting in bed net installations.  Ethiopia has been great in its efforts to distribute bed nets.  Bed nets are pretty much everywhere.  However, the result of mass distributions of nets hasn’t been as successful in decreasing malaria as one would hope.  And this is because, as I said earlier, bed nets are pretty much everywhere – everywhere except on beds.

Nets are used as head scarves, to secure loads of jerry cans to the top of busses, to protect seedling plants, to line hay wagons, to carry bundles of hay or corn, to dry crops in the sun, to protect the storage of 100 kg bags of crops from bugs, to line beds to prevent fleas, braided together as rope, and an all time favorite – as the roof of a pit latrine.

Creative use (read: misuse) of nets: pit latrine roof, hay wagon lining, made into rope, seedling protection.

So while nets here are everywhere, my plan is to try and get the nets where they need to be – on beds.  What we really need here is help installing the nets.  As I mentioned, most nets don’t even make it to the beds, and let me tell you, the ones that do make it are rough!  They are hung in the most haphazard manner, with huge gaps between the net and the edge of the bed, or so a person is unable to then use the bed, or some nets seem to have had a previous life with a much more industrious utility and are now making it to the bed full of holes.

Graph of malaria cases in a rural Ethiopian town Health Center

I’m starting to work on a Bed Net Distribution and Installation Campaign. My plan is have trainings/demonstrations to heads of households in the rural areas we visit on how to install the nets, then give them a net and check-sheet of how to do it and send them on their way.  A week or so later we pop back in to inspect how it went.  This plan is a bit stalled right now as we’re waiting for the seasonal shipment of nets to come in for distribution.

The Good Doctor hard at work.

Until new nets are available, I have been working in the rural areas with a local Health Extension Worker on installations of preexisting nets.  This means sewing up holes, attempting to reinstall crazily hung nets, and just trying to keep my chin up….oh and trying not to lose my life to some vicious guard dogs.

Malaria season is upon us now.  The beginning and end of rainy season are the worst times for malaria — perfect mosquito breeding conditions.  I’ve been working in the Health Center laboratory in my town diagnosing and tracking malaria cases and this is the month when cases start sky-rocketing.  Both Plasmodium vivax and Plasmodium falciparum are found within my town here in northern Ethiopia.  Last year malaria was the number one problem in my town, accounting for approximately 50% of total morbidity observed within my town’s Health Center.

Generally speaking, malaria in Ethiopia is a problem due to lack of net ownership (or ownership of a net > 1yr old), lack of net use, and lack of treatment seeking behavior. Net use is less in rural areas than urban; in fact predictors of net use in pregnant women are education status, radio ownership, and urban living, therefore making rural areas the focus of our intervention.  According to the 2007 Malaria Indicator Survey (results from the 2012 survey will be out soon) only 41% of Ethiopian women recognized mosquito bites as the cause of malaria and only 38% cited nets as a mode of prevention.  This tells us that we have to get the word out there.  If Peace Corps Volunteers can accompany Health Extension Workers and have them discuss malaria transmission/prevention/and symptoms, perhaps large strides could be made.

So all in all, the nets that are out there need to be hung.  We need more nets to hang.  And we have to convince people to use their nets.  Just a small task for a large group of people who are taking 2 years of their lives to try and change the world…right?