'The Village'

It is still the rainy season here but thankfully most of the torrential downpours occur at night. The nights are much cooler however the days are still very hot! I thought I would’ve acclimatized by now but unfortunately I still walk around pouring in sweat much to the amusement of our Ugandan colleges. With the increased precipitation, there is a visible increase in the amount of mosquitos around, which as expected equates to an increasing number of children admitted with severe malaria despite the amount of preventative work going on all over Africa. As part of malaria prevention initiatives, most households in many countries in sub-Saharan Africa are given a number of free mosquito nets. This is especially valuable in rural areas where the incidence of malaria in children under 5 is particularly high. I can vouch that these initiatives do take place as several friends and family have been supplied with mosquito nets.

Hence my confusion at the incidence of severe/complicated malaria in the children we see at Jinja. A vast majority of them are from the rural areas which are the targeted areas, so most of them should have free nets. We often ask them about preventative methods and although the majority of them admit to receiving mosquito nets, whether they use these nets is another question. On a recent ward round, the issue of whether parents use mosquito nets or not created an interesting debate. Much to my disappointment I am informed by reliable sources that most of these families in ‘the village’ have found alternative, more lucrative uses for mosquito nets;

1. Making several vests for the men of the house to wear
2. Fishing
   
   
   
   
3. Collecting large numbers of plastic bottles to be recycled for a reward
4.  On a medical side, apparently even we doctors are using them. Mosquito nets are also very good for hernia repairs.

Aside from these profitable alternative uses for mosquito nets there are also several myths about nets (e.g. it is government propaganda to harm people, and that mosquito nets kill babies). I am not surprised about these myths; it wouldn’t truly be Africa if there were no myths (I’m allowed to say this, I’m African after all). I suppose that all of this suggests a new plan of attack for our malaria prevention strategies. We need to go to ‘the village’. Health education in these communities is just as important, if not more important than all the work we are doing in the hospital. The only problem is, after all the tales of cannibalism and kidnappings I have heard occur in ‘the village’, I am slightly scared.