17 Novembre 2010

Last week we had mosquito net distribution here in the SAVA region complements of USAID, the President’s Rollback Malaria initiative and the NGO Population Services International. Every house in every fokontany (village) in the commune (county) was supposed to receive enough long lasting insecticide treated bed nets to protect all members in each household. It was quite an operation to say the least.

When I came back from my regional meeting with the other volunteers down in Antalaha at the beginning of November, I was greeted by about 200 huge white bundles of mosquito nets sitting on my porch. Each bundle had about 40 bednets plus packaging, weighing about 50lbs each. I guess since I live in a huge house right next to the hospital, they figured it would be the best place to store all of said nets. At least there was a small pathway on the porch conveniently left for me to enter my house. So as soon as I got home I helped the president of the hospital roll all the hefty packages inside.

A few days later there was a training session for the workers who were to distribute the nets. Before the distribution week began, the village leaders had to go around to each house in each village and record the head of household’s name and the number of people currently living in the house. The leaders then had to assign each household a number and write said number on the outside of the house.

A big truck came by to drop of mosquito nets at several distribution centers in the commune: one at my house, one 7km north and one 9km south along the main road. Then people from villages further away had to come to the three distribution centers to carry the huge 50lb bundles by foot all the way back to secondary distribution centers (some as far as a 2hr hike away). During the distribution week, bed nets were given out to a different village in the area each day of the week according to a set schedule. The end of the week (Saturday) was a free for all, with all those who had not received a number on their house the week before scrambling for the remaining nets that were left over from the past week.

Since there were plenty of people to help with distribution in town, I went out to a smaller rural village that I frequently work at to help with bed net distribution there. I assisted mostly by giving health talks during the week on malaria prevention and with some of the paperwork. I also requested the public health NGO PSI to come with their cinemobile at the end of this week to show a film on malaria prevention.

It was interesting just observing the whole process to see what the hang-ups were and how such a public health intervention could be improved in the future. The trickiest part was accounting for the middle school and high school students who study in big towns during the week and go back to their homes in the rural villages on the weekends. Some people thought the students were supposed to be accounted for back in their villages while others believed the students should receive a net in town where they study during the week. Other people were sneaky and sent multiple family members to pick up nets at different times of the week, claiming that they had never received a number on their house when in fact they had. Others missed the whole number-on-the-house thing the week before and never received a net at the end of the week when some distribution centers ran out.

The program might have worked better if the count was done by number of beds per house rather than number of people. The ratio was three people to one net, which would work if there were two adults and a small child; however three adults sleeping in separate beds in the same house should probably receive more than just one net. Other people who have only one bed in their house received as many as three nets, because they have a lot of small children or children studying in other towns that they still counted as part of their household. The discrepancies caused a lot of frustration among community members and bed net distributors. If the village leaders had simply entered each house and counted the number of beds, which should equal number of nets distributed, their might not have been as many discrepancies. There’s no reason for someone to receive three nets when they only have one bed in their house. But at least a lot of people got insecticide treated nets, and hopefully the herd immunity effect will help protect everyone against Malaria this year. Rainy season is coming up, and there have already been several deaths this past month at the hospital due to Malaria so I hope the program proves successful.

Either way, there were a lot of angry people crowded outside my house Saturday evening fighting over nets, with distributors working on my front porch from 8am until 7pm. So I decided to have dinner at my neighbors’ instead that night. It was actually kind of nice…we hung out, chatted, took some shots of home-made Malagasy whiskey and had some kind of fried insect that they eat here along with our rice for dinner. Being the adventurous Peace Corps volunteer that I am, I partook of the local fare, which was actually surprisingly tasty.

Unfortunately I found out later on that evening that the insect must be in the same family as yellow-jackets, which I am very allergic to. As I was getting ready for bed, I started breaking out in hives, so I popped two Benadryl and called the Peace Corps doctor. He advised me to use my handy Epi-pen if the symptoms got worse. So once my face swelled like a balloon, I couldn’t hear because my ear canals had closed up and my chest started tightening, I decided to bite the bullet and jab the unpleasantly gigantic needle into the side of my thigh. The stick was surprisingly painful, but at least I could breathe after that, and I started calming down. I was still very itchy but was finally able to fall asleep and woke up the next morning much improved. The only remnants were a very sore right thigh and still slightly swollen eyelids. I guess that’s what I get for trying to integrate into another culture. But at least it made for a good story.

On a side note, when I was helping out with bed net distribution in one of the other villages, a guy came in to pick up his net and was wearing the most unique outfit I have seen yet here. That’s saying something considering some of the ensembles the Malagasy manage to put together. They have some of the funniest used clothing here, which probably is shipped over in bulk from Salvation Army or Union Mission or something. I have seen everything from pink frilly princess gowns to college mascot t-shirts to 80s style Technicolor warm-up suits. But this guy came in wearing a bright yellow plastic construction hat, a t-shirt with a cartoon of a Rasta-man playing bongos and a black, faux leather trench coat with fake black fur along the hem and the collar of the jacket. It was a pretty amazing site.

Today was election day…the Malagasy are voting on a referendum on the constitution, which meant every one was at the polls (the local elementary school) and the rest of the town was really quiet. It also meant that there was no school today, so I could finally have my very first meeting with the healthy teen club members!

I headed to the CEG (local junior high school) expecting maybe 10 kids to show up, but there were actually around 85. We met and talked about what my goals and hopes for the organization are: to improve the health of community members in general and youth in particular, and to help the youth develop skills to set goals for themselves and to make healthy choices in life in order to achieve those goals. I also asked them to think about what their goals for the organization were. Then we shared ideas for health projects activities the organization could do in the community and started to come up with a program and schedule of how often we would meet.

Everyone seemed really interested in learning about HIV/AIDS, STD prevention and family planning, so I’m very excited about that. To end the meeting, I taught them a song in Malagasy about HIV/AIDS prevention (to the tune of Shakira’s World Cup song “Waka Waka”). We had a great time, and some of the students even walked me home and hung out with me for a while at my house. We chatted about Peace Corps and the U.S. and about life in America versus life in Madagascar. I explained to them about how young adults in the States often wait longer to get married and have kids, because they like to graduate from college first and get a job to earn money before starting a family. It’s a totally different concept to them from what they see every day here: fifteen year olds leaving school to have children out of wedlock and families with an average of five to seven kids. There are still high rates of illiteracy and elementary and middle school drop-outs. Some of the students in the group seem very smart and have a lot of potential, so I hope they get something out of the program I’m trying to start up with them.

In the afternoon I went over to one of my friend’s houses to hang out. We had the most interesting conversation about homosexual, bisexual, transgender and transvestite individuals. I think it’s so cool that I can actually talk about those things in Malagasy now. It was just really fascinating to hear about local people’s perceptions of the LGBT community here. My friend seemed totally fine with the idea of homosexuality and bisexuality, but she seemed to have a negative perception of transvestites (men dressing up as women in particular). Apparently there is a whole openly gay neighborhood in Antananarivo and quite a few men that dress up as women in Nosy Be! It was funny to see her reaction when I tried to explain about transgender individuals and sex change operations. I’m sure it seems far-fetched to people here, in a country where a majority of the population can’t afford clinic fees for the most simplest of procedures, such as properly setting a broken bone. And to think that the whole conversation started with the topic of earrings.

Parents are coming soon, and I get to go on my very first vacation since I left the States in October of last year. I’m very excited for everyone here to meet them, and I’m also looking forward to seeing more of this unique and amazingly diverse island over the coming weeks.