ChildAlive - From the Field

From the Field

April 2008: Launching the Malaria Protection Project in Burkina Faso

In late April 2008, Dr. Ian Macdonald, founder and chairman of ChildAlive, along with Board Member Dr. Stuart Showalter, travelled to Burkina Faso, West Africa, to launch the foundation’s Malaria Prevention Project. With support from the tribal chief of the Kaan people of Burkina Faso, local community liaisons and health officials, Dr. Macdonald and Dr. Showalter visited 12 villages in five days and distributed 445 treated bed nets, 694 door curtains and 539 window curtains, providing protection that can potentially save thousands of lives.

Below is Dr. Showalter’s account of the successful distribution effort.

Wednesday, April 23
Thursday, April 24
Friday, April 25
Saturday, April 26
Sunday, April 27
Monday, April 28
Tuesday, April 29
Wednesday, April 30
Thursday, May 1
Friday, May 2
Saturday, May 3
Monday, May 5
Tuesday, May 6

Wednesday, April 23
Ian and I arrive in Ouagadougou, the capital of Burkina Faso, at 7:40 p.m., where the temperature is around 33° centigrade (91° Fahrenheit). Ian and I are very thankful for the air conditioned rooms at the SIL center tonight.

Thursday, April 24
The morning is spent getting cash in local CFA francs, shopping for supplies, and calling contacts in the southwest Burkina town of Loropéni to help arrange for transportation of the treated bed nets and door and window curtains to the village of Obiré where we will distribute next Tuesday. A good friend named Togo, who drives a bush taxi, agrees to come up to Ouaga with a truck driver friend on his regular Ouaga run and oversee the pick-up and transport of the nets and curtains all the way to the village. Togo is an energetic, reliable Lobi who knows the area and the transportation trade well. We’re very glad he’s willing to take this on for us.

4:00 p.m.
We meet with U.S. Ambassador Jeanine Jackson to discuss details of Somerled Foundation projects in Burkina Faso. Ambassador. Jackson mentions her discussions last week with Madame Priscille Zongo, wife of the Prime Minister of Burkina Faso, concerning her interest in supporting the national fight against malaria. Ambassador Jackson promises to try to arrange a meeting for us with Mme. Zongo after our distribution campaign to report what we will have accomplished and learned from this pilot program. We’re excited to have this high-level contact, and even more motivated to make it go well. I think our village committee will also be even more motivated by the prospect that the Prime Minister’s wife may hear of their work a day or two after it is done!

And speaking of the village committee, I learned in a phone call to the village this morning that our main contact person there, Raphaël, has been hard at work organizing things on the ground, and training the local workers. He had been working with them to practice filling out the questionnaires we’ll use to get info from each recipient of a net or set of curtains. Raphaël has been the director of the local language literacy program for a couple years now, and is dedicated to helping promote literacy in the Kaansa language. We wrote up these questionnaires in Kaansa and in French, the first time the Kaansa language has been used in written form for this kind of scientific research.

5:00 p.m.
Visit to the offices of the Centre National pour la Lutte Contre le Paludisme (CNLP – National Center for the Fight Against Malaria). The director is not there, so we meet with one of his administrators. He receives us well and encourages us in the plan. Later, Ian and I inspect the curtains that have come through BF customs. All seems to be in order.

Friday, April 25
Morning:
We go shopping in downtown Ouagadougou for supplies for our stay in the village. I find it all routine (having navigated downtown Ouaga for more than 20 years), but Ian finds all the street activity fascinating, with the added element of danger due to aggressive street vendors, chaotic traffic and whizzing motorbikes.

Afternoon:
Togo shows up from Loropéni. Within an hour and a half, Togo has 1) hired a porter off the street to move all the bales of nets and curtains to one convenient spot on the SIL center, 2) contacted the truck driver he knows who will take the bales to Gaoua, the provincial capital 25 miles (40 kms) from Loropéni, and given him directions to where the bales are stored, 3) negotiated a price for the transport, which ends up being less than half the starting price.

Saturday, April 26
My SIL project colleague Gloria also came in on Friday, and now starts working on some other net-distribution details. She heads off downtown to find some plywood to make a backdrop for the posters we’ve made to teach about how malaria is transmitted. Once again, we’re using the local language and people who have learned to read it to raise awareness about how to prevent malaria.

Afternoon:
Final preparations are done, supplies are purchased, bags are packed, village people are notified; we’re ready to roll down to the village Sunday afternoon.

Sunday, April 27
The seven-hour drive to the village goes smoothly. Gloria drives a double-cab pick-up truck with six bales of nets and curtains, with Lily as a riding buddy. Lily is the 18-year-old daughter of colleagues of mine who is studying photography in college in Canada. She is coming along to do some photo shoots of the distribution in Obiré.

The roads are paved as far as Gaoua, then we take a graded dirt road to the regional town of Loropéni. After that it’s a rutted, pot-holed, rocky, narrow road for five miles (8 kms) to the village of Obiré. We arrive at around 6 p.m. to the house my family lived in from 1994 to 2003, and where I still return periodically to work with a team of local mother-tongue speakers on the language development project we began in 1987.

Monday, April 28
So much to do today! Ian and I meet with the Kaan Iya, the traditional chief, who is head of the local organizing committee for the net distribution. We hash out some last minute plans and discuss how the big kick-off meeting will go tomorrow. I am once again impressed by the serious effort given by the local committee to make this distribution a success. They have really put themselves into it and thought about many details that I would have missed. They have notified everyone in the surrounding satellite villages, called all the important village elders to attend, done a preliminary census to discover the approximate number of people we will distribute to, invited a traditional dance troupe to perform, and handled many other small details.

Afternoon:
We drive 30 miles back to Gaoua to see the head doctor of the Gaoua health district, the head of all the health clinics in the province, including the one in Loropéni, which handles malaria cases from Obiré. Dr. Bakyono seems skeptical when we first start our presentation of what we hope to accomplish. However, he seems to warm up to the idea as we explain more. In the end, we’re all smiling, and he promises to show up tomorrow at our opening ceremony in Obiré. It seems that our personal visit to him has been very important; we doubt that he would have come if we hadn’t seen him that afternoon. His presence will be very important in demonstrating the importance of the project to villagers.

6:00 p.m.
The 16 bales of nets and curtains sent on a truck from Ouaga show up at my house in Obiré. Now we are fully equipped for the start of the distribution tomorrow.

Tuesday, April 29
The big day is finally here. Gloria drives the pick-up truck down to our house outside of central Obiré by 8 a.m. to pick up bales of nets and curtains. Ian and I meet the members of the local organizing committee at the big, ancient mango tree in the center of the village, the arbre de palabre (palaver tree). The village committee is setting up plastic chairs and benches for the invited VIPs: the Prefect, Mayor, and Police Commissioner from Loropéni, traditional and religious leaders, the Kaan Iya, the head nurse from the Loropéni clinic, and the head doctor of the provincial health district.

By 9 a.m. most of the VIPs are in place, but the sound system we are renting from a local school teacher is not working. His technician is frantically trying to find out why. Seems the amplifier has blown a fuse. After more than an hour delay I ask Gloria if we can use the literacy team’s karaoke machine that runs on a truck battery. She brings it right up and we put on a tape of a local Kaan musician playing traditional music. It works beautifully. Villagers finally start to come to the palaver tree. Raphael gets on the mic and calls to people to come out of the village to the central meeting place. Finally we have enough of a crowd to begin.

I introduce all the VIPs and give a speech about why we are doing this and what we hope to accomplish (create a malaria-free zone). The Kaan Iya and the head doctor of the district also give speeches that are short and to the point. I introduce Ian, who gives a short speech as well. To everyone’s astonishment, the Kaan Iya extends his hand to shake with Ian when he is done – something I have never seen the king do with anyone yet. Kaan royalty generally do not shake hands with people.

Next comes some dancing and traditional music, a skit, and a public reading of posters in Kaansa educating about how malaria is transmitted and how it can be stopped. Then I give some distribution instructions, which Raphael augments with instructions of his own. We escort the VIPs over to the distribution table to show them how we will be operating, then the distribution starts. Since we’re all getting a feel for how to do this, it is somewhat chaotic to begin with. Most people line up in an orderly fashion, and the four clerks are duly filling out the questionnaires.

Our distribution follows WHO guidelines: giving nets for free to women with children under the age of 5, and to pregnant women. But we’ve also added some innovations of our own. We’re allowing people who already have nets to trade them in for a new one, no matter how damaged, old, or dirty their old net is. We’re also handing out treated curtains to men and women to hang on the windows and doors of their houses. This, we hope, will provide some protection in almost every inhabited house in the village, so that we will reach critical coverage and be able to lower the incidence of malaria significantly.

The Kaan king oversees the whole ceremony, checking off the prepared list of women eligible to receive the free nets, and makes some valuable suggestions about how to adjust our system tomorrow

We finish the distribution by about 3 p.m. The villagers start a traditional dance as we pack up our things. We watch for a while, then return to my house, pretty tired from the day’s activities, buy very happy that things have gone pretty well.

Rough distribution numbers for the day: 89 mosquito nets, 105 window curtains, 130 door curtains.

Wednesday, April 30
The King comes down to my house at 8 a.m. as planned, and we hold a short meeting on how to deal with some of the problems that arose yesterday. Since the King and the village working group had prepared themselves by making a census of the local population to find out how many women would be receiving nets, we will make good use of their hard work to use the list to regulate access to the distribution point. This will avoid much of the crowding and chaos that developed yesterday at times.

The issue of how to deal with men feeling slighted by not getting nets (except when they exchange an old one for a new, treated one) was solved by simply adding better explanation of the reason for the distribution (to protect the weakest and most vulnerable), with further explanation that curtains have proven to be as effective, if not more so, as the nets in a study in Kenya. The reality is that some people are more ready to put up treated curtains than to sleep under a net, especially when it is really hot inside the house.

With these slight changes in mind, we set out for the next hamlets - He’re and Khonthan (where I live), and later Tahuron. The explanations and distribution went very smoothly. Ian was holding up well, taking lots of photos as usual, and really enjoying the interaction with the people of the village. Ian, with no French or Kaansa or any other language local people can speak, was able to communicate with the villagers with gestures and smiles, and they accepted him as a friend.

1:15 p.m.
Done with the last scheduled village of the day. Do we press on? Everyone seemed in good spirits. The King is willing, and so is everyone else, so we decide to take a lunch break, then go on to the next village on the list at 3 p.m.

3:30 p.m.
We drive across the dry creek bed on a wide path and arrive in Nyimiye for the final village distribution of the day. We finish there by 5 p.m. and are glad to pack up and go home, glad to have done an extra village today and get ahead of schedule. It looks possible now that we might be able to finish the distribution on Saturday instead of Monday, as planned.

We really appreciate the time and personal attention the Kaan King has given to this project. We hope that it helps him establish his name and respect among his people. He’s young, around 30, and enthroned just three years ago. This is probably his first big project to help his people develop and improve, so he is giving it a great deal of personal attention. May it be a great success for him.

Thursday, May 1
Mayday in Burkina Faso, a national holiday. In Ouagadougou and Loropéni, government workers and school children have the day off. In Obiré and its satellite villages, it seems like any other day.

We arrive in Ithabuntanga (means ‘the royal well’) and gather the village inhabitants. All goes smoothly here.

We move on the Nahusongo, a short drive down the path from the first village. We wrap up here by 11 and head back to central Obiré to get the road out to Nyogothan. Half of this village was wiped out by a freak fire in February of 2007. Though no one was hurt (the villagers were all off working in their fields), more than 20 huts were destroyed, along with everything in them. I was able to solicit donations of clothes and cash from one of our supporting churches, and delivered the gifts during my next visit. Since that time we have had a special relationship with this village, and their appreciation and good will showed in the huge turnout and friendly welcome they gave us.

By 1 p.m. we were wrapping up, and so the team decided to try to do two more smaller villages in the afternoon. These were the first villages we could not drive to because the paths were rough, narrow and overgrown by the bush. So we parked the truck in an open rocky area and walk 5 mins to the first village. The local committee had called people from the second village to come into the first one, so we were able to distribute to both villages in just one visit. We wrapped up these two villages by 5 p.m. and packed our stuff out to the parked cars.

Five villages done today – very satisfying.

Friday, May 2
It’s market day in Loropéni, and most of the Kaan villages within six miles (10 kms) are empty. So we did not plan any distribution today. Instead, Ian and I worked on several small projects, including organizing the information we have gotten from each recipient, and writing up a first accounting of materials given out. According to our records, we have distributed 382 mosquito nets, 629 door curtains, and 467 window curtains so far.

We also started getting some feedback from people who had put up their curtains and slept under their nets already. The brother of one of our local team members was all excited about having watched mosquitoes and other insects fall dead from having landed on the net he had over his bed. We went out to visit Daniel, the caretaker of my house in the village. He had put his net and curtains up and showed us the little piles of dead insects on the floor below them. Word is traveling around the village that these nets and curtains really work.

Saturday, May 3
The last two villages today, and the most remote: Khabthe and Buro’ro. To get to them, we have to drive the truck and supplies up to Safihe’re, about 2½ miles (4 kms) northeast of Obiré, park the truck in the courtyard of a friend, unload the bales of nets and curtains, the speaker system, the truck battery to power it, the box of questionnaires, and all other supplies needed for our distribution visits, and tie them to the backs of motorbikes or mobylettes or bicycles, or lift them onto the heads of porters who have come to meet us from the village.

The village elders of Khabthe greet us warmly and have already arranged chairs and tables under a tree where we can gather the village for the distribution. The Kaan king shows up about 15 minutes after we do; he’s constrained by custom to walk slowly with a deputy going before him. We guess that this is frustrating for him, since he is a young man who could easily keep pace with everyone else. But such a thing would be undignified for a king, so he comes along finally at a more dignified pace.

We finish in Khabthe, load up our things, and walk for another half hour up to Boro’ro. . There is a good turnout in both these villages, but before we know it, we’re handing out the last net, filling in the last questionnaire, then packing up what’s left, shaking hands all around, and walking back to the truck. The team disperses in Obiré, and we set a meeting to evaluate and plan for the future for Monday at 9 a.m. in the King’s courtyard.

Monday, May 5
This morning at 9 a.m. we held a final evaluation and planning meeting in the king’s courtyard in central Obiré. I paid the campaign workers, thanked and encouraged them in the good work they gave us. We also discussed problems that have arisen, or that they might foresee in future distributions.

On interesting problem had already come up: women in the traditional mourning period, which follows the loss of a husband or a close male relative, can’t touch or use things that are the color white until their mourning is over. This can last up to a year or more. This means they would feel they could not sleep under a white mosquito net. We discussed possible solutions to the problem, Dye nets another color? Would that have an effect on the pesticide? Just use the curtains on the windows for that period? Can they use white curtains during that period even if they couldn’t sleep under a white net? We didn’t come up with any simple answers for that one. We’ll see through the follow-up visits how much of a problem this might become.

The local committee met to plan for the next stages of distribution. They will take a census of women with children in Kassithan, Bopthan, and Togo. They will also count the number of inhabited houses in those villages to give us some idea of how many curtains we would need to distribute. We planned to do one village with curtains only, one with nets only, but which village will get each set will be determined after the census.

We leave Obiré around 11:15 a.m. During a stop for a cold coke at a restaurant in Boromo, we call the U.S. embassy, and learn that Ambassador Jackson has arranged meeting for us with Madame Zongo tomorrow!

Tuesday, May 6
Ian gets everything packed and ready before we leave for the Prime Minister’s residence.

At the residence we are ushered into a large salon with comfortable leather couches arranged in a squared semi-circle around a low table with a white marble top. Already sitting there are two faces Ian and I recognize immediately. They are Drs. Sanou and Tiendrébéogo, high level public health officials who helped us significantly in 2004 to learn about the meningitis situation in Burkina Faso. Dr. Sanou has now been promoted to General Director of Health, just underneath the Minister of Health, and Dr. Tiendrébéogo is now the head of the Direction de la Lutte contre la Maladie, the Burkinabe equivalent of the Centers for Disease Control in the US. We greet each other with smiles and handshakes, and already we begin to relax a bit.

Mme. Zongo arrives. After being served drinks and snacks, she gives us the opportunity to describe what we have done in the village of Obiré. Ian speaks in English, and I translate into French. Ian talks extensively about the project with the two doctors and with Mme. Zongo. She listens carefully and asks some good questions, particularly about Ian’s background and what our hopes for future involvement are. On a few technical questions she asks the Burkinabe doctors for input, and they confirm the technical aspects of our project, and even praise the plan of having villagers name a contact person who will be involved in the follow-up in each sub-village. In their own projects they call people like that relais communautaires, community liaison people.

Mme. Zongo is cautious in her questioning, but seems to relax a bit as we discuss more detail and as she learns more about Ian’s background and his foundation’s goals and desires. She also sees the good relationship we already have with Drs. Sanou and Tiendrébéogo. She agrees to allow us to post a photo of her with Ian on the website.

We left with high spirits. It was a good meeting which, we hope, established us as serious players in the malaria program in Burkina Faso. We were particularly happy that our previous work in meningitis had laid the groundwork for good relationships with two key people now at the highest levels in the public health service.

Ian took off on the 8:15 p.m .flight to Paris, and I will head back down to the village tomorrow, after writing and delivering a quick thank-you note to Mme. Zongo, and sending a quick email message of thanks to Drs. Sanou and Tiendrébéogo.