No one should die of malaria today

I spoke to Egleé a week ago, just ahead of project leaders’ return to the Amazon to continue community visits to the Indigenous communities leading this work, starting with a visit to Betania. Over the next four weeks, they will reinforce the strategies set up for epidemiological vigilance and control over malaria, and deliver mdicines and medical equipment.

The headline is, “No cases of malaria in Kayama since November!”, Egleé said. “In an extended community of almost 1,600 people, no cases—neither autochthonous (the parasite is in the community, the transmission is within the local population) nor imported (the malaria comes from the outside)! And very few cases in Caño Iguana—only 6 or 7—since the last time we visited in December.

“Malaria used to be the topic, the thing we talked about all the time. Now when we communicate, they don’t even talk about it! Instead, we talk about weather, other health issues, hunting or….”

These community-led impacts—and our ability to deliver, document, and share them—are possible thanks to the generosity of you, the project’s donors. And now those impacts, combining prevention, rapid diagnosis and effective treatment, have come to the attention of national and international actors working to address malaria in Venezuela and beyond! But I’m getting ahead of myself. Egleé shared the following detailed report on the project’s work since our last report to you.

“During December 2022, project leaders returned to the Jotï community of Caño Iguana (AmazonasState, Manapiare, Alto Ventuari). We continued the training, distribution of long-lasting insecticidal mosquito nets (LLINs)), medical supplies, generic medicines targeting morbidity and especially enough Rapid Diagnostic Tests (RDTs) and treatments for malaria, reaching our numerical targets in all categories. See Table 1, below: Caño Iguana (Jotï) by the numbers.

We attended several community meetings, and it was a wonderful surprise to see the results accomplished in the area by the community’s implementation of the malakits: the portable kits for malaria diagnosis and treatment. The way the Jotï have appropriated the strategy to control, diminish and eventually eliminate the malaria and made it their own was amazing!  Each responsable, the person responsible for one or more of the (25) sectors that the Iguana area is composed of, truly took care of the people with malaria or malarial symptoms. They walked from their home sectors to meet with us and report what had been doing since May of 2022. A synthesis of what was done and found is represented in the Figure 1 (table and pie graphic, below). 

Figure 1, below. Sector-based strategy for malaria control: Sectors of Jkalo Ijkwala, or Caño Iguana, by name, population, person responsible (sector head), rapid diagnostic kits used, and cases recorded.

The sectors are to different distances from the ambulatorio where the clinic and the only microscope to diagnose malaria are located, some as far away as two day’s walk. The possibility of a precise diagnosis through the proper use of RDT, supervised by a well-trained sector head are therefore crucial, given that most people are too far from the diagnostic microscope to get there, especially when they are ill. Now, each sector head has the diagnostic kit, treatments and training to use it on hand, and can give it to anyone affected (see Image 1 and Image 2). If the test is initially negative, they will repeat it in 24 hours. If it is positive, the correct diagnosis and immediate treatment can save the life of the patient, and also stop transmission.

The impact is to stop malaria before it gets severe and before it is communicated to others nearby.

Image 1, below: The sector heads meet, compare experiences, and organize their work: all have walked from their sectors to the control point at the central clinic in Caño Iguana. The pictures show the used RDTs being classified by each sector’s population while the data is processed onto the accompanying forms

One of the most amazing results and our best metric is the reduction of malaria cases and zero mortality.

Image 2, below: The forms above the RDTs from each sector record minute data of the person with malaria symptoms (name, age, and condition, like pregnancy or another specific health issue); the date when the test was performed; the result; if positive the Plasmodium specie; and the treatment provided among other data.

Image 3, below: The Rapid Diagnostic Tests (RDT's) used by two health leaders in two of the 25 sectors.

The new year has been one of intense and formal articulations with several key actors in the work for the elimination of the malaria in Venezuela. Since early January we were invited and selected to be part of the Technical Group for Malaria (TGM). The main goal of TGM is to put together a structured plan, suggested and followed by civil society actors (like us!) in line with Pan-American Health Organization (PAHO) and the Health Ministry’s National Strategic Plan for Malaria. We have been attending weekly and sometimes twice-weekly meetings that can last all day. It has been a huge learning experience, and has afforded an interchange of views and approaches that can be extrapolated to other Indigenous/rural/urban peoples vulnerable to malaria in the most endemic areas.

We’re at the table with PAHO and the Health Ministry, and also United Nations Development Program, Doctors Without Borders, Medicos del Mundo (Spain), Rotary Club, Proyecto Maniapure, and Proyecto Acoana, among other marvelous, committed people. Our project, though, is the first to test the malakits anywhere in Venezuela. Partners and supporters of the Group are gladdened by its success in multiple cultural contexts. They emphasize the importance of our commitment to work always by honoring community requests, in collaboration with community and partner expertise.

Thank you once again for making the amazing work of these communities' possible! Please keep us in your hearts as we visit diverse Indigenous communities in Amazonas State over the next month."

In the last three months, the team visited two out of our three project communities: Betania (Sept-Oct 2022) and Kayama (Oct-Nov 2022)! Following the Pan-American Health Organization strategy to reduce or even eradicate malaria, we committed to developing the best possible understanding of population demography, distribution and movement. We elaborated a detailed population census of both communities (see images of population pyramids, below), and linked malarial prevention and tracking efforts with community sectors (the equivalent of a neighborhood, or census block). We continued training on use of the RDTs, portable diagnostic and treatment kits for malaria. We translated all the steps for self-diagnosis into Jotï, Eñepa and Piaroa, the three Indigenous languages, and compiled them in a sort of brochure with pictures and drawings. We also made videos in the three Indigenous languages, requesting that each community's malariologist, or malaria prevention and treatment personnel, explain the self-diagnosis steps, materials and process, as well as the treatments. 

We were able to accomplish a lot more, besides. You can help us to accomplish even more, as we head back into the third project community this week! Your donation to the project on Giving Tuesday, November 29th, will receive matching funds from GlobalGiving. But enough about that--we have so much more to tell you!

We are very content with the results of our recent work, including the distribution of 2,500 mosquito nets (LLINs, long-lasting insecticidal nets); 3,525 Rapid Diagnostic Test (RDTs) individual buffer kits; 1,450 Rapid Diagnostic Test (RDTs) packages, enough treatments according to current morbidity and mortality (0), and many more items needed to address malaria, as the table below shows! Our project has had a very positive impact, according not just to the figures above, but also to the testimony of the Indigenous people who recognize how the cases have been reduced since we started. They are seeing significant reduction in morbidity (people becoming ill from malaria) and mortality, the latter reduced to zero. The greater availability of treatment is also recognized. A nurse in Kayama got malaria shortly after we returned to the city. She messaged us using the new communications device we'd left for community medical use, and told us, “Shoot, I have malaria, but thanks to you, I also have a diagnostic and treatment kit!”

We donated two microscopes (see the picture of the Eñepa nurse receiving it, below), and a critical assortment of medicines for all the prevalent ailments in both communities. The medicines have been deeply appreciated, since from the beginning of the pandemic until now they are the only ones that have arrived to the community clinic (ambulatories; see the picture of appreciative people in the community of Betania).

As part of our effort to help the people to fight malaria, we helped Kayama to install a communication system, acquiring a radio transmission with its corresponding antenna and 100 ft of coaxial cable, along with an InReach satellite communications device paired with a cell phone. That equipment allows us now to know the incidence of malaria with precise numbers each month (see the pictures of installing the antenna). We also donated a new laptop to allow the malariologist in charge to maintain a proper record and be more able to properly communicate the reports, maintain an updated census, and overall support the needs of the community with more modern technology.

We keep learning the amazing sharing ethics so engrained in these communities: we took about 9 pairs of reading glasses, and in a community meeting the nurse decide to distribute them among the most in need. I grabbed a pair and gave it to a good friend who I knew needed it, but he returned to me right away saying: "I will wait until all that are in need have one pair if there is one left, I can take it!" Sharing is central for survival: food and laughter, ailments and sadness, pain and work are equally shared.

Thanks!