No one should die of malaria today

We greet you on project leaders Egleé and Stanford's return from 12 packed days in the Jotï and Eñepa community of Kayama.

On March 14th, Egleé wrote, "We are entering Kayama tomorrow really early in the morning by small plane, loaded with 30 boxes of medical help and supplies, anti-malaria medicines, and mosquito nets.... We are very happy about it. Among the medicines collected, bought and donated are 1500 complete malaria treatments--a year's supply; about 1400 self-diagnosis tests, equally all equipment necessary for the diagnosis with the microscope of malaria, including 2000 microscope slides and 2000 slide covers, additionally medicines for a range of tropical diseases, we even got a soccer ball!

She and Stanford returned just over a day ago, on March 27th, and Egleé was able to share a few photos and a first report of their visit.

Most significantly, they trained Jotï and Eñepa community members on malaria self-testing and treatment kits, designed to serve community members on their journeys deep into the Amazonian forest. The training, and the 1,400 self-diagnosis test kits they delivered at its conclusion, represent the pilot launch of a new Pan-American Health Organization (PAHO) campaign, in concert with the Venezuelan Health Ministry, to eliminate malaria in the region. The strategy equips communities with tools and culturally-specific training to take control of infection management, limiting the spread of the pathogen through continued prevention, but also through treatment, not just in community health centers, but when and where infection first occurs, as people travel far from those centers. The goal is to stop infections early, limiting vector transmission, and reducing and eventually eliminating the pathogen's spread.

"We are so excited to be aligning the strategy of our project with the PAHO strategy to eliminate malaria!" says Egleé. "The whole thing came and flowed in a nice way." Children proudly helped Egleé and Stanford turn the kit's instructions into a series of Jotï and Eñepa-language illustrated posters, for community-wide training sessions.

Community members have worked tirelessly to grow their capacity to deal with malaria and avoid its deadly impacts. They emphasized how pleased they were by the success of the nets the project delivered some 3 years ago. And they immediately appreciated how small, field-ready, pocket-sized self-diagnostic and treatment kits for malaria would fit within and extend their existing set of tools, strategies and practices. Egleé notes that, other than the general strategy of self-isolation and community dispersal when malaria begins to spread, there are few traditional strategies to deal with the pathogen. That is likely because malaria is not indigenous to the region, but rather recently introduced and spread by miners and mining activity. 

In addition to these kits, and the medicines and supplies Egleé lists above, she and Stanford took advantage of the slightly larger capacity of the only available small plane operator currently flying in the region. They brought along salt and soap at the community's request--basic supplies terribly difficult to acquire during the pandemic. They shared 100 copies of the 500-page, full-color Jotï-Spanish bilingual book co-authored with the community just before the pandemic, about themselves and their territory. And on their return flight to the nearest city with a medical center, the pilot also transported several community members facing health issues so severe that they could not have walked the 9 days needed to seek help on their own.

Going forward, Egleé says, "We want to center malaria, but also other diseases." There's a failing community radio, and many more nets to be replaced. There's also a need to co-design and implement options for trade that don't involve taking up gold mining, a  suggestion from their nearest non-Indigenous neighbors that deeply troubles Kayama community members.

We'll tell you more about these and other things, next time.

Thank you, friends, for making this work possible. This most recent visit reaffirms our belief that our project remains grounded in two things: innovative, collaborative partnerships within and beyond these Indigenous communities, and respect for community decisions that support and enhance wellbeing. Your support uplifts us, quite literally, and carries us where we need to go.

With this report, we announce a new phase of work of the project. Your contribution, today, will help us to once again deliver lifesaving results.

In preparation for a return to Venezuela this winter, Egleé has been back in touch this week with members of the amazing network that enabled delivery of those 3,000 insecticidal mosquito nets, almost 2 ½ years ago: the bush pilot, the health worker, the local doctor, tthe malarial specialist, he NGO leader, the shipping contractor, among others. Their consensus? After a year without visits by medical personnel to any of the three communities since early November 2020, there is critical work to be done, and it is newly possible to do it. “Our project strategy looks promising, with different dynamics,” reports Egleé.

We were delighted to learn that, thanks to an initiative of the United Nations Development Program (UNDP/PNUD), the government has offered to take up the work of providing nets and key antimalarial medications and diagnostic supplies to Atures, Manapiare and Cedeño, the counties that include Jotï, Eñepa and Piaroa sovereign territory. The UNDP partnered with Venezuelan health authorities to acquire all the necessary anti-malarial paraphernalia (preventive medications, treatments, diagnostic kits ) including all the estimated nets to fulfill the Venezuelan population exposed to malaria —including ones designed for hammocks. They expect to receive all these materials between January and February 2022. How wonderful, says Egleé, “to think that the mosquito nets can start to be part of the government health policy!”

The news arrives just in time, as the current nets approach the end point of their useful 2-3 year insecticidal life, and antimalarial medications have run out. After an astounding 2 ½  years of without a fatality from malaria in any of the three communities, news of the first lethal cases just reached us, via radio: two Eñepa who fell ill while they were outside the community, and also some members of the nearby Pemon community have ded of this terrible disease recently.

While the government/UNDP initiative is tremendous news, Egleé also learned, “there will not be resources for the little plane flights for distribution of the nets and medical supplies”. The new initiative doesn’t include last (several hundred-) mile delivery to small, isolated communities. 

That’s where your support comes in: no need for the project to navigate trans-Pacific shipping this time—but a critical need to cover other costs:

- the direct distribution to communities of the new nets, specialized medications, diagnostic materials, and training on use of both by trusted personnel. They’ll travel via small plane or by truck, accompanied by members of our project. This is the most important—and most costly—component of this new stage of the project.

- generic medicines and supplies associated with diagnosing and treating malarial infection that we’ll procure for the ambulatorios, the community clinics, to complement the specialized medications provided by the government. These items range from a new microscope, slides and vials for the dedicated microscopist in Betania de Topocho (first requested before the pandemic), to Tylenol (paracetamol), alcohol, swabs, and sterile gauze. As in the past, Egleé will send careful translations of the dosing and usage instructions for each medication. Each clinic has a trained field nurse on hand to received and manage them. We’re working to update the detailed lists clinic personnel provided in 2018. There’s a particular critical addition they are calling urgently for in their community radio updates:

- snakebite antivenoms and treatments, antiofidicos. These are out of stock because they are no longer being produced at the Universidad Central de Venezuela in Caracas. With your support, the project will work to obtain a supply of most critical antivenoms, ideally in neighboring Colombia, which hosts a strongly overlapping set of venomous snake species.

In addition, we hope to piggyback on these delivery efforts to begin to adapt and distribute small, portable malaria testing and treatment kits, called malakits, in partnership with our network and the three communities (https://www.malakit-project.org/; see images, below). First designed for and with small-scale miners in Suriname, the initiative would like to expand to Venezuela, building an initial strategy in highly mobile Indigenous communities like Betania, Caño Iguana, and Kayama: communities that are well-organized, and have trusted liaisons. The hope? For community members to be able to diagnose and treat malarial infections in real time while they are on the move, in the rainforest

away from any health center to confirm diagnosis and deliver treatment—further complementing the nets, and avoiding unnecessary malarial deaths and transmission. The central idea is to increase the capacity to learn where and when malaria in transmitted (local contexts) to improve the strategies to eradicate the infection, morbidity and mortality.

“In that sense,” says Egleé, “we believe that we can target our project with these ideas in main for this new stage. We will keep you posted!”

Please contribute today to support this community-driven, lifesaving, evolving work!