Zambia- Malaria Transmission and the Impact of Control Efforts in Southern Africa (Choma District)
The student will assist with a new initiative to accelerate malaria control in Southern Africa through an NIH-funded International Center of Excellence for Malaria Research. Our goal is to make substantial contributions to regional malaria control in Zambia and Zimbabwe through state-of-the-art research on malaria epidemiology, vector biology and the genetics of the malaria parasite in three different epidemiological settings, representing regions of effective malaria control (Choma District, Zambia), ineffective malaria control (Nchelenge District, Zambia) and resurgent malaria (Mutasa District, Zimbabwe).
To reach the remote town of Macha, Zambia, I first had to fly into Lusaka International Airport, catch a local bus 4 hours to the town of Choma, and then ride in the back of a truck. Macha lies 12km off the paved road that runs between Namwala and Lusaka. What strikes you first is how quiet it is there; you can hear dogs barking, bells tinkling as cattle are herded nearby, and children laughing. It is also extremely flat and dusty, with no stores or cafes or banks within walking distance of the hospital. Surrounding the hospital are offices and labs, and very modern housing for visitors and staff. Locals refer to it as “little America,” because there is electricity (most of the time), internet (usually), and hot water (almost always). The hospital grounds however were unique in the area; visiting homesteads with the local field team was one of the best ways to experience real life in the rural Southern Province of Zambia.
Reaching each household was an adventure in and of itself. I crammed into jeep vehicles with the field team and drove through mazes of dirt roads, sometimes over rivers or straight through the bush. Handheld GPS devices guided us to homesteads, which contained anywhere between one and ten structures, mostly made of mud and thatch. Each homestead at its center had a cooking area, with a thatch roof and open sides. Everyone living at the homestead came out to greet us, and chat while we conducted questionnaires and blood draws. Sweet beer, or “chabuantu,” was prepared for us and passed around in a bucket with plastic mugs; it is a beverage that one must chew AND drink, as large pieces of grain are at the bottom. Sometimes local food was also prepared for us, such as boiled sweet potatoes or okra with inshima, which is the staple food in the area (sort of like mashed potatoes). I learned introductions and formalities in the local language, Chitonga, which everyone found extremely amusing. I also received very strange looks for picking up chameleons, despite my attempts to explain that in the US they are kept as pets, and their attempts to explain that in Zambia, they are viewed as pests. I really enjoyed visiting homesteads and having the opportunity to talk to local families about their lives and experiences, particularly with regards to malaria and public health.
Many individuals and families reported living too far from local health clinics or posts. Most had to walk, and some reported using wheelbarrows or bicycles to transport sick family members when seeking medical attention. Even those that did not live too far away reported frequent stock outs of important medications, or long wait times for care at the clinics, some of which are run by only one nurse. However, clinics and health posts were not the only places utilized for healthcare; traditional healers are very active healthcare providers in Zambia. There is extensive overlap for healthcare between western medicine and traditional healing, and I was fascinated by how treatment for different diseases and syndromes are approached in the area. My area of interest in particular was the treatment and prevention of malaria, and I learned a lot about local knowledge and behavior. For example, most individuals reported knowing that mosquitoes cause malaria, but perhaps as a result, many reported not sleeping under the bed nets when there were not many mosquitoes around, because their perceived risk was lower. I also learned through talking with local individuals that bed nets are sometimes used for other activities, such as fishing, which has made me interested in determining how long nets are effective in the field (which is not currently known). It was also amazing to be able to visualize the region firsthand since my main area of interest is maps and using GIS to analyze spatial relationships.
GHEFP allowed me to experience and observe public health in action, an experience that is invaluable particularly in the early stages of a PhD. I was able to determine specific aims for my PhD dissertation, and confirmed my decision to specialize in spatial analysis and mapping of malaria. Working with the field team, visiting households, and speaking with locals gave me a greater understanding and insight into the culture and environment in which I will be conducting my dissertation research.