Pringle, Julia

Zambia

Malaria Transmission and the Impact of Control Efforts in Southern Africa (Nchelenge)

The student will assist with an 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). .

Global Health Mentor: William John Moss, MD, Head of Epidemiology, IVAC

Touching down on the small, dusty airstrip outside of Macha, Zambia after a grueling thirty hours of non-stop travel, I expected to feel completely upside down. After all, this was my first time in Africa, and more notably, my first time in a rural town in a developing country. I kept waiting for that feeling of foreignness—the one you think you ought to have when so far from home—but it didn’t come. In fact, that feeling never hit me the way I had expected it would. Instead, I found myself immersed in a life which felt so comfortingly basic, stripped down of the extravagance and excess consumerism of the developed world. Zambian life felt, in many ways, natural and good—centered around family and loved ones, slow paced and never rushed, sustainably integrated with nature. Rather than feeling as though I’d landed far from home, I felt surprisingly at peace, as though this lifestyle is somehow more natural than my life in Baltimore.

My lack of culture shock and immediate love of the Zambian lifestyle led me to struggle with the meaning of “progress” throughout the duration of my stay in Macha. In some ways, the trajectory of progress was clear. Doing rounds with the missionary doctors in the rural hospital’s pediatric ward was particularly eye-opening; nearly every case would have been either averted or handled easily in the United States: congenital blindness of an infant due to rubella infection of the mother is prevented by the MMR vaccine in the USA, tuberculosis is diagnosed with an easy chest X-ray, and very few children come close to death after toxicity from the herbal remedies of natural healers. In the United States, most women are not expected to walk far distances and carry with them surgical gloves and clamps in order to deliver a baby. In most parts of the United States lab equipment and reagents are readily available and a variety of diagnostic tests can be run before treatment begins. In these basic health care services, Zambia is clearly struggling, although the people who are working towards progress in this arena are truly inspiring.

However, in other ways, the concept of “progress” becomes muddled. This is exemplified in the way fast food and processed, high sugar content foods are infiltrating the country. Not only were these “first world commodities” highly coveted, they were regarded as modern, as symbols of progress. During our lab’s daily tea time, people would stir in not 1, not 2, but 5 spoonful’s of sugar into their cup of boiling water. Furthermore, after an awkward conversation in which Zambian friends told several of us Americans that we were fat, we learned that fat is a compliment, and that gaining weight is associated with health, status, and progress.

It feels strange to see a nation poised on the verge of an epidemiological transition; still very much affected by the infectious diseases of the developing world, and yet beginning to follow in the footsteps of more developed nations. It really made me wonder how to support people progress without setting them up for the same pitfalls that developed nations are currently dealing with, like obesity, diabetes, heart disease, and cancer. My experience in Zambia made me think critically about what “progress” looks like, and what attaining it means in our world. For Zambians, it might mean better health services and a decline in infectious disease mortality; is this type of progress inextricably linked to a fast-food diet, a society that is stressed, under-rested, and distancing themselves farther and farther from nature and their families? Moving forward, as my interest in global public health has been deepened by my time in rural Zambia, I plan to continue grappling with this idea of “progress.” Is there a way to hold on to the rich wholesomeness of the rural Zambian lifestyle while still “progressing” in the arena of health and disease? This sounds more like progress to me.

Harry, the leader of Macha's field team is pictured here collecting blood from a mother and her baby in order to conduct malaria rapid diagnostic tests:

Girls Carrying Water- In Macha, it is a common sight to see young girls and women on their way to and from the bore hole pumps to collect water for their daily activities:

Macha Field Team and Index Household- After being alerted by a health center about an index case of malaria, the Macha field team would visit the index home to conduct malaria rapid diagnostic tests on the other family members. Pictured here is the Macha field team along with members of an index household who generously allowed us to collect samples of their blood:

Macha Research Trust lab- Macha Research Trust graciously accepted several students into their lab for the summer; here, several members of the team are gathered outside of the lab facilities for a quick picture break:

Negative RDTs- After a case of malaria is confirmed, the Macha field team visits all of the households within 250m of the index case to screen for malaria using rapid diagnostic tests; all of the tests pictured here show negative results for this particular household:

RDTs- Here I am working on the malaria rapid diagnostic tests for a family living in close proximity to a confirmed case of malaria:

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