Malaria – “the biggest problem in Senegal”

Alec Yeh - Senegal


April 24, 2010

Every once and a while, I’ll sit next to Seck to observe a consultation. But for the first time, I sat in the patients’ seat, facing the ominous head nurse. Fortunately for me, I was only sitting there for an interview, and not for health reasons.

“My last question. What is the biggest problem in Senegal?”

“Malaria,” he responded without hesitation.

I hadn’t been in Senegal for very long when that question was first asked. And I really didn’t understand why malaria was the biggest medical problem in Senegal. I mean, so we get some people with malaria every once and a while. What’s the big deal? They just get an IV and they get better, right? It’s just like getting the flu.

The first time I saw somebody with malaria was back during the first month of being in Sangalkam. This girl walked through the cast-iron gate and she looked like death. Her eyes were bloodshot and where they weren’t red, they were yellow. The girl’s lips were flakey from her body losing moisture. Her skin was pale, even though she must’ve been over 104 degrees. She walked slowly and wobbly, as if she was a 10-month-old baby just beginning to stand on two feet. Halfway to the pharmacy, she bent over and vomited in the sand, though it was mostly water; a sure sign that she hadn’t been eating. Malaria isn’t like getting the flu. It might be like getting the flu if the flu was jacked up on steroids.

From that moment on, I began to see malaria everywhere. The hospitalization room was constantly filled with infected patients. They laid there for hours and hours with an IV in their arms. They stared up into the air, captivated by some world that only malaria patients can see. Often times I thought they were dead. Most of the time I was wrong. The only time I’ve ever seen a person die right in front of me was at the Poste. And as one would expect, it was from malaria. Though this woman was extremely old, it’s incredibly heart breaking to see a daughter run out into the street, crying at the top of her lungs. It was even more disturbing when they carried the body out in a small truck, the ones they use in the morning to deliver the cardboard-like bread to all the boutiques.

Living in the United States all my life, I’ve never had to worry about malaria. Malaria was eradicated long before I was a born. And even here, I still don’t have to worry too much about malaria. I have my prophylaxis to protect me, and if that fails, I have the comfort of knowing that I’d be rushed to the hospital for treatment, all paid by my health insurance. And in the worst-case scenario, I would be airlifted out of Senegal. But nevertheless, coming here I got to see malaria firsthand. Yes, it is true that it’s preventable. And yes it’s very treatable. Then why do so many people die from it? I really don’t know.

After seven months, I have seen my fair share of malaria patients and malaria is definitely pretty bad. What’s amazing is that I didn’t even see close to the worst. My whole in-country experience was during the dry season. The three wettest months are July, August, and September. The roads flood with human waste and any open container, any stray tire fills with water, breeding mosquitoes. During those three months, the Poste is filled beyond its capacity. Seck is a good guy and I know if he could do anything to help anybody at all, he would in a heartbeat. But even during the wet season, the Poste gets so packed that Seck has no choice but to deny treatment to people.

The consultation room at the Poste de Santé could pass for a cluttered closet with a desk in the center. The walls are lined with yellowing out-of-date posters promoting certain drugs and hygienic habits. On the central desk, there are papers regarding conferences and protocols shuffled together. There is a stethoscope laid on top of the stack of paper and usually a blood pressure cuff. I say usually because there is only one blood pressure cuff in the entire Poste and it’s often being fought over between Seck and Madame Diouf . There is a thermometer that’s hardly used, and a tape measure, 60 centimeters long.I don’t think a 60-centimeter tape measure will do much good if most adults are over a meter and a half tall.

Can you imagine being a health practitioner and having to turn people away from a state-run public clinic? That gives a whole new meaning to global health, one that isn’t really global. And with the Poste being packed with malaria patients, you can just imagine how the mosquitoes must look upon these poor people like it is Thanksgiving Day. But what can you do, right? Nobody does anything to prevent malaria. Nobody uses mosquito nets. Nobody gets rid of his or her standing water. Nobody does anything at all. I’ve been to many “Malaria Discussions” funded by USAID, UNESCO and the Senegalese government, but to so say that they’re effective is difficult. The first time I went, all we did was eat peanuts and drink tea. Nobody got up to address the group. And before I knew it even started, it had ended. Considering that malaria is “the biggest problem in Senegal,” you would think that people would treat it as such.

But the issue is that the public doesn’t know. And why would they when they have more important things to think about, like making a living and feeding their families? But nevertheless, the most important thing is to educate them. And the most important thing they have to learn is that besides having the ability to kill, malaria can cripple one’s financial security. Health insurance is almost non-existent. Only the rich, the bureaucrats, and some of those employed in the formal sector get health insurance. That probably leaves more 95% of the population without health insurance. If nobody thinks about saving money in case of sickness, the cost of the hospitalization and drugs alone can decapacitate an entire family. Now on top of that, the patient loses his or her ability to produce any sort of income for more than a week. It’s like getting kicked by this microscopic malaria plasmodium when you’re already down. Now imagine a whole community being out-of-commission like that for three months. It’s not only a family that loses their ability to produce income, but the entire economy of the community is very much disrupted for a fourth of the year. I’m not a health official nor do I pretend to be one. I only know what I see. But what I see is not enough.

Malaria really is the biggest medical problem in Senegal, and arguably, in the developing world. Let’s hope that as a whole world community we can address this issue and eradicate malaria completely. When I come back in the future to visit my family, friends, and community, I hope to sit down with Seck again. I hope to sit across from him in his very own white coat, one that wasn’t given to him by some French hospital, in a new consultation room, one that isn’t masquerading as a closet. I hope to ask him the same exact question.

“What is the biggest problem in Senegal?”

And he would respond, “Not malaria.” And then we’d hold hands and ride off into the African sunset together. The End. Okay, maybe not the last part.

Alec Yeh