There is more to Malaria than dealing with the Mosquito! A tale of hard working field workers in South Odisha.

Even a child in school today, knows that malaria is caused by the bite of an infected female Anopheline mosquito ! https://www.who.int/features/qa/10/en/

Today, we know of what causes malaria, how it is transmitted, its diagnosis, treatment etc etc…. We know the contribution of Ronald Ross https://www.cdc.gov/malaria/about/history/ross.html

But does this child or that child’s parent know tales of field workers who are out there, toiling relentlessly to reach out to people who are affected, people whose lives are impacted by that tiny parasite, the Plasmodium that is at the root cause of untold human suffering, possibly even before a mysterious ailment termed “Mal’ aria” (literally meaning bad air) along the swampy marshland around the River Tiber in Rome, led to much thought about this many centuries ago. Malaria has indeed been affecting a major chunk of humankind since times immemorial.

The Tiber river as it is today…… it used to meander through Rome 2000 years ago and in its bends used to be marshy with swamps which lent itself to extensive breeding of mosquitos in the summer months.

The story behind this blog post is to highlight some of the efforts being undertaken to address the problem of malaria, in one of the states of India.

Odisha, is located along the Eastern Coast of India, and has large tracts of tribal dominated lands (https://en.wikipedia.org/wiki/Odisha) scattered across  an underdeveloped , difficult to access terrain. Odisha has the largest number of tribal communities in India, (62 tribes including 13 primitive tribes) with a population of 8.15 million constituting 22.3% of state’s population. In addition to the tribal population, there are many other marginalized sections of society, who do not have easy access to health care services – all these populations are at high risk of malaria infection (Source: State Govt DAMaN guidelines).

A vista somewhere in South Odisha, to give the viewer an idea of the kind of terrain thereabouts.

The intensity of malaria transmission in any given area largely depends on two main factors:-

Firstly, the local environment and ecotype that determines the dominance of a malaria vector species and its vectorial capacity ( did you know that each vector species behaves differently , in terms of where it likes to rest, where it breeds, when it bites etc ?)

Secondly, access of an affected community to effective diagnosis and treatment along with preventive measures.

Communities living in isolation in natural forested habitats are at risk for being affected by malaria, more than their more affluent semiurban / urban brethren, progress in the field of diagnostics, curative and preventive health notwithstanding.

The Odisha State Govt, launched a visionary program “DAMaN” (Durgama Anchalare Malaria Nirakaran) being implemented in inaccessible areas of high endemicity districts http://www.newindianexpress.com/states/odisha/2018/apr/14/odisha-becomes-model-state-in-malaria-control-1801609.html

The rationale behind this program is that preventing malaria infection and averting disease manifestation would potentially have a positive effect on the health and well being of the population residing in remote, inaccessible and underserved areas.

Have a look at the Southern Odisha districts on this map

DAMaN  is presently being implemented in high malaria endemic Sub Centre areas of all Blocks of the following eight high malaria endemic Southern districts: Koraput, Malakangiri, Nawarangapur, Kalahandi, Rayagada, Gajapati, Nuapada & Kandhamal. These districts reportedly have only 20% of total population of the state, but used to have a very high malaria incidence and contributed around 50% of the malaria cases and 47% of the deaths due to malaria in the past (Source : State Govt DaMaN guidelines).

The Tata Trusts in partnership with the Govt of Odisha , through the Livolink Foundation have been working on a project in the remote fastness of the South Odisha region since 2016-17 to eliminate malaria as a public health problem. https://www.livolink.org/eliminating-malaria/genesis-of-the-program/ Partnering with Community Based Organizations and with another local NGO had been ongoing in the region since 2010. However, the work achieved full steam ahead impetus after the formalization of the interventions in 2016-17.

A quick meeting to catch up on Project rollout enroute to a village in South Odisha

Presently, under the aegeis of the Livolink Foundation , the Malaria Control Project (due to various historical precedents in the chequered story of malaria, it is more appealing to me, to refer to ‘control’ rather than ‘elimination’ of a disease such as malaria!) is functional  in five Blocks (Th. Rampur, Lanjigarh, Muniguda, Bissamcuttack and Kotagarh) of Kalahandi, Rayagada and Kandhamal districts of South Odisha. Over the past years, this Project funded through the Tata Trusts / Livolink Foundation has benefitted nearly 50,000 households across 263 underserved villages in the region.

City dwellers getting a feel of the tough ground terrain

Hard working Cluster Coordinators of the Project, have toiled selflessly , day in and day out, walking their way across hilltops and landslides, braving the sweltering heat and in the monsoons even wading across streams, to reach the villages (nay, hamlets actually) in their Areas of Responsibility.  The hardy tribal folk have nominated amongst themselves, enthusiastic young people to work within their fold, as “Village Health Volunteers” , mentored by the aforesaid Cluster Coordinators. Providing a doorstep service of onsite early diagnosis of fevers using Govt provided Malaria Rapid Detection Kits and collecting Peripheral Blood Smears for later examination at distant microscopy centres, the Village Health Volunteers also provide supervised standardized Malaria Treatment to those diagnosed with malaria. For those with unmanageable fevers, referral is the only recourse, which is facilitated by the Project personnel through their liaison efforts. Please note that there is almost no cellphone connectivity in the hilly hinterland. And it takes a few hours of walking through hostile territory to reach the nearest roadhead, with a patient often having to be carried on a makeshift cot.

A city dweller may ask “what is this Hello Point??”
Its that isolated point in the landscape where some fleeting signal may be received by accident and not by design to make that quick call, or send an SMS. These are properly signposted and peppered across the countryside in the parts of Odisha that I travelled to.
Training on correct usage of Insecticide Treated Bednet being imparted by a Cluster Coordinator at Kannadi Hamlet , Muniguda Block, Rayagada District

This simple system of mentoring a network of village level health volunteers, is what is making the Project tick ! Reaching out to thousands of impoverished folk in this tribal belt, and making an impact by lowering the incidence of malaria……

Village folks being provided an orientation to prevention of malaria through simple community based vector control measures at Village Lepes Padar in Th. Rampur Block of Distt Kalahandi
Warmth in their welcome! Reaching these farflung villages requires travel on tarmac roads, dirt tracks, and finally walking it ….a new twist on last mile connectivity.

The determination and the dedication being exhibited by the frontline workers of the Project under the inspiring leadership of Dr Govind, a local lad, giving his best back to his home turf, is what is so refreshing to have witnessed first hand, in a recent visit to the area.

The intrepid Dr Govind leading us onwards into a hamlet somewhere in Kalahandi District

“Odisha Government showed political commitment by allocating resources and working with development partners in looking at the big picture and ensuring last-mile connectivity”

https://www.business-standard.com/article/current-affairs/world-malaria-report-2018-led-by-odisha-india-reduces-cases-by-3-million-118112300064_1.html

Grand old ladies of the village enjoying their social session during the Mahua festival

If you would like to know more about how this Malaria Control Project is coming along, please contact me for updates.

If you would like to learn more about malaria prevention and control , and what you as an individual can do , please contact me for further guidance.

Published by Delta Zulu Consultancy

I am a Public Health Specialist with a passion for sustainable promotion of human co-existence with the environment! My areas of interest and expertise are Health Risk Communication and Community Engagement, Food Safety, Environmental Medicine and Mass Gathering Medicine. I believe in leveraging the power of technology to capture the imagination of people to inspire them to achieve their health potential, in a sustainable manner. I aspire to empower my partners and motivate stake holders to consistently seek 'work around' solutions, while hoping to achieve an utopian ideal balance.

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