SUCCESS STORIES

Malaria in Mali: Community Health Centers

Story and Photographs by Amy Ellis

The dirt road to Kalifabougou is winding and dusty, dotted with small villages, millet fields, and occasional sparse herds of cattle. During most of the year, the arid landscape reflects various shades of brown and beige, giving testament to the force of the Malian sun.

Yet for about four months of the year, the land is verdant with grasses and plants fed by long-awaited rains that soak the parched land. These rains allow the local population to cultivate crops that will sustain them throughout the year, allowing communities to survive in this harsh climate.

However, this season of growth also brings with it a dramatic increase in disease and illness – particularly due to malaria. The rains that allow the crops to thrive also provoke an explosion in the numbers of mosquitoes that transmit malaria. Although everyone is susceptible to malaria, the vulnerable immune systems of young children and pregnant women cause them to suffer the most from this debilitating and often deadly disease.

Upon arriving in Kalifabougou, a mid-sized rural town about 55 kilometers north of the capital Bamako, the road widens to reveal an elementary school, a community health center, and a small weekly marketplace. The health center is clean, well-attended and fully staffed and is a model of what is possible in Mali’s decentralized health care system.

Much of this is due to the active involvement of the local oversight committee and the dynamism of the chief health agent, Djoma Keita. While many of Mali’s community health centers are in disrepair, devoid of essential drugs, understaffed and underutilized, the health center in Kalifabougou is bustling and busy.

Pregnant women are poised patiently in the outdoor sitting area awaiting their pre-natal consultation. Families meander about, providing food, assistance and encouragement to new mothers resting with their newborns in the post-delivery room. Parents bring prescriptions for their sick children to the adjoining pharmacy to purchase treatment. On the walls of the center are hand drawn charts illustrating that vaccination goals, rarely reached in many regions of Mali, have been surpassed month after month. Targets for safe deliveries performed at the health center have also been achieved. The health center even mans a simple motorized ambulance, ready to transport women in labor to the regional health center in the case of an obstetric emergency.

Despite these achievements, treating the ill and injured of Kalifabougou is an ongoing challenge for Djoma Keita and his staff. Mr. Keita has been a health agent for over 18 years, having chosen to pursue a profession in health because his own community lacked basic access to care.

“I decided to become a community health agent because my natal village did not have a health center,” said Mr. Keita. “We were far from a health center, people suffered a lot, and there were many deaths and disabilities caused by illnesses that could have been avoided. I chose to work in health to save people.”

The vast majority of patients treated at the health center are children, who often suffer from respiratory and diarrheal diseases, as well as malaria. While treatments for these illnesses are available at the community heath center, they are not necessarily the most efficacious ones. Although Mali has recently adopted a national policy that endorses the use of artemisinin combination therapies (ACTs) for the treatment of malaria, many community health centers currently only have access to chloroquine, quinine and other anti-malarial drugs to which resistance is extremely high. Mr. Keita asserts that the lack of effective drugs to treat malaria is a critical problem.

“The most serious illness among children is malaria, severe malaria,” he said. “This is because it is an illness that kills many children, especially at the end of the rainy season. Many parents bring their children when they have severe malaria and are convulsing. Often, the children recuperate. But others, unfortunately others are lost.”

A lack of effective drugs for treatment is not the only concern in the fight against malaria – a lack of insecticide-treated mosquito nets is also a problem.

“Impregnated mosquito nets are given for free when a child finishes their vaccinations and to first-time mothers who come for prenatal consultation” said Mr. Keita, “But now, there aren’t any more mosquito nets. Those that already received them are protected, but those who did not receive a net are much more vulnerable.”

Given the resources that they currently have, the health center of Kalifabougou is doing as much as it can to promote the health of the local community. However, reliable access to effective anti-malarial drugs as well as to insecticide-treated bednets would greatly assist Mr. Keita and other community health agents in their struggle to save the lives of women and children throughout Mali.