The Face of Malaria

By Caroline Brennan

Recently, in a village in eastern India, I came face-to-face with the reality that is malaria.

Like many Americans, for years my only familiarity with malaria was through the adventure stories of a few friends who had dared to travel to places far from their hometowns, and had contracted the disease while roaming jungles in the midst of a wildly non-suburban life. Of course, their experiences evolved into animated tales worthy of late-night cable. Some people even started their stories with, "The tenth time I got malaria …"

But, in the end, they were able to tell their stories. They had recovered and, no doubt, added notches to their "tough" belts.

Here in India, people's stories of malaria are not fodder for after-dinner conversation — they break your heart. When access to medical facilities is virtually nil — and a family's income to cover treatment nonexistent — a disease that should be preventable, that should not take the lives of children or their parents, can turn a family's world upside down.

It was in a village outside Ranchi, the capital of India's eastern state of Jharkhand, where I first met Sindi Sangha. When her husband became ill with malaria a few years ago, the impact was immediate. He tossed and turned with fever. It was impossible for him to go to work. Without work, there was no money. The flow of income stopped just as his malaria set in.

In the meantime, the costs in Sindi's household were increasing. The price of medicines to treat her husband was out of reach, medical insurance unheard of and the nearest hospital several miles away. Without a car or cash, the Sanghas had no way, and no reason, to get there.

Mortgaging a Cure

Determined to save her husband, but with few available options, Sindi borrowed money from the local moneylender at a criminal rate of interest. Sindi was the ideal client. As in many countries, it is impossible to get a bank loan without credit in India. Someone from an impoverished, uneducated home like Sindi's would be unlikely to even get anyone from the bank to talk with her.

Now that they finally had the money for medical treatment, Sindi's husband was able to slowly recover. But it was at a heavy price: Sindi had mortgaged her family's land to pay back the moneylender. They had lost everything they owned.

Sindi's story is common in this area. Of the 5 million confirmed cases of malaria reported each year from countries outside Africa, nearly 3 million are from India and Pakistan. But in India, the risk of contracting malaria is unevenly distributed across the country; 20 percent of the population is reporting 80 percent of the cases. Sindi lives in the heart of that 20 percent of the population.

Jharkhand has recorded a sudden increase in malaria cases with the onset of the monsoon season, which occurs from midsummer to early fall. A recent survey identified 13,000 people with the disease in Jharkhand alone. Given that malaria is the world's deadliest disease, this is a frightening statistic for the people of the state.

So people are joining forces to combat malaria's wrath. CRS has collaborated with the state government and local health and social agencies to share best practices, resources and expertise for saving lives.

Preparing a Community

First and foremost, programs are equipping people with awareness on prevention and treatment. Health workers take part in trainings for treatment, safe blood collection, and techniques for properly identifying and treating the various strains of malaria. The health workers are also leading village awareness campaigns.

Self-help groups and student assemblies attend the campaign events, which often combine entertainment with education. Health camps, offering free diagnosis, treatment and education, are set up in village centers. For those living in extremely remote areas, health workers make door-to-door visits, offering treatment and collecting blood from those showing symptoms of malaria.

Just as important as education is building up people's financial reserves. That way, when there's a problem, it doesn't have to turn into a disaster. Self-help groups establish a central, formal savings practice for people of all incomes. In these groups, village women meet each month and contribute to a collective fund from which they can take out a loan — at low interest — during times of need. In some groups, each woman may save as little as a scoop of rice (worth only a cent or two) a month. In other areas a woman may save 10 rupees (20 cents) or more each month. But they are all slowly strengthening their families' means for recovery.

One self-help group invited me to an awareness campaign taking place in the center of the village. I sat with about 50 people on the ground. The children giggled as we waited for the show to start. No lights, stage or auditorium, but it was clearly a theater. Soon, a man came and lay on the ground, rolling as if overcome by fever and chills. Then a woman, yelling and waving, rushed to help. A nurse emerged to narrate and we saw and heard — step by step — what any of us should do if this happened at home.

As the play carried on, I couldn't help but think about how far this felt from my home and my friends' late-night dinner theatrics. But I also hoped for the same outcome for the children sitting around me watching the play: that, as adults, they would gather around with their friends and talk about how they had avoided or beaten malaria.

Caroline Brennan is South Asia regional information officer for Catholic Relief Services. She is based in New Delhi, India.