By Michal Matejczuk
Imagine yourself standing in front of a beautiful lake; let’s envision Lake Victoria within Sub-Saharan Africa to simply name one. Beyond you are the waterlogged kilometers separating Uganda from Rwanda/Tanzania amid a horizon rich with the local catch awaiting your net before the sun finally breaks the sky. With the rising sun dissolving the chilled morning off your hands, you throw in your repurposed mosquito net now fishing net after expressing a silent prayer to yourself, with the hope of catching something to later support you and your family. Only that in this instance your situation includes having a family of eight with one more on the way, the with others awaiting for the payment of school fees, food for your family’s rumbling stomachs and extra supplies to ensure a successful path to a better future. An unfortunate burden for which you truly have no idea of.
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On the day of her wedding (referred to as an “introduction” in Uganda), women can be seen in a variety of styles. With wedding dresses ranging from the standard bridal dress from the western-side of the world kind of look, to a culturally rich gomesi dress made from kitenge fabric with striking edges and raised shoulders, all signifying the entrance into womanhood and marriage; though if you are truly wishing to set off a fashion statement with some added side gossip, a gentle mix of the two could maybe do. Finishing the look, the anxious but overjoyed bride receives her veil, but instead of the soft tulle normally draped across faces of those in the Western cultures, a few resourceful measures have given way to the opportunity of older mosquito nets being repurposed, re-sewn and bestowed for her special day; an addition with a former purpose, now with a splash of creativity.
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Coming off from one of the dry seasons, which in Uganda are never your best friends, millions of Ugandans descend out into their fields to prepare for the upcoming season with a hoe in hand and newborn children fastened to the backs of their mothers. The field for those who have the acreage proceed to have been dug and sowed, but for those who have inherited their smaller shares within Uganda’s new issue of diminishing land inheritances, shielding your promising crops from your chickens and your neighbor’s chickens and perhaps a roaming goat is the family’s newly acquired government-funded mosquito net, aside the few that have also been worn out from use.
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If you happen to have the spare time today to read any of these articles from DispatchUG, NewVision, Massachusetts General Health, and even the NYTimes, you would’ve gotten the sense that there is a pressing issue with the use, abuse and rate of adoption of insecticide-treated bednets in malaria-endemic countries throughout Africa, more so in Uganda. Furthermore, that there is a bit of a childhood game of who to point the “blame finger” on when the intended use isn’t exactly achieved, but rather misused.
“Malaria kills nearly 650-1,000,000 people a year world-wide with Uganda having the world’s highest malaria incidence, with a rate of 478 per 1000 people per year. Malaria represents the leading cause of health care visits and is the cause of 70,000-100,000 child deaths annually. Universal access to insecticide-treated bednets has been the official policy since 2009, with 7.2 million bednets distributed in 2010 alone. However, in 2009 only 1.5-20.2% of children under 5 slept under a bednet the night before and a subsequent study in 2011 showed only 28% coverage. Obstacles to bednet use in rural sub-Saharan African households have direct effects on child survival.“ (Dr. Paul Krezanoski – Assistant Professor at UCSF School of Medicine)
In speaking with a handful of Ugandan children and older adults, to develop my own reality about mosquito net use, I found that you can write a book on the variety of answers why some people are not using these, often free, government-funded nets or if they do, what they are dealing with while using them.
“I don’t sleep under a net as I haven’t had malaria in over eight years, so it’s like I am immune to it,” spoke a young entrepreneur I met within Kampala.
“They are too expensive, and I want a free one,” spoke Sarah, a local bartender in Mbale, Uganda.
“Western companies are putting drugs in these nets to prevent our people here from getting pregnant. I don’t like…” from a woman living within village of Budadiri.
“I need to protect my maize first, and then I will protect myself. Mosquitos don’t live here in the mountain since its cold,” expressed a farmer from the district of Bududa.
“It TOO HOT when I’m sleeping, so I don’t use,” spoke Roony, one of my neighborhood kids in Mbale, Uganda who later received malaria later that month; still not using the net.
So, who is to likely to be blamed for the misuse or misconceptions about these nets? Is it the communities with a disregard to using nets? The government, or agencies responsible for distribution? The poor planning, or the spread of misconceptions about these nets? The blame finger continues to spin around these options more than the degree dial on a compass, with neither side available to accept the fault or determine the error.
In my opinion, the greater issue at hand is beyond that of the distribution of these nets, and the misappropriations found throughout the various household products made of them. These organizations combating malaria are attempting to combat the much-needed battles of malaria, yet somehow falling short with first satisfying what I believe to be the first level of Maslow’s hierarchy of needs, physiological.
“I’ve seen nets as dress detailing, as head wraps, as diapers, as seedling covers, as fishnets, as ant collecting nets, as toys and as loofahs.” Peace Corps Volunteer Kelsey Sabo
“I’ve seen them [mosquito nets] used more often for what they shouldn’t be than what they should – soccer goal nets, fishing nets, goat ropes…” Peace Corps Volunteer – Chelsea Gaylord
Maslow was onto something when he expressed his research about the various levels of human motivation, in relation to being “relative”, “general”, and “primary,” based on the level of need attempting to be satisfied. Instead of being frustrated about the unorthodox list of uses these costly nets with the millions of dollars invested into their distribution turn out to become, some of these government programs and assisting agencies should be frustrated on why the greater needs of the same individuals they wish to assist aren’t being worked on.
Rather than address the immediate need that they perceived to be the greatest need for these countries that they don’t even live within, perhaps after taking some advice from Ernesto Sirolli, they would also remember to simply, “shut up and listen.” How much do we actually listen to each other or the group we are interested in supporting before we ever put a dollar amount or a grant to?
As Maslow noted, a certain need “dominates” the human organism, and I find that to the be case with bednets sent out to treat malaria-endemic areas, where the true need is not being met before a new need is adopted by that same community [Maslow, A (1954)].
Being a Peace Corps volunteer stationed in Eastern Uganda has opened not only my mind to the struggles of living, trudging and working within a country termed “developing” by the Western model of economic development, but my experience in its entirety has granted me the opportunity to bare witness to domestic and foreign aid programs while being at the grassroots’ level of behavior change.
The real-life scenarios I wrote earlier in this article represent a small drop in the bucket of what lives are like in Uganda. I say that not to convey sympathy or to bring about another group of “white saviors” to come “save Africa” on their own terms over their communities’ terms, but what I try to attempt to do is to persuade others to understand. To understand that billions (if not trillions) of dollars continue to circulate around the world in the name of aid meaning to impart assistance is often the assistance that ends up not quite assisting in what they are meant to support.
Upon reading this article in NewVision of the local government wanting to jail a fisherman for diverting government-distributed malaria nets into their livelihoods, I was moved. From a Peace Corps volunteer mindset, wouldn’t the better decision to come of witnessing this be to intervene with better motives by supplying new nets for those fishermen, offering the same type of catchment with no insecticide residue. This action would greatly reduce the risk these fishermen are causing on the local water sources, meanwhile allowing them to continue providing for their families. Why shame or threaten the same individuals you are wishing to assist rather than taking a step back to setup a chain of services to better the growth of their livelihoods and protect against malaria, than a growth aimed at their criminal records.
I may be a Peace Corps volunteer for another year or two, but it doesn’t mean I cannot contribute my part to both sides of the “battle to end malaria.” The truth of the matter is, the rate of malaria throughout Uganda has decreased over the years, and it has been due to a wide variety of angles meant to subdue this disease from growth. The government of Uganda along with the agencies affiliated with the national malaria campaigns are fighting a tough battle, but in the years to come I hope that their methods continue to be refined around the individual.
If I have learned something about malaria from my short time here, it is that malaria doesn’t care if you are black, white, female or male, a Peace Corps volunteer or just a tourist here to visit the gorillas of Bwindi. It is a 100% preventable and treatable illness, but one that requires more of a humanitarian approach instead of a “white savior complex” approach in dealing with malaria-affected countries.
Whether it means discussing bed net care to youth at the village-level to relinquish their common misconceptions or changing bad practices about mosquito nets with older adults, I envision being a better advocate for change. I like to think that twenty years from now, by recounting my personal experiences living as a volunteer in Uganda, I can hope to advise on better strategies for agencies wishing to throw a few million mosquito nets at a problem when they should first just introduce themselves, and listen.
Disclaimer: The views and opinions are exclusively my own and do not represent the opinions of the United States Peace Corps, the government of Uganda, and the government of the United States of America.
A year ago, Michal Matejczuk came into the country of Uganda with no expectations of what he would eventually experience. From daunting taxi vans with curious passengers examining the amount of his arm hair, or to waking up to a pack of goats found chewing up his garden, these are his experiences as a Peace Corps volunteer in Mbale, Uganda.