Community Net Distributors handing out Long-Lasting Insecticide Treated Nets to Maaji Parish community members
My October was very busy with capacity building sessions with civil society organizations, writing success stories, and gathering information for a Letter of Intent for an US-based international organization. But one of the highlights of my October 2009, was the distribution of long-lasting insecticide treated nets (LLIN) to households in Ciforo Sub-County, Adjumani District in Northern Uganda. This distribution was a 10-day event; it was exhausting for everyone involved, but in the end, when we saw nets being aired out in trees before the actual use, the 10 days were so rewarding.
First, an introduction to the infamous LLIN in the health world. A LLIN is a net that is treated with insecticide during the manufacturing process. The LLIN’s insecticide does not wear off, it is easy to clean, and can last up to four years. Four years is the time that one expects the net to become frayed, worn, ripped, etc after the long use. These are badly needed commodities to households in Uganda, especially in northern Uganda, where malaria is the killer of many children under five.
Second, the event. Many of the days were prep-days. You cannot just expect a project like this to be successfully implemented without it coming from the community members themselves. So, for three days, we engaged local district leaders, civil society organizations, village health leaders, and community medical distributors. The central team (MIHV from Arua, and CSO leader from Moyo District) briefed the district, provided two partnering CSOs operating in Adjumani with the skills and knowledge about LLIN registration and distribution. These CSO leaders then trained the community medical distributors, who are registering their respective village’s household and distributing the nets to each head of household. 69 CMDs were trained. The following day, they headed out into their communities and gathered vital information such as the number of sleeping nets and the number of sleeping places. Other information like number of children under 5 and pregnant women was also recorded. All of these trainings lasted full days. We often did not get back to our guesthouse until 6:30pm, and this would be the first time eating since breakfast. We were busy bees for a good cause.
Allocation day might have been the hardest. This was due to several things: 1) Adjumani was unbearably hot. Way hotter than Arua. The allocation took place at the Ciforo Sub-County office, where we had to sit outside under the sun (at times, shade), which was brutal. 2) We tallied up the number of households for each village BY HAND. Well, half was done by hand, half by calculator. And we were very short on calculators. We had 29 villages and 3 calculators. 3) Even after the training and supervision f CMDs, some still experienced difficulty with the registration process. Numbers were not making sense. 4) A couple villages decided to inflate their number of village households, which made for a change in allocation.
The Ministry of Health is advocating for “Universal Coverage” of mosquito nets. Prior to this summer, the MOH conducted distributions to pregnant women and children under 5, as they are the most vulnerable. However, it has been determined that if 80% of the population sleeps under a net, malaria will be greatly reduced. One reason for this is “herd immunity”. So in our campaign we were targeting EVERY sleeping place. A sleeping place is any mattress, bed, mat where a person sleeps. You could have one sleeping room with one double bed and this would be considered one sleeping place. Or one might have a room with two sleeping mats, this would be two sleeping places Unfortunately, the census underestimated the total number of households (or the number was inflated during registration), so the estimate of nets was off. The allocation was determined as follows:
• Those villages far away would receive nets per sleeping place. Others would receive via sleeping rooms.
• Those villages that received nets based on a “per sleeping place” were:
• All villages in Maagi Parish (4 total)
• Agali and Opejo villages in Opego Parish
• Lori and Liri villages in Loa Parish
Distribution day was brutally hot, stressful, exhilarating, and an eye-opener to rural work. I was placed in Maaji Parish. When we first arrived, people crowed around the bales of nets, waiting to receive one. We set up distribution points, outlined and bordered by a rope. CMDs were responsible for handing out the correct number of nets to each head of household. Some village members gave them difficulty, demanding more nets, trying to sneak in line with a fake ticket to get more nets, and taking the bags in which the nets were. It was vital that the bags did not go with the nets, as this was to stop the beneficiaries from selling the nets off to markets, shops, etc.
However, despite the trouble and some of the flaws, this entire distribution event was just so amazingly rewarding. The sun beat down on us, as the shade was not enough. With the distribution lasting all day, the amount of stress to ensure that it does go smoothly can be overwhelming. Exhilarating because on the drive to the site, I saw lines of people walking from many kilometers away, just to receive the nets- to reduce the probability of getting malaria- to reduce the chances of losing a child to a preventable acute disease. And then at the end of day, these people walked back home, to their grass huts, excited to put up their new net. This net will last for 4 years. They will be safe for 4 years if they use it properly and consistently. As we passed many homes, I could see the blue net hanging from a tree to air out the possible smell of the insecticide. In 24 hours, these nets would be hanging over a child in his sleeping place. And that was the best part of my day.
Now, some people may think that this is public health at its worst. Going into villages, distributing free nets, and then leaving the village.But with this event, the district, parish, village and community leaders were all involved. Follow-ups will be done to ensure that each net is actually hung properly and used consistently. It helps to see the nets as a polio vaccine. In the States, polio is eradicated. In Uganda, some people crawl on their hands and knees through the streets, begging for money. The culprit- polio. There is no vaccine for malaria. The closest we can get is the Long-Lasting Insecticide Treated Nets. If used properly and consistently (every night of the year, with the net tucked in the mattress), malaria deaths will be reduced significantly in Uganda, and this little corner of the world will be a better, healthier place.
First, an introduction to the infamous LLIN in the health world. A LLIN is a net that is treated with insecticide during the manufacturing process. The LLIN’s insecticide does not wear off, it is easy to clean, and can last up to four years. Four years is the time that one expects the net to become frayed, worn, ripped, etc after the long use. These are badly needed commodities to households in Uganda, especially in northern Uganda, where malaria is the killer of many children under five.
Second, the event. Many of the days were prep-days. You cannot just expect a project like this to be successfully implemented without it coming from the community members themselves. So, for three days, we engaged local district leaders, civil society organizations, village health leaders, and community medical distributors. The central team (MIHV from Arua, and CSO leader from Moyo District) briefed the district, provided two partnering CSOs operating in Adjumani with the skills and knowledge about LLIN registration and distribution. These CSO leaders then trained the community medical distributors, who are registering their respective village’s household and distributing the nets to each head of household. 69 CMDs were trained. The following day, they headed out into their communities and gathered vital information such as the number of sleeping nets and the number of sleeping places. Other information like number of children under 5 and pregnant women was also recorded. All of these trainings lasted full days. We often did not get back to our guesthouse until 6:30pm, and this would be the first time eating since breakfast. We were busy bees for a good cause.
Allocation day might have been the hardest. This was due to several things: 1) Adjumani was unbearably hot. Way hotter than Arua. The allocation took place at the Ciforo Sub-County office, where we had to sit outside under the sun (at times, shade), which was brutal. 2) We tallied up the number of households for each village BY HAND. Well, half was done by hand, half by calculator. And we were very short on calculators. We had 29 villages and 3 calculators. 3) Even after the training and supervision f CMDs, some still experienced difficulty with the registration process. Numbers were not making sense. 4) A couple villages decided to inflate their number of village households, which made for a change in allocation.
The Ministry of Health is advocating for “Universal Coverage” of mosquito nets. Prior to this summer, the MOH conducted distributions to pregnant women and children under 5, as they are the most vulnerable. However, it has been determined that if 80% of the population sleeps under a net, malaria will be greatly reduced. One reason for this is “herd immunity”. So in our campaign we were targeting EVERY sleeping place. A sleeping place is any mattress, bed, mat where a person sleeps. You could have one sleeping room with one double bed and this would be considered one sleeping place. Or one might have a room with two sleeping mats, this would be two sleeping places Unfortunately, the census underestimated the total number of households (or the number was inflated during registration), so the estimate of nets was off. The allocation was determined as follows:
• Those villages far away would receive nets per sleeping place. Others would receive via sleeping rooms.
• Those villages that received nets based on a “per sleeping place” were:
• All villages in Maagi Parish (4 total)
• Agali and Opejo villages in Opego Parish
• Lori and Liri villages in Loa Parish
Distribution day was brutally hot, stressful, exhilarating, and an eye-opener to rural work. I was placed in Maaji Parish. When we first arrived, people crowed around the bales of nets, waiting to receive one. We set up distribution points, outlined and bordered by a rope. CMDs were responsible for handing out the correct number of nets to each head of household. Some village members gave them difficulty, demanding more nets, trying to sneak in line with a fake ticket to get more nets, and taking the bags in which the nets were. It was vital that the bags did not go with the nets, as this was to stop the beneficiaries from selling the nets off to markets, shops, etc.
However, despite the trouble and some of the flaws, this entire distribution event was just so amazingly rewarding. The sun beat down on us, as the shade was not enough. With the distribution lasting all day, the amount of stress to ensure that it does go smoothly can be overwhelming. Exhilarating because on the drive to the site, I saw lines of people walking from many kilometers away, just to receive the nets- to reduce the probability of getting malaria- to reduce the chances of losing a child to a preventable acute disease. And then at the end of day, these people walked back home, to their grass huts, excited to put up their new net. This net will last for 4 years. They will be safe for 4 years if they use it properly and consistently. As we passed many homes, I could see the blue net hanging from a tree to air out the possible smell of the insecticide. In 24 hours, these nets would be hanging over a child in his sleeping place. And that was the best part of my day.
Now, some people may think that this is public health at its worst. Going into villages, distributing free nets, and then leaving the village.But with this event, the district, parish, village and community leaders were all involved. Follow-ups will be done to ensure that each net is actually hung properly and used consistently. It helps to see the nets as a polio vaccine. In the States, polio is eradicated. In Uganda, some people crawl on their hands and knees through the streets, begging for money. The culprit- polio. There is no vaccine for malaria. The closest we can get is the Long-Lasting Insecticide Treated Nets. If used properly and consistently (every night of the year, with the net tucked in the mattress), malaria deaths will be reduced significantly in Uganda, and this little corner of the world will be a better, healthier place.
Pictures for your viewing:
This was the ferry that took us, our vehicle, buses, and motorcycles across the Nile River from Moyo to Adjumani
During Registration Day, many children watched eagerly as their parents signed them up for a net!
The fish in the Nile... Nile perch, mud fish, eel, etc.... tasty!
Me by the fishing boats on a small stream that leads to the Nile
Supervision Day of Registration in Maagi Parish
The Arua Central Team waiting anxiously by the bales of nets to be unloaded
Crowds of people swarmed the distribution sites, waiting for their turn to get a net
The group of Community Medicine Distributors who made Distribution Day a SUCCESS!
The LLINs airing out in trees so they can be used soon
