New Internationalist

Malaria battles in Sierra Leone

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Bankolay Turay comments from Freetown on the tussle between traditional beliefs and pharmaceuticals in treating the epidemic.

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Radio Okapi under a Creative Commons Licence

Malaria is not a picky illness. You go to bed one evening and the next morning find you are unable to move: malaria has taken hold. The recently released 2013 World Malaria Report, which ranks Sierra Leone as the country with the fifth-highest prevalence of the disease, reveals the struggle Sierra Leoneans face in controlling malaria. According to the report, there are more than two million suspected cases in Sierra Leone; with fewer than six million inhabitants, this suggests around a third of our population are potentially living with the disease.

Malaria doesn’t care about skin colour. Locals die; expats die. Once you’re Sierra Leone, malaria will come to pay you a visit

Those working on the frontline of treatment and prevention suggest the number may be even higher. ‘In Sierra Leone, I estimate that around 70 per cent of population has some form of malaria,’ says Mohamed S Jalloh, a pharmacist at the busy Connaught Hospital in Freetown. ‘The lack of sanitation systems is the leading problem and it affects almost all communities.’

Globally, Sierra Leone ranks 26th with regards to the number of suspected malaria cases, but jumps to 5th when you measure the number of cases against the total population. The report shows that the number of suspected cases of malaria nationally jumped by over one million between 2011 and 2012.

A poor person’s illness

In the colonial era, Sierra Leone was dubbed the ‘white man’s grave’, but malaria doesn’t care about skin colour. Locals die, expats die. We have many Chinese immigrants in Sierra Leone currently doing road construction and they die, too. Once you’re Sierra Leone, malaria will come to pay you a visit.

I am myself sick with malaria four times a year. It can take me a week to a month to recover. Most of us are used to self-medicating. We go to the corner shop and get the pills we need, but as we grow older, our resistance to the drugs increases. The medication can be very hard on the body: the side effects are brutal. I was rushed to hospital last time I had malaria, to be flushed with fluids. The drugs can close down your system.

The recommended drug, Malarone, can cost more than $5 per tablet. The average income for Sierra Leone is 90 cents a day

While anyone can contract the disease, recurrent malaria is a poor person’s illness. Those with money can treat themselves intensively every three months and keep themselves symptom-free, while those in the provinces die of it more frequently because healthcare isn’t readily available and the treatment is not affordable. Just the test itself is expensive, and the medicine is not cheap either – the recommended drug, Malarone, can cost more than $5 per tablet. The average income for Sierra Leone is 90 cents a day.

Nowadays, most of the affordable tablets are Chinese made. Many on the market are counterfeit. Fake drugs make their way into the market through the porous borders and corrupt officials. Many of these drugs carry the label, brand and package of the originals. At best, these drugs are ineffective; sometimes they can make the situation much worse because people delay visiting a doctor and getting other treatment. The Pharmacy Board of Sierra Leone is responsible for testing, approving and issuing a licence for every medicine brought into the country. Though they claim that people have been arrested for trafficking fake drugs and that the existent stock has been destroyed, these tablets continue to saturate the market.

Many people have raised concern about the influx of counterfeit drugs but the authority says it has limited resources to track them down. ‘I have reported cases where people were suffering from side effects from these drugs; excessive dizziness being the most common one,’ says pharmacist Jalloh.

Bitter herbs and baboons

In the rural provinces, people take Bang Baa; a traditional herb made from the roots of a forest tree. A long, yellow root, you have to dry it first, then place it in water under the sun for a day before drinking the juice. It’s bitter and it will make your face look like a baboon when you take it but you must drink it every morning and evening.

Some say it has been the salvation of those who can’t get their hands on drugs. Most of the people who take it are impoverished villagers; they cannot afford medical treatment. Medical authorities strongly advise people not to take it, but there doesn’t appear to be any efforts to take the root to a lab to do some research to see if it offers an alternative. There seems to be some hypocrisy. The Chinese, who hold the market on antimalarial drugs in Sierra Leone, take their own traditional herbs and have turned them into medicine, but Sierra Leonean authorities are unwilling to test the country’s own natural resources.

‘Malaria continues to eat at the fabric of the youth in our society, under the eyes of those who are charged with the responsibility to prevent it’

Amjata Bayoh is a medical student from Freetown and a fellow community reporter. He says: ‘Malaria is a disease that can be resistant to certain types of drugs, based on geographical region. Earlier this year I was doing some malaria-related research for teaching purposes and I found out that chloroquine, one of the most popular drugs for malaria known in Sierra Leone, can’t treat the disease any longer in certain other African countries. So one of the reasons why the Chinese drugs are not trusted anymore could be that in Sierra Leone we are building resistance to them.’

As for Bang Baa, Bahoy believes that it can be effective: ‘Yes, it works; even I have tried it. The only fair concern that the medical profession has about it is that the dosage isn’t set – it can cause harm to your immune system if you take too much.’

Across the country, the lost days from malaria take their toll on industry, family life and development. ‘Malaria continues to eat at the fabric of the youth in our society, under the eyes of those who are charged with the responsibility to prevent it,’ says David Hindolo, a 24-year-old student from Freetown.

Many elders, often sceptical of new advances in medication, have found their fears confirmed by failing standards of medical scrutiny with regards to antimalarial drugs. My aunt says no to all ‘white man medicines’. All her life, she has taken only traditional medicines. I used to provoke her: ‘Your herbal medicine doesn’t even show an expiry date! You will kill yourself one day.’ Then one day I was sick and I had tried all the painkillers, with no relief. Finally, I went to my aunt and asked her to help me. Smiling, she turned and said, ‘Sorry! My medicine has expired!’ I took the teasing and I took the herb. I started to sweat, and within a few hours, I felt better again.

Bankolay Turay is a reporter for Radar.

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