Poverty and Malaria

Malaria, HIV/AIDS and Tuberculosis are
diseases of poverty in Africa. When asked what he was doing wrong to have
experienced malaria 85 times, Bishop Joao Somane Machado caught the audience of
the Time Summit on Global Health unaware.

Bishop Joao Somane Machado caught the audience of the Time Summit on Global Health unaware when he was asked what he was doing wrong to have experienced malaria 85 times in his life. He replied simply, “I was born to poor parents in a poor, rural village.”

He then recounted the difficulty of getting medicines and prevention information to isolated villages. He also noted that 60% of Mozambique’s population is illiterate, making it impossible to understand written information about disease prevention.

He said the most effective way to convey information to people in these circumstances in community-based radio. He told the group community radio is effective because content is delivered to people in their own village by persons whom they trust. With 16 languages in Mozambique it’s necessary to overcome language and cultural barriers. This is possible when the message bearer is someone from the village known to the people, he said.

He also spoke of the need for information about following the full course of treatment for tuberculosis which is coming back in Africa with disease-resistant strains that are more virulent and difficult to control. He told the audience that the need to grow food and tend to families causes African men and women to return to survival needs before they have completed a full course of treatment. Once they begin to feel better they leave hospitals and many stop taking medications before the full regimen has been completed.

This behavior is the result of the need to survive, he said.

Dr. Paul Farmer, who has pioneered community-based treatment in Haiti and Rwanda among other places, said this illustrates the connection between poverty and disease. The impact of poverty interrupts good practices in treating disease.

He also noted a worse by-product. Interrupting treatment of TB can lead not only to recurrence. It can also lead to adaptation by the bacteria so that a more resistant strain of TB results. He noted that even switching medications during the course of treatment can have the same effect.

Some patients switch medications due to costs. When they learn they can purchase a cheaper medication than the one with which they started, they often decide to use the lower cost medication. But this also encourages adaptation that can result in resistant forms of the disease, he said.

He called for access to health care as a universal right. He was critical of the practice of social marketing in which mosquito nets are sold to poor families on the rationale that something purchased is valued and used more than something given freely. He said there is no evidence to support this claim.

He was also critical of hospital user fees for the poor. Charity K. Ngila, Minister of Health of Kenya, recounted how mothers in hospitals in Kenya were discovered tossing babies from the windows of hospitals to conspiring persons on the ground because the mothers are detained in the hospital until they can pay user fees. Poor women have languished up to nine months after the delivery of a baby as a result of this policy, she said.

Dr. Farmer said the issue is deeply embedded in social policy that not only recognizes health care as a human right but also recognizes a greater challenge–access. He said the more meaningful part of this claim is accessibility. He called for social policies that provide bed nets and access to health care at no cost to the poor. Ms. Ngila noted that monies given to her country for development aid are not available for paying the salaries of health care workers because health is not considered an economic development issue.

“Money given for development is considered wasted if it’s used for health,” she said.

Dr. Farmer said the drain on the economy of developing nations from managing inadequately such diseases and malaria, HIV/AIDS and TB illustrates the need to look at their costs differently and see them as threats to economic growth.

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