Mirriam Banda is a midwife, nurse, administrator, counselor and health advocate for 15,000 residents of her community in eastern Zambia at the Kafumbwe Rural Health Center in Katete District. She is married and a mother of three children. In 2011, a severe malaria outbreak nearly cost her daughter her life. The ordeal continues to deeply affect Mirriam, who also battled malaria numerous times during her childhood – so many that she cannot remember the exact number. Today she faces the disease day after day in her work and her community and, in the context of World Malaria Day (April 25), we spoke to her.
How does a person live day to day in a place where you feel constantly threatened by the simple bite of a mosquito? How does malaria change people’s lives?
In a country where malaria is endemic, you tend to wonder most of the time when you are bitten by a mosquito, if that mosquito carries the parasite that will transmit malaria to me or not. It is quite worrying; it’s just a mosquito bite. Imagine someone dying from just a mosquito bite! It’s really scary. You don’t know who will be next in your family or who will be the next in your community. And malaria is preventable and curable, but if the diagnosis tests and the treatments are not provided on time, it can lead to death. I’ve seen many lost lives as I was growing up and in my line of work as a healthcare provider, including a lot of babies that lose their lives whilst being rushed to reach the nearest facilities. One in five children dies every minute from malaria. It is very disheartening for a mother, even a guardian, that we continue to lose our dearly ones. We must do more.
In your country, Zambia, there are still almost 5 million cases each year, but… how has the fight against malaria changed from when you were a child to today?
While growing up, I used to suffer from malaria about two to three times a year. That really impacted on my education, as I would miss 3 to 5 days of school a week and that made me fall behind, because the rest of my classmates had made progress in subjects that I hadn’t learned. But, in the last two decades there has been tremendous progress in the fight against malaria with the help of donors such as the Global Fund. Now, it is different than back in the days when people had to travel miles and miles to reach the nearest facility center to access the services for malaria. Now, facilities have been built as close as possible to the families. The preventive measures that have been put in place such as provision of long-lasting insecticide treated bed nets, malaria diagnostics and treatments are readily available in the community and at the health facility. People had been trained as Community Malaria Agents, so they can perform a simple malaria test – and if a person is found to have malaria, the Artemisinin combination therapy is given to them.
You work as a midwife at a health center in rural Zambia. Pregnant women and children under the age of 5 are the most vulnerable to mosquito bites. How do you work with them on prevention and treatment?
We reach out to these pregnant women and children through healthy education at the health facility and in the community during outreach sessions. We sensitize them on what malaria is and how they can prevent themselves from it. It’s important that they can be able to recognize signs and symptoms, so they can have a diagnostic test when they start to feel them. When pregnant women come for their antenatal sessions, we usually provide them with preventive treatment, Fansidar, taken through a direct observation treatment, which means we need to observe the woman taking the drug. We also provide them with long lasting insecticide mosquito nets, and we inform them of the importance of sleeping under the bed nets year in and year out so that they can prevent themselves from being bitten by mosquitoes and having malaria in pregnancy. Children under five are also provided with long lasting insecticide bed nets.
With aid coming through in the fight against malaria such as The Global Fund, without an agency like…… most people would not have access to free drugs and testing?
With the aid that is coming in through the Global Fund, Zambia is implementing the measures that are needed to curb the endemic issue of malaria. The aid that comes in from the Global Fund not only focuses on malaria, but it also focuses on the programs to deal with tuberculosis as well as HIV/AIDS. The Global Fund has helped Zambia to run a lot of programs, helping the country to have the rapid diagnostic test, treatments like Artemisinin combined therapy and the long-lasting mosquito nets that are mass distributed in the country.
The funding has also helped to build capacity for us, health workers, on how we can diagnose and manage malaria. The aid is helping Zambia to implement the strategies that the National Malaria Elimination Center has put in place to have a malaria free Zambia. If we have a malaria free Zambia, it can also be brought out to the other regions and as well as the world.
We are talking about a disease that is preventable and curable but still causes more than half a million deaths a year, almost all in Africa. Is this a repeated pattern in global health?
Africa is much affected by malaria, especially in the sub-Saharan region. We should not fight this fight alone because it doesn’t mean that if you are not infected, then you’re not affected, because this can come to anyone. It is just distributed due to the geographical settings, but when we look at the climate change and global warming that is happening nowadays, anything is possible. So, if we don’t invest more and don’t put our hands together, even in those regions that are not affected with malaria, they could be affected some years in the future. If this happens… it will bring us back to square one. Look at what happened during the COVID-19 pandemic. We really had made a step further on the fight against malaria and these other diseases, but since the resources and funding were directed to COVID-19, we lost a lot of the progress that had been made on the malaria program. To eradicate malaria, we need to join hands and invest more not as a region, but as a world.
It’s true, lately more alarm bells are ringing because with global warming malaria is spreading to areas of the world where it had not reached before. Does this need to happen for the international community to finally react and invest more in tools and R&D for malaria control and elimination?
Yes, the regular seasons are not like they used to be. Now you find that you can receive rain any time. Looking at the weather pattern that we are having in Zambia, we’re experiencing a drought and, in some areas, where they’re experiencing some rains it’s in extreme, leading to a lot of floods. And floods are a breeding site for mosquitoes, because of the stagnant waters. It will mean a lot of malaria cases in those areas. Measures need to be put in place due to climate change. The mosquitoes are mutating and are changing their patterns. Before, we would experience a lot of mosquitoes in the evening, but it is different nowadays: even during the day we experience mosquito bites. We need to be prepared by investing more and researching more on what measures should be put in place. So that prevention, diagnostics and treatment are readily available and accessible by everyone, helping us also to reach universal health coverage by 2030.
Can you imagine a future where countries with fewer resources no longer depend on international aid to care for their citizens?
Sure, it’s something that I’m also looking forward to, as an advocate that is why I’m giving out my voice, talking for the voiceless, because many other people that are affected are unable to voice out. But first, we must invest together so that we can reach zero cases of this deadly but preventable and curable disease. Once we fight this malaria epidemic, there will be no malaria in Zambia, there will be no malaria in our region, there will be no malaria in the world. In this context, malaria cases will be so few that it will be easily manageable for a particular country with the local resources that they have. This is a future that I’m looking forward to, and I feel that it would be possible with joint effort. So, I call upon all governments to invest in this noble cause in the fight against malaria, tuberculosis and HIV/AIDS.
