As Violence Recedes into Liberia’s Past, IMC Helps Combat an Overlooked Disease

Malaria has long been the leading cause of death in Liberia, as it is in so many African countries where the disease is endemic. Part of the problem is the lack of access to diagnosis and treatment. One-third of Liberians in rural areas live several miles from the nearest health clinic, and their only mode of transportation is walking or cycling. For someone who is experiencing the classic symptoms of malaria—fever, sweats, chills, headaches, nausea, and vomiting—the journey is often too grueling to make. And yet: if patients are not diagnosed early in the course of the disease, the disease will progress and severe, even fatal, complications can develop—among them, anemia, brain disease, and kidney failure.

PHOTO: IMC When 18-month-old Kebeh fell ill with a fever, cough and cold, her mother brought her to the IMC clinic in Borkeza, Liberia, to be tested for malaria. Kebeh tested positive, but after one week of treatment with anti-malaria medication, she was well again and her mother was able to resume her farm work.

Years of political turbulence have also exacerbated the problem.

For much of the past two decades, concern over the threat of sickness has been eclipsed by concern over the threat of violence. During the Liberian civil war, which raged on-and-off from 1989 until 2004, the country was in a state of chaos. More than 200,000 people were killed, and hundreds of thousands more were displaced. During the late 1990s, 95 percent of the population abandoned their villages to escape the murderous rampages of warlord Charles Taylor’s guerilla army. Many wound up in crowded refugee camps where the overburdened health clinics scarcely had time to treat all the patients clamoring for medical care, let alone to coordinate malaria prevention campaigns. By the time Liberians began returning to their homes in 2004, the country’s health infrastructure was destroyed, and the population had no access to medical services.

With the peaceful election of a new president in 2005, Liberia began a long, steady climb toward stability. That same year, IMC began helping to rebuild the country by rehabilitating 18 health clinics, two health centers, and one hospital. At first, it remained difficult for many Liberians to get accurately diagnosed for malaria because the blood-smear test used to diagnose patients was not available in rural areas, which had only the most basic health care facilities. Instead, health care workers were diagnosing people according to their symptoms. Patients who complained of malaria’s classic symptoms were often presumed to have malaria, sometimes incorrectly.

In late 2005, in an effort to mitigate the devastating effect that malaria has long had on the population of Liberia, IMC introduced a Rapid Diagnostic Test (RDT) for diagnosing malaria to these rural clinics, along with new, highly effective combination drug therapy, as recommended by the World Health Organization. Accurate and easy to use, the RDTs have made it possible for health workers in rural Liberia to diagnose patients with malaria early in its course, before it progresses into a more severe, life-threatening form of the disease.

IMC also stepped up prevention efforts among the communities it serves. Staff members at every clinic have been training members of the community, known as community health promoters, to spread awareness about malaria among neighbors and family members. They emphasize the importance of using mosquito nets sprayed with insecticide and the importance of creating drainages to get rid of standing water, which attracts mosquitoes. They discourage community members from spending time outside after dark, when mosquitoes are rampant. And they encourage pregnant women to take advantage of the prophylactic drugs available to them at IMC health centers: because pregnancy depresses women’s immune system, they become increasingly susceptible to the disease. If a pregnant woman contracts malaria, it might result in a low birth weight for her baby, which jeopardizes the child’s chance of survival.

The efforts to prevent malaria and treat it early are paying off: the disease decreased by 12 percent between 2005 and 2006. “In a relatively short time, IMC has improved the health, the well-being and the economic self-reliance of this community,” says Derege Terefe, Country Director of IMC’s Liberia program. “If we are able to continue meeting these needs, we can make real progress in our battle against malaria.”

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