I spoke to Egleé a week ago, just ahead of project leaders’ return to the Amazon to continue community visits to the Indigenous communities leading this work, starting with a visit to Betania. Over the next four weeks, they will reinforce the strategies set up for epidemiological vigilance and control over malaria, and deliver mdicines and medical equipment.
The headline is, “No cases of malaria in Kayama since November!”, Egleé said. “In an extended community of almost 1,600 people, no cases—neither autochthonous (the parasite is in the community, the transmission is within the local population) nor imported (the malaria comes from the outside)! And very few cases in Caño Iguana—only 6 or 7—since the last time we visited in December.
“Malaria used to be the topic, the thing we talked about all the time. Now when we communicate, they don’t even talk about it! Instead, we talk about weather, other health issues, hunting or….”
These community-led impacts—and our ability to deliver, document, and share them—are possible thanks to the generosity of you, the project’s donors. And now those impacts, combining prevention, rapid diagnosis and effective treatment, have come to the attention of national and international actors working to address malaria in Venezuela and beyond! But I’m getting ahead of myself. Egleé shared the following detailed report on the project’s work since our last report to you.
“During December 2022, project leaders returned to the Jotï community of Caño Iguana (AmazonasState, Manapiare, Alto Ventuari). We continued the training, distribution of long-lasting insecticidal mosquito nets (LLINs)), medical supplies, generic medicines targeting morbidity and especially enough Rapid Diagnostic Tests (RDTs) and treatments for malaria, reaching our numerical targets in all categories. See Table 1, below: Caño Iguana (Jotï) by the numbers.
We attended several community meetings, and it was a wonderful surprise to see the results accomplished in the area by the community’s implementation of the malakits: the portable kits for malaria diagnosis and treatment. The way the Jotï have appropriated the strategy to control, diminish and eventually eliminate the malaria and made it their own was amazing! Each responsable, the person responsible for one or more of the (25) sectors that the Iguana area is composed of, truly took care of the people with malaria or malarial symptoms. They walked from their home sectors to meet with us and report what had been doing since May of 2022. A synthesis of what was done and found is represented in the Figure 1 (table and pie graphic, below).
Figure 1, below. Sector-based strategy for malaria control: Sectors of Jkalo Ijkwala, or Caño Iguana, by name, population, person responsible (sector head), rapid diagnostic kits used, and cases recorded.
The sectors are to different distances from the ambulatorio where the clinic and the only microscope to diagnose malaria are located, some as far away as two day’s walk. The possibility of a precise diagnosis through the proper use of RDT, supervised by a well-trained sector head are therefore crucial, given that most people are too far from the diagnostic microscope to get there, especially when they are ill. Now, each sector head has the diagnostic kit, treatments and training to use it on hand, and can give it to anyone affected (see Image 1 and Image 2). If the test is initially negative, they will repeat it in 24 hours. If it is positive, the correct diagnosis and immediate treatment can save the life of the patient, and also stop transmission.
The impact is to stop malaria before it gets severe and before it is communicated to others nearby.
Image 1, below: The sector heads meet, compare experiences, and organize their work: all have walked from their sectors to the control point at the central clinic in Caño Iguana. The pictures show the used RDTs being classified by each sector’s population while the data is processed onto the accompanying forms
One of the most amazing results and our best metric is the reduction of malaria cases and zero mortality.
Image 2, below: The forms above the RDTs from each sector record minute data of the person with malaria symptoms (name, age, and condition, like pregnancy or another specific health issue); the date when the test was performed; the result; if positive the Plasmodium specie; and the treatment provided among other data.
Image 3, below: The Rapid Diagnostic Tests (RDT's) used by two health leaders in two of the 25 sectors.
The new year has been one of intense and formal articulations with several key actors in the work for the elimination of the malaria in Venezuela. Since early January we were invited and selected to be part of the Technical Group for Malaria (TGM). The main goal of TGM is to put together a structured plan, suggested and followed by civil society actors (like us!) in line with Pan-American Health Organization (PAHO) and the Health Ministry’s National Strategic Plan for Malaria. We have been attending weekly and sometimes twice-weekly meetings that can last all day. It has been a huge learning experience, and has afforded an interchange of views and approaches that can be extrapolated to other Indigenous/rural/urban peoples vulnerable to malaria in the most endemic areas.
We’re at the table with PAHO and the Health Ministry, and also United Nations Development Program, Doctors Without Borders, Medicos del Mundo (Spain), Rotary Club, Proyecto Maniapure, and Proyecto Acoana, among other marvelous, committed people. Our project, though, is the first to test the malakits anywhere in Venezuela. Partners and supporters of the Group are gladdened by its success in multiple cultural contexts. They emphasize the importance of our commitment to work always by honoring community requests, in collaboration with community and partner expertise.
Thank you once again for making the amazing work of these communities' possible! Please keep us in your hearts as we visit diverse Indigenous communities in Amazonas State over the next month."
In the last three months, the team visited two out of our three project communities: Betania (Sept-Oct 2022) and Kayama (Oct-Nov 2022)! Following the Pan-American Health Organization strategy to reduce or even eradicate malaria, we committed to developing the best possible understanding of population demography, distribution and movement. We elaborated a detailed population census of both communities (see images of population pyramids, below), and linked malarial prevention and tracking efforts with community sectors (the equivalent of a neighborhood, or census block). We continued training on use of the RDTs, portable diagnostic and treatment kits for malaria. We translated all the steps for self-diagnosis into Jotï, Eñepa and Piaroa, the three Indigenous languages, and compiled them in a sort of brochure with pictures and drawings. We also made videos in the three Indigenous languages, requesting that each community's malariologist, or malaria prevention and treatment personnel, explain the self-diagnosis steps, materials and process, as well as the treatments.
We were able to accomplish a lot more, besides. You can help us to accomplish even more, as we head back into the third project community this week! Your donation to the project on Giving Tuesday, November 29th, will receive matching funds from GlobalGiving. But enough about that--we have so much more to tell you!
We are very content with the results of our recent work, including the distribution of 2,500 mosquito nets (LLINs, long-lasting insecticidal nets); 3,525 Rapid Diagnostic Test (RDTs) individual buffer kits; 1,450 Rapid Diagnostic Test (RDTs) packages, enough treatments according to current morbidity and mortality (0), and many more items needed to address malaria, as the table below shows! Our project has had a very positive impact, according not just to the figures above, but also to the testimony of the Indigenous people who recognize how the cases have been reduced since we started. They are seeing significant reduction in morbidity (people becoming ill from malaria) and mortality, the latter reduced to zero. The greater availability of treatment is also recognized. A nurse in Kayama got malaria shortly after we returned to the city. She messaged us using the new communications device we'd left for community medical use, and told us, “Shoot, I have malaria, but thanks to you, I also have a diagnostic and treatment kit!”
We donated two microscopes (see the picture of the Eñepa nurse receiving it, below), and a critical assortment of medicines for all the prevalent ailments in both communities. The medicines have been deeply appreciated, since from the beginning of the pandemic until now they are the only ones that have arrived to the community clinic (ambulatories; see the picture of appreciative people in the community of Betania).
As part of our effort to help the people to fight malaria, we helped Kayama to install a communication system, acquiring a radio transmission with its corresponding antenna and 100 ft of coaxial cable, along with an InReach satellite communications device paired with a cell phone. That equipment allows us now to know the incidence of malaria with precise numbers each month (see the pictures of installing the antenna). We also donated a new laptop to allow the malariologist in charge to maintain a proper record and be more able to properly communicate the reports, maintain an updated census, and overall support the needs of the community with more modern technology.
We keep learning the amazing sharing ethics so engrained in these communities: we took about 9 pairs of reading glasses, and in a community meeting the nurse decide to distribute them among the most in need. I grabbed a pair and gave it to a good friend who I knew needed it, but he returned to me right away saying: "I will wait until all that are in need have one pair if there is one left, I can take it!" Sharing is central for survival: food and laughter, ailments and sadness, pain and work are equally shared.
Thanks!
This report celebrates a continued burst of project activity, enabled by your generous gifts and by close collaboration with old and new partners. In early May 2022, we collaborated to divide the eye-popping USD $13,000 cost of drop-off and pickup by small cargo plane in the Jotï community of Jkalo Ijkuala, or Caño Iguana, with the project of longtime partner and medical advisor, Oscar.
In my previous dispatch, I'm afraid I underreported by half the number of portable kits for rapid malarial diagnosis and treatment the project distributed in Kayamá in late March 2022. So, I wanted to make sure to get my figures right for today’s report, focused on the project's visit to Caño Iguana and census efforts in both communities. I reached out to project leaders Egleé and Stanford just as they arrived in Venezuela. Via WhatsApp, Egleé shared the following succinct report on the project's May 2022 work:
Digging into that May 2022 report to UNICEF’s lead in the region, I found it was co-authored by the dedicated doctor, the leaders of this project, and local community health personnel, along with members of the Caño Iguana and Kayamá indigenous communities, who sent back with Egleé and Stanford a series of letters asserting their communities’ needs in different arenas.
The report is titled, “Current situation of vulnerability of children and adolescents of the Jotï/Jotö indigenous communities of Caño Iguana and Kayamá, especially associated with their identity [documentation necessary to access legal rights and government services], health and education rights”. It emphasizes the status of the Jotï as the most recently contacted people in Venezuela (December 1969). The document combines newly updated census figures carefully detailing Jotï presence, with a description of their lifeways. It details their most pressing needs, especially after 3 years of school closure. I leave you with this excerpt translated from the report, and our thanks!
_____
“1. Caño Iguana is the community focus of a [total] indigenous population of 681 inhabitants, according to the census prepared by Ricardo [pictured below], Jairo ____, Lucia ____, Egleé ___ and Balujwe ___, in May 2022. This population is concentrated in 24 sectors, exhibiting a pattern of mobile and dynamic settlement by virtue of ecological and cultural factors. The most numerous sectors are Jkalo Ijkuala (Caño Iguana) with 153 inhabitants and Morocoto with 143, which is located 12 hours away, although they have river access.
“2. Kayamá is also the community focus of 889 Jotï according to the census carried out by Alirio [pictured below] in May 2022. Far from settling in a nucleated manner, the population of the Kayamá region is organized into two sectors, Baejka with 472 people and Maykou with 417 people, however, each sector is made up of a series of sub-sectors that occupy regions in flexible and deconcentrated ways, in groups of 3 to 23 families and 13 to 115 people, the most numerous being Jkwan Jkyewi in Mayjou and Jkyeo Wa in Baejka.
“It is worth noting that this way of occupying space is flexible but consistent with harmonious, supportive and mutually caring ways of living with each other, where the values of solidarity, peace and love are the fundamental pillars of life, and where sharing is the central strategy to reproduce and maintain themselves, especially for those who have some type of lack, beyond family ties."
____
I've included a numbers of photos from the report to UNICEF, as detailed below:
Cover photo of this report: Kayamá school students in 2018, photo by Gerardo
2. Microscopist Ricardo in Caño Iguana dispensary, May 2022. Photo by Egleé
3. Caño Iguana clinic personnel treat a foot injury, May 2022. Photo by Egleé
4. & 5. Kayamá Community health leaders Alirio and Luis Eduardo, March 2022. Photo by Egleé
6. 'Malariaología' - Center for malarial diagnostics at the Kayamá clinic, March 2022. Photo by Egleé
6. Caño Iguana, an Amazonian forest community, May 2022. Photo by Egleé
6. Crossing a handmade bridge, to head towards the sector where a boy who had lost his lower right limb due to a snake bite was found, May 2022. Photo: Doctor who treated the child
We greet you on project leaders Egleé and Stanford's return from 12 packed days in the Jotï and Eñepa community of Kayama.
On March 14th, Egleé wrote, "We are entering Kayama tomorrow really early in the morning by small plane, loaded with 30 boxes of medical help and supplies, anti-malaria medicines, and mosquito nets.... We are very happy about it. Among the medicines collected, bought and donated are 1500 complete malaria treatments--a year's supply; about 1400 self-diagnosis tests, equally all equipment necessary for the diagnosis with the microscope of malaria, including 2000 microscope slides and 2000 slide covers, additionally medicines for a range of tropical diseases, we even got a soccer ball!
She and Stanford returned just over a day ago, on March 27th, and Egleé was able to share a few photos and a first report of their visit.
Most significantly, they trained Jotï and Eñepa community members on malaria self-testing and treatment kits, designed to serve community members on their journeys deep into the Amazonian forest. The training, and the 1,400 self-diagnosis test kits they delivered at its conclusion, represent the pilot launch of a new Pan-American Health Organization (PAHO) campaign, in concert with the Venezuelan Health Ministry, to eliminate malaria in the region. The strategy equips communities with tools and culturally-specific training to take control of infection management, limiting the spread of the pathogen through continued prevention, but also through treatment, not just in community health centers, but when and where infection first occurs, as people travel far from those centers. The goal is to stop infections early, limiting vector transmission, and reducing and eventually eliminating the pathogen's spread.
"We are so excited to be aligning the strategy of our project with the PAHO strategy to eliminate malaria!" says Egleé. "The whole thing came and flowed in a nice way." Children proudly helped Egleé and Stanford turn the kit's instructions into a series of Jotï and Eñepa-language illustrated posters, for community-wide training sessions.
Community members have worked tirelessly to grow their capacity to deal with malaria and avoid its deadly impacts. They emphasized how pleased they were by the success of the nets the project delivered some 3 years ago. And they immediately appreciated how small, field-ready, pocket-sized self-diagnostic and treatment kits for malaria would fit within and extend their existing set of tools, strategies and practices. Egleé notes that, other than the general strategy of self-isolation and community dispersal when malaria begins to spread, there are few traditional strategies to deal with the pathogen. That is likely because malaria is not indigenous to the region, but rather recently introduced and spread by miners and mining activity.
In addition to these kits, and the medicines and supplies Egleé lists above, she and Stanford took advantage of the slightly larger capacity of the only available small plane operator currently flying in the region. They brought along salt and soap at the community's request--basic supplies terribly difficult to acquire during the pandemic. They shared 100 copies of the 500-page, full-color Jotï-Spanish bilingual book co-authored with the community just before the pandemic, about themselves and their territory. And on their return flight to the nearest city with a medical center, the pilot also transported several community members facing health issues so severe that they could not have walked the 9 days needed to seek help on their own.
Going forward, Egleé says, "We want to center malaria, but also other diseases." There's a failing community radio, and many more nets to be replaced. There's also a need to co-design and implement options for trade that don't involve taking up gold mining, a suggestion from their nearest non-Indigenous neighbors that deeply troubles Kayama community members.
We'll tell you more about these and other things, next time.
Thank you, friends, for making this work possible. This most recent visit reaffirms our belief that our project remains grounded in two things: innovative, collaborative partnerships within and beyond these Indigenous communities, and respect for community decisions that support and enhance wellbeing. Your support uplifts us, quite literally, and carries us where we need to go.
With this report, we announce a new phase of work of the project. Your contribution, today, will help us to once again deliver lifesaving results.
In preparation for a return to Venezuela this winter, Egleé has been back in touch this week with members of the amazing network that enabled delivery of those 3,000 insecticidal mosquito nets, almost 2 ½ years ago: the bush pilot, the health worker, the local doctor, tthe malarial specialist, he NGO leader, the shipping contractor, among others. Their consensus? After a year without visits by medical personnel to any of the three communities since early November 2020, there is critical work to be done, and it is newly possible to do it. “Our project strategy looks promising, with different dynamics,” reports Egleé.
We were delighted to learn that, thanks to an initiative of the United Nations Development Program (UNDP/PNUD), the government has offered to take up the work of providing nets and key antimalarial medications and diagnostic supplies to Atures, Manapiare and Cedeño, the counties that include Jotï, Eñepa and Piaroa sovereign territory. The UNDP partnered with Venezuelan health authorities to acquire all the necessary anti-malarial paraphernalia (preventive medications, treatments, diagnostic kits ) including all the estimated nets to fulfill the Venezuelan population exposed to malaria —including ones designed for hammocks. They expect to receive all these materials between January and February 2022. How wonderful, says Egleé, “to think that the mosquito nets can start to be part of the government health policy!”
The news arrives just in time, as the current nets approach the end point of their useful 2-3 year insecticidal life, and antimalarial medications have run out. After an astounding 2 ½ years of without a fatality from malaria in any of the three communities, news of the first lethal cases just reached us, via radio: two Eñepa who fell ill while they were outside the community, and also some members of the nearby Pemon community have ded of this terrible disease recently.
While the government/UNDP initiative is tremendous news, Egleé also learned, “there will not be resources for the little plane flights for distribution of the nets and medical supplies”. The new initiative doesn’t include last (several hundred-) mile delivery to small, isolated communities.
That’s where your support comes in: no need for the project to navigate trans-Pacific shipping this time—but a critical need to cover other costs:
- the direct distribution to communities of the new nets, specialized medications, diagnostic materials, and training on use of both by trusted personnel. They’ll travel via small plane or by truck, accompanied by members of our project. This is the most important—and most costly—component of this new stage of the project.
- generic medicines and supplies associated with diagnosing and treating malarial infection that we’ll procure for the ambulatorios, the community clinics, to complement the specialized medications provided by the government. These items range from a new microscope, slides and vials for the dedicated microscopist in Betania de Topocho (first requested before the pandemic), to Tylenol (paracetamol), alcohol, swabs, and sterile gauze. As in the past, Egleé will send careful translations of the dosing and usage instructions for each medication. Each clinic has a trained field nurse on hand to received and manage them. We’re working to update the detailed lists clinic personnel provided in 2018. There’s a particular critical addition they are calling urgently for in their community radio updates:
- snakebite antivenoms and treatments, antiofidicos. These are out of stock because they are no longer being produced at the Universidad Central de Venezuela in Caracas. With your support, the project will work to obtain a supply of most critical antivenoms, ideally in neighboring Colombia, which hosts a strongly overlapping set of venomous snake species.
In addition, we hope to piggyback on these delivery efforts to begin to adapt and distribute small, portable malaria testing and treatment kits, called malakits, in partnership with our network and the three communities (https://www.malakit-project.org/; see images, below). First designed for and with small-scale miners in Suriname, the initiative would like to expand to Venezuela, building an initial strategy in highly mobile Indigenous communities like Betania, Caño Iguana, and Kayama: communities that are well-organized, and have trusted liaisons. The hope? For community members to be able to diagnose and treat malarial infections in real time while they are on the move, in the rainforest
away from any health center to confirm diagnosis and deliver treatment—further complementing the nets, and avoiding unnecessary malarial deaths and transmission. The central idea is to increase the capacity to learn where and when malaria in transmitted (local contexts) to improve the strategies to eradicate the infection, morbidity and mortality.
“In that sense,” says Egleé, “we believe that we can target our project with these ideas in main for this new stage. We will keep you posted!”
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