No one should die of malaria today

by Global Diversity Foundation
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No one should die of malaria today
No one should die of malaria today
No one should die of malaria today
No one should die of malaria today
No one should die of malaria today
No one should die of malaria today
No one should die of malaria today
No one should die of malaria today
No one should die of malaria today
No one should die of malaria today
No one should die of malaria today
No one should die of malaria today
No one should die of malaria today
No one should die of malaria today
No one should die of malaria today
Drawing malaria self-test and treatment kit steps
Drawing malaria self-test and treatment kit steps

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.

Anti-malaria medication & public health materials
Anti-malaria medication & public health materials
Elements of malaria test & treatment kit explained
Elements of malaria test & treatment kit explained
This poster may be larger than its illustrator.
This poster may be larger than its illustrator.
Children present the full field kit instructions
Children present the full field kit instructions
Demonstrating the malaria kit self-test element
Demonstrating the malaria kit self-test element
Eglee trains community members on field kit use
Eglee trains community members on field kit use
Reviewing the Joti community book
Reviewing the Joti community book
Unloading supplies on arrival at Kayama's airstrip
Unloading supplies on arrival at Kayama's airstrip
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Please support health and cultural wellbeing!
Please support health and cultural wellbeing!

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!”

Please contribute today to support this community-driven, lifesaving, evolving work!

The clinic in Cano Iguana
The clinic in Cano Iguana
The Betania de Topocho clinic
The Betania de Topocho clinic
The clinic at Kayama
The clinic at Kayama
Malakit mobile malarial prevention & treatment kit
Malakit mobile malarial prevention & treatment kit
Malakit diagnostic components
Malakit diagnostic components
Malakit treatment elements
Malakit treatment elements
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Evaluating a severely malnourished child
Evaluating a severely malnourished child

Two years ago, an entire network of sensitive, committed people working in solidarity got together and articulated ourselves to really try to help alleviate the problem of malaria in key Venezuelan Amazonian Indigenous communities. Together with these committed individuals, and the concerted efforts of communities themselves, that initiative has been incredibly successful: even now, there has not been a single reported death from malaria in any of the three communities where the project distributed and trained residents on the use of nets.

“They love them, they absolutely love them,” says Egleé of the nets—and they continue to use them. The only suggestion for improvement? A community review, conducted recently through the radio, indicates community members like the nets and have put the nets to very good use. The nets have had a very positive effect in reducing morbidity (illness), as well as mortality. The only suggested design improvement? As the chemical repellents have begun to wear off the nets over time, tiny midges and no see ’ums are becoming bolder, and making their way through the mesh of the netting. Eglée and Stanford are contemplating a slight redesign for the replacement nets, which they hope to reorder and deliver this fall and winter.

Right now, though, Venezuela remains at a standstill: there is no fuel available to transport supplies by plane or truck to communities--or to transport patients facing serious illness or injury to medical treatment. And while an active Indigenous-led policy of isolation has largely protected remote communities from COVID-19, it cannot protect from all forms of illness and injury. It is also very difficult to obtain many needed supplies and medications locally, and those impacts are greatest on already marginal communities.

Indigenous patients facing extreme medical issues often arrive walking—or carrying infants and children—to the main hospital in the capital city of Puerto Ayacucho Amazonas State. Children are arriving very sick at hospital. Sometimes people arrive so ill that the hospitals are unwilling to accept them—and the hospital, too, has limited supplies.

Given that it has not possibility to directly deliver medication and supplies to address malaria to communities in the past 4 months or more, we have pivoted to redirect a limited quantity of project resources to support some of those determined patients seeking care. The project has helped Piaroa and Jotï patients, as well as Yanomami, Yek’wana, and members of other Amazonian ethnic groups. We are working through the same network of dedicated project partners who enabled us to deliver the mosquito nets, and extending our connections to partners to whom they introduced us, like Astríd, a woman who has an unflagging commitment to the health of Indigenous people, and supports patients with difficult cases.

Most of the cases we have partnered to support are those of Indigenous women and children: the most vulnerable. We have sent small tranches of money designated for specific cases: $40, $60. These funds supported have supported three women with breast and cervical cancers, and a woman with problems in the digestive tract. The funds have covered fees for x-rays, blood tests, 4 diagnostic breast x-rays, simple but specialized surgical apparatus to support care, and nutritious food to aid in recovery

With care so difficult to access, sometimes by the time patients arrive the care offered can only be palliative: despite support for medication and food, a Yek’wana mother who arrived at the hospital with a dramatic case of cerebral tuberculosis passed away. She was 33 years old. Project funds, though, have also successfully supported Indigenous children: kids with poor nutrition and malaria, surgical evaluation for children with hernias, with a broken femur, and two with injuries from snakebite. The difficult cases continue: just 3 hours before we sat down to write the report, a little girl arrived with 16% of her body affected by 3rd degree burns. 

Those seeking medical care are resourceful. “When you send resources,” says Egleé, “Indigenous patients who are mobile go where the resources are.” Thank you for sharing your resources: you have helped us to extend a small, protective net of care, patient by patient. Thank you for your solidarity with Indigenous Venezuelan Amazonian communities striving to care for one another, to find resilience, health and wellbeing in these challenging times.

Medical supplies & nutritious food help patients
Medical supplies & nutritious food help patients
A child receives medical attention at the hospital
A child receives medical attention at the hospital
X-ray after casting a child's fractured femur
X-ray after casting a child's fractured femur
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Jkali x 2! A young Jkali with Eglee's, also Jkali
Jkali x 2! A young Jkali with Eglee's, also Jkali

Jkali, pictured above as a boy, has been this project’s main point of contact with his Jotï community, Caño Iguana. He received messages via the community’s radio, and relayed them to the project via WhatsApp message, using a project cell phone. Since he was able to catch a flight into the community in February, carrying the medicines and supplies sent by the project, we have not had any direct communication Caño Iguana. But we continue to receive news! Another group has supported the purchase of a satellite phone in the community. Now community members are able to send text messages every few days, keeping allies abreast of health issues, emergencies and difficult situations. Our project, in turn, receives news via those text messages—including the news that Jkali and the medicines arrived in good order. He has remained there, protected with his community from COVID by isolation.

The project leaders’ relationship with this group supplying the sat phone dates back nearly 30 years. When Egleé and Stanford first visited the Jotï, in 1994, the group’s representatives were suspicious of the young anthropologists, perhaps because of a previous experience with fractious graduate students. But after 2 years, in which the pair kept a respectful, low profile, the group came to appreciate their shared commitment to work for the community’s wellbeing, and have kept up a friendship ever since.

Egleé says, “The Amazon is difficult, very complex. If you start out in conflict, you won’t survive. Instead, our relationship has been one of cooperation and respect.”

School director Gerardo and his family have remained in town, and he continues to relay messages received via radio from his Jotï and Eñepa home community of Kayama. Project leaders learned some sad news that way, recently. Alberto, “one of the wisest men in Kayama”, passed away; he and his wife drowned when their canoe overturned. He was still strong and in good health, in his mid-fifties. The Jotï , Egleé says, are people of the mountains and deep forest; most of them only began to use canoes about a decade ago. “We met Alberto on our first visit to the community, in 1996,” she said, “He was very dear to us.” The radio has its limits; Gerardo didn’t have many details.

In February, a trainee doctor in his last year of residency was able to reach Kayama. He entered at the insistence of Gerardo, who was concerned about possible cases of COVID in the community. Fortunately there were none, but there were a few cases of malaria, and respiratory and stomach infections. The doctor spent just 3 days, but brought with him medicine that the project sent from the U.S., and other medicines and supplies purchased locally with project funds.

The copies of the book which the community co-wrote with Stanford and Egleé were published in Venezuela, but most have remained locked up in a deposit. On that same flight that carried the young doctor and the medical supplies, though, 15 copies of the book entered the community of Kayama, and it has been very well received, with delighted reports coming in by radio. Egleé isn’t sure whether they, in turn, have shared copies with Caño Iguana yet; a 529-page book is a lot to carry on a 4-5 day walk, over 100 km away.

Most recently in Kayama, Gerardo reports that there are many children with respiratory infections right now, who are at risk of developing pneumonia. The project has sent--and will send more--funds for medicines, to be delivered at the next opportunity. In addition, we plan to send anonther round of medicines and supplies via a monthly service that delivers items to Venezuela via container ship. 

Thank you for your gifts, which make  this continuing relationship of cooperation and respect possible, even in the hardest times. To celebrate the longstanding character of the connection with these communities, I asked Egleé to share some photos from the archives. Below are her selections, from the early to mid 2000's, in and near Caño Iguana and Kayama. "What nostalgia!" she says. 

Eglee in Cano Iguana with her son in 2003
Eglee in Cano Iguana with her son in 2003
Stanford prepares for a communal ritual, in Kayama
Stanford prepares for a communal ritual, in Kayama
Eglee and family, Rio Moya, Enepa territory, 2003
Eglee and family, Rio Moya, Enepa territory, 2003
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Joti field nurse Jkali tests PPE before a delivery
Joti field nurse Jkali tests PPE before a delivery

Project leader Egleé called me in excitement earlier this week.The three communities have finally received the boxes of medicines and supplies that we sent! “It’s almost a miracle,” says Egleé. She sent the boxes from the U.S. months ago—you can find pictures in an earlier report—and they finally arrived, complete with Egleé’s meticulously detailed pages translating indications and dosing instructions. The boxes sent to the community Caño Iguana arrived on a recent Sunday; Jkali entered on a flight. He was the first person with medical training to visit his community in over a year. 

Jkali, shown above wearing PPE (“Amazonauta!”, a friend quipped), has completed a field nurse training program. He is currently working with a network of NGO medical personal delivering medicines and health information to tiny, remote satellite communities of Caño Iguana. “Everybody know him,” says Egleé. “All are Jotï, making him almost uniquely qualified to do this work.” Jkali is one of only 4-5 bilingual Jotï/Spanish speakers with this medical training. In addition, he contracted and recovered from COVID-19 early in the pandemic, while stuck in the city. The NGO’s doctors believe this makes him the best person to carry out these deliveries. 

As far as we know—from Jkali’s conversations, and reports relayed by radio, then cell phone, COVID has not reached these communities. But no medical doctor has visited in 14 months. No flights have been possible, and the communities have kept themselves in isolation throughout the pandemic.

Project partners helped the other two sets of boxes reach their destinations. “In Kayama there is a set of wonderful medical doctors who have, for at least 30 years, been traveling to at least 60 Indigenous communities,” says Egleé. Kayama is one of those communities. “Just for the month of December, it has become possible, informally, for NGO workers to travel once again to the communities. These doctors just delivered the medications we sent to Kayama.”

A Piaroa nurse delivered the supplies to her community of Betania de Topocho, overland. “They sent a really lovely message of gratitude,” Egleé reports. “They said were going to go walking to deliver medicines to the houses where they were needed.”

Egleé is hoping to travel herself early next year to deliver additional medical supplies and more mosquito nets, as soon as she can get vaccinated against COVID-19, so she will not risk being a carrier when she visits communities.

It took too long, she says, to honor communities’ requests. But once again, despite all odds and in this year unlike any other, much-needed medicines and supplies were delivered.We thank you for your part in that work! Please consider a year-end donation to support the project’s ongoing efforts.

Medicines and supplies reach Kayama
Medicines and supplies reach Kayama
COVID-19 health infographics shared, in Joti
COVID-19 health infographics shared, in Joti
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Organization Information

Global Diversity Foundation

Location: Bristol, VT - USA
Website:
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Project Leader:
Susannah McCandless
GDF International Program Director
Bristol, VT United States
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