From the description of the population problem, next I was immersed in the world of Five and Alive, what we call our programs that help children live their 5th birthday, no easy task in poor countries. This year, 10 million children world will die before their 5th birthday from pneumonia, malaria, diarrheal disease, and other easily preventable causes. Rwanda’s government, in addition to wanting very much to meet the Millennium Development Goals, has set “2020” goals for itself, and to that end has one of the most intensive child survival and maternal health agendas in the world.

And, they need it. 1 in 12 children born here will die before age 1, and then an additional child per 7 will die before 5. Malaria, preventable and treatable, is cause number 1. There are 2 million cases of simple malaria a year in public health facilities and 4 million cases that are not treated at all….children average 2 – 3 cases a year. Death by mosquito bite. I think that the next time I play badminton and get all annoyed I’ll remember, at least it’s not killing me and my babies.

To take this on, we socially market a net called “tazanet,” which is pre-treated with the appropriate insecticide and lasts for 3 years. It is available at very small price which research shows different sectors of society can afford (“market segmenting”), and we give them away for free in many areas as well. This blended approach of private sector availability combined with recent free distribution of 3 million bed nets to care-givers of children under age 5, pregnant mothers, and the HIV+ helped achieve a stunning 60% reduction in malaria cases in 2007! This is the greatest reduction of malaria rates in the world, something the government can be very proud of doing for its people.

For treatment, we have made Coartem available at government 227 registered pharmacies nation-wide (registered is important to ensure correct education is given with the sale of the product regarding its use to avoid generation of myths and creation of resistance to meds). We have “over packaged” from the manufacturer, one of my favorite things that we do. We make it a brand, “Primo,” which we can “market,” and provide pictoral and local dialect instructions for the low/non literature. Even the photos of the babies guide care-givers to correct dosing based on age. It’s a truly wonderful thing and I get very, very excited about over packing!!!!!!!!!! (Another piece of malaria treatment is presumptive intermittent care for pregnant women, who are very susceptible to malaria morbidity/mortality.)

Publicity and marketing campaigns, via billboards, paintings on buildings, radio and TV spots and “infotainment” like skits and plays, puppet shows, etc. help create awareness of the need for sleeping with a mosquitaire, tazanet as a locally available LLITN, symptom recognition/treatment seeking behaviors, as well as drug compliance. The umbrella term for all this is “Behavior Change Communications,” BCC. Perhaps this is a good time to mention that Staci, our Country Representative, did her undergrad at UCLA and her MBA at Columbia! Our social marketing staff generally have both multiple degrees and Peace Corps backgrounds….very, very cool folks.

ALL CHAPTERS:
Day one — arrival
Day two — genocide memorial
Day three — the countryside
Day three — the PSI.org offices
Day three — malaria nets
Day four — you go, global girl
Day four — water purification
Day five — world malaria day
Day six — Women for Women International
Day six — Democratic Republic of Congo
Day six — heal Africa
Day seven — Sonrise
Day seven — Dushishoze
Day seven — reflections