After years of treating malaria, doctors in Myanmar and other neighboring regions are findingthat the vector-borne disease spread by mosquitoes is becoming increasingly resistant to most first-line antimalarial drugs. The World Malaria Report 2014 reported healthcare workers finding resistance to the antimalarial drug artemisinin in Cambodia, Laos, Myanmar, Thailand and Vietnam. The hardest hit areas are often also the poorest. In 2013, the World Health Organisation (WHO) tracked 333,871 malaria cases in Myanmar. Roughly 60% of locals, mostly migrants and farming families, live in remote areas hard for medical staff to reach. But an unlikely hero has emerged in the fight to prevent malaria – the midwife.
The midwife – an essential influencer in malaria prevention
Villagers trust knowledgeable midwives with their health. The midwives understand the barriers that villagers face in receiving proper care and treatment – many provide services out of clinics, which occasionally double as their homes. Midwives typically earn 80,000 kyat (about $80) per month.
As part of their healthcare services, midwives throughout Myanmar help educate those at risk of contracting malaria about low-cost prevention tools such as bed nets, repellent creams and mosquito baits.
One reason locals are so receptive to midwives is the ubiquitous use of traditional and natural medicine throughout the country. In Myanmar, the International Federation of Red Cross and Red Crescent Societies records that 80% of the population relies on traditional medicine for their healthcare needs, and 70% of deliveries are home births. Villagers sometimes combine traditional medicines to create their own tools for preventing mosquito bites.
For example, villagers in Myanmar commonly use thanaka cream, a paste made from the ground bark of the thanaka plant and mosquito repellant, mixed into a topical skin cream. Thanaka paste offers locals cooling sun protection and cosmetic benefits such as reducing oiliness, tightening pores, and improving their overall complexion. Thanaka cream on its own can help cure acne, fungus, and prevent mosquito bites. So, when mixed with an additional mosquito repellent ingredient the potency and preventative qualities of this magical ingredient grow.
Challenges ahead
But despite steady progress in malaria prevention, challenges remain. The WHO World Malaria Report tracked about 198 million cases of malaria worldwide in 2013 and around 584,000 deaths. Globally, the disease caused an estimated 453,000 under-five deaths in 2013. Many villagers needing malaria prevention live so remotely, healthcare workers can only enter by motorbike or foot. This means the most vulnerable population for malaria – pregnant woman and young children – remain largely at risk. The larger problem for Myanmar families, often living in mud structures without a toilet, electricity, or water, is overcoming poverty. Securing education and providing food for their children often trump malaria prevention as a concern for most parents.
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