World Malaria Day: Imani House’s Bisi Ideraabdullah discusses Liberia’s struggle against malaria


World Malaria Day: Imani House’s Bisi Ideraabdullah discusses Liberia’s struggle against malaria

April 24, 2009

"Every fever in Liberia is considered malaria," says Bisi Ideraabdullah, founder and director of Imani House, which runs a clinic serving 14,000 women and children in Brewerville, Liberia, in West Africa. The deadly mosquito-borne disease, practically extinct in the U.S. and Europe, kills nearly a million people each year and sickens as many as half a billion people annually in 109 countries in Africa, Asia and Latin America. Liberia has among the highest rainfalls in Africa, a ripe environment for the malaria mosquito.

Waiting for treatment at the Imani House Clinic.

Ideraabdullah founded Imani House in 1986 to stimulate local development, improve literacy and provide basic healthcare. In 1990 the organization mobilized to respond to the needs of the thousands displaced by Liberia's devastating civil war. Since the war, it has become a dynamic social services and healthcare provider. Its clinic, founded in 1992, is the only clinic in a 50 km radius. Its nine medical practitioners treat approximately 1,100 women and their children each month, mostly free of charge.

Ideraabdullah explains that malaria strikes the rich, the poor, locals and foreigners equally—sickening local children and UN officials alike. Yet this disease, that for the strong and healthy is merely a highly uncomfortable fever, can be deadly for the poor, sick and malnourished. "If your body is weakened, the immune system compromised for any reason, your chances of dying from malaria are high."

According to Imani House, poor nutrition is one of the primary causes of malaria deaths. The average income in Liberia is the equivalent of $1 USD a day, and the cost of a bag of rice is nearly half of a school teacher's monthly salary, says Ideraabdullah.  "In the average household of six people, living off little more than rice, children are getting no protein and very few of the essentials needed for growth. They are simply not getting what they need to resist disease." Ideraabdullah explains that part of the problem lies in customs of food allocation. In Liberia, as in many African cultures, "the man is going to get the best food out of the pot, including meat, if it exists. The children will get the least."

Ideraabdullah stresses the importance of teaching mothers about children's nutritional needs, and empowering them to be the first line of defense in their children's medical care. The clinic teaches them how to recognize and stabilize diarrhea and malaria symptoms so that children can survive the time that it takes for a family to seek medical attention. It also stresses the importance of seeking care in the first place, as far too many Liberian children die of this treatable disease because parents don't take them to a clinic or hospital until it's too late. This is a trend that Liberia's medical community is working together to overcome. Public awareness campaigns and dissemination of free drugs to providers are meant as incentives to get patients to a clinic or hospital when fevers strike.

Misuse of medicine is also a factor in raising malaria's death toll in Liberia. Because of the limited number of healthcare facilities, many people get drugs off the street, often outdated or inappropriate medicine that can be lethal. During the early stages of the war, parents of children with bodies swollen from severe malnutrition were frequently sold Lasix, a diuretic. Children quickly died despite the "cure." Imani House educated parents to tell their friends not to buy the fraudulent drug and lobbied the government to broadcast radio announcements warning parents against dangerous street cures.

Yet even approved malarial drugs can be bought easily and without a prescription on the street in LIberia, enabling citizens to self-administer treatment, often improperly, a practice that has nurtured tough drug-resistant strains of the disease. Liberia's high rate of illiteracy is part of the problem: "Not reading and writing means that mothers can't always understand the instructions given by medical practitioners for use of medicine," Ideraabdullah says. "Teaching them what to do while they're in the clinic can go a long way to preventing drug resistance and tragic outcomes."

In addition to Western medicine, a bouquet of traditional treatments for malaria are also available from local herbalists and in the market. Some, Ideraabdullah says, are more effective than others. Imani House would like to explore incorporating a trained herbalist into the clinic's staff so that families can access traditional medicine in a controlled way. "I believe that herbs could have a positive effect on many illnesses, as long as dosages are correct," she says.

Like treatment, prevention of malaria is a subject of some debate. Insecticide-treated nets (ITNs) are widely considered the most effective prevention method. Their use has reduced incidence of the disease around the world.

But critics of the method, including Ideraabdullah, worry that the dangers may outweigh the benefits, especially in communities where there is a high chance of misuse or contamination of water sources. "There's no way I'm giving a bottle of insecticide to an illiterate family to impregnate a mosquito net, especially when they use the same water for washing and drinking." She also worries about skin irritation and inhalation, especially for children, and about contaminating rivers when ITNs or insecticide bottles are washed or disposed of. "We have to find solutions that won't poison our rivers, solutions that strike a balance between preventing disease and harming people or the environment. Many of the international NGOs have said that the impregnated nets are a better alternative than catching malaria, but in my opinion, they're not."

Instead, Ideraabdullah believes that the NGOs would better serve her population by helping people to screen their homes with non-chemically-treated materials. "You also have to do public education," she says. "Everyone wants a quick fix, but education is the way to go, because it's sustainable."

Ideraabdullah would also like to see a local approach to malaria research. "I'd like to see a research institute connected with a clinic in Liberia," she says. "Scientists in the labs that I saw in the United States work a lot with imported strains in Petri dishes, not real malaria being experienced by families. They aren't always in touch with the disease on the ground. Maybe putting the two together will work for us."

Today, Imani House is active in Liberia's malaria campaign, and works to advocate for effective, healthy and sustainable treatment of this and other diseases affecting children and families. The clinic has a highly successful midwifery and maternity practice as well as a well-baby clinic, immunization services, general health care and testing and treatment for a variety of diseases. Much of its focus is on preventative education, teaching mothers about family planning, HIV and responding to illness. "We are able, for pennies, to really reduce the infant mortality rate."

The clinic is a rare island in Liberia's healthcare system where the poor are treated with dignity. "It treats them like human beings," says Ideraabdullah. "There's no tribalism in our clinic, we don't insult them because they can't read and write. People like the way they're treated, so they come to us. They have said: 'we can't get healthcare like this anywhere else.'"

With grants from AJWS and the Liberian embassy, Imani House plans to expand the clinic by renovating an old orphanage where it once housed abandoned children from the war.  Imani House's medical staff hopes to soon provide nighttime hours to cater to women in labor and other emergencies. They are also organizing an internship for student nurses, providing the taxed staff with extra help and giving the young nurses a chance to practice their skills.

"We wouldn't be at the level we are now, even thinking about growing, without AJWS," she says. "I'd just like to say thanks for asking us what we need, rather than telling us what is needed. If other groups partnered in this way, it would help the local NGOs. AJWS trusted us, and it's working."