Helping to fight malaria with positive deviance volunteers

Approx reading time: 5 mins

Wanweena Tangsathianraphap, External Communications Officer for the Asia region, visited Ratchaburi province in Thailand to report on Malaria Consortium’s Positive Deviance project.

At the community centre in Bor Wee village, Ratchaburi province in the western part of Thailand, a group of 14 positive deviance volunteers were conducting a role play on how to protect oneself from a mosquito bite. A mosquito net had been hung up and a volunteer acting as a mother was encouraging her children to sleep under it. It is simple thing to do, but can yield great results for malaria prevention if the behaviour is adopted by all villagers in the community.

The threat of malaria still exists in Bor Wee village. When Malaria Consortium’s team spoke to the children who participated in the latest positive deviance session, two thirds of them said they had contracted the disease more than once and thought that malaria was just a mild illness, similar to a common cold.

Dao Horla, one of the community health volunteers, shared her story with us: “My child once had a fever from malaria. I had to walk five kilometres to take her to see the doctor at the nearest clinic. At that time, I did not even know what had happened to my girl. She had very high fever and cried from pain. I was so afraid I might lose her.”

Dao and her youngest daughter
Dao and her youngest daughter

Dao’s house is located near a stream and is built in the typical hill-tribe style, on the side of a hill with an open door and window. “I did not realise that I have to use a mosquito net to protect my children. They love to play outside near the stream, and they did not always sleep under the mosquito net. But since I learnt about malaria, I make sure they sleep under the net every night. I do not want them to get malaria or any other mosquito-borne diseases again,” said Dao.  As a mother of five, she understood the pain and suffering children undergo because of malaria, and has now volunteered to learn more about the disease and to help raise awareness about malaria in her own community.

“My children no longer get malaria and I would like to tell my neighbours how to protect themselves and their families,” said Dao.  Her story is one of the several positive deviance tales that are being shared among the community members.

According to a report by the World Health Organization (WHO) and Department of Disease Control, Ministry of Public Health Thailand, the malaria incidence rates in parts of Thai-Myanmar borders are still high compared with the overall rates for Thailand. This high prevalence is due to the surrounding thick forest environment and the mobile population. With the natural borderline of Tanaosri mountain range, people in the area usually stay overnight in the forest either for work or to travel across the border to Myanmar. Over 80 percent of malaria patients live on this border. It is estimated that 70 percent of the patients diagnosed with malaria are adult males, who are likely to work in the forest.

Dao shares her story with the community
Dao shares her story with the community

Baan Huay Pak village is approximately 16 kilometres from the Thai-Myanmar border. Korwa Jorod, known by his community as Uncle Korwa, described his experiences of malaria to Malaria Consortium’s representatives.

“Most men in this area work in the forest and along the border. They usually come home late at night or during the next day. Sometimes they get sick. They are not careful about protecting themselves. I used to be the same,” said Korwa.

“I used to be careless and go to the forest without any protection from mosquitoes and, as a result, I kept getting malaria again and again. I didn’t think it was very serious until a local health organisation visited the village and told us about malaria. I then realised how dangerous the disease really is. My perception was drastically altered. So I joined the volunteer programme to learn more about malaria. I am so glad that I am now much better informed and also that I have a part in helping my community. Protecting people from mosquito bites is the best way to prevent malaria,” Korwa explained.

Uncle Korwa shows a picture from the IEC material which demonstrates how to protect oneself in the forest.

Apart from being a community health volunteer, Korwa is also the religious leader in the village, and is a member of the community river committee. His roles give him many opportunities to interact with villagers on a regular basis.

“I talk to the villagers like I’m their relative,” Korwa told Malaria Consortium. “Of course, not everyone will listen to me, but I will do my best in my role. One volunteer may not control the disease, but together we may create some changes. Importantly, I know I have the support of the other volunteers and the staff from Malaria Consortium and the Pattanarak Foundation. This encourages me. I feel that every life is worth living and I will do my best to save them.”

Both Korwa and Dao are part of the pilot activity on community mobilisation through positive deviance volunteers. Six villages in a high-risk area of Ratchaburi province were selected to apply this innovative approach on behaviour and social change.

Uncle PD
Uncle Korwa shares his lessons with the community

Funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, the community mobilisation through positive deviance project is conducted by Malaria Consortium in close collaboration with the Pattanarak Foundation, a local non-profit organisation, as an attempt to improve malaria prevention methods in hard to reach and vulnerable communities. Since the project was launched in April 2014, more than 20 community health volunteers have been recruited and trained. Their work is vital to help bridge the gap between the community and the health authorities. This pilot in Thailand will provide learning about this approach and evidence of impact and, if successful, can be scaled up across the country.

My first week with Malaria Consortium: Positive Deviance in the Suan Phueng district of Thailand.

Approx reading time: 3 mins

Pavan Singh works as an external communications volunteer at Malaria Consortium’s Bangkok office. As part of his six month placement, he visited a remote village in Thailand to get a first-hand account of Malaria Consortium’s Positive Deviance project.

As a GlaxoSmithKline (GSK) Pulse Volunteer, I joined Malaria Consortium’s Bangkok team at the start of July for a six month work placement. The PULSE Volunteer Partnership is GSK’s skills-based volunteering initiative. Through PULSE, selected employees are matched to a non-profit organisation for three or six months full-time, contributing their skills to help meet healthcare challenges.

Following orientation and training, I undertook a two-day field visit to learn more about Malaria Consortium’s Positive Deviance project being implemented in a small village in the Suan Phueng district of Ratchabury province in Thailand, close to the border with Myanmar. There is growing evidence of the emergence of artemisinin resistance along the Myanmar-Thailand border and significant efforts have been underway for a number of years to contain its spread. The transmission of a malaria parasite which is immune to the artemisinin vaccine could have catastrophic consequences in the fight against malaria.

Many migrant workers in this area of Thailand look for work during planting or harvesting seasons, and frequently cross borders with their families and stay for several months. For these communities, malaria is one of the most common diseases, and there is a risk of spreading a drug resistant parasite across borders.

Positive deviance involves identifying people who, despite sharing similar living conditions and resources with the rest of their community, are already demonstrating positive preventive and care-seeking behaviours. These individuals are encouraged to share those behaviours with the rest of their community. The strategy has been implemented in a number of countries to identify positive behaviours associated with newborn health, family planning, female genital mutilation and HIV/AIDS. Malaria Consortium is the first to implement the strategy for malaria control.

The pilot villages were identified based on the presence of mobile and migrant populations in high risk areas for malaria throughout Thailand. The men work in the rice fields until late, and the village is surrounded by forests. The risk of being infected by a malaria parasite-carrying mosquito is high, and there is a chance that an infected person could then spread the parasite.

I attended a community meeting which began at in the early evening and was attended by 25-30 villagers. Five positive deviance volunteers spoke and shared best practices to avoid being bitten by a mosquito, including advising to always sleep under a mosquito net, to always wear long-sleeved shirts and long trousers when working in a field, and to immediately go to the health centre for a blood test if suffering from malaria symptoms.

Villagers who work in the fields are particularly at risk of contracting malaria.
Villagers who work in the fields are particularly at risk of contracting malaria.

It was clear to me that the simple practices and solutions being shared by trusted members of a community made a big impact on the villagers. After each volunteer spoke, behaviour change specialists and project staff reinforced the key messages around malaria prevention and control. The meeting was conducted in English, then translated into Thai, and further translated into Karen, the local language, by Anusha from the Pattanarak Foundation, Malaria Consortium’s implementation partner on this project. This process was exhilarating to watch, and it was very rewarding to see life-saving messages being translated and successfully conveyed to people in the community.

Worth mentioning is that the language barrier is just one difficulty to be overcome when organising and implementing positive deviance activities. It is challenging to organise and motivate people to attend, especially in remote villages. Positive deviance volunteers have to conduct sessions sometimes at the convenience of the community, matching timings for as many members of the community as possible, organising a location, and making sure that the methods taught in seminars by volunteers are fully understood.

Community members attending the positive deviance meeting.
Community members attending the positive deviance meeting.

The following day we returned to the village for a feedback session. The objective was to consider further interactive tools for communication and to improve the quality of the meetings. As a result, we decided to provide further training to the positive deviance volunteers.

I have now been working with Malaria Consortium for just over a month, and my colleagues have returned to the village in Suan Phueng to provide further training to volunteers and improve integrated community healthcare and prevention techniques. It has been very interesting to see how Malaria Consortium projects work at community level and the challenges associated with disease prevention and control.