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.

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