I fight malaria in African island countries

  With brown skin, floral clothes, and small curly hair, the locals walked on the road in groups of three or five, carrying a scimitar with a blade length of 20 to 30 centimeters.
  When he first arrived in a foreign country, this scene of suspected gangster young and Dangerous, shocked Li Mingqiang’s nerves. “Are the people here so scary? Just walking on the road with a knife?” He was puzzled.
  Li Mingqiang quickly understood that this was a misunderstanding. Locals don’t carry knives with them to threaten or hurt people. In this farming-dominated country, knives are their survival tool, and they cannot do farm work without it.
  This is Sao Tome and Principe (Sao Tome and Principe), a small island country 200 kilometers away from the African continent, with a population of 215,000. It is one of the least developed countries announced by the United Nations, and 90% of its development funds rely on foreign aid.
  In December 2016, Sao Tome and Principe severed the so-called “diplomatic relations” with Taiwan. After the resumption of diplomatic relations, mainland China sent a team of anti-malarial experts to assist Sao Tome and Principe. In early January 2017, a 26-year-old Li Mingqiang, a graduate student of Guangzhou University of Traditional Chinese Medicine, arrived in Sao Tome and Principe as a member of the expert team. He served as the project team leader and was stationed there to assist malaria prevention and control work, which has continued to this day.
  Malaria is a life-threatening disease caused by parasites. According to the WHO report, an estimated 229 million people worldwide were infected with malaria in 2019, and 409,000 died as a result. Children under 5 years of age are the most susceptible group.
  In June 2021, China was certified as a malaria-free country by the World Health Organization, affirming China’s achievements from the annual report of 30 million cases to zero. At present, malaria is still the top priority of Sao Tome and Principe’s three major infectious diseases. The goal of Li Mingqiang’s foreign aid team is to help Sao Tome and Principe to eliminate malaria and achieve zero cases.
  This year is Li Mingqiang’s fifth year in Sao Tome and Principe. This contingent of no more than three or four people, working and living here, promotes the Chinese anti-malarial program to assist the local area, but also sees a real and vivid African island country.
First experience in African island countries

  When he selected a professional tutor for graduate school, Li Mingqiang knew that he was destined to have a foreign aid experience in his resume.
  At the end of 2016, the Ministry of Commerce’s “Sao Prudential Malaria Prevention and Control Assistance Project” recruited Song Jianping, a malaria control expert and professor at Guangzhou University of Traditional Chinese Medicine, under the tutelage of Li Guoqiao, who was a member of the National Malaria Control “523 Mission” in 1967. Li Mingqiang is a student of Song Jianping and the third generation passed down from his teacher’s school.
  At the end of 2016, when Li Mingqiang received the assignment, Sao Tome and Principe had very little public information. Because Sao Tome and Principe’s full name is “Sao Tome and Principe”, he once thought that these were two countries and he could choose one of them. The lack of supplies in Shengpu was expected. Before he was ready to set off, Li Mingqiang took everything he could bring, and packed pots and pans together with napkins.
  After three transfers and more than 30 hours of voyage, this strange country finally has a real appearance.
  The infrastructure here is backward. Water and power outages are the norm. The network is still in the 2G era. There are no buses, no traffic lights, and carts are not always unimpeded. In addition to walking, most people can travel freely between villages only by relying on motorcycles. , Trapped in the difficulty of material transportation, there are vacancies on the supermarket shelves from time to time…Although it lacks a modern sense, the city streets are clean and tidy, and there is no stereotype of dirty and messy.
  What made Li Mingqiang most incredible was that China and São Tomé and Príncipe had resumed diplomatic relations. But before Li Mingqiang and his entourage arrived, Chinese businessmen had opened department stores and supermarkets here for many years, and they were very familiar with local officials. “It is true that where there is land, there are Chinese.” He said with emotion.
  Toasted breadfruit is the staple food of the locals, and the taste is between taro and bread. “Three main dishes”: grilled steak, grilled chicken, grilled fish, all seem to be hard dishes, but there is only one way-grilling: throw into the fire, or put on the iron cover rack of the discarded electric fan On the fire, quite primitive. This makes it difficult for the Chinese taste accustomed to steaming, frying, stewing, sweet and sour, “sweet and spicy”. Li Mingqiang recalled.
  The emptiness of taste buds has to be saved by Chinese food. A few days later, they ran into a corporate office with a Chinese flag and had a meal of porridge and buns. Li Mingqiang said that it was the most fragrant porridge he had ever eaten.
  I settled my body and stomach within a week, and then there was a day to do business. Clearing malaria is a difficult task, and this group of aid teams with an average age of less than 30 years have provoked the backbone.
Mosquito PK treatment

  After many years of international assistance, the malaria of São Tomé and Príncipe has been improved. Around 2013, the infection rate was still 20%, and by 2017 it dropped to less than 2%. This is the starting point of the work of Li Mingqiang’s foreign aid team and a bottleneck in malaria prevention and treatment. From control to elimination, clearing cases is a qualitative change and it is not less difficult. To reduce the infection rate.
This is the starting point of Li Mingqiang’s foreign aid team and a bottleneck in the prevention and treatment of malaria. From control to elimination, clearing cases is a qualitative change, and the difficulty is no less than reducing the infection rate.

  The difficulties are mainly due to two aspects: the people’s willingness to cooperate has decreased, and the old plan for malaria prevention and control has limitations and cannot be cleared.
  The previous aid team used the “mosquito and anti-malarial method”, which mainly relied on spraying insecticides staying indoors. It required local residents to move everything in their homes outside, spraying insecticides on one wall of the house, and then re-use them. Go back to the original place, but this process is too much trouble. In the past few years, because of the high incidence of malaria, the people actively cooperated. However, in recent years, fewer people have contracted malaria.
  Li Mingqiang said that Sao Tome and Principe’s spray coverage rate has dropped from 90% to 60%, and according to WHO standards, the coverage rate should not be less than 80%. At the same time, mosquitoes are already resistant to insecticides.
  More importantly, mosquitoes are a transmission channel. It is also because it bites a person who is infected with malaria, and then continues to bite, bringing parasites to other people, causing more infections, and killing mosquitoes is inexhaustible. The source of malaria infection is Plasmodium parasites in the human body. Only if the Plasmodium is eliminated, is a more thorough solution.
  Therefore, if Sao Tome and Principe continue the old plan, malaria can only remain at a low level and cannot be eliminated. Once it relaxes, the number of cases will quickly rise and relapse. Sao Tome and Principe, which plans to eliminate malaria by 2025, needs a new plan.
  The plan of the Chinese aid group is to “kill the source and fight malaria, and take medicine for all people.” By taking three rounds of artemisinin-based drugs, the malaria parasites in the human body are eliminated and the goal of preventing and treating malaria is achieved. Artemisinin has the best safety and efficacy among the existing antimalarial drugs. For discovering the role of artemisinin in the treatment of malaria, Tu Youyou won the 2011 Lasker Prize for Clinical Medical Research and the 2015 Nobel Prize. Physiology or medicine awards.
  Since the 1990s, this program has been successfully tested in Cambodia and Comoros. Moeli Island, the most severe malaria island in the Comoros, has dropped by 93.2% after two months of taking the drug. Bringing new solutions to these two countries is the team directly under Li Mingqiang, two professors Li Guoqiao and Song Jianping from Guangzhou University of Traditional Chinese Medicine.

  But it is not easy to get people from the Ministry of Health of Sao Tome and Principe to accept the plan of the Chinese aid group. The local area has been accustomed to “mosquito nets + insecticides” for more than ten years. The two countries have just resumed diplomatic relations. Mutual trust in work has not yet been established. Even officials in charge of public health and medical care do not fully understand the source of infection and transmission channels. , Also due to various interest considerations, there are worries in the heart.
  In addition, there are practical difficulties. Taking medicines for all means that the local population needs to be found out. However, the information that the aid team has is not sufficient. The demographics provided to them in 2017 are the 2012 demographics. Even if the area of ​​Sao Tome and Principe is less than the size of Hong Kong, the census is an expensive task in a country where 90% of development funds rely on aid.
  In short, everything must start from scratch.
“Are you going to every county?”

  The diplomats of the embassy provided a lot of help when introducing the “Medicine for All” malaria prevention program to the Ministry of Health of Sao Tome and Principe.
  When Wang Wei, the ambassador to Sao Tome and Principe, met with Li Mingqiang and his party in 2017, he came up and asked them: How to carry out malaria prevention and control work and what is the principle? This diplomat was also a former malaria-infected person, and he almost died because of this when he was in Angola.
  This experience made him very interested in the team’s anti-malarial program. “He has thoroughly understood our plan.” Li Mingqiang said. Thanks to this, the communication with the Sao Tome and Principe government level has become much smoother. “Many questions do not need to be found to us, he can explain clearly.”

At the entrance of Shengpu Village, the local people painted the big stone like a hippopotamus

  The assistance team is also taking a two-pronged approach to help Sao Tome and Principe set up a three-level malaria prevention and control system, and when training technicians, in addition to the correct use of artemisinin compound, microscopy training, and review of blood films, the team members also explained to them that “eliminate the source and fight malaria for all people. The theoretical basis for taking medicine, but this work also encountered difficulties at the beginning.
  ”Indoor spraying does not require a theoretical basis, and it can be operated with a watering can, which is equivalent to spraying pesticides by farmers.” Li Mingqiang said, but understanding “all people take medicine, eliminate the source and prevent malaria” should start from theory.
  After several training lectures, the team members were engaged in speaking, but the audience was confused and confused. After the class, someone came to ask what the “gametophyte” was mentioned repeatedly in the class? Only then did they realize that they had overlooked the lack of knowledge in the medical field for the technicians recruited by the CDC.
“The best way is to talk to the more receptive technicians, and then let them communicate with people who don’t understand them in their own language and habits, so that they can learn faster.”

  After discovering the problem, they no longer use professional terms, but use the most popular words to explain the principle of extermination: ordinary mosquitoes and insect-carrying mosquitoes have different life spans. It is guaranteed that the human body is free of malaria parasites for three months, and new mosquitoes will not be exposed to malaria. The protozoa and the old mosquitoes that carried the worms are all dead… Eliminating professional terms, communicating in vernacular, and supporting video explanations, they have a “big understanding” feeling.
  After assisting in Sao Tome and Principe for two years, Tan Ruixiang, who was in charge of personnel training, also summarized the trick: “The best way is to explain to the more accepted technicians, and then let them and those who don’t understand. Use your own language and habits to communicate so that you can learn faster.”
  Sao Tome and Principe is divided into seven regions, because the area is small, the assistance team is used to calling these regions “counties.”
  In addition to the training, the bottom-line research is also carried out simultaneously.
  ”We are going to every county in Sao Tome and Principe for research.” In 2017, the aid team found the coordinator and said.
  ”Are you going to each one?” The other party was surprised and confirmed to him again, and Li Mingqiang gave an affirmative answer.
  They go to the remote villages of Saint-Prince and Principe. In some places, not only by car, but occasionally on dirt roads, they need to travel through mountains and rivers to make a way out of the grass. Some villages have not even been to the accompanying guide or local health officials, and they do not even know that there is such a place.
  This is not to say that officials are not working properly. Li Mingqiang, who has been stationed abroad for more than 4 years, understands their real difficulties. Not to mention the poor road conditions. When going to the countryside in remote areas, it will cost money for transportation, gas, and labor, but the funds are tight. This also contributed to the habit of their office management.
  In two years, the aid team visited 215 villages. At each place, population surveys, blood tests to find out the malaria situation, observation of the collective environment, analysis of specific causes of malaria, organization of cleaning activities, step by step, to fill in the gaps.
  Visits and investigations and personnel training are the main tasks of the aid team in the first two years of its permanent presence in Sao Tome and Principe. In July 2019, the assistance team’s plan had a chance to be put into practice, and the preliminary preparations had a practical use.

The technician is testing the children for malaria
“Be a village first”

  In 2019, the aid team once again communicated the theoretical plan with officials of the Ministry of Health of Sao Tome and Principe, and also invited Comoros malaria prevention and control experts, and asked him to show up, because there are three islands in Comoros that promoted “elimination of the source and anti-malarial, national medication”. , The effect is remarkable, but Sao Tome still has concerns.
  The assistance team proposed to select the village with the highest malaria incidence in São Tomé and Príncipe as a pilot. “First, make a village and make the effect. It looks good. Let’s continue. If it’s not good, let’s improve the plan.” Li Mingqiang repeated. The other party agreed to start the pilot in Bairro Da Liberdade village.
  The aid team cherishes this pilot opportunity. The key and difficult point is to win the trust and cooperation of the villagers.
  In the beginning, they went to the village to promote the work on working days. They planned to convene the villagers to intensively popularize science. They prepared drinks, candies, and cakes for entertainment. This should have been quite tempting to the villagers who lacked resources, but there were only a few people who came to the two games in a row. “Prepare so much and not come? This is impossible.” This was Li Mingqiang’s confusion at the time.
  They quickly discovered their own negligence—the misalignment of working hours caused embarrassment. From Monday to Friday, the main family members went out to work, and only the elderly and children who could not go out were idle in the village. After that, they adjusted their strategies. For half a year, the project team had almost no weekends, and they chose these times to go to the village for science popularization.
The Ministry of Health of Sao Tome and Principe was surprised and delighted about the results of the pilot villages. It approved the plan of the aid group and changed its attitude.

  This way of working also makes the WHO Global Fund and local health officials, who are working together to fight malaria, feel incredible. “They can’t do it. They don’t rest on weekends for half a year and spend all the time in the village. It is impossible for him.” Li Mingqiang said that in order to get things done, he sacrificed his personal time, strives for excellence in work, and is willing to work hard. This is ours. Advantage.
  Although “taking medicine for the whole people” is the focus of the new plan, the team also knows that the combined boxing that cures both symptoms and root causes is better.

  In terms of symptom treatment, the aid team does not rely on spraying pesticides. They focus on treating the public health environment of the pilot villages, weeding, and clearing ponds to reduce mosquito breeding. They hired villagers to clean up the village, call them a car, and transport the garbage and weeds out. When the work was started, the unemployed villagers also took up their tools and came to help.

The children in Shengpu village threw breadfruit into the fire to bake, which is their staple food

  ”We provide vehicles and tools and return subsidies. The villagers themselves help build the village.” Li Mingqiang said that it was in this kind of work contact that the assistance team won the villagers’ trust, and follow-up work such as three rounds of medication was carried out smoothly.
  Li Mingqiang felt support and trust from a pregnant woman who was pregnant in July. (Li Mingqiang explained that if the fetus is more than 3 months pregnant, artemisinin can be taken.) The expectant mother took the medicine. Maybe the medicine was a bit bitter. She couldn’t help but vomited out. The group members stepped forward to comfort him. The mother-to-be said that this was her morning sickness reaction, and it had nothing to do with them, and asked the aid team to give her another medicine.
  In this small village with only 600 people, the original annual number of malaria cases remained at 200-300, with an average of 10 cases per week. At the peak, 32 people contracted the disease a week. After the whole village took artemisinin, in the second half of the year, the village’s cases showed a cliff-like decline, and there were no reports of malaria for 5 consecutive months. Later, due to the new coronavirus epidemic prevention measures, the transportation of materials was blocked, the follow-up maintenance intensity was weakened, and there was still a movement of people, there were more than 30 cases, but the number of infections has dropped by 90% compared with the previous period.
  Some villagers told Tan Ruixiang that they had to run to the hospital three or four days a week. Today this child got malaria, and another child got malaria two days later. All the money they earned was spent in the hospital. Li Mingqiang also said that once an adult has malaria, he can usually not work for a week. But in the pilot villages, the malaria troubles have been greatly reduced.
  The Ministry of Health of Sao Tome and Principe was surprised and delighted about the results of the pilot villages. It approved the plan of the aid group and changed its attitude. “When we first launched the project, we were like asking people to let us do the work. Now they will take the initiative to contact us and ask about the next village, how to develop it, how they can cooperate, and even say whether it can be fast. One point.” Tan Ruixiang said.
  There have been small-scale successful trials of malaria clearance, and mutual trust in the work of the two parties has also taken root.
Candy, friends and god

  Living in a foreign country, the work of preventing and treating malaria is serious, but wrapped in cultural differences, the Shengpu people I meet are lively, interesting and lovely.
  Children are the most heartwarming. All the people take the medicine, and the child is the key protection object. Artemisinin-type medicine is bitter and the child does not like to take it. The aid team will “trade” with the child and give sugar when the medicine is taken. Candies are rarely seen in children’s lives, and this trick has been tried and tested again and again.
  Over time, candy became the code name of the China Aid Group. When the children saw them, they shouted “Duo Di Duo Di (Candy Candy)” in Portuguese and asked them for sweets. Sometimes they don’t call candy, they call “Amiga” when they see a female team member, and “Amigu” when they see a male team member. In Portuguese, this all means “friend”.
  At a “Children’s Day” event in the village kindergarten, three children played the role of a doctor, a patient, and a neighbor of the patient. The kid playing the role of a doctor prescribes medicine by auscultation, and asks the patient to call his family to smear the blood film to check if he has also contracted malaria.
  In Sao Tome and Principe, there are no special toys and entertainment facilities, and children’s happiness is very simple. Sometimes it’s candy, sometimes it’s going to the house with the aid team who enters the village. They are the most enthusiastic guides. But the most attractive thing for children is the camera of the group members. “They like taking pictures.” Tan Ruixiang said, taking pictures of them with a mobile phone. After taking pictures, they scrambled to watch the pictures. “Many children don’t have mirrors at home. They are surprised when they see the pictures. This looks like “”.
  The foreign customs also made Tan Ruixiang quite fresh, such as Shengpu people not obsessed with marriage. “It’s quite a lot of people who don’t get married, but they have a lot of boy and girl friends.” This is also forced by life, because marriage requires money. Rather than having a husband, the girls of Saint-Prince and Principe want to have long hair.
Living in a foreign country, the work of preventing and treating malaria is serious, but wrapped in cultural differences, the Shengpu people I meet are lively, interesting and lovely.

  Because the locals are naturally curly, regardless of men and women, their hair is always long or not, and many girls will look enviously at the long hair of the female team members. In recent years, girls have become popular to pick up their hair. This is their favorite job. In this matter, they are extremely patient, one by one, one after another, day after day, and then into trendy dirty braids or mop heads, the happiness of girls is so simple.
  Sao Tome’s time goes slowly, which is different from the Chinese people’s punctuality. The Sao Tome people are not in a hurry. Not being punctual in meetings is the norm, even if officials are waiting, they are still late. “It all started in half an hour…Said that the meeting started at 9 o’clock and only started at 11 o’clock, we are not surprised.” Tan Ruixiang said.
  The local normal working hours are eight in the morning and four in the evening, but the aid team and the most frequently dealt with the medical center for disease control can hardly meet three meals together. At 8 o’clock in the morning, the aid team arrived. After 10 o’clock, it was easier to see people from the CDC in the office; at 12 o’clock, the aid team had a lunch break and the CDC continued to work; at 2 pm, the aid team went to work. , No one can be found at the CDC again. They do not have the habit of eating lunch, only a tea break, their dinner, they have to wait until 8 o’clock in the evening.
  Shengpu people are no strangers to assistance. They accept it with gratitude, but their way of expressing gratitude can only be “going to the village and doing whatever it is.”
  ”We help them eliminate malaria and take care of the public environment. What they said to the face was’Thank you for helping us do these things’, but what they said privately was’Thank God for sending Chinese people here to help us clear malaria.’ He thinks We are doing these tasks, and we are working for nothing. It is difficult for an atheist like me to understand.” Li Mingqiang said that they can only comfort themselves with “at least our work is recognized”.
  Ninety percent of Shengpu people believe in Catholicism. Although they are generally poor in material life, they are not sloppy at worshiping and paying membership fees. The church is the most magnificent building.
  Li Mingqiang has reached his fifth year of working and living in Shengpu. In his opinion, the life attitude of Shengpu people is quite “Buddha”, the desire for material enjoyment is not strong, and it has not been transformed into a strong self-drive. “When it comes to work, they don’t pay attention to excellence… We will say,’Today I have to finish one thing, I must work overtime to finish it’, but the people of Shengpu will get off work at some point, so he is not happy to do it.”
  Li Mingqiang believes that this difference in concept cannot be attributed to “laziness” and “diligence.” “There is no public transportation in this country, and the traffic basically depends on walking. If you work overtime until 8 or 9 o’clock and then go home for two or three hours, it will be tiring to think about it.” He said.
  There is something to do every day, looking for food in the fields, those who have regular jobs, get off work at some point, occasionally fish, earn a little money, buy a bottle of beer and go home to talk to the neighbors. They seem to be very happy and content, but they have never seen the world outside the island.

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