Thu, Aug 09, 2018 - Page 9 News List

As Paraguay eliminates malaria, regional outbreaks grow

Paraguay is the first South American country to eradicate malaria, but neighboring cases and climate change threaten to spread the disease

By Laurence Blair  /  The Guardian, ASUNCION

Illustration: Mountain People

One recent morning, the halls of the Paraguayan National Malaria Eradication Service (SENEPA) echoed to the sounds of folk songs and a violin. The health minister handed out medals and a dancer, balancing a bottle on her head, swished her skirts around the room.

The traditional celebrations marked Paraguay’s official elimination of malaria in June — the only country in South America to have eradicated the infectious, life-threatening disease, and the first in the Western Hemisphere to do so since Cuba in 1973.

After 60 years of struggle, it is for many an achievement akin to a military victory.

The campaign began in 1939, when during a grueling war with Bolivia, an outbreak of malaria infected 80,000 people out of a population of 1 million.

“It had a huge social and economic impact,” said Monica Ozorio, a biochemist and the director of SENEPA’s anti-malaria program. “It affected all the regions — we even had it in the Chaco.”

Tens of thousands died.

The epidemic prompted Paraguay to establish its health ministry — and, in 1957, the anti-malaria agency.

It was the beginning of six decades of sustained eradication, WHO representative Luis Escoto said.

“Passing through different political moments and governments of different colors, it has become a policy of state,” Escoto said.

A lasting commitment to spending a fixed portion of income from the country’s social security program — first 0.5 percent, later 1.5 percent — on battling the disease was a “decisive factor,” he added.

So too were shifts in strategy — from a top-down, SENEPA -led effort that focused on mass fumigation of mosquito breeding grounds, to one that incorporated the Paraguayan National Health System and focused on diagnosis, treatment and monitoring of cases.

SENEPA clustered dozens of diagnosis laboratories in malaria-prone regions and those adjacent to Brazil. Private and public clinics are required to treat cases free of charge. Businesses and media outlets run information campaigns.

“If there’s an imported case of malaria these days, it’s national news — all the ministries are informed,” Ozorio said.

However, most people point to the key factor as being a network of up to 5,000 unpaid volunteers — including urban community organizers and indigenous leaders — that is still working to educate fellow citizens, eliminate mosquito habitats and stay alert for new cases.

Everyone has a grandparent or cousin who did their bit, Ozorio said.

“We feel proud that a small country has done it, with our own resources and everyone working together,” she added.

By the turn of the last century, these efforts were bearing fruit. The last case of Plasmodium falciparum malaria, the deadliest form of the disease, was registered in 1995. The Plasmodium vivax variety was eliminated in 2011.

A five-year program with the support of the WHO and the Global Fund thereafter worked to prevent retransmission and boost community education, prevention and treatment.

Finally, in April this year, the country was certified as having been free of home-grown malaria cases for three years, the first of 21 countries — including Mexico, Belize and El Salvador — that were earmarked by the WHO as on course to do so by 2020.

“Paraguay is an excellent demonstration that it is possible,” Escoto said.

The victory is a much-needed success story, both for Paraguay and the region. The country’s health service is fragmented and otherwise short on funding, often making the headlines for shocking reasons, such as Paraguay’s high rates of child pregnancy.

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