On March 8, International Women’s Day, we take the opportunity to recognize the important role women, who make up almost 70% of the global healthcare and social care workforce, play in preventing and controlling malaria around the world. We interviewed three amazing women scientists leading the fight against malaria in three countries in the Americas about the progress they’ve seen during their careers and the challenges they still face.
At the 4th Global Forum of Malaria Eliminating Countries in Cape Town, South Africa, in January 2023, the World Health Organization (WHO) presented a “special recognition award” to countries that have made significant progress toward malaria elimination. Suriname was recognized for achieving a more than 50% reduction in malaria cases in 2021 compared to the previous year.
Dr. Hélène Hiwat has been the coordinator of Suriname’s Malaria Program since 2015. She has a Ph.D. in vector entomology from Wageningen University & Research in the Netherlands. Hélène was working at Suriname’s Anton de Kom University when she was approached to work for the Malaria Program, which she joined as an entomologist in 2005. At the time, Suriname had the highest annual parasite index for malaria in the region.
Hélène is very proud of the country’s progress and accomplishments over the last 20 years. Suriname now has a high-capacity reference laboratory for diagnostics, a supporting molecular laboratory, and a national malaria gene bank that collects positive samples. The Malaria Program is also providing low-threshold integrated health services for malaria, HIV, leprosy, leishmaniasis, and COVID-19 at the community level and in remote gold mining camps. “All this was possible,” she says, “with considerable support from national and international stakeholders and donors.”
“So now we are at a point where we are very close to the elimination of malaria [in Suriname]. Actually, in 2022, for the first time, we could report zero malaria cases …. and we hope to be able to continue that and apply for certifications of elimination,” she says.
Hélène explains that one of the key strategies behind this success has been the establishment of a network of malaria service deliverers or community health workers (CHW), composed largely of women, to reach migrant workers in the largely illegal remote gold mining camps. These women have access to the camps and know the various languages and socio-economic dynamics behind them, working on health education and disease diagnosis and treatment while conducting their daily businesses.
She is aware of the battle still ahead to prevent malaria re-introduction and the specific challenges associated with working with migrant populations. However, she is confident that the CHW’s contributions to the fight to end malaria can take the country to the finish line.
In looking to the future, Suriname will continue to collaborate with neighboring countries and international partners on a regional approach to prevent malaria re-introduction post-elimination, share experiences, and build capacities.
Belize, a Central American country famous for its barrier reef, rainforests, and vibrant ethnic diversity, is currently on track to receive malaria-free certification from WHO. Between 2000 and 2018, Belize achieved a 99.8% reduction in indigenous malaria cases, and there have been zero indigenous cases reported after 2018. This year, Belize can become the next country to be certified malaria-free in the Americas.
Ms. Olympia Ramclam, Senior Malaria Microscopist at the Ministry of Health and Wellness National Reference Laboratory, could not be prouder. For over three decades, she has seen and been part of Belize’s progress against malaria while working with the Vector Control Program since 1990. In her current role, Olympia coordinates a monthly quality control and assurance check for all blood samples from all districts.
As the team leader of the current microscopists’ network, Olympia has faced many challenges, from issues with sample transportation to staff shortages and outdated equipment. Olympia remembers past times when the Vector Control team would travel to remote areas on their motorbikes, where they would often have to cross rivers and camp out, delaying the process of diagnosis and treatment. Now, the team has vehicles and equipment in each district, including malaria rapid diagnostic tests (RDTs) for use in remote communities.
With increased capacity, the team has been able to take on a more active role in overseeing malaria patients. “The vector-control personnel is in charge of going and doing a 14-day [supervised] treatment,” she emphasizes, “a much-improved treatment policy from the one in the 1990s, early 2000s.”
As population movement across country borders increases fueled by the agricultural industry’s labor needs, the team is also in charge of detecting imported cases of malaria. “The passive detection (of malaria) in the banana farms is one area we are focusing on, ensuring that workers at the banana farms are tested as they come into the country and before they get employed. At present, most of the banana farmworkers are compliant with this,” Olympia explains.
Olympia is committed to maintaining her team’s high-quality malaria surveillance work to prevent malaria re-introduction into the country. “We will continue to do microscopic training to strengthen our capabilities in the diagnosis of malaria, to help maintain a malaria-free Belize,” she says.
Dr. Keyla Ureña works for the Center for Prevention and Control of Vector-Borne and Zoonotic Diseases (CECOVEZ) as the project coordinator for the Carter Center’s project in the Dominican Republic. Keyla started her career as a general physician after graduating from Universidad Autonoma de Santo Domingo. She found her passion for malaria elimination while pursuing a master’s degree at the Nagasaki University Institute of Tropical Medicine (NEKKEN) in Japan.
According to Keyla, becoming a doctor inspired her to be an advocate for malaria elimination. “I thought about all the things that can be done to prevent a person from getting infected by this deadly parasite… I came to the realization that it is possible to stop transmission and reach the elimination goals we have set for our country.”
While Keyla enjoyed working directly with patients, she realized she could have an even larger impact on people’s health if she worked in public health policy. In 2009, she joined the National Malaria Program (NMP) and supported the decentralization and integration of the malaria strategy. According to Keyla, the new approach presented multiple challenges that required additional staff training and supervision. Nonetheless, the hard work paid off and in five years, the Program saw malaria cases dropping in almost all endemic regions, with a concentration of cases in the capital, Santo Domingo.
Keyla highlights the Program’s role in empowering women to be part of the local health response in their communities. “If we look at homes, the women are the ones who decide what they are going to do when a child is sick, so they have a vital role, and they have played a vital role in the Program as well.” Women have become effective community leaders who have helped the Program convey information and raise awareness about malaria transmission, including supporting vector control actions, such as the distribution of mosquito nets.
Even though the Dominican Republic is moving in the right direction, several challenges remain. Even after the Program managed to control malaria in Santo Domingo between 2015 and 2019, new cases started to pop up in remote farming regions due to an increase in population mobility. Keyla underscores the importance of considering the dynamics of malaria. She states that surveillance plays a critical role in combating the challenges that come with the environment. “We can’t simply forget that our territory has these conditions. Thus, we must raise awareness among health personnel, as well as in the population in areas at risk.”
She reminds us that efforts to “expand detection, diagnosis, and treatment at all levels” are vital to controlling and preventing the spread of malaria.
© United to Beat Malaria. 2024 • Save Lives, Beat Malaria
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