Global Lens Reflections on life, the universe, and everything

Net girl

A girl awakes in her bed, covered with an anti-malarial mosquito net, in Dundube Kadambo, Malawi.

In response to last week’s photo, I had two people write me to ask why the family of the boy who died didn’t have bed nets to prevent the transmission of malaria. I responded that it’s not that simple.

I've had malaria, and it’s no fun. I had a good friend die of malaria. As a result, I’m currently in South Sudan and I’m taking mefloquine every week and I use a bed net every night. Bed nets are an important tool in the fight against malaria. But they’re not the only tool, and campaigns like “Nothing but Nets” really represent the triumph of marketing over epidemiology. By reducing the fight against a complicated disease into one simple slogan works great to raise money and in the process grant smug self-righteousness — give ten bucks and you've saved a life, right? — but it misrepresents the comprehensive nature of what we’re fighting against. For example, I spent most of Sunday in the Makpandu refugee camp near the Congo border, where thousands of Congolese who fled from the Lord’s Resistance Army have found safety for the last four years. As I walked around talking with folks and imaging life in the camp, I found several people sick with malaria. I asked a few if they had a net, and a common reply was that, yes, they had received a net, but they had sold it to buy food. One woman told me she’d received a net four years ago, but she had 12 people sleeping under it and before long it was in tatters. No one has been back to offer her a new net since. Nets do work, but unaccompanied by other measures, such as cleaning up stagnant water sources where mosquitoes breed, they are at best a stop gap measure for a while, until the net wears out. Yet few NGOs handing out nets make plans to come back. They’d rather take the show to some new location where they can take pictures of some celebrities handing out nets to poor people. It’s a troubled form of aid at several levels. Fortunately, there are folks who understand that rather than “nothing but nets” it should be “nets and everything else,” and they’re working at comprehensive solutions, the most important of which is ending poverty. Certainly, malaria is one factor that keeps people poor, but it’s also a disease that thrives midst the poor. By working for justice and ending violent conflict, we help empower people to combat malaria on their own—and buy their own bed nets if needed. If we don’t do all that, nets may just add to the problem. Recent studies have raised concern that extensive bed net use, especially if unaccompanied by other measures, may both increase the disease’s resistance to insecticide as well as lower the immunity of affected populations to the parasite.

Taking pictures of people under bed nets is simple. You mainly have to insure that the camera focuses on the person rather than the net, and that your light source doesn’t over-illuminate the net at the sake of the persons underneath. Getting rid of malaria is much harder, and requires thinking beyond paternalistic quick fixes that sell well in sound bites, but which do little to end the suffering caused by a virulent disease.

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