Nowadays the word ‘poke’ brings facebook to mind. But in the good old days, it meant much angst, tears, wails, subtle threats or bribes of lollipops and other tooth decaying goodies. Perhaps it still does if you are a brand new parent, but I’ve learned that there are exceptions to every rule, and not every child fears the needle.
My part of India is famous (or perhaps infamous) for it’s many M’s – Mountains, Minerals, Mining, Maoists, Mosquitos, Malaria, Malnutrition. We have beautiful forests, gently flowing streams, plenty of water and wildlife. Including Mosquitos. Especially the female anopheles mosquito which transmits Malaria. India is home to four types of malaria parasites – Plasmodiums vivax, falciparam, malari and ovale. I bet Captain Haddock came up with those names – I can see him hopping around, waving his hands in the air, swearing loudly!
As luck would have it, we’ve got the most deadly parasite of the lot, the killer, Plasmodium falciparum. Our Government estimates that every year one thousand Indians die of Malaria. The World Health Organisation puts this figure much much higher, between fifteen-twenty thousand. The Million Deaths Study says two hundred thousand is probably a more accurate figure. Whichever number you decide to believe, it’s too many deaths. Especially from malaria, a preventable disease.
Our town, Bissamcuttack, was named for a reason. In Oriya, Bissam means poison and cuttack is derived from kotta or fort. We are a breeding pool of malaria and death, a poisonous fort. Our climatic conditions of decidueous forests, and hills with gently flowing streams are perfect for all three players in the game – parasite, vector and humans. For the last twenty five years, MITRA (another of those Ms), the community health team of our local hospital, has been working extensively on Malaria. They invite me to tag along on a MalMal camp.
A part of the MALaria-MALnutrition strategy (MalMal for short) involves offering all mothers and fathers the option of getting their kids tested for malaria, followed up by treatment for those who test positive. And what’s the test for malaria? Yes, you guessed it – a little poke, a little drop of blood on a glass slide and a microscope with a good scientist at the other end. The team carries its mobile lab (except for microscope) and sets up in the varanda of a mud hut in the village. The health workers record heights and weights to see if the kids growth is on track. The nurses give them an overall check up, looking also for spleenomegaly (your spleen can get swollen if you have malaria). And then it’s poke time, the dreaded blood test. Most kids are familiar with the routine.
A few run away right at the start, when they see the jeep drive up, and have to be dragged back by parents or older siblings, howling their protests for the all, especially the other kids, to hear. Some march forward bravely, smiling and chatty through their health check ups, but the bravado crumbles when they see the disarmingly little, and very bright blue, lancets. Sharp tiny needle point that glint in the sunlight. The littlest babies in parents arms have no choice in the matter but somehow their crying tends to stop quite fast. They get a jab on their big toe. For the rest, there seems to be a lot more crying before, in anticipation of the poke, rather than during or after. The expert poker (read lab technician), works efficiently, oblivious to all the bawling around him.
There was one little boy, in bright red shirt and rather long shorts, who caught my attention. He waited his turn with the other kids but unlike the rest, there was no sad face, no whimpering, no nervous chattering, no trying to escape the inevitable. He stood on tiptoe, almost in anticipation, clutching his health card tight. His mother was ahead of him in the queue, carrying his unhappy little sister who was vociferously voicing her protests. But he smiled calmly, even though he knew it wasn’t a merry-go-round waiting for him at the end of the line. When his turn came, he sat down on the mat eagerly and stuck out his palm, fingers pointing upward. He watched carefully all the time, through the poke, the smearing of the slide, the disposing of the needle. He held the little cotton swab tight against his finger, watching as his name and details were written down. His eyes followed the little rectangle of glass with fascination as it was labeled and neatly tucked away into its holder.
‘Do you want to do this when you grow up?’ I asked him, ‘to check if children have malaria?’ He smiled shyly and hid behind the folds of his mothers sari. I hope that some day, when he grows up, he will be part of the campaign against malaria. His little howling sister too. That they will sleep in mosquito nets. Will survive the malaria seasons. Will grow up healthy and strong. And their children too. The light in those shining little eyes tells me there’s hope!