By Julia Jaroschewski

With a list of names in his hand, Lino trudges through the palm grove. He knows almost every one of the nearly 3000 inhabitants of Canhabaque Island. But of the many children here, not every one survives the rainy season. Now he is trying to find the children on his list.

Next to a shelter made of palm leaves, rice is spread out on flat sacks to dry. A little boy in a stained shirt comes up and reaches out his finger. A prick, it bleeds, the sample is labelled. It is supposed to reveal whether the little boy has malaria. The disease is still fatal for many children here in Guinea-Bissau. 26-year-old Lino is neither a doctor nor a nurse, but the local people trust him. He is on the village council and for a few years he has been supporting international scientists as a health worker.

For a long time, almost no one was interested in the West African Bissagos Islands in Guinea-Bissau – until researchers discovered them for their studies. The 88 islands are isolated by the water, the inhabitants remain mostly among themselves and allow valid comparisons between test groups – a natural open-air research laboratory. Just like the island of Canhabaque.

Poor infrastructure on the islands

„Actually, we have everything here and the island has its natural resources. The people who live here can survive without having to leave the island“, says Lino. Surrounded by beach and mangroves, monkeys, chameleons and poisonous snakes live here. In the villages there are mud huts with thatched roofs. No electricity, no running water.

The heat is stifling. Lino types on his mobile phone, reception is poor. For the inhabitants, the remoteness of the islands is both a curse and a blessing: with hippos and turtles, the archipelago is a small natural paradise. But much is missing for life. Even medical care in case of illness. Here on Canhabaque there are only three nurses, no doctors. No roads either. Those who have money rent a motorbike for the narrow sandy roads. Those who don’t have one sometimes have to walk 20 kilometres to be examined. In the rainy season, diseases like malaria become more frequent.

The London School of Hygiene and Tropical Medicine, which specialises in tropical diseases, has been active in the islands for years. They have built up valuable contacts through their projects on the ground. Despite the fact that the expensive and complex medical studies are quite controversial. On the one hand, financially strong western institutes often test in poor countries where the control is unclear and the need is great. On the other hand, research on complicated diseases is a great hope for the plagued population.

Coups, corruption and political scandals

Guinea-Bissau is a malaria high-risk area and marked by poverty, corruption and political scandals. In its 48 years of independence, the small country has shuffled from coup to coup. Governments have changed frequently. The health system is dilapidated – Guinea-Bissau itself is not in a position to combat problems like malaria. International researchers have been studying malaria for decades – but even they have not succeeded in eradicating the disease. Successful results could help many – especially in Africa.

Harry Hutchins is a medical doctor. The 31-year-old leads the study group of the current project: all islanders were given malaria prophylaxis. Half receive additional ivermectin, on the remaining islands a placebo is distributed. After two years, the results should show whether ivermectin can reduce malaria. The drug has long been used as a vermifuge in animals and humans.

„Ivermectin makes human blood toxic to insects that drink the blood. So if you have taken ivermectin and a mosquito drinks the blood, the mosquito will die. We want to use this drug in humans to kill mosquitoes. Hopefully, if you kill the mosquitoes, the malaria will also go down“, says Harry.

The people here speak Bijagos, Creole and a few the official language Portuguese. Each study participant has to sign a form or confirm it with a fingerprint. But do the inhabitants really understand what is at stake? Harry Hutchins is sure: „Everyone here has had malaria. Everyone knows people who have died of malaria. They know it is a serious problem. When you come and say we have a drug that is free and that we believe helps against malaria and is safe, people are by and large very happy to take it for themselves and their children.“

Increase of Malaria during the Covid-Pandemic

On the island, medicines often cost a lot of money. The residents have to make a choice: They become participants in a study and receive free medication – or live with health risks.

Fewer malaria cases were reported in the Canhabaque health centre in 2021 than before. Worldwide, however, the number of malaria cases increased by 14 million in 2020 compared to the previous year. In total, there were around 241 million cases of the disease. The pandemic reversed much progress in the fight against malaria: personnel and financial resources were concentrated mainly on Corona, lockdowns prevented treatment and supply bottlenecks also affected medical equipment or mosquito nets.

The World Health Organisation (WHO) estimates that around 627,000 people died of malaria in 2020. A large proportion of these, around 96 percent, in sub-Saharan African countries. And most of the victims are children under five.

Scientists have been working for many years to find a cure for the dangerous tropical disease – but unlike Corona research, progress has been slow. Is malaria so difficult to research or is Africa less relevant than the rich West?

Less money for „poor“ countries diseases?

„This is mostly due to the biology of the disease“, Malaria is a complex disease, says study leader Harry Hutchins. Nevertheless, he too sees differences in funding: „There is not a lot of money for malaria treatment because the people who die of malaria are usually very poor and very isolated. I think if it was a disease that still affected the wealthy countries, as it did a long time ago, you would probably see much faster development and progress.

The fact that international organisations and donors play a big role is also evident on the mainland. A small fan rattles in front of the desk of Danish professor Ane Baerent Fisker from the Bandim Health Project in Bissau: „I think health policy is largely dictated by what donors want and less by local data.“

The pandemic, she says, has highlighted the country’s dire situation as well as its dependence on international organisations.: „I don’t have data yet to say what impact the Corona vaccines have had. But it is a problem that the few resources that exist are currently concentrated on one disease. I’m not saying Covid isn’t a problem, but we are neglecting other potentially much more important areas. Providing vaccinations that are scheduled at birth should be a priority. Because studies have shown that these vaccines have a very large impact on infant mortality.“

There is also a lack of data on the pandemic – like Corona deaths: „We can’t say whether they died from COVID or whether they died from the lockdown and difficult access to health care or from the fear of COVID. When we asked people if they would have taken them to the hospital if they died, they said no. Because if you went to the hospital, you would get COVID.“

Foreign Interest – loose control

The large market in Bandim is bustling with people – only a few wear masks. Rusty multi-passenger taxis meander over the sandy potholed roads. In Guinea-Bissau, money often flows into the pockets of corrupt politicians and entrepreneurs instead of into health programmes or development. In the city centre, houses from the Portuguese colonial era are crumbling, while a few conspicuously modern hotels stand around the renovated presidential palace: Investments from China, Saudi Arabia or Equatorial Guinea – a bizarre contrast. And objects for money laundering.

Military officers and politicians were also demonstrably involved in drug deals. There were consequences for only a few: „Corruption is clearly a big problem. Guinea-Bissau is at the bottom of the list of countries with the highest levels of corruption. The president has spoken out on corruption issues in several speeches and has himself approached the United Nations to help the government implement an anti-corruption strategy,“ says José Levy, Deputy Director at the United Nations Development Programme, UNDP in Guinea Bissau.

But what everyone knows but is reluctant to say is that the president who wants to fight corruption is part of the problem. Umaro Sissoco Embaló, against whom a coup attempt has failed recently in February, is controversial, after a close election he appointed himself president – against the opposition of the majority of the parliament. Recently, he defended an ex-general on whom the US had placed a five million dollar bounty for drug trafficking.

Health for money

The population is left behind. At the entrance of the state hospital Simao Mendes hangs a poster with the price list – many of the treatments are practically impossible to carry out.

„There are no specialised doctors in the operating theatre – there are some Cuban doctors who operate on simple things. Complicated operations are not feasible. There are no recovery or surgery units, no intensive care units, no ventilators for after surgery, so these patients with serious diseases like cancer are either evacuated to Europe or Senegal, which is also very difficult, or they are left without treatment“, says Portuguese surgeon Rita Castro. Castro and her colleague anaesthetist Isabel Flor de Lima came to Bissau with an NGO to help out.

„It is clear that doctors and medical staff are not paid, and they steal medicines or equipment that is available in the hospital. They steal what can be sold in the market outside. If they can charge patients, they will, they will charge patients for treatments that should be free: an operation, for example, or blood reserves.“, says Isabel Flor de Lima

Heavy cars with the logos of international organisations push their way through the streets in front of the hospital. Without international aid, many things would not work. But is the country better off with them?

UN staff member José Levy sits in a guarded building near the port. He wants to keep hope despite the difficult outlook: „It is a country that is at the bottom of almost all development indices: health, governance. The UNDP Human Development Index is at this stage 48 years after independence – which is why I assume the situation will not change in the coming years. But at the United Nations, we must remain optimistic.“

About the author:

Julia Jaroschewski is a journalist with expertise in the fields of foreign politics, organized crime, the war on drugs and security policy and she is also the founder of Buzzing Cities Lab, a think tank focusing on digital technology and security in informal settlements.

Published on March 17, 2022.