In recognition of World Malaria Day this past Friday, P+P has a related offering from contributing author Laurie Lathem.

St. Louis University medical students Andrew Sherman and Jesse Matthews refer to the summer of 2005 as their “last summer” because it fell between their first and second years of med school. Facing three more years of medical school and three grueling years of residencies after that, they might have been expected to take it a little easy as most of their colleagues were doing. Instead they formed a non-profit organization called NetLife Africa, and spent several weeks bicycling over dirt roads in rural Senegal distributing anti-malarial bed nets to villagers.

Malaria is the number one killer in Senegal, as well as in other parts of Africa, with children the most vulnerable. It is estimated that malaria kills one child under the age of five every 30 seconds in sub-Saharan Africa which amounts to 3,000 children every day. Picture four 747 jumbo jets loaded with children crashing every day, or a 9/11 every single day of every year. While there is treatment, many malaria sufferers have no access to medical care, particularly in rural areas. The prospect of a vaccine remains poor. Spraying DDT is unpopular and safe only under certain circumstances. As the parasite carrying mosquitoes are nocturnal, the best prevention is the simplest: long-lasting insecticide-treated bed nets (LLIN’s) that provide protection while children and their mothers are sleeping.

Concentrating on an area of Senegal called Kedougou that is largely without roads or health care facilities, Sherman and Matthews distributed 600 nets in 2005 and 1,110 more on a subsequent trip in 2007 (their next trip is planned for 2009). They have protected approximately 3,400 people from malaria carrying mosquitoes and have saved an estimated 85 lives (on average, two or three family members sleep under one net, and for every 20 nets delivered, one life is saved). Adamant that NetLife Africa remain a zero overhead organization and that every dollar raised go to the cost of bed nets, Sherman and Matthews pay for their travel with their student loans and raise money from their friends and families to pay for the nets. The cost of one LLIN is $5; the average donation to NetLife Africa is $20.

Asked where they got the crazy idea of going around Senegal on bikes loaded with bed nets, Sherman says, “When I was in the Peace Corps in Kedougou, I saw that the main problems were diarrheal diseases and malaria.” But water problems, as Matthews puts it, are “harder to get your arms around” than malaria. As a Peace Corps volunteer, Sherman recruited a troupe of non-performers from his village to perform a theatrical presentation on the cause and effect of malaria and take it around to neighboring villages. Everyone, Sherman said, had the same question. “How do we prevent this?” After educating the villagers on how to best prevent malaria, he had no way of helping them obtain the nets which at that time in 2002 were about $10 each, roughly double their current cost. Sherman “was stuck with one hand tied behind my back.” It was this feeling he says, and the fact that the price of LLIN’s was dropping, that made him want to go back to Senegal during his “last summer.” “I wanted to do something,” he says. “I didn’t want to go back as a tourist.” So he teamed up with fellow medical student Jesse Matthews and NetLife Africa was born.

Their method is simple and efficient. Sherman and Matthews (who incidentally look so much alike they could easily be mistaken for twins) fly to Dakar where they pick up the LLIN’s, rent a minibus and drive the sixteen hours to Kedougou where the nets are stored in rented rooms under lock and key. There they work with a local health official to identify which villages are at most risk, a determination made on the basis of access to health care, amount of stagnant water and high incidences of positive malaria testing in the past. In each village, they work with a community health agent to make up a list of recipients, prioritizing married women and children first. Sherman, who is fluent in Pulaar, the local language, and Matthews who is becoming proficient, greet the villagers, and give an educational talk on the nets and how they should be used.

Everyone wants a net. They are hard to come by. When a local police officer attempts to bribe Sherman and Matthews on the roads, for example, he wants a net, not money. As they hand out each LLIN, Sherman and Matthews write down each recipient’s ID card number in order to keep the distribution organized and to track their coverage for future visits. Even though Netlife Africa works with the larger organization Against Malaria to buy LLIN’s for the low price of five dollars each, this is still beyond the reach of most rural Senegalese. But the .20 cents that Sherman and Matthews charge is a minimal, symbolic amount that they say helps give a sense of ownership. NetLife Africa then donates the proceeds to a group called Senegad that works to educate adolescent girls in Senegal. Once the distribution is complete, there is singing and dancing, Sherman and Matthews are fed and, once they have slept, they pack up, get on their bikes and do it all over again. The process is physically punishing (Matthews lost 25 pounds in one month in 2007), but the reward keeps them going. The people receiving the LLIN’s are extremely thankful, and the impact is obvious and immediate. Matthews likens the trip to backpacking. “It’s satisfying because it’s hard,” he says.

While the response to NetLife Africa both in Senegal and here in the United States has been almost entirely positive, resistance has come from the most unlikely corners. Some Peace Corps volunteers in Senegal have been unwilling to work with Matthews and Sherman, subscribing as they do to a more free-market enterprise approach to humanitarian work. They believe that LLIN’s should not be given away for free ($0.20 is negligible) and that money is better spent paying for ads that encourage people to buy them. The opposing view is that the urgency of malaria is akin to that of a famine or a natural disaster, both instances in which other outreach organizations such as the World Health Organization routinely give handouts. “There is a fence within the Peace Corps,” explains Sherman, “and Peace Corps volunteers fall on either side of that fence.” Sherman explains his position this way: “These are people who are below the first rung on the ladder of poverty. They need a little help.” Health problems as persistent and devastating as malaria help keep poverty’s oppressive grip on the population he works with. “They need a boost in health to reach the first rung.” Nevertheless, Sherman says he was asked by a Peace Corps volunteer in Senegal not to distribute the LLIN’s in her village, an encounter that left him in tears.

However, recent developments in relations between NetLife Africa and the Peace Corps have changed for the better. The new Peace Corps country director in Senegal, Christopher Hedrick, has announced that volunteers in Senegal should also be “anti-malaria volunteers” and has agreed to work with NetLife Africa to distribute LLIN’s over a wider area and with a larger workforce. With these new promising collaborations underway they hope to distribute 4,000 nets in Senegal this summer and eventually to partner with other organizations in neighboring countries such as Guinea

Now that Sherman and Matthews are about to enter highly pressurized medical residencies, and with the Peace Corps wiling to take over the responsibilities of distribution, how much involvement can they realistically expect to have in the future of NetLife Africa? Says Matthews, “malaria is not going anywhere.” And with a new study showing that widespread distribution of LLIN’s and medical therapies in Zanzibar reduced mortality in children under five by half, they have every reason to continue what they started. They only considered residencies whose directors were receptive to their efforts in Senegal. Matthews will be specializing in infectious diseases and Sherman in pediatrics, all the better to serve the population in Kedougou with such things as staph infections and water borne illnesses. Mr. Sherman’s fiancée, Chrystal Jenkins, also a doctor, will travel with them in 2009 to work on programs that empower women. Having scoped out this remote 30 by 40 mile rectangle of the globe where each corn stalk growing between the huts holds enough water to breed mosquitoes, Sherman and Matthews plan on going back to Kedougou every two years. They will even buy a hut there to use as a home base for the price of $500. However grueling their methods seem, they say they have the process streamlined.

“The better we can do it, the more we can do it,” says Sherman. “Besides, we like to get on the bikes.”