Logistician Kim learns to change her mind about insecticide...

We finally enact the final unaddressed objective of the year.  It took until September, but we embark on our campaign of insecticide residual spraying (IRS) for the entire hospital.  It's a joint effort between the Ministry of Health and MSF.  We're both providing the teams who will spray the insecticide on all the walls and ceilings of every room of the hospital.  The coordination of moving patients, equipment, and beds from one room to the next, and even into the open air, is taken care of by the Hygiene Committee, newly formed this year after MSF's construction of a large new waste area.  After a few months of a rocky start, things are rolling along at a fast pace.

We've eliminated garbage bags (which can hide harmful waste in mis-labeled containers and are a costly consumable resource) and replaced them with brightly-colored, sterilizable waste buckets; we've emptied latrines and rehabilitated them to last longer; we've changed hygienist rotations to cover after-hour deliveries (of children); we've outlawed animals on the hospital grounds.  And now we're taking an important step in vector control.  Our Malaria Ward will be that much safer for patients after this week's spraying starts to kill mosquitos that enter the ward.

The team prepare to spray the hospital

I was dubious at first about spraying pesticides around a large area (isn't that the personification of evil for the environmentally-conscious American?), but after a month of research, I can tell you which of the four chemical compounds is least harmful to mammals (synthetic pyrethroids) and which are highly toxic to fish and ducks (carbamates).  I've read about and understood the history, benefits, and drawbacks of the feared DDT (organochlorines are not currently recommended for IRS).  I've talked to the WHO representative in the region, and read the five-year anti-malaria plan published by the Chadian government.  I've assembled and combed the hundreds of pages that MSF has available for spraying, and I feel ok about spraying a chemical everywhere.

We take proper precautions for the health of everyone involved, and we strictly follow the instructions.  I spend the morning training the spraying agents (In French, everyone is an agent.  I like it), and after a brief rearranging of furniture, we're off.  It's one to two buildings a day, with two hours of drying time per room, and time on either side to remove all furniture, vaccination campaign posters, weight-to-medicine conversion charts, and other wall-hangings.  Every inch of wall and ceiling will be sprayed with our high-tech pulverizers (I'm borrowing the French term here--it's more dramatic).  After washing the floor, patients are moved back in with no side effects.  The next mosquito to land on the walls is toast.  And the one after that.  And the one after that…  And so on, for three months, when the chemical loses its effect.  Then we'll spray again, which will ensure protection until the end of the peak-malaria season in December.

And we'll do the house and office while we're at it.  I'm covered in mosquito bites, but my prophylaxis has (so-far) kept me out of the malaria stats.  Knock on wood.  I'm looking forward to not getting eaten alive.