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A Note From Our Director:

Andy and Sherman

Drs. Andy Aligne and Andy Sherman in Senegal.

Is There a Right Way To Do & Teach Global Health?

Global aid in general and global health education in particular are areas of controversy, as detailed in books like "Great Escape" by Angus Deaton and "Hoping to Help" by Judith Lasker. Some people argue that people in poor countries would be better off if we just left them alone. I think this is a dangerously wrong-headed idea. While some aid programs are wasteful or even harmful, that doesn't mean that they all are.

Netlife grew out of Dr. Andy Sherman’s experiences as a Peace Corps Volunteer. While living in a small village in Senegal, he got to know children who would go on to die of malaria. This motivated him to found a non-profit to facilitate distribution of insecticide-treated bed nets. These have been shown to have a huge impact on malaria mortality, but nets were very underutilized when he began this work. Through medical school, residency, fellowship, private practice and parenthood, he has kept going back to Senegal to maintain relationships and keep the good work going. Nowadays, net distributions are done routinely by the Senegalese government, but Netlife has continued to look into how things can be improved.

Recently, Netlife conducted a survey that revealed that people needed more nets than World Health Organization (WHO) guidelines recommended.  Observations and interviews discovered several reasons for this, including the harsh rural conditions, which caused the nets to wear out faster than predicted.  Local people were also sleeping outside regularly at night because of the extreme heat, and that issue was getting worse with global warming. Sleeping outside meant they were unprotected by nets. This was new information that was not in the malaria literature at the time. For a previous project, Netlife sponsored a contest to come up with a practical solution for hanging up mosquito nets outside. Winners got prizes like a cow or a goat. One of the winning teams came up with a wire and rubber contraption that can be made with locally available materials and is easily used.

On our 2019 trip, we went back to help distribute hundreds of these kits along with nets for outside use, and we made a video and posters to help teach others how to hang up the nets outdoors. All of this work is done in partnership with local health workers, doctors, nurses, Peace Corps Volunteers, village chiefs, etc. Everything we do is with very low overhead. We visit the villages by bicycle-not air conditioned SUVs- and pay for all of our own travel expenses. The residents and students who come with us get to watch Dr. Sherman demonstrate his mastery of community relationship building and cross-cultural communication.

We will be getting feedback on the impact of our novel outdoor use of nets from the regularly collected malaria statistics. I go on these trips to help with the scientific evaluation of the project but also because they do me a tremendous amount of good. Hearing all the little children in the village come to “give me five” and say hello while I’m trying to find a spot where my phone works (They have cell service now!), helping the team overcome some of the many obstacles inherent in this kind of work, completing long bike rides – all of those are good antidotes to burnout. And then there is the fact that everywhere we went, people thanked us profusely for helping them to fight malaria, which for them is a real and terrible danger. They all know people who have suffered or died from this disease. One municipal official told us his job is to promote economic development but he can’t do that when malaria makes people too sick to work.

Long-lasting insecticide treated nets work to prevent malaria and save lives. We know we are moving the needle in one of the world’s malaria hot spots. And as explained in historian Randall Packard’s brilliant book “The Making of a Tropical Disease” controlling malaria in places like Senegal can be particularly important for “shrinking the map” and perhaps eventually eliminating one of the world’s major killers. Netlife’s approach is community-level, preventive/upstream, evidence-based, locally sustainable with longitudinal relationships and high return on investment with measurable impact.

I believe that there are many right ways to do and teach global health. The Netlife experience is just one of those, but one example is enough to disprove the nihilistic notion that nothing works.

- Andrew Aligne, M.D., M.P.H., Director of the Hoekelman Center