Data Sounds the Alarm; Community Drives the Solution

A woman stands on the porch of her home overlooking the water near Kanku, Honduras. (Photo Credit Masha Hamilton)

The community has no electricity, so there was no way to call ahead. Srumlaya residents speak Miskito; Espinoza and his team speak primarily Spanish.

But they made the trip, and managed to communicate. “Let’s map out where malaria occurs,” Espinoza proposed.

Similar to John Snow’s efforts at disease mapping 170 years ago during a cholera outbreak in London, about 40 community members plunged into the joint effort.

Together they made a discovery. The homes with repeated cases were near a swampy area with plenty of still water—a telltale sign of mosquito breeding grounds.

“We can drain it,” residents said.

“They asked for a small investment – less than $100 – to buy shovels, machetes, and hoes,” Espinoza said. “The men drained the site, and the women cooked a meal of rice, beans, and meat.”

Dr. Myra Haylock, director of Kaukira’s medical center, talks to a pregnant woman showing symptoms of malaria. (Photo Credit Masha Hamilton)

“Now they have maybe one or two cases a year,” Espinoza said. “Before we started this effort, we would have only been able to respond reactively. This allows us to reach out to a community while an outbreak is in progress. Together, we can be proactive.”

The data collection work, supported in part by The Rockefeller Foundation, is aimed at countering mosquito-borne diseases worsened by climate change in places like Gracias a Dios, which borders the Caribbean Sea in the north and Nicaragua in the South.

An estimated 112,000 people live in Gracias a Dios, most in remote pockets. The region, overlaid with swamps and rainforests, has the highest poverty rate in Honduras at 84.9 percent, and the lowest access to piped water and sanitation at 27.7 percent.

Prisma Alvarez takes a blood sample to check for malaria in Mocoron, Honduras. (Photo Credit Masha Hamilton)

To further humanize what’s at stake, consider the 2022 case of Wilner, a five-year-old from the Indigenous Uhi peoples, living in the tiny community of Yahurabila on a sliver of land bordered by the Caribbean Sea on one side, and a lagoon on the other.

When Wilner got sick, the Yahurabila health center was out of Rapid Diagnostic Tests, and the lab technician was on a trip. So it took days to diagnose the disease. Once malaria was pinpointed, Wilner was scheduled to be transferred to the region’s only hospital.

It was too late.

Waiting for the boat to take him on the 40-minute trip to Puerto Lempira, his body went into shock and he died. A poignant photo shows him laughing at a birthday party just ten days earlier.

“Once a malaria parasite is in your blood, it can multiple 32 times in 48 hours,” Espinoza said. “By the fifth day, there are about 5 million infected cells—and that’s about as much red blood cells in a child’s body. That’s why we need systems that give us information in real time.”

Denilson Guevara arrives in the small community of Kanku to collect reports on malaria cases. (Photo Credit Masha Hamilton)

But Espinoza and other health leaders evaluated the case, and found a gap.

“To set the system up, we have to evaluate on a case-by-case basis,” Espinoza said. “You have theories about what works. In practice, each place is particular. And you have to continue to look for bottlenecks in the flow of information.”

What they discovered in Yahurabila’s case was that technicians hired to collect data and check on supply stocks in remote outposts were not always able to reach communities every three days as mandated.

Gracias a Dios is dotted with tiny communities, some surrounded by water and others deep in the Honduran jungle. Much of the region faces flood risk, particularly with a changing climate.

So motorcycles were purchased as an agile form of transportation for parts of the area.

Now, Denilson Guevara is among those who now uses his motorcycle to collect reports from remote communities without electricity and to refill stocks every three days.

Dr. Hector Bulnes, Honduras Health Ministry, leads the work to compile and digitize regional data from a small room in Kaukira. (Photo Credit Masha Hamilton)

In the small community of Kanku, he visits the home of Leki Mique, 23, who is trained to help her mother, a community healthcare worker for the last 8 years.

She feels relieved that her community is connected to larger medical facilities through Guevara and the reporting she and her mother do.

“Almost every day,” Mique said, “someone comes with a fever or other symptoms.”

Guevara then delivers the handwritten reports to a small room in Kaukira, where a three-person team quality-checks the data while digitizing it and ensuring it is relayed up the chain.

In this way, Mique’s and Guevara’s work reaches the Health Ministry for analysis in near real time. Guevara also reaches deep into local communities by giving talks in schools to raise awareness about malaria symptoms and the importance of seeking a quick diagnosis.