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Malaria during pregnancy and in children continues to be a problem in Zambia and in Africa as a whole. It is responsible for many deaths, especially pregnant women and children under the age of five.
According to the National Malaria Control Center in Zambia, malaria kills over one million people globally each year, most of whom live in Africa, south of the Sahara. Over 300 million cases of malaria are reported in health centres worldwide. This is five times as many as the cases of TB, AIDS, measles and leprosy combined. Malaria is responsible for one out of every four childhood deaths in Africa. It kills an African child every 30 seconds. Those who survive an episode of severe malaria may suffer from serious physical and mental disabilities.
Sadly, women are four times more likely to get sick and twice as likely to die from malaria if they are pregnant. In Zambia, twenty percent of maternal deaths are due to malaria. Pregnant women and children with malaria occupy a large percentage of hospital beds.
Health experts recommend several practices to prevent transmission of malaria. One suggestion is to use insecticide-treated bednets in homes. Another is to have their homes and surroundings sprayed. Pregnant women living in malaria-endemic areas must take anti-malarial drugs each time they are pregnant in order to protect themselves, as well as the unborn child.
This script focuses on the experience of Mrs. Mirriam Chawila, a Zambian woman who is seven months pregnant. It shows what she experienced when malaria hit her hard.
This script is a mini-drama based on actual interviews with a pregnant woman and health workers. You could use this script as inspiration to research and write a script on a similar topic in your area. Or you might choose to produce this script on your station, using voice actors to represent the speakers. If so, please make sure to tell your audience at the beginning of the program that the voices are those of actors, not the original people involved in the interviews.
Script
Mrs. Chawila:
Nancy, could you please come and help me finish cleaning the windows? I’m almost done. The only one remaining is this kitchen window.
Nancy:
Auntie, let me finish cleaning these pots and pans – I’ll be there soon.
Mrs. Chawila:
EEEEEEhhhhyeeeee! Na Na Nanc …!
Nancy:
(Screaming and scared)Auntie! Auntie! Auntie, what’s the problem? Auntie … Auntie … Talk to me! Help! Help, please help … My auntie fell down off a stool and then fainted!
Mrs. Bwalya:
(Sounds of hurried footsteps coming on mic) (Scared) Ho my God! Mrs. Chawila … Mrs. Chawila, my neighbour, wake up! Can you hear me please, Mrs. Chawila? Please talk to me! (Short pause and sounds of people talking and whispering in the background about what could have caused Mrs. Chawila to fall off a stool. Sounds continue under Mrs. Bwalya.) Ensure that she has a lot of air around her to help her gain consciousness quickly. Nancy, please hurry and get a taxi to take her to the clinic as soon as possible. It takes a while for the taxi to get to us in this part of the shanty town.
Sound of Mrs. Bwalya’s footsteps fading off mic. Two second pause. Fade in sounds of a vehicle approaching and stopping.
Mrs. Bwalya:
(In a low tone) Alright Nancy, let’s lift your auntie and put her in the taxi. We need to take her to the clinic now! She seems to be in serious condition.
Sounds of Nancy and Mrs. Bwalya making efforts to lift Mrs. Chawila into the taxi, then sound of taxi door closing. Pause, then sounds of vehicle moving. Fade out sound of vehicle moving, then fade back up. Sound of vehicle stopping at emergency room, and door opening. Sounds of nurses and doctor approaching in a hurry to carry Mrs. Chawila on a stretcher.
Doctor Kamanga:
What happened to her?
Nancy:
(Explaining with fear and worry)I don’t know, doctor. She was cleaning windows outside, and then I just heard her scream and fall off a stool to the ground. When I came outside, I realized she had fainted and could not talk to me.
Doctor Kamanga:
What’s your name and relationship with this lady? What’s her name?
Nancy:
My name is Nancy and I am her niece. Her name is Mrs. Mirriam Chawila.
Doctor Kamanga:
How many months pregnant is she? Has she been unwell? Do you know if she has been experiencing headaches, fever, dizziness?
Nancy:
I don’t know exactly, but I think she is about seven months pregnant. Generally, during this pregnancy, she has not been very well. In fact, we think someone put the evil eye on her because she has been getting sudden terrible headaches and also dizziness.
Doctor Kamanga:
Ok, thank you, Nancy. You can go outside and wait. We will see what we can do to help.
Fade out sounds, then fade up sounds of emergency treatment room, sounds of medical equipment being placed on tables, people talking in low voices, etc. Hold under following scene.
Narrator:
Nancy leaves the treatment room where the doctor and nurse are working on Mrs. Chawila. The doctor gives her some IV fluids and medication to inhale so that she will gain consciousness, while the nurse does a malaria slide test and checks the condition of the baby in the womb and realizes the baby is coming.
Doctor Kamanga:
Nurse, this woman has malaria +++ and is severely anaemic. She is in labour right now (Editor’s note: In Zambia, health workers use the term “malaria +++” to describe advanced malaria). We need to help her deliver this baby.
Nurse:
Yes doctor, I agree. The baby’s heartrate in the womb also sounds weak. Look, I think she is regaining consciousness now. Mrs. Chawila, can you hear me?
Doctor Kamanga:
(Interrupting) See, she is conscious now and don’t even think about a Caesarean, nurse! Let’s see (short pause while he examines her) … Alright, I think she can stand the labour pains as well as pushing the baby. Let’s not make a quick decision to send her for surgery. We may lose her or the baby, even both of them. Especially if she is anemic from the malaria. Mrs. Chawila … Mrs. Chawila, can you hear me?
Mrs. Chawila:
Eeeesh! Eeeesh! Yes, I can hear you. But who are you? Where am I?
Doctor Kamanga:
I’m Doctor Kamanga and you’re in an emergency clinic. You fainted because you have advanced malaria, which caused severe anaemia, which some people call “weak blood.”
Look, there’s no time to answer any more questions right now. You’re in labour and the baby is on its way. I will need you to follow my instructions very closely …When I say push, you push, alright?
Mrs. Chawila:
Ok.
Doctor Kamanga:
Alright now! Push! Again! Ok w …wait … wait … wait! Ok, give me one big push and then we will be out of here. Puuush! Wow! (Pause) There, it’s a girl. But since the baby didn’t cry or make any sound, we need to do a malaria test as well. Nurse! Do that test and then put the baby on oxygen immediately. Connect a drip for food to the baby as well. I will be right there soon.
Nurse:
Ok doctor, the baby will be on bed number 37.
Fade out sounds of clinic. Two seconds silence, then fade up the sounds of the clinic. Sounds of doctor’s footsteps approaching.
Doctor Kamanga:
Mrs. Chawila, you will have to stay in the clinic for sometime as your baby has malaria as well. We have to treat both of you until we are sure you are alright. Then we can release you and your baby to go home.
Mrs. Chawila:
Ok, but can I see my baby now?
Doctor Kamanga:
No! You need to rest and allow these drips of blood and sugar to finish. Then, you can start moving. Then you will feel much better and stronger. The nurses will take care of your baby, don’t worry.
Pause, then fade up sounds of people walking and talking in a clinic.
Narrator:
It has been two weeks since Mrs. Chawila came to the clinic. Today she is getting discharged together with her baby girl. They are both fine. Nancy is on hand to help her with her bags. She sees that her auntie is entering the doctor’s office so she waits for her outside. The doctor tells Mrs. Chawila that he has to counsel her on how to prevent and cure malaria during pregnancy for the safety of the mother and the unborn child. Let’s listen attentively as the doctor talks to Mrs. Chawila in his office.
Doctor Kamanga:
Mrs. Chawila, from your antenatal card, I can see that you attended antenatal clinics three times during your pregnancy. Were you ever given drugs to prevent malaria or advised to sleep under a treated net?
Mrs. Chawila:
Yes, doctor, I was given those tablets, but I have to confess that I didn’t take them.
Doctor Kamanga:
Yes, go on.
Mrs. Chawila:
My grandmother always told me that when a woman is pregnant, she should never take any English medicines because they could cause miscarriage or harm the baby in the womb. I have a neighbour who just gave birth to an abnormal baby, which made me worried. So I just threw the tablets away.
Doctor Kamanga:
And what about a mosquito net? Have you been using a treated net?
Mrs. Chawila:
I never used to sleep under a mosquito net because my friend told me that the chemical used on the net causes allergies.
Doctor Kamanga:
I see. Were you feeling unwell during this pregnancy? Your niece mentioned that you were having terrible headaches and dizziness.
Mrs. Chawila:
Yes, when I was six months pregnant, I developed this terrible headache, high fever, and I lost my appetite. I only felt like this in the evenings, so I ignored it. I thought it was just the pregnancy. But as the days went on, it became clear to me that it was not just pregnancy illness. Then one day as I was outside my home cleaning the windows, I suddenly felt dizzy. All I can remember from that moment is that I fell.
Doctor Kamanga:
Mrs. Chawila, first of all I want you to know that malaria is the number one killer disease in Zambia, and in Africa as a whole. The people who are most prone to malaria are pregnant women, children under the age of five, and people living with HIV and AIDS. In fact, malaria is more dangerous than HIV and AIDS. Malaria can kill within a few hours or days. AIDS may take months or years to manifest or kill someone.
Mrs. Chawila:
So is it malaria that led to my having a premature baby? Or were there other problems I need to know about?
Doctor Kamanga:
No, there were no other problems. It was the malaria that caused you to give birth at seven months instead of at nine months. You see, when a female mosquito bites you during pregnancy, it transmits a malaria parasite to you. It is this parasite that causes malaria. The parasite goes immediately to the uterus where it multiplies at a much faster rate than in someone who is not pregnant. The uterus is fertile ground for malaria parasites. So the baby in the uterus becomes infected. The parasite continues to multiply while the baby is in its infancy and has little strength to fight the infection. A pregnant woman with malaria is also at high risk of delivering early, which means that you could deliver at seven months, instead of nine months. A baby born at seven months with malaria can be very weak and small. Many do not survive because they do not have the strength to fight the infection.
Mrs.Chawila:
(Interrupts the doctor)So that’s how dangerous a female mosquito can be. (Amazed) My God! But how can we tell if a mosquito is female or male?
Doctor Kamanga:
It’s the female mosquito that brings all the danger. But since we can’t tell with our naked eyes which is female and which is male, we have to guard ourselves from any type of mosquito by using the methods I will talk about soon. As I was saying, the first signs of malaria are that you begin to have a fever, headache and many other signs. At this stage the “soldiers” in your body – by this I mean the kind of blood cells that fight off infections – are under attack. The parasites begin to fight and kill them, leaving you and the baby more vulnerable. If pregnant women with malaria are not treated, the disease can cause abortions, premature births and anemia. Here in Zambia, we’ve adopted two strategies to prevent malaria during pregnancy and safeguard the life of the unborn baby. The first is using insecticide-treated mosquito nets. The second is for pregnant women to take anti-malarial medication during pregnancy. Usually, these medications are given through antenatal clinics.
Mrs. Chawila:
Doctor, all this information is too much for me. I may not remember all those details, even though I know it’s very important. I want the women in my community to have it.
Doctor Kamanga:
Ok, ok! But please listen to this – it is very important in case you become pregnant again. Antenatal clinics are absolutely critical. Whenever I have a chance to talk to women at the clinic, I encourage them to continue visiting their nearest health centre while they’re pregnant. This is not just to see the midwife. It’s about the general health of a mother and the developing baby. When you don’t go to antenatal clinics, you put your life and that of the baby at great risk. Because you may not detect the signs of early malaria. Or you may simply ignore the signs of infection. Just like you did, Mrs. Chawila.
Mrs. Chawila:
But doctor, can’t malaria drugs cause my child to be born with a disability?
Doctor Kamanga:
I understand. You are worried that the malaria drug might have side effects on the unborn child. The malaria drugs that prevent malaria during pregnancy are the same medicines that we give to people who are not pregnant. We give the drugs to prevent malaria only when it is safe for the mother and the baby – that is after 16 weeks of pregnancy. This is when the baby’s organs are already developed, and there is no risk to the baby. At most, the malaria prevention drugs are given three times during the pregnancy.
Mrs. Chawila:
I see,Doctor. So you are saying that women shouldn’t start taking the malaria drug immediately after they discover they are pregnant?
Doctor Kamanga:
No. As I said, we avoid giving the drug to pregnant women when the baby’s organs are just developing in the womb or in the first three months of pregnancy. During this early period, we advise women to sleep under an insecticide-treated mosquito net and have their surroundings cleaned and sprayed. The chemical used to treat the mosquito net has no side effects on the mother or the unborn child. The treated nets only cost 3000 Zambian Kwacha (Editor’s note: less than 1 US dollar), and they keep both the pregnant woman and her unborn baby safe from malaria.
Mrs. Chawila:
(Smiling with satisfaction and appreciation) Doctor, thank you very much for this information. I never knew about this. This information is too powerful to be known by me alone. A lot of women in this community do not know about this. I think I should organize a meeting with my fellow women and tell them what happened to me. What do you think, doctor?
Doctor Kamanga:
Yes! That’s a good idea, Mrs. Chawila. I suggest that you especially invite women who shun clinics and hospitals when pregnant.
Sound of a knock on the door
Doctor Kamanga:
Come in.
Nurse:
Doctor! There’s a woman who has just come into the emergency room and she seems to be in labour. Please come quickly.
Doctor Kamanga:
Oh! I almost forgot I am on duty. On my way, nurse! Mrs. Chawila, if you have any more questions about malaria or how to care for yourself, please talk with this nurse. She can explain everything as well as I can.
Mrs. Chawila:
Yes doctor. I will do that. And, doctor, wait! Can you also come so that you can help me when I can’t answer the questions women at the meeting ask?
Doctor Kamanga:
Of course, Mrs. Chawila. I would be more than willing to help, as would any one of my colleagues here. We take malaria very seriously, especially when it concerns pregnant women. Please come back to tell me the date and time for that community meeting, and one of us will be ready to support you.
Narrator:
The doctor leaves the counselling room in haste. Mrs. Chawila calls Nancy to come and pick up the bags so that they can go home. Before they leave the room, Mrs. Chawila asks for a favour from her niece, Nancy.
Mrs. Chawila:
Nancy, Nancy! I will carry the baby. Let’s go home. Will you help me write a letter to the chairman of the women’s group? I want to organize a meeting with the women and tell them of the dangers of …
Nancy:
(Interrupting) Dangers of what? Auntie! … You’re supposed to be home just looking after this newborn child and resting. You know what you went through during this illness. You may not even know who your enemy is. Hey, that kind of malaria attack, eesh?
Mrs. Chawila:
What are you hinting at, Nancy? That witchcraft made me ill? No no no! Niece, I have learned that it was malaria. I need to tell the women how dangerous malaria is, and how they can prevent it by using treated nets and anti-malarial drugs. And of course how to cure it if attacked.
Nancy:
Auntie, you sound like you are coming from a school instead of a clinic. How are you going to manage organizing a meeting as well as speaking in front of a crowd of people?
Mrs. Chawila:
(Calm)That’s why I am asking you to help me write a letter to the chairman of our community inviting all the women to attend without fail. Doctor Kamanga has already said he will come and help answer questions when I get stuck. But I think my story of what I and my baby went through because of malaria will be more than enough to prevent this killer disease in our community. (Pause) Come on, let’s go. Time is not on our side.
Acknowledgements
- Contributed by: Senior Writer Alice Lungu Banda
- Reviewed by: Ellen Brazier, Senior Technical Advisor, Community Engagement, EngenderHealth
Information sources
- National Malaria Control Centre (Zambia): http://www.nmcc.org.zm/
Interviews with:
Doctor Elizabeth Chizema. National Malaria Control Center. Deputy Director in the Directorate of Health and Research-Malaria, July 3, 2009.
Doctor Ameck Kamanga, a gynecologist and programme manager with Marie Stopes
International Zambia, May 25, 2009 and March 10, 2010.
Honourable Kapembwa Simbao, Minister Of Health for the Republic of Zambia.
Mrs. Mirriam Chawila, March 9, 2010.