After four years with the Peace Corps, Matt McLaughlin became program manager of Stomping Out Malaria, a Peace Corps program that aims to eradicate the mosquito-born disease in Africa. He recently began the Master of Public Health (MPH) Program at the University of Vermont. Because the program is offered online, he’s able to keep his job, working out of his home in Burlington and also fitting in travel. We recently asked him about his work in Africa and how an MPH might further his goals.
What was your Peace Corps experience like?
When I joined the Peace Corps, my recruiter keyed in on my business experience, and they sent me to Senegal to work in small enterprise development in the eco-tourism sector. After being in the country for a little more than a year, I came to the conclusion that my business skills would be more useful in the public health arena addressing malaria. Like many other public health challenges, the main issues are not clinical, but logistical. The test for malaria needs little to no clinical skill — an illiterate person can ably administer a malaria test. But stockouts are rampant. And managing supply is a key business process that I had experience with when working in a variety of businesses (mostly law offices) in New York City.
My major contribution was in the area of bed net distribution. In 2007, when I began working with nets, there was an understanding that mass distribution could create a “community effect” (similar to “herd immunity” in vaccines).
If you achieve a sufficient level of coverage, even those who aren’t actually sleeping under a bed net receive some degree of protection. But the open question at the time was: How do you effectively distribute that many nets?
And the common thinking was that a thorough census would be too difficult; that local community health workers would not have the skills necessary to accurately conduct a census. Looking back, it sounds ridiculous that that sort of nonsense was a common belief, but it was.
A small group of volunteers and I worked with a small NGO called NetLife and the local health system to pilot a census-taking and net-distribution methodology with about 5,000 nets. The following year, we distributed 20,000. That was when the government of Senegal decided to adopt our methodology nationwide. To date, millions of bed nets have been distributed in Senegal using an approach that we piloted.
How did you get involved with Stomping Out Malaria?
When I finished my service, my then director, Chris Hedrick, who is currently the CEO of Kepler University, suggested that Peace Corps could learn from what we had done in Senegal and launch a focused initiative Africa-wide. At the same time, Dick Day, director of the Peace Corps’ Africa Region, was looking for a way to be more proactive in the fight against malaria; malaria prevention was an issue he cared very deeply about. It was a happy confluence of people all wanting to push Peace Corps to take a more active role in malaria prevention.
I developed a proposal for how the initiative should be structured, and I have been working with Stomp ever since. We’re active in every Peace Corps country in sub-Saharan Africa that has a significant malaria burden.
Can you tell us about malaria and why it’s such a problem?
Malaria kills almost half a million children under 5 years old in sub-Saharan Africa every year. It is a disease that disproportionately affects the most vulnerable population on the planet. It is a disease that manages to cause that much death despite the fact that truly excellent treatment drugs exist and can be purchased for less than a dollar. The way I think of malaria is as a failure of systems thinking in the health system. Malaria can be easily defeated, but it requires people to think outside of the box. It won’t be defeated by doctors at clinics. It requires trusted community health workers in every village with a coordinated, almost militaristic precision to reach every symptomatic individual. And they can do it. I’m desperately tired of people underestimating what community health workers are capable of.
What is your organization doing to eradicate malaria?
As a grassroots development agency, the Peace Corps has been working in malaria prevention for 50 years, strengthening the capacity of our host countries to build their health systems. Traditionally, that capacity-building has been very isolated — each volunteer would work with an individual counterpart, and any lessons learned would tend to be lost or, at most, travel to the next town over.
The Internet is fundamentally changing that equation. What Stomping Out Malaria in Africa is attempting to do is to cultivate knowledge-sharing from volunteer to volunteer across the continent. That means regular town hall-style meetings, use of video conferencing and online forums, and purposeful documentation.
One of the most important things I do is to help identify and evangelize flagship projects. The current most important project is called PECADOM+. It’s a French acronym for home-based care, and the “plus” is a unique addition that Peace Corps and our partners have identified.
For most home-based care, the patient — even if they are to receive care in their home — has to seek out the community health worker. The patient needs to initiate care while the health worker passively waits for patients. But in many places where trust in the system is imperfect, people don’t seek care when they have a fever. The “plus” in PECADOM+ is having the community health worker do a weekly active sweep of the community inquiring at each household for individuals with fever. This simple expedient radically increases the number of malaria cases identified and treated. In a controlled trial in 30 villages, this approach led to a 16-time drop in malaria rates over the course of the 2013 rainy season.
Since that time I’ve been evangelizing the approach across all our countries. I’ve personally met with the ministries of health of Benin and Togo, and volunteers in Cameroon, Madagascar and Zambia are working toward their own pilots of the approach.
What does your work involve from day to day?
I have three pillars of my work: training, mentorship, and partnership development. I run two week-long training events per year in Senegal where I bring together volunteers and Peace Corps staff from across the continent for an intensive malaria prevention training. These volunteers and staff are the focal points for malaria prevention in their countries. Much of my time is spent preparing for and running these trainings. Then I follow up by providing ongoing mentorship. That means that when volunteers are engaged in project design, they’ll send me an email or we’ll Skype and I’ll help them think through the planning process.
Finally, to be successful in the modern age, you need partners. A substantial part of my day is spent liaising with partner organizations, looking for opportunities for collaboration, managing the relationship, and evangelizing the partnership to volunteers who can work with that partner in the field.
My days involve a lot of email, a fair amount of Google Docs, some Skype, and a heap of critical thinking.
Where do you work? Do you travel a lot? Do you use a mosquito net?
I work from home in the new North End of Burlington. No mosquito net, though I do wear repellent in the spring. Especially down by the water, they’re merciless.
I do travel quite a bit. I’m generally in Africa four to five times per year and on domestic work travel (mainly to Washington, D.C.) another five to six times per year. When in Africa, I sleep under my bed net, wear repellent, and take my chemoprophylaxis religiously.
Why are you pursuing a graduate degree in public health?
There are two reasons: knowledge and credibility.
I consider myself pretty good at self-study. I’m extremely knowledgeable about malaria despite never once having taken a formal class to study it. I keep up with the scientific literature and can hold my own with my peers in the CDC (Centers for Disease Control) and USAID (U.S. Agency for International Development).
But self-study won’t get you the credibility that a graduate degree confers. And there are some areas where I find unfocused self-study extremely difficult. I’m looking forward to really solidifying my knowledge of epidemiology and biostatistics.
How is the MPH program meshing with your job?
My professors have been extremely accommodating in allowing me to focus papers and projects on malaria-related themes. Particularly, the technical writing we’ve been doing in my environmental health class has provided a springboard to let me explore environmental issues around malaria prevention that I had been struggling with in my work.
Do your colleagues have MPHs, and what do they do?
Most of my CDC and USAID colleagues have MPH degrees. I’m the odd man out. Their jobs range from backstopping very specific areas like malaria in pregnancy or indoor residual spraying, to more general capacity-building of national malaria control programs.
How will the degree fit with your goals?
My long-term goal is to be part (an ever so small and humble part) of the team that eradicates malaria worldwide. To operate on that plane, I will need the credibility that a degree confers and the knowledge and ability to engage with scientific literature. The world needs more people who can bridge the gap between scientific insight and concrete operational interventions based on those insights.
Right now, there’s just too much lag time and every day that passes more children die. I see that translational aspect as one of my strengths and hope that a degree will unlock opportunities in that arena.
What’s something illuminating you’ve learned about Africa?
There have been so many illuminating experiences that have happened to me in Africa that it’s hard to tell where to begin. I think the most important thing I’ve learned is to stop thinking of people as part of a monolithic exotic culture. There’s everything under the sun in Africa. Venality and selflessness, incompetence and excellence, acceptance and prejudice, knowledge and superstition. If that sounds like America, it should.