Madhavi Sharma, whose family farms rice and cattle in the southern Bhutanese village of Samteling, often spends her evening with her family in the kitchen, where they cook over an open fire whose smoke drives the insects away.
A report in BBC elucidated how Sharma, who was educated up to Grade 10 (up to 16 years old), has, through word of mouth and government campaigns absorbed plenty of information about the threats of malaria and dengue fever, which are both mosquito-borne diseases.
Subsequently, they don’t keep stagnant water lying around and use the long-lasting insecticidal nets distributed for free by the government. Their home is also sprayed with insecticide twice a year.
Notably, BBC reported that the Bhutanese government's strong push to reduce malaria has seen cases being dropped dramatically, from a 1994 peak of about 40,000 cases (including 68 deaths) to 54 in 2018 (of which only six cases were indigenous).
The sole fatality in 2017 was a soldier deployed to the Bhutan-India border who arrived at a hospital too late for doctors to treat his cerebral malaria.
A malaria diagnosis in Bhutan means that a patient has to spend three days in the hospital in order to ensure proper treatment – a more stringent regimen than in neighbouring India. However, sometimes Indian day labourers, who cross into Bhutan in the morning and are required to exit by 6pm, leave the hospital rather than submit to losing three full days of wages and family time.
The progress in terms of fighting malaria has outpaced the advancements in India, but then Bhutan is a small country with some unique features that have aided it in the fight against malaria. Furthermore, another important aspect was the strong political commitment to banishing malaria, which spread from the national government all the way down to the volunteer community action groups that created their own training camps in their local areas.
While the Bhutanese anti-malaria drive was helped because of the country’s small size and commitment, it’s been hurt by the limited collaboration across borders. Notably, Bhutanese areas affected by malaria are those bordering India, while the Indian states most affected by malaria are clustered around the border with Bhutan.
While health and government officials barely converse with each other from the two countries about the issue, in early September, a meeting finally took place in Bhutan to discuss cross-border malaria in India and Bhutan.
Bhutan is hoping to eliminate malaria entirely within the next few years, and India within the next decade.