With brown skin, floral clothes, and small curly hair, the locals walked on the road in groups of three or five, carrying a scimitar with a blade length of 20 to 30 centimeters.
When he first arrived in a foreign country, this scene of a suspected young and Dangerous boy going out on the street strongly shocked Li Mingqiang's nerves. "Are the people here so scary? Just walking on the road with a knife?" He was puzzled.
Li Mingqiang quickly understood that this was a misunderstanding. The locals don’t carry knives with them to threaten or hurt people. In this farming-dominated country, the knives are their survival tool and they cannot do farm work without it.
This is Sao Tome and Principe (Sao Tome and Principe), a small island country 200 kilometers away from the African continent with a population of 215,000. It is one of the least developed countries announced by the United Nations, and 90% of its annual development funds rely on foreign aid.
In December 2016, Sao Tome and Principe severed the so-called "diplomatic relations" with Taiwan. After the resumption of diplomatic relations, mainland China sent a team of anti-malarial experts to assist Sao Tome and Principe. In early January 2017, the 26-year-old Li Mingqiang, a graduate student of Guangzhou University of Traditional Chinese Medicine, arrived in Saint Tome and Principe as a member of the expert team. He served as the project team leader and was stationed there to assist malaria prevention and control work, which has continued to this day.
Malaria is a life-threatening disease caused by parasites. According to the WHO report, in 2019, about 229 million people were infected with malaria worldwide, and 409,000 died as a result. Children under 5 years of age are the most susceptible group.
In June 2021, China was certified as a malaria-free country by the World Health Organization, affirming China's achievements from the annual report of 30 million cases to zero. At present, malaria is still the top priority of Sao Tome and Principe’s three major infectious diseases. The goal of Li Mingqiang’s foreign aid team is to help Sao Tome and Principe to eliminate malaria and achieve zero cases.
This year is Li Mingqiang's fifth year in Sao Tome and Principe. This contingent of no more than three or four people, working and living here, promotes the Chinese anti-malarial program to assist the local area, but also sees a real and vivid African island country.
African island nation early experience
when selected graduate professional instructors, Li Mingjiang, we know that his resume foreign aid destined for some experience.
At the end of 2016, the Ministry of Commerce’s “Sao Prudential Malaria Prevention and Control Assistance Project” recruited Professor Song Jianping, a malaria prevention and control expert at Guangzhou University of Traditional Chinese Medicine. He was under the tutelage of Li Guoqiao, who was a member of the national malaria prevention and control “523 Task” expert group in 1967. Li Mingqiang is a student of Song Jianping and the third generation passed down from his teacher's school.
At the end of 2016, when Li Mingqiang received the assignment, Sao Tome and Principe had very little public information. Because the full name of Sao Tome and Principe is "Sao Tome and Principe", he once thought that these were two countries and he could choose one of them. The lack of supplies in Shengpu was expected. Before he was ready to set off, Li Mingqiang took everything he could bring, and packed pots and pans together with napkins.
After three transfers, and after the 30-hour voyage, this strange country finally took on a real appearance.
The infrastructure here is backward. Water and power outages are the norm. The network is still in the 2G era. There are no buses, no traffic lights, and carts are not always unimpeded. In addition to walking, most people can travel freely between villages only by relying on motorcycles. , Trapped in the difficulty of material transportation, there are vacancies on the supermarket shelves from time to time...Although it lacks modernity, the city streets are clean and tidy.
What makes Li Mingqiang most incredible is that China and Sao Principe have resumed diplomatic relations. However, before Li Mingqiang and his party arrived, Chinese businessmen had opened department stores and supermarkets here for many years, and they were very familiar with local officials. "It is true that where there is land, there are Chinese." He said with emotion.
Toasted breadfruit is the staple food of the locals, and the taste is between taro and bread. "Three main dishes": grilled steak, grilled chicken, grilled fish, all seem to be hard dishes, but there is only one way-grilling. Throw it into the fire, or put it on the iron cover of a discarded electric fan, and then put it on the fire, which is quite primitive. This makes it difficult for the Chinese taste accustomed to steaming, frying, stewing, sour, sweet and spicy, "I can't stand it for three days." Li Mingqiang recalled.
The emptiness of taste buds has to be rescued by Chinese food. A few days later, they ran into the office of a company with a Chinese flag and had a meal of porridge and buns. Li Mingqiang said that it was the most fragrant porridge he had ever eaten.
Within a week, the body and stomach settled down, and then it was time to do business. Clearing malaria is a daunting task. This group of aid teams with an average age of less than 30 years provokes the mainstay.
Mosquito PK treatment
After receiving international assistance for many years, the malaria infection situation of the people in São Tomé and Príncipe has improved. Around 2013, the infection rate was still 20%, and it fell to less than 2% by 2017. This is the starting point of the work of Li Mingqiang’s foreign aid team and a bottleneck in malaria prevention and treatment. Inferior to reducing the infection rate.
The difficulties are mainly due to two aspects: the people's willingness to cooperate has decreased, and the old plan to prevent and treat malaria has limitations and cannot be cleared.
The previous aid team used the "mosquito and anti-malarial method", which mainly relied on spraying insecticides in the room. The object returns to its original position, but this process is too much trouble. In the past few years, because of the high incidence of malaria, the public actively cooperated, but in recent years, fewer people have contracted malaria.
Li Mingqiang said that Sao Tome and Principe’s spray coverage rate has dropped from 90% to 60%, and according to WHO standards, the coverage rate should not be less than 80%. At the same time, mosquitoes have become apparently resistant to insecticides.
More importantly, mosquitoes are a transmission channel. It is also because it bites a person who is infected with malaria, and then continues to bite, bringing parasites to other people, causing more infections, but mosquitoes cannot be eliminated. The source of malaria infection is the plasmodium parasitic in the human body, and only the elimination of the plasmodium is a more thorough solution.
Therefore, if Sao Tome and Principe continue the old plan, at best, the malaria infection rate can be kept low and cannot be cleared to zero. Once it relaxes, the number of cases will rise quickly. Sao Tome and Principe, which plans to eliminate malaria by 2025, needs a new plan.
The plan of the Chinese aid group is to "kill the source and fight malaria, and take medicine for all people." By taking three rounds of artemisinin-based drugs, the malaria parasites in the human body are eliminated and the goal of preventing and treating malaria is achieved. Artemisinin has the best safety and efficacy among the existing antimalarial drugs. For discovering the role of artemisinin in the treatment of malaria, Tu Youyou won the 2011 Lasker Prize for Clinical Medical Research and the 2015 Nobel Prize. Physiology or medicine awards.
Since the 1990s, this program has been successfully tested in Cambodia and Comoros. Moheli Island, the most severe malaria in the Comoros, has seen a 93.2% decrease in the monthly number of cases after two months after the entire population took the drug. Bringing new solutions to these two countries are the two professors Li Guoqiao and Song Jianping of Guangzhou University of Traditional Chinese Medicine, and Li Mingqiang's direct team.
But it is not easy to get people from the Ministry of Health of Sao Tome and Principe to accept the plan of the Chinese aid group. The local area has been accustomed to the "mosquito net + insecticide" model for more than ten years. The two countries have just resumed diplomatic relations. The mutual trust in work has not yet been established. Even the officials in charge of public health and medical care are not sufficiently concerned about the source of infection and transmission channels. Cognition is also due to various interest considerations, and there are worries in the heart.
In addition, there are practical difficulties. Taking medicine for all means that the local population needs to be figured out. However, the information that the aid team has is not sufficient. In 2017, they were provided with the demographic results of 2012. Even if the area of Sao Tome and Principe is only the size of Hong Kong, in a country where 90% of development funds rely on aid, the census is an expensive task.
In short, all work must start from scratch.
"Are you going to every county?"
The diplomat of the embassy provided a lot of help when introducing the "Medicine for All" malaria prevention program to the Ministry of Health of Sao Tome and Principe.
When Wang Wei, the ambassador to Sao Tome and Principe, met with Li Mingqiang and his party in 2017, he came up and asked them: How to carry out malaria prevention and control work and what is the principle? This diplomat was also a former malaria-infected person, and he almost died because of this when he was in Angola.
This experience made him very interested in the team's anti-malarial program. "He has thoroughly understood our plan." Li Mingqiang said. Thanks to this, the communication with the Sao Tome and Principe government level has been much smoother. "Many questions do not need to be found to us, he can explain clearly."
The assistance team is also taking a two-pronged approach to help Sao Tome and Principe set up a three-level malaria prevention and control system, and when training technicians, in addition to the correct use of artemisinin compound, microscopy training, and rechecking blood films, the team members also explained to them "to eliminate the source and fight against malaria, and for the whole people. The theoretical basis for taking medicine, but this work also encountered difficulties at the beginning.
"Indoor spraying does not require a theoretical basis, and it can be operated with a watering can, which is equivalent to spraying pesticides by farmers." Li Mingqiang said, but understanding "all people take medicine, eliminate the source and prevent malaria" should start from theory.
After several training lectures, the team members were engaged in speaking, but the audience in the audience was confused and confused. After the class, someone asked what the "gametophyte" was repeatedly mentioned in the class, and they realized that they had overlooked the fact that these technicians recruited by the Center for Disease Control and Prevention in Sao Tome and Principe lacked knowledge in the medical field.
After discovering the problem, they no longer use professional terms, but use the most popular words to explain the principle of extermination: ordinary mosquitoes and insect-carrying mosquitoes have different life spans. It is guaranteed that the human body is free of malaria parasites for three months, and new mosquitoes will not be exposed to malaria. The protozoa and the old mosquitoes that carried the worms are all dead... Excluding technical terms, communicating in vernacular, with video-assisted explanations, they have a feeling of "big understanding".
Tan Ruixiang, who had assisted in Sao Tome and Principe for two years and was in charge of personnel training, also summarized the trick: “The best way is to explain to a few highly acceptable technicians, and then let them and those who don’t understand Communication with one’s own language and habits makes learning faster.”
São Tomé and Príncipe is divided into 7 districts. Because the area is small, the assistance team is used to calling these districts “counties”.
In addition to the training, investigations and investigations were also carried out simultaneously.
"We are going to every county in Sao Tome and Principe to investigate." In 2017, the aid team found the coordinator and said.
"You are going to every county?" The other party was surprised and confirmed to him again, and Li Mingqiang gave an affirmative answer.
They went to the remote villages of São Tomé and Príncipe. Some places are not accessible by car and dirt roads, but they need to travel through mountains and rivers to open a way out of the grass. Some villages have not even been to the accompanying guide or local health officials, and they do not even know that there is such a place.
This is not to say that officials are not working properly. Li Mingqiang, who has been stationed abroad for more than four years, understands their real difficulties. Not to mention the poor road conditions. When going to the countryside in remote areas, he has to pay for transportation, gas, and labor, and the funds are even more tight.
In the past two years, the aid team visited 215 villages. In each place, the population was surveyed, blood tests were performed, the malaria situation was investigated, the collective environment was observed, the specific causes of malaria were analyzed, cleanup activities were organized, step by step, and the gaps were filled.
Visits and investigations and personnel training are the main tasks of the aid team in the first two years of its permanent presence in Sao Tome and Principe. In July 2019, the assistance team's plan had a chance to be put into practice, and the preliminary preparations had a practical use.
"Be a village first" In
2019, the aid team again communicated the theoretical plan with officials from the Ministry of Health of Sao Tome and Principe, and also invited Comorian malaria prevention and control experts to come out and say, because three islands in Comoros have implemented The plan of taking medicine for all people has achieved remarkable results, but Sao Tome and Principe still have concerns.
The assistance team proposed to select the village with the highest malaria incidence in São Tomé and Príncipe as a pilot. "First, make a village and make the effect. It looks good. Let's continue. If it's not good, let's improve the plan." Li Mingqiang repeated. The other party agreed that the pilot was selected in the village of Bairro Da Liberdade.
The aid team cherishes this opportunity very much. The key and difficult point is how to win the trust and cooperation of the villagers.
In the beginning, they went to the village to publicize on working days and planned to call villagers for science popularization. They prepared drinks, candies, and cakes to entertain the villagers, which should have been quite tempting to the villagers who lacked supplies, but there were only a few people who came for two games in a row. "Don't come with so much preparation? This shouldn't be." This was Li Mingqiang's confusion at the time.
They soon discovered their own negligence-the misalignment of working hours brought embarrassment. From Monday to Friday, the main family members went out to work, and only the elderly and children who could not go out were idle in the village. After that, they adjusted their strategies. For six months, the project team went to the village to make popular science lectures almost every weekend.
This way of working also makes the WHO Global Fund and local health officials, who are working together to fight malaria, feel incredible. "They don’t take a break on weekends for half a year, and they have been spending time in the village. They can’t do it." Li Mingqiang said, "In order to get things done, sacrifice personal time, strive for excellence in work, and be willing to work hard. This is ours. Advantages."
Although "medication for the whole people" is the focus of the new plan, Li Mingqiang's team also knows that the combined boxing that treats both symptoms and root causes is better.
In terms of symptom treatment, the aid team did not rely on spraying insecticides, but focused on treating the public health environment of the pilot villages, weeding, and clearing ponds to reduce mosquito breeding. They hired villagers to clean the village, call them a car, and remove the garbage and weeds. When the work was started, the unemployed villagers also spontaneously brought tools to help.
"We provide vehicles and tools and return subsidies. The villagers themselves help build the village." Li Mingqiang said that it was in this kind of work contact that the assistance team won the villagers' trust, and follow-up work such as three rounds of medication was carried out smoothly.
Li Mingqiang felt support and trust from a pregnant woman who was 7 months pregnant. Li Mingqiang explained that after 3 months of pregnancy, artemisinin can be taken after the fetus is stable. The mother-to-be took the medicine. Maybe the medicine was a bit bitter. She couldn't help but vomited up. The team members stepped forward to comfort her, but the mother-to-be said that it was her morning sickness reaction and it had nothing to do with them. Give her a medicine.
In this small village with only 600 people, the number of annual cases of malaria was 200-300, with an average of about ten cases per week. At the peak, 32 people contracted the disease a week. After the whole village took artemisinin, in the second half of the year, the number of cases in this village showed a cliff-like decline, and there were no reports of malaria for 5 consecutive months. Later, due to the new coronavirus epidemic prevention measures, the transportation of materials was blocked, the follow-up maintenance intensity was weakened, and there was still a movement of people, there were more than 30 cases, but the number of infections has dropped by 90% compared with the previous period.
Some villagers told Tan Ruixiang that they had to run to the hospital three or four days a week. Today this child got malaria, and another child got it two days later. All the money they earned was spent in the hospital. Li Mingqiang also said that once an adult has malaria, he usually cannot work for a week. But in the pilot villages, the troubles caused by malaria have been greatly reduced.
The results obtained in the pilot villages surprised and delighted the Ministry of Health of Sao Tome and Principe. They approved the assistance team's plan and changed their attitudes. "When we first launched the project, we were like asking people to let us do the work. Now they will take the initiative to contact us and ask where the next village will be, how to develop it, how they can cooperate, and even say whether it can be faster. "Tan Ruixiang said.
There have been small-scale successful trials of malaria clearance, and mutual trust in the work of the two parties has also taken root.
Candy, friends and God
in a foreign country, malaria is a serious work, but wrapped in cultural differences, people are exposed to Sao Tome fresh, fun and cute.
Children are most heartwarming. All the people take the medicine, and the child is the key protection object. Artemisinin-type medicine is bitter, and the child does not like to eat it. The aid team will "trade" with the children and give sugar when they take the medicine. Candies are rarely seen in children's lives, and this trick has been tried and tested again and again.
Over time, candy became the code name of the China Aid Group. When the children saw them, they shouted "Duo Di Duo Di (Candy Candy)" in Portuguese and asked them for sweets. Sometimes they don't call candy, they call "Amiga" when they see a female team member, and "Amigu" when they see a male team member. In Portuguese, this all means "friend".
In a "Children's Day" activity in the village kindergarten, three children played the role of a doctor, a patient, and a neighbor of the patient. The kid playing the role of a doctor prescribes medicine by auscultation, and asks the patient to call his family to smear the blood film to check if he has also contracted malaria.
In Sao Tome and Principe, there are no special toys and entertainment facilities, and children's happiness is very simple. Sometimes it’s candy, sometimes it’s going to the house with the aid team who enters the village. They are the most enthusiastic guides. But the most attractive thing for children is the camera of the group members. "They like taking pictures." Tan Ruixiang said, taking pictures of them with a mobile phone, and after taking pictures, they gathered around to look at the pictures. "Many children don’t have mirrors at home. They are surprised when they see the pictures. It looks like this'."
The customs and habits of foreign countries also made Tan Ruixiang quite fresh. For example, Shengpu people have no obsession with marriage. "It's quite a lot of people who don't get married, but they have a lot of boy and girl friends." This is also forced by life, because marriage requires money. Rather than having a husband, the girls of Saint-Prince and Principe want to have long hair. Because the locals are naturally curly, regardless of men and women, their hair is always long or not, and many girls will look enviously at the long hair of the female team members. In recent years, girls have become popular to pick up their hair. This is their favorite job. They are very patient in this matter, one by one, one by one, day after day, and then into trendy dirty braids or mop heads.
Unlike the Chinese who take punctuality as a ritual, the people of Shengpu are not in a hurry. Not being punctual in meetings is the norm, even if officials are waiting, they are still late. "It's at least half an hour late...Said that the meeting starts at 9 o'clock, and it starts at 11 o'clock. We are no strangers to it." Tan Ruixiang said.
The local normal working hours are eight in the morning and four in the evening, but the assistance team and the staff of the medical center for disease control, which are most often dealt with, can hardly meet three meals together. At 8 am, the aid team arrived. After 10 o’clock, it was easier to see people from the CDC in the office; at 12 o’clock, the aid team had a lunch break and the CDC continued to work; at 2 pm, the aid team went to work. , No one can be found at the CDC again. They do not have the habit of eating lunch, only a tea break, their dinner, they have to wait until 8 o'clock in the evening.
The people of Shengpu are no strangers to assistance. They accept it with gratitude, but the way they express their gratitude we can only "go the way in the home".
"We help them eliminate malaria and take care of the public environment. What they said to the face was'Thank you for helping us do these things', but what they said privately was'Thank God for sending the Chinese here to help us eliminate malaria.' They think We are doing these tasks, and we are working for nothing. It is difficult for an atheist like me to understand." Li Mingqiang said that they can only comfort themselves with "at least our work is recognized".
Ninety percent of Shengpu people believe in Catholicism. Although they are generally poor in material life, they are not at all sloppy in worshiping and paying membership fees. The church is the most magnificent building in the area.
Li Mingqiang has reached his fifth year of working and living in Shengpu. According to him, the life attitude of Shengpu people is quite "Buddha", the desire for material enjoyment is not strong, and it has not been transformed into a strong self-drive. "When it comes to work, they don't pay attention to excellence... We will say,'I have to finish one thing today, and I must work overtime to finish it', but the people of Shengpu will get off work at the point and let them continue to do it. They are not happy. "
This kind of conceptual difference, Li Mingqiang believes, cannot be attributed to "laziness" and "diligence." "This country is no public transportation, travel basically rely on walking, if work until eight or nine twenty-three hours before you go home, think about all tired."
Honest people of Sao Tome and Principe has something to do every day, to the ground looking for food, Those who have regular jobs, get off work at some point, occasionally fish, earn a little money, buy a bottle of beer, go home and talk to their neighbors... They seem to be quite content with this kind of life, but they have never seen the world outside the island. .
