‘Every Life is Important’

Malaria remains a widespread challenge in Uganda, with unequal access to protection and treatment. Krystal Mwesiga Birungi, a scientist and Global Fund Advocates Network speaker, is determined to change this. In an interview with Peter Wiessner, Action Against AIDS Germany, she shares what drives her mission.

When her son turned five recently, it was no ordinary birthday for Krystal: “I walked around all day with a big smile on my face and kept telling myself: He’s alive”. From a purely statistical perspective, her child’s reaching this age was a significant milestone. In Birungi’s childhood and youth, one in three children died of malaria before the age of five. With the rain came the mosquitoes, and each one could transmit the parasite. Although treatment was possible, the medication required was unaffordable for many. People felt powerless in the face of this constant threat. “We knew that we could get malaria at any time. And, if we got it, there was no certainty that we would survive,” she says, describing her life. “But nobody should have to grow up and live like that. That’s just wrong.” Krystal and her siblings also fell ill; she nearly lost her youngest brother to malaria. She can never forget her mother’s relentless efforts to cool her five-year-old’s feverish body and halt his convulsions.

Krystal has therefore made it her life’s work to raise awareness of how malaria can be eliminated. Over the decades, her efforts, alongside those of other advocates, have helped drive remarkable progress. She works as an entomologist for Target Malaria Uganda and studies the population dynamics, behavior and species composition of mosquitoes, among other things, and thus contributes to improving malaria prevention and treatment.

“The Global Fund has been decisive in improving the country’s situation,” explains Birungi. “We owe this success to the mosquito nets that have been distributed in the villages, for example, but also to the health care teams in rural areas”. The Global Fund provides both financing and training for these teams. People are now responsible for preventing and treating malaria in their own communities.  But there is still no reason to be satisfied with what has been achieved. “It is a matter of the heart for me, because so many people have already died from this disease,” says Krystal. “I am one of the people who are lucky enough to be able to protect themselves with a mosquito net and – if the worst comes to the worst – to have access to treatment.” And no less important: “I can also afford treatment for my child myself.” 

Unfortunately, many people have a completely different reality. They don’t know if their children will live long enough to enroll in school. However, Krystal cannot and will not accept this fact. “It’s simply not fair,” she says.” People have no voice and hardly any chance. This is despite the fact that malaria deaths in Uganda could be prevented with measures like mosquito nets and vaccinations, saving thousands of lives each year.” The prerequisite for this, however, would be to reduce the striking inequalities in health opportunities and access to care.

 Health centers away from the big cities are rare and poorly equipped.

As part of her work, Krystal visits numerous villages in the country and has gained a unique insight. In many of the worst-affected areas, such as the islands in Lake Victoria, there is a lack of even the most basic healthcare. Residents must travel by canoe to larger islands to access treatment. However, during stormy seasons, even this option is unavailable. The lack of health facilities creates significant challenges across the region. “People often have to walk many kilometers to reach a doctor and even if they manage to reach health centers, they often cannot be helped.” This is because the centers are often inadequately equipped and lack medicines. “The people who live there are therefore cut off from both malaria prevention measures and malaria treatment. They are simply left in the lurch and therefore die from a disease that has long been preventable”. 

Stigmatization increases inequality of opportunity 

But it’s not just a lack of medicines and health facilities. “There is also a lack of education, especially in remote places,” she notes. Many people do not know how to protect themselves against malaria or how the disease can be treated. Another problem is stigmatization. “A pregnant woman with HIV may not go for check-ups for fear of being stigmatized if her HIV status becomes known.” Sex workers are also exposed to such discrimination. People from the LGBTQIA community, on the other hand, run the risk of being identified as queer in health centers and thus fear being prosecuted. “So, we have a number of barriers in Uganda that we urgently need to break down before we can claim that we have equal health opportunities,” says Krystal, summarizing the situation. “Equality means that the place where people are born cannot determine whether they live or die.” 

This is not impossible to achieve, but it will require united forces. Also, the situation can change for the worse at any time in the face of threats like climate change. “So, we have no reason to sit back and relax,” says the malaria researcher. The COVID-19 crisis has shown that a pandemic can be brought under control if the global community stands together. However, it has also become clear that countries with a strong public health system are best able to respond appropriately to such health crises. 

“Without support, countries like Uganda will never achieve health equity” 

“The knowledge and opportunities to eliminate HIV, tuberculosis, and malaria and achieve equal health opportunities for all have long been available. But without support, countries like Uganda will never achieve equal health opportunities. We need strong partners for this.” 

The Global Fund has the tools, the will, and the necessary structures; – “And we see in Uganda, as in many other countries, that the work of the Global Fund works. But we also know that there are not enough financial resources available.” This is why Krystal calls upon the unity of the global community: “Those who have a voice and the means, who have the necessary resources, therefore have a moral obligation to prevent people from dying simply because they were born in the wrong place”. It cannot be right that parents must decide whether they can pay for their children’s vital treatment or buy them something to eat. “That is not the world we want to live in. To achieve equality, we can no longer just talk about it, we must act.” 

Text: Axel Schock 

Interview: Priyanka Ayer, Global Fund Advocates Network and Peter Wiessner, Action Against AIDS Germany