A couple weeks ago I wrote about malaria in Venezuela, a disease I practically knew nothing about before I started to write that post, and I wanted to talk about the Cacique Isaias Rodriguez Anti-Malaria Project, but I decided (wisely, I believe) that it was a lot better if I let its founder, Steve Baker, talk about the things he knows about and I don't. So, here it is the interview that he so kindly answered for me and for Th!nk.

What is the main objective of the Cacique Isaias Rodriguez Anti-Malaria Project?

The primary objective of the Cacique Isaias Rodriguez Anti-Malaria Project is to reduce the incidence of malaria in the villages of the Sanema and Ye’kuana Indigenous people who live in the Alto Ventuari by distributing insecticide treated bed-nets (mosquiteros) specially designed for use with hammocks. The Alto Ventuari is defined as the Rio Ventuari from Salto Tencua up river to its source and includes communities that live on tributary rivers such as the Usete and the Yatiti. The population is approximately 2500 people, all of whom are members of one or the other of the two tribes I mentioned.

It is clear that Insecticide treated mosquiteros can reduce the incidence of malaria by at least 50%. Dra Magda Magris & Dra Yasmin Rubio did a study of Insecticide Treated Bed-nets in an area of Amazonas near La Esmeralda with Yanomami people that proved this to be as true.

Study Abstract: (Community-randomized trial of lambdacyhalothrin-treated hammock nets for malaria control in Yanomami communities in the Amazon region of Venezuela Magris, M.; Rubio-Palis, Y.; Alexander, N.; Ruiz, B.; Galvan, N.; Frias, D.; Blanco, M.; Lines, J. Tropical Medicine & International Health, 2007; 12(3):392-403 DOI · PubMed · Abstract · WWW · Full Record · · Corrections · Journal Article - Original Research · IF(2008): 2.312 Record added: 3-07-07

We conducted a community-randomized controlled trial in an area of moderate malaria transmission in the Amazon region, southern Venezuela, home of the Yanomami indigenous ethnic group. The aim was to compare the malaria incidence rate in villages with lambdacyhalothrin-treated hammock nets (ITHN) or with placebo-treated hammock nets (PTHN). In both arms of the study, intensive surveillance for early case detection was maintained and prompt malaria treatment was administered. Baseline data were collected before the intervention and a population of around 924 Yanomami was followed for 2 years. Despite the recent introduction of nets in the Yanomami villages and the adverse natural conditions in the area, the nets were accepted enthusiastically by the study population, used conscientiously and looked after carefully. The malaria incidence rate per thousand person-years at risk was 114.6 in the IHTN group and 186.8 in the PTHN group. The adjusted rate ratios indicated that ITHN prevent 56% [IRR: 0.44, 95% confidence interval (CI): 52-59%] of new malaria cases. ITHN reduced the prevalence of parasitaemia by 83% [relative risks (RR): 0.17, 95% CI: 47-100%], according to a cross-sectional survey carried out during the high transmission season. The prevalence of splenomegaly and anaemia was too low to detect any possible reduction as a result of ITHN. The main conclusion of the present study is that ITHN can reduce malaria incidence in the area and it is the most feasible method for malaria control in a forested area where indigenous villages are scattered over a large territory. This is the first community-level epidemiological trial to show that ITHN are highly effective against malaria transmitted by Anopheles darlingi.

Why is that fighting Malaria in indigenous communities is so important?

As I see it, there are three reason. 

1. The Ye’kuana & Sanema people I work with live in an isolated part of Amazonas State where health care delivery is very difficult. They live far from Puerto Ayacucho where the nearest hospital that can treat malaria is located. Although malaria detection is improving, treatment remains difficult due to lack of medication and treatment facilities. Fighting malaria through prevention with treated mosquiteros is the best way to save lives!

2. The Indigenous communities that I work with, the Sanema and the Ye’kuana of the Alto Ventuari live traditional lives, much as their ancestors did. They, along with a few other tribes in Venezuela are the guardians of special knowledge of the plants and animals with whom they live and interact in ways that the rest of humanity has forgotten. Saving their lives and health is key to preserving their special knowledge. Fighting malaria through prevention with treated mosquiteros is the best way to save lives!

3. The jungle itself is under threat throughout the Amazon basin. In places where there are vibrant groups of Indigenous people living on their land, the jungle has been better protected from the rapacious acts of illegal miners, loggers and others who would destroy the jungle. Helping Indigenous people to continue to live on their land preserves the jungle. Fighting malaria through prevention with treated mosquiteros is the best way to save lives and keep the people on their land!

How is Malaria spread? Which population groups present more risk?

1. Malaria is spread by mosquitoes and by people who have already been infected. Both are required for new infections to occur. All mosquitoes are born free of malaria. They become infected when they bite an infected human. The plasmodium parasite is transferred from the infected human to the mosquito at the moment when the female mosquito (the males don’t bite) pierces the person’s skin with its biting proboscis. The female needs several blood meals in order to produce her eggs. Once she has bitten the infested person, the mosquito rests for several days, digesting the blood meal. During this time, the infection develops in the female mosquito. Soon the mosquito will bite another person and perhaps a third before she lays her eggs in water and dies. Each person the infected mosquito bites becomes infested. In Venezuela there are many kinds of mosquitoes but only the Anopheles darling mosquito carries malaria. This mosquito bites between sundown and sunset. That means that a person who sleeps in a well made mosquitero that is properly setup are protected from the disease. It must be remembered that a second benefit of the mosquitero is that uninfected mosquitoes cannot become infected by biting a person who already has malaria if that person uses a mosquitero. That means that fewer infected mosquiteros are around to bite healthy people and give them malaria

2. Malaria was not a disease of Pre-Columbian South American. It was brought to the jungle by Conquistadors and Missionaries. It appears that the immune systems of Indigenous people of Amazonas generally have trouble dealing with a variety of Western disease.

3. There are two types of malaria endemic in Amazonas Plasmodium vivax & Plasmodium falciparum. P.vivax causes recurring and debilitating sickness. P.faliciparum is a deadly form of malaria that kills many of its victims. Children under the age of 6 years and pregnant women are at most risk. Young children are at risk because their immune system is not yet fully active. Both pregnant women and their fetus are at risk because their pregnancy often lowers their immune response to the disease.

Is there a specific reason why you decided to start working with the Ye'kuana & Sanema people, instead of another indigenous community?

My wife Peggy and I lived in Caracas from 2001 to 2006. In 2002 I made my first visit to the Alto Ventuari at the invitation of a friend, Robert Sonderman. Robert was operating a tourism business, using his twin engine Piper Aztec to fly people into the town of Jodoimenña to visit with the Ye’kuana and Sanema people who live in the area. It was on that first trip that I met Cacique Isaias Rodriguez, the most famous and influential Ye’kuana of his times. Since that initial trip I returned to the Alto Ventuari many times, traveling to most of the villages, both Ye’kuana and Sanema, including some very isolated ones far up in the headwaters of the Ventuari and its tributary rivers. My initial motivation for these visits was fascination with Indigenous culture and a strong personal drive for adventure. However, I found that the health problems that I observed the indigenous people struggling with soon changed the focus of my visits. With the help of other interested people and the encouragement of Cacique Isaias, I embarked on a variety of projects to try to improve the health of the people. Some of the things we did were successful, others less so.

In 2006, at about the time Peggy and I moved back to the USA, I read the UN Millennium Report on Malaria. That report highlights ITNs (Insecticide Treated Bed nets) as the most powerful preventative intervention available at present to fight malaria. I decided to concentrate all my future efforts on bringing ITNs to the Alto Ventuari.

I guess the main reason that I continue to concentrate my efforts in the Alto Ventuari is that I consider many of the people there my friends. I have known them for years. I know their children and grandchildren. Also, I promised Isaias I would help his people. Although Isaias died several years ago, I still feel committed to that promise.

Which are the priority needs and the most urgent problems of the Ye'kuana & Sanema people?

First let me say that, since I do not live in the area full time, it is difficult for me to talk in an authoritative way about what the people themselves would consider their most urgent problems. I have concentrated on health issues so I will discuss those.

There are three practicing Ye’kuana shaman in the Alto Ventuari amongst the Ye’kuana. There are more shaman in the Sanema communities but they are quite secretive about the inner working of their society so I don’t know how many there are. The Shaman are quite effective in treating many of the ailment that afflict the Indigenous people. However, they are not capable of treating many other diseases some of which come from the outside (like malaria) and others, like diabetes and cancer that even our Western medicine has trouble with.

There are 5 enfermeros in the Alto Ventuari. Enfermeros are men who have had training as field nurses. Three of the enfermeros are stationed in the biggest town, Cacuri. There are two more far up river, one in Wasaranña and one in Caño Guamo. The up-river enfermeros have small supplies of first aid type medicines and bandages supplied intermittently by the state. The “ambulatorio” (health care center) in Cacuri is of decent size and is better supplied than the outlying ones. There is also a person trained on the microscope in Cacuri who can look for malaria in blood samples, but there is no medicine or equipment to treat the patients. The nearest hospital in Puerto Ayacucho is a 3-7 day trip away by river (depending on river water levels). Air-ambulance is sometimes available. There are sometimes young criollo doctors stationed in Cacuri, sometimes not. There is a new Tele-medicine ground station operated by the UCV and paid for by Total, the French oil company that will bring better diagnosis in the long run.

That is the situation in terms of man power, not so bad. The big problem is that the Sanidad in Puerto Ayacucho has not been consistent in keeping the ambulatorios well stocked with the equipment and medications needed by the enfermeros. Other services, such as immunization has also been intermittent at best. Clearly the Ministerio de Salud in Puerto Ayacucho has a daunting task to service the hundreds of small and isolated villages around Amazonas State. The folks I have met at the Ministerio have a genuine desire to help, but not the resources. In a nutshell, detection of malaria is improving but treatment is not. The best solution is prevention by the use of treated mosquiteros!

Another problem is water quality. The River is full of parasites and the children suffer because of the situation. The whole area needs an effective clean water program.

There is one area not connected to health care that needs addressing. The people of the Alto Ventuari have not yet been successful in gaining legal ownership of their territory. Although the Chavez government , much to their credit, have given legal documents to some tribes for their territory, that has not yet happened for the Ye’kuana & Sanema of the Alto Ventuari, despite numerous attempts by the elders to obtain approval for the territorial claims. That is a problem that needs fixing as soon as possible..

While working with indigenous communities, what are the factors that must be taken into account, in relation to respect for their traditions, customs, beliefs and social structure?

How to collaborate with their development, without this means trying to impose a Western view of this concept, or invade their autonomy as a people? This is a most vexing question. The simple answer is that there is no way for non-Indigenous people to interact with the Indigenous tribes without having an effect. Some groups, such as the New Tribes set out to destroy Indigenous culture and replace it with their own ideas of what is “correct”. Cacique Isaias & other eiders in the Alto Ventuari kept them out of the region for that reason.

For the rest of us non natives who want to visit them and help them cannot help but affect their way of life through our visits. The good news is that their culture is strong, 400 plus years of contact has not destroyed either the Ye’kuana or Sanema culture in the Alto Ventuari.

So, in the end, a healthy respect for the Indigenous culture, a recognition that what they know about the jungle in which they live and how to stay in balance with nature is real and important. Too many people look at the Indigenous communities and see only poor people living in a “backwards: manner. In fact, both Indigenous communities I know live well according to their own standards They have all the food they need. The jungle provides most the materials needed for living. Their culture is rich and provides them with a full spiritual and social life. They are free to live as they want on their own land. Most of the time, they are happy people, satisfied with their way of life. How many of us fee free and happy most of the time? To my eyes, health problems are the most difficult ones they face.

For my project, I paid special attention to the shape and size of the mosquiteros. . Most of the bed nets distributed by anti malaria programs in the world are designed to be used by people who sleep in beds, on mats, or on the ground as is the practice in Africa and South Asia. The Indigenous people of the Amazon sleep in hammocks as you know.. Conventional bed-nets will not work for them. Working with Hart Baur of Nicamaka Hammocks along with Lisardo Rodriguez and Alex Yaramare two Ye’kuana fiends from Jodoimenña (Alto Ventuari) I developed a mosquitero that can be successfully used by the Indigenous people all over the Amazon.

Insecticide treatment really enhances the protective nature of the moquiteros and also improves their usefulness against a wider variety of insects. Ye’kuana & Sanema people, especially the one who live in the cabcera the mountainous regions at the headwaters of the Ventuari and its tributaries, keep fires lit at night for warmth. Sparks sometimes burn holes in the moquiteros. If the net has been treated, mosquitoes cannot walk on the material and therefore cannot find the holes. Sometimes a sleeper will roll in their hammock so that the skin of an arm or leg touches the net. With untreated mosquiteros, a mosquito can land on net and bite through the material. With treated nets, the insect cannot land so the sleeper is protected. Biting ants and annoying cockroaches cannot climb up the inside of material of a treated net to drop into a hammock at night.

In 2008 I made an alliance with Insect Shield, a US based company that treats clothing and equipment with permithrin, a very effective insecticide. In 2008 I purchased 200 mosquiteros for a pilot project donation. Insect Shield treated those first 200 mosquiteros free of charge. In 2009 Insect Shield decided to continue this sponsorship of my project by offering to treat up to 2000 more mosquiteros free of charge as their Annual Holiday Gift for 2009.

How can ordinary people help with your work?

All of the mosquiteros that I donate are purchased with funds raised from ordinary people. $20 buys and delivers one mosquitero.

Each mosquitero can fit two hammocks strung one above the other, and each hammock usually sleeps one adult and one child, especially amongst the Sanema. That means a single donation of just $20 can protect four people from malaria. Anyone can make donation by mailing a check to

Mosquitero Project

C/O Amurtel USA

P.O. Box 232

Warren VT USA 05674

Be sure to put “Mosquitero Project” on the check so the donation will go the correct account.

Your work is directly related with one of eight Millenium Development Goals, set by the UN, which is to combat malaria and other diseases. Which do you think is the importance of eradication of malaria in the fight against poverty of this indigenous communities?

Prevention is a key to fighting to many insect borne disease. Malaria is the most wide spread and devastating, however, Dengue fever is spread by mosquitoes, but those mosquitoes bite in the daytime so other strategies, like reduction of breeding areas, are needed. Chagas Disease is found throughout Venezuela. It is caused by the “chipa” or “kissing beetle” that is active at night. Treated mosquiteros can help prevent that terrible disease that has no cure. Vaccination is by far the best preventative measure when available, but as of yet, there are no vaccinations for Malaria, Dengue or Chagas so prevention is the best option.

It is simple and clear, mothers who are chronically ill from malaria cannot work in their conucos (jungle gardens) to feed their families or care for their children. Fathers who are sick from malaria cannot hunt to put protein on the table. Children who are sick cannot learn or develop. Families who lose children and pregnant mothers to malaria are stressed, sometimes beyond their breaking point. All of these debilitating outcomes of malaria tend to drive Indigenous people off of their land and into the city. That is a prescription for disaster for the survival of Indigenous groups who want to live on their traditional lands in a traditional manner. Treated mosquiteros cn prevent this bad outcome by keeping the people healthy.

One more thing, the people of the Alto Ventuari are fellow human beings plagued by a deadly disease who struggle to get effective medical help in a timely manner. I feel that it is my duty as a person to help my friends fight malaria. I invite l your readers to join me by making a contribution to the Cacique Isaias Rodriguez Anti-Malaria Project.

Steve Baker

The featured photo belongs to dr_relling in Flickr and it's under a Creative Commons License.