In the villages of Uganda’s Karamoja region, malaria is part of everyday life. For community health worker Lena Godfrey-Lofan, years spent moving from household to household have revealed something worrying: people are still getting sick, treatments are often misused, and conversations about medicines “no longer working” are becoming harder to ignore.
By mid-morning, the heat in Karamoja has already settled heavily over the dry plains. Lena Godfrey-Lofan walks slowly along a dusty path connecting one village to another, greeting people as he passes. Children call out his name. Women wave from shaded courtyards. Near a small trading center, a group of men sit under a tree discussing the latest rains and the rising number of malaria cases in nearby homes.
This is routine for Lena.
For more than twenty years, he has worked across communities in northeastern Uganda as a community health worker and advocate, helping families understand malaria prevention, treatment, and basic health practices. Through his organisation, Glory Uganda, he moves between villages, schools, churches, and community gatherings, often covering long distances in areas where healthcare services remain limited. In many of the communities he serves, malaria is not treated as an emergency that comes and goes. It is simply part of life.
“During the rainy season, the cases increase very fast,” Lena says. “But even outside the rainy season, malaria never completely disappears.”
Children miss school because of fever. Parents lose days of work caring for sick family members. Pregnant women become weak from repeated infections. Some households spend what little money they have on transport to health facilities or repeated medication. And for people living far from clinics, delays in treatment are common.
“They start feeling better and stop”
Much of Lena’s work happens far beyond the walls of health centers. Some days he visits households to discuss mosquito net use or follow up on patients recovering from illness. Other days, he gathers students for school debates about malaria prevention, or facilitates community meetings where families openly discuss health concerns and local beliefs around treatment.
Over time, these conversations have allowed him to notice patterns. One concern comes up repeatedly: many people do not complete malaria treatment.
“Some patients take the medicine for one or two days and stop when they begin feeling better,” he explains. “Others share tablets with relatives or neighbours who are also sick.”
He says some people mix treatment with alcohol. Others keep unfinished medication in their homes and reuse it later without a proper diagnosis. In some villages, traditional remedies are still used alongside prescribed antimalarial medicines.
To Lena, these are not simply small household habits. They are warning signs.
“When treatment is interrupted, the parasites may not be fully cleared,” he says. “That is how resistance can begin to develop.”
The term “drug resistance” is still unfamiliar to many people in the communities where he works. But the idea that malaria is becoming more difficult to treat is already entering local conversations.
A woman named Nakong and her child kept returning to the health centre with malaria. Each time they received treatment, they seemed to improve. Then, weeks later, they were sick again.
“At first, nobody understood why the malaria kept coming back,” Lena recalls.
Community health workers eventually began looking more closely at the family’s daily situation. They discovered that Nakong’s husband, Lukwang, was regularly sleeping outside in the bush because of insecurity in the area. He often returned home late at night after being heavily exposed to mosquitoes.
Even when the rest of the household received treatment, he had never been fully tested or treated himself. Once he finally received proper follow-up care, the repeated cycle of illness in the family began to slow down. For Lena, the case changed the way many people in the community thought about malaria prevention.
“We realised we had focused most of our attention on women and children,” he says. “But the men were also part of the transmission cycle.”
The experience also reinforced something else: malaria is rarely only about medicine. Housing conditions, insecurity, movement, poverty, and access to healthcare all shape how the disease spreads and how difficult it becomes to control.
In many rural communities, community health workers are often the first people families turn to for advice. But Lena is careful not to overstate what frontline workers can do alone. There are days when medicines arrive late. Days when health facilities are overwhelmed. Days when transport becomes impossible. Sometimes patients arrive after trying multiple home remedies or buying medicines from informal drug sellers.
Like many community health workers across Africa, Lena works at the intersection of trust and limitation. He can educate, encourage, follow up, and refer patients. But larger questions (medicine quality, surveillance systems, diagnostic capacity, resistance monitoring, supply chains, and health financing) sit far beyond the community level.
Still, frontline workers often notice changes before official systems do. They observe repeated illness in the same households. They see how poverty pushes people toward incomplete treatment or self-medication. And because they live inside the communities they serve, people speak openly to them in ways they may not speak to outsiders.
“People trust us because we are part of the community,” Lena says. “They watch how we live. They want to know whether we practice the same advice we give.”
Protect the Cure
Across Africa, concerns about antimalarial drug resistance are growing. Health experts warn that if resistance to artemisinin-based combination therapies continues to spread, many of the gains made against malaria over the last two decades could be threatened.
That is what the “Protect the Cure” campaign seeks to highlight.
Led by partners including Impact Santé Afrique (ISA), the campaign aims to raise awareness about antimalarial drug resistance and the importance of preserving the effectiveness of malaria treatment in Africa. It also calls attention to the role communities themselves play in protecting these medicines through proper diagnosis, treatment adherence, and stronger engagement with local health systems.
For Lena, these discussions are not abstract policy conversations. They connect directly to what he sees every week in villages and households. He believes stronger community awareness is essential — not only about mosquito nets and prevention, but also about how malaria medicines should be used.
That is why he continues organising school discussions, household visits, and community dialogues that encourage people to ask questions openly and learn from one another. Some communities have even started recognising households that maintain what he calls “malaria-smart homes”, families that consistently use prevention measures, seek testing early, and complete treatment properly.
“It takes time for behaviours to change,” he says. “But when communities understand why these things matter, they begin to take responsibility themselves.”
