“They arrive by the truckload in poor, waterside communities,” the New York Times reporter wrote. They’re bed nets to prevent the contraction of malaria—and they are considered a great gift.  But once the trucks leave, the nets may be put to a more pressing need: sewn together and used as giant sieves for fishing. Pulled through the water from shore, they can feed families that might otherwise starve.

As writer Jeffrey Gettleman noted, in the poorest parts of the world, “There is no fear but the fear of hunger.”

Thus begins the report from Zambia and other African countries that has badly rattled one of the largest, most efficient, and most reputable of humanitarian aid projects.

Gettleman’s article in the Times brought into public view what aid workers have known for years: Many of the hundreds of millions of bed nets distributed in the world’s malarial regions are not being used as intended. This is neither new nor particularly surprising.

The kicker, though, is that when altered and used for fishing, the nets can nearly wipe out life in the rivers and lakes on which rural residents depend for protein.  Few organisms can escape their finely woven mesh. And over time insecticides with which the nets are treated might poison local waterways. This is especially dangerous in areas where fishing grounds are also used as sources of drinking water. A large percentage of nets are treated with permethrin, a suspected carcinogen.

New York Times photo by Uriel Sinai

New York Times photo by Uriel Sinai

There are serious questions about the potential side effects of repeatedly eating fish caught or dried in bed nets. And their use for fishing is believed to have contributed to a dramatic decrease in fish stocks in Zambia.

I’ve always loved the notion that it’s possible to donate a little money to implement a simple, well-conceived solution to poverty and suffering. The bed net project has been a shining example of that model.

Sure, questions arose in late 2013, when scientists discovered that mosquitoes were building up immunity to insecticides used in the nets. But programs like the Against Malaria Foundation assured us that formulas for new insecticides would be found. (Charity officials had no ideas for addressing a second glitch: Mosquitoes are beginning to change their patterns of behavior, biting in the mornings after people have risen and left their net-protected beds.)

Now, though, the wide use of the nets for fishing and fish drying presents a problem that has no solution, only a range of unsatisfactory answers.

Against Malaria’s web site reports that the disease kills more than a million people each year. Seventy percent are children under the age of five. Malaria is also the number one killer of pregnant women.

But poor nutrition kills 3.1 million children each year, according to the United Nation’s World Food Program. Starvation stunts growth, including brain development. Of the two scourges, hunger is a far more dangerous and demanding adversary.

How frequently are bed nets used for fishing? In Gettleman’s article, a spokesman for the Global Fund to Fight Aids, Malaria, and Tuberculosis claimed that the number of nets being misused was “infinitesimal, less than 1 percent.” Maybe so—but one percent would total 4.5 million nets.

In a study published in 2008 in Malaria Journal, researchers found 283 bed nets being used for fishing and drying fish in seven villages along the Kenyan shore of Lake Victoria. They considered this number to be significant. In November the Journal published a subsequent study, based on surveys of households in four countries, that concluded that less than few nets (only 255) were used for purposes other than protection during sleep. The repurposed nets tended to be old and torn.

Would people have told surveyors the truth about the way they were using nets they had received for free or at greatly discounted prices? I’m not the only person to ask that question. The Times article cited a third study along a shoreline of Lake Tanganyika that found that 87.5 percent of the households were using nets to fish.

What does all this mean? With hundreds of millions of nets having been distributed, I’m not sure anyone knows.

In an interview, Gettleman said he published his article with some qualms, knowing it would be controversial. After its appearance aid organizations issued emphatic denials that their nets are being used for fishing or fish drying. Nets for Life, an impressive program run by the Episcopal Church, reports that it distributes nets only in villages where local volunteers are on hand to install them in houses.

“We recognize the potential environmental, health, and economic impacts of misuse of insecticide-treated nets for fishing, and believe that our methodology of education, direct installation and follow-up—especially as integrated with community-led development programs to address the root causes of poverty and hunger—greatly reduces the likelihood of misuse,” Nets for Life officials wrote.

I want to believe this. And I know organizations that establish a permanent presence in the communities where they work are more likely by far to deliver effective, long-lasting help.

Still, I’m skeptical.  People in many developing countries live according to communal practices that Westerners don’t entirely comprehend. Individual authority is not necessarily recognized. Would a man or woman in such a society try to prevent a neighbor from using a bed net to fish if the neighbor’s children were malnourished? I don’t know that they would. For that matter, I don’t know that I would.

The question that most caught my attention in the Times article was voiced by an exasperated American doctor on Lake Tanganyika. Can’t alternative malaria control measures be found—treated wall coverings, perhaps, or window screens? But no one even seems to be exploring that avenue. And we should be.

I am not arguing here for the complete abandonment of the bed net initiatives. But the charities that distribute the nets need to carefully reexamine their approach.

Will they? Or will they continue to push the simple, efficient “solution” that for decades has brought them such acclaim?

It’s difficult for bureaucracies—and many aid programs are just that—to quickly change tack. In the next year or so we’ll see which ones are flexible enough to respond to this challenge.

As for the rest of us, we need to remember the central lesson here.  If an aid project requires nothing of us besides a small donation, if its claims of success seem too simple and good and uncomplicated to be strictly true, they’re very likely not.

Here's a link to Gettleman's article in the Times. It's thorough and detailed and definitely worth a read.

AuthorJan DeBlieu