Wednesday, December 8, 2010
The Malaria Handbook
Antonio Langa is the informaticist at the Manhica Institute, left, he is examining a blood slide, positive with Malaria, with journalist Jonathan Clayton, on assignment with the photographer from the Times newspaper in London.
Dr. Montse Reno, at her office in Manhica, Mozambique. The Malaria Vaccine Initiative in Manhica, Mozambique is organized by the University of Barcelona and supported by the Gates Foundation.
Mosquito Nets protect Karoline Ntchanga, in Kasongo, DRC, who has been in the local hospital for 2 weeks with her son who is suffering from Malaria.
Malaria is not the worst thing ever, if you have the right medication. Many in Africa do not have good access to anti-malarial medication, and this is the cause of eight hundred thousand deaths per year.
One of the most primal and powerful weapons in the battle for this disease is our own immunity. Many researchers have shown that people who are exposed to the malaria protozoa from a young age develop some sort of resistance to it. In Africa, the disease has been among the population for millions of years, so many people with African ancestry have some sort of immunity or resistance. What might kill a Swedish person may only make a healthy African sick with something akin to the common cold, -unless their immune system is compromised by hunger or HIV.
Malaria mutates quickly according to the latest news from the World Health Organization (WHO), and it seems to get deadlier and more able to cause havoc in the systems of those who were showing resistance. So the disease mutates and creates new strains, resistant to it's victims immune systems as well as the pantheon of drugs thrown at it.
The drugs themselves fall loosely into two categories, ones to stop you from getting it, and ones that cure it. Often there is crossover, where the same preventative drugs are given in shorter, higher doses to cure the illness. For anyone who visits Africa it is prudent to take some of these drugs in combination -according to a knowledgeable doctors advice. But for those of us who live here for years, it is not healthy to take any of the drugs for more than a year or two.
Some of the drugs can be dangerous. People have had heart problems, liver failure, and in some cases permanent dementia. This is probably enough to make most people change their Serengeti holiday plans to the sunny beaches of Florida, and indeed the presence of Malaria partly accounts for the tiny tourism numbers in Africa.
But these drugs are far less dangerous than the disease. Malaria can lead to liver failure, kidney failure, ruptured spleen, stroke and death. For visitors to Africa who are here for less than a year, there are excellent preventative drugs with minimal side effects.
For everyone in a "red zone", Malaria is a reality that we cannot avoid. Sometimes as journalists we choose stories to cover about Malaria as much for our own education as that of our readers. This puts us into contact with some of the most accomplished Malaria researchers in the world, like the Malaria Vaccine Initiative in Manhica, Mozambique who are close to developing a new trial vaccine that might be one more tool to fight this deadly disease.
So now you may have guessed it. I figure I got this case of Malaria about ten days ago in Mozambique. Because the camp I was staying in is far from villages and there is no history of Malaria there, I probably got it somewhere else.
There was one evening where I waited in the post-rain dreariness of mud in a small town for a grilled chicken and chips. It took about three hours, and since I had arrived there from the bush on my way back to camp around 4 pm, I was still in my shorts.
So there I sat, hang-dog hungry for hours while being food for the whining multitudes buzzing hungrily around me. The mosquitoes were thick under the table, and the place had all the Malaria sign posts: wet, populated, poor health care, and after dark.
Well I had my dinner, the mosquitoes had theirs, and now I am doing battle with the legions of parasites they sent to feast on me, breaking open my red blood cells to use for their own replication.
I am laying on my sofa in Johannesburg, watching a long epic from the Pacific in World War Two with the sound turned very low to stop my head from pounding. I can't help identifying those fresh faced young marines with my own white blood cells, valiantly defending island-like organs, getting drug-filled reinforcements from pill-like ships.
I think of visiting the Malaria Vaccine Initiative, where I asked Spanish Researcher Dr. Rontse Reno whether she had enjoyed the occasional brain busting bout of the disease. She laughed, "We all get it, all the time, this is a Malarial hotspot, so we take our cure quickly, we take a few days off... if you have the drugs, this is not a serious thing".
But there was that classic 100 yard stare in that pregnant pause and the unsmiling look behind the grin spoke volumes. It is the same one seen in soldiers and combat journalists, it is the "I have been to war, and I don't really want to talk about it" look. Anyone who has been there knows it's not cool to get shot at and its even less cool to have Malaria.
So here are a few life-prolonging tidbits to take on holiday:
Most Mosquitos that carry the disease only come out after sunset, so cover up with trousers and long sleeves.
If you are worried about the effects of DEET, that evil smelling stuff in mosquito spray, put it on your long clothes (especially your back), and the backs of your hands and neck.
No Malaria mosquito was born with it, they just get it from people they have dined off of. These Malarial mozzies aren't long-distance fliers, they have to have bitten someone else with Malaria, and then flown to you. So if you can help it, try to sleep and relax in the evenings at least 300 meters from the nearest possible Malaria victim. If they snore, that should be easy.
Travel in Africa with a fold-up mosquito net, its easy to put up, small to carry and oh-so-romantic.
If caught in the first few days, Malaria is not so serious. When it is allowed some time to establish itself it gets ugly. Watch these signs and assume its Malaria first.
1. headache behind the temples and eyes
2. sweaty and then chilled
3. aching joints
Many Africans and long-term expats will travel with the cure, and take it as soon as they think MIGHT have it (including yours truly). The up-side is, if you think you have it, you probably do, and the quicker you treat it the better. The down side is you may actually have the flu, but at least that won't kill you.
Only a few Malaria strains re-occur, and even then there are drugs to cure pretty much all of them completely.
Most doctors in the west don't understand Malaria, so do your own research on drugs and side effects, especially on these sites:
Roll Back Malaria (WHO)
The Center For Disease Control (CDC) Traveler page.
A negative Malaria test DOES NOT mean you don't have Malaria. Its a sneaky disease and can hide easily on a blood side.
If you are worried, speak to a doctor in the country you are visiting to get the best information.