Wednesday, June 27, 2007


The current cover story in National Geographic Magazine is "Malaria," by Michael Finkel, who reports on the disease's disastrous effects in Zambia.
It's difficult to comprehend how thoroughly Zambia has been devastated by malaria. In some provinces, at any given moment, more than a third of all children under age five are sick with the disease.

Worse than the sheer numbers is the type of malaria found in Zambia. Four species of malaria parasites routinely infect humans; the most virulent, by far, is Plasmodium falciparum. About half of all malaria cases worldwide are caused by falciparum, and 95 percent of the deaths. It's the only form of malaria that can attack the brain. And it can do so with extreme speed—few infectious agents can overwhelm the body as swiftly as falciparum. An African youth can be happily playing soccer in the morning and dead of falciparum malaria that night.

Falciparum is a major reason nearly 20 percent of all Zambian babies do not live to see their fifth birthday. Older children and adults, too, catch the disease—pregnant women are especially prone—but most have developed just enough immunity to fight the parasites to a stalemate, though untreated malaria can persist for years, the fevers fading in and out. There are times when it seems that everyone in Zambia is debilitated to some degree by malaria; many have had it a dozen or more times. No surprise that the nation remains one of the poorest in the world.
The article focuses on the North Western Province of Zambia, where I grew up, and, in particular, Kalene Hospital, located about six miles from the boarding school I attended.
In the North-Western Province, competent medical help can be difficult to find. For families living in the remote northern part of the province, across more than a thousand square miles of wild terrain, there is only one place that can ensure a reasonable chance of survival when severe malaria strikes a child: Kalene Mission Hospital. This modest health center, in a decaying brick building capped with a rusty tin roof, represents the front line in the conflict between malaria and man. Scientists at the world's high-tech labs ponder the secrets of the parasite; aid agencies solicit donations; pharmaceutical companies organize drug trials. But it is Kalene hospital—which functions with precisely one microscope, two registered nurses, occasional electricity from a diesel generator, and sometimes a doctor, sometimes not (though always with a good stock of antimalarial medicines)—that copes with malaria's victims.

Every year for a century, since Christian missionaries founded the hospital in 1906, the coming of the rainy season has marked the start of a desperate pilgrimage. Clouds gather; downpours erupt; mosquitoes hatch; malaria surges. There's no time to lose. Parents bundle up their sick children and make their way to Kalene hospital.
Now that malaria is resistant to synthetic drugs, a drug based on a herbal remedy is being brought back.
The country has dedicated itself to dispensing the newest malaria cure, which also happens to be based on one of the oldest—an herbal medicine derived from a weed related to sagebrush, sweet wormwood, called artemisia. This treatment was first described in a Chinese medical text written in the fourth century A.D. but seems to have been overlooked by the rest of the world until now. The new version, artemisinin, is as powerful as quinine with few of the side effects. It's the last remaining surefire malaria cure. Other drugs can still play a role in treatment, but the parasites have developed resistance to all of them, including quinine itself. To help reduce the odds that a mutation will also disarm artemisinin, derivatives of the drug are mixed with other compounds in an antimalarial barrage known as artemisinin-based combination therapy, or ACT.
DDT is also being used in controlled applications and mosquito nets are being distributed.

The article describes the sadness of the death of so many children from malaria, as well as the lasting effects on the children who make it through:
This legacy of malaria has sobering repercussions for people and nations. "It's possible [...] that due to malaria, almost every child in Africa is in some way neurologically scarred."