The rainy season is dwindling, which means mosquitos are on the wane, yet malaria continues to circle all around us. During my last trip Nathan, Gama’s three year old son, contracted malaria; seeing his tiny curly headed body shivering under blankets on a 95 degree day testified to the potency of the disease. He recovered fully while I was away, but in the interim Gama came down with it, as well as Becca, a missionary from Ohio, and Angie, a long time missionary with a nursing newborn.
This sequence of events prompts me to investigate how malaria epidemics flow. Since a person can only contract malaria when bitten by a mosquito carrying the virus, that implies malaria will peak and ebb in parallel to the population of carrier mosquitos. However, one way a mosquito becomes a carrier is by biting a human with the disease, which makes a malaria epidemic a dance between humans and mosquitos; the more they feed on us the more frenzied they transmit the disease. Once Nathan was infected, any mosquito that bit him could carry the boy’s diseased blood to others, including his father, who contracted malaria a few weeks after his son (the incubation period is fifteen days).
Malaria is not an equal opportunity disease, it occurs disproportionately around the world in tropical climates where poverty flourishes. Over 650,000 people die from malaria every year, 89% of them in sub-Saharan Africa, where it kills more people than any infectious disease except HIV/AIDS. Haiti, in keeping with its pattern of being more aligned with Africa than the rest of the Caribbean, is the only country in the Western hemisphere where malaria is prevalent throughout (CDC Interactive Malaria Map Application).
The shame of malaria wreaking havoc on so many poor people is that it can be virtually eradicated through public health measures and, if contracted, is easy to treat. However, a person with malaria must be treated in a short period of time or the flu-like symptoms, fevers, and stomach pains can escalate quickly. Left untreated, malaria victims can die within weeks of contracting the disease.
Malaria has roots over 4,000 years old. In the second century BCE the Chinese used the Qinghao plant to treat the disease, though its active ingredient, artemisinin, was not isolated until 1971. Another effective natural remedy, Quinine, was discovered in Peru in the early 17th century. Today, most Americans use, chloroquine, which was developed around World War II, as the malaria treatment of choice.
Travelers to malaria prone regions, like me, have to decide whether to treat themselves prophylactically, which the CDC recommends for travelers to Haiti, or treat the disease only after contracted. I started in the first camp, taking chloroquine once a week for two weeks before and four weeks after every visit. The math is not hard to figure – I was taking chloroquine continuously. I did not like ingesting such a potent drug on a regular basis, but considered it preferable to contracting malaria until three people here on the chloroquine regimen contracted it anyway. People taking the medicine in advance get a milder version of malaria, but having a milder case can make malaria more difficult to diagnose. One volunteer was sick almost a week before they confirmed the disease.
Two months ago I changed my strategy. No prophylactic chloroquine; instead I carry a full regimen of the drug in case I contract malaria. Though mosquitos have never swarmed to my bony body, I take precautions to reduce my exposure to bites. They love the ankles, so I wear long pants and full high socks, as well as collared shirts and a shaded hat. In the past two months I have taken no medicine and have had virtually no bites; a good track record but as they say in the brokerage business, past success is no indication of future performance. I could get malaria any day and carry my pills between Haiti and the United States in case I need them.
I am happy to report that Gama is fully recovered from his bout of malaria. Unfortunately, Nathan has contracted the disease a second time, a few weeks after his father had it. Nathan and his mother flew home to the United States and will stay remain there for the rest of the summer. Nathan’s chances of contracting malaria in Massachusetts are nearly impossible.