RIP. One More Malaria Death on to Malaria’s Annual Million Fatalities Worldwide

June 2012 opened with the closing of a coffin. Under the sun-sheltering expanse of a white canvas tent, amidst a hundred men and women, hailing from over a dozen countries, we came to give our final respects to a colleague who died of malaria. The victim, very well-educated, bi-lingual, Africa-savvy and very well-liked … an American, a wonderful example of the best our nation can offer … lost consciousness at home for hours before alarmed neighbors, after a no-show, no replies to phone calls, broke down the door and discovered the disaster, too far advanced to turn around even with emergency medical intervention.

That this person’s responsibility had been with coordination and support for prevention/treatment programs for HIV/AIDS in a number of countries across Africa only added an uncomfortable irony and a wider impact to the loss, and a reminder that HIV/AIDS infection requires a lot more purposeful intimate physical contact than just dining out in the evening at a restaurant, sitting typing at the office computer, slicing vegetables in the kitchen for dinner, playing in the yard, reading a book in a hammock at the end of a day or sound asleep alone in bed. Malaria is transmitted in the most common of circumstances, by mosquitoes which lurk in homes, schools, offices, buses, bushes, trees … even the colorful bloom-filled flower pots can shelter killers.

Malaria strikes anyone, no respecter of age, sex or social status. We nearly lost three of our own to it … in three different countries. We’ve spent days at a time in hospitals, sleeping on the floor by our children’s sides to keep 24/7 vigil during the malaria seasons, in grim solidarity with crowded clinic wards of African parents staying by their children’s bedsides, watching the life-saving drip-drip of the IVs. Over the years, we’ve hauled disoriented colleagues to the hospital who were unaware their reasoning faculties were degrading as their fevers were spiking, been part of pounding on doors to find other absent colleagues in their apartments. Every single fever must be evaluated with the potential of malaria in mind … misjudged and the costs are appalling.

We were all bitterly reminded the hard way a few days ago: in malaria zones, one has to keep track of co-workers, especially of the unmarried staff, because without a spouse or family to raise the alarm or take charge, more single aid workers die, not caught in the cross-fire of actual conflict in conflict zones, but silently on their couches in the security of their rooms. In this region, five thousand miles wide, there is not a soul who doesn’t know personally someone who’s been sick or died from it or been sick with it themselves or not been treated at least once for it, preventatively or therapeutically.

The oil companies seem to get nothing but dismissive abuse from our media and administration, so it would be inconvenient to report the number of employees of oil companies stationed overseas who’ve died of malaria or how many of their spouses and children have been lost to it as a result of their work location. Maybe we will remember next time at the pump that a percentage of any offshore-originating gallon of gas extracted out of tropical malaria-endemic zones didn’t make it to our gas tanks without a collateral human cost in malaria mortalities. Our Military, our State Department, our Foreign Service and every type of foreign-based Non-Governmental Organization (NGO) and private company or corporation loses staff every year to malaria. That’s all despite medicines and preventative resources.

We can reduce the transmission, and protect ourselves to a point, but until malaria’s destroyed, it’s an omnipresent mortal danger. This month, as happened again this time with a face and a name we all knew, a person who lived quite comfortably over twenty years in Africa died of malaria … the parasite is extremely unforgiving of complacency.

The onslaught of the infection initially resembles flu … so staying home resting seems to be the sensible thing to do. But single adults die at higher rates simply because no one knows what’s happening to them, and before they comprehend they need help, they are incapacitated.

Yet for the toll which malaria takes on Westerners, noting that before the discovery of quinine, the malarial regions of Africa were once called, “The White Man’s Graveyard,” and Christian missionaries accepted missions to Africa knowing full well in advance they could only hope to live on average only about two years after their arrival, it is nothing compared to the magnitude of the devastation it wrecks on Africans every single day. Hundreds of millions of people worldwide are sickened with it every year, up to a million die from it – men, women, children, infants and growing children in the womb, killed by the parasite before they had a chance to see the light of the world, women carrying robust babies to term, then delivering stillborn, the malaria devastation of the body … and of the spirits of the grieving. Malaria leaves widowers, widows and orphans; it strikes down breadwinners and caretakers leaving many of those who depend on them destitute or stranded.  It destroys children at higher rates than adults.

Malaria invades the liver and attacks the blood cells. The parasite enters a cell, consumes it, reproduces itself and bursts out multiple parasites, looking to invade other cells. It progresses then exponentially, destroying more blood cells. The destroyed cells float uselessly, pumped around by the heart, unable to carry oxygen or nutrients. The heart stresses pumping blood which doesn’t work, organs are damaged, the victims struggle for oxygen. Chronic sufferers, in a slow-motion downward spiral can’t sleep, yet are exhausted. They can hardly fulfill their normal tasks; they work at a greatly lowered capacity, and are extremely vulnerable to opportunistic secondary infections of all kinds, including deadly tuberculosis, thus enabling the spread of that scourge and others.

Is there any greater active mortal threat to human life on this planet today? But the priorities of today’s world are peculiar. Sudanese struggling with a deadly cholera epidemic were disgusted that epidemiological research teams had been flown to Sudan at great expense to investigate possible avian flu in literally a handful of local chickens … an urgent priority apparently based on a computer model of a hypothetical avian flu pandemic which never materialized … money which could have gone to the cholera outbreak for urgently needed treatment for real, not virtual sufferers. While doctors of virology sternly inspected a few barnyard birds, humans were literally dropping like flies a couple miles away. The terror of potential avian flu was obsessive in the media … the real cholera – well … same old same old: a short, buried paragraph … maybe.  Not noteworthy. 

Any American readers recall any news reports heralding the annual opening of the onslaught of the full-bore malaria season in thirty countries and how awful it is? No?  Did we all not get grim statistics from Iraq intoned daily from the networks?  Today, in this 24 hours, while you are reading this, more people worldwide are dying from malaria than a year of war in Iraq and Afghanistan combined.  The media can make time if they want to.  We had wealthy suburbanites outside of Washington DC earnestly ask us if we were afraid of the avian flu. With the real deal, malaria, cholera, yellow fever, dysentery, meningitis, dengue fever … well avian flu … wildly mild in comparison, bordering on a joke … has a lot of serious real-world competition.

What was going on alarmed us: WHY are so many Americans today terrified of computer models while ignorant of common brute reality? Africa is not a country, it’s a huge continent plagued by malaria. America is actually in the minority of the planet which isn’t affected by malaria … thanks to the efforts of Americans.

In America, Malaria-free wasn’t a natural gift, it had to be accomplished.

With battle triumphs under America’s belt in the war against malaria, how goes the war today?  When Bill and Melinda Gates announced their Gates Foundation’s support of anti-malaria efforts, they discovered their one gift had nearly doubled the entire world’s funding for that sector. So many people at risk and affected, yet so underfunded.

President George W. Bush committed billions to fighting and treating malaria and HIV/AIDS in Africa. When Africans came to the White House to thank him, the media mentioned not the funding, not the diseases, not Bush’s unprecedented efforts to help Africans have a better quality of life, but that he was an awkward dancer.

Decades ago, Americans broke the back of malaria parasite transmission in the United States with a massive integrated public health program.  America’s astounding transformation of Panama a hundred years ago during the construction of the Panama Canal from a deadly, disease-ridden zone to a beautiful, healthy,  tropical settlement is a tour-de-force of Occam’s Razor applied up and down to cut malaria and yellow fever out of the area, a superb case study on how it’s done.*  The anopheles mosquitoes continued on … but no longer infected with the deadly malaria parasite, yet the drive was cut short in Africa before that critical tipping point had been reached so malaria came back with a vengeance.

Environmentalists must still value their hatred of DDT over the value of human life in Africa; they constantly resist the use of it to hard-hit regions, pushing measureably less effective alternatives, yet insecticides have never been or will be a magic bullet.  Their effectiveness depends completely on the effectiveness of a combination of complementary works.  DDT was and remains the best suited of all the insecticides to the habits of the anopheles mosquitoes, yet was always simply a “force-multiplier.” Alone, it was not enough. Malaria has always required a multi-pronged attack for malaria eradication, by shovel and trowel, hammers, saws and nails basics: draining standing water, leveling ground, installation of window screens, bed nets, removal of trash, debris and other objects, denying the mosquitos stagnant water in which to lay their eggs, educating the public as to the nature and quirks of the insect enabler of their microscopic enemy, to be used against it.   The malaria parasite will die out without the vehicle of a particular species of mosquito to move it from infected person to uninfected person.

Today’s generation –  healthy and robust, beneficiaries of earlier, concerted efforts to wipe out malaria from America evidently have little empathy for doing the same efforts for Africans. Despite proof it can be done, a lazy argument that ‘we just have to live with it’ is making the rounds. Our forefathers didn’t accept that, why do the beneficiaries of their hard work shrug off their duty to the next generation or to those in this generation who are still under siege from this ruinous parasite? Our means are more than ever before in history, so why the unnecessary surrender?

The second the world believed it might be vulnerable to dying by avian flu, the media gushed and money surged to the cause … evidently the same people who panicked about avian flu cutting their own lives short don’t think malaria can reach them, so they aren’t interested. No skin in the malaria game. The ‘we have to live with it’ is really, ‘they have to live with it. Yet, if malaria re-appeared in Philadelphia or in Washington, DC where it once flourished, how long would it take for the massive public panic and a frantic outcry to DO something?

Now, at the cusp of the arrival of rains to break the long dry season, knowing the dusty ground will be inundated soon with puddles the size of ponds, ponds the size of lakes, and water, water standing everywhere in open drains, those with means have much to consider to prepare … screens, nets, repellents. Africans with little spare money prepare themselves to be stoic. The rains mean the agricultural season can begin, which means food and life, but the swarms of mosquitoes out of all that stagnant water bring death and debilitation.

It is no mystery how to stop transmission of the malaria parasite. The world, led by Americans in historical malaria eradication, has many successful historical models which wiped it out in entire regions, even before any newer innovations in drugs and technology. What is required today is to restore the will and the conscience to use what we have to decisively defeat a plague which destroys life and handicaps the productivity of a huge part of modern humanity.


* Superb account of the malaria and yellow fever eradication program in Panama is found in The Path Between the Seas: The Creation of the Panama Canal 1870-1914 by David McCullough


Update from West Africa:  Many thanks and welcome to Glenn Reynolds and Instapundit readers!