| Nov 11, 2009
The door to my office opens and a mother carries a young child to the chair beside my desk. Before she speaks I can guess the story she is going to tell me. I can see beads of sweat on the child’s face. The mother shifts in the chair and the child’s head falls back it’s eyes staring unseeing at me.
Fever, chills, cough and vomiting. Every day in the Nakivale clinic the story repeats itself. This is the picture of malaria, Africa’s biggest killer of children under five. Without treatment the child may recover after a few weeks of fevers, or it may develop malaria in the brain and slip into unconsciousness. A million children die each year, most of them in this part of Africa. There is no vaccine. Early diagnosis and treatment is the key to preventing this child from dying.
I reach for the rapid diagnostic kit on my desk. Impregnated in the paper encased in plastic are chemicals that will interact with the malaria parasite and create a line indicating malaria. I reach for the child’s finger, prick it and harvest a tiny amount of blood for the test. A few drops of chemical completes the test. We now wait for the verdict.
The result in the middle is a strongly positive malaria test - a line beside the ‘T’. To the left is negative and the right is weakly positive.
This little test kit has transformed the treatment of malaria. No longer to we have to guess at the diagnosis. We target the medication to those who need it most.
Today one of the children I saw with malaria was vomiting repeatedly. She wasn’t going to be able to take the pills we usually treat malaria with, so I set up an intravenous and gave her quinine mixed with glucose and water. After four hours of IV therapy her fever had subsided and, more importantly, she had stopped vomiting. I sent her home with her parents with three days of medication.
Pregnant women are especially susceptible to malaria. It causes stillbirths, low birth weight and increases infant mortality. We give each pregnant mother a mosquito net to prevent being bitten my the anopheles mosquito at night. It is this mosquito that injects the plasmodium parasite in it’s saliva into the blood stream. The parasite can get to the liver (and beyond the reach of the body’s immune system) within 15 minutes of a mosquito bite.
Repeated episodes of malaria in childhood do provide an adult with some immunity. Adults still get malaria but it is not as severe as in children. Visitors to Africa who have no immunity will suffer the same fate as children if they don’t take medication to prevent it. I take doxycyline every morning. It would not be feasible to give every African child this medication daily.
Most of the children I see with malaria do not use mosquito nets. They have been distributed in Nakivale but I assume they fall apart after a few months use in the refugees little hovels. I have seen mosquito netting used to fence chickens. The parent’s may not be aware of how important it is to use a mosquito net for their children.
Malaria is one of the human species oldest diseases. Malaria parasites have been found in mosquitos preserved in amber from the Paleogene period, 30 million years ago. Will modern science find a way to bring this ancient disease under control? The Bill and Melinda Gates Foundation thinks that this is indeed possible. In collaboration with the World Health Foundation it is investing hundreds of millions of dollars in research to find a solution, or possibly many solutions.