The PanAfric hotel in Nairobi was fairly nice. The Sirikwa hotel in Eldoret was nice compared to other hotels in Eldoret. The Sirikwa came with mosquito netting in the rooms should you want to use it. At the conference center where I taught I saw mosquitos in the evening. Upon seeing my first one on me I reached into my backpack and coated my arms and neck with 40% DEET. Had one bitten me? Could I contract malaria? If so, I wouldn't know for a week. "Malaria symptoms will occur at least 7 to 9 days after being bitten by an infected mosquito. Fever in the first week of travel in a malaria-risk area is unlikely to be malaria; however, you should see a doctor right away if you develop a fever during your trip." (CDC, here)
I did not get malaria. But I'm reading a book review (in the Wall Street Journal, by W.F. Bynum) of Sonia Shah's The Fever: How Malaria Has Ruled Humankind for 500,000 Years, and Bill Shore's The Imaginations of Unreasonable Men: Inspiration, Vision, and Purpose in the Quest to End Malaria. What I am learning is:
- "It is no coincidence that the most intensely malarious locations in the world today—sub-Saharan Africa, Southeast Asia, parts of South America—are also some of the poorest. This connection between poverty and malaria is undeniable, but their causal chain is problematic. Does malaria cause poverty through premature death, chronic disability and low productivity? Or does poverty itself cause the social chaos and unhealthy conditions that permit malaria to take a stranglehold on a town, region, country and even a continent? This seemingly straightforward question has been fiercely debated for a century and more."
- How one comes down on this debate results in how malaria is treated; viz., either "vertically" or "horizontally." The vertical treatment of malaria comes from the view that malarial areas create poverty. If that's so, then wipe out malaria with, e.g., DDT. The horizontal approach assumes poverty leads to malaria. "If prosperity brings health along with it, Western aid for developing countries ought to be devoted to helping provide modern infrastructure." Shah argue that this approach has not, for the most part, been effective.
Malaria is "complex." "Four different species of parasites can cause it, and each evokes a different response in its human host. More than two-dozen species of Anopheles mosquitoes can transmit the parasite, and each species has its own breeding patterns and favored habitat... The treatment that works best in one location may not work elsewhere—and "elsewhere" may be only a few miles away."
- In India, spraying with DDT reduced incidences of malaria. But "the mosquitoes gradually grew resistant to DDT, while the parasites themselves became resistant to anti-malarial drugs such as chloroquine and atebrin." Malaria returned with a vengeance.
- Shah feels that, now, neither vertical nor horizontal approaches are succeeding. Re. the latter, most mlaria-infested countries lack the medical infrastructure needed for effective treatment.
- Shore's book is about "naive vertical" hope that, with the assistance of well-meaning groups like the Bill Gates Foundation, western science will develop a malaria vaccine. "What comes through very clearly [in Shore's book] is that the Gates money has transformed American malaria research. "The Gates Foundation very much acts like the general contractor responsible for eradicating malaria," Mr. Shore writes, "using a wide variety of subcontractors who specialize in vaccines, drugs, diagnostic techniques, and public health systems."" Can this work?
- "Most malariologists agree that malaria cannot be eliminated without a vaccine. But that does not mean that a vaccine will necessarily eliminate malaria. The depressing fact is that both mosquito and parasite are highly adaptable, and malaria has been central to human life for (to borrow from Ms. Shah's subtitle) 500,000 years. Our battles with it have been written into the human genome: Sickle cell anaemia and other similar disorders, for instance, are genetic evidence of how humans and malaria have evolved together. Given this history, it is optimistic to think that the disease can be easily stamped out, especially considering that whatever magic solution might be discovered will still need to be delivered via a social infrastructure that doesn't exist in much of the world."
- Bynum, who is professor emeritus of the history of medicine at University College London, concludes: "In most of the world today, malaria is a disease of poverty, and any doctor knows that the best way to get rid of a disease is to attack its cause."