Iowa Alumni Magazine | February 2007 | Features

An Unnecessary Tragedy

By Carol Harker

The sun sets and millions of predators begin their hunt. Programmed to reproduce, these tiny animals—each about as big as an eyelash—need blood to feed their developing eggs. The blood they prefer is human.

It's easy to find. Any child playing outside, or even sleeping in an unprotected place, is easy prey. Adults, too, are convenient victims. Somehow, the insects can tell the difference between a cow and a man, between a goat and a little girl, and, given the choice, they'll dine on Homo sapiens first.

Although their attack isn't painful and the quantity of blood they require is small, many of these mosquitoes leave miniscule parasites within the people on whom they feed. And that's what causes illness and death for their victims.

Malaria is a scourge that has hounded man since the beginning of time. It was so bad in Rome in the 14th century that church policy prohibited pontiffs from the North from living at the Vatican; without the immunity that comes from repeated exposure to malaria-infected mosquitoes, clerics from cooler and drier climates were particularly vulnerable to "Roman fever."

Identified as the most deadly disease mankind has ever suffered and believed to have killed more people than all wars and other illnesses combined, malaria has not discriminated. Poets and presidents, emperors, commoners, painters; conquerors and kings, physicians, writers, and explorers—all have been sickened and many have died from malaria.

Until relatively recently, Americans knew well the torment of malaria. Presidents George Washington, James Monroe, Andrew Jackson, Abraham Lincoln, Ulysses S. Grant, James Garfield, Theodore Roosevelt, and John F. Kennedy endured bouts of illness from the disease. It was so prevalent in Washington, DC, in the 1880s that one scheme to control infection called for encircling the capital city in a wire net as tall as the Washington Monument.

Success in containing malaria began to be realized in much of the world in the 20th century. When more than 80 percent of people working to build the Panama Canal needed hospitalization to treat malaria in 1906, something had to be done or the project would surely fail. Project overseers responded with multifaceted plans to control infection.

Workers drained standing water, cut back brush and other foliage, and installed screens on dwellings. At a time without commercial insecticides, sanitation engineers concocted a larvacide of carbolic acid, resin, and caustic soda and spread it liberally to discourage mosquitoes. In addition, everyone working on the canal was given free access to quinine. By 1912, only 11 percent of canal workers required hospitalization for malaria.

By mid-century, public health efforts in the U.S. eradicated malaria. In 1975, the World Health Organization (WHO) declared that Europe was also free of the disease. The West had conquered another illness, and most Westerners quickly lost their cultural memory of living and dying with malaria. By 2006, Americans questioned for a Gallup poll went so far as to identify malaria as the least serious disease in the world.

This village in northern Ghana is probably much like Ponyamayiri, where Suonguno lived.

Twilight falls over Ghana, alerting the mosquitoes that it's time to eat. Sniffing out their human prey, the insects alight on bare skin to sip a warm drink.

Little Suonguno was just over a year old when a malaria-infected mosquito tasted her blood in the rural village of Ponyamayiri, Ghana. Within two weeks, she was fussy and irritable, feeling sick. She vomited bile; her skin took on a yellow cast. She cried inconsolably. Convulsions wracked her small body. Too uncomfortable to eat, she began to dehydrate.

Suonguno's parents were frantic. They cradled and rocked her, singing to her and humming the hope that she would get better. She didn't. Her father carried her to a clinic in a neighboring district, where he learned she was dangerously anemic and in need of a blood transfusion.

Weakened by the parasites taking over her body, Suonguno's cries quieted. Her grandmother held her that night. In the morning, the little girl would be transported to the hospital in Wa, more than an hour away by car. As it happened, Suonguno never made the journey. She took her last breath in her grandmother's arms.

Every day of every year, some 3,000 children die from malaria in sub-Saharan Africa. That's one child every 30 seconds. Professor Wen Kilama of the African Malaria Vaccine Testing Network in Tanzania says that "malaria is equivalent to crashing seven jumbo jets filled with children every day."

Not all of the children die as quickly as Suonguno. She was infected at the worst possible time, after losing the immunity to malaria that her mother gave her during gestation and before building up much of her own. Almost everyone in sub-Saharan Africa is bitten by infected mosquitoes many times, helping them build up protection that probably won't keep them malaria-free, but might help them live through the disease. The problem is that, even if they live, many victims of malaria suffer lasting consequences, including anemia, seizures, spasticity, blindness, brain damage, speech impediments, and difficulty learning.

Unbelievable as it may seem, the death toll from malaria has climbed in recent decades. After WHO officials realized that they couldn't eradicate the disease worldwide, they ended their global program in 1972 and malaria made a rousing comeback in the tropics. Drug and insecticide resistance, poverty, war, politics, the logistics of delivering help to places without adequate roads, and public attitudes in both the West and in Africa have contributed to the resurgence of a disease that we've long known how to prevent and to treat.

Doctors test an African child's blood for malaria. In sub-Saharan Africa, this preventable disease claims 3,000 children's lives each day.

Today, about 40 percent of the world's population is at risk from contracting malaria—up from 10 percent in the early 1960s. Why the big increase? Malaria vectors—the mosquitoes that carry the parasite—have been remarkably adept at developing resistance to pesticides, and malaria parasites themselves have developed increased resistance to a growing number of drugs used to treat the disease.

Somewhere between 300 and 500 million people will be infected with a malaria parasite this year; in Africa, more than one million people will die, 90 percent of them children under the age of five.

Speaking at the White House Summit on Malaria in December 2006, Nigeria's minister of health shared his country's statistics. In Nigeria, a nation of 150 million people, malaria accounts for 60 percent of patient visits to health facilities, 30 percent of childhood deaths, 25 percent of infant mortality, and 11 percent of maternal deaths.

Since they created the Gates Foundation in 1998, Microsoft founder Bill Gates and his wife, Melinda French Gates, have earmarked hundreds of millions of dollars to develop children's vaccines, including vaccines to prevent malaria.

It might be some years before a vaccine is ready, but new interest in beating an ancient disease has prompted governments and business, private foundations and worldwide organizations, churches and individuals to coordinate efforts to minimize the damage that malaria causes. Thousands of people from the WHO, UNICEF, the Red Cross, Doctors Without Borders, and many other groups have taken up the cause. As the director-general of WHO said recently, "If a soft drink can get to the far corners of the world, why can't we get our drugs and our bed nets there, too?"

Over the past five years, the fight against malaria has made headlines and attracted interest in some unexpected places. Sports Illustrated writer Rick Reilly wrote an 815-word article about the need for bed nets in Africa and raised $1.2 million in six months, enough to purchase, deliver, and install 150,000 insecticide-treated bed nets in Nigeria. Since the WHO estimates that fewer than five percent of Africa's children sleep under such nets, ample opportunity remains for others to contribute to the cause.

Meanwhile, the big organizations are getting creative in delivering integrated community-based health care in Africa. Parents who take their children to clinics for measles vaccinations can also pick up insecticide-treated bed nets, as well as instruction about how to use them.

Melinda Gates tells the story of her visit to a Mozambique hospital, where she saw many sick children. She remembers one child particularly, a young girl teetering on the precipice of death. Fortunately, doctors at that hospital had the drugs necessary to treat the girl. Once the medicine cleared the malaria parasite from her body, her health was restored.

"We need to repeat that miracle millions of times," Gates says, "until it's not a miracle any more. It must become routine."