malaria

The news came up on my Facebook feed.  A friend was sick.  She was suffering seizures.  She was comatose. She was dead.  She was not a woman I knew particularly well, having been only 2 months in her presence.  She was kind and generous to a fault.  She was single minded and stubborn.  She had strong faith and was eager to share it.  She also had had malaria several times.  And this last time proved too much.  She was killed by cerebral malaria.

Sometimes, if you are unlucky, the parasite can enter the cerebral microcirculation and essentially cause clogs.  These clogs - caused by sticky parasites that clump and deform red blood cells - make it difficult for oxygen to get where it needs to be in the brain.  The mechanisms are not particularly well understood, but all these little awful parasites in the cerebral circulation lead to seizures, to coma and eventually, to death.  It is not inevitable that death occur, but the mortality rate is 20% at best.  A small hospital in Chad with no oxygen and no telemetry is not the best that medicine has to offer.  Though, it is the best that Chad probably has to offer.

I related my own adventure with malaria here some time ago.  I reread the post today and am annoyed at myself.  My blase attitude belies just how serious malaria can be.  Malaria is not, for most people, an amusing adventure.  I certainly wasn't amused at the time.  I was exhausted and miserable and vomiting everywhere. I had a very mild case.  When you've spent even a short amount of time in malaria endemic areas you know people who have chronic malaria, who have lost children to malaria, who have died of malaria.  As an ex-patriate, I have know many people over the years who have opted out of taking the malaria prophylaxis that we are all encouraged to take.  Some have very good reasons, some have terrible reasons.  I was on malaria prophylaxis when I got malaria (perhaps one of the reasons that I wasn't too terribly sick).  I was also on malaria prophylaxis when I didn't get malaria but did suffer their side effects: night terrors and hallucinations so real and awful I woke a whole village with my screams.

There are no easy answers when it comes to malaria.  I know a lot of people who argue that the banning of DDT is terribly unfair to places where malaria still ravages populations.  After all, we would probably still have malaria in the US (we did until at least 1951) if not for DDT. It is hard to argue against pesticides when you see people dying so regularly from what is essentially a preventable disease.

It feels like a betrayal of so many friends, but somehow when an ex-patriate living far from home dies it is more shocking that when a host-country national dies.  I am appalled that I feel that way, and I am fairly certain that it is this sense that somehow it is different when one of "us" is sick versus one of "them" that allows the "them" to keep getting sick.  We are more comfortable with the deaths of "them" that we are with our own.  Perhaps it is just human nature, but that seems a poor excuse.

The woman who died: her life was not any more or less valuable than any of the others who've died of malaria at Bere Hospital this year.  She was not on malaria prophylaxis, she did what she thought was best when she knew she had malaria to treat it with medicines she thought would work, that had worked in the past.  She was not so different from the pregnant women I saw whose babies were dead in the womb, the young men ravaged with fever unable to care for their families, the children skinny and insensible with fever.

I feel awful for the men and women that cared for her at the end of her life.  While being a health care provider is a great privilege, it can be incredibly difficult to provide care to friends and family.  To have such a terrible outcome, to have to call a woman's family thousands of miles away and explain the death of their daughter... it is too much.  I wish I could be there, to tell them it is okay.  That I know that they did the best they could.  They did everything they could.

Of course, it isn't okay.  And that is what gets me.  Death from preventable disease makes me incredibly angry.  It doesn't matter if it is malaria or diarrhea or gun violence.  Everyday we make the choice to not stop malaria, to not stop malnutrition, to not stop extreme poverty.  We allow it to continue and we are complicit in these deaths.