Entries tagged with “malaria”.


There is a great post up at Good on “Pretending to be Poor” experiments, where participants try to live on tiny sums of money (i.e. $1.50/day) to better understand the plight of the global poor.  Cord Jefferson refers to this sort of thing as “playing poor”, at least in part because participants don’t really live on $1.50 a day . . . after all, they are probably not abandoning their secure homes, and probably not working the sort of dangerous, difficult job that pays such a tiny amount.  Consuming $1.50/day is one thing.  Living on it is entirely another.  (h/t to Michael Kirkpatrick at Independent Global Citizen for pointing out the post).

This, for me, brings up another issue – the “authenticity” of the experiences many of us have had while doing fieldwork (or working in field programs), an issue that has been amplified by what seems to be the recent discovery of fieldwork by the RCT trials for development crowd (I still can’t get over the idea that they think living among the poor is a revolutionary idea).  The whole point of participant observation is to better understand what people do and why they do it by experiencing, to some extent, their context – I find it inordinately difficult to understand how people even begin to meaningfully parse social data without this sort of grounding.  In a concrete way, having malaria while in a village does help one come to grips with the challenges this might pose to making a living via agriculture in a rather visceral way.  So too, living in a village during a drought that decimated a portion of the harvest, by putting me in a position where I had to go a couple of (intermittent) days without food, and with inadequate food for quite a few more, helped me to come to grips with both the capacity and the limitations of the livelihoods strategies in the villages I write about in Delivering Development, and at least a limited understanding of the feelings of frustration and inadequacy that can arise when things go wrong in rural Africa, even as livelihoods strategies work to prevent the worst outcomes.

But the key part of that last sentence was “at least a limited understanding.”  Being there is not the same thing as sharing the experience of poverty, development, or disaster.  When I had malaria, I knew what clinics to go to, and I knew that I could afford the best care available in Cape Coast (and that care was very good) – I was not a happy guy on the morning I woke up with my first case, but I also knew where to go, and that the doctor there would treat me comprehensively and I would be fine.  So too with the drought – the villages I was living in were, at most, about 5 miles (8km) from a service station with a food mart attached.  Even as I went without food for a day, and went a bit hungry for many more, I knew in the back of my mind that if things turned dire, I could walk that distance and purchase all of the food I needed.  In other words, I was not really experiencing life in these villages because I couldn’t, unless I was willing to throw away my credit card, empty my bank account, and renounce all of my upper-class and government colleagues and friends.  Only then would I have been thrown back on only what I could earn in a day in the villages and the (mostly appalling) care available in the rural clinic north of Eguafo.  I was always critically aware of this fact, both in the moment and when writing and speaking about it since.  Without that critical awareness, and a willingness to downplay our own (or other’s) desire to frame our work as a heroic narrative, there is a real risk in creating our own versions of “playing poor” as we conduct fieldwork.

The BBC reports on a recent article in the Lancet suggesting that funding levels for malaria control and eradication are much too low to be effective in 77% of malaria-endemic countries.  Awful.  I’ve said it before, and I will say it again: if we had anopheles gambiae mosquitos (the most effective malaria transmitters, mostly found in Africa) and plasmodium falciparum malaria (the nastiest version, again mostly found in Africa) in America or Europe, this disease would be long gone.  But when Africans are the principal population of concern, the disease persists . . .

Just a side note: climate change and global travel patterns may yet make us sorry for our avoidance of this issue.  It is easy for someone to contract malaria in Africa and bring it back to the US – lord knows I have done that myself.  This is not a public health issue right now, but if a few anopheles gambiae manage to get aboard a commercial flight and get into an environment that is conducive to their reproduction (i.e. the Southeastern US during the late spring or summer), we could yet have really nasty malaria show up in America.  I wonder how fast funding would increase for malaria control and eradication then?

Ah, malaria – I’m all too acquainted with this particular issue, having had it several times in the course of my fieldwork.  The first time is pretty miserable . . . but by about the fourth case, it is just a day feeling like you have the flu.  Of course, this presumes that you are relatively young and healthy – if not, malaria can be quite dangerous.

I am one of the “lucky” few who could not go near Mefloquine (brand name Larium to those of you who have taken anti-malarials) back when it was the “best choice” for preventing malaria.  I didn’t get malaria . . . but it did drive me toward a temporary bipolar situation and left me with residual vertigo that even now, 13 years later, I still feel at times.  So, after that experience, I simply stopped taking antimalarials entirely, and tried to deal with bugsprays and long pants as much as possible.  The relatively recent arrival of Malarone has made it possible for me to take effective antimalarials again, and when I am on short trips I do.  For the long term, though, you really shouldn’t be taking anti-malarials . . . they are really not good for you, and at some point they do become more problematic than malaria itself.

Given this situation, I have taken a rather acute interest in the efforts to battle malaria.  I’ve watched vaccines come and go.  I’ve seen the rage for bed nets as panacea consume everyone, even though they are quite compromised in their effectiveness by the fact that the anopheles mosquito likes to fly in the evening, when people are not yet in bed, and tends to fly very low to the ground, and thus below the level of many beds.  Hell, some crazy people have come up with a laser that can shoot mosquitos out of the air, thus preventing bites – the coolest, and most totally impractical solution for malaria I’ve ever seen (click here for a movie – really).  How, precisely, are people meant to power and maintain a LASER WHEN THEY HAVE NO ELECTRICITY?  And as I have watched all of these efforts, I have wished and hoped that someone could figure out a way to deal with this damn disease for the purely selfish reason that I am tired of getting it.

So, I was pretty excited to hear about a new development in this fight – an effort to genetically engineer mosquitos so that they cannot carry the parasite in the first place (LA Times, BBC, Tonic).  Malaria is obscenely difficult to kill, because it goes through a large number of stages in its life cycle, and each stage is vulnerable to treatment in different ways – thus, a treatment that works early in the infection cycle may not work on later stage infections – and worse, if there are parasites going through different stages at the same time (some have been gestating for longer than others), a treatment might only work on a fraction of the parasites in the bloodstream and liver at any given time.  But malaria has one weakness – it must have people to live in.  Without us, eventually there would be no malaria – we are the host, and mosquitos must collect it from our blood, before passing it to other people.  So, if the mosquito cannot act as the carrier, the parasite cannot move between hosts – and eventually the parasite dies out (the only real way to contract malaria is through mosquito bite*).  In other words, this just might work . . .

But there are serious caveats here.  First, we have to genetically modify mosquitos to do this.  Then we have to get the genetically modified versions to mate with unmodified versions, and for the genes that restrict malaria to be the ones that emerge in the offspring.  Since these genes would not convey any adaptive advantage to the mosquitos (the genetic modification actually causes them to die young, which strikes me as a significant genetic disadvantage), there is really no guarantee that this would happen – it could be that the modified mosquitos’ impact on the overall genetic pool is tiny – or huge.  I shudder a little at the proposed solution for this (From LA Times):

“connecting the gene to a piece of DNA that helps it spread by, for example, producing something that kills any mosquitoes that don’t contain the desired gene. Other research groups are working to develop such clever genetic tricks, but they are still years away from implementation.”

Once we start playing with a wider set of genes, I get worried.  As the article goes on to note, the effects of such modification are hard to predict in a single species, and since that species participates in a wider ecosystem, the impact on other species is equally hard to predict.  The last thing anyone wants are supermosquitos (a la superweeds and other superbugs that have resulted from previous genetic modification efforts).  So this is not a magic bullet, just a hopeful volley in what has been, and promises to be, a long battle.

*Funny side story: in 1999, I arrived back in Syracuse, NY just as a pretty bad case of malaria flared up.  Despite my protestations, several of my grad student colleagues bundled me off to the emergency room.  When the admissions person asked me what was wrong, I told her – rather simply – “I have malaria”.  The women stared at me for a second, and then said “should I be wearing a mask or something?”  I was pretty beaten up at that point, with an accordingly short temper, which explains my response: “Honey, unless you have a jar of anopheles mosquitos back there, I think we’re going to be alright.”