Malaria is a disease most of us know something about. Through the news and stories from friends who’ve traveled abroad we know that malaria is caused through mosquitoes bites that carry a particular parasite that enters the blood and causes the often deadly symptoms.
In Africa, the mosquito is known as the number one killing animal, surprisingly followed by the hippopotamus. Within my first three weeks in South Sudan, I learned of 4 deadly malaria cases. One of the deceased was an up and coming young leader of the church who died after receiving the wrong treatment. He was dehydrated, which occurs frequently with malaria, and was given a saline drip instead of glucose drip (or, in other words, they injected salt into his blood instead of sugar).
Even I came down with malaria in my second week of Juba. I slept under a mosquito net and took daily anti-malaria medication but the parasite found a way to get me. Thankfully my symptoms were pretty mild. It felt like I had the flu, and I could tell I had a fever. The day I went for treatment, I decided to walk 4 miles through Juba to become acquainted with the city. After the walk I was a tired, but more tired than I would suspect. Plus, my stomach hurt a little. I took a nap and woke up 3 hours later feeling the same symptoms and my body was aching. When I went for dinner, I had no appetite. The others whom I live with said I looked “horrible” and that I should get checked for malaria. After they finished eating, we walked about ¼ mile to a nearby clinic where they tested and confirmed I had malaria.
I remember I asked people in a village once how often they catch malaria and they all murmured in annoyance and said, “Malaria is like air, it’s always there!” This is true, particularly during the raining season, when it may rain everyday. I usually follow-up to such responses by asking how many people sleep under mosquito nets, to which they respond “Bayine” (It’s not there!). At first I would just let that type of response slide, but now I ask, “Why don’t you go buy one?” A mosquito net costs between 10 and 15 South Sudanese Pounds (or 4.2 USD), which for some people in the village is hard to come by. Still, villagers find money for luxury items like sodas and beers.
Truthfully, even if each villager had a mosquito net, they would still get malaria quite frequently. The mosquitoes bite most often around dusk and dawn, which in South Sudan is about 6:30pm and 6:30am. As the air begins to cool at dusk, malaria causing mosquitoes travel from the fields looking for warmer spots to loiter. Homes full of human bodies are one such spot. At dawn, when the air inside homes begin to cool, the mosquitoes move from the homes to the warmth of the sunlit fields. At the times when the mosquitoes are moving from one location to the other are the times when people are most likely to be bit from malaria causing mosquitoes. But these are also the times when people are walking home from working in the fields, preparing food, looking after animals, fetching water, or walking to school. It’s almost impossible to expect them to be under a net during dusk and dawn. I traveled to the village once with a lab technician that would tell people that they are taking malaria with them under the net as they slept.
So what can reasonably be done? For starters, malaria is most harmful to infants and pregnant women. So those who fall into that category should actually spend time under a net during dusk and dawn. People in general can wear long sleeve clothes at night to shield their body from mosquitoes. But, perhaps the most important steps are removing standing water and vegetation away from the immediate vicinity of the home.
Mosquitoes breed and rest in standing water and plants (especially the village staple plants like corn, sorghum, and cassava). If you keep that away from the home, the mosquitoes have a longer journey to travel to get to the house, and they don’t like to travel far. If a person is really advantageous they could plant lemongrass (or a few other strong scented plants) around the home. Mosquitoes don’t like those. When I go into some of the NGO compounds around Juba, lemongrass is planted all around and the mosquitoes are naturally repelled. Some of the people who live there don’t even use nets because the mosquitoes are not present. They probably also spray insect repellant, which is another option for villagers.
Another huge factor contributing to the high mortality rate of malaria is the treatment. For those who live within walking distance to a medical clinic, death from malaria primarily occurs because treatment was not sought soon enough. For many people, even those who live near clinics, the first treatment of malaria is a local herb called “dikori ti melo”. The herb has given a degree of protection against malaria for generations, but no one knows the proper dosage. People just give a pinch or two or more like it’s a secret ingredient to a baked good. Sometimes people ask me to research the medicinal properties of dikori ti melo and notify them of the proper dosage. Many people will only go to the clinic after dikori ti melo has failed to help them. This practice is often fatal, because the malaria can become advanced to a stage where emergency measures are needed.
Severe cases of malaria lead to a high fever (104+), and seizure-like convulsions. If the symptoms become this advanced, a person needs emergency medical treatment. They have to be taken to Juba or another city with a full hospital. Without a vehicle, this is quite a challenge, and the result is often fatal.
In America we used DDT, an effective but believed to be ecologically harmful pesticide, to kill malaria carrying mosquitoes. In South Sudan, and much of the world that still has malaria, DDT campaigns have been pretty much ruled out by the international community. Thus prayers, preventative measures, and treatment are the best remedies.