Mal Aria

The two words combined mean ‘bad air.’ Together they cause the death of one million people a year. Estimates range from a low value of 655,000 to a top end of 1.2 million—the spread is almost the same as the lower bound, which is a sure indicator of huge uncertainty. The people killed by malaria are the disenfranchised, the poor devils who live in the slums and rural backwaters of Africa and Southeast Asia.

The origin of the word might be Italian, or even Portuguese. In The India Road, I describe how it afflicted Vasco da Gama’s crew when they landed on the African east coast. My writing draws from the diary of Álvaro Velho. The classic chronicle speaks of the episode, just as it talks of scurvy, and the Portuguese sailors must have been well acquainted with both―in the first case due to the colonies in West Africa, in the second due to the long periods at sea.

Cerebral malaria kills you in three to four days, so if you don’t diagnose it in short order, you’re done. The parasite responsible for your death is Plasmodium falciparum―as far as parasites go, it’s hugely successful, at least in terms of distribution; however, it kills its host rather quickly, whereas many parasites prefer to torture you slowly, providing you with a long but miserable life.

The parasite is transmitted by the bite of the female Anopheles mosquito; a single cell heads for the liver, where it multiplies rapidly, and a few days later, an army of thousands of parasites attacks the bloodstream.

That’s when you know you’re in trouble―fever, headache, and body pains make it abundantly clear things are not well. And that’s because your red blood cells are literally exploding. The malarial parasite repeats this cycle of invasion of the liver, then explosion in the circulatory system, until it kills you.

A few years ago I was in Cape Town, recently arrived from Mozambique, and felt a little feverish. Although malaria was an unlikely cause, you really can’t afford to wait―anyhow, by western standards, doctors in South Africa are inexpensive, lab tests and all. Two hours later I knew I was fine.

The doctor told me others were often not so lucky: a few days before two guys had died, after returning from a chess tournament in Nigeria―and you thought chess wasn’t a dangerous sport.

The world killers are malaria, tuberculosis, and HIV; but apart from AIDS we don’t hear much about this unholy trinity. Why? For the same reason one hundred deaths in a Pakistani city is a mere statistic. Too far from the world of tweets and blogs, golf tees and botox.

Even HIV is now less in evidence, because the richer West can afford the retrovirals that turn the disease from an acute killer to a chronic companion. Not so in South Africa, where Jacob Zuma publicly explained that ‘a good shower’ was the remedy for unprotected sex.

Malaria was not always distant from European and American shores. In Portugal, the disease was endemic in particular areas―the paddy fields at the head of the Sado estuary being one of the better known. And the swamps in south Florida were rife with it―those marshlands later became Miami.

Mostly, malaria was eradicated in the west through public health programs, which in this case involved the lavish application of dichloro-diphenyl-trichloroethane, better known as DDT. In the 1960’s, at the height of the hippie movement, Rachel Carson published her seminal book ‘Silent Spring,’ denouncing the environmental costs of DDT, and the West moved to outlaw the use of this class of organic compounds―contrary to what the marketing guys tout, not everything organic is good.

Of course, just as in the cigarette trade, DDT went east and south, in search of market opportunities.  And lo and behold, the big agrochemical corporations found a willing and ready market―sacrificing the environment to save human lives was a simple and robust game-changer.

You have to remember there are milder forms of malaria, and that once infected, the human host stays infected. There were a good number of people of my father’s generation, men and women who had been out in Africa and the East, who contracted chronic forms of the disease.

Occasionally they were laid up with a malarial ‘attack,’ a high fever that subsided after a few days. If you’re interested in the land expeditions of Africa, the great treks of Livingstone, Burton, and Speke, their accounts speak also of malarial ‘crises.’

And while we’re at it, we can broaden those Anglo-Saxon explorations by adding men like Sá da Bandeira, Mouzinho de Albuquerque, or Roberto Ivens and Hermenegildo Capelo. The latter pair wrote a book called ‘De Angola à Contracosta’, an account of  the land crossing of Africa from Angola to Mozambique―not a picnic even now.

I can’t get this book on Kindle, certainly not in English, and not even in Portuguese. Printed copies of the Portuguese edition are scarce. Unfortunately, there’s an awful lot more bad books translated from English to Portuguese than good books going the other way. A good reason for learning another language.

Where in the world is malaria? A primer from the U.S. Centers for DIsease Control.

Where in the world is malaria? A primer from the U.S. Centers for DIsease Control.

When I first started travelling to areas where cerebral malaria was endemic, I thought it would be wise to take a pill or two. My doctor prescribed Lariam (which trades by a different name in Portugal), and explained that I might feel a little ‘funny’ after I took it.

“Funny ha ha or funny wierd?”

“Umm… a little strange. You might have peculiar dreams.”

Peculiar is a peculiar word, so I bought the drug but did a bit of homework. This was back in the days of ‘Blackhawk Down,’ and the Canadian special forces on duty in Somalia took the drug on the second day of the week (it’s a weekly dose)―the soldiers called it ‘Psycho Tuesday.’

I went for an alternative. On that trip, I met a South African guy who was taking Lariam, and his blue eyes looked vaguely demented. There’s a fair sprinking of people who’ve just gone plain mad from taking it. I’m not sure madaria is better than malaria.

The problem with all those drugs, even the ones that don’t drive you nuts, is they’re very hard on the liver―that means you can’t take them for more than a couple of weeks, so the locals use other measures; light clothing helps, and of course the ubiquitous ‘Peaceful Sleep,’ a South African DEET insecticide.

The only vaccine that ever worked was developed, and exclusively used, for the American military, and it used a parasite whose virulence was attenuated by means of a radiation treatment―that was back in the 1970s―I’m guessing Vietnam war.

Now there’s a new effort in this direction, with some work on torins, chemicals originally used to fight cancer. A recently published article in the prestigious Proceedings of the National Academy of Science explains how torins can be used as ‘malaria bombs,’ and a number of laboratories around the world have taken the idea up and are testing and developing torins.

I’m not sure how enthusiastic big pharma will be, given the profit prospects of selling vaccines to the poorest people in the world.

The scientist who did the ground-breaking work is from the U.S., but she’s working at a Portuguese lab.  Nice to see Portugal reaching out to Africa―isn’t that what peripherals do?

Atmos Fear and The India Road. Quick links for smartphones.

Atmos Fear and The India Road. Quick links for smartphones.

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