Even before I left for Ghana, this past January, malaria was on my mind. I didn’t have any parasites circulating in my bloodstream; however, I had begun taking my anti-malaria medication before entering the endemic zone. My drug cocktail of choice was Malarone – a combination of atovaquone and proguanil hydrochloride – meant to arrest the development of malaria parasites if, by chance, I was infected. Malarone and I would form a close relationship over the course of my four months studying abroad in Ghana – like a good ol’ friend. Like clockwork, I would wake up every morning and gulp down one of the small pink tabs after breakfast. Becoming so attached to my dear medication, I often experienced separation anxiety if I went traveling without it.
An advertisement for Malarone. From my experience, only travelers administered anti-malarials like this one. Ghanaians themselves would not pursue medication. Picture cited from dannysullivancopywriter.com
Here I was completely medicated and protected against a disease that infects 350-500 million cases annually, is responsible for killing between 1 and 3 million persons, and creates barriers to economic development. Additionally, I was traveling to the heart of its endemic sprawl – Sub Sahara Africa (SSA) – where nearly 90% of all malaria-related deaths occur. Ready – set – go.
I don’t know the exact moment when my perspective on malaria began to change and it might as well be that there was never a specific moment that instigated a change. What do I mean by change?
From my experience, all I’ve ever heard about malaria is the havoc it wreaks physically, socially, and economically, and the death that it incurs. From these statistics, I would assume it to be a disease of great danger and fortitude. Something of much greater magnitude than swine flu and definitely more than the common cold. But in the urban, university setting – malaria was perceived much differently than I expected.
There was a fatalistic attitude about malaria, especially if you were African (however, a few of my international friends adopted such mindset). You were going to get it. More than once “–” in a year. When you got it – there wouldn’t be a concern over life or death. There didn’t even seem to be much rush to get better. You would accept the fact that tiny little parasites are bursting out of your liver and swarming your bloodstream, call up the doctor (or not), buy some prophylaxis (either prescribed by the doctor or by yourself) and wait for symptoms to die down.
Sometimes, people skipped the ‘waiting’ part and got on with life. I remember I was at a rugby tournament when one of the players on the sidelines pointed to the referee and told me that he had malaria – meanwhile, this referee was on the field running in place and doing push ups during halftime.
Several of my Ghanaian friends would fall ill with malaria during the semester. Many international students did too, even when on medication. One of my closest friends succumbed to the toxic mosquito bite more than once. One of my economics professor lecture for a week because he fell ill. In the severest case, one classmate had to be hospitalized for three days, but this was after ignoring symptoms for over a week. Symptoms included full-body fatigue, fever, and nausea. If hit pretty severely, you would probably lie in bed for a couple of days recovering.
In my time spent at a suburban clinic and one of the largest hospitals in Ghana, malaria was THE most common cause of complaint. In the clinic, nearly every order for a blood test would include a test for malaria. It was in the doctor’s experience – the high rate of malaria prevalence – that it was more cost effective to test for malaria in nearly 80% of all patients than to test for other symptoms, only to find out it was malaria all along.
University students were privledged with a well-maintained, relatively sanitary environment near able health-care facilities.
If anything, malaria was even more widespread than the common cold. However, I don’t want to discount the magnitude of malaria’s infection or undermine any efforts trying to relieve the burden. First, let’s look at the situation and take note of the environment I surrounded myself with: I lived in an urban setting, close to medical and pharmaceutical facilities; most students had the financial means of buying treatment if needed; and most persons were relatively healthy, well-nourished individuals to start with. Plus, we were living in an environment where food was readily accessible, where water and electricity were provided with some reliability, and accommodation was more than adequate. Even with these advantages, productivity level of those infected with malaria was undoubtedly reduced. For us, losing productivity didn’t matter much. We were students, yes, who had to get to class. But in a worse case situation, we could siphon notes from a classmate.
Now, let’s take a step back. Let’s look at the average person in Sub-Sahara Africa:
- Life expectancy at birth is 46 years old;
- Infant mortality rates are double the global average
- 28% of children under 5-years-old are moderately or severely underweight;
- Only 36% are using adequate sanitation facilities
- 45% are living on less that USD$ 1 a day
- USD$611 is the average yearly income
One way to eradicate mosquito breeding sites but have access to potable water, espeically in the rural regions, was to maintain a capped water tub much like this one. Hazards did come with this method, though, as water was transported from local streams whose water-quality was unknown.
I think we can infer that the average university student (okay… above-average university student, in terms of socio-economic status and afforded living standards) is much more privileged and predisposed to healthier living conditions than the average Sub-Saharaian. When living in an isolate village, health care is hard to access and difficult to afford. Contracting malaria can be much more of a disability – or even a death threat – for those who don’t have adequate access to health care, proper levels of nutrition, and proper levels of sanitation. For a majority of SSA, these lacking factors are daily realities.
A key recognition is that malaria significantly affects the productivity of the nation. As I mentioned before it’s taken with varying degrees of disability. Some people power through the disease while others accept the fact they’re sick and take the time to rest. In these cases, they cannot work. If they cannot work, they cannot earn income. If no income is earned, sometimes, there is a question if enough food can be bought, etc. In this case, it has profound effects on the local economy of the poor. However, let’s say one of a wealthier class is afflicted. They can afford to miss a few days of work; of course it implicates their earned income, but they have enough to live money to live off without generating it on a daily basis. Here is another reason why we can say malaria discriminates. Those who it hits the hardest, those who can’t protect themselves nearly as well, those who can’t afford to treat it – these are the persons who are also the ones who can’t afford to live with it. When teetering on the threshold of non-poverty and poverty, one bout of malaria can quickly sink a family into such a state.
It is villages like these, in the largely-ignored Northern Region, that feel the greatest burden from malaria-caused symptoms.
Therefore, I would like to suggest that it is the discriminatory nature of malaria that transforms it into threatening disease. It doesn’t have to be a threat. It certainly isn’t in the upper echelons of society, but it certainly is in the majority of the populace. This proves a challenge because these same people also lack political power and institutional power; how can they advocate for their health without a strong voice? We must recognize this key disparity between socio-economic classes and influence policy to address these issues. Although such diseases may just be nagging pains for the well off, it can be an affliction of much greater magnitude for the majority of the population.
Conclusion: Malaria is much more common than I thought, and for some, much less severe than originally perceived. It is approached in a fatalistic attitude. It reduces the productivity of daily life in varying degrees. My observations derive from relatively upper-end living arrangement and lack evidence from less-privileged, or even ‘average,’ Sub-Saharaians. Research focusing on the prevention and eradication of the disease is compulsory to improve the social well-being of Sub Saharan Africa.
Data cited from UNDP and UN Health Reports.
This post was written by melissa.frick
