August 23, 2013

Malaria in Me

I recently took a malaria rapid diagnostic test when I was sick and the result was negative. Yay! But did I ever tell you about the time I actually got malaria?

April 2011. I haven't had a headache this bad in YEARS.

I took some pain killers and closed my eyes, hoping sleep would take the pain away. I awoke the next morning to sun highlighting sections of my hut. The headache was gone. Great, back to work.

A week later, I came down with a really bad case of the flu. Or what I thought was the flu. As I started walking to the clinic from my house, my body felt like I was going in slow motion. I was walking in a blizzard, fighting against strong wind and freezing cold. But no such thing existed. Something was wrong. My body won over my stubborn persistence to walk to the clinic and I retreated home. With the wind knocked right out of me, I collapsed on the floor of my hut.

 
Malaria Rapid Diagnostic Test: cassette, reagent, pipette, needle prick, and alcohol swap


I looked at the cassette sideways, sliding it back and forth in my hand. This can't be... right? A line appeared under P. falciparum on the cassette. Hm, I must've done something wrong. I guess I'll use the other one. So, I repeated the process with the second cassette. The second cassette had an identical result.


 I bundled myself in blankets and called the Peace Corps Medical Office so they could monitor my condition.
I followed a set schedule: Take Coartem, eat some peanut butter, drink some milk, take my temperature (oh, it's still 40 Celsius?), close my eyes. Rinse, repeat. There wasn’t much else I could do but lay in my bed and follow the rhythmic pattern of letting the medicine restore my health. Opening my eyes was the biggest effort on my part. The Coartem course was 3 days, so by day three I could at least stand for short periods of time. Other than a traumatizing experience with the headman's family force-feeding me dried fish which I subsequently threw up, I eased into eating green, leafy vegetables to gain my strength. I soon recovered from my illness but the memories of my time with malaria will forever be vivid in my mind.

When did you first learn about malaria?

I learned about malaria from my history teacher, Mr. Murphy, when I was in high school. He shared a story about his brother becoming gravely ill from malaria when he was a Peace Corps volunteer in Mali. I’m sure he’s surprised I remember all of that story over 10 years later but it really freaked me out!

What was your attitude about malaria when you first became a PCV?

That I wouldn’t get it. I was fascinated with the history and biological background on the disease but I thought my chances of getting malaria were slim to none for the following reasons: I’m pretty good at taking medication per doctor’s orders and the preventive measures didn’t seem that hard to practice.  As soon as I arrived in Zambia, I took my prescribed malaria prophylaxis every Saturday at the same time and slept under a mosquito net every night, as instructed by the PCMO. 

Why did you wait to test yourself for malaria?

I never had malaria before so I related my symptoms to the flu. A really, really bad case of the flu. So, once my headache and other symptoms appeared to go away, I thought that was the end of it… until I started getting the cyclic chills.

During training, the PCMO (Peace Corps Medical Office) staff teaches us how to test ourselves for malaria using rapid diagnostic tests (RDTs). I've always hated needles, especially finger pricks, so I hesitated to test myself. I also didn't want to waste a kit just in case I was negative. Just in case. Because, in my mind, I wasn't going to test positive. So, I tested myself for protocol's sake and waited for the results.

Where were you when you malaria?

 I was in my old village in Lusaka Province, Zambia. I did not get malaria in Lusaka town.
 
How did you get malaria?

Even though I took my malaria prophylaxis and slept under a mosquito net every night, there were plenty of other possible causes to me getting malaria:

Mosquitoes Come Out At Night

I ate with the headman's family every night and nearly every night we ate late (between 8:30pm and 9pm). Being that I was not one to "eat and run," I often hung out with the family for about a half an hour after dinner.

Sleeveless Mondays (and Tuesdays, and Wednesdays...)
Oftentimes, it was so hot that I would *gasp* not wear long-sleeved shirts. Let's be realistic here: how many people walk around in 80 degree weather wearing long-sleeve shirts? Yeah, not many. Sure, my likelihood of catching malaria would’ve probably been less if I wore long-sleeve shirt s but I probably would have suffered from heat exhaustion instead. Nice trade-off, right? As such, I dressed appropriately for the weather. I also applied plenty of bug repellant to my exposed skin.

Malaria, Malaria Everywhere
I lived in a malaria high prevalence area. During peak season, the clinic in my area saw 90 patients with reported malaria symptoms per day. Yes, I said Per Day.

Blades of Glory, Living for the Village
I lived in the bush: surrounded by tall grass with chickens and pigs making mud holes in my front yard during rain season. 


What have you learned from your experience?

Have you ever notice that once something affects you or someone you know you can’t stop talking about it? Yeah, that’s me now. All of my experiences, from the death of the infant at the clinic who suffered from malaria to my own experience getting malaria, made me more invested in finding ways to educate people on malaria and promote ways to eradicate an illness that affects so many lives.

My personal experience with malaria allowed me to come from a place of empathy when trying to help my community practice malaria prevention behaviors. What do I wish I could’ve done differently? This meant I had to lead by example: covering the standing water spots in my yard (and getting the neighborhood kids involved was messy fun too!), slashing grass around places I frequented (my bathing shelter, my pit latrine, and my house), wearing thin, long-sleeved shirts at night when I was out late. I also collaborated with community leaders to brainstorm reasons why people held the common practice of sleeping under extremely worn and damaged mosquito nets and worked with the clinic to increase the efficiency of the mosquito net distribution. I encouraged young mothers to assess their child's health and send the child to the clinic in a timely fashion. Behavior change is a long and difficult process, especially when you’re trying to change community health behavior. However, leading by example and involving the community to teach malaria prevention practices makes reaching health goals that much easier.


Sometimes, when I speak to people here about malaria, they tell me “I don’t think it will ever go away.” I try to encourage them by relating the U.S.’s triumph over malaria. Only 67 years ago the Centers for Disease Control, a global leader in public health, evolved from the Office of Malaria Control in War Areas, and initially focused on fighting malaria by killing mosquitoes and using media to educate Americans on how to prevent malaria. Today, the CDC is one of the 13 major operating components of the Department of Health and Human Services. From its beginnings as a malaria control agent, it expanded its role to helping research communicable diseases and find ways to eradicate them. Through the combined efforts of the U.S. Army and the Office of Malaria Control, the U.S. was able to eradicate malaria in 1951. The CDC remains at the forefront of malaria research and global eradication, while expanding its role to researching and eliminating communicable diseases. Only when people realize how interconnected we are can we truly stand together to fight diseases like malaria.