Accelerating the Fight Against Malaria

Medical Volunteer Opportunities Abroad

It’s World Malaria Day. The World Health Organization selected the theme “Accelerating the fight against malaria for a more equitable world” and this theme is right on point for our communities. While the risk of transmission of the disease is low overall in Panama, it is most prevalent is in the Comarcas, which are mostly rural with less access to prevention, detection, and rapid treatment.

In addition to the conversation surrounding malaria in what are, for many, far off lands, Dr. Ben (who has his own intimate experience with the disease,) shares his thoughts on why we should all be concerned:

“I have actually had ‘uncomplicated malaria’ which sounds like it wouldn’t be too bad…but I actually didn’t know someone could feel that sick and still be alive.  And before taking the ‘radical cure’ to eliminate hypnozoite parasites hiding in my liver, my malaria came back every year for a couple of years in the spring or fall (how malaria knew it was spring or fall, when mosquitoes are most active when I was on a different continent in a different hemisphere, is a mystery). It’s the sickest I’ve ever been; I lay in my cabin aboard our ship in Haiti, alternately drenched in sweat or violently shaking, so weak as the parasites rampaged through my bloodstream feasting on my precious hemoglobin.  I’ll never forget looking through the microscope of one our Haitian friends and seeing the malaria parasites all through my blood on the slide.  I could not imagine dealing with that when you still have to get up and milk your cow and tend your farm or take care of your children.  So a few months ago, I saw an  interesting article about mosquitoes turning the tide against us and exploiting new environmental habitats as areas become warmer, and developing resistance to insecticides, and so on. 68 F (20C) is a magic temperature (here Malaria and humans seem to overlap in our preference for a minimum comfortable ambient temperature); below this malaria takes several weeks to complete its life cycle–a bit of a problem for malaria when the average lifespan of a mosquito in the wild is less than two weeks. But above 68°, malaria completes its lifecycle in only a few days allowing it to do very well in areas where mosquito survival time may only be even a week. 

“I teach a course on malaria at USC Keck School Of Medicine every fall, and I saw this article right after we had just spent an entire module discussing how so much malaria research and policy is created far from the areas where malaria is actually a burden, and that our preference for “silver bullet “solutions that can be applied globally cause us to overlook the fact that malaria is–in the words of malaria pioneer Robert Koch over 100 years ago– “often 1000 different problems in 1000 different places, and the best thing to do in one place might be the worst thing to do only a a few miles away.”  What struck me about this article was this statement by the journalist:  “I was a bit taken aback, as a global health reporter who has been writing about malaria for 25 years, to realize that the common public narrative of a straightforward trajectory of progress against the disease is inaccurate.”  My first thought was “you’ve been covering malaria for 25 years and just now figured this out? what have you been doing?” I realized it was because she had done all her malaria learning far from malarial areas, listening to huge multimilion dollar NGOs and agencies (what a great allegory for malaria research and control programs, too), but for her newest article she actually went to where malaria was a problem and finally talked to people who suffer from malaria, and talked to local malaria researchers and walked through swamps and spoke to people implementing interventions locally. And that’s when she finally learned the real story:  that malaria has co-evolved with us since our days as other primates, and it is really, really, REALLY good at developing resistance to antibiotics and really good at finding new ways to exploit vectors and changes to ecosystems in order to continue making us its prey. And it is NOT being steadily beaten back and put on the path to eradication.  Far from it, in fact. After all, we’ve recently had our first local cases of  malaria transmission IN THE US this year–at least 3 cases– in decades, and dengue, west Nile encephalitis, chikungunya and other mosquito-borne diseases are newly establishing themselves in North America as climate changes and ecosystems evolve.  As malaria resistance to our only really truly effective class of malaria medicines (a plant derivative from an unassuming shrub discovered in a 2000+ year-old Chinese home first aid manual as a part of a secret Chinese government project in the late 60s–I’m telling you, you can’t even make this stuff up; google ‘Project 523’ for this remarkable story) continues to grow rapidly, as habitat disturbance and warming climate create new habitats for mosquitos, it is not complete hyperbole to be concerned that we one day may see again a time when malaria death rates in, say, Wisconsin or South Carolina rival that of sub-Saharan Africa–as they sometimes did only 200 years ago.  After all, the mortality rate for untreated cerebral malaria is almost 100%–Ebola is only 90%.  Just saying.”

Community Collaborators are the Key

In the past few years, there has been a spike in malaria cases in Panama, 90% of which occurred in the remote indigenous communities (source: PAHO). This prompted the Ministry of Health to put our a health alert in responding to the outbreak and issue a resolution to enhance malaria response efforts in the four areas of the country with the highest number of cases, including Ngäbe-Buglé.

Recruited from the communities themselves, the Panamanian Ministry of Health and the Pan American Health Organization (PAHO) has trained Community Collaborators to carry out malaria diagnosis and treatment. Floating Doctors plays a supporting role within these communities by working with the Community Collaborators to ensure broad health monitoring and rapid transport for advanced care when necessary. By tasking individuals to monitor the health landscape from within their own community, the indigenous populations are able to have a more active role in their healthcare.

“Accelerating the fight against malaria for a more equitable world” in Panama means ensuring communities are integrated into their own health surveillance. The Ngäbe are integral to the efforts to eliminate malaria in Panama. These Community Collaborators are accelerating the move toward empowering communities to control their own health initiatives, now and for generations to come.