WITNESS-Even with treatment, malaria takes its toll
Source: Reuters
By Ed Cropley BANGKOK, Dec 11 (Reuters) - I'd always been under the impression that malaria, if treated quickly, was no worse than a bad bout of `flu -- a bit of a temperature and some aches and pains but nothing too severe. After a week in hospital hooked up to quinine and saline drips, followed by two weeks off work, followed by a bout of a different form of the parasite, followed by another two weeks off work, that view has changed. I suppose I should have expected as much from a disease that kills an African child every 30 seconds, one which the United Nations estimates puts a "growth penalty" on some sub-Saharan countries of up to 1.3 percent of gross domestic product a year. A healthy 33-year-old, I lost 7 kg (15 lb) -- nearly 10 percent of my bodyweight -- in a week, and was out of action for the best part of six weeks despite being lucky enough to receive treatment in a First-World Thai hospital. Most of the 300-500 million people who get malaria each year -- from Africa to South America to Asia -- have scant access to medical resources, resulting in hit-and-miss diagnosis and less effective treatment. JUNGLE MEDICINE In the jungle of eastern Myanmar, where I was infected while reporting on the plight of ethnic Karen fleeing an offensive by the military junta, correct diagnosis can be the difference between life and death. The bamboo hut that doubled as a medical centre in one refugee village housed several suspected malaria cases -- men, women and children lying listlessly on mats waiting for the next wave of fever to attack. Large, grubby jars of anti-malarial pills sat on a shelf nearby but the orderly, who had no formal medical training, refused to treat the patients until he knew what type of malaria they had. "We have no microscopes here. We just have to wait for the fevers to come," he said. Different strains of malaria have different life cycles, he explained, and require different treatments. Two weeks later, I would be putting his advice to personal use when I came down with a fever that returned almost exactly 48 hours later -- a classic symptom of "Plasmodium falciparum", the most serious strain that accounts for nearly all malaria's one million or more victims each year. It was only after two more days and two microscope blood tests at hospital that the diagnosis was sure. SHIVERS, ACHES, NAUSEA Falciparum can lead quickly to "cerebral malaria" due to clogging of the arteries going to the brain. Had I been a small child, the delay could have meant brain damage or even death. As it was, it was a frightening and debilitating experience. The shivers were so severe I could hardly hold a pen to sign my hospital admission papers. Every bone in my body felt like it was being crushed in a vice. After 12 hours of popping large quinine pills, my body reacted violently against the drug, inducing half-hourly vomiting that would last for two days. Doctors started delivering the quinine intravenously, another option unavailable to many Third World victims. That made sure the drug stayed inside me but intensified the nausea. For three days, I was too weak to stand any my blood platelet count slid to 10 percent of normal levels, meaning I could not brush my teeth, shave, or do anything else that might cause bleeding. As I dimly recalled reports of drug-resistant strains of malaria surfacing in Myanmar, for the first time in my life I wondered whether I would make it. An Australian army friend later recounted his brush with falciparum during a tour of duty with the United Nations in Cambodia in the early 1990s. As he emerged from several days of delirium, a doctor handed him a scrap of paper on which somebody had scrawled a poem about being too young to die and fear of "the other side". "Bloody hell," my friend said. "Who wrote this?" "You did," the doctor replied.
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