Friday, July 16, 2004

Mosquitos, West Nile Virus and Malaria

The only snail mail I got today was a little pamphlet from the Cambridge Public Health Department, warning about West Nile Virus and other mosquito-borne diseases.

I thought it was quite appropriate given the alarming incidence of malaria, especially back home as this map indicates. My bouts with malaria as a child and teenager still loom large in my psyche - especially the couple of epic episodes that never seemed to be overcome, recurring weekly for almost 6 weeks. I remember losing a scary amout of weight. Not to mention the fear of being taken to the 'London School of Hygiene and Tropical medicine" where mum would warn "you'll be sure to be treated as a guinea pig for weeks by doctors, or worse, students who've never seen a malaria parasite, will order up the most exotic tests they can think up, while never curing you". The notion of ever going through a malarial fever is about the worst thing I can think of, hence my paranoia whenever I'm back in Ghana (bug spray, drugs etc).

In my memory what I had gotten in most memorable bouts was called the 'go-slow malaria' which was thought to be caused by newer drug-resistant strains of the malarial parasites that emerged in the 80s. You had the awful, but standard fever for a few days, would get well enough to get back to work, but then the next week, you would relapse and the fever would come back, repeat ad nauseum. Clearly this would be a big drag on productivity, people would be weak, essentially walking wounded during the week and never get well for months on end.

Interestingly it turns out, trust Google, that my recollection was in part inaccurate; at least per the following - Problems of Irrational Drug Use.

In many African countries, malaria is treated with injectible chloroquin rather than adequate doses of oral chloroquin. This leads to apparent treatment failure, which in Ghana is called "go slow malaria."
The symptoms I observed are still prevalent, but "go slow" has a different cause. You learn something everyday, don't you? I'll need to follow up with Dr. Ofori-Adjei (who knows more about malaria and mosquitos than almost anyone.)

Of course, if it isn't adequate doses or adulterated pills, there's also the interaction between people's prescribed drugs and the herbal remedies they are taking on the side. This is an a big deal these days because people are questionning the effectiveness of AIDS drugs. The tension between the scientists and the healers serving traditional medicine regimes is something that Abena will hopefully address in a definitive study.

Searching around on this issue, I found a funny exchange on a Ghanaian forum. First this:
Korle-Bu Hospital now plans to use herbal medicine, my concern are those medicines combo that cures hiv, hypertension, diabetes and cancer that patients so believe in. herbal medicines are not researched on neither animals nor humans and the datas are not collected and documented for other reseachers to continue improving on it. These are herb mixture made up by herbalist on their merits, no data, no national food and drug regulation and yet, the administratve board at korle-bu is approving it use. People talk of the benefits of herbs in china, yet no one talks of the high cases of stroks in that population and why that happens. why not use the effort to continue medicine from 2004 standard, why go back to the the days of the cave man?. Please help me on this matter. and please ask yourself if you will choose traditioal medicine over orthodox to treat your mother's diabetes or cancer.
This was the angry response from someone annoyed that 'herbal medecine' was being denigrated:
Hello Mr Ignoramus !!!! Herbal medicine has been undergoing intensive research for so many years in the country. I'll tell you for a fact that when people were dying of the strain of Malaria called "go slow" locally, it was herbs my 2 grandmothers prepared and boiled that was administered to my father a herb sceptic that cured him. After korle-bu had thrown its hands up in resignation to an imminent end. Please be wise and learn from your people. My remaining grandparents who use herbal medicine in support of orthodox medicine are still alive and still healthy, past 77 years old . My deceased grandparents who also did the same died at very old ages, 90 & 99. Is that testament enough?
Our way with the English language is great, isn't it?

West Nile virus hit the east coast of the US a few years ago and seems to have spread to California this year. I can remember the slight panic of the that summer, when I saw trucks roaming the steets of Cambridge, loud horns exclaiming warnings and spraying insecticide over the streets.

They call this state "Taxachusetts", supposedly because it the high tax burden (actually a bit of an exaggeration, but, even if the claim were true), this to my mind is exactly what government is good for. I don't mind paying taxes if my city would have a public health department (testing, monitoring, spraying my streets and even sending educational pamphlets.

On to the pamphlet itself, it covers the basics: personal protection and source reduction. The idea is simply not to get bitten (insect repellent, screens on windows and doors) to eliminate standing water sources, clogged gutters and the like where mosquitos breed.

Again it is only not much more than 50 years or so since diseases like malaria were endemic in New York even in Paris and cold London. The West has devoted massive amounts of resources towards Public Health measures and education (see for example The Gospel of Germs: Men, Women, and the Microbe in American Life by Nancy Tomes).

Bill Gates, God bless him, has put up more than $250 million up for malaria research, far more than most countries. Hopefully we'll start to make a dent on it. Now that mosquito-borne diseases like West Nile virus are again hitting the US, perhaps the government will start applying it's energies to it. More likely though, we'll need a 'War on Terror' tie-in, that's what government spends these days. There are actually a couple of incidents on that front:

First, soldiers in tropical and countries like Iraq need to take Larium to ward off malaria - which has serious side-effects (hallucinations and the occasional psychotic episodes). There were a rash of murders at Fort Bragg by Marines returning from Iraq, typically killing their spouses). Now this is not new, my psychiatrist uncle treats some of the exchange students at Legon who were prescribed Larium and has to deal with their mental health issues (student life in a poor, foreign country is difficult enough without daily hallucinations). This article is ties the use of Larium to the torture scandal.

And then there's fiasco of the marines in Liberia. Mr Bush, how do we 'take the fight to Al Queda' in those tropical places if all our troops fall ill?
The number of malaria cases among U.S. Marines serving in Liberia ose again Thursday, with 51 showing symptoms of the illness, defense officials said. The 51 sickened represent almost a fourth of some 225 who went ashore to help West African peacekeepers last month.
I wonder, does Accra even have a Public Health Department? I suspect the answer is a sad one.

Update - July 20 2004

I certainly didn't know this: if you catch a mosquito feeding on you, you should flick it away rather than squashing it, lest you drive its infectious guts into your body.
The issue is reviewed in an article published this month in the New England Journal of Medicine that focuses on a 57-year-old Pennsylvania woman who died in 2002 of a fungal infection in her muscles called Brachiola algerae.

Doctors were puzzled because the fungus was thought to be found only in mosquitoes and other insects. But it's not found in mosquito saliva like West Nile virus and malaria, so a simple mosquito bite could not have caused the infection.

The article's authors concluded that the woman must have smashed a mosquito on her skin, smearing its body parts into the bite.

See also: West Nile Blues

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