Come for Dinner! (One.org malaria op-ed)

“Come for dinner!”

With a table that seated twenty, my house in Mtwara, Tanzania was often filled with visitors from around the world. Attached to our home, the mission guesthouse on Shangani beach welcomed German and Dutch missionaries, English and American volunteer builders, Australian and Korean travelers, and a wealth of Tanzanian church elders, youth workers, and guest preachers.

Stories and laughter floated above the hand-planed wood and out the screened windows, lifted by the Indian Ocean breezes up to the waiting stars. Our table heard songs of thanks in a chorus of languages, and offered up steaming rice and beans, tiny finger bananas, long canoe-shaped papaya strips and golden mangoes, cross-hatched and flipped inside out, a sweet libation to drip down our chins.

Now back in the United States, we seldom entertain unexpected visitors. Our children, who absorbed fluent Swahili, a smattering of German, a collection of hilarious British idioms, and an eclectic wisdom from our guests, have taken off on their own adventures. Our memories of conversational “iron sharpening iron” grow wistful, as my husband and I now exchange hectic schedules via email and squeeze in “date night,” trying to stay awake over burgers long enough for genuine dialogue. Tanzania is poor in cash, but taught us to value the wealth of human contact.

I still have physical memories of salt-scented air, a golden halo of lantern light, and sudden silence when the generator was stilled. My ankles remember the itch.

As we shared meal after meal with friends, anopheles mosquitoes discreetly met under our welcoming table for a feast of their own. Guests were cautioned to wear long clothing and socks, to spray any vulnerable exposed skin before dusk, and to join the ritual of swallowing bitter anti-malaria tablets, but as we lived and worked in Tanzania for ten years, we found it hard to follow our own advice.

Bwana Samaki, the fishmonger, waited at the door, four feet of swordfish ready to be negotiated by the kilo. His friend, Ali the woodcarver, was already setting up his ebony figures for our guests on the porch, and needed translation of his wheeling and dealing. Our lives couldn’t stop at dusk, and we certainly never climbed under a mosquito net in time to escape the cloud of insects that rose to meet us as the reflected sun blinked out of the puddles in which they bred.

Malaria is endemic in southern Tanzania, and thrives in the tropical heat and rain. We fought off attacks by the parasite with high fevers, chills, aches, squinty-eyed headaches, diarrhea and vomiting, all of which struck suddenly and violently. Swallowing the pills that could kill the parasite as it performed its multiplication in our red blood cells and liver became a cruel race: twenty minutes in the stomach meant the medication would be absorbed enough to do its job, but if we couldn’t hold it down that long, we had to try

again. Chloroquine, fansidar, halfan: in ten years we used several generations of drugs until the parasite developed resistance to each one. If they all failed, we might try that nasty old stand-by, quinine, which occasionally caused temporary blindness or deafness, or both.

Our kids could diagnose their own malaria before they were six, and performed finger-stick blood test to proved their claim. They impressed their friends by comparing “parasites per 200 red blood cells” on the slip the local clinic sent back to us by bicycle. Malaria became a frequent visitor to our home, and we created peace of mind by viewing it as a part of life, knowing that in our American wealth we could afford multiple tests and a wide menu of treatment drugs. Too often, that fragile sense of safety was shattered by the death of African neighbors and friends, and even Americans and Europeans who used the same preventive strategies as we did. Malaria kills a million people a year, most of them in Africa, and no ethnic or even socio-economic group is exempt.

But things are changing; a new movement to eradicate this disease is growing. Nets treated with insect repellant have been distributed in record numbers, lowering deaths and illness from malaria. Researchers are continuing the search for an effective vaccine, while testing and treatment have been improved, made less expensive, and provided more quickly. Campaigns to simply eliminate standing water in overgrown fields, ditches, and open water containers have reduced the breeding grounds for mosquitoes that carry malaria. To finally clear dwellings of resident mosquitoes, one old tactic could make all the difference: the weapon that ended the reign of malaria in European and western nations.

Dichlorodiphenyltrichloroethane, DDT, has never been surpassed in its effective elimination of mosquitoes, although researchers are trying to find a match that would cause no harm in any circumstances. But the truth is, no study linking DDT to premature births, low birth weights, inhibited lactation, or other health problems has been successfully replicated or favorably confirmed by similar research. The harmful and fatal effects of malaria, especially on small children and pregnant women are, however, undisputed.

Well-intentioned environmental bans on DDT make dinner safe for the cloud of nibbling mosquitoes , but the proper use of DDT on the walls of my home could make life measurably and dramatically safer for my family and guests. Until an alternative is found that can just as effectively prevent malaria and contribute to its permanent eradication, DDT should be invited to the table.


(I submitted this for my Malaria Griot on-line course that I take from ONE.org and Malaria No More)









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