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07.10.2008 Feature Article

My Malaria

My Malaria

I had the privilege last year to be at a conference in Gabon, which was attended by medical researchers from many African and other countries.

Many topics were discussed and it was interesting to be reminded of the fact that in African countries, we have so many challenges in common, not only as far as diseases such as Malaria, tuberculosis and of course HIV are concerned, but also in areas of politics, economics etc.

Over meals and during the bus rides, the Kenyans in the group shared in vivid detail stories about the then just ended civil unrest and the Nigerians reminded us that discovering oil is not always a blessing.

(But we know that already, don't we?) Of course the then recently ended Africa Cup of Nations tournament came up too.

(Incidentally on the way back, we were again reminded of just how much alike Africans are when we got to the airport in Libreville.

After our bags were weighed and checked in we were asked to go behind the counter to “verify” our bags which request we dutifully obeyed.

We all found it strange that having checked in our luggage only five minutes earlier we were being asked to go and “verify” it behind the counter.

We, however, pointed out our bags to the airport staff, confirmed that they were indeed ours and left.

Ten minutes later we heard one of our names being called over the airport intercom system to report to the baggage counter.

Our colleague whose name was mentioned went back to the check-in desk. We all wondered what was wrong.

One of my colleagues even jokingly said that they might have mistaken the gari in our bags for cocaine.

It turned out, however, that when we were asked to “verify” our bags we were actually supposed to “leave something for the women”… I suppose in Ghana it would have been “leave something for water”…)

We had a whole presentation on problems with Malaria treatment in African countries and I was reminded about the hue and cry that arose early last year (or was it the year before?) when the Ghana Health Service introduced the Artesunate- Amodiaquine combination as the new treatment for Malaria and the problems that came up.

Whenever the topic comes up, one often hears people in Ghana say things like:

“As for 'my Malaria', when I take chloroquine, it goes”, or, “As for 'my Malaria', when it comes, I just take artesunate alone for two days and I am okay”.

Is there anything wrong with this very common attitude of not complying with the standard recommended treatment for Malaria?

What's the big deal? After all if you take four tablets of chloroquine or two days of artesunate and you get better, what does it matter?

Since the aim of taking medicine is to help one recover and get back to work or school or whatever, does it make a difference what drug you take or for how long you take it?

It all depends on how you look at it. We had a presentation on Anti-Malarial drugs and how they work, by a Kenyan lady colleague and I would like to share some of the things she reminded us about in her excellent presentation.

As every Ghanaian schoolchild knows, Malaria is caused by the Malaria parasite which is introduced into our bodies when mosquitoes bite us.

The Malaria parasites do all kinds of nasty things in our body including destroying our blood cells, invading our livers etc.

They also multiply and produce more parasites which can be picked by other mosquitoes and transmitted to other people.

The important point here is that there is nothing like “my Malaria” because the parasites that grow in my body today can be sucked up by a mosquito and given to my children, my neighbours, or even to the President!

Remember these mosquitoes are no respecter of people and a President's blood tastes like any other.

Artesunate is a wonderful drug.

When a sick person takes it, it acts fast and within a day or two it can clear up to 80 per cent of the Malaria parasites in the sick person's body so that he begins to feel better quickly.

However, if you take any population of living things be they humans, plants, or mosquito parasites you will find that each individual is slightly different from the other.

For example, if you take a group of schoolchildren of the same age and measure height or any other natural trait, you will always find that whilst most of them will be roughly around the same average height, a few of them will be very tall and a few very short.

Similarly, if you take a group of Malaria parasites, you will find most of them will be of average strength and will, therefore, eventually be killed by the drug.

A few of them will be weak and, therefore, very easily killed by the drug and they will often be the first ones to die.

However, there will always be a few champion parasites that the drug will have to fight with extra hard to overpower them.

Whilst, as I said earlier, artesunate is a wonderful drug which works very fast and effectively, it doesn't last very long in the body.

It kills enough parasites to make you feel a lot better but it may leave a few still alive and these ones still alive are, of course, the champions I mentioned earlier.

They may not be enough to make you ill again but remember that champions often give birth to more champions.

Thus anyone who takes only artesunate is likely to get better but at the same time will contribute to breeding a pool of super champion Malaria parasites that with time will become so many that if we continue using it alone, we will find that a few years down the line, artesunate no longer works.

That is exactly what has happened to Chloroquine and this is why more than a quarter of the Malaria parasites in the system are now resistant to it.

Amodiaquine works more slowly, but lasts longer in the body so after the Artesunate has quickly got rid of the bulk of parasites, the Amodiaquine stays behind to mop up the super champion drug-resistant parasites which left alone would be passed on to someone else who, especially if a child, might just die.

You can think of Artesunate as the striker who causes the drama of cure and Amodiaquine as the rest of the team - equally important in winning the match against Malaria but not always as visible. Another analogy would be that if you had cockroaches in your storeroom and decided to spray, you would probably kill most of them with the first spray.

If, however, you stopped after the first round of spraying, there will always be a few champions who will bounce back and start a family so that within a short time, your storeroom will be infested again.

If, however, you go on spraying every day for a week, you will eventually get rid of all of them.

Next time you fail to take your Anti - Malaria medications as prescribed (and keep in mind that the same principles apply to antibiotics!) remember that whilst you may feel better after a short time, you are contributing to the death of over a million children who die every year in Africa from Malaria because they have not yet got the immunity that adults have.

If you are extremely selfish and are not moved by that figure, think about this:

Those super champion Malaria parasites you helped breed by your careless attitude to taking drugs may just go round, kill a few children and eventually having done the rounds, come back and kill you because by then they would have grown into little monsters that no drug can control.

Take both the Artesunate and the Amodiaquine and if your doctor prescribes only artesunate tell him or her to add the Amodiaquine unless there is a real reason why you cannot take it, for example a drug allergy.

(Of course some tablets have both drugs combined so make sure you ask before you are accused of being “too known”!)

I know many doctors still don't bother to prescribe the two drugs because old habits die hard but it is important that we all help in the fight against drug resistance.

Remember, it is not my Malaria or your Malaria or even their Malaria, it is our Malaria. We are all in the boat together.

Daily Graphic
Daily Graphic, © 2008

This author has authored 236 publications on Modern Ghana. Author column: DailyGraphic

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