Eradicating diseases is catchy. Who wouldn’t want to rid the world of HIV, TB, or malaria? While the idea or eradicating malaria is certainly appealing, given our track record of successful disease eradication, this goal must be carefully considered and quantified.
I’d like to share a personal anecdote in order to highlight some of this uncertainty. I spent last spring studying community health in Tanzania and Vietnam. A large portion of my time both in the classroom and in community visits was spent studying malaria through the lens of global health policy coursework, lecturers, and personal acquaintances. Before going to Tanzania I understood the basics about malaria as a vector borne disease transmitted by mosquitoes. What I didn’t understand though, was why it might be so pervasive and complicated.
I spent some of my time in Tanzania staying in Tegeta, an unplanned suburb of Dar es Salaam. What does it mean for an area to be unplanned? It means that there were no paved roads, that there was a stream/large puddle/sometimes river to cross on my way to the bus stop, sporadic electricity and running water, and no waste disposal. All of a sudden, it seemed as if malaria could be anywhere, from the ditches and puddles that filled roads to the uncovered buckets of water next to toilets used for flushing.
When I visited a health clinic outside of town, I was shown a commonly used malaria medication. I was shocked I could read the instructions. In a country where most inhabitants speak only Swahili, the instructions were in English. I was also told that when patients came in bearing common malaria symptoms , they were immediately given medication. Interestingly enough,the test to diagnosis malaria was in fact more expensive than the medication. It was no longer a surprise to me that resistance to malaria medication was increasing. How could it not, when people were given medication when it might not be necessary and when patients couldn’t read instructions to take the full dosage?
When I asked my host mother about malaria, she told me not to worry because they had the walls of their house sprayed with insecticides a few months before. When I asked my host father, a doctor who worked for the WHO, he sat me down and drew me a diagram that explained how malaria is transmitted. A week later my host brother got cerebral malaria, the most common complication and cause of death in malaria cases—he couldn’t speak and could barely walk; for two weeks he sat in the house in a dreamlike daze.
My point is that it is impossible to treat malaria on its own. While it is certainly admirable to pour huge resources into vaccinations and bed nets, what about the conditions that contribute to the spread of malaria? Malaria is connected to poverty, poor infrastructure, and unclean or inaccessible natural resources. If we dump funding into malaria in the same way we have dumped funding in to HIV/AIDS we will fail. If we neglect to understand the connection between poverty, inequality, and natural resources, we will be unsuccessful. That said, rather than creating the narrow goal of eradicating malaria, let us try to improve basic health services, let us build roads, and create wells—let us see the whole picture, rather than a single shot.