WHEN MALARIA STRIKES… [Archives:1999/17/Health]

April 26 1999

The plasmodium falciparium – the parasite that causes malaria in Yemen – resembles a tiny football, visible only through a 1000-power microscope. It can lodge in the nasal passageway, mouth or throat. Usually, saliva in the throat, the tiny hairs in the nose and windpipe, and coughing, keep malaria’s microbes out of the lungs… 
Although not a major killer in the West, malaria in Yemen accounts for 20,000 deaths every year. Often, it seeks out the weak: tiny tots, the elderly, and people of all ages whose resistance is sapped by other ailments and/or malnutrition. It is prevalent in the countryside, especially in Hodeidah, Taiz, Ibb, Dhale’ and Lahej. 
Zainab, 30, woke up one winter day with special flu symptoms – slight headache, dry cough and chills. She knew there was something wrong. But it was already 6:00 am and she – as mother/wife, had to take care of the family’s needs. A strong woman from a village in the mountains near Habeelain town in Dhale’, she had not complained of many things in the past. 
Zainab first completed a few household chores, tended the family livestock, and then left the house to fetch water from the nearby well. She got weaker and weaker as she drew up the water, and was just able to make it back home before she collapsed. The family was still asleep. There was no one to care for Zainab. A woman not given to much complaining, she was left on her own. 
Omar is a teacher at a government school in Sanaa. At the young age of 26, he is fit as a horse, or so he believed. 
Last December, he became ill. He thought it was a common flu. He took sick leave from his work at school. Unawares, he had been seeded with plasmodium falciparim – a parasite generously distributed by the female of the anopheles mosquito, Omar stayed at home waiting for his “flu” to subside. But a day later, he awoke delirious from fever – he thought he saw hair growing out of the wall. Sweat was beading on his forehead, and his body was trembling as he asked for more covers, in spite of very high temperature. Relatives and friends rushed him to hospital, as he gasped for air. By the time he arrived at the hospital, he was unconscious. 
The doctors did not take long in the diagnosis. Omar was struck by malaria. The parasite lodging in the mucous membranes of his upper respiratory tract now stuck to his trachea. There, his cilia – undulating microscopic hairs – tried to force the invading bacterium back up his windpipe. But, perhaps because his millions of cilia had been decimated by cigarette smoking, they were paralyzed. The bacteria swept past more cilia in the windpipe – then down into the teacher’s lungs. 
Every day, there are some 5,000 new cases of malaria patients in Yemen. If these people are lucky, they survive the ordeal after a few days’ battle. If they are unlucky, they are either dead or stuck with repeat attacks of the disease. 
Given the gravity of this problem, many people wonder why the authorities do not give it higher priority. It is doubly puzzling when one notes that senior state officials have also been exposed to it. Over the last few months, the prime minister, Dr. Abdul-Karim Al-Iryani; the Vice President’s son, Nasser; two ministers; a governor; and many other notables have been among the victims. Of course, the senior officials do get special care. And in almost all cases they are flown out for treatment. 
Doctors strongly urge patients to immediately seek medical assistance if they suspect malaria. “The germ reproduces explosively,” explained Dr. Abubakar Al-Qirby, Professor at the College of Medicine at Sanaa University. Indeed, every half an hour or so, the bacterium divides, as do its progeny and all their descendants. In one day’s time, each pneumocouus becomes a colony of a trillion. 
At first sign of the infection, the body reacts. White blood cells begin to multiply in the bloodstream. The battle between these knights of the immune system and the fast reproducing plasmodium falcparium soon clog the hundreds of millions of alveoli, the microscopic air sacs that make up the lung. As sputum builds up faster than the patient can cough it out, his/her lungs become damp sponges, barely able to provide inhaled oxygen for the bloodstream. If the situation persists, the patient dies. Immediate hospitalization to get a strong dose of antibiotics administered is life-saving. 
Gasping for air and thus inhaling twice as much air as normal, malaria patients try hard to get oxygen in. But too little passes through the congested lungs into the haemoglobin, the pigment that gives blood its red color, and carries oxygen to the cells of the body. The patient also endures terrible nightmares with sweat beading down the forehead and other parts of the body. Sleep is haunted by terrifying visions and the days are plagued by anxiety and restlessness. 
Time is the critical factor at this stage. 
Omar was lucky to have been hospitalized quickly. That saved his life. Zainab was not that lucky. The nearest hospital is a day’s drive from her village, and on bad roads. Besides, her family did not have the cash at hand to ship her out immediately. They still mourn her. 
The Minister of Health is not leaving a stone unturned in search of financing. “I need all the help I can get. Even small amounts of money will go a long way to save many people’s lives,” he pleads.