Fighting malaria: It takes a family, a village, and more

By Christine Mubiru

I have experience with malaria, but this is not an enviable position to be in. The disease has affected almost all members of my family to varying degrees and has become increasingly expensive to treat. Fighting malaria requires tremendous support—within our families, from neighbors, and especially from our government. We need to pay greater attention to preventive measures, and I would urge our politicians to take a leading role in sensitizing the public to take advantage of existing methods to combat the disease and to be open to new interventions when they come along.

Malaria episodes grew less frequent for me but more expensive
Growing up in the 1960s, malaria episodes were common, but the consequences seemed less dire than today. Many times, I would miss a day or two of school. Treatment mainly came in the form of injections or pills—usually the bitter quinine kind—and neither was desirable to a child. I would feel weak and dizzy and really hated the idea of lab testing, which usually meant having technicians repeatedly prick my arms in search of blood. They would say it was difficult to get a hold of my veins and sometimes would postpone this painful process to another warm day. But because I knew all the malaria symptoms, I would find a way to get medicine, sometimes turning to self-medication, a practice embraced by many who lacked adequate funds or who were hoping to reduce the time spent at a health facility.

As I grew older, malaria episodes became less frequent—though very expensive. As I pursued a Master of Sciences degree in the U.K., I was surprised at certain questions that appeared on doctors’ forms, such as, “how often have you had malaria?” I thought then that the disease was so common that nobody would be interested in its frequency.

All the children in the family, including my nieces and nephews, cried in the presence of uniformed nurses, whom they hated more than the doctors, as the nurses were the ones responsible for administering injections. My youngest sister was seriously affected with the disease as a child. My parents worried that malaria would eventually cause her mental disability. She would have unconnected talk, convulsions, and cerebral malaria episodes, and she would be hospitalized for at least a week at a time. It was expensive for my civil servant father, who at times had to seek private health care, without the benefit of insurance. After primary school, my sister appeared to develop some immunity to the disease, and her situation improved.

Payment for treatment was always an issue
In the 1980s, my young daughter and first born had fewer episodes than her brother. One explanation in our family was that she had a good appetite and therefore a stronger body to fight disease. But one day while I was at work, she started convulsing. The maid carried her to the nearest local clinic only to be turned away by the doctor in charge because he was not assured of payment. In those days, mobile phones were not yet on the market and public transportation was not easily available. The doctor advised the maid to take the baby to the hospital, but this was a challenge for her, considering that the hospital was quite a distance away and that she neither had the money nor the know-how to deal with emergencies and hospital bureaucracy. My daughter was saved by a young visiting doctor, who injected her with Valium while waiting for my arrival.

My son had a rough time during his primary school years in the 1990s. School administration would call me from time to time to have him taken for treatment. He was usually so talkative and playful that it would be easy to notice he was sick, as he would get quiet and would want go to bed at unusual times. His situation improved when he advanced to secondary school. I remember being called no more than twice in six years to pick him up for treatment. Since then, treatment has become far more expensive, with introduction of the artemisinin-based combination therapy Coartem, which the schools can’t afford. Bed nets are always among the items on the list given to parents when their children are admitted to school—particularly boarding school.

Many in my family have been treated by my brother-in-law, who is a doctor. My children and I have also attended the clinic of a family doctor close to where we live. Both are considerate with regard to payment, as those who do not have enough funds at the time of their visits are allowed to pay the balance soon after.

We need an enabling policy environment to beat malaria
Today, as a policy analyst, I see the need to create awareness about current malaria control measures. We also need an enabling policy and legislative environment that allows the allocation of adequate funding to research new malaria interventions, that evaluates the various interventions currently in use, and that allows the most effective ones to be scaled up. It is also important to prepare policymakers and health care providers for timely decisions, should a malaria vaccine become available. Given the suffering and cost of malaria, it is imperative to continue to use the tools we have and to seek additional, effective ways of combating the disease in the interest of finally controlling the disease.

*Christine Mubiru is a policy analyst in Uganda

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