We have all seen the faded photographs depicting the success of the “Big Game Hunter” of the Victorian era: well dressed, well fed, often mustached; a shotgun in the crook of the arm and one leg flexed at the knee with a foot on the head of the trophy: lion, tiger, elephant; certainly a creature that warranted the adjective “big” and, by implication, the more sizable the game, the greater the courage and therefore the prestige of the hunter.
Today, I became a “Small Game Hunter”. I know exactly the moment when I became implicated and it is the reason why I write this small piece.
It was at noon today when I shone my bright torch into the deep dark eyes of little David and confirmed that his life had departed and moments later performed again this, my final duty for Bernadette, already knowing well that like her small body that we had tried so hard to resuscitated, her eyes were already empty of life.
And when, as I watched the saddened tearful parents of David and Bernadette leaving our little ward of severely ill children for the last time, each with their small lifeless bundle, beautifully wrapped in the intensely coloured materials so customary in Africa, I reflected upon what had happened during this one minute of time, at midday, here in rural Chad and suddenly the enormity of the tragedy that is malaria struck me with full force.
In our world, and particularly here in Sub-Saharan Africa, a David and a Bernadette die each minute; two children each minute!
More than one hundred children every hour. The equivalent of six big jets full of children crashing each day.
Just a few days ago when walking with my colleague Alex in an isolated part of the country, near the river besides which our small town is built, watching the birds of prey circle above our heads and observing the thick cover offered by the tall grasses and thick shrubs, I commented that one might expect a lion to appear from the undergrowth any moment.
Alex assured me that this was most unlikely and we continued our walk without a further thought for this eventuality, but we avoided the ground that remained wet and boggy and where, at this time, the end of the rainy season there were still small lakes and pools of water, believing that this was probably the ideal habitat for serpents. For some reason, neither of us gave a thought for the real danger that lay in these places. The “Small Game”, the mosquito that was responsible for the deaths of David and Bernadette.
For, it is the mosquito that carries the parasite that causes malaria. We have known this fact for close on one hundred years and we know further that it is in those places where Alex and I feared the serpents that the mosquito develops from its aquatic form to its fully fledged winged form, capable of locating its human victim from up to fifty metres by reason of the carbon dioxide that we breathe out and the large variety of odours that emanate from our bodies.
So, if we know so much about the life cycle and habitat of the mosquito why have we not eliminated this “Small Game” in the same manner as the “Big Game” had, we believed, been eradicated from those places where we walked in such tranquillity?
Probably, the reason for the persistence of malaria is at least in part because malaria has been “medicalised”. It is a disease and therefore like other diseases it “is best left in the hands of the medical profession.”
Without doubt that is the case for those already inflicted by the disease and certainly the medical and pharmaceutical professions can be proud of what they have achieved and certainly I am proud that due to the program put in place by Médecins Sans Frontiers here in Chad of which I am a part, we have reduced the mortality of those children suffering from severe malaria from a level approaching 100% to less than 5%.
Likewise, the contribution of the pharmaceutical industry, that has produced products that if taken regularly reduce the risk of malaria developing in ones’ body, even if bitten by an infected mosquito as well as treatments that if taken early on in the course of the disease are usually effective.
And of course we all sleep under mosquito nets and spray our bodies with products that hopefully make us less attractive to the mosquito and even spray the nooks and crannies of our building where the mosquito may linger, even for many months.
But to eliminate malaria totally from our planet one has need of a military rather than a medical mind, for, with malaria the only chance of real success is to start from a point where malaria does not exist and progressively extend this malaria free area. The “Small Game Hunter” must follow a plan similar to that of General Eisenhower during the Second World War, establishing and securing a beachhead as at the Normandy Landings of D-Day in 1944 before spreading from that point to liberate Europe.
Here in Africa, the beachhead already exists; it is the Sahara desert, where, on account of the dry climate and the relative absence of humanity the malaria parasite cannot spread effortlessly as it does here in the more densely populated and humid areas further south.
And it is to the small pools and lakes that surround the villages and centres of population that ones’ attention must first turn remembering that the perimeter of activity of a mosquito is not great even when assisted by a favourable wind.
Each village must locate those places where water accumulates and where the mosquito develops from its aquatic form as the following diagram shows.
The Life cycle of the mosquito © Enchanted Learning
Sensibilisation and prevention activities are key today to tackling the vector factors: distribution of mosquito nets, use of insecticides, respecting local ecological environments, soap with lemongrass etc are initiatives going in the right direction.
It is these small game hunter strategies which could diminish significantly the risk of malaria for the population living near mosquito pools.
With all these means against mosquitoes, there is no reason why this disease that, let us remember, previously affected much of southern Europe, could not be eliminated from Africa – or really contained – thus permitting little David and Bernadette, and so many like them, to live their lives of which they were so cruelly deprived today .
Top image is an archive photograph of a family waiting for a malaria consultation in Moïssala, 2011