Malaria and Africa by Dr Stephanie Jones

Dr Stephanie Jones is an Infectious Diseases Physician at Dandenong Hospital. Dr Jones held senior positions from 2004-2010 working in many of the world’s most disadvantaged developing countries. Of her 7 year overseas experience, Dr Jones spent 2 years working in Africa with Malaria Control Programs. This is her story.

I worked for over 2 years as a doctor in areas of Africa where malaria is hyper-endemic; that is almost everyone in that area will get malaria at least once, at some time in their life. Most people get malaria when they are a baby and at their most vulnerable in terms of development and survival. 

I worked at a hospital that had the best medical facilities in the region, supported by a mining company. During the rainy season our hospital beds would be full of babies receiving medicine for malaria and for the complications of malaria. Severe malaria can affect the brain causing coma and seizures, it can break down red blood cells causing jaundice (yellow eyes) and anaemia. It causes high fevers, body pain, kidney and liver problems, inappropriate bleeding and often death, even in a hospital as well supported as the hospital I was working.

In the local medical facilities where they don’t have the right drugs to treat malaria or give blood transfusions or to provide the life-saving support that we were able to, and in the villages where the people had no access to medical centres, babies and young children die every day from malaria.

I looked after a 3-year old boy who had very severe malaria. He was in our hospital for 4 weeks, near death and it was only the good luck that his parents had in being able to access our clinic and the tireless efforts of the nurses that allowed him to survive. I met him some weeks after he was discharged from hospital and he had not yet fully recovered from malaria’s effect on his developing brain. He may be permanently disabled. He may not be able to get an education, a job or a family. He is alive.

My other role was working with local and international staff in implementing Vector Control Programs to reduce the number of mosquitoes and the opportunity for mosquitoes to spread malaria in communities affected by large-scale gold and copper mining. Trying to prevent malaria is very complex and requires action at all stages of the malaria life cycle. The parasite causing malaria is spread from person to person only by Anopheles mosquitoes, which bite people from dusk to dawn.

In rural Africa, extended families live together in mud brick houses with thatched roofs with no windows and no screens; they have no electricity, no air conditioning, and cooking is often done around a kerosene stove in the open air. The rainy season fills puddles, latrine pits and outdoor sewers with water in which the mosquitoes breed. The families have no protection from the mosquitoes which can bite dozens of people in one night spreading malaria continuously through communities.

The team I worked with was trying to reduce the number of mosquitoes and provide some protection to the people in the villages. To reduce mosquito numbers the team would go into all the houses in the villages and spray toxic chemicals on the walls that would kill mosquitoes on contact. They would also help the communities to reduce breeding sites for the mosquito by putting biological control measures into stagnant water and cleaning up as much standing water as possible. The team would also distribute bed nets to families. Each family would get 2 bed nets; up to 6 people might have to sleep under one net. If the family were so poor that they were unable to feed themselves, they might take the net and sell it or use it as a fishing net in order to have food.

The people most at risk of malaria have no jobs, no money, little education, and many other serious threats to their survival. Even though people in these areas have had recurrent episodes of malaria and lived and died with it every day they don’t understand what causes it and how to protect themselves. We worked with schools and in the communities giving education and testing and treating school children who were infected with malaria.

By providing education, mosquito control and bed nets we hope that people can participate in protecting themselves, by staying covered when the mosquitoes are biting, using bed nets, reducing mosquito breeding sites around their houses, recognising the symptoms of malaria and going to a good medical facility to get the right diagnosis and the right treatment when they get sick. Our program also worked with the local medical facilities, training the doctors and nurses, giving them microscopes so that they could diagnose malaria, and helping them to keep stocks of effective malaria treatment. 

A bed net is a small but very effective protection in the big fight against malaria. Every little contribution to preventing malaria will save a life.