Malaria

So I purposefully did not put too much technical information in the last post about my malaria diagnosis and treatment. I feel that is better left to a separate post, as it is a fairly complicated thing. The first think you have to understand is that malaria is a parasite. Mosquitoes are not deadly on their own, and neither is malaria a virus. Second, you have to understand the parasite's life cycle.

Believe it or not, this is the least-confusing graphic I can find. (Found here, good info too!) Super basically, When an infected mosquito bites you, infected baby parasites are taken through your blood stream into your liver, where they grow. When they are big enough, they release into your blood stream and use your red blood cells to multiply. Eventually, your red blood cell can't take it anymore, they burst into your blood stream, which is how malaria makes you sick and eventually kills you. This may happen several times until a mature gameotocyte is formed. (Gameotocytes are precursors to male and female gametes, or eggs and sperm.) Then another mosquito bites you, takes up the gametocytes, allows them to mature, and the parasite's life cycle continues.





There is no vaccine for malaria, just like there is no vaccine for any other parasite. Creation of this particular vaccine has found many obstacles, including the fast life cycle of the parasite, mutation of the parasites, and monetary problems. (I'm going to include this link, which is currently not working, but I'm hoping will come back soon because it's great.)
In order to prevent malaria, I have been taking doxycycline. (Unfortunately, Google is giving me fits trying to figure out HOW it prevents malaria instead of just finding that fact that it DOES prevent malaria.) It is approximately 98% effective in preventing malaria. From what we learned in training, doxy and the other two prophylaxis medications PCVs in Uganda take, malarone and mefloquine, do not prevent a person from getting the malaria PARASITE. Instead, they prevent a person from getting malaria SYMPTOMS. As PCMO explained it, regardless of the prophylaxis a person is taking, the parasite will still be in the person's liver. This, however, does not make a person sick, as I explained above. 
So how did I get malaria? Well, I was in the 2% where the prophylaxis is ineffective. I have not missed a dose of my medication; I tuck my mosquito next in every day; and I avoid going out at night. Per usual for my life, I am just in the minority health-wise. 
And to be honest with you, whether I actually have malaria or not is questionable. I have had my blood tested three times, with two tests for malaria each time, and of those six tests, only one of them came back positive. (If you're interested in how the tests are run, the CDC's website has some great information.) That means I literally have a 5:1 chance that I don't have malaria, but even with that small chance, they are making sure I finish the medicine to treat malaria and keeping an eye on me.
Why is malaria so deadly, though, if there are such simple ways to prevent it? If I can be blunt, perhaps because the most malaria-endemic nations in the world are also the poorest in the world. Although by an American's view doxycycline is a fairly affordable medicine (about $30 a month without insurance, probably less when you buy in bulk), just because its affordable in the US doesn't mean it's affordable. (EDIT: One of my fellow PCVs pointed out that taking prophylaxis for long periods of time can be harmful to your health, which is very true, so in addition to the cost, the health factor makes prophylaxis simply unreasonable for Ugandans, with the exception of pregnant women during their pregnancy.) This is not to even mention hospital care for malaria. For some, even mosquito nets are not affordable. Thankfully, my host family has and uses mosquito nets, but this is not the norm. To add to the lack of affordability, many do not understand that even if a person grows up in a malaria-endemic country, that person is still not completely immune to malaria. They do not understand the malaria life cycle, how it is spread, how it is cured, etc. Education is lacking in these countries because when your people are starving, are you going to feed them or educate them first? Although I am here to be a PTC tutor, part of my job is still to educate Ugandans on malaria, its life cycle, its treatment, and most importantly, its prevention. Maybe we won't stop malaria completely, but I hope we can lessen its impact on this country.



PS: Here's a picture my sister created of me as a mosquito.