Category Archives: malaria

DDT Good! Chloroquine Bad!

On one occasion in 1976 when I left my New Guinea village to make a trip into town, my host family asked me to get medicine to kill the head lice their son had picked up while away at school. I did so, and he rubbed it into his hair and then tried to refrain from scratching his scalp as the lice ran around in their death throes. I think he may have had to “lather, rinse, repeat” to get the remaining nits after they hatched, too. It seemed to be effective, but I was horrified at the time to read on the label that the active ingredient was DDT. Nowadays, though, the reputation of DDT seems to have entered rehab.

On 11 April, the New York Times carried a story by Tina Rosenberg headlined, What the World Needs Now Is DDT:

[The book] ”Silent Spring” changed the relationship many Americans had with their government and introduced the concept of ecology and the interconnectedness of systems into the national debate. Rachel Carson started the environmental movement. Few books have done more to change the world.

But this time around, I was also struck by something that did not occur to me when I first read the book in the early 1980’s. In her 297 pages, Rachel Carson never mentioned the fact that by the time she was writing, DDT was responsible for saving tens of millions of lives, perhaps hundreds of millions.

DDT killed bald eagles because of its persistence in the environment. ”Silent Spring” is now killing African children because of its persistence in the public mind. Public opinion is so firm on DDT that even officials who know it can be employed safely dare not recommend its use. ”The significant issue is whether or not it can be used even in ways that are probably not causing environmental, animal or human damage when there is a general feeling by the public and environmental community that this is a nasty product,” said David Brandling-Bennett, the former deputy director of P.A.H.O. Anne Peterson, the Usaid official, explained that part of the reason her agency doesn’t finance DDT is that doing so would require a battle for public opinion. ”You’d have to explain to everybody why this is really O.K. and safe every time you do it,” she said — so you go with the alternative that everyone is comfortable with.

”Why it can’t be dealt with rationally, as you’d deal with any other insecticide, I don’t know,” said Janet Hemingway, director of the Liverpool School of Tropical Medicine. ”People get upset about DDT and merrily go and recommend an insecticide that is much more toxic.”

So DDT is now making a comeback, but Chloroquine, the antimalarial I took in New Guinea, is now anathema. (And it wasn’t all that effective for me. I got a bad case of Plasmodium vivax while there, and another within a year of returning from fieldwork.)

On 8 April, the Independent carried an alarming story by its health editor, Jeremy Laurance, headlined WHO failures led to hundreds of thousands dying from malaria, say medical experts.

Two of the world’s most powerful medical organisations have been accused of medical malpractice for knowingly promoting useless drugs that have led to the deaths of hundreds of thousands of children.

The World Health Organisation and the UN Global Fund, which was set up to buy drugs for poor countries, have allocated millions of dollars to malaria medicines that are no longer effective against the disease, a group of specialists said. They claim negligence by the two organisations contributed to a rising death rate from malaria, which has doubled in a decade in some parts of Africa because of growing resistance to older drugs.

The WHO launched its Roll Back Malaria programme in 1998 with a target to halve the number of deaths by 2010, but six years into the 12-year programme deaths have risen from between 600,000 and 800,000 to over one million annually, of which 90 per cent are in children under five.

Amir Attaran, of the Royal Institute of International Affairs in London, who made the accusation of malpractice in The Lancet with 12 malaria specialists from Britain, the US, Africa and the Far East, said yesterday: “I am angry because I know hundreds of thousands of kids have died for nothing; possibly millions. It is really negligent for these organisations to have made no progress towards the target in six years. Why should anyone connected with the programme still have their job?”

In 2003 the Global Fund, acting on advice from the WHO, spent $41.4m (£22.5m) on the outdated anti-malarials, chloroquine and sulfadoxine-pyrimethamine, which have been rendered useless by growing drug resistance, but only $18.3m on artemesinin-based therapies, which are effective.

Countries worst affected by malaria in sub-Saharan Africa have proved reluctant to buy the new artemesinin drugs because they are more expensive at $1 to $2 a dose, 10 times more than chloroquine. Although they get help from the Global Fund, they fear they may be left to foot the bill themselves. As a result, patients treated with the outdated drugs in Africa outnumber those given the effective artemesinin drugs by more than 10 to one.

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Morobe Field Diary, November 1976: Demographics

The population figures of nearby villages I obtained from the kiap in Morobe [Patrol Post] follow:


Village   Total     Adults      Children    Adults outside province

Buso 108 24m 27f 23m 27f 3m 1f
Kui 333 81m 81f 88m 69f 8m 2f
Sipoma 294 84m 69f 69m 58f 12m 2f
Paiewa 276 69m 72f 70m 61f 4m 0f
Maiama 483


[The predominant local language of Kui & Buso is Kela.

Sipoma is the only village that speaks Numbami.

Both Kela and Numbami are Austronesian languages.

The predominant languages of Paiewa and Maiama are non-Austronesian (Papuan),

members Binanderean family.]

This confirms my impression that the eligible young men of this village far outnumber the young women.

More statistics: Two Sepiks are married into the village. They work at the timber co. and so are in the village mostly on weekends. Their children are too young to talk yet but will probably speak Nu. The fathers mostly don’t speak Nu. but understand some. One Wain man recently married in — also works for the timber co. — no children yet. Two Kui women married in — both speak Nu. and kids of both do also but I’m less sure about one family. One Kui woman doesn’t speak Nu.; neither do her kids though they may understand it fairly well. One Morobe woman speaks Nu., her kids speak Pidgin [Tok Pisin] and their father speaks T.P. to them most of the time too. Also one Markham woman speaks Nu. as do her kids I believe; her husband is Nu. & away a good bit.

Next year one young Nu. is off to do 5th & 6th form at the new national H.S. at Aiyura (where SIL headquarters is), one if off to Sogeri H.S. near Mosbi [Port Moresby], 2 off to Kerevat in Rabaul (brother to 5th form; sister to 6th). One girl and 2 boys will go to Junior High in town. Some people working away from the village:

1 agricultural inspector (Jack S.)

1 malaria service mosquitologist (Tom S.)

1 development bank clerk (Kaukisa S.)

1 N.S.W. bank teller (off to Mosbi for training)

1 teacher at Kaiapit

1 NCO in PNG Army (Igam Barracks)

1 in forestry service (Bing Siga, in Aust. for training)

1 radio repairman in Lae

1 cattleman (half Nu., half Sepik)

1 machine repairman in Wau (half Nu., Peter)

1 policeman at Rabaul (Marawaku’s son)

1 assistant kiap at Boana (__ Siga)

1 store clerk in Mosbi (__ Siga)

1 secretary at UniTech (Aga __)

1 medic at Morobe (Dei)

1 in fisheries (Lukas)

1 in transport co. (Panett)

1 teacher at Kui

In addition, Daniel/Siga said that everyone older in the village except his mother has gone to Yabem School (max. 4 years). Evidently they went thru in age cohorts: Abu Bamo’s, then Giyasa’s, then Yali’s, then Siga’s. The war disrupted people like Lukas, who claims he’s had only about 1 year of school but has a well-respected business head.

NOTE: Blogger doesn’t turn off the <pre> tag very predictably. It wouldn’t wrap the paragraph after </pre>, so I had to force linefeeds. I initially tried the <table> tag, but blogger added way too much white space above it.

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How Padre Carlo Came to Phekhon, Burma

My tribe were mostly animists, although some were Buddhists, who worshipped the Nats. These nature spirits are not peculiar to the Burmans, who had received them into Burmese Buddhism, but are part of popular religion in most of South-East Asia…. But my grandfather, and later his wife, were converted to Catholicism.

It was an unusual conversion, brought about involuntarily by an Italian missionary, Padre Carlo, who was on his way to China. He had no intention of winning Phekhon for the Church, and was simply passing through. My grandfather was out on a hunting trip, and came upon this strange being, who he decided was either a wild beast or a khimakha (an ogre in the style of the Tibetan yeti, that looks like a cross between a bear and an ape and is tall as a tree). So he captured him and brought him home. Padre Carlo was chained in a pigsty for the night, where his wailings and lamentations could be heard throughout the village. He made signs that he wished to eat, and accepted some cooked rice. This made the villagers suspect that he might, after all, be a human being, and that therefore he had rights, including traditional hospitality. (Some doubts about his humanity lingered, due to the fact that he had no toes. The Padaung had never before seen shoes.) He was persuaded to stay in the village for the rest of his life, and in due course converted the whole village to Catholicism, except for my grandfather. He finally consented to join the new religion only after he lost a wrestling match with the priest, whom he had challenged about the power of his god. The Christian God was obviously potent, because my grandfather was taller and more powerfully built than the priest, who was anyway suffering from malaria at the time.

SOURCE: From the Land of Green Ghosts: A Burmese Odyssey, by Pascal Khoo Thwe (HarperCollins, 2002), p. 25

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Burma: Broken Heaven, Broken Earth

Canadian essayist, novelist, and poet Karen Connelly wrote about Burma in the Asia Observer:

There is only one other person staying at the hotel above the river. She is an artist from Spain. On the evening before her departure, we dine together. She has a pressing need to explain herself.

“I’m an idealist like you. I really am. I grew up in Spain, you know. I remember what it was like, during Franco’s time. My parents were always telling me not to get involved in the politics, it was very dangerous. Really, I am an idealist, and I think it’s terrible that these people are so badly off.”

“I don’t think badly off really explains it. They are poverty-stricken, malnourished. And oppressed. Hungry for many things.”

“Do you really think they are? Really? Is it really possible to be hungry in the tropics? There is so much fruit everywhere. When I was in the north, there were two children sitting outside my restaurant with empty bowls, so of course I gave them some of my food. But someone else would have fed them if I hadn’t. They wouldn’t have gone to bed hungry.”

I swallow a sip of my water, bottled water.

She continues, “A doctor I met up there said that he has never seen the infant mortality rate so high. I agree, that is really awful. But in a way, it’s a natural form of birth control.”

I want to ask this elegant, beautiful woman if she is on the pill. She was educated at one of the most expensive art schools in London. Has she ever had a baby, and watched her baby die, slowly, of diarrhoea? Dysentery? Malaria? Food poisoning? Those are the common killers of babies born in Burma, ailments often complicated by malnutrition. I finish my glass of water. The food has come but my appetite has left me.

“And they are always smiling! I really don’t believe they’re so miserable. They’re always so happy.”

Surely she will hear the exasperation in my voice. “But that’s part of being Buddhist. Many people, especially the poor, accept the conditions of their lives, and they revel in whatever life is around them. The Burmese are a deeply hospitable people, too: that’s why smile at us.”

“They look so happy. There seemed to be a lot of people with bad eye diseases in the north, and even they laughed a lot.”

Awkward pause. What can I say?

“I really am idealist, but if democracy came all at once to Burma, this country would disintegrate! It can’t come too quickly.”

“But the people of Burma already voted in a democratic government. There were elections in 1990. The NLD, Aung San Suu Kyi’s party, won by a landslide. The military refused to hand over power.” Surely she must know these little details from her guidebook.

“Well, voting for freedom is one thing, but living with it is another. If it comes too quickly, Myanmar will disintegrate!”

How can she not see? She is a painter; her vocation is in her eyes. “But the country already is disintegrating. Nothing works here. The currency is a farce, corruption is rife, the military makes deals with druglords, and the overwhelming majority of people cannot afford to live on what they make because inflation is so high. Even the electricity doesn’t work. People die after operations because the hospitals cannot afford proper sterilization equipment!”

She looks at me squarely, condescendingly. “Journalists exaggerate the situation.”

“I haven’t been talking to journalists. I’ve been talking to Burmese people. Students, doctors, artists, market women.”

But the doubt remains plain on her face, tightening her lips. “I know how bad it is. But if democracy comes too quickly …” Her voice trails off. She begins to eat. I move my food around with a fork.

Strange, the fork. Lately I’ve been eating Burmese-style, with my hands. There is something intensely pleasurable about touching the food one puts in one’s mouth. Messy, but fun.

The Spanish artist looks up from her curried chicken with an alarming intensity and asks, “What are you trying to do for the Burmese people?”

This question takes me by surprise. I think for a moment, but can’t decide how to reply. I feel acute embarrassment. Flustered, I say, “Nothing.”

“But you must be trying to do something.”

I raise my eyebrows, searching. “Um. No. I’m not.”

“Why did you come here then? You said you would never come here only as a tourist, so what are you doing here then, if not trying to accomplish something?”

“I’m just talking and listening.”

“But aren’t you trying to accomplish the freedom of these people?”

I laugh out loud; her statement is so lofty. I am embarrassed and uncomfortable that we are sitting at this table in Burma, talking about the Burmese, while the waiters stand at the dining room doors like sleepy sentinels. They might understand everything we’re saying. Or nothing, which is worse. I want to apologize to them. I want to flee. “I don’t pretend anything like that. It’s too presumptuous. It sounds silly. Only they can accomplish their own freedom. I am … hanging around.”

“But you’ve been going on about how terrible the government is here, and how much all these people you’ve met have suffered, and how powerful this place is for you. Don’t you want to do anything? You must be trying to do something. Why don’t you just say it?”

“I just want to write about what I see here. That’s all. That will do whatever it can do. All things considered, that will be very little.”

Now it is her turn to sip water. Oh, let the meal be done, let this be over. In other circumstances–in a gallery in Madrid, for example, drinking sangria in a bar in Segovia, I know I would like her. It is foolish as well as fraudulent for me to stand on the moral high ground, though the natural birth control comment was appalling. But we all say appalling things sometimes. It’s the nature of being white, or powerful, or simply human. I have Gorky to temper me: By then I could see that all people are more or less guilty before the god of absolute truth, and that no one is as guilty before mankind as the self-righteous. The sharpening edge of defensiveness in her voice comes from a guilt which has nothing to do with me. I want to say, “It’s unnecessary, please don’t feel that way,” but I just listen to what she says next with a small, pained smile on my face.

“I really feel that I have done a lot for them. I have tried to talk and smile as much as possible. You know, I’ve tried to let them know that foreigners are not threatening, not awful people. And it’s absolute hell up in the north where there are no other tourists. The locals won’t leave you alone for a second. It’s hard work, to be up there, wandering around, trying to get to places they won’t let you get to, and all the people are mobbed around you, and there’s no other white people. I kept calm the whole time, never lost my temper, always just smiled as much as possible.”

I smile myself. The news is coming on. Out of respect, or perhaps out of curiosity to catch more fragments of our conversation, one of the dining room attendants turns down the volume. Conversation wanes in the presence of the silent news; we turn, along with the young Burmese waiters, to watch images of a fine mango crop on screen, box after box of the small, sweet spheres lined up and glowing like orange gems. Surely it is impossible to be hungry in the land of a million mangoes. Now come the obligatory scenes of a military leader inspecting a new factory. Then a whole troop of soldiers marching on some road somewhere in the jungle. Shot after shot of automatic weapons, belts heavy with ammunition. They are very serious, very thin young men, every jaw bone a study in angles, clenched muscle. The Spanish woman turns away from the television and talks more about the difficulties of being a tourist. I nod slowly, suddenly tired. White-shirted waiters come, take away our plates. With great concern, the younger one asks, in Burmese, why I have eaten so little. “I am not hungry.” He is aghast, despite my attempts to reassure him. When the table is cleared and the poor waiter becalmed, the Spanish artist and the Canadian writer stand up. “Perhaps we will meet again some day in Madrid.” Perhaps. We exchange Buenas noches.

Oddly enough, as I get ready for bed, I think about the Basque country, Euskadi: northern Spain, but not Spain exactly. And so very far from Burma, another world, another lifetime. But every country shares history, just as every human being does. If I know one thing, it is the ultimate meaninglessness of borders. A decade ago, I lived with a woman, also a painter, who was still a child when the tyrant Franco was pronounced dead. As soon as this news came, the children of Euskadi were turned loose from school. The most vivid memory of Maru’s childhood was made that day, when she ran through the village streets with her classmates, crying joy.

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Morobe Field Diary, August 1976: A Visit to Gitua

Dear Residents,

I have a mind to visit you and compare villages, notes, and diseases before heading for Mosbi. G. wrote and said you were thinking of a panel discussion for us three [fieldworkers] on our language work. I’m a little uncertain how it would work….

The visit might be around the end of the month, after which I’ll head back thru Lae, pick up my materials and get set for Mosbi by the 16th.

The doldrums have hit my fieldwork and a fever has laid me low the past couple of days. Everyone in the village is getting it. It doesn’t seem bad enough to be malaria but it’s no fun.

The [M.V.] Sago goes to town tomorrow. Fishing has been terrible lately. [The 48-hour vivax malaria hit hard shortly after the boat left the next day, so I took a treatment dose of chloroquine but had to wait a week before getting into town.]

Let me know if your plans make mine possible. Did J. pay you a visit?

Tako [‘okay, enough’ = Tok Pisin em tasol]


[Later]

Just got back from a trip to P.’s village. It’s a bloody resort. In fact, only 10 miles down the coast there is a resort (at Sialum) where Europeans come for a weekend from time to time. The beaches are sandy, there’s no jungle, not too much rain, beautiful coral reefs offshore, wide, clear, cold rivers nearby, an airstrip–everything great for a resort but detrimental to easy livelihood for the village dwellers. The flat stony ground can’t be near as fertile as the bushy slopes of Siboma; the reefs hinder access to the ocean by canoe (and there are indeed few canoes in Gitua); coconuts are the only likely cash crop; and the place is so windy (from lack of forest or ground contour windbreaks) that small gardens are frequently protected by [manmade] windbreaks. But there is plenty of room to walk about so you don’t get the feeling of ‘living at the bottom of a well’ (P.’s phrase) as you do in Siboma.

The geology is spectacular. The village is on the north coast and the coastline is terraced from the collision of the Australian plate with the one to its north. It makes the ground very rocky and full of limestone (which may make the rivers so blue) instead of volcanic soil as most of the coastline is (when it is not swamp). This collision is what causes the numerous minor tremors that occur all along the north coast and the periodic large ones as a recent one in West Irian near Djayapura.

P.’s language is unbelievable. Its lexicon is practically Proto-Oceanic itself with very few sound changes. A. picked Siboma for its conservativeness but Gitua outdoes it. P. wants to surprise A. with it when he goes through Auckland on the way back.

J.S. & I flew out there in a 9-passenger, twin-engine plane as far as Sialum and then transferred to a 4-seat, single-engine for the 10 mi hop to Gitua. We flew along the marshy coast on the southern side of the Huon Peninsula at about 2-3000 ft, turned inland and climbed to 7000 to go over the mountain-tops (10,000 ft on the way back to get over clouds as well), then descended fairly quickly when we came out on the north coast.

We brought taste treats to the [fieldworker family] like salami, steaks, fresh vegetables, bread & cheese & butter and beer. They were overjoyed. We also took betel nut, pepper catkins & lime. I was made much of when I chewed and complimented on my Tok Pisin by people in the village.

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Not a Hazardous Sport

‘Anthropology is not a hazardous sport.’ I had always suspected that this was so but it was comforting to have it confirmed in black and white by a reputable insurance company of enduring probity. They, after all, should know such things.

The declaration was the end result of an extended correspondence conducted more in the spirit of detached concern than serious enquiry. I had insured my health for a two-month period field-trip and been unwise enough to read the small print. I was not covered for nuclear attack or nationalization by a foreign government. Even more alarming, I was covered for up to twelve months if hijacked. Free-fall parachute jumping was specificially forbidden together with ‘all other hazardous sports’. But it was now official: ‘Anthropology is not a hazardous sport.’

The equipment laid out on the bed seemed to contest the assertion. I had water-purifying tablets, remedies against two sorts of malaria, athlete’s foot, suppurating ulcers and eyelids, amoebic dysentery, hay fever, sunburn, infestation by lice and ticks, seasickness and compulsive vomiting. Only much, much later would I realize that I had forgotten the aspirins.

It was to be a stern rather than an easy trip, a last pitting of a visibly sagging frame against severe geography where everything would probably have to be carried up mountains and across ravines, a last act of physical optimism before admitting that urban life and middle age had ravaged me beyond recall.

In one corner stood the new rucksack, gleaming iridescent green like the carapace of a tropical beetle. New boots glowed comfortingly beside it, exuding a promise of dry strength. Cameras had been cleaned and recalibrated. All the minor tasks had been dealt with just as a soldier cleans and oils his rifle before going into battle. Now, in pre-departure gloom, the wits were dulled, the senses muted. It was the moment for sitting on the luggage and feeling empty depression.

SOURCE: Nigel Barley, Not a Hazardous Sport (Henry Holt, 1988).

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Scenes of Old Batavia

“In June 1775, C. P. Thunberg dined with a party of fifteen, on the eve of his departure for Japan. On his return at the beginning of 1777, he found that eleven of the fifteen were dead. Von Wollzagen found in 1792 that all his friends had died within a period of sixteen months. Of one hundred and fifty soldiers who arrived with the ship Morgenstern in 1770, only fifteen were alive four months later. Dysentery, typhus, typhoid and malaria were the principal diseases.”

“In Batavia everybody drank a bottle of wine a day as a manner of course, quite apart from the beer, sake, spirits and so on which were consumed on the side. Heavy drinking was customary at parties. Visitors were given a toast with each glass of wine, principally no doubt to compensate for the lack of intelligent conversation. Official parties were punctuated with a numerous and official toast list, sometimes accompanied by cannon shots and three cheers. The widow of Governor-General van der Parra, about 1780, who according to contemporary witnesses was an exceptionally sober and strait-laced man, died long after her husband but still left forty-five hundred bottles of wine and over ten thousand bottles of beer.”

In 1811, the British took control of Batavia. The Dutch resumed control in 1816.

“Today an average international gathering in the Far East would probably greet with amused incredulity the statement that a British government, of all groups, should have had a lightening, gay effect upon any society whatever, but so it was in 1811. In those days and by comparison with the slow Dutch, the British looked like tearing, merry madcaps.”

SOURCE: Emily Hahn, Raffles of Singapore, as quoted in Nigel Barley, The Duke of Puddledock: Travels in the Footsteps of Stamford Raffles (Henry Holt, 1992).

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