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Column: If they are lazy, are we stupid?

February 16, 2014 - 21:15 -- Bart G.J. Knols
The following is an actual quote from an investigator/professor (who shall remain anonymous) working in a malaria-endemic region whilst referring to the local riverine population, in a relaxed while-drinking-a-beer environment: “They could have less malaria, but they’re just too lazy to build proper houses”.
 
I don’t know about you, but for me that was the spark for a 30 minute argument that ruined the relaxed while-drinking-a-beer environment of that afternoon! The thing is, I find it difficult when I have to sit and listen to educated men and women from a variety of backgrounds and in a position to actually have their opinions on malaria heard (WHO, big regional Hospitals or small local district health centers, professors and researchers at universities or NGO workers) being asked the question of why malaria hasn’t been eliminated so far and hear that, in some way, it is the fault of individuals living in malaria endemic areas. Usually the arguments for that go somewhat like: they don’t clean their gutters or other possible mosquito breeding grounds; they don’t close the gaps between the wooden boards of their houses or between the roof and the walls, they don’t sleep under bednets, they insist in staying outdoors after dark, they don’t use insect repellent or have fans in their houses, etc, etc… I’m sure you’ve heard it all before, if you haven’t thought it yourself...

 Even when some of my acquaintances, who really know nothing about malaria, ask the question “but isn’t malaria preventable?”, they seem to sometimes really want to ask: “How is it possible, that parents of children living in malaria-endemic countries won’t do everything they can to protect their kids?” 
 
Well, besides the obvious answer: “Maybe because pneumonia, undernourishment, cholera, typhus, and diarrhea are also concerns, together with, you know, those tiny worries that come with general poverty?” we could argue less cynically, like others in MalariaWorld have done recently (see here), that ‘malaria is an ecologically embedded disease which transmits through many intricate links to human society’. But, to put it more bluntly, I think that the following is better:
 
How many of you (whether you are medical doctors, research scientists, professors, military men and women, consultants, company workers, NGO workers, WHO staff) are from non-malaria endemic countries, or even non-malaria endemic regions within a country and got malaria whilst visiting or conducting fieldwork in malaria-endemic areas? I am certain that a fair percentage of you have (I know I have) and a few of the expats I have spoken to, who live or have lived in malaria-endemic countries, have also fallen to the disease.
So I have to ask you this: if the local population is lazy, then are we simply stupid? I mean, we KNOW the country has malaria. We KNOW how to prevent it. We KNOW we should sleep under a bed-net. We CAN AFFORD malaria tablets from verifiable sources. We usually have access to clean water and electricity. And still, a fair percentage of us get malaria. Then, how can we almost demand that individuals from malaria endemic areas that live EVERYDAY under the threat of malaria be less lazy when we go for a few months or years to their countries/regions and we cannot avoid getting it? It should be so easy to prevent it, right? Simply ask an expat about these malaria prevention measures and check if these aren’t some of the answers you will hear back:
 
You - Do you take anti-malaria tablets? 
Expat - (Cynically) who doesn’t enjoy a good Doxy sun-burn or Meflo psycho episode? 
You- Do you use insect repellent?
Expat- Always a pleasurable smell and sensation mixed with sweat… I prefer long sleeves and long pants.
You- Do you sleep under a bed-net? 
Expat-33 C and 80% humidity convinced me that that was quite a challenge.  
You- Do you go indoors when it is getting dark? 
Expat- (While cracking open a tonic) Really? But that is usually G&T O’Clock!
 
In short, neither the locals are lazy, nor are we stupid. Malaria really is an intricate part of an ecological system of which we are but a small component and only a real attitude change towards it from all the stakeholders will lead to its elimination.
 
Now, and just as a curiosity and a tribute to the ‘lazy or stupid ones’, comment below if you got malaria or not and lets find out how many of us, members of MW have had it. I’ll go first:
 
Ricardo Ataíde
Species – Falciparum
Country – Angola
Year- 2004 

Ricardo Ataíde is a Portuguese PostDoctoral scientist living in Brazil (but soon moving to Australia) working on malaria in pregnancy and mechanisms of pathology and immunity, which are his passions.  He loves doing fieldwork and the close contact with reality. Ricardo is a keen supporter of collaborative work, public discussion of ideas and the engagement of scientists with their scientific community as well as with the general public.
 
 

Comments

Bart G.J. Knols's picture
Submitted by Bart G.J. Knols on

Well, my list would be longer than yours, Ricardo. In the 11 years that I lived in East and Southern Africa, I had malaria 9 times. In the first 7 years I took prophylactics and still got it 6 times (resistance...), and after I stopped another 3 times. Following your definition I am both stupid and lazy, thank you ;-)). Even though I always had access to repellent I hardly ever used it. Even though I knew I would get protection from prophylactics and had them, I stopped using them. Even though I knew that sitting outside at night increases your risk I never went indoors when sitting outside with friends was much nicer...

Submitted by Ricardo Ataide on

I'm sure a lot of researchers would like to get a hold of your B cells ;). Thanks for that comment, though. It is exactly what I was hoping for. When I went to Malawi I met loads of expats who loved going up to the lake (who wouldn't?) and who, of course, caught malaria. Among them a few of the malaria researchers, and that always got me thinking...So lets see if we can get a few of them to share their stories.

Ricardo Ataíde

Submitted by Pierre Bush (not verified) on

I was in Zambia for 4 weeks, conducting my malaria research. Mosquitoes are just too many! They were everywhere. I took (still taking it) for prevention. I sprayed every night, and avoided outdoors at night. I slept in the ITN, but I still got thousand of bites. But the mosquitoes were probably not infected. Laziness: yes many people on our continent are still very lazy, drink a lot, and work less to improve their living conditions. In general malaria is declining. I will share my findings in few weeks.

Ingeborg van Schayk's picture
Submitted by Ingeborg van Schayk on

Ooh, I am guilty too of not taking my prophylaxes, sitting outside at night (lovely) and not using repellent outdoors at night during my 8 year stay in east and southern Africa... And yes, malaria almost killed me (within 3 days). Malaria somehow was part of life (not the most pleasant part of life though). Ricardo describes it very well: for many people in sub-Saharan Africa there are so many other daily concerns that malaria simply is not a priority. Imagine that you are not able to feed your children today, that your land has just been flooded by rains and your crop yield has been lost, that you are struggling to pay for the school fees of your children, and that you just lost another member of your family who died of HIV/AIDS. Would you then be thinking about malaria? Most likely, I wouldn't.

Submitted by Kate Dieringer (not verified) on

Species – Falciparum
Country – Ghana
Year- 2013

EXCELLENT article, thank you! In addition to all of the preventative measures that humans can adopt, the fact that this parasite (and the mosquitos that harbor it) is an ancient, evolutionary master that continues adapting to our methods (feeding behaviors, resistance, ect. A crucial part of the story that many individuals similar to the those characterized in the column seem to brush off as trite. I'll never stop bristling (and sometimes causing riots) when my favorite comment is made: Expat: "Oh, I am not worried about malaria, everyone gets it and it is just like the flu, I'll survive"......too much to go on about the implications of that statement here. Thanks for your post! Well done.

Andre Siqueira's picture
Submitted by Andre Siqueira on

I did catch malaria despite working unprotected even acting as "human bite", but that was just luck as it was low season at the time. I completely agree with your view and know many researchers who wouldn't sleep under nets or spare themselves of enjoying the evenings at the rainforest. We definitely need to engage more on understanding the local communities and their leisure activities and be less patronizing when trying to develop more effective control measures.

Andre M. Siqueira