By Babu Dutta and Joel Crane 

    In Ecuador, drug Resistance Malaria primarily occurs with Pasmodium falciparum. The species most commonly ocurring in Esmeraldas, the region we visited. Plasmodium vivax is also present but with lower incidence.

     The town we visited is a fishing village with obvious extreme poverty, poor sanitation, housing and poor drainage that offers plenty of areas for mosquitoes to breed. In our visit to a local health center in Tonchique the local health workers raised concern that P.  falciparum resistance to chloroquine is on the rise.

     In our observations, it was apparent that the local Malaria case detection efforts are very aggressive, but under funded. The local dispensary for Malaria is staffed by only one person with a microscope and materials to do a thick blood smear. Any patient coming in with a fever is immediately finger-pricked, the blood is stained with Giemsa and examined under a reflective light microscope. If a positive is detected, the patients are then treated with chloroquine followed with Primaquine if the parasites found are P. vivax. If P.  falciparum is detected, the treatment is a regiment of Fansidar, chloroquin and Primaquine.

     Some of the broader challenges that face health officials in Tonchigue in dealing with malaria are much larger.

a)      Poor Surveillance: The clinic is acutely understaffed; there is a real possibility that a patient with Malaria goes undetected. With infected humans being live reservoirs. In a town and area, where unemployment is high, there is bound to be migration of infected population.

b)      Socio-Economic Conditions: The area has large pockets of unemployment and poverty. The housing is poor, with roaming gangs of violent youth at night. All these conditions make it difficult for health officials to perform extension work to educate the population about Malaria and its prevention.

c)   Cultural: There appears that a male dominated society exists among some sectors of the population. In these instances women were discouraged from leaving the homes to take children to get medical help. Complicating matters, some prefer the treatment with witch-doctors.

             In conclusion, the rise in Malaria has many folds. It is truly a disease that takes advantage of the weakness of a society. It is an opportunistic disease that takes advantage of the population’s ignorance, of poverty, and also its cultural norms. To eradicate Malaria, a comprehensive plan would be needed that include educating the public, proper prophylaxis, and also well financed surveillance.