Malaria

Lush vegetation frames the road for as far as the eye can see as we bump our way across the Ecuadorian roads. Everywhere I look, I see trees laden with fruit and children running merrily along the side of the road. With all this life and tranquility around us, it is easy to forget that this is a country struggling with many public health problems, including the ever-present threat of malaria. In Ecuador, the two species of protozoa that are responsible for most malaria cases are Plasmodium falciparum and P. vivax. The parasite is transmitted through the bite of anophelid mosquitoes, which are endemic to tropical and relatively low altitude environments (about 70% of Ecuadors territory). Malaria typically manifests itself as a cyclical sudden high fever, which is often associated with chills, nausea, general malaise and, in the worst cases, convulsions.
 

Posters with images of Plasmodium aid in microscopic diagnosis

Although incidence varies from region to region, it is safe to say that where there are mosquitoes, there are also cases of malaria. In fact, as we have spoken to people all over Ecuador, we have realized that malaria is ubiquitous enough that it is simply accepted as an unpleasant, but normal part of life by most. This acceptance has lead to problems with drug resistance. As one physician in the Pedro Vicente Maldonado hospital put it, “cloroquine (the predominant treatment) is as common as bread” in local stores and is available over the counter. Because it is so accessible and affordable, he said that people will take them on the slightest suspicion of malaria, then stop taking them as soon as they feel better, leaving the treatment incomplete. As evidence of the growing problems, a nurse we spoke to in the coastal community of Tonchigue listed at least five different antimalarial drugs that they use to treat patients because chloroquine is no longer adequate.

Public health poster in a community in a malaria-endemic area

Standing water provides breeding grounds for mosquitos that transmit malaria

In Ecuador, a separate department for malaria control has been established in the Ministry of Health. The expense of materials for malaria prevention, such as bed nets and insecticides, relative to the income of the citizens that are most at risk is a barrier to effective prevention in this country. Furthermore, the root of the problem is deeper because extreme poverty prevents many people from living in completely safe environments. For example, poor house construction and the many mosquito breeding areas around them put most of the rural population at high risk for mosquito bites and, therefore, malaria. Few households can spare the time, money, and effort to reduce this risk by improving their houses, draining stagnant pools of water, and regularly spraying insecticide. Most are simply more concerned with elevating their standard of living to acceptable levels.

We have seen that there are still many problems to be solved in terms of malaria prevention in Ecuador and we have experienced first-hand the difficult questions that local health workers have to contend with. However, we have also seen some successes. For example, the Ministry of Health was able to provide one bed net per family in the community of Tonchigue. As we walked through the community and visited some homes, we were pleasantly surprised to see that most people were actually using them. Also, we spoke to a physician in the Pedro Vicente Maldonado hospital about a successful education program they have started in which they train locals to teach their peers at home about tropical diseases. While there are still many problems ahead, the progress that has already been made shows that there is definitely hope.

Tree from which the first anti-malarial drug, quinine, was extracted. This drug is now largely useless due to drug resistance.