Karen Grepin's Global Health Blog

I spent most of the summer retreating from the heat and humidity of New York City in Litchfield County, Connecticut.  It was the perfect place to hang out with my new baby, catch up on lost sleep, and recover from the difficult last few months of my pregnancy.  Compared to the city the air was cool and relaxing.  I went for long walks in the forests and fields.  I picked wild growing raspberries, blackberries, and concord grapes.  By mid-July the farmers markets were brimming with fresh local fruits, produce, and meats.  I sometimes went days without buying anything that was not grown or raised within 5 miles of my home.  It is just what my body needed.

It is therefore very surprising for me to to learn that this exact area of Connecticut was once the site of a terrible outbreak of malaria that once afflicted thousands.  In the late eighteenth century, a man by the name of Elijah Boardman, who eventually became a prominent business man in the town of New Milord (where I regularly visit the excellent Saturday morning farmers’ market), had once been a soldier in the Revolutionary War.  When he returned to his home town after the war, he brought with him more than just some bad memories – he also brought some malaria parasites that continued to stream through his veins for years. 

After this return home, the Housatonic River, which happened to run through the backyard of the now wealthy Boardman’s mansion in New Milford, was dammed to help generate energy for the expanding industrial base of the region.  Soon after the banks of the river were raised, thousands, including Boardman’s own wife and son, fell seriously ill with malaria.  The outbreak came and went for years and eventually took the lives of hundreds of people spreading throughout this area of New England.  Litchfield County and the Berkshires were no longer known as areas where people went to relax, it was known as a place to get sick from malaria.

This story is just one of the really fascinating stories author Sonia Shah describes in her new – and excellent – book “The Fever“.  In this well researched book, Shah chronicles how malaria, which is currently experiencing a resurgence of attention from the global health community, in her words “ruled humanity for 500,000 years”.

I’ve always been a big fan of historical accounts of the interplay of infectious diseases and humanity, but when I think of the diseases that have really radically shaped society through geopolitical struggles, malaria is not on the top of my list.  I tend to think first about smallpox, measles, the plague, and now HIV.  But Shah chronicles a long history of how plasmodium influenced the world, like how the development of partial immunity against malaria helped provide an advantage to the Bantu-speaking people of Africa allowing them to spread across the continent and forcing their rivals to the peripheral regions.  Or how even as recently as WWII, malaria had played a role in weakening armies which led to the Japanese army employing elderly women as “net tuckers” to tuck bed nets around soldiers on the front lines at night.

In one chapter, Shah provides a nearly comical account of the “Global” Eradication program launched by the World Health Organization in the mid 1950s.  In retrospect it is always easy to mock the failures of a program as ambitious as this program, such as the irony of trying to eradicate malaria globally without even addressing Africa, but it does make you wonder why there had been such devotion from so many players who should have known better.  It also raises some important questions as the international community begins to whole heartedly embark on another effort to eradicate this disease.  She also comes down hard on what she sees as the over zealous advocates who are over relying on bed nets to eliminate malaria.  Go big or go home, Shah argues.   I tend to agree.

In perhaps my favorite chapter of the book, titled the “Karma of Malaria”, Shah raises and attempts to answer a very important question.  Why does a disease that has the potential to kill so many people not invoke the same level of fear in people living in malarious areas that it does to us outsiders?  She argues that when one lives around malaria one develops a very different attitude to the disease, it becomes part of life, and we need to take this into consideration when developing programs to address the disease.  In one memorable story she asserts that in some areas, if a child presents with fever and receives a positive test for malaria it might actually be welcomed – it means the child is not sick with something more serious!

I liked this book – a lot – but some people might find some aspects of her book hard to accept, such as description of a malaria control manager from Panama who only tends to get excited about malaria when donors are around to impress, or her critique of the Western donor communities over reliance on bed nets.  I can’t judge the validity of all of her claims, and was frequently irked at some of the generalizations she makes, but overall I think this is an excellent book to add to your global health reading list.