Falciparum is a major reason nearly 20 percent of all Zambian babies do not live to see their fifth birthday. Older children and adults, too, catch the disease—pregnant women are especially prone—but most have developed just enough immunity to fight the parasites to a stalemate, though untreated malaria can persist for years, the fevers fading in and out. There are times when it seems that everyone in Zambia is debilitated to some degree by malaria; many have had it a dozen or more times. No surprise that the nation remains one of the poorest in the world: A country's economic health has little chance of improving until its physical health is revitalized. Zambia's goal is to reduce malaria deaths by 75 percent over the next four years.
To witness the full force of malaria's stranglehold on Zambia, it's essential to leave the capital city, Lusaka. Drive north, across the verdant plains, past the banana plantations and the copper mines—copper is Zambia's primary export—and into the forested region tucked between the borders of Angola and the Democratic Republic of the Congo. This is the North-Western Province. It is almost entirely rural; many villages can be reached only by thin footpaths worn into the beet-red soil. A nationwide health survey in 2005 concluded that for every thousand children under age five living in the North-Western Province, there were 1,353 cases of malaria. An annual rate of more than 100 percent seems impossible, a typo. It is not. What it means is that many children are infected with malaria more than once a year.
In the North-Western Province, competent medical help can be difficult to find. For families living in the remote northern part of the province, across more than a thousand square miles of wild terrain, there is only one place that can ensure a reasonable chance of survival when severe malaria strikes a child: Kalene Mission Hospital. This modest health center, in a decaying brick building capped with a rusty tin roof, represents the front line in the conflict between malaria and man. Scientists at the world's high-tech labs ponder the secrets of the parasite; aid agencies solicit donations; pharmaceutical companies organize drug trials. But it is Kalene hospital—which functions with precisely one microscope, two registered nurses, occasional electricity from a diesel generator, and sometimes a doctor, sometimes not (though always with a good stock of antimalarial medicines)—that copes with malaria's victims.