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JULY 2007
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By Michael Finkel
Photographs by John Stanmeyer

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But it was also clear that the campaign was far too ambitious. In much of the deep tropics malaria persisted stubbornly. Financing for the effort eventually withered, and the eradication program was abandoned in 1969. In many nations, this coincided with a decrease in foreign aid, with political instability and burgeoning poverty, and with overburdened public health services.

In several places where malaria had been on the brink of extinction, including both Sri Lanka and India, the disease came roaring back. And in much of sub-Saharan Africa, malaria eradication never really got started. The WHO program largely bypassed the continent, and smaller scale efforts made little headway.

Soon after the program collapsed, mosquito control lost access to its crucial tool, DDT. The problem was overuse—not by malaria fighters but by farmers, especially cotton growers, trying to protect their crops. The spray was so cheap that many times the necessary doses were sometimes applied. The insecticide accumulated in the soil and tainted watercourses. Though nontoxic to humans, DDT harmed peregrine falcons, sea lions, and salmon. In 1962 Rachel Carson published Silent Spring, documenting this abuse and painting so damning a picture that the chemical was eventually outlawed by most of the world for agricultural use. Exceptions were made for malaria control, but DDT became nearly impossible to procure. "The ban on DDT," says Gwadz of the National Institutes of Health, "may have killed 20 million children."

Then came the biggest crisis of all: widespread drug resistance. Malaria parasites reproduce so quickly that they evolve on fast-forward, constantly spinning out new mutations. Some mutations protected the parasites from chloroquine. The trait was swiftly passed to the next generation of parasites, and with each new exposure to chloroquine the drug-resistant parasites multiplied. Soon they were unleashing large-scale malaria epidemics for which treatment could be exceedingly difficult. By the 1990s, malaria afflicted a greater number of people, and was harder to cure, than ever.

The story of malaria is currently being written—by hand, in ballpoint pen—by the staff of Zambia's Kalene Mission Hospital. Every morning, soon after dawn, a nurse's aide who has just finished the night shift records a brief update on each child in the intensive care ward. The report is written on lined notebook paper and clipped into a weathered three-ring binder. The day workers add frequent notations on the small patient cards, kept at the nurses' station. Together, the night report and the cards form a compelling, immediate account of a deadly disease.

Many entries are simply terse, staccato jottings. "Mary: Has malaria. Unconscious." "Belinda: Malaria. Seizures." But others are far longer, enumerating clinical details about medicines and dosages and checkup times, as well as offering vivid glimpses into the struggle for survival in one of the world's most malarious places. Leaf the pages; flip through the cards—there are thousands upon thousands of entries—and the stories emerge.

Here's Methyline Kumafumbo, a skinny three-year-old who was taken to Kalene hospital by her grandmother. They journeyed ten miles from their home village, and by the time they arrived, malaria parasites had already latched onto Methyline's brain. "Admitted yesterday," the night report reads. "Fevers and seizures. Malaria." The right side of Methyline's head was shaved, and an IV line inserted. Quinine, which remains Kalene hospital's frontline drug for severe cases, was administered, dose after dose, each treatment dutifully recorded.

For almost a week, Methyline languished in a coma. A malarial coma can be a horrible thing to observe: arched back, rigid arms, twisted hands, pointed toes. A still life of agony. The reports continue their unblinking assessment. "Unconscious. Continues on IV quinine." "Still unconscious though not seizuring." "Still unconscious."

Then the seizures started again. There are times when the night report reads almost like a personal diary. "I was worried," the aide wrote about Methyline. "So I informed Sister"—the honorific bestowed on the hospital's two nurses—"who came and ordered Valium, which was given with relief."

Finally, the entries turn hopeful. "She's opening up her eyes but she still looks cerebral." "Drinking and eating porridge." And then: "Is conscious and talking!!" Three days later, Methyline was released from the hospital. "Looking bright," says the report. "But still not walking well."

One insidious thing about malaria is that many who don't die end up scarred for life. "Her walking issues point to larger problems," Robert Gwadz says after reviewing the progression of Methyline's sickness. "She may have permanent neurological damage." This legacy of malaria has sobering repercussions for people and nations. "It's possible," says Gwadz, "that due to malaria, almost every child in Africa is in some way neurologically scarred."

And Methyline has to be considered one of the fortunate ones. The Kalene hospital night report is filled with heartbreak. Christabel: "The patient is in bad condition. Grunting and weary. Irregular breathing. Sister was informed. Midnight she collapsed and died. The body was taken home. May her soul Rest in Peace." There's an entry like this on nearly every page. Ronaldo: "Semi-conscious. IV for quinine. Seizure. Valium. Pain suppository. Fever. More pain suppository. At 0500 hrs, child had gasping respiration. Finally, child suddenly collapsed and died. His body was taken home."

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