September 20, 2004
Pharmacist Shares His Perspective on Malaria in Zimbabwe
Peter Rollason lives with malaria.
He doesn’t actually have the disease. But with 50 years of experience as a community pharmacist in Zimbabwe, Rollason is quite familiar with malaria and its toll in Africa. Speaking at the Johns Hopkins Bloomberg School of Public Health on September 16, Rollason presented a picture of what it’s like to deal with malaria as part of daily life.
“I’m not an academic, I’m not a doctor, I’m not a hospital man,” said Rollason, MPS, FRPharmS, MCPP. “I’m what they call in England the chemist around the corner.”
In his village in Zimbabwe, being the local pharmacist means he was often the first health professional sought by sick people. (Rollason is now a consultant for a pharmaceutical company.)
In southern central Africa, one child under 2 years of age is lost every 20 seconds to the disease. In Zimbabwe itself, there is not an especially high overall incidence of malaria, but there are regions that have seasonal malaria outbreaks, and Rollason says that there is more and more “commuter malaria”: transmissions of the disease by mosquitoes who’ve hitched a ride on buses and trains and in suitcases to non-malarious areas.
Ninety-eight percent of those cases come from the Plasmodium falciparum parasite, which is transmitted by the Anopheles mosquito. “This little creature is ruling the world,” said Rollason.
The best way to avoid getting malaria is not to get bitten. And that’s hard when the mosquito that transmits the disease doesn’t buzz and bites only between sunset and sunrise so that you can’t see her.
“The answer is bed nets,” Rollason said. “But people don’t like them. It’s a terrible thing to sleep under.” He also recommends spray-repellents for dwellings--especially DDT, which has been banned for its toxicity. “There are stockpiles of DDT. And provided it’s used correctly, it’s fine,” said Rollason. “It’s tragic that the do-gooders have gone too far.”
Rollason listed a number of treatments and preventive drugs for malaria, all with varying availability, cost factors, and side effects. Chloroquine, which is cheap, available, and effective, is still the drug of choice for malaria treatment. Although much has been written about chloroquine-resistant strains of malaria, Rollason believes that the reason chloroquine doesn’t seem to work in some patients is not that the disease resists, but that many patients treated for malaria with chloroquine are misdiagnosed and never had malaria in the first place.
The health care system in Zimbabwe and southern Africa in general is a pyramid: a progression from village health worker workers with limited knowledge to clinics to urban general hospitals. It can take days for a patient to work her way up the referral ladder to a facility that actually has modern laboratories and technology. As a result, along the way, many diagnoses in Zimbabwe are presumptive.
“Most of it is guesswork,” Rollason said. “We need more real diagnoses with microscopes in clean, dust-free environments.” He recommends “dip-stick” strips, which have been highly accurate, for diagnoses, and that they be made available in all clinics and even with village health workers. Proper diagnoses done sooner could save lives and prevent costly unnecessary treatment.—Kristi Birch