Malawi surprised me. I had never traveled there before and never felt called to. However, an opportunity came about to test our experimental diagnostics as sub-study to a large randomized control trial looking at effective treatment for malaria infection in pregnant women. Travel to the city of Blantyre in Malawi is not easy. It requires a dreaded third flight after 2 other long ones. I think our transit time elapsed to about 40 hours from Seattle to Blantyre and my body never quite clicked into gear- the jet leg lingered and I could feel the 11 time zones moving in me and my body passively resisting. I had brought all of my tricks for jet leg with me- Melatonin, ear plugs, and doTERRA essential oils lavender, namely, and other blends) and yet, I could not sleep at all. Still, the body is an incredible tool and every morning I “got up” as if I had rested and worked and talked and interacted and got it done (some days better than others).
Blantyre is much smaller than other large cities I’ve visited in Africa and therefore felt more manageable. The air quality was moderate and while traffic moved slowly (did I see a stoplight?), the cars on the road chugged along. Malawi gained independence rather early (1964) and contrary to most of it’s neighbors, civil war did not ensue afterward. While I only scratched the surface of learning about Malawi, I imagine that to live without the legacy of a civil war means a lot for stability of Malawians. All the same, the World Bank lists Malawi as one of the poorest countries in the world, however, the health education system that I witnessed (albeit superficially) seemed to function well. People were seeking their masters, doctorates, clinical degrees, and were engaged with the health system. It was hard for me to tell what economic and job opportunities existed in the country and whether its small size and isolation inhibited it from growth
The landscape was also a stunner. There were 360 degrees of foothills surrounding Blantyre and I’m told there are opportunities to hike within a few klicks out of town. We didn’t make it up on a hike- I bought in readily to my local colleague’s recommendation to refrain from hiking in the rain, but this did not stem out of a fear of getting wet. Mainly I was concerned about malaria since the rainy season had made for a vibrant and plentiful vegetation. Most trips I forget to bring anti-malarials, and sometimes there is an educated reason why- this visit, I should have brought them since we were spending much of our time in the rural clinics and “town” itself did not seem removed from the vegetation line.
The case for better diagnostics for malaria in pregnant women is simple. Most pregnant women who have malaria infection are asymptomatic, this means they do not seek care because they are functioning as normal and not displaying illness such as fever. However, malaria parasites sequester in the placenta, which can lead to adverse birth outcomes for the baby (low birth weight, anemia and in some cases still birth). This makes preventative prophylaxis necessary. Current World Health Organization (WHO) guidelines advise that if women visit the clinic for regular antenatal visits, they’ll receive intermittent preventive treatment of malaria in pregnancy (IPTp) which means they will be administered a full regime of antimalarials regardless of malaria testing results or a test at all. With a test that could detect low parasitemia thresholds, women would accurately be diagnosed and treated for malaria early on and the clinical pathway would be clear for health practitioners. In addition, and the main reason for the study we were taking part in, is that better drug treatments are being explored because of a high level of resistance of the current drug regimen recommended and endorsed by WHO.
My colleague and I were invited out for a Malawian gin after the work week on Friday and it did not disappoint. I’m not sure if it was that I was served a large bottle of tonic along with my double shot to make the drink stay extra cold and last extra-long, nonetheless I enjoyed it and myself.