This is how Alex Perry had to get ready to go to bed in Apac, Uganda—considered the most malarious town in the world—the first time he stayed there in a hotel overnight, in 2009: “The bed has a newish-looking net over it, but the screen across the bedroom window, which looks onto a back alley, is torn, and the window won’t close. I find a hole in the shower wall through which I can see clear into the alley. It is filled with rubbish. The toilet is stained and smells stagnant. I try the shower and receive a sharp electric shock from the metal tap. Using a T-shirt wrapped around my hand to work the tap, I wash, cover myself with mosquito repellent, put on a pair of long socks, jeans, and a long-sleeved sweatshirt, take my Malarone pill, get under the net, and lie sweating in the nearly 90-degree heat until I fall asleep.”
In the morning, his neck is covered with a “handful of fresh bites.” The day before, when he first drove through the streets of Apac, the only people he observed were three men—all naked and filthy. When he asked the doctor at the hospital who the men were, wandering around outside, Dr. Emer replied, “Brain damage. Severe malaria can do that to a baby. You never recover.”
Perry’s grim account of malaria in the world—but especially in Africa—focuses on Ray Chambers, a Wall Street tycoon turned philanthropist who, because of an incident in 2006, started a campaign to rid the world of malaria which at the time affected half the people on the planet and killed a million people every year, mostly children. With help from Jeffery Sachs and numerous others, Chambers launched “Malaria No More,” with the goal of controlling the dreaded disease by the end of 2010. Perry (formerly Time’s African correspondent) began tracking Chambers’ campaign, sometimes accompanying him on his numerous trips to Africa, where the American businessman encountered African infrastructures which were often reliant on earlier aid programs or resistant (or incompetent) in implementing his bold new goals.
Which is only to say that Lifeblood: How to Change the World One Dead Mosquito at a Time is both depressing and hopeful. The information provided about mosquitoes could not be more discouraging. They’ve been around for millions of years; researchers have discovered that some of the mosquitoes in Apac (in the swamps near Lake Kwania) “will bite human flesh around a hundred ninety times a night.” No wonder the place is so unlivable. Perry refers to mosquitoes and the spread of malaria as the “original sickness,” but others have provided a more disturbing commentary: “malaria is nature’s solution to over population.” And in case you’ve forgotten this from your high school biology class, it’s the female mosquito that does all this damage.
At one time, malaria was widespread throughout the entire world. Genghis Khan, Tutankhamen, and Oliver Cromwell succumbed to it. DDT eradicated malaria in the United States in 1952 and soon afterwards in other western countries, though DDT worked its way into the food chain and was subsequently banned. That left much of the non-Western world still racked by malaria’s victims: Africa, Asia, Latin America. Until fairly recently, western pharmaceutical companies were reluctant to invest in a vaccine to eradicate the disease because little profit—it was assumed—would result from the enormous costs of research. Then, finally, with the Bill and Mindy Gates Foundation, Jeffery Sachs, Chambers, and his remarkable aid, Suprotik Basu, and numerous others, eradication began to look like a possibility, beginning with sleeping nets impregnated with insecticide and spraying as the dual attack to get malaria under control.
We’re talking nearly a billion mosquito nets to ring the world, billions of dollars to produce the nets and disseminate them. Chambers’ focus was on Africa where 300 million nets would be needed. Working with corporations (such as ExxonMobile in Nigeria), with governments, NGOs and religious leaders, Chambers and Basu led the attack with support from the UN. Their focus was on some of the worst places on the continent (Nigeria, Uganda, Rwanda, Kenya, DRC) where every imaginable complication evolved, as well as several that were not anticipated. Yet, enormous progress was quickly evidenced, with the number of dead falling dramatically. Over a 32 month period, the campaign saved a quarter of a million lives; malaria in Africa was halved—no small miracle.
Yet as the end of 2010 approached, it was clear that even “control” could not be achieved in some areas—let alone the idea of eradication. After three years, the bed nets needed to be treated with insecticide again; funding in many areas had dried up. In spite of the increasing awareness of leaders across the African continent that human productivity can be dramatically increased by controlling malaria, the disease persisted. Suprotik Basu observed of the campaign, “I worry about those countries that still look at malaria programs as a handout, because the moment you go away, those programs fall apart.” His awful realization: “We had to go through three or four more cycles of nets and spraying at least before there was a decent hope of eliminating malaria, and more like six or seven in the worst places. It was like we’d been climbing this mountain for so long and when we finally get to the summit, we see four more peaks ahead of us.”
Alex Perry’s Lifeblood is a horrifying journey which Ray Chambers called “a genocide of apathy.” The resources for malaria’s eradication are within our reach, but man’s will has often been lacking. Perry’s account of the recent valiant fight against malaria is sometimes overly detailed (especially when he records the encounters that Chambers had with the numerous people he had to work with across the continent) but the narrative has the tension of Joseph Conrad’s Heart of Darkness.
CODA: When Perry returned to Apac two years after his original visit, the eradication had been so successful that, for the first time in years, the streets were crowded with people—no longer intimidated by the area’s mosquitoes and the dreaded disease.
Lifeblood: How to Change the World One Dead Mosquito at a Time
By Alex Perry
PublicAffairs, 242 pp., $25.99
Charles R. Larson is Emeritus Professor of Literature at American University, in Washington, D.C.