Thursday 27 April 2023

Refugees, Rwanda and Malaria

I have some practical experience of trying not to get malaria and supervising rules to help prevent others catching it. Malaria is endemic in the coastal (ie hot) areas of Papua New Guinea so when I went to teach in Port Moresby in the early 1970s I was warned to start taking the then standard prophylactic, chloroquine, a couple of weeks before l left the UK, and to continue to take two tablets weekly as long as I was there. This I did religiously. The local people didn’t need to take prophylactics because they had built up immunity during childhood. After just short of four years at Port Moresby High School I moved to a Sixth Form College in the Highlands. There it was too cold for the malaria-carrying mosquitos to survive but I was advised to “keep on taking the tablets” if I was likely to travel back to the coast for any reason. This I did. After two years I moved to an Anglican Mission School at Popondetta, close to the north coast and the weekly dose of chloroquine became obligatory again. The School a “living memorial to the Anglican Martyrs who remained in PNG during the Japanese invasion, took Anglican boys from all areas of PNG. Those who cam from lowland areas had the usual immunity, but boys from the Highland areas needed to take chloroquine tablets. In a symbiosis of religious practice and medical science the Highland boys were required, immediately after receiving communion at the Sunday Morning Eucharist, to queue up outside the school clinic, to receive their chloroquine tablets. Some Highland boys were from areas which didn’t like to accept treatment from women so would furtively throw away the tablets dispensed by our female school nurse. So there were odd cases of malaria in the school which had to be treated at the local aid post. On these occasions I would issue stern head-masterly warnings. Although I kept up with my own weekly “two tablets” regime” strictly, somehow or other malaria managed to get into my blood. It was a pretty mild form but it needed about three doses of treatment by my GP on my return to the UK before it was eradicated. When I want to work in Malawi in the late 1980s I was based in Blantyre. Although this city is at a fairly high elevation (just over a thousand metres,) and so not sweatily hot, malaria prophylactics were still advised, along with sleeping under mosquito nets. Once again I followed the advice, and remained malaria free until almost the end of my two-year VSO stint. With only a few seeks to go I took the holiday leave to which I was entitled and visited Kenya, primarily to take part in a Quaker World Conference, but I also spent a few days camping in one of the famous game reserves.. On my return to Blantyre I was stricken by violent agues while at work. Fortunately a colleague recognised the symptoms and I was rushed to a well-equipped hospital with which VSO had a contract. It was run by the Seventh Dav Adventist (SDA) Church. There I was placed on a quinine drip, went completely deaf, but recovered after a few days along with most of my hearing.) I was lucky. Although I had kept up my chloroquine treatment I suspect that I had caught the malaria in Kenya, where there was known to be a chloroquine-resistant strain of mosquito which was working its way gradually south. Malaria is endemic in Rwanda, where the government plans to deport refugees and asylum seekers who come to the UK by illegal routes.. Rwanda is on roughly the same latitude as Kenya so I speculate that the malaria there is from the same chloroquine-resistant strain. A more scientific explanation is given in this letter to the Guardian which appeared a few days age: Rwandan residents will have built up resistance from malaria, so will any refugees or asylum seekers who have grown up in areas where malaria is endemic. Those from malaria-free areas, without access to posh hospitals run by such as the SDA in Blantyre, are probably being condemned to serious illness or even death.

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