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Malaria in Malawi: From the Lab to the Front Lines

View of Blantyre, Malawi

View of Blantyre, Malawi – Photo by author

I am not a doctor. I haven’t spent much time working in hospitals.

That made working at a malaria research ward in the African country of Malawi a challenge—and an experience that continues to inspire me.

I’m a fourth-year Ph.D. student performing my thesis research in the laboratory of Dr. Johanna Daily. What drew me to Dr. Daily’s lab was that she studies malaria and I have always been interested in infectious disease and global health.

According to the CDC, there were an estimated 216 million cases of malaria worldwide in 2010, resulting in 655,000 deaths, most of those in sub-Saharan Africa. Increased attention has been paid to malaria over the past 10 years, but much about the disease is still unknown. I wanted to see the disease and its effects close up.

I traveled to Queen Elizabeth Hospital in Blantyre, Malawi, to study cerebral malaria, one of the most severe forms of the disease, which causes coma in patients. I joined Einstein collaborators at the Blantyre Malaria Project (BMP), led by Dr. Terrie Taylor of Michigan State University.

The BMP has been studying and treating patients with cerebral malaria for more than 20 years. The doctors and healthcare workers provide quality care to children with cerebral malaria, as well as to those with neonatal sepsis, HIV, epilepsy and countless other conditions.

My study focused on neutrophils, a type of immune cell possibly associated with disease  in pediatric cerebral malaria patients. Neutrophils are notoriously tricky to study—they don’t live long outside the human body and they don’t survive freezing, so they have to be studied onsite within 12 hours of a blood draw.

Before traveling to Malawi, I had spent a year and a half analyzing patient samples and clinical data, but data don’t tell the whole story. Excel files and coded patient IDs can’t do justice to flesh-and-blood struggles.

At Queen Elizabeth, children with cerebral malaria are admitted into the ward and parents can choose to enroll their children in the study. All children receive the same lifesaving care even if the parents choose not to enroll them. Whenever a patient was enrolled, I would get a text, pick up the blood sample and then spend four hours at the lab processing the sample. Over the course of my 10 weeks there, I also trained a Malawian lab tech, Alex, to process the samples throughout the rest of the malaria season.

I went to Malawi to collect and process lab samples, but I was also given the special opportunity to go on rounds. The malaria research ward was clean and well lit, unlike the normal pediatric ward, which was cramped and stifling. In the malaria ward, half a dozen or so cribs filled the room and there was a chair and cabinet placed beside each bed for the mothers.

It was heartbreaking to see these children so very sick. Upon admission, they were basically unresponsive. Doctors and nurses performed clinical and laboratory tests while the mothers sat quietly by, unmoving and unspeaking as the doctors discussed the fate of their babies. In the ward, I saw doctors and nurses working tirelessly to save these extremely sick children. But, even with the best treatment available, the mortality rate is still 20 percent and many of those who do survive live with physical and mental disabilities. Malawi doesn’t have the same disability programs that other developed countries have, so these children will be disadvantaged their whole lives.

After having studied malaria in the lab, I found it a transformative experience to meet the children and families affected by the disease. I feel more committed than ever to fighting tropical diseases.

Malaria is complicated. Only by working together will enterprising and passionate researchers and clinicians help find better treatments. I am proud to be part of that mission.

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