Editor's Note: The following is an excerpt from Changing Planet, Changing Health: How the Climate Crisis Threatens Our Health and What We Can Do about It (University of California Press, April 4, 2011).
Elena Githeko was normally energetic and chatty. But on a Tuesday morning in 2003, Elena's mother, Anne Mwangi, found her daughter quiet and listless, her forehead warm with fever. Anne thought it was just the flu, so she did what any concerned mother would do: she stayed home from work to care for her daughter.
At age seven, Elena had her mom's mischievous almond eyes, her dad's chubby cheeks, neatly braided cornrows, and a broad smile. Until that Tuesday, she'd been perfectly healthy.
The phone rang late that afternoon at Mathaithi Secondary School, a girls' high school where Anne teaches history and Christian religious education. As the maid spoke, Anne's fineboned face knotted with worry.
Elena could not keep her food down. She had a horrible headache, and she was burning with fever. Anne called her husband. Within minutes, Mwangi Githeko arrived to pick up Anne in the family vehicle, a blue 1970sera Toyota pickup. At 5 p.m., they sped home over winding, hilly roads. By the time they arrived at their house, Elena was crying. Her feet were cold, she was dehydrated, and her forehead was on fire.
They raced to another a nearby clinic for a second opinion from another doctor. Take Elena straight to the hospital, he the doctor told them. It was 6 p.m. At Jamii Hospital in Karatina, a doctor quickly took Elena's blood pressure and temperature, listened to her symptoms, and did some tests. Malaria, he said. She needed to be admitted—immediately. That horrible headache might be a sign of cerebral malaria, a condition in which the malaria parasites burrow into the cerebrospinal fluid that bathes the brain, and sometimes into the brain itself. Anne Mwangi had lived in Kenya her entire life, long enough to know what cerebral malaria could mean. "I thought my daughter was condemned to death," she says.
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Each year, malaria sickens one of every 20 people on the planet—some 300 million people, a total roughly comparable to the population of the United States. In many ways, Elena Githeko's case was typical: intense fever, sweats, shaking chills, and extreme weakness. Many of those who recover suffer longlasting anemia, periodic fevers, and chronic disability. The World Health Organization estimates that malaria kills more than a million people a year, most of them children. In Africa, where 75 percent of all cases occur, a child like Elena Githeko dies of malaria every 30 seconds.
In much of subSaharan Africa, Elena's diagnosis would have been sadly routine. Here, in the foothills of Mount Kenya, it was remarkable. Mount Kenya is a massive, longextinct volcano, more than 50 kilometers (31 miles) wide at its base, with snowcapped peaks that graze the sky at an altitude of more than five kilometers. Despite being just 50 kilometers (31 miles) from the equator, Karatina sits in Mount Kenya's foothills at an altitude of 1,600 meters (almost a mile), high enough to have a distinctly cooler climate than the lowlying tropical areas of the country. When the first British colonists settled in Kenya in the late 1800s, the central Kenya highlands, like highlands in Tanzania, Uganda and Ethiopia, were considered a place to escape the mal aria—the bad air—that was thought to cause the disease. When Anne Mwangi and Mwangi Githeko were growing up in Karatina in the 1960s, malaria was unheard of. A 1970 national atlas had deemed the region "malariafree." "We never had this problem," Mwangi Githeko says.
Elena, however, definitely had a problem with malaria, and possibly cerebral malaria. As her mother watched, the doctor approached Elena with a syringe full of antimalarial drugs. "Doctor, do not touch me! Don't inject me!" she cried. But the doctor did what he had to do, putting an intravenous line into Elena's hand. A powerful antimalarial drug coursed directly into her blood, where it could do battle with the parasites then wreaking havoc in her frail body.