All Thursday night, Anne lay with her daughter on a narrow bed at Jamii Hospital as other patients and their mothers lay nearby. From inside the white mesh mosquito net, Anne listened to the slow whirring of the overhead fans and held her daughter. She slept with one eye open, ready to call a nurse in case of trouble. Because the antimalarials made her ears ring loudly, Elena couldn't hear. She didn't eat, she didn't talk, and she hardly moved.
On Friday, the epic battle of drug versus parasite continued in Elena's body. On Friday night, Anne again slept in the hospital bed, holding her daughter close. On Saturday morning, Anne left her daughter briefly, then returned with family friends. Another little girl, a friend of Elena's, called out to Elena. Elena answered! Soon she was sitting up and smiling. She remained in the hospital for another day before she was released.
Elena is now an energetic girl of 14, but for years the experience haunted her. Months later, she spoke of a dream she'd had while her body was in the grip of malaria. Three clouds were coming for her—one for mom, one for dad, and one for herself. "I saw a white cloud coming down, and I wanted to go in it," she said. And again and again in the months and years that followed, Elena would ask her mom, "Do you remember the day when you walked into the hospital and carried me because I was dead?"
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Elena Githeko's close call shocked more than just her parents. It stunned Andrew Githeko, Mwangi Githeko's brother and Elena's uncle. Andrew also happens to be a friend and colleague and a worldrenowned malaria expert who directs the Climate and Human Health Research Unit at the Kenya Medical Research Institute (KEMRI) in Kisumu. When I first met Andrew in the late 1990s, he was a rising star in the field of medical entomology, the study of insects that carry disease. Andrew Githeko's is the tale of a scientific underdog who, through patience and persistence, triumphed against formidable opposition. And it's a tale of discovery that has helped settle a contentious question: Can global warming contribute to the spread of disease?
Now a compact man of 52 with an oval face, closecropped hair, and a steady gaze, Githeko grew up as the eldest of five brothers in a prominent and relatively welloff teagrowing family in Ihwagi, a rural village near Karatina, approximately fifty miles north of Nairobi. He listens patiently when asked a question, then speaks without hesitation or hurry, with the air of someone who's used to being heard.
In 1991, before returning to England for his final year of training worldfamous Liverpool School of Tropical Medicine in England, he witnessed his first intense malaria epidemic in the hills of western Kenya. It was pandemonium. "Patients come in. Some need a blood transfusion," Githeko recalls. Others develop cerebral malaria. "They're mad, and you need to strap them to the bed…Others, there's nowhere to put them; you put them outside, and it's raining." Githeko shakes his head. "You've got people under the bed; others are yelling…You can't go home. You can't get tired. The morgue is full." As KEMRI's resident mosquito biologist, Andrew went from village to village, hunting for malariacarrying mosquitoes. "They were everywhere, breeding in large numbers," he recalls. The malarial parasites responsible for the epidemic had evolved resistance to chloroquine, the most common antimalarial drug. "We couldn't control this thing," he says. "It was very scary."
Runaway epidemics like the 1991 western Kenya outbreak occur only at the edge of malaria's range, typically at higher elevations. At lower elevations in the tropics, steamy weather maintains mosquitoes and malaria yearround, and people have developed an uneasy balance of power with malaria parasites. Most residents are exposed as children, and some succumb to the disease. But the majority of malaria patients survive, and those who do develop partial immunity. That reduces the intensity of later malaria infections to that of the flu.