The Rhythm of Malaria

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There is a rhythm to malaria. I know there is but I don’t have enough experience to feel it. Knowing the rhythm is important. When you know the rhythm, you’re inside the disease and can feel the ebb and flow. Inside is a very intimate experience because you can see the future. When you are inside you are in control, not the disease.

 I do not feel anything yet. Rhythms are like puzzles that move and you need to know the precise fit of the various pieces to feel the rhythm. So far I’ve figured out the basic pieces but have no sense of how they might fit together. There’s always a temporal sequence of events.

 A medical history is fundamental to understanding the rhythm. The infection starts with an initial symptom. Then another symptom develops. Then another and another, all in a sequence that is often remarkably consistent. I cannot take a good history because I do not speak the language. Without a better history I will not understand the beginning. Beginnings are important.

 I only see the severe end of the malaria spectrum. Fortunately, this is likely a small percent of all the infected children. However, this selection bias limits my ability to understand the rhythm.

Some children survive and some don’t. There are several pathways to death. The most common is brain death but heart and lung deaths are possible. The death rate with cerebral malaria is about 15%. I know that some children are more susceptible due to malnutrition or a pre-existing illness like HIV.

Good record keeping and data analysis is necessary to learn the rhythm. The record keeping by the nursing staff is very good so there is data available. I have not had the necessary time to collate and analyze the data.

 Without a good history, an appreciation of the less severe end of the spectrum, and time to study and reflect on clinical data, I might not learn the rhythm. This means I might not catch up with malaria. I will only be able to react, which is what I am doing now. This is an uncomfortable feeling, because this means the disease is in control and not me. Ouch!

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