Quest for a vaccine

Caught in Kenya's deadly tide

Overcrowded, understaffed public hospitals often receive young patients near death.


After the Long Rains of late April and May, malaria sweeps through East Africa, carried by mosquitoes that breed in the puddles that form in rice paddies, fields and even elephant footprints. Last year brought some of the worst malaria outbreaks in recent memory, especially along the Indian Ocean and in the verdant highlands of western Kenya.

Malaria kills 1.1 million people worldwide each year, making it, along with AIDS and tuberculosis, one of the world's deadliest infectious diseases. It causes another 300 million cases of illness each year, bleeding many countries of the skills and energy of their citizens.

But because malaria claims most of its victims in the tropics, because it is a rare visitor to the developed world, many Americans think that the disease has been conquered.

Here, in these photographs taken by Sun photographer Doug Kapustin last year, are some of the faces of malaria.

Several of the images come from Kilifi District Hospital. Kilifi's is similar to many public hospitals in Kenya: old, understaffed, overcrowded and short of medical supplies. But it is also the site of a malaria research center run jointly by the Kenya Medical Research Institute and Britain's Wellcome Trust, the world's largest medical charity.

The institute employs a group of committed physicians and scientists from Kenya and the United Kingdom, who have cut the death rate among children brought to the center nearly in half. Still, the tide of sickness can sometimes seem overwhelming.

"Malaria is the first illness you think of when someone comes to the hospital," says Dr. Faith Osier, 28, a researcher-physician who splits her time between Kilifi's overcrowded pediatric emergency ward and her laboratory. "If it's a medical patient, it's likely to be malaria."

Many children are brought to Kilifi only when they are near death. One reason is that malaria can be hard to distinguish from other fevers. Another is that severe malaria often causes seizures, and in many traditional cultures, seizures are a sign of spiritual possession.

Many times, desperately sick children are brought to traditional healers -- "mganga" in Kiswahili -- like Katana Karisa Mwanjemo, who lives with many of his 28 children and grandchildren in an extensive compound in the forest.

"The hospital is trying to take blood from a kid and examine it," he says. "I try to treat with exorcism and some herbs. They have more or less the same effectiveness."

In Kisumu, on the shores of Lake Victoria in western Kenya, one crowded ward is reserved for children with Burkitt's lymphoma, a type of cancer common there, but rare in the United States.

The reason isn't clear, but scientists suspect one cause of the cancer may be a dual infection with Epstein-Barr virus and malaria. Burkitt's rarely kills in developed countries: It is easily controlled with drugs. But in Kenya the public hospitals are overwhelmed. Most victims die within a few years.

In Kenya's highlands, in the mountains above the Rift Valley, the peaks are covered with vast tea plantations that employ thousands of workers. There, the number of deaths from malaria has risen dramatically in the past decade.

Scientists suspect the reason is the spread of drug-resistant strains of the parasite. Dr. G. Dennis Shanks of the Walter Reed Army Institute of Research has conducted extensive studies of drug resistance there, including the schoolchildren in Kericho's Brooke Bond Tea plantation.

When they give blood -- a sacred substance in many traditional cultures -- he gives the children pencils.

The study shows an alarming rise in resistance rates, raising fears that the world is running out of inexpensive drugs capable of controlling the parasite.

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