INGWAVUMA, South Africa - In this lush countryside bordering the Indian Ocean, malaria strikes so rarely that Hervey Williams, chief physician at Mosvold Hospital, finds it difficult to remember whether any of his nearly 50 patients are getting treatment for the disease.
He scans the residents of the intensive care ward. Tuberculosis. Broken limbs. A medical textbook's worth of other ailments. Malaria? He's not sure.
"Two," a nurse finally reminds him, and both patients are on the mend.
One year ago, Williams wouldn't have needed to ask. Malaria ravaged the Zulu homesteads and sugarcane fields in northern KwaZulu Natal Province, infecting thousands of people. Almost every person who walked into the mountaintop hospital suffered from severe headaches and chills, the telltale symptoms of the disease. Dozens of people were dying.
"We were getting slaughtered," recalls Williams, who alone was treating up to 130 malaria patients a day. "It was ridiculous. It was a case of one person on a bed and two people under it."
Why the difference?
Williams has a three-letter answer: D-D-T.
"This is the first time we haven't been swamped with malaria," Williams says.
In South Africa, the insecticide is making a comeback. Developed in the 1930s, DDT, or dichlorodiphenyltrichloroethane, was prized as the world's most powerful weapon against mosquitoes carrying the parasite that causes malaria.
During World War II, the U.S. Army used DDT by the ton, dropping it on Pacific Islands in advance of landing Allied troops. After the war, farmers sprayed their fields with it. And public health workers made it the cornerstone of an ambitious program to eradicate malaria from all parts of the globe.
But then evidence of the compound's deadly side effects emerged. In the 1960s, scientists found traces of DDT in the breast milk and blood of people living in the treated areas. It was linked to human reproductive and nervous system disorders, and then to destruction of wildlife.
DDT the miracle compound became an alarming example of the unintended effects of human tampering with nature. Beginning in the 1970s, more than 80 countries prohibited its use.
Until the mid-1990s, South Africa had used it to kill the most common species of malaria-carrying mosquito in the region, Anopholes funestus. Concerned about the health risks of DDT, the government then ended its use in favor of more environmentally benign insecticides.
Switch to other chemical
After making the switch, health officials noticed an alarming increase in the number of malaria cases. By last year, the country faced a crisis as more than 62,000 people fell ill from the disease and more than 340 died.
The Funestus mosquito, entomologists found, had returned, and this time it was resistant to the new insecticides.
South Africa turned to DDT for help.
Health officials began an aggressive DDT spraying campaign, applying a thin coating of DDT to thousands of homes, where people are most vulnerable to getting bitten by the mosquito. The insects like to feed at night and often cling to the indoor walls of home, the perfect spot to leave a fatal dose of the insecticide.
The new strategy worked. The number of malaria cases plummeted.
In KwaZulu Natal Province, the region hardest hit by the epidemic, the number of malaria cases dropped by more than 70 percent, from 41,000 last year to fewer than 10,000. This year the disease has claimed 44 lives.
The insecticide has been so effective that certain parts of the province are for the first time in history being declared malaria-free, a status that locals in this economically depressed region hope will bring development and more tourism.
"DDT is our savior," says Jonathan K. Gumede, malaria control manager for KwaZulu Natal's northern district, a mountainous area near South Africa's border with Swaziland and Mozambique. "We know the controversies about DDT, but you cannot gamble with people's lives. We knew that if we used DDT, the cases of malaria would go down."
The World Health Organization estimates that malaria afflicts more than 300 million people a year and kills more than 1 million of them. About 90 percent of the victims live in rural Africa, most of them young children. To combat the disease, about two dozen developing countries continue to use DDT, produced in China and India.
The decision to use DDT is not an easy one. Health officials have to decide whether to use a chemical that is as effective at destroying life as it is at saving it.
