Malaria has remained constant in North Maluku for centuries.
The mosquito-borne disease has ruled almost every corner of the province, which is blessed with an exquisite panoramas and beautiful waters, from the time of Alfred Russell Wallace until the second millennium.
Malaria paralyzed Wallace, who proposed the theory of evolution with Charles Darwin, when he was in Ternate in 1858 to collect animal and plant samples.
It is during that period that Wallace wrote the famous “Letter from Ternate” that assured Darwin natural selection was indeed real, and that those who survived were the “most fit” creatures.
Wallace is not the only well-known figure who was felled by deadly disease. Alexander the Great, Genghis Khan, Thailand’s King Mongkut and many other prominent people were also afflicted. Malaria has forced an end to wars, stopped invasions and changed the course of world history.
Renowned Indonesians have also suffered from the disease. The Sultan of Ternate, Mudaffar Sjah, contracted malaria when he was 15.
“I believe almost all the people of Ternate have suffered from malaria,” said the 48th leader of the 8-century-old sultanate.
His parents, grandparents, great-grandparents and almost every royal family member he could name had suffered from the disease, the sultan said.
“The disease knows no identity,” he added.
The sultan routinely takes anti-malarial medication prevent another infection.
It’s a good move. Prevention is the best option. People who contract malaria suffer horribly.
Malaria begins with a painless bite from a mosquito that hunts for human blood starting at twilight and continues through the night.
The mosquito plunges a stiletto-shaped proboscis into the skin of its human victim to feed on blood, and sometimes it transfers a parasite, plasmodium malaria, into the victim.
The mosquito that transmits the disease is always female and always from the Anopheles genus, which is the only type of mosquito that can harbor human malaria parasites.
The parasites then “eat and multiply” inside the victim’s body, said Professor Tjandra Yoga Aditama, the health ministry’s director general for Communicable Disease Control and Environmental Health.
The patient’s body starts to break down. The parasites destroy oxygen-carrying red blood cells and only a few remain to sustain the body’s vital functions. Lungs fight for breath. The heart struggles to pump.
Brain cells die. The victim struggles, trembles, and finally breathes a last breath.
Ahmad Abdullah, 39 and a resident of Doro, a remote village in North Maluku, is familiar with the lethal process.
“It was only one bite. He died few days later,” said Ahmad as he described the death of his month-old child from malaria.
Immediate treatment is essential for malaria patients. To survive, a patient must take medication as soon as symptoms emerge, such as high fever, body shivers, headache, nausea, vomiting, diarrhea or muscle aches.
“Early detection is vital,” said Dr. Khancit Limpakarnjanarat, the World Health Organization (WHO)’s representative in Indonesia.
Accurate diagnoses by physicians will save many lives, including those of pregnant women and infants, who are most at risk, he said.
Malaria contributes to the deaths of Indonesia’s pregnant women, infants and toddlers, Health Minister Endang Sedyaningsih said.
“Malaria is endemic in approximately 80 percent of the country’s districts, where 45 percent of the population resides.”
Indonesia recorded more than 1.1 million malaria cases in 2009. However, the actual figure could
be much higher because many areas with endemic malaria are secluded, and have inadequate access to transportation — let alone healthcare.
The conditions in remote provinces prevent health care workers from detecting malaria cases promptly. Patients who may have malaria must be diagnosed with rapid diagnostic test (RDT) kits or samples must be examined under a microscope in a lab, Prof. Tjandra said.
In North Maluku, swift malaria detection is a huge challenge: The province is comprised of more than 300 islands.
Faizal Prabowo Kaliman, a community health center doctor in Gane Barat, a remote district of North Maluku, leads a 10-person medical team that serves hundreds of people out of a 16-square-meter clinic. The district is a one-day sea trip from Ternate.
Kaliman fights malaria hand-in-hand with traditional healers due to lack of healthcare workers.
“It is impossible to inspect the district every day and perform door-to-door checks for malaria,” he said.
The district’s chief shaman, Senen Naim, 60, sends patients to the clinic after he treats early symptoms of malaria with papaya-leaf water. He has no idea of how to deal with parasites, he said.
“I’ve done my part, the rest is [the doctors’] business,” Senen said.
Early referral is not the only answer. Doctors must also chose anti-malarial drugs with great care. The legendary anti-malarial panacea, quinine, may no longer work, Prof. Tjandra said. Physicians now promote artemisinin-based combination therapy (ACT), a multi-drug cocktail.
“Prevention remains the best measure,” he added.
The writer is a consultant for UNICEF Indonesia.