While we have yet to determine Liberia’s annual budget due to 14 years of conflict, if Liberia were to spend $200 million annually on the treatment of malaria-related diseases, similar to Uganda’s $210 million malaria treatment budget (allafrica.com), Liberia would have spent 5000 million on the treatment of malaria in the last 25 years alone. But this is a huge financial and human cost overlays that Liberia might not afford in the next 50 or more years. The 14 years of unprecedented civil wars in Liberia has led to the displacement of an estimated 600,000 Liberians, while according to Medicins Sans Frontiers (MSF), recorded deaths in Liberia resulting from malaria-related diseases and water-borne diseases during the war years skyrocketed. MSF said among Liberian children under five, deaths were “eight per 10,000/day, a figure two to three times higher than that found in Liberia during peacetime.” Similarly, the Incident Displaced People (IDPs) recorded in fall of 2002 that, “53 percent of deaths in the under-fives [in Liberia] resulting from these same four diseases, i.e., diarrheal, respiratory infections, measles, and malaria.” In addition, in his article, “Removing Obstacles to Effective Malaria Treatment in Emergencies”, Richard Allen laments that the lack of “Skilled health staff shortages and inadequate national supplies” in Liberia, which he said contributed to Liberians resorting to the use of “CQ intramuscularly for the treatment of severe malaria cases, an outdated and dangerous method in the face of rising CQ resistance” www.globalhealth.org/conference_2002).
It seems to me that Liberians are caught in a catch-22
situation in which they must choose to die from malaria
or subject themselves to unsafe and outdated CQ intramuscularly
treatments for malaria. But all hope is not lost as
long as Liberian national leaders and health officials
take appropriate steps to eradicate malaria in the
same way the United States, China, Cuba, and other
nations did when confronted with menacing effects
of malaria. For example, in 1935 the United States
experienced an estimated 135,000 cases of malaria,
including 4,000 deaths, but the U.S. government launched
a vigorous malaria eradication campaign with a battery
of trained health professionals that eventually paid
off. China, Cuba, and India equally launched vigorous
malaria eradication campaigns with marked successes
by combining political leadership, mass communications,
and both medical and grass roots educational and training
techniques. In addition, India launched a series of
national health campaigns that effectively succeeded
in eradicating the bandicoat rats that destroyed about
one fourth of the country's grain. Of particular note
was India’s reliance on local traditional technique
involving 300 members of the 28,000-strong Irula tribe
- a rare mixture of patriotism and individual empowerment
- to act as a true national resource against the pests.
This effort helped India to secure sufficient meal
to feed its 900 million people.
Liberia therefore needs to emulate the national campaigns of the United States and other nations, especially India, in combating malaria in Liberia. Liberia needs to reconsider its reliance on chloroquine as malaria treatment by seeking other viable treatment options for malaria, including ATD and traditional Liberian herbs. Chloroquine and other malaria treatment drugs are becoming less effective against malaria, as malaria-producing mosquitoes are gradually fighting back. According to Kenyan researcher Kevin Marsh, malaria is no longer responding to treatments that rely on Chloroquine and other popular drugs. “The resistance is spreading fast, and science is running out of time. ‘Nowadays you have resistance all over the continent. We need to find urgent solutions.’” Marsh said (www.2001pray.org/Malaria.htm). Like Dr. Marsh, Dr. Vonhn of the Liberian Health Ministry expressed similar concern about the resistance of malaria-producing mosquitoes to treatment. “… In 1996 studies in three locations showed the southeastern port city of Buchanan with 38 percent, the capital city Monrovia with 18 percent and the northwestern border town of Vahun with five percent…in 1999, two other studies in the Central Liberian city of Gbarnga and southeastern Pleebo showed 28 percent and 22 percent resistance respectively. Plasmodium falciparum resistance to chloroquine up to 24% has been reported,” he said (www.republic-of-liberia.com/vol4_no5.htm).
What Can We Do Now
I indicated earlier that hope is not lost in the treatment or eradication of malaria as long as Liberian national leaders and health officials summoned the political will to act by launching vigorous malaria eradication programs in Liberia. First, a battery of health inspectors would help with mosquito surveillance and control programs. The health teams must conduct appropriate mosquito surveys and determine the right species of malaria-producing parasites present in each political subdivision of Liberia, to determine their abundance and seasonal variations, and to identify the breeding habits of the various species of mosquitoes in and around the city areas. Second, the Ministry of Health could use biological control method to determine the various species of small fish that mosquitoes feed upon to create mosquito larvae and pupae and adult mosquitoes that are eaten by birds, dragonflies, and bats. The Ministry of Health could develop pools for raising species that naturally attack mosquitoes and construct city parks that will attract bats and birds that feed on mosquitoes. Given this kind of Integrated Mosquito Control Management Plan (IMCMP), the high incidence of malaria in Liberia could be adequately controlled or eradicated knowing the population' dynamics, the reproductive behavior, seasonal cycles, and resistant populations of falciparum and malariae issues. Once this information is known, the Liberian government can begin sanitation improvement measures, habitat alteration, cultural practices, reproduction of harborage and mosquitoes proofing.
Third, our nation should consider the safe application of DDT, which is 90 percent effective in destroying mosquitoes and it is cost-effective due to its 90-year durability. Swiss chemist Paul Hermann Muller invented DDT in 1937 and it soon emerged as “miracle chemical” in the treatment of –mosquitoes, by helping to eradicate malaria in Western Europe and the North America. However, DDT use in Africa felt apart in 1962 when environmentalist Rachel Carson released her book, "Silent Spring," which dismissed DDT as a poison for the environment rather than a miracle treatment for malaria. DDT was labeled as the world’s most toxic substance and eventually banned, though DDT is not known to have killed anyone. Other research scientists eventfully questioned Carson’s conclusion and DDT was restored as a treatment against malaria-producing mosquitoes. In “Malaria Remains Real Tyrant” visiting professor Jason Lott of Oxford University writes, “Recent studies have shown that DDT is actually less toxic than aspirin for humans, and the minimal amount needed for protective indoor spraying will likely have little, if any, environmental impact. DDT's effectiveness was proven again in 2000, when South Africa broke rank with environmental standards and implemented indoor residual spraying of DDT to end a malaria scare along its border with Mozambique” (www.humanbeams.com).
“A blight that has been all but eliminated
in the West, malaria still claims between one million
and two million lives every year in the underdeveloped
world. ... The bigger problem is the politicized international
health agencies that discourage the employment of
all available tools of prevention -- specifically
insecticides containing DDT that is anathema to environmentalists,"
The Wall Street Journal noted in a 29 December 2004
edition. In addition, “Roll Back Malaria should
reconsider the role DDT can play in the fight against
malaria. For the most part, “Roll Back Malaria
of 1998” has not met its goals. In his article,
“Day-After Day After Day After Day” by
Dr. Roger Bate, he argued that: “The WHO, World
Bank, the US aid agency, USAid, and Unicef launched
Roll Back Malaria in 1998. Their aim was to reduce
malaria deaths by 2010. So far malaria deaths have
risen 12 %” (www.fightingmalaria.org/article).
If saving as many lives as possible is what truly
matters, then prevention protocols emphasizing the
use of ITNs and DDT must be adopted and implemented
across the region. Vague appeals to environmental
integrity and unfounded warnings of human harm do
not justify the needless deaths of so many, especially
when a solution is near at hand,” the U.S.-based
Roll Back Malaria Campaign said in an article (www.humanbeams.com).
In addition to the Integrated Mosquitoes Control Management Plan (IMCMP) suggested earlier, DDR and traditional Liberian herbs could be used in the control of malaria in Liberia. I have already discussed the success of DDT in South Africa, so I would suggest that Liberian health authorities must engage in a national campaign to learn about all the herbs our people knew and used to treat malaria that we have abandoned to crave for western medicine. Instead of cutting down the forest, we must leave the trees where they are and invite pharmaceutical companies to test these herbal remedies as other nations are doing. For example, China for centuries have a plant called the "sweet wormwood" that work effectively against malaria. Though it is not known in the West, the WHO just learned about the Chinese herb and is now recommending its use of multi-drug combinations based on artemisinin after researchers concluded that Africa needs the sweet wormwood to treat malaria. The Chinese wormwood is now being mass-produced and sold at affordable prices to the African people. I believe that we have a Liberian “sweet wormwood" in our backyards, and we need to exploit it. For example, a local herb popular among the Bassa people for treating malaria is the “deede-chu,” while other popular Liberian traditional herbs for treating malaria or fever includes the “jologbo”. These are popular herbs found among the Bassa people of Liberia, but efforts should be made to find and catalogue all herbal medicines used by traditional Liberia in the war against malaria and other illnesses in Liberia. In the United States and other developed traditions, herbal medicines use are on the rise under such names as “herbal supplements” or “alternative medicine,” and Liberia as a developing country cannot afford to overlook its traditional herbal medicines reserves. Any new governments in Liberia need to encourage the cataloguing of traditional herbal medicines for purposes of refinement for use by the general public. And this is why previous efforts by Isaac Smith, RN at TB Hospital and biologist Dr. Dickson Redd of the University of Liberia and his students in cataloging some herbal plants in Liberia must be resurrected and expanded as part of a national effort.
Nevertheless, the success of any national health campaign would depend on two major factors—education and cooperation, which have been two of Liberia's greatest challenges. Even now, if Liberian health authorities were able to mobilize the Liberian people to embrace a malaria eradication campaign that combined cultural and individual empowerment similar to the Indian program, it might still not be possible to reach Liberians living outside the city centers in each political subdivision of Liberia. So the first step is to ensure that the national radio stations reach every corner of Liberia if we want the full participation of the Liberian people. In fact, once we succeed in a vigorous malaria eradication campaign on our own, the rest of the world will see an opportunity for investments in Liberia.
· Clinical evaluation of our forest trees to produce herbal medicines or industrial production of anti-malarial drugs from plants extracts on an industrial scale. Instead of deforestation, we can preserve our forest and contract with pharmaceutical companies or find investors and researchers to partner with our nation’s universities, laboratories to study anti-malarial plants like “zeechu” (Bassa)· National Health Campaign to rally the people to action· Involve the University of Liberia and the nation’s elders in the identification of useful herbs for the treatment of malaria· End deforestation and contract pharmaceutical companies to begin testing extracts of trees. In that way Liberia makes money and still keep the ecology intact
I strongly believe that if a nation and its people are to participate fully in the bright prospects of democracy, it is necessary for the people to be healthy and strong so they can take an active part in nation building. Nation building is impossible without changed mindset about national health and sanitation in Liberia. Combating malaria is not an easy task in Liberia, given the country’s current political and economic conditions, but a national health and sanitation campaign to control wastes and garbage disposals and the construction of public latrines and sewer disposal systems will go a long way in controlling the spread of malaria-producing mosquitoes in Liberia. Above all, we need a new Liberian leadership that will take the health and wellness of the Liberian people more seriously, to properly plan, with respect to effective and efficient sanitary system, environmental impact surveys, and so forth. To delay action in the treatment of malaria in Liberia now, may lead to a drastic turnabout in the future, which might result in -an expensive proposition--and this can make it into an extremely intolerable venture.