Malaria in Rhodes
By George Brits
The Rhodes area has had some of its best late summer rains in a long time this year. After a stupidly long absence, we thought it a good idea to look up old haunts and re-acquaint ourselves with the magical art of waving a stick around. (Fishing images from an earlier trip, as will become apparent later).
We arrived at the farm Balloch in the Wartrail district late on Sunday afternoon, fresh from two weeks in the Kruger National Park. This is obviously not our normal route, but it involved a best friend’s daughter getting married, an eldest son who was keen to explore the most northern reaches of the country, and a last opportunity for the three of us to do a road trip before the youngster departed for French shores (studies and a girlfriend beckoning – necessarily in that order).
The farm was everything as beautiful as we remembered. But, the Vlooikraal was running high, and slightly off-colour. With the luxury of ahead of us, we decided to take it easy on the Monday, leaving the rivers to run off for another day.
Towards late afternoon I assembled my rod for a quick dip in the pool right below Willow Stream cottage. I was about to wander off, when I discovered that youngster had driven off to find signal (girlfriend) – with my fly tying bag in the back of the truck. After a few weeks of stocking up on flies, all my boxes were still in the tying bag! Fortunately, the pouch on my fly vest still held a few discards from days past. It was a motley collection: two stringy Zacks, one extra buggy hare’s ear, and two nymphs that were so scruffy, it was hard to tell what they were. This collection was topped off with two lopsided Adams parachutes, whose posts stood only half-mast over a ragged spray of hackle despite my best efforts at resuscitating them.
The half hour in the first pool produced a beautiful brownie of about 10 inches, a smaller rainbow, and a handful of fingerlings. The next pool higher up was a little less productive, with only fingerlings pestering my fly.
At last light I tied on one of the Adams parachutes, and proceeded to give it a liberal rubbing down with Henry’s sinket! The second Adams was properly doused with floatant, but by then the light was all but gone. Feeling unusually tired, I retired for the day.
After a restive night we woke to dark skies – and a day of relentless rain. Not much to do but get stuck into a good book, I was soon lost in David Reich’s Who We Are and How We Got Here. Fascinating how a body of knowledge can make more progress in a few years than the previous decades put together after a defining breakthrough like (cheap) whole genome sequencing.
Tuesday night was fidgety again. But Wednesday morning broke crisp and clear. After a lazy breakfast, I was back on the river. The river was still a little milky with run-off after the previous day’s rain. Not expecting much, I did not wander far from the cottage. Still, within an hour, I was bone tired, and decided to nip back to the cottage for a cup of tea and a short rest. Within minutes of getting back, I started to shiver mildly. This quickly developed into a full blown cold fever. Half an hour later, I was in bed.
For the next five hours I was barely conscious of what was going on around me. Youngster returned from Barkly East at 5pm and loudly proclaimed that his elder sibling had just been diagnosed with malaria back in Cape Town. And that was when the fun started.
We made it to the hospital at Barkly East just after half past six, where I was seen by a very helpful young doctor. But none of her charm could compensate for the fact that you can’t medicate without a proper diagnosis, and even if she could miraculously conjure up a diagnosis, a place like Barkly East does not exactly keep malaria medication in stock. The nearest place that could do a real time blood smear was East London, four-and-a-half hours away on Eastern Cape back roads! I was still feeling like dirt after an afternoon from hell, so it’s easy to imagine our reluctance. But the doctor kept insisting, ever so gently, and at a quarter past seven we set off for East London.
The rest of the story is rather tedious. We arrived at St Dominic’s Hospital at 11:20pm. Blood was drawn within minutes. The kind doctor in Barkly had phoned ahead, so they were expecting us. The diagnosis was confirmed just after 1am. Medication was provided just before 2am. Apparently it was quite a scramble to get hold of it. (We had to visit four pharmacies the next morning before we found one that had a single dose of meds on hand). Finally, I was in bed by 3:30am – which involved a trek across town to Beacon Hill since all the beds in St Dominic’s were occupied. Discharged at 10:00am. Back at Balloch at 5:00pm, just in time for my second cold fever attack. Only started feeling well enough to fish two weeks later, when the fish had started spawning behaviour and the summer fishing season was all but over.
In the final analysis, a lot of this little drama comes down to stupidity. Actually, all of it does. We can think of a number of excuses for not taking prophylactics. I won’t bore you with the detail. But these excuses only sound heroic when you come away unscathed. An episode like this puts an entirely different complexion on it!
Malaria is an infection of red blood cells caused by a single-celled parasite. It is almost always spread by the bite of an infected female Anopheles mosquito.
There are four species of the parasite that cause malaria: Plasmodium falciparum, P. ovale, P. vivax, and P. malariae. Once bitten, the parasites move to the liver, where they multiply. They mature over an average of 2 to 4 weeks, then leave the liver and enter the blood stream. Here, the parasites infect red blood cells and multiply until they cause the infected cells to rupture. The parasites that are released infect more red blood cells in an ever-increasing cycle of destruction.
P. ovale and P. vivax mostly infect young red blood cells. P. malariae prefers older red blood cells. P. falciparum, on the other hand, targets red blood cells of any age. This results in a much higher number of parasites in the bloodstream, which is what makes P. falciparum the quickest and most dangerous of the four. It is also the most common, which is what makes malaria such a killer disease. According to the World Health Organization, there were 216 million cases of malaria worldwide in 2016, resulting in 445 000 malaria-related deaths. The US Institute of Health Metrics and Evaluation in Seattle, Washington puts the mortality statistic at more than twice this number.
Symptoms usually begin anywhere from 10 to 35 days after the mosquito bite and include periodic attacks of chills and fever. It is often dismissed as the onset of the flu. But if you’d been to a malaria area in the recent past, it is best to get medical advice forthwith. (The diagnosis, and identification of the specific species of Plasmodium, can only be confirmed with a blood smear).
After a few days, the typical paroxysms may occur – chills, followed firstly by a high fever for a few hours, and then by profuse sweating. Between paroxysms, you may feel well, depending on the type of malaria that has been contracted. Some forms of malaria are more severe than others, and the time between the paroxysms differs. With P. falciparum the paroxysms are not as regular as with other forms of malaria (the rupture of the red blood cells is not as well co-ordinated). Patients often have a fever between paroxysms.