An Investigation of Malaria

By Zoe C

        Malaria is a mosquito-borne disease that comes in the form of a parasite and is transmitted by female Anopheles mosquitoes to humans. There are at least 100 species of the malaria parasite, but the most common one is Plasmodium Falciparum, the deadliest parasite of the species. According to Unicef, in 2015, there were 214 million malaria cases that led to 438,000 deaths.

        Depending on climatic factors (temperature, humidity, and rainfall), malaria has different levels of intensity. The disease is commonly found in warm regions usually located near the equator; it appears that tropical and subtropical areas are the most common places where malaria transmission occurs. It has been researched that a warm climate is the best environment for mosquitoes to survive year long and the malaria parasite to fully develop. If the temperature goes beyond or below the specific climate parameter for malaria parasite growth, transmission will either occur or not, be seasonal, and less severe. In terms of humidity, the higher the moisture level in the air is, the greater the chances of the mosquito-borne disease being present in a certain location. A contributor to the humidity and prevalence of mosquitoes would be the amount of rainfall. Similar to humidity, the more it rains the greater chances of mosquitoes invading an area. As documented by the Center for Disease Control and Prevention, the highest records for malaria transmission have been noted in Africa south of the Sahara and part of Oceania.

        The number of transmission occurrences correlates to the population of mosquitos in a certain location and its environmental conditions. In order for the malaria parasite to have an effect on individuals, it must be incubated in a certain environment where the growth cycle of the parasite can be successfully carried out. This process of parasite growth is known as the extrinsic incubation period. Once the parasite has finished its complete growth, the mosquito infected will become a carrier and will be the agent for transferring it to humans.

        Being infected with malaria can be extremely dangerous if not addressed and cared for immediately. Once an individual gets bitten by an infected mosquito, the parasite reproduces and grows in the liver cells and eventually enters the bloodstream. This results in red blood cells being infected and cell death. The parasite responsible for malaria severity is called the Plasmodium parasite. Symptoms often appear ten days to four weeks after transmission. Some of these symptoms include fever, headache, nausea, chills, and vomiting.

        There are two main methods one can take to minimize the chances of getting infected or the preexistent infection from spreading within the body. It is advised that prior to, during, and after visiting a region where malaria is prevalent, an individual should take anti-parasite, antimalarial, and antibacterial pills to build immunity. Taking pills will kill the parasites and stop the growth of the parasites. Another form of prevention is buying a mosquito net. This acts as a barrier from mosquitos coming in close contact with a person and prevents transmission.

Citations:

“Malaria.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 3 Oct. 2017.

A Short Timeline of Yellow Fever

By Zoe C

Yellow Fever is a mosquito-borne viral infection that is prevalent in South America and Africa. The species responsible for yellow fever transmission is the Aedes Aegypti mosquito.

Scientists speculate that the virus evolved around 3,000 years ago in Africa. It is believed that the virus was brought to the western hemisphere on slave ships. Being one of the first carriers, slaves were believed to have exposed the disease to the east coast of the United States. Reported symptoms and deaths took place in the following locations: New York (1668), Boston (1691), and Charleston (1699). As the virus swiftly made its way across Europe in the 1700s, America faced the biggest yellow fever outbreak in 1793. This deadly disease became a reality in Philadelphia. The mortality rate reached a total of 5,000 people by the end of its sweep. The arrival of the virus occurred when refugees from the Caribbean, where a yellow fever epidemic had already broken out, fled to Philadelphia in the hope of remaining healthy. However, they unknowingly were carriers of this life-threatening virus and brought it to America. In October of 1793, approximately “100 people were dying from the virus every day” (History). This historic epidemic was later recognized as the American Plague. The last outbreak of yellow fever in the United States occurred in New Orleans in 1900.

The identification of the carrier and the cause of yellow fever were hypothesized by a multitude of scientists and citizens. Many scientists, in the mid 1800s, initially predicted that it was through direct contact with infected individuals or contaminated objects that made the lethal virus spread rapidly. However, in 1848, an American physician, Josiah Clark Nott, challenged prior hypotheses by proposing mosquitos as the ones accountable for the transmission of the virus. Nott’s theory was supported by a Cuban physician named Carlos Finlay in 1881. In 1900, the Reed Yellow Fever Commision identified and proved that the Aedes Aegypti mosquito was the agent for transmission.

Because the origins of yellow fever were proven to be derived from a mosquito, countries have become more aware and active about putting forward intensive sanitation programs to reduce or eliminate the disease in a certain area. To decrease chances of getting infected by the disease, in 1930 two yellow fever vaccines were developed. It is now rare for a yellow fever outbreak to sweep through America.

Before Washington Square Park became a public space, the parkland, which is about six and a half acres, was used as a potter’s field. Potter’s fields, also known as common graves or pauper’s graves, are burial grounds that are designated for the unidentified poor, criminals, indigenous people, and victims of epidemics. In 2008, a burial ground was discovered below Washington Square Park. The majority of corpses were believed to have been victims of yellow fever from a series of epidemics in the years 1797 to 1803. There were about 10,000 bodies buried under Washington Square Park, which exceeded the capacity of the original burial ground. The creation of a pauper’s field was a common measure for locations that were at risk of a potential outbreak.

Citations

“Yellow Fever Breaks out in Philadelphia.” History.com, A&E Television Networks, 26 Oct. 2017.

“History Timeline Transcript for Yellow Fever.” Center for Disease Control and Prevention, Center for Disease Control and Prevention, 26 Oct. 2017.

Santiago de Compostela Changed Me

By Zoe C

Hiking the UNESCO World Heritage Site, Camino en Ingles to Santiago de Compostela, at 15 years of age was something I never thought I would get the opportunity to experience and accomplish in my life. Located in Galicia, a northern region in Spain, my sister and I would travel 3,586 miles away from home to spend five days hiking a total of 72 miles on the Camino en Ingles, also known as the English route. Through this journey, I would grow as an independent young adult, expose myself to Spain’s extraordinary culture, learn about the history of the famous pilgrimage and Saint James, and meet new people who soon became friends.

Going to Santiago de Compostela was a moment where I experienced a sense of independence and discovered new values. Although I was hesitant at first about going on this trip, it ultimately exposed me to a sneak peak of adulthood. I, along with my sister, learned how to be self-reliant by navigating around a foreign country, to manage money by setting a budget for myself each day, and to build strong communication skills by meeting new people (fellow pilgrims) and with adults within the group. In addition, I had to face responsibilities that I had not encountered before, such as doing my laundry, and making sure I was hydrated and had eaten balanced meals before and during a day’s worth of hiking. The freedom I was given allowed me to become more confident because I realized that I didn’t need my parents at all times and I could do a lot on my own.

Because we were free to explore on our own, it was common for Mei and me to naturally walk around the small traditional towns at each resting stop and to immerse ourselves in the culture. We would stop in restaurants to taste some delicacies and smell the aroma of paprika. We would walk into little shops with money in our hands eager to purchase clothes and artifacts. We would stroll along the cobbled stone or dirt paths to hear the beautiful native tongue and to see street performers and architecture. I got the chance to taste Santiago de Compostela’s renowned dishes like the polbo á feira, which is boiled octopus with pimento picante, and torta de Santiago (St. James Cake), an almond cake embellished with a powdered sugar outline of St. James’s cross as a symbol for his remembrance. I was mesmerized by the culture that Spain proudly embraced. I even had an internal debate on whether I should document it or just live in the moment.

Accompanied by Santiago de Compostela’s culture, history plays a major role in the foundation of its traditions and heritage. Being a member of the St. James Episcopal Church congregation, I started this journey unfamiliar with the story of Saint James. This pilgrimage to Santiago de Compostela was an eye-opener from a historical point of view because many of my questions were answered. As we made our way across the Camino en Ingles, we had small history lessons provided by our reverend. We even walked into churches to admire the shrines dedicated to vital characters in the Bible, which of course included Saint James. I can recall walking into a church and aligned on both sides were statues of those biblical figures. Having really no clue who everyone was, my reverend told me each character possesses a certain object that acts as an identifier. For instance, Saint James is known for being portrayed with a staff in his hand, barefoot, books in his other hand, and wearing pilgrim apparel. James, who is also known as Jacobus Major, is a disciple of Jesus. The cause of his death has two stories: one where he is a martyr and beheaded and the other where he freed Hermogenes, a magician who sent devils to capture James, but authorities in Jerusalem were unsatisfied and had him beheaded. James’s body was then placed in a boat by his followers, who traveled wherever the boat took his corpse, which ended up in Galicia.

Through this adventure, I met a diverse group of people, both from around the world and with varied professional backgrounds. Taking this journey with only adults, who were at least 20 years older than I, was special in that I got to learn who they were beyond them being fellow Episcopalians. The group consisted of an executive of a well-known multinational fashion company, a fashion photographer, two priests, the wife of a US diplomat serving in Senegal, a high school history teacher, and an attorney. On top of becoming closer to these people, I also got the opportunity to meet fellow pilgrims who were taking the same journey. I met people from Germany, France, Norway, China, and many other places. I was impressed by their stories and reasons for taking part in this famous pilgrimage.

These people have truly become my friends, and I am grateful I know them. I returned home more independent and thrilled that I pushed through the challenges I had to confront. Being around older adults is an environment that I have greatly valued because I enjoy their stories and appreciate their perspectives. The life lessons they shared helped me discover my personal values.

A Short History of Malaria

By Mei C

Malaria is a disease that can be caused by the Plasmodium parasite. The parasite can be transmitted from person to person by a specific type of mosquito called the Anopheles mosquito. When a female mosquito bites a person to obtain blood to help nurture her eggs, the parasite gets injected into the bloodstream of the person and potentially infects the person. The side effects start to become more prominent among the communities that are affected with symptoms of chills, fevers, and sweating.

In China around 2700 BCE, there were symptoms of what would later be diagnosed as malaria in a city called Nei Ching in Taiwan. By the 4th Century BCE, it was widely recognized in Greece as being responsible for the decline of city-state populations. Hippocrates, who was said to be the father of medicine and the best physician, took note of the symptoms and began a study. While Hippocrates was collecting information, there were numerous references to malaria in literature, and the depopulation of rural areas was being recorded. In the early years, many Roman writers believed it was due to the swamps, while there was a “Sanskrit medical treatise” that recognized the symptoms relating to a bite from a specific insect.

Malaria has been around for millennia, and it has taken scientists a long time to properly diagnose the disease. Malaria was first diagnosed by a French doctor named Charles Louis Alphonse Laveran (1845-1922). During Laveran’s life, he spent time studying military medicine. He noticed that malaria could occur in not only temperate zones, but also in the tropical regions. Laveran decided to go to Algeria’s North African coast to investigate a new theory. He stated “many diseases previously ascribed to miasmas, or evil vapors, were in fact caused by microbes” (NCBI). On October 20, 1880, Laveran used a microscope to study the blood of a febrile soldier. He “saw crescent-shaped bodies that were nearly transparent except for one small dot of pigment” (NCBI). A decade later, he had discovered that the “brownish-black pigment was hemozoin (now known to be the product of hemoglobin digestion by the malaria parasite”) and was found in corpses’ spleens and the blood of malaria victims (NCBI). He continued his study by examining blood specimens of “192 malaria patients” and noticed that there was that same pigment in “148 sufferers” (NCBI). As a conclusion to his study, he recognized four distinct forms of different states of the malaria parasite: “the female and male gametocyte, schizont and trophozoite stages” (NCBI). Camillo Golgi affirmed Laveran’s finding, stating that there was a linkage between the “rupture and release of asexual malaria parasites from blood schizonts with the onset” (NCBI). From the research done by Laveran, Golgi found that the “single-celled protozoan” was what caused malaria (NCBI).

Until the early 20th century, the malaria endemic plagued the United States. In the 19th and 20th century, malaria claimed “between 150 million and 300 million lives, accounting for 2 to 5 percent of all deaths” (NCBI). It weakened soldiers during the Civil War, traveled to California during the Gold Rush, claimed Native American lives across the United States, and attacked “presidents from Washington to Lincoln” (NCBI). It continued onward until the Tennessee Valley Authority brought “hydroelectric power and modernization” to the rural South in the 1930s, where malaria unforgivingly drained the physical and economic health of the entire region (NCBI). As the United States worked hard to eradicate malaria, it came back to haunt many Americans during World War II. More United States soldiers died of malaria than the number of casualties inflicted on the opposing side. In response to the numerous outbreaks of malaria, the United States founded the Centers for Disease Control and Prevention (CDC). When the United States got involved with the Vietnam War, the “U.S Army established a malaria drug research program” when they “encountered drug resistant malaria during the war” (Malaria Site). By 1967, Chinese scientists were working on a “secret military project” to help the “Vietnamese military defeat malaria” by creating a malarial formulation (Malaria Site).

Even today, places like Saharan Africa, Asia, the Amazon basin and other tropical regions continue to be affected by malaria. In 2015, there were “roughly 212 million malaria cases and an estimated 429,000 malaria deaths” (WHO). The people who are at higher risk of contracting malaria are young children, pregnant women, and non-immune travellers from malaria-free countries. Today Sub-Saharan Africa continues to hold a high share of global malaria burden. “In 2015, the region was home to 90% of malaria cases and 92% of malaria deaths” (WHO).

Citations

“10 Facts on Malaria.” World Health Organization, World Health Organization, 16 Dec. 2017.

“Malaria in Wars and Victims.” Malaria Site, 25 Feb. 2015.

“At Least Eight U.S. Presidents Had Malaria.” Entomology Today, Entomological Society of America, 14 Feb. 2014.

“Laveran and the Discovery of the Malaria Parasite.” Centers for Disease Control and Prevention, U.S Department of Health & Human Services, 23 Sept. 2015.

Institute of Medicine (US) Committee on the Economics of Antimalarial Drugs. “A Brief History of Malaria.” National Center for Biotechnology Information, U.S. National Library of Medicine, 1 Jan. 1970.

The Science of Yellow Fever

By Mei C

Yellow Fever is a virus that is present in tropical areas like South America and Africa and is related to the West Nile virus, St. Louis encephalitis, and Japanese encephalitis virus. Scientists have discovered that it affects living organisms’ RNA strand (a messenger to carry genetic information copied from DNA and converted to proteins) and not the DNA strand (a sequence of proteins that gives instructions needed for an organism to develop, survive and reproduce). The virus is primarily transmitted to people through the bite of an infected Aedes or Haemagogus mosquito and is acquired through feeding on an infected primate (human or non-human) and passing it onto another primate.

The virus specifically attacks the immune system, liver, spleen, lymph nodes and bone marrow. Once an infected mosquito bites a primate, there is a period of time where there are no symptoms of the virus. During this resting period, the virus is multiplying in the body. Once the virus has begun to attack the body, the most common symptoms are “headaches, backaches, rapid rising fevers, nausea, and vomiting” (Britannica). These symptoms can last between two to three days until they slowly ease off. There is a small percentage of patients who unfortunately enter the second phase of symptoms, which are the most toxic. Those patients will experience the return of high fevers, the infection of the liver and kidneys, jaundice, dark urine and abdominal pain with vomiting. “Half of the patients who enter the second phase will die within seven-ten days” (WHO).

Yellow Fever can be classified into three cycles depending on the mosquito species (Aedes or Haemagogus) and the habitat in which the mosquito lives. The Sylvatic (Jungle) Yellow Fever occurs in tropical rainforests where monkeys, which are the primary source of the virus, can be bitten by mosquitoes in the wild and the virus can be then passed onto other monkeys. Humans can also attract the virus if they are traveling to these areas and come in contact with an infected mosquito. The Intermediate Yellow Fever occurs when semi-domestic mosquitos (those that breed in the wild and around the households) infect both humans and monkeys. The rise in contact between mosquitoes and humans can result in an increase of transmissions, causing outbreaks of the virus throughout communities. The Urban Yellow Fever occurs when the infected come into contact with a populated area where there is little to no immunity to the virus and there is a lack of vaccines and preventives. In this instance, the infected mosquitoes will transmit the virus person to person, resulting in a large epidemic.

Yellow Fever is diagnosed based on the “patient’s clinical features, places and dates of travel (if the patient is from a non-endemic country or area), activities, and epidemiologic history of the location where the presumed infection occurred” (CDC). A laboratory diagnosis can be taken by collecting a blood sample in the early stages of the illness. If the sample does not show the virus itself, the blood test can detect antibodies and other substances specific to the virus.

There is no current treatment to cure the viral infection itself, but it is recommended to get supportive treatment early from hospitals to help improve survival rates. One can get medical treatment to help ease some of the symptoms, such as fevers, muscle pain, and dehydration, but hospitalization is often required. Treatment can include “providing fluids and oxygen, maintaining adequate blood pressure, replacing blood loss, providing dialysis for kidney failure and treating any other infections that develop” (Mayo Clinic). In some cases, patients will receive transfusions of plasma to replace blood protein to prevent clotting. Once someone has yellow fever, they are immune to it for the rest of their lives.

Due to the lack of treatments to cure Yellow Fever, it is crucial patients take preventive measures. The yellow fever vaccine is recommended for adults and children over nine months of age who travel or live in countries with a known risk for yellow fever. There are other preventive measures one can take when traveling to yellow fever prevalent countries, which include using the right insect repellent, covering exposed skin when outside, using screens on windows and doors, using mosquito nets over beds, and avoiding outdoor exposure during peak hours (dusk to dawn).

Yellow Fever is the most prevalent public health problem in sub-Saharan Africa, resulting in a high mortality rate. Africa faces “periodic yet unpredictable outbreaks of urban yellow fever” and “32% of African countries are now considered at risk of yellow fever” (WHO). Yellow Fever is endemic in ten South and Central American countries and in the Caribbean islands. Bolivia, Brazil, Colombia, Ecuador, Peru, and Venezuela being at the greatest risk. “Urban centres in the American tropics have been re-infested with Aedes aegypti” and urban residents are vulnerable due to low immunization coverage. “Latin America is now at greater risk of urban epidemics than at any time in the past 50 years” (WHO). The density of the Aedes aegypti has expanded to both rural and urban areas, resulting in eradicated regions being reinfected with the virus.

Citations

“Yellow Fever.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 1 Aug. 2017.

“Yellow Fever.” Centers for Disease Control and Prevention, U.S Department of Health & Human Services, 21 Aug. 2015.

“Yellow Fever.” World Health Organization, World Health Organization, May 2016.

The Editors of Encyclopædia Britannica. “Yellow Fever.” Encyclopædia Britannica, Encyclopædia Britannica, Inc., 4 Dec. 2017.

Summer Program at Brown University for Global Health

By Mei C

By the time I was in the third trimester of my junior year, my mom began to ask me what I wanted to do during the summer. My family had already planned to go to the Poconos, where we are part of a “private” community, for the month of July. I had a job working at the daycare there, watching over children who were between the ages of three to six. My mom asked if there was any pre-college program that I would want to do in the month of August. She thought it would be good to see what it is like to live away from home and to attend a college styled course, but also to figure out if I was comfortable possibly going to a different college than my sister. I began to think about all the hobbies and interests I have and what stood out to me the most was my community service work and growing interest in public health.

For several years, I have volunteered monthly in the soup kitchen at my church where the youth group takes over and serves our 90 guests. I have been helping out since I was in 7th grade. Not only do I get to meet new teens, but I am able to give back to my community. I love meeting the guests and welcoming them to my church. I like preparing the meal and passing out the food and seeing how all the hard work pays off because the guests at the end of night tell us how much they appreciate the warm cooked meal.

Last year, I went on a service trip to Haiti and plan to go again in February. We were at a school for handicapped children and spent our four days in the facility working with the director, the teachers, and the students. I was struck by the challenges the school faces given limited access to resources and healthcare support. Through my experiences, I learned about economic and social disparity and the potential for foundational change that can build from local efforts. I always feel a sense of gratitude and accomplishment after these kinds of events happen, knowing I could help make someone’s day a little brighter. I started to research different global health programs offered by colleges and found one at Brown University that was a leadership program based on global health. I filled out the form and all I had to do now was wait…

It began the morning my mom came into my room and told me it was time to head to Rhode Island. I remember opening my eyes and seeing that my alarm clock had read 5:30 am and wanting to sleep for 15 more minutes. I knew I couldn’t sleep anymore because I had a few more things to pack. I slowly crawled out of bed, got ready for the day, and did the last minute packing that was needed. By the time it was 6:00 am and my mom had said, “Mei, time to head out,” I quickly walked to the room my sister and I were staying in and told her, “See you in two weeks, Zoe.” I closed the door behind me and walked to the end of the hallway where I grabbed my suitcase and made my way to to the car. While in the five-hour car ride to Brown University, my mom and I discussed topics from how I was feeling that morning, to politics, to what I was thinking about as we reached the sign that read “Welcome to Rhode Island.” That was when the butterflies in my stomach started to settle in.

My mom asked if I was getting nervous, but I wasn’t quite sure. Instead, I told her I was excited and ready to go on my adventure when my true feeling was nervousness. After finding a spot to park, which was nowhere close to my dorm or the main green (where many of the academic buildings are), my mom and I walked to the check-in desk, where I got my room key and ID and was off to the dorm to do some unpacking before it was time to say goodbye to my mom. After some time getting lost, we found the building and we hauled my heavy suitcase up three flights of stairs and approached my room where I would be spending the next two weeks. I unpacked and my mom asked once again how I was feeling. I told her how I was now feeling, which was completely nervous. I could tell she was trying to help me feel more at ease by reminding me what it was like taking my sister to her program and how she reacted. Before I said goodbye to my mom, we made our way back to the main green where we were to have a summer program orientation presentation before splitting up into groups to play icebreaker games with our floor Resident Assistant (RA).

I gave my mom a hug and made my way into Solomon Hall, where I wouldn’t see her again until the day of my action plan presentation. I walked down a flight of stairs where I saw a group of people waiting to go into the auditorium. I once again felt the butterflies in my stomach as I walked closer to the group and made my way through the doors. The minute I walked in all I heard were the sounds of everyone talking and laughing with one another as if they all knew each other and I was the only one who didn’t know anyone. I found a seat and told myself that the only way to get rid of my nerves was to begin speaking to the people around me and asking them about what program they were in and the class they were taking. After the presentation, I met my RA and the people who lived on my floor and we began playing our icebreaker games. We all decided that we would eat together that night to get to know each other better. I remember laughing a lot with all the girls and talking about what we were most excited and nervous about.

I came to my first global health class confident and excited to investigate the importance of health worldwide. I walked into class, found my seat and took the same approach as the time I walked into the auditorium. I began talking to people next to me and before I knew it, I became really good friends with them. I was surrounded by friends and classmates from other states and all around the world who had stories about their experiences that were different from mine. I found it interesting to hear their insights on the different health issues that are prevalent in other countries and how they are handled.

What I really liked about the course was the readings. Some of them were personal narratives of people who live in infected areas, while others were research papers discussing the causes of a disease. One takeaway from the readings and the two weeks spent learning about global health was how economic, social, political, climate, and environmental factors can play a key role in the spread of disease and the levels of health support in a country. I liked learning about the different mosquito-borne viruses and how they are all different in the way they react and infect a population. We also spent time talking about different diseases, viruses, vaccines, and mental health, and the impact they have on the development of a society. We discussed terminology and processes that are used in understanding global health and epidemiology. In class, we learned about the components that are needed to find the root cause of an epidemic and what is needed for an investigation to take place. One of the activities was a simulation of how to help confine Ebola from spreading through Liberia and neighboring countries. We were broken into five different organizations and worked together to prevent the spread of the disease. The goal was to have the five organizations share what they are known for and to agree upon what each organization would need to provide. We then had to share our final plan with some of Liberia’s government officials.