Yesterday, I thought I had malaria. Fever, headache, diarrhea, extreme fatigue. Like most people I know in Dar es Salaam, I quit taking malaria prophylaxis almost as soon as I arrived—I didn't want to hassle with it and malaria prevalence is low in the city, at about 4 percent.
A friend ran out to the local pharmacy and got me some Coartem and oral rehydration salts. It was surreal—this is the stuff I had read and wrote about in Washington, and here I was having to use it. (Side note: the “orange”-flavored ORT tastes like death.)
But I still didn’t know if I actually had malaria. I wondered: should I just start taking Coartem, and treat myself presumptively, as some friends had done? It was tempting—going to the clinic would take too much time and cost too much money. Plus, I'd been there twice recently for my ankle and didn't want to start feeling like a "regular."
But I wanted to know for sure, so I decided to go to another, better stocked pharmacy nestled in a shopping mall in an expat enclave by the bay and pick up a rapid diagnostic test, or RDT. These handy little things, I knew from having read about them back in Washington, were easy and relatively cheap and could tell me in minutes whether or not I had malaria. Voila.
The South African-manufactured RDTs cost about 25,000 shillings (or about $19) for five tests. (Like the Coartem, which cost 16,000 shillings for a full adult dose, it is prohibitively expensive for most Tanzanians.) I went home and assembled the pieces on the kitchen table: lancet, pipette, alcohol swab, and the test device/strip. Then I realized: the buffer was missing. So I called the taxi driver back and went back to the pharmacy, where they apologized and gave me some buffer.
Round two. I assembled the parts, and my friend sat down to help me administer the test. He pricked my finger, but hardly any blood came out—the lancet was dull. We took another lancet and pricked another finger. More blood this time. He took the tiny plastic pipette and tried, as the directions instructed, to suck up enough blood to drip into the test device. But the pipette wasn't sucking anything—it merely moved the blood around on my fingertip. We kept trying for about ten minutes and gave up.
Now the chances that I have malaria are low. More likely it is some nasty parasite. But the lesson is: getting things like RDTs on the shelves is one thing. Getting them to work (even under the best of circumstances) is another.
*Tanzania has made huge strides in malaria control (see Paul Smithson's Down But not Out: The Impact of Malaria Control in Tanzania), but it is still the leading cause of illness in the country. Next year, the Affordable Medicines Facility-malaria will launch in Tanzania, which will subsidize the cost of effective malaria drugs such as Coartem, making them affordable for average Tanzanians.