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Biology 103
2003 Third Paper
On Serendip

Ethiopia's Medical Dilemma

Maria Scott-Wittenborn

Living in an industrialized country like America, and especially in a community such as Bryn Mawr, we are well fed and given excellent healthcare. Despite student complaints that they cannot go to the health center for a cough drop without being asked if they could be pregnant, most students are aware that they are very lucky and appreciate that there are parts of the world that are ravaged by diseases such as Malaria, which kills three children every minute. We donate money, we participate in clothing drives, but it is there that our involvement often ends, and we rarely see how effectively organizations such as Doctors without Border or Unicef ameliorate epidemics and other crisis developing countries. If one judges by the recent outbreak of malaria in Ethiopia; these human rights organizations are not living out the 'I Dream of Africa'-esque humanitarian fantasy that the donors may have imagined.

Unicef, in conjunction with the Ethiopian government has been using what some claim are outdated drugs to fight the disease, which The World Health Organization predicts will infect 15 million of Ethiopia's 65 million population ( three times the normal infection rate) (1) . However, international doctors groups' such as Doctors Without Borders argue that the outdated drugs will be ineffective and may even make the epidemic more severe. There are new drugs that both W.H.O. and Doctors without Borders favor, but they are expensive and it is felt that it might worsen the situation to switch tactics now. And so the problem presents itself: expensive, effective new drugs, or cheaper, older drugs that may not work(1). One can understand the position of the Ethiopian Government so far as that they would like to choose the less expensive option. However, if the treatment they buy is not effective and if the second line of treatment is not possible for many of the citizens, then it is not only in the Ethiopian government's best interest, but also their responsibility to seek out and use a drug that will in fact help their citizens.

In a country with an average life span on 44 years and a death rate of 17.2 percent for children under five, the health care in Ethiopia is already poor and this malaria epidemic is the worst that the country has seen since 1998 (3). Malaria is spread largely by Anopheles mosquitoes and attacks the liver and red blood cells, though it can also attack other organs, depending on the case (4). Heavy rains this year and hot weather encouraged the breeding of mosquitoes and caused the spread of the disease. Unicef tried to take preventative action by sending hundreds of thousands of mosquitoes nets and over a million dollars in drugs. Clearly the efforts did not prevent the spread, though whether they lessened the severity of the outbreak cannot be known. Unicef does not take full responsibility for the choice of drugs. As a United Nations agency, they must be guided by the country's government, and in this case, Ethiopia's government chose the older medications (3).
The problem with the 'out-dated drugs' is that the diseases they were designed to treat have mutated and are no longer responsive to the treatment. This is the problem that is facing Ethiopia (1). The strain of malaria that is currently ravaging the country is thought to be resistant to the drugs chosen by the Ethiopian government and supplied by Unicef: a combination of chloroquine and sulfadoxinepyrimethamine. The pills must be taken for one day and it costs roughly twenty cents per person. Doctors Without Borders has claimed that up to 60 percent of the patients they see have not responded to this treatment (1). The second line of treatment—that which is used if the first treatment fails—is a five day in-patient hospital stay while being given quinine. In a country such as Ethiopia, where many citizens live in rural areas or are nomadic, checking into a hospital or clinic for five days can be nearly impossible. In fact, resistance to chloroquine is so common that the World Health Organization advises against its use (1).

The treatment suggested by Doctors Without Borders is using medications that contain artemisinin (5). Artemisinin, a chemical that is found in the sweet worm wood plant, does fight malaria more effectively, but it also costs between $1.00 and $1.25 and the pills must be taken for three days, not one day (1). The World Health Organization also supports the use of "artemisinin cocktails." Other African Countries including Burundi, Liberia and South Africa are using "artemisinin cocktails."(5)

Some doctors would argue that the treatment chosen by Ethiopia is not only ineffective, but in fact detrimental. The drug attacks the malaria parasite during one phase of its life, but also speeds the rate at which it produces the cells that are transmitted by mosquitoes, making it spread faster. If it doesn't kill the parasite, then all you have is a more virulent and easily spread case of the disease (1).

What it comes down to is how accurate the reports of resistance is and how widespread the resistance is to the drugs that are currently being used. If the 60 percent resistance that Doctors Without Borders is reporting is accurate, then switching tactics would be "a sensible strategy to follow" according to Dr. Mary Ettling, chief malaria expert at the United States Agency for International Development. Indeed, the USA endorses using artemisinin (1). In the meantime, the disease continues to spread. This problem is not going to go away, indeed as diseases mutate and develop resistance to the currently available drugs the problem of new expensive drugs versus older and cheaper drugs will only become a more pressing dilemma. Perhaps Unicef will in the future be able to put more pressure on the governments of the countries in which it is working, but until then finances will continue to provide a barrier to health services in developing countries.

WWW Sources

1)New York Times Article ,Newspaper article on Malaria in Ethiopia, but you have to Purchase it.

2) W.H.O., the World Health Organization's site on Ethiopia.

3) Unicef, Unicef's webpage on Ethiopia

4) Web MD: Malaria, Web MD's summary of Malaria and its symptoms. In case you were worried that you had contracted it for some reason If you are a hypochondriac, I wouldn't recommend exploring this site. I speak from experience.

5)Doctors Without Borders, Doctors Without Borders website on the current outbreak of Malaria in Ethiopia.

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