Malaria, DDT, and Desperation in Uganda

WITH MALARIA sapping so much life and potential, Uganda has been driven to spray the interior of homes with DDT. The insecticide, made infamous by Rachel Carson's "Silent Spring,'' has long been banned in the United States for wildlife devastation; among other consequences, it made bald eagles' eggs too thin for their young to survive. But malaria here in Uganda is so intense, top officials have answered local and international DDT critics by saying, as Vice President Gilbert Bukenya put it, "You can start with my house. Those shouting against it are shouting ignorance. They are simply not informed.''

DDT makes me shudder. But the issue arouses great passion in sub-Saharan Africa, where access to the best drugs is woeful, and where simple home protections, such as window screens, are lacking.

Uganda, a nation of 30 million people, had an estimated 10.6 million cases of malaria in 2006, according to the World Health Organization, with 70,000 to 110,000 deaths a year, according to government and university researchers. The disease seriously hampers economic development.

At ground zero of malaria control, Abwang Bernard is so persuasive, he might get permission to spray from even Carson herself. Bernard directs malaria control in the Mbarara region. With his 6-year old son sitting by him during a 90-minute interview, there was no doubt that taking care of villagers was his chief concern.

"Why do we sit around looking for the impact on things we cannot see when we have the problem we can see right now?'' Bernard said. "We have 5-year-old children dying. Many people have four episodes of malaria a year. They miss weeks and weeks of work. They cannot feed their families. Why not protect them for their future?

"I understand the environmental arguments, but sometimes they cry so much fear, their arguments become inhuman to the people. It's almost like they want the people to perish for the animals. No chemical has no side effects. But let us first reduce infant mortality. That is the environment I care about right now.''

The government this month announced a goal of having an insecticide-treated mosquito bed net in 85 percent of households and spraying the interior of all homes in the most hard-hit of districts.

According to UNICEF, just 10 percent of 5-year-olds live in a house with an insecticide-treated net. Bernard praised the goal but was highly skeptical that it would work.

"It is part of the strategy but only a part,'' Bernard said. "Nets work when you use them right, but let's be practical here. Only so many people can get under one net, and in lots of houses, the net goes to the head of the household. So if you have only one net, it goes to you, Derrick. Your kids are still getting bit by the mosquitoes.''

Bernard said many families do not use nets because they feel claustrophobic or they stifle ventilation. The Harvard University disease researchers whom I accompanied here were told that frustrated families turn their nets into fishing nets, volleyball nets, and even wedding dresses. "Before people really start using nets,'' Bernard said, "the government is first going to have to demystify them.''

Bernard was also skeptical of new national goals for nets and malaria-fighting drugs because the economic downturn months ago slashed his home spraying schedule. He is the sprayer, but the families have to purchase the insecticide. The government says the poor may spend up to 34 percent of household income on malaria treatment.

"A year ago last quarter I sprayed indoors in 50 homes,'' Bernard said. "This past quarter, I sprayed five. In 2001, we had a big international donation and we sprayed 50 homes in a day. If we could spray the homes to get malaria under control, then maybe the nets and drugs will help. If the environmentalists want to help us, they need to come here to see the total picture.''