Aya Obara

The Malaria Capers: More Tales of Parasites and People, Research and Reality. Robert S. Desowitz.  New York: W.W. Norton & Company, 1991. 288 pp.

Tropical medicine is viewed as a foreign and exotic field of study, though application of this research is sparingly successful.  For medical researchers, public health practitioners, and leaders in organizations providing funding, Robert Desowitz exhibits the epidemics of kala azar (visceral leishmaniasis) and malaria as two cases where the link between research and medical assistance was and continues to be missing.  While he covers the detailed history and research pathway of both diseases in Malaria Capers, he also layers this background with vivid personal stories of those who caused this infliction as well as those who experienced the consequences of inaccessible healthcare in the tropics.  Desowitz finalizes his critique of inapplicable scientific endeavor with a call for compassionate, proactive leaders but lacks to include examples of probable practical solutions to the misguided powers and thinkers of tropical disease research in the past.  Malaria Capers reaches out to its varied audience of scientists, politicians, and activists, as a historical review of problems without successful solutions, and compels the reader to seek practicality over technology in viewing future disasters in health.

A recurring theme in Malaria Capers, and the most significant one at that, is the lack of communication between aid organizations and the communities in need.  For instance, when the World Health Organization’s Division of Vector and Biological Control unleashed swarms of mosquitoes genetically lethal to sandfly vectors of kala azar, without a word, in a small village near Delhi, of course the post-event apologies of the meaning behind the science-based raids were meaningless (89).  Additionally, when roofs collapsed within a month of DDT application by malaria aid workers from the National Institute of Health, complex explanations to the connection between malaria, DDT, and the palm fronds of their roofs were not taken well (140).  Desowitz gives these two examples as effective evidence of an internal problem within research institutions of poor “public relations,” the true downfall for progress of vaccination in tropical medicine.  What he refers to as “epidemiological diplomacy,” is a key step that is overlooked in the process towards immunity from infectious disease.  Desowitz highlights this as a universal downfall for failed scientific-based health interventions; it is his strongest and most convincing argument in Malaria Capers.

While other comparative global health literature presents the protagonists of the world in grassroots, non-profit and non-governmental organizations, Desowitz creates an antagonistic view of research-driven, scientific, larger institutions.  Going into intricate depth of the entomology behind both kala azar and malaria, he indulges the reader’s inquiries for the scientific background behind both diseases, perhaps to the point of excess for the leisurely reader.  The sheer contrast of the time he spends reiterating the research trials and organizational focus on vaccination research with the amount of chapters dedicated to the stories of Susheela and Amporn mirror the imbalance he refers to in the title.  Directing the analytical light at the skew of focus on science from the supposed focus on helping people, Desowitz successfully achieves his primary goal of illustrating this disconnect.  Though, he does not give alternative solutions to the reoccurring problems that organizations repeated to process, and therefore leaves it to the reader to decipher ideas for successful interventions.   As he runs through the research history with no applicable and successful solution in sight for malaria and kala azar, he constructs a powerful sentiment in the reader, universally speaking, to take action in light of those in the field who were silent.  While this call to action is an all encompassing, theoretical finale to the build up of the trials and tribulations that malaria and kala azar research and application have endured,  Desowitz neglects to add examples of simple, community-based solutions throughout his accounts; this may have further strengthened his argument for the need of effectively applying knowledge.  Topics such as promoting mosquito nets or  recruiting community members to learn more about insecticides and become applicators in their own communities are possibilities that adds a sample backdrop to Desowitz’s call for proactive and meaningful work.

Malaria Capers captures the extensive reality of research for tropical diseases and Desowitz undoubtedly relies on the future for the in-the-field solutions that past generations of research did not accomplish.  In highlighting significant factors such as the lack of scientific, risk-based communication with inhabitants of the tropical world, Desowitz touches on a fundamental fact of public health.  His conclusions about relating the research to the reality of people comes down to the continual momentum of public health; it is a system not about starting anew but a process dependent on progress and improvement and working with what is already available.  Although Desowitz shines the lime light on the corruption of aid and the dead end trials of the research sector, he simultaneously exhibits the wealth of lessons learned and the time already committed to malaria and kala azar.  Putting faces and histories to these diseases, Desowitz makes a lasting impression on the public health activist mindset to utilize the running start of tropical disease research and explore meaningful solutions for the global population.