Read The Fever: How Malaria Has Ruled Humankind for 500,000 Years for Free Online

grounds, mostly women wearing traditional wraps and silty blouses, carrying swaddled children on their backs, hanging laundry out to dry along the gates. Inside, the hallways are packed with patients clutching tattered health booklets, waiting to be seen by a doctor. The painted turquoise wall is affixed with an orange plastic laundry basket filled with garbage, and a small sign that reads “Osalabvula.”
Do not spit.
There are no fans, no air-conditioners, and although the unscreened, glass-paned windows are flung open, the air is fetid and still. Roaming down the hallway, one passes through several mild but discernible zones of odor: mold, sweat, urine. Inside the crowded wards a handful of white-coated doctors drag their stools across the floor and lean in to each patient to hear their whispered complaints.
    The pediatric research ward, at the very edge of the hospital complex, consists of two large rooms holding about fifteen wooden raised beds each, a narrow, fluorescent-tube-lit hallway, and some barren, closet-size offices, including Terrie Taylor’s. Unlike the rest of the hospital, with its crowds and smells, the research ward has a certain serenity to it, despite the drumbeat of child deaths that occur within its walls. Most of the young patients here are deathly ill with malaria, and comatose. There is no welter of plastic tubing or beeping machines around them, as one would see in the West. Their small bodies rest on the high beds unadorned. They appear to be simply asleep.
    Under their beds, their mothers and grandmothers have unrolled their thin wraps and are resting on the cool cement floor. When Taylor and her team stride into the ward, the women jump up abruptly, like schoolkids who’ve been sneaking a nap.
    Two-year-old Duke arrived at the hospital on the Friday before I came to Malawi. He’d been visiting relatives living near Blantyre when he suddenly fell terrifyingly ill. His mother and aunt—his father was at home in their village, two hours north of the city—brought him to Queen Elizabeth Hospital. Duke most likely shared one of the steel-frame beds with another patient, while his family camped out on the hospital grounds so they could bathe him and wash his bedding. They’d have joined the hordes of others forsaking the demands of an unforgiving corn crop back home—Malawi is a nation of subsistence farmers—to provide hospitalized relatives with this basic nursing care. There’s no one else to do it.
    After Duke’s breathing grew labored, he fell into a coma. His muscles started to flex and extend involuntarily into stiff, bizarre positions. It was in this state that Taylor’s team discovered him and rushed him to the research ward.
    While he lay unconscious, they pumped him with anticonvulsants and drew his blood, dabbed a ruby drop on a glass slide. Down the hall, in the sole air-conditioned room in the ward, a lab technician focused a microscope on the slide and spied the lavender, pale-centered spheres of his red blood cells. For each healthy one, there was another that had been invaded and occupied by
Plasmodium falciparum
.
    Ironically, while the symptoms of severe malaria are alarmingly apparent to the victim’s family, the disease isn’t easy for clinicians to diagnose. The only surefire way Taylor’s team can finger severe malaria is by lifting their comatose charges’ eyelids and spending up to thirty minutes examining the backs of their eyeballs. A normal eyeball is gray and laced with a thin spiderweb of red blood vessels. In a patient in the throes of severe malaria, those vessels are burst, leaving the eyeball speckled with white splotches and red spots. The spidery vessels themselves are pale orange, not red, the parasite having eaten all the hemoglobin. 54
    Duke and the other comatose children who appear in Taylor’s ward are surely sick, and they are often clearly carrying the malariaparasite, but this isn’t enough for doctors to know that they are