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Mission Man

David Colwell

Mission Man (continued)

One measure of Thuma's connection to Macha is revealed by the pain in his voice as he recounts malaria's lethal swiftness: "I have seen kids under five who are looking fairly normal one day, fever and headache the next day, by the third day they're in bed, and by the fourth day they might be dead," he says.

His lifelong commitment to the community's health has yielded unprecedented trust in Thuma and his work. In a culture where reverence can be measured by the number of babies named after a local hero, there are enough Thumas in Macha (Philip or Alvan, take your pick) to fill a phone book. "You walk in the bush, or stop by a hut, and everyone knows 'Thuma,'" says Greg Glass, PhD, a Bloomberg School microbiologist and professor in Molecular Microbiology and Immunology (MMI). "One time my tech, a jogger, got lost in the bush. He bumped into somebody and said, 'Take me to Thuma!' Well, they took him to Thuma, but it wasn't Phil ... it was some other guy, even farther out in the bush, named for Phil or Phil's dad. Fortunately he knew Phil, and got my tech back home."

The deep connections Phil Thuma has made, from the upper reaches of Zambia's Ministry of Health to generations of the poorest of Macha, take decades to establish. His hope: that the trust and communication that have taken root in Macha, nourished by the continuing scientific rigor that he has established, can be seeded elsewhere.

Diane Griffin was looking for a very special partner. It was 2001, and Griffin, MD, PhD, chair of MMI and the founding director of the Johns Hopkins Malaria Research Institute (JHMRI), knew that to do the work she envisioned for the Institute, she needed a living, breathing touchstone, an African field site that could serve as a wellspring for investigation, discovery and, ultimately, healing. A place where the presence of a community-oriented researcher would open the door to important projects (especially those that ask African subjects for bodily fluids such as blood) that often run into roadblocks among wary populations.

In Philip Thuma and Macha, she found that match. Alerted by colleague David Sullivan, MD, who had previously met and worked with Thuma, Griffin first met Thuma in Baltimore, during one of Thuma's stateside trips. She found they shared a mindset for ways of investigating malaria, and soon she visited Macha. Griffin discovered that Thuma's record keeping of malaria cases that came through his hospital was impeccable, giving her great confidence in his case numbers going back for years. And right next door to the hospital was a fledgling research lab, complete with something Griffin felt was absolutely vital for any sustainable control efforts: Zambian raised and trained technicians.

Thuma and Griffin soon found that, in hoping to better control malaria, they were both headed in the same direction ... back into the communities where the disease originated and continued to thrive. "Phil had exquisite records of malaria cases, but it was all hospital based and people were getting malaria out in the countryside," says Griffin. "The mosquito populations out there were totally unknown. The area hadn't been mapped. Everything was there to be done."

Even more enticing was the fact that, from an environmental viewpoint, Macha was virgin territory. While other African sites in Kenya and Mali had been pored over by a plethora of scientists, Macha, says Griffin, "was a brand new type of area of study, with seasonal [non year-round] transmission, no previous DDT spraying, no distribution of bed nets. Nothing had really been done to try and control malaria in the community before."

But even before JHMRI's imprint had been felt on Macha, the entire malaria landscape there changed. By 2004 the hospital cases had slowed to a trickle. On the surface, the cause was as simple as looking up at the cloudless skies: A severe drought had wiped out the mosquitoes' breeding sites. No mosquitoes = no malaria. But theoretically, that respite should only have lasted until the next rainy season. It came and went, but still the malaria stayed away.

Philip Thuma thought he knew why. It had everything to do with what had happened on the ground versus in the skies. Thuma had always sought better drugs for treating malaria. He knew that antimalarial drugs were often problematic, especially in adults who rarely died from the illness.

"In the days when we had quinine, we used to say that you're supposed to take seven days of it, but by day three, you were so dizzy and your ears rang so much that you usually couldn't function and you had to go to bed," recalls Thuma, who has contracted malaria numerous times. "In those early days, it was sometimes hard to separate out the symptoms of the disease from those of the drugs."

Things only got worse when malaria became resistant to chloroquine in the 1980s and '90s. Then, in 2003, the Zambian government made a strategic decision to spend big dollars on a new antimalarial medication, artemisinin combination therapy (ACT), which promised fewer side effects and the opportunity for malaria-stricken employees to return to work far sooner.

In Macha, Thuma discovered that ACT also held the potential to stop the disease. He got his Zambian government connections to procure for him large doses of the medication, which he and one of his first Hopkins hires, Zimbabwean Sungano Mharakurwa, PhD, delivered directly into the community. What they found astounded them. Before artemisinin, other antimalarials were capable of killing the parasite that caused the disease and its symptoms. But there's a stage to which the parasites can mature—a reproductive stage where they become known as gametocytes—that survived such previous treatment. Infectious gametocytes can persist for months in people with asymptomatic parasitemia. Seasonal mosquitoes die off, but come back in the next rainy season, and have a human source of the disease all ready to ingest.

Artemisinin stopped this process, knocking out both the blood-borne form of the parasite that causes clinical symptoms as well as the asymptomatic gametocytes. Aided by a relatively new field technology, rapid diagnostic testing, Thuma and company could quickly identify and treat malaria carriers with artemisinin—and do it right in their homes.

"We would take malaria smears every six hours, to count the parasites and quantify them," says Thuma, who had conducted similar tests during numerous previous drug trials held at his hospital. "Suddenly, with this drug, those parasites melted away faster than anything we'd ever seen."

Relying on a coterie of chiefs, medicine men and other influential community elders, Thuma and Mharakurwa, along with Zambian field workers they trained, visited every hut they could in 2003, testing asymptomatic people for gametocytes. Screening these unknowing carriers and offering them drug treatment was, by Thuma's own admission, a controversial choice. Some argued that parasites' presence in the body offered some immunity against serious cases of malaria. Eliminate the parasites and that potential protection is gone, but so is the chance of reinfection.

"People are taught about Typhoid Mary in medical school," says Thuma. "I talk about 'Malaria Mary'—though it's not just women. [My] example: If there's a parent in a hut with five or six kids, if the mosquito bites an asymptomatic parent, and then, after the 10- to 14-day incubation period, that mosquito bites their kid and the kid gets sick with malaria, you'll treat the kid at the hospital, the kid will go home, and the same thing will happen again because you've never found the source."

Thuma had found and treated the source. By 2004, cases at the hospital had plummeted, and malaria was on the ropes. The question for both Thuma and JHMRI had now shifted: What could they do to knock malaria down to the canvas ...  and keep it there?

Comments

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  • Kathleen Stuebing

    Ndola, Zambia 01/13/2011 01:32:27 AM

    This is an excellent article that accurately presents Macha and the incredible ways through which Dr. Phil Thuma has brought relief from malaria. Both of our children were born at Macha by Caesarean section, and I had no complications or infection, attesting to the quality of the medical care in the middle of the African bush. Now Dr. Thuma has added his malaria triumph, which your article describes so well. We eagerly await the time when malaria is controlled to such a degree where we live in urban Zambia. Our students and their children regularly suffer from malaria. This is a wonderful story of hope for all malaria ridden places, and it rightly honors the man who has given his life to pursuing this goal--Dr. Philip Thuma. Thank you.

  • Lee Nell

    Florida, USA 11/14/2012 12:14:32 PM

    Great article about a great man. Phil is a genius, in my opinion, the most unassuming person I've ever known considering the miracles he's accomplished so far, and, I'm proud to say, my brother-in-law. As the article notes, he is totally committed to the people in and around Macha and to eradicating this dread disease. As I've always said, my money is on the tenacious Phil Thuma to win that battle. Maybe then, and I'm sure only then, would he even consider accepting some credit for his success in the remarkable life's work he has undertaken. Maybe.

  • Juliet Laverley

    Sierra Leone 07/13/2013 11:52:01 AM

    This is great work it takes a special person to make this happen, I wish we can clone Dr. Thuma for other areas in west Africa. Is there opportunity for adoption of best practice and protocols from his experience and success for other African countries with similar challenges?

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Macha Slideshow

Fighting Malaria in Macha

Photographer David Colwell journeyed to Macha, Zambia and returned with images and sounds of malaria research and prevention.

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