José de Souza Nogueira is 63 and says he has had malaria more than 130 times. It is an exceptionally high number, even for a country like Brazil, where the mosquito-borne disease is endemic. But doctors agree that it is quite possible for a smallholder farmer who has spent his entire life in rural areas – the mosquito’s preferred breeding ground.
“I work and live alone, selling what I grow: bananas, oranges, sugarcane, cassava … When I have malaria, I can’t tend to the plants,” he says.
Malaria causes misery for tens of thousands of people in Brazil every year. The most common type, Plasmodium vivax, is less deadly than the malaria typical in Africa, but can be trickier to combat.
The parasite can lie dormant in the liver before it once again flares up and causes symptoms – including fever, chills, muscle and joint pain, profuse sweating, nausea and vomiting.
Officials hope that the rollout of a new test and treatment regimen, now in its infancy, will help them eliminate the disease from Brazil by 2035.
Since the 1990s, the country has used two drugs to treat P. vivax: chloroquine for three days and primaquine for at least seven.
But because chloroquine combats the symptoms, many stop taking the medication after the first three days when they feel better, leaving the parasite in the liver to “wake up” after a few weeks or months.
Patients’ reticence to continue with treatment is understandable, says Eliana Pasini, the municipal health secretary of Porto Velho, the capital of the Amazon state of Rondônia, where Nogueiro lives.
“They need to work, they want to get back to work quickly,” she says. “Usually, these are small farmers, self-employed individuals, people who come from everywhere to this region in search of new opportunities.”
But it stores up future costs. “When a patient has a malaria relapse, you need to give them more medication, they may need to be hospitalised,” she says. “That’s why treatment abandonment is very bad for us, but also for the patient who will end up bedridden for days.”