Malaria: new methods and new hope in battling an old scourge.

• Author: Marlow, Jeffrey

In THE SOUTHERN MEXICAN VILLAGE OF Colotepec, most mornings unfold slowly as villagers tend to their animals, weed their fields, or shop for the day's food. But on this hot Thursday morning in August, the day begins with a meeting on the town's basketball court. Armed with rakes, brooms, and sticks, nearly 50 villagers of all ages gather to fight malaria. After a brief presentation by health workers, the villagers mobilize and walk down the dirt road past the peanut fields to the small river that runs through the town. They have been taught that water is the enemy--stagnant pools provide breeding sites for mosquito larvae--and they are taking the battle to the insects' own turf. Seeking out the slow-moving water at the river's margins, they scrub the bottoms of such pools to agitate the water and destroy the growing larvae.

It turns out to be a short day of work; the kilometer-long stretch of the river is deemed larva-free in just over half an hour. On the walk back to town, the health workers provide troubleshooting advice. One young man asks if the stirring of standing water must extend to the toilets ... and grudgingly accepts the affirmative response. Another villager seeks assistance to make sure his water tank is larva-free. But most seem to already know the answers to these questions, having grown up with visits from government health workers.

[ILLUSTRATION OMITTED]

The cultural acceptance in Colotepec of the responsibility to deal with malaria is a key element in making this region a successful model for malaria control and prevention. The Centro de Paludismo, a division of the state health system that oversees the management of infectious diseases, has provided education and treatment over the last half century to each of 68 towns scattered throughout the Oaxacan jungle. Through close, longterm contact with these villages, Paludismo workers have made their educational talks a ritual of sorts. Today's town leaders have observed the treatment of malaria symptoms and heard about the importance of vector control all their lives. They have a sense of ownership of the problems of malaria and, more importantly, their solutions. The number of malaria cases in the Southern Oaxaca district has plummeted from several thousand per year a few decades ago to 458 in 2006 and less than 200 in 2007. Malaria deaths are now rare. There is a sense of optimism and empowerment in Oaxaca that has come with the ability to effectively combat malaria.

This optimism is noteworthy because malaria is one of humankind's oldest and most stubborn afflictions. It has preyed on countless millions of people since the inception of our species, including several Egyptian pharaohs, Alexander the Great, Dante, four Popes, George Washington, and Abraham Lincoln. Malaria has been so pervasive that some scientists estimate it has killed half of all people who have ever lived. Today, malaria is largely a disease of the developing world, killing 1 million people each year. Roughly 2.5 billion people are at risk, particularly in the tropical regions of Latin...