Doctor Uses Cookies to Help Farm Workers’ Malaria Pills Go Down

One night this week, Dr. Bernard Nahlen was out until 10 p.m. in the hills that border Agua Hedionda Lagoon in Carlsbad, talking to the hundreds of Mexican farm workers who live around the lagoon about the malaria outbreak that has afflicted several of their co-workers.

On Friday afternoon, Nahlen, an epidemiologist with the federal Centers for Disease Control in Atlanta, and county Health Department officials hiked back into the hills with dozens of cookies and jars full of malaria pills.

No, health officials were not using the carrot-and-stick approach to persuade the workers to take the bitter orange chloroquine tablets that prevent malaria.

“We’re going to take cookies to these guys because, as with most medicines, it helps to have something in your stomach when you take it,” Nahlen said earlier in the day about the cookie patrol. “We’re going to dispense the tablets to them, and if taken on an empty stomach, the medication can cause gastrointestinal discomforts.”

Friday marked the second weekly dispensing of free malaria tablets by local health officials, who hope to stem the outbreak of the disease that began with five victims in July and has now grown to 22. Dr. Donald Ramras, acting county health director, said that 20 of the victims are Mexican aliens living in shacks and holes dug into the hills bordering the lagoon, while two U.S. citizens who live nearby or frequent the area have also been stricken.

After an initial period of wariness, the Mexican workers are no longer shy about talking to Nahlen, who speaks Spanish, or to local health officials when they appear at their campsites. And the Border Patrol has promised local officials that they will not attempt to arrest aliens hospitalized with the disease or who seek treatment.

“I think that we’ve earned their trust,” Nahlen said. “They know that we’re out there to help them and will not charge them for medicine or treatment. In fact, now that we’ve been out there almost every day, the workers are now reporting others who are sick and need help. This has been very helpful to us in controlling this outbreak.”

According to Ramras, health officials distributed medication to 250 workers last week. The weekly dispensing of medication will continue until the end of October, when the mosquito season ends in the county. Meanwhile, county vector control officials will continue spraying the affected areas--south and east of Agua Hedionda Lagoon--about three times a week.

“The spraying has been effective. After we sprayed the first time, we trapped 150 of the malaria-carrying mosquitoes one night. The last time we trapped, earlier this week, we only found 11,” Ramras said.

Nahlen, a malaria specialist, called the current outbreak, which is restricted to the lagoon area, “surprising,” but not threatening. However, local and state health officials asked CDC for help in curbing the outbreak, and CDC officials sent Nahlen and another epidemiologist, Dr. Yvonne Maldonado, to assist.

“Twenty-two cases in one small general area in California is surprising,” said Nahlen. “But I don’t think there’s anything to worry about. But people in the Carlsbad area who develop a high fever should be aware of the malaria outbreak nearby and should see a doctor immediately.”

The malaria strain found in the lagoon area is called vivax, the mildest form of the disease. Nahlen said that death rarely occurs in vivax victims, but the chills and high fever can be quite uncomfortable.

“The other day the workers told us of a young man who was quite sick. We went out to where he lived, in a hole that he dug on the side of a hill, and found him lying there, sweating profusely and with a temperature of 105,” said Nahlen.

The man was given medication and is showing signs of recovery, he said.

According to Nahlen, malaria was pronounced eradicated from the United States in 1964. Practically all of the cases reported today are imported. Of the 500 to 600 malaria cases reported every year, more than half are reported in California, Nahlen said.

“There are a couple of reasons why California has about half of the malaria cases,” Nahlen said. “First, California has a better reporting system and its public health agencies are more efficient. But more important, California is one of the most populous states and it has a high population of immigrants from Asia and Latin America, where malaria is still very common.”

County health officials said that most of the early victims of the disease come from the Oaxaca and Cuernavaca areas of Mexico. The disease is spread by mosquitoes that bite those afflicted with the disease and transmit the parasite to healthy people.

Chloroquine kills the parasite in the bloodstream, but it must be taken once a week for several weeks. Primaquine is used to treat people already suffering from the disease.