S. Africa Fights One Scourge With Another

On a steamy afternoon in South Africa’s most spectacular wildlife region, a medicine woman shows off the leaves of an orchid used to treat asthma, as she waits for a malaria control team to spray her hut with a far less natural, but notoriously effective, mosquito repellent: DDT.

The insecticide coats the mud-and-twig walls of the hut with a chalky white residue and drips into a pumpkin patch. Then the spray operator rinses a mixing bucket and dumps the milky residue into a hole in the sandy earth, just a few hundred yards above a river.

South Africa, which has revived DDT use in its fight against malaria, applied 99 tons of the pesticide to about 1.1 million huts and traditional structures in the lush eastern region near the Indian Ocean during the 2001-02 malaria season, the first full implementation of its new effort. This year’s tonnage will probably exceed that by the time spraying ends this month, according to Caron Johnson, deputy manager of the National Malaria Control Program. In 1999, the World Wildlife Fund advocated a global ban on the production and use of DDT by 2007 because of the pesticide’s links to the decline of wildlife and the potential risks to human health, saying, “As long as it is used in the world, nobody is safe.”

But in Africa, malaria is the leading cause of death for children under 5 and is second only to AIDS as the leading infectious agent contributing to death, according to Bernard Nahlen of the World Health Organization.

Malaria kills nearly 1 million people a year on the continent, most of them young children in sub-Saharan countries, where it strains health resources and drains the economies of billions of dollars in lost growth, said Nahlen, a Geneva-based technical advisor with the WHO’s Roll Back Malaria program.

DDT is cheap and so effective that South African public health officials say malaria cases rose when they phased out its use in August 1996. Incidence of the disease declined 90% after they reintroduced it two years ago after an epidemic and evidence that some mosquitoes were resistant to other pesticides.

“The bottom line is DDT saves lives,” said Dev Moonasar, manager of South Africa’s malaria program. It also helps defeat a potential deterrent to tourism.

The spraying is what Environmental Affairs and Tourism Minister Mohammed Valli Moosa calls an “imposed choice.”

“It’s not the ideal measure,” Moosa said. “Once it is sprayed, it persists in the environment, so it can have unintended consequences. But the shame is that lots of people die of malaria in Africa, and you can prevent it. It’s a trade-off.”

Even ardent opponents of DDT have accepted this. A U.N.-brokered accord to eliminate the use of dangerous pollutants contains an exception for its restricted use to fight malaria.

“We support South Africa’s use of DDT,” said Rich Liroff, director of the Alternatives to DDT Project of the World Wildlife Fund, which would still like the pesticide eventually eliminated. “South Africa has made the difficult choice that developmental risks from spraying with DDT are outweighed by the need to provide protection from malaria.”

Swaziland also uses DDT to fight the disease, and South African program managers have tried unsuccessfully to persuade neighboring Mozambique to do the same.

Other African countries with DDT in their anti-malaria arsenal include Ethiopia, Eritrea, Madagascar, Sudan, Zimbabwe and Zambia, according to Jacob Williams, a biologist with the WHO malaria program. Kenya and Uganda have notified the agency of their intention to start using the pesticide, he said.

“The WHO actually championed the restricted use of DDT until countries are able to move away from DDT without increasing mortality rates,” Williams said.

If the pesticide has edged away from absolute pariah status, it’s not exactly a friend.

Many international aid donors disapprove of its use, and some reportedly have set deadlines for beneficiary countries to halt spraying. The South African government finances its DDT program, according to Johnson, the malaria control official. Poorer African countries cannot afford to pay for theirs.

“Donors are very reluctant to fund any kind of spraying using DDT because it’s politically incorrect,” said Richard Tren, director of the Johannesburg, South Africa-based Africa Fighting Malaria, which advocates the limited use of DDT. “They have this strange idea that because DDT isn’t being used in Sweden or the U.S., that they can’t use it in Africa. But people in Sweden and the U.S. are not dying before the age of 5 of preventable diseases.”

The United States and southern Europe used the pesticide to eradicate malaria-bearing mosquitoes after World War II. American farmers dumped large quantities on their fields, and government officials routinely sprayed wetlands to keep down bugs, making it the most widely used pesticide in U.S. history. Much of it was manufactured by Montrose Chemical Corp. of Torrance.

Environmental Catalyst

DDT’s links to the near-extinction of the American bald eagle, the peregrine falcon and the California brown pelican made it an early catalyst for the environmental movement. It also is suspected of causing cancer in humans who consume contaminated fish and of disrupting the hormones of marine animals. Banned in the U.S. in 1972, it became an icon of pesticide abuse.

South Africa’s phaseout of DDT more than six years ago was prompted partly by studies finding a byproduct of the pesticide in the breast milk of lactating mothers.

There were 27,000 cases of malaria in South Africa in 1996, concentrated in the nation’s eastern region. By the malaria season between October 1999 and May 2000, the east had 62,220 cases. More than 40,000 were in the province of KwaZulu-Natal, as were 334 of the country’s 480 malaria deaths.

Then DDT was reintroduced, along with aggressive combination drug therapy to treat malaria. So far this season, there have been only 3,390 malaria cases nationwide and 28 deaths, three in KwaZulu-Natal, according to Health Ministry figures.

“The spraying is definitely helping to prevent new cases,” said Dr. Stefano Fieremans at Themba Hospital in Mpumalanga province. He has seen only three patients die of the disease this year.

“The countries that shout the loudest against DDT used it to eliminate malaria,” said Kobus la Grange, malaria program manager in Mpumalanga.

La Grange, a rugged, grizzled Afrikaner, has spent 30 years on the front lines of South Africa’s anti-malaria efforts, which today are focused on the three northeast provinces -- KwaZulu-Natal, Limpopo and Mpumalanga -- that border Mozambique. Photos on his wall show the hideous conditions -- enlarged spleens, horribly ulcerated gums -- of victims in countries with severe malaria.

La Grange regularly drives over the border into Mozambique to assist with malaria control -- traversing back roads that still conceal deadly land mines from the nation’s civil war during the 1980s -- into a region where 80% of the children are infected with malaria and from which illegal immigrants bring the disease with them to South Africa.

This year, La Grange lamented, Mozambique’s unusually virulent host mosquito demonstrated a resistance to pyrethroid insecticides -- common pesticides used in U.S. flea shampoos -- “so our only alternative was DDT.”

But La Grange said Mozambican officials declined DDT, saying it would alienate international donors. “If they start asking for international donors for DDT, they’re not going to find them,” he said. Donors pay 80% of the budget for Mozambique’s Health Ministry and, according to an article in BMJ, the British medical journal, have refused to allow the use of DDT.

“They asked me my opinion about the South Africa program. Officially, the Swedish are against the use of DDT,” said Lars Carlson, agriculture program officer for the Swedish Embassy in Maputo, the Mozambican capital. “It’s only for an emergency -- say, in a refugee camp, for a limited time. We don’t like it much.”

But Dr. Avertino Barreto, deputy director of Mozambique’s Health Ministry, said he worries more about studies showing that DDT harms wildlife and might be linked to infant deaths. He worries that it could seep into the environment via floods or black-market sales to agriculture.

“It’s not a question of pressure from international donors. No, no, no,” Barreto said. “It’s because nobody knows the possible future effects of this product. “

In addition, he said, malaria is Mozambique’s No. 1 killer -- with AIDS running second -- so measures to combat it must be taken nationwide.

Consensus Elusive

In South Africa, DDT “is used only in the poor, sparsely populated parts of the country,” Barreto said. “They don’t use it where there are rich people. I have to worry about 18 million people. Malaria is a terrible problem, but you can save one life today and kill 10 lives in the future.”

La Grange knows that consensus is elusive.

“They say, ‘You use DDT -- that’s bloody stupid,’ ” La Grange said. “Of course, the main thing is the environmentalists. They’re always shouting and breathing down our necks.”

But no one is looking over La Grange’s shoulder as he barrels down a rutted dirt track in Mpumalanga province in his white pickup truck, dressed in sandals, shorts and a khaki vest, to a DDT-spraying demonstration.

La Grange pulls up to a spraying camp just a few hundred yards above the boulder-strewn Komati River, whose waters join the Crocodile River near the southern tip of famous Kruger wildlife park and flow on to Mozambique.

There’s a heat wave, and the breeze feels like a blow-dryer. Workers sit in the shade, covering mosquito nets with a pyrethroid insecticide, as a blues song about two-timing love plays on the radio.

A new pesticide sprayer, Grace Ngobeni, dons plastic gloves and a mask and rips open a plastic bag of DDT.

She dumps the pesticide in a pail, and a bit of the white powder blows in the hot breeze. Adding water from a tap, she stirs the concoction with a stick and pours it into her spray canister. Rinsing the mixing pail, she dumps the chalky waste water into a small hole and shovels dirt on top.

La Grange shrugs.

“This way of doing it obviously would not be acceptable scientifically,” he said. “But this is the field. There is no way of disposing of this water.”

Next, they rattle down a rocky back road in La Grange’s pickup to the village of Phiva, seven miles from Mozambique, and stop at the compound of the respected nyanga, or root doctor, whose hut will be sprayed. Mosquitoes carrying the malaria parasite linger on the walls of huts.

La Grange is greeted by the beaming medicine woman, Zodwal Lukhulen, whose compound has electricity, running water and a rusted metal corral filled with goats and piled with drying goatskins. Lukhulen sees patients in a tiny hut filled with medicinal roots and seeds. An altar, topped with candles and bottles, aids spiritual healing.

Spraying commences, but the DDT canister jams. Its nozzle is flushed with water over a pumpkin patch. Finally, the sprayer cakes a small portion of the hut’s exterior wall, leaving a white coating. DDT is not used on the painted interior walls of Western-style homes because of the stain and its failure to adhere well.

“If you’ve got a nice Western house and the walls are painted a nice lilac, I don’t think you would appreciate the white marks on the wall,” said Marlize Booman, La Grange’s colleague.

Spraying the outside of the hut is not quite up to par with WHO guidelines, which stipulate that only interior walls should be sprayed, according to agency scientist Williams. But the rules are frequently implemented in the bush, far from air-conditioned office suites, by people who say their first priority is curtailing human suffering.

The Tourism Trap

La Grange said they sprayed only a small portion of the hut’s exterior, under the eaves, because mosquitoes cluster there.

He said DDT use is closely monitored, with one recent study showing traces of the pesticide in puddles but “at such low levels, it was like background noise.”

“In all houses that are sprayed, it falls from the walls, maybe gets in things, and you can inhale it in the dust,” La Grange acknowledged. “It ends up in the breast milk, but no one can prove it will hurt the mothers or their baby.”

If they stop the spraying, La Grange said, then people will die and “malaria will start creeping back into the South African interior.”

There is a development motive as well, according to Moosa, the environmental affairs and tourism minister. The three provinces being sprayed embrace South Africa’s most spectacular wilderness parks, some of them relatively undiscovered, and “tourists are not going to go to a place to pick up malaria, are they?”

And tourists mean jobs.

“This corner of South Africa is very depressed,” Moosa said. “One of the biggest things we can do for the people is to reduce the incidence of malaria.”

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DDT’s lasting effects

Although DDT has not been used in the U.S. since 1972 and is banned in more than two dozen countries, other parts of the world continue to use the pesticide for agriculture and disease control. But because it may cause cancer and other health problems -- and can take more than 15 years to break down in the environment -- the World Health Organization has called for a worldwide ban on DDT by 2007.

Effects on humans

Probable carcinogen

Damages the liver, possibly causing cancer

Temporarily damages the nervous system

Damages reproductive system

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Nervous system damage

A cell’ outer layer, the plasma membrane, allows food, oxygen and water to enter and leave the cell. DDT dissolves easily into the membrane and causes the cell to leak sodium and potassium ions, which prevents nerve impulses from firing when they are supposed to. A DDT-poisoned organism dies of convulsions or paralysis.

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How DDT is transmitted

DDT in soil can contaminate crops.

Soil and sediment runoff might contain DDT.

Fish and shellfish absorb DDT in water.

May also be absorbed by inhalation or direct contact with skin.

Infants may be exposed through breast milk.

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Effects on the environment

Most of the millions of tons of DDT produced in the past remains in soil and continues to be redistributed throughout the environment.

Soil: Soils in the U.S. Cotton Belt still release an estimated 110 tons of DDT and its metabolites annually into the atmosphere.

Fish: Primarily damages plasma membrane in cells.

Birds: Eggshell thinning in birds of prey; bald eagle, above, almost became extinct because of DDT.

Invertebrates: Retain DDT in bodies, making it dangerous for predators who eat the organisms.

Microorganisms: DDT slows growth and photosynthesis in green algae.

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DDT timeline

1873: DDT first made in a laboratory.

1939: Dr. Paul Muller, a Swiss, discovered DDT was effective in killing insects.

WWII: First used as a pesticide. It was so effective as an insect killer that some called it the “atomic bomb” of pesticides.

1940s through 1960s: DDT used widely on farms to control some common agricultural pests. At one point, the U.S. was producing 220 million pounds of DDT a year.

1962: “Silent Spring,” Rachel Carson’s landmark indictment of DDT, is published and helps lead to the banning of the pesticide in the U.S. 10 years later.

1972: Worried about DDT’s environmental and health effects, the EPA canceled all use of DDT on crops. (In certain cases of disease control, the EPA allowed for limited use.)

Similar bans were instituted later in most of the developed countries and by Sweden in 1969.

Today: DDT use continues in other parts of the world. Many tropical countries still use DDT to control malaria.

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Sources: Environmental Protection Agency; Duke University; World Health Organization - Researched by Times graphics reporter Joel Greenberg

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Times staff writer Kenneth R. Weiss contributed to this report.