Picturing health: making malaria visible in Asia-Pacific

 

Photos from a project conducted in collaboration with photographer Pearl Gan at EOCRU (Eijkman-Oxford Clinical Research Unit) in Jakarta, Indonesia were published last week in the Lancet. The See Malaria in Asia Project aims to raise public awareness of malaria as a serious health problem for the region by telling the human story of Asia’s invisible malaria burden.

Most malaria in Asia occurs among the rural poor, who do not yet live among the benefits of the profound economic progress that the region has seen. These populations are often “invisible”, not only in an epidemiological sense but also in social terms. And therefore communities who are engaged with the global malaria problem do not see all those affected by malaria in Asia.

Funded by the Wellcome Trust, this photography project aims to engage the public with exhibitions later in the year in Jakarta, Singapore, Phnomh Penh and Ho Chi Minh City. While working on the project, photographer Pearl Gan visited remote communities where endemic malaria causes illness and deaths.  EOCRU Director Prof Kevin Baird says, “Pearl Gan captures much in her art – humanity, dignity, suffering. Her lens exposes the reality of the isolation and poverty that give malaria such freedom of harm and constraint of human development.”

In Asia, malaria is a pervasive and diverse problem, with around 2 billion people at risk. Malaria in Asia is complex, with all four strains of malaria in existence, and several dozen species of the anopheline mosquito which carries the disease. Only a small fraction of research endeavour and public funding for global malaria control is centered in Asia, in part because WHO reports less than 10% of the global burden occurs in the region. Prof Baird points out that there may be substantial difference between the actual and that perceived burden of malaria in Asia, which constitutes Asia’s invisible malaria burden.

The intense malaria transmission in much of sub-Saharan Africa can be considered the basis of its dominance in global morbidity and mortality estimates: in 2010, about 327 million Africans lived in places where P falciparum prevalence exceeded 40% among children aged 2–10 years compared with 16 million people in Asia. Such intense malaria transmission, however, comes with a protective naturally-acquired immunity which narrows vulnerability to severe malaria in infants, small children, and pregnant women. In Asia, by contrast, the transmission rates are low and all demographic groups are vulnerable.

The populations affected by malaria in Asia are often living in very isolated areas. For example, one study showed that 86% of deaths in India occurred beyond the reach of health-care systems that provide diagnosis and reporting.

Asia has very large numbers of people vulnerable to progression to severe malaria living with that risk, most of them in isolated rural and impoverished communities. These are the most invisible people in the Asia-Pacific and the See Malaria in Asia Project aims at making them more widely seen and counted.

A link to the photos is available on The Lancet’s website:

www.thelancet.com/gallery/lancet/asia-pacific-malaria

You can see a selection of images from the project at:

http://asiamalariaimages.com/