In pregnancy, malaria is a big tsunami

Beverly* lay quietly in her bed staring at the ceiling, multiple tubes sticking out of her. She was grateful to be alive but the pain of losing her little one before he was even born seared through her like a hot knife. 

The past two months flashed by in a haze. She was seven weeks along when she found out she was pregnant. When she told Marvin*, he sent her some money and told her to get rid of it. He then vanished from her life without a trace. So much for first love! She had no idea how to tell her parents that their only daughter was pregnant in her final year of campus and she was going to be a single mother. 

Beverly suspended her reality and threw herself into her books. She had diligently worked towards a first class honours degree before Marvin became a distraction. She vowed to correct that. It was the least she could do to placate her parents. She stoically ignored her morning sickness, quietly withdrew from her friends and focused on her studies. She had six months to sit her final exams. She prayed fervently that she would finish school before the baby arrived. 

Fate had other plans. One morning, she woke up feeling sick. Her head hurt, her body throbbed, the nausea that had subsided was back with a vengeance and she was feeling exhausted. She managed to drag herself to class for two more days but on the third day, she was overwhelmed. Shivering like a rag doll in the high noon sun, she dragged herself to the campus clinic. 

While waiting to see the doctor, she went to the bathroom and noticed she had started bleeding. She yelled for help as she doubled up on the floor in pain. The nurses moved her to the examination couch and summoned the doctor immediately. She was burning up with fever and was almost incoherent. She vaguely remembered telling the doctor that she was pregnant before passing out. 

When Beverly woke up, she was in hospital, with her mother dozing on a chair beside her, worry lines deeply etched in her face. Her tongue was dry and her voice raspy as she tried to call out. She was shocked to learn she had been there for nine days, gingerly testing the boundaries of the afterlife without success. 

She had been evacuated by an ambulance from the campus clinic and handed over to the hospital team. As she was not able to give a history of what had happened, the doctor grossly assumed that she had been attempting to procure an abortion that went south, a phenomenon he encountered frequently among the university students. 

It was too late to save her baby, but even worse was that for the first two days, she was treated for bacterial sepsis, assuming that she had gotten infected from an unsafe abortion. The fevers raged on and her body began to shut down. She was moved to the intensive care unit before she was diagnosed with severe malaria, one foot in the grave. 

Thankfully she responded well to malaria treatment but by then, she had suffered acute kidney failure, requiring dialysis while her kidneys recovered. The urine draining from her catheter was still the colour of black tea. The doctors called it blackwater fever. 

She also remained on oxygen while she recovered from acute respiratory distress syndrome with pulmonary oedema. She had suffered severe anaemia as the aggressive malaria parasite destroyed her red blood cells, demanding transfusion of five units of blood. 

Beverly had never suffered malaria in her life. She had no idea that pregnancy made her extremely susceptible to malaria in its most severe form. Even worse was that she was found to have two different strains of the parasite: Plasmodium falciparum, common in Sub-Saharan Africa; and Plasmodium vivax, rare here but common in South America and the South Pacific. 

Beverly could not believe her battered body had survived this tsunami! She crowned it all a few months later, at the graduation square; the only first class honours graduate in her class! It was worth the fight.

Dr Bosire is an obstetrician/gynaecologist