Last April, my 7-year-old daughter had cerebral malaria in Malawi, where my family and I live. Given the international discussion about the value of engaging beyond one’s borders in today’s world, I have been thinking a lot about why as an American oncologist employed by one of the country’s preeminent public universities, I choose to live and work abroad, placing myself and my family at risk of things that wouldn’t be concerns if we just stayed home.
Thankfully, my daughter is fine now, swimming and hiking with her usual gusto during our recent 5-week sojourn back in the United States for work and family visits. I have never brought myself to acknowledge this out loud, but she might have died during her acute illness that included a precipitous drop in her red blood cells to half their usual number, a fever peak of 106°, and significant confusion and sleepiness from swelling in her young brain. A parasite inside a mosquito that bit her was perhaps the most proximate cause, but in a very real way, I did that to her, putting her in a place where she was exposed and making decisions on her behalf about the risks vs benefits of long-term malaria prophylaxis.