Diplomatic Doctor

Today, Israel has more embassies in developing countries than in the developed nations, and Dr. Schwartz, a leading expert on malaria and other tropical diseases, advises diplomats and their families who take up residence in their newly adopted, albeit temporary, homes. "I maintain a hot-line in case of any special problems," says Dr. Schwartz. "I guess you could say I'm always on call."

Often called the "travel doctor," Dr. Schwartz opened his first travel clinic in Israel in 1988. Now there are several. Israelis who travel to distant places have probably visited one of his clinics to receive necessary medical advice.

Dr. Schwartz along with Professor Jacob Golenser, of the Kuvin Centre for Tropical Diseases at the Hebrew University Hadassah Medical School, and Dr. Hedva Pener, Director of the Entomological Laboratory of Israel's Ministry of Health, are often called on to help in international emergency situations.

In March, 1996, the team traveled to Angola in southwest Africa for a two-week mission. After 20 years of civil war, the warring factions signed a peace treaty and UN forces were called in last year to help keep the peace: 8,100 UN soldiers and observers suddenly became high risk candidates for malaria. "These were non-immune people sent to spend time in the tropics," says Dr. Schwartz. They arrived from different countries, with varying medical advisers, and many were not properly prepared. It was a disaster waiting to happen. When several soldiers died and 50% of one battalion became sick, the Israeli ambassadors to Rwanda and Angola met with the Israeli Head of African Affairs from the Ministry of Foreign Affairs who offered Israeli assistance. Dr. Schwartz and his team were sent in.

The team visited the UN troops and advised them as well as their accompanying physicians on how they could best avoid becoming infected with malaria. "Most doctors don't know much about malaria," explains Dr. Schwartz. "In many countries, doctors may never see the disease and, if they do, they often cannot readily identify it." The team also discussed how to fight malaria with government officials, counselled the local population, collected data from hospitals with the help of the Ministry of Health, checked available facilities, and finally, drew conclusions and made recommendations.

"This cooperative effort had both medical and diplomatic importance," adds Dr. Schwartz. "It was the first time that Israel gave the UN medical support, which opened the gate for other possibilities." The medical support and humanitarian assistance were greatly appreciated.

"Most people do not realize that the number one killer in Africa is not AIDS, but malaria," explains Dr. Schwartz. Every year, malaria kills 1-2 million people in the world, most of them from Africa, while 300 million people become infected. Caused by the bite of the female Anopheles mosquito, malaria is preventable, treatable - yet getting worse, for several reasons: the parasite is becoming drug resist, a more lethal strain of malaria is becoming increasingly prevalent, and mosquitoes are becoming more resistant to insecticides such as DDT. Economic conditions such as increased migration, wars and budget constraints have made malaria control more difficult.

Drug resistance is a serious problem. "Parasites are cleverer than we are," says Dr. Schwartz. "Within a few months, they can develop a new resistance to a drug. We have to keep changing the medication to try and stay one step ahead of the parasites. It is not a pleasant sight to watch someone dying of malaria."

Absence of adequate health services frequently results in people self-administering their drugs, often resulting in incomplete treatment. This is another major factor in the increase in resistance of the parasites to drugs.

Although proper medication is important, preventing bites is the best policy. "In order to prevent bites, we need to understand the behaviour of the mosquito. There are three things that you can do to prevent bites," advises Dr. Schwartz. "Use repellant, bed nets and wear long sleeves. To rely only on medication is useless and dangerous."

In many countries of Asia and Africa, a big problem is lack of money. The local hospitals do not have enough money for adequate medication and, as a result, people die. Lack of money prevents the reduction of breeding sites and development of an infrastructure to enable it to fight the disease. "Among the local population, those with a low immune system, usually young children and pregnant women, are more susceptible to malaria," explains Dr. Schwartz. "The UN troops who come to these areas for the first time have the immune systems of young children when it comes to malaria. In addition, their doctors have often never seen the disease and have trouble diagnosing it. That's where we came in. We flew from place to place talking to doctors, advising troops and treating difficult cases."

There are two different types of malaria: malignant and benign. Although the malignant malaria is the type that usually kills, it is the benign malaria that can cause relapse after a person has returned to his home country. "The danger here is that a local doctor may not recognize it as malaria," warns Dr. Schwartz. "If you develop the symptoms of malaria (fever, shivering, pain in the joints, headache), be sure your doctor knows where you've been traveling so he can take this into consideration. We need to take responsibility for our own health. Malaria, as deadly as it is, is a treatable disease."

Although uncommon, it is possible to develop a relapsing type of malaria months or even years after traveling to a malaria-infected country, even if you took the appropriate malaria medications to prevent the illness. Dr. Schwartz advises any returning traveler who develops a fever that lasts more than a few days to get prompt medical attention to screen for a malaria infection.

Mistaken diagnoses can occur. Dr. Schwartz relates the story of one Israeli who came down with a high fever after returning home from a two-week visit to Africa. His doctor gave him antibiotics and within three days, the man was in a coma due to cerebral malaria. Death can come within a short time. This particular man was lucky - Dr. Schwartz was able to treat him in time.

"Treating someone with an advanced case of malaria can be very difficult," says Dr. Schwartz, who has treated hundreds. "Each case is different. You don't just give pills and shots and walk away. The patient must be monitored continuously."

Dr. Schwartz is constantly on call and often receives interesting and important requests from the Foreign Ministry. Three years ago, the leader of Eritrea was in a coma with cerebral malaria, the most deadly form of malaria. The man was flown to Tel Hashomer Hospital near Tel Aviv by the United States where he was treated intensively by Dr. Schwartz. Within one week he recovered and, Shimon Peres, then Foreign Minister, was able to meet with him. The following year Eritrea became one of Israel's good friends in East Africa.

At home, Dr. Schwartz spends much of his time raising awareness about malaria in Israel. He lectures and teaches as often as his busy schedule allows him. All of Israel's cases of malaria were contracted by traveling to malaria-infected areas. As Israelis continue to travel abroad, Dr. Schwartz is helping to ensure that Israeli doctors become more familiar with tropical diseases.

"Fighting malaria is a never ending battle," pronounces Dr. Schwartz, "and we don't expect to win it. All we can do is find a way to, literally, live with it." We can all sleep a little sounder knowing that Dr. Schwartz and his team are doing just that - and making diplomatic friends for Israel in the process.