The Malaria Guru

Zul Premji’s Malaria Memoirs begins in much the same way as Primo Levi’s classic The Periodic Table: deep within a childhood world of family relationships. Perhaps especially for a scientist, those early days of self-discovery influence one’s personal folklore in ways that can hardly be classified.

For both Levi and Premji, the importance of siblings, teachers, and youthful adventures is self-evident, proof that science and life play out side by side. To connect these realms — physical nature and the human world — and to notice their correspondences is to gain insight into personal, social, and political experiences. In the tradition of the Italian chemist, Premji has written an episodic narrative full of metaphors and broader lessons drawn from a long career.

Premji was born in 1954 in Iringa, Tanzania, to a somewhat poor Ismaili family who were often on the move. First in Morogoro, then in Tanga, then on the outskirts of Masasi, he attended a series of public schools: “I did well in my studies and was active in sports, playing soccer, cricket, and volleyball. This comfortable and rather stable life came to an abrupt end in August 1968. . . . I received a telegram saying that my dad had been hospitalized due to a heart attack.” But rather than open a duka to help the family financially, as his father and older brother wanted, Premji knew he had “to continue with my education no matter what.” Eventually, with the support of a university sponsorship, he ended up at the Muhimbili Faculty of Medicine in Dar es Salaam. There he studied parasitology and began building a reputation as a “malaria guru.”

As a specialist, Premji took part in several influential studies. He was a leader in the Bagamoyo BedNet Project, a collaboration with Johns Hopkins University that analyzed the impact of insecticide-treated bed nets. And he helped to pioneer a new diagnostic tool, popularly known as the Rapid Diagnostic Test, that’s now deployed globally for malaria diagnoses, especially in sub-Saharan Africa. “I feel proud that I was involved in this research,” he writes, “but my entrepreneurial skills are poor and I failed to capitalize on the monetary aspect of this opportunity.” Later he served as an adviser for Tanzania’s ministry of health in “the era of chloroquine resistance.” Premji’s lack of entrepreneurial skills notwithstanding, his trajectory from “the vicious cycle of poverty” to the hallways of influence reads like a rags-to-riches ­narrative of personal grit.

Premji does not intend his account to be a comprehensive view of malaria research and development. Beyond “The Five Enigmas of Malaria,” a concise chapter that portrays the disease — from its complex life cycle between human and mosquito to the impossibility of predicting its outcome in any given individual — the book is more about a pathologist’s roaming mind. Pensive articulations abound: a chapter on the politics of disease control is followed by an account of an enjoyable trip to India; major career events are succeeded by topics such as “how medical school could be made more interesting and less of a torture” and thoughts on aging. “To grow old,” Premji writes, “is to pass from passion into compassion.” These thematic leaps — shifting directions, multiple confessions — put the work of science and the work of life on equal footing.

Premji notes William Osler’s aphorism that “medicine is a science of uncertainty, and an art of probability.” He experienced this existential truth early on and became “wary of assigning defining moments in my life. . . . Too many influences swirl around us, and other secret ones percolate up from the unconscious.” Both in and out of the lab, he believes, “instead of striving for certainty we should be in constant search for doubt”: doubt about our beliefs, our feelings, and our futures. Like Levi, who constructed his memoir using the periodic table as an interpretive frame, Premji observes through the lens of the empiricist, through a hermeneutics of doubt. He traces events in his life straightforwardly and with a healthy skepticism, never rushing to over-define his experiences or make them into something they are not.

Yet the reader can’t help but feel that Premji is holding something back. The resistance to over-prescribed meaning — the privileging of hard facts over narrative or belief — prevents the memoir from finding a distinctive shape, a logical through line. Some of its most interesting ideas, notably that malaria is a social disease that mainly targets the poor, are broached through anecdotes but are not fully articulated. Without a thesis or a conspicuous narrative arc, the material feels somewhat raw, in search of its organizing principle.

Zul Premji retired to Calgary in 2016, to help take care of his grandchildren. “With time,” he writes, “hopefully I will return to Tanzania.” Until then, he speaks with the authority of someone who has met with success. With prose that’s well paced and matter-of-fact, Malaria Memoirs reads like an intimate conversation with a friend, someone who has lived a dedicated life full of achievements and is ready to share.