Sunday, May 27, 2012

You'll get malaria...

"Mwazula insapato?!?" men and women exclaimed as they saw me make my way through the mud, flip-flops in hand, imploring why I'd removed my shoes, adding, "you'll get malaria!" Laughing and pointing, they scolded me for what was apparently appalling behavior.  It was Munada, our festive monthly market day, and a torrential downpour had made parts of the path all but impassable, at least for me.  Rendered immobile by the muck's grip on my flimsy sandals, I decided to remove them and walk about more freely as I perused the selection of clothes, foods, and household items spread out on plastic sacks and makeshift pole displays.  Considering that children wander barefoot all the time, I didn't think this would raise too much concern.  I was wrong.

I tried to respond to the insistent demands that I put my shoes back on by holding out my mud-covered sandals, by miming myself stuck, by explaining that I couldn't walk in them.  My frustration grew, and at least once I replied to someone with a Mambwe rebuttal of, "I'm 28 years old, and if I want to remove my shoes, I can do so!"  I know people were concerned about me, though.  First, amused; second, concerned.  I'll get malaria.

Malaria comes from mosquitoes, I tried to explain.  Not mud.  Of course, walking barefoot isn't advisable in general, for other health concerns--cuts, germs, tapeworm.  But not malaria.  In the past, my host father also admonished me for bathing with cold water on a day where time was too short or willpower too sparse to heat a saucepan full first.  "You'll get sick with malaria," he said.  No, I won't.  Malaria has nothing to do with cold water.  Certainly I could catch a cold from bathing in the breezy outdoors in cold water.  But not malaria.

In Zambia, however, as in much of subtropical Africa, malaria is shorthand for sick.  So when I say you can't get malaria from this or that, I know that I'm confusing people--possibly detrimentally so.  Because you can get sick from this or that.  Just a different kind of sick.

Peace Corps, in conjunction with local counterparts, NGOs, and the President's Malaria Initiative,  is currently running an initiative called "Stomp Out Malaria," a campaign to raise awareness of the illness and focus efforts to eradicate it across the continent of Africa.  In Zambia, we've kicked off a research study on the longevity of Long-Life Insecticide-treated Nets--LLINs.  In March and April, 40 volunteers in Northern and Luapula provinces, along with their counterparts, have each enrolled 25 homes in a two-year study.  As one of the government's malaria prevention measures, rural clinics, neighborhood health committees, and local head(wo)men facilitated a mass distribution of two brands of LLINs last year.  Using their distribution lists and random sampling, we signed up houses that have the nets in use, collecting data about how the net is used and by whom.  We also examined the nets physically, recorded the number and size of holes, burns, and tears, and noted the type of sleeping space in which the net was hung.  It was a fascinating process; a bedroom is a very private space in Zambia, and there was a certain element of cultural exchange in being allowed into these bedrooms while implementing the initial phase of this study.  We'll make four more visits to each of the homes, every six months, monitoring the wear-and-tear of the nets and submitting one for several tests of the integrity of the insecticide by the CDC each time.  Ultimately, the study--which is being conducted through the collaboration of Society for Family Health, a non-profit organization in Zambia which does a lot of HIV and malaria prevention work, the Malaria Control Center, and Peace Corps--hopes to inform Ministry of Health policy, letting them know how often nets should be redistributed.

The training for the study was as fascinating as the process of enrolling homes was, because I realized how much I didn't know about malaria.  Mosquitoes are vectors; this I knew.  This I didn't know: malaria is transmitted only by the anopheles mosquito, though, and only the female of that species, and they typically tend to bite at night.  While people are sleeping.  Mosquito nets, then, are shown to be highly effective in reducing the transmission of malaria.  And here's the catch: mosquitoes don't create malaria, or carry it from stagnant water or someplace.  They are merely messengers from one person to another.  You have malaria (whether symptomatic or not), mosquito bites you, then bites healthy me.  I have malaria.  Mosquito #2 bites me, carries malaria off to a new friend.  This is incredibly important to understand because the way to reduce malaria is to get a lot of people treated and the prevalence below a certain threshold.  That is, if we could reduce--through mosquito nets, insect repellant, insecticide spraying, or treatment--the number of people in a given place who have malaria for even a short period of time, we could make a big step toward wiping malaria out of that area completely.  Mosquitoes bite people who aren't sick, and then bite other people without making them sick.

This lends a big hint as to why malaria is almost nonexistent in the U.S.  The rise of air-conditioning, window screens, and DDT in the American south helped to knock malaria out because over the course of a few years, the number of malaria cases dropped significantly.  The fewer people who have malaria, the harder it is to spread.  Seems obvious, right?

It's actually pretty exciting, though.  The implication of this is that when I sleep under an insecticide-treated mosquito net, I'm not just reducing my own chances of contracting malaria.  I'm reducing the chance of everyone around me contracting it, too.  If everyone within a 10-kilometer radius (or even less) used a net, indoor spraying, and/or insect repellant, it could be possible for malaria to become a much smaller threat to our area. 

And yet we found, as we went through the study, that things aren't so simple.  Nets are often used improperly or not at all.  Several people asked us why we weren't distributing more nets, and then showed me the nets they had already received--wadded up in a suitcase or still in the unopened packaging.  My very own host family told me over dinner one night that they don't sleep under nets because they don't have any, that they weren't given them.  Despite the fact that every household on my family's compound received at least one in the mass distribution, and I've seen their signatures on the list to confirm it.

I've lived in Zambia for over fifteen months now.  I've even taken Coartem, just to be safe, when I had a high fever which could have been due to malaria or to an infection on my leg.  And yet I am still painfully unaware in my everyday life of how treacherous malaria is.  Because so many people say they are suffering from malaria but don't go to the clinic to have RDT (rapid diagnostic testing) done to confirm their self-diagnosis, and thus they don't get the treatment.  Because malaria seems so commonplace that we've become desensitized to it.  Because malaria just means sick.  And all too often, sick can mean, all too soon, deceased.  They are unnecessary, these deaths from malaria, this suffering.  It really is time to put malaria in our past.  I'll be tucking in my net as I lie in bed each night, trying to figure out what role I can play in doing just that.

Saturday, May 19, 2012

How Strange and Glorious

(written 6 May 2012)

I've been snippety.  For the past three weeks, I'd say.  My mom paid several thousand dollars to come visit me in the African bush, and by day 4 my apprehensions were realized--we started driving each other a bit crazy.  It wasn't continual, but at various points throughout her eleven days in Zambia, I was rude.  Snarky comments, minimal eye contact.  I knew it and yet I felt almost powerless, or at least unwilling, to stop it.  I'd say something, unneeded or in a rude tone, and my bewildered conscience would probe, bewildered, saying, "Why did you say that?"  But I failed to apologize when I knew I should, when I know that apologizing is not that hard.

But Mom went home, and arrived there safely, and seems to have had a good time despite her unappreciative daughter.

I also returned home, up north to where I live, though it took me longer to traverse the country than for her to cross the ocean.  Transport from Lusaka to Kasama wasn't particularly pleasant, compounded by logistical incongruencies within Peace Corps.  It took me two days to reach the provincial house in Kasama where I had a restorative (if not restful) night with a few good friends and new members of the NoPro family getting ready to go to their villages.  The next morning, I reached my village and was in my house for less than an hour, exchanging a few things in the suitcase and passing almost cursory greetings to my family.  Then off to Camp GLOW (Girls Leading Our World), after a 4.5 hour wait at the roadside for a ride, complicated by me dropping my phone as we boarded and then needing to get off, run back to retrieve it, get a new ride, and meet back with the others.  However, I found the phone and we arrived not too much later than the rest of the PCVs, counterparts, and campers.

The week went well--11 PCVs, 6 counterparts (mine went home due to a family urgency), 14 girls.  But I was in a funk.  Again, rude comments and a general poor demeanor surfaced without much explanation.  Not the whole time, of course; I think I did well when working with the camp participants.  But with my friends, at moments at least, I was bitchy, just as I'd been with my mom.

And I hated it.  I was in a funk and couldn't get out.  Not fully, anyway.  I tried writing, reading, artwork, alone time.  It soothed a bit but not fully.  I made a list of possible reasons why I was cranky (everything from cigarette smoke to needing attention).  And while I couldn't figure it out exactly, I did realize that--contrary to the experience of many others--when I am with other volunteers is often when I feel the most isolated.

And today I reached home, and it was amazing.  My equilibrium was restored.  My zen settled in on the sofa of my psyche.  I felt like myself again--the self that I like, the self that, lately, I only seem to find here, in my house, in my village.  There's something wonderful about a troupe of cheering children running to greet you when you return (though they had staged a dramatic mock-cry when I left for camp and refused to leave the plastic tea set out for them to play with in my absence).  There's something lovely about being home, and being wanted there.  Being missed.

As I watched the football (soccer) game this evening, I felt so much more at peace.  So much joy in the air--and with a few differences, I could have been at a hometown American football game on an early autumn Friday evening.  So many things feel the same: the chill in the air sneaking in through my hoodie; the children playing, the meandering of spectators along the sidelines, the community seeing and being seen.  The breeze was nice, the air crisp, the sky so big and blue (reminding me, as always, of Montana).  I thought of the song we used to sing in Ku'umba, "I weep," (lyrics at bottom for the unitiated), and looked up from the game to see a rainbow arced cross the sky.

"It could not be more perfect," I thought.  And tears rolled down.

How strange and glorious.  That I feel happiest in all the world at Masamba.

*******
(lyrics approximated from memory)

I Weep
I weep
Not from the hurt
Nor from my pain
But from the power in Your name
And the unfathomable love You've shown to me
Lord I cry
Not tears of doubt
Nor of distress
But from the joy of Sabbath rest
I feel no alarm, I'm a child in Your arms
Though I'm unworthy to be
So I weep
On bended knee
My arms stretched wide
This joy I have, so deep inside
I try to keep my cool
But tears they flow
You love me so
Oh I weep