Seriously Funny: Part II, The Malaria Chronicles

Malaria:
Malaria is caused by Plasmodium parasites. The parasites are spread to people through the bites of infected Anopheles mosquitoes, called "malaria vectors", which bite mainly between dusk and dawn.

In 2008, there were 247 million cases of malaria and nearly one million deaths – mostly among children living in Africa. In Africa a child dies every 45 seconds of Malaria, the disease accounts for 20% of all childhood deaths.

- Malaria is preventable and curable.
- Malaria can decrease gross domestic product by as much as 1.3% in countries with high disease rates.
- Non-immune travelers from malaria-free areas are very vulnerable to the disease when they get infected.
-World Health Organization, 2011

Malaria is one of those things that you grow up hearing about, but in an intangible way. A missionary from your neighbor’s cousin’s best friend’s aunt’s church had it. Or you heard about it in a history or social studies class. Maybe you even took a class in college where infectious diseases were discussed. But it’s an experience isolated to people in foreign countries – like owning a pet tiger or eating crickets.

Like with so many things, malaria is a disease directly related to privilege. Without the right environmental conditions, diagnoses and medications, or if it is piled on top of other complications, malaria is a killer. But factor in access to healthcare, both prior to contraction and at the time the disease presents, and it’s a bump in the road – a mosquito bite gone bad.

Right?

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After getting home Thursday night, I had just fallen asleep when I woke up to what felt like lava landing in the middle of the bed. It was, in fact, Ava getting in bed with us, burning with fever and shaking with violent chills. After some Advil and an hour or so or chattering teeth, she fell asleep – but clearly, something was wrong.

There was no question the next day that she needed to be tested for malaria. This, however, presented an entirely new set of issues. It’s one thing to go to the pharmacy and stumble my way through a diagnosis by pointing to various body parts and making faces. But going to an actual medical clinic to request blood tests and provide a medical history does not typically involve the word “cheese” and was, therefore, well beyond my French vocabulary. Fortunately, Chris has an amazing team of co-workers and they, unanimously, look out for us – especially the girls who have become mascots of sorts for the group. And so, mid-morning, Chris and Roger, our wonderful French-speaking friend, showed up to take us to the clinic.

I should explain a little something about Libreville. The Bord de Mer is the main road through the city. This is where you will find most of the government buildings, hotels, larger shops, supermarkets, major businesses, etc. It’s easy enough to imagine as you drive through Libreville via the the Bord de Mer, that you are in what was once a fairly metropolitan city circa 1980. And while not like any U.S. I’ve ever been to, it far exceeds the standards of it’s counterparts in developing countries.

But, turn off the Bord de Mer and within a block you will find a very different world. The streets become narrow, the buildings more dilapidated and the pavement questionable. Here, the real life of Libreville is lived. Houses of cinder block and corrugated tin line the streets. Stray dogs wander through dirt yards and trash-lined alleys. Rusted and faded signs advertise local bars, restaurants, tailors, shops and markets. Everywhere there are people standing, sitting, walking, talking, half-heartedly selling vegetables or energetically peddling household items. And then suddenly, there will be a break in the scenery, occupied by a large office building, a church or mosque.

It was on these winding streets off the Bord de Mer that we found ourselves. For the record, if I were dying and my only hope of survival was to relocate this clinic, I would have to trust Chris to retrieve my lifeless body and remember that I want at least one Bob Dylan played at my funeral, preferably “Sweetheart Like You.”

After approximately 112 left turns, we ended up on a narrow, unpaved, red dirt road full of potholes deeper than most swimming pools. I am going to work under the assumption that the majority of medical cases seen at this particular clinic involve head trauma received by one’s head being repeatedly smashed into the window of their car while on this road.

Add to this the fact that we were away from businesses of any sort, surrounded by trees and vegetation camouflaging small houses and sheds, and it’s only natural that I asked Chris if we were by any chance visiting a witch doctor before going to the actual clinic. But then, all of sudden, there was a paved parking lot surrounding a clean, modern-looking medical building.

All I have to say of the experience is thank God Roger was there. He is fluent in French so he first got us checked in then went with me to meet the doctor. We went through the basics of her symptoms a little medical history. She was weighed and her temperature was taken. Then we got a little surprise. The doctor said she would need a shot to bring the fever down. After pulling out a needle roughly the size of the space shuttle, it became clear, without translation, that the shot would NOT be administered in Ava’s arm. At this point, poor Roger was the only person who wanted to be in the room less than Ava. He ran madly for the door, prompted no doubt by Ava screaming, “Get Roger out of here!” Poor guy.

After a shot, 2 blood tests and an hour wait, we got a negative reading for malaria, “paludisme” or “palu” as it is called here. However, they recommended treating for malaria, a 3 day cycle of meds and antibiotics, because of the nature of her symptoms.

We went home but had to wait until the next morning to get the meds because our local pharmacy did not have the right kind. By then, her fever had not gone down, even with Advil, her chills continued and were now being followed by sweating…and she simply looked pitiful. We found out about another pharmacy that administers blood tests without a long wait and for about $100 less than the clinic. An hour after the test, Chris returned to the car where I was waiting with the girls. As soon as I saw his face, I knew the results.

Now, I know enough not to panic. I know that this was not so very serious, but forgive me, I couldn’t help a few tears. It’s not like she was in any danger at this point, but malaria. It just sounds so bad, right? No sooner had the first tear dropped and our poor driver went into a panic. “Pas grave, madame! Pas grave!” he repeated, nearly running off the road in an effort the comfort me.

Apparently, malaria is the rest of the world’s flu. Nearly one hundred years ago, my great-grandfather died of the flu (or was it pneumonia?) But now, we have a shot for it. That’s not to say that people don’t get sick and even die, but those people are the unfortunate exception. Think of how much money has been spent on research and medications to reduce the flu from epidemic to seasonal annoyance. And so what about malaria?

In so many places, it is endemic – a continuous killer for those without education on prevention or access to both preventive measures and treatment. If the flu was causing hundreds of thousands of deaths in America, would we segregate the acceptability of the disease by class? I don’t think so. But before I go too far down the path of angry diatribe, let me just say that my tears were, in one part, selfish. They were of self-pity, for both me and Ava. But they were also tears of gratefulness that I had access to medicine and care for my daughter. Gratefulness that she had been exposed to the highest level of healthcare in the world from the time of her birth – and before. She had always had healthy food and clean water in abundance.

Yet, they were also tears of sadness that a disease, so manageable in the right setting, could kill. They were for other mothers who, at that moment, were crying tears of grief and loss.

In the last week I have talked to a number of people who have had malaria. It does seem to be “pas grave.” But I have also talked to people who have known children and adults who have died right here in Libreville. One woman was allergic to the medication and threw up the treatments. Instead of getting a new medication, she grew increasingly ill and died. It’s hard to make sense of it.

It was a long week for my little one. Continuous fever and recurring chills followed by intense sweating and extreme fatigue. We spent 5 solid days lying in my bed with the curtains drawn. By the time we emerged, we were a bit weary, a bit worn, but none the worse for it.

As I finish this post, we are one week out. Ava is back to her old self, mostly. She tires easily, but for a kid that was doing handsprings on the trampoline the same day she got a cast on her arm, she seems to be doing just fine. It takes a lot to keep her down.

I know I have spent the last seven years asking people for one thing after another – for money or activism or involvement. And I know I have probably made everyone crazy with my constant soapboxing. But I have been both humbled and honored by the way so many of you have reached out and rallied behind my ever-growing “causes.” I was not going to use this blog as a tool for social activism – and I promise not to turn it into that. But I will close by asking you to consider visiting the following site: www.nothingbutnets.net For a small, one-time or ongoing donation, you can provide life-saving mosquito nets to families. And maybe, somewhere there is an 8-year old who will grow up to make a difference in her world because of it.

Seriously Funny: Part I

In the last 72 hours, I have been stopped at a roadblock, bribed a police officer and visited 2 medical clinics where Ava has had 1 giant shot, 2 bloodtests and a positive diagnosis of malaria. It’s been one hell of a weekend.

I promised myself when I started blogging that I would not use this space as a personal journal, rather as an opportunity to share stories. It may seem like a fine line, but it’s an important one. So forgive me if I make any of the following sound flippant, as it is not necessarily “funny ha ha” so much as it is “funny, we’re not in Kansas anymore, are we, Toto?” The topics could be quite serious in certain lights or settings, but the reality is my life is blessed – and I don’t have the energy to do much else other than laugh right now.

The last three weeks have really been quite magical. But I have to remember that I am in a bubble. I am staying at an exclusive hotel – fruit flies on the breakfast pineapple or not, the point is that I have breakfast pineapple and lovely people serving it to me. I have food, clothes, money, air conditioning, medical care and protection. And while I fancy myself a rapidly evolving part of the local community, there are days and moments where I am reminded just how much a community is more than 1 hotel and 4 city blocks. Having 3 roadside vendors that I talk to every day on the way back and forth to school and knowing much of the hotel staff by sight and many by name isn’t quite the same as being integrated into…well, into anything other than a hotel. A community is a small microcosm of something much, much larger, encompassing a world that I cannot even begin to know. But I am learning.

It all began on Thursday. Ava woke up with a pretty high fever, so we kept her home from school and pumped her full of Tylenol. By the afternoon, she was doing ok, just a little tired.

In the meantime, Chris had called that morning to let me know that there were murmurings of potential protests and maybe some imposed curfews in town. Apparently the opposition party from the 2009 election was claiming that he finally had proof, 18 months later, that the election had been rigged and was threatening a coup. Now, I am not a political expert, but I’m going to throw this out there…18 months later? Really Opposition Leader?

Anyway, the opposing party was now ready to declare themselves the winner, a statement they made by holing up in a building downtown that provided political sanctuary and watching through the windows as armed guards milled about in the street. To the outside perspective, this may not appear to the most brilliant political strategy, but what do I know. Maybe they’re just laying early claim to campaign headquarters for the next election. It really did not seem to be a big deal, although the ratio of large men with large guns on the street compared to normal men without guns did go up noticeably.

All the same, after a day cooped up in a hotel with a sick child, an uncomfortable number of armed men at the hotel and in the streets on the way to school and nothing to listen to but local news stations that I have no way of understanding, I jumped on the chance to go to a book club with a new friend here. The book club was held at a beautiful home in Haut de Gue Gue, a neighborhood about 20 minutes away where we hope to have an apartment within the next few weeks (another story for another day).

As a brief aside, since this isn’t really about the book club, I have to say I was BY FAR the most boring person in attendance. There were 8 or 9 women there, so let’s just start with the hostess. She’s German, grew up in Tanzinia, returned to Germany briefly, then returned to Tanzinia where began her own artisan furniture company using reclaimed dhowes (a type or fishing boat). She has published a book and now lives in Gabon with her husband and 3 children (with a 4th on the way) and runs a boutique. The friend I came with is Irish/Tennessean and has lived all over the world. She and her husband met in Zaire while working with Doctors Without Borders and now have 3 amazingly cool sons who are bilingual and have lived in more countries than most people can even name. Another woman from Sweden lives here and works with UNICEF. Two others are foreign service and work at the Embassy. And so on. I pretended to have my mouth full whenever anyone asked me anything. It was one of those things where you just knew that if you said something like, “Oh, I really like wine.” Someone would have asked you what your favorite region in France was. To which I could have only responded, “Ummm, Turning Leaf?”

But, really, I am so excited to have met this group and am already looking forward to going again. I have exactly one month to come up with a really good back story and forge the appropriate supporting documents.

Anyway, after a few lovely hours, we headed home. About halfway there, we saw police cars and barriers completely blocking the road up ahead. A few cars seemed to be going through, but no such luck for 2 blonde women in an SUV. We were pulled over and asked for our IDs. I have not made a habit of carrying my passport as it had never seemed necessary. That being said, all I had to give the officer was a Virginia Driver’s License. He looked at me much the same way he might have if, say, I had put on a top hat and started tap dancing while singing “I Did It My Way” at the top of my lungs.

I was immediately asked to get out of the car.

So there I am. Standing on the Bord de Mer at a roadblock while Police Officer #1 is questioning my friend and demanding to see every piece of paperwork she has in her car (including proof that she had a fire extinguisher – a new requirement from the government which leads me to the alarming conclusion that cars are prone to spontaneous flames here?) At this point, she has explained that I am an American staying at the hotel up the road and that, at the moment, my passport is locked in a safe in my room – which, naturally, prompted the officer to insist that we go downtown with him. Fortunately, my friend has spent the better part of the last 15 years in various parts of Africa. She said absolutely not and asked to see his superior officer.

Now were we in the states, this is the guy who would have been firmly established in the patrol car with a box of Dunkin’ Donuts. He strolls over to the car, leans up against the window, grins at us and proceeds to flirt…I mean, really. Now, I have not been ogled much in my life. It’s one thing to have a beer-soaked frat boy in flannel ask you if you want to go to his room to “listen to a CD” , it’s another thing altogether to be grinned at by a police officer speaking a language that you have mastered only enough to ensure that you can find a toilet should you need one. It was the first time in my life I though I might actually have cleavage. I didn’t, of course, but I could have.

Following what I am sure is standard roadside interrogation procedure, he asks my friend if I’m married. She looks at him and says, “YES. With 3 kids.” He looks back at me, shakes his head and said, “Oh….”, with a hint of disappointment. Now, even at this moment, I had to question this. Why was he disappointed exactly? Had he hoped we would go on a date? Some dinner and dancing perhaps? One day, after many happy years, mostly spent talking about toilets for lack of other topics, a friend might ask, “So how did you two meet?” We would chuckle softly and reply, “Well, it’s a funny story actually. You see, there was this roadblock…”

But as it was, me being off the market and all, he was actually very nice. He explained that it’s illegal to be without your passport when you’re a non-resident. After a bit more back and forth, he was kind enough to suggest that if we offered Officer #1 a little something for his troubles we could be on our way. GLADLY. I was finally allowed back in the car where I grabbed the first few bills I could find, passed them through the window and before he could see whether I had either given him insultingly too little or ridiculously too much (it was really dark), we were off.

While this type of roadblock / bribe-the-officer-to-avoid-being-arrested-for-not-having-a-passport thing isn’t that much different than a roadblock in the States and being caught without proof of car insurance…it was kind of very different. It didn’t help that the day had been spent discussing a possible political coup, and honestly, it was just weird, being as that it was my first roadblock in a foreign country. But certainly, this type of thing is not all that uncommon and if handled properly, as it was by my friend, amounts to little more than a hassle.

This was, however, a reminder that such is not the case everywhere. Gabon is a relatively safe, peaceful country – not to say I’m going to run out and do anything stupid – but I have felt safe here, as much as in most cities I’ve been. Yet in all of that, I think I have taken for granted the political stability, rules and regulations of home. And while the system does not always work and is often abused, it’s still a good one and I am grateful for it. But, I’m also grateful to be here. It hasn’t always been like this for Gabon, and so many people in so many places, some of them only a day’s drive from here, live in fear right now. Fear for themselves, for their families, for their political or religious views or for simply being in the wrong place at the wrong time.

And while I live with respect for my surroundings, I do not live in fear. Such is the blessing of my privileged life – I hope I never take it for granted again.

Seriously Funny: Part II - The Malaria Chronicles to follow...