Thursday, 14 July 2011

What Statistics Can't Tell You

Being a Peace Corps Volunteer in sub-Saharan Africa, you can only imagine how much we hear about malaria - it's about the most popular topic aside from HIV/AIDS. During our three month training, there was no end to the information - parasites from this mosquito, these blood cells explode, these pills prevent, those medicines treat, these programs fight it all over the country, etc etc and hey does Lisa have a new capulana dress, cause I need to talk to her tailor... Like most things, you don't really pay attention - and really, can't fully understand - until you experience it.

And Peace Corps is all about experiences, right?

But perhaps if I had listened a little more closely, I wouldn't have wound up in the hospital...

As detailed in a previous entry, I had an amazing time when Kris came to visit, going on a safari and snorkeling in the lagoon. Unfortunately, I apparently had such a good time that I forgot to take my weekly malaria prevention pills.

At the end of the trip, Kris and I headed back to Johannesburg, South Africa, and through a strange but convenient twist of fate, we arrived a day earlier than planned - on Friday, and Kris's flight and my bus were leaving on Sunday. That evening, we ordered dinner at the hotel. Though it was a delicious (and to my PCV pocketbook, expensive) meal, I didn't have much of an appetite, and I ended up taking most of it in a to-go box.

So when I tossed my cookies in the middle of the night, I figured it must’ve been the fast food we had picked up on the road.

When it happened again the next morning, I counted my blessings that we had nothing planned for that day and we hung out around the hotel watching B-rated movies on TV, reading, and, in my case, sleeping, all day. After a full day of rest and much crackers and Sprite (Mom's best sick food next to cream of mushroom soup), I was sure I'd be fine.

Sunday morning, after spending some more time sitting beside my friend the toilet bowl and assuring Kris that I would be fine and she couldn’t miss her flight, we headed to the airport. I left her there and took a taxi to catch my 8 am bus back to Mozambique.

At the station, after becoming acquainted with both a toilet and trashcan and ensuring that I had paper bags on hand for the ride, I found my way through the line and onto the bus. I was asleep within five minutes of sitting down - in a carefully selected seat without any obstructions between me and the bathroom.

I stayed that way for most of the next nine hours. The one unfortunate exception being when we had to cross the border. In the immigration lines, I leaned on the wall. Then I leaned on the railing that separated the lines. Then I leaned on a random stranger or two. Somehow, standing up was simply exhausting. I made it to the booth where the immigration officer gave me curious looks but stamped my passport anyway, then made a bee line back for the bus. I fell asleep.

My seat neighbor was kind enough to wake me up when we pulled up to the bus stop in Maputo at 4:30. And then wake me up again after everyone else had gotten off at 4:35. Praise be to advance planning, the hostel where I’d arranged to spend the night was only two blocks from the bus drop-off. I saw those two blocks as a necessary evil that must be conquered in order to reach the prize - a bed - and with that driving force, I managed to keep my feet moving straight through the front door and to a top bunk in a room full of Germans getting ready to head out for the evening. I ate half a cracker, had another sip of Sprite, and fell asleep just before 6 o'clock.

At this point in time, any normal person probably would’ve suspected that something, possibly more serious than bad beef, was wrong. But I was sure that if I just slept through that night, I'd be fine to catch the chapa for the four-hour ride back to Chokwe in the morning.

The following morning, when my crackers and Sprite from the day before made a frustrating reappearance, I decided it would be best to take advantage of the fact that it was Monday and I was in the same city as the Peace Corps office and our Peace Corps Medical Officer. If nothing else, she'd be able to hook me up with some Pepto or whatnot.

I didn’t even attempt public transportation, but instead called a taxi to take me to the PC office (which cost more than my four-hour ride home) to minimize the amount of time I had to spend in an upright position. At the office, our beloved PCMO, Dr. Isadora, listened to my symptoms, found I didn't have a fever, and hooked me up with some pills, Gatorade, a hotel room for the night and a firm order to eat something.

The next morning, I was asleep on Dr. Izzy's office couch when she came out of a meeting. I explained that I'd followed her instructions, but all the pills and fruit-punch flavored Gatorade had done was brighten up the toilet bowl a bit in what was now part of my morning routine.

When the thermometer said I had a fever of 103, out came needles and a line of various tests for illnesses I only vaugely remembered from training. It wasn't long before one came back positive.


I was more than a little surprised and annoyed at this prognosis, which came with a whole new set of meds, cold compresses on my forehead and stomach, and a very concerned PCMO.

I slept. When Dr. Izzy woke me up later, it was to say that the fever wasn't getting better. Could I make it to her car to go to the hospital?

But not a real Mozambican hospital. No, near the waterfront of Maputo, deep in the territory of embassies and houses with tall gates and multiple guards and garages that have two cars, where expatriates go to enjoy the cheap living of a developing country, is a private clinic. Thank God.

At the clinic, Dr. Izzy and the part-time PCMO, Dr. Nurja, introduced me to two other physicians, a couple more shots and an IV that caused a permanent ringing in my ears (quinine?) and a room on the second floor that would be my home away from home.

My notebook during the next 48 hours makes for an interesting read that I am unquestionably going to burn when I die. But from the dream-like tidbits I can remember and the pages I wrote, I apparently spent my time in the clinic counting the number of holes from needles (two in my left wrist for the IV, three in my left elbow and two in my right for unknown reasons, and two in places we won’t speak of), counting the TV channels (four), counting the ceiling tile, avoiding the deplorable food despite the fact that I hadn’t really eaten in five days, talking on the phone with the Aggie (I wasn't aware of this until he called again a few days later and asked if I was better, at which point I asked, "How'd you know I was sick?" and got a rather disconcerting answer...), and assuring the doctors that I was going to die of boredom sooner than malaria and to please let me go recover somewhere with more TV channels.

And in between all that, I slept.

Thursday, when I was a little more lucid and conscious, one of the doctors finally said that I was fine to leave the hospital so long as I didn’t overexert myself. The IV was removed (I could hear again!), I was helped out the door and to a waiting taxi and found myself back at the hotel.

Friday morning, I ate a bowl of cereal at the hotel. I officially broke it off with the toilet bowl.

My meals the next few days were small and simple and always accompanied by Gatorade and a cocktail of three different drugs (six pills at breakfast, three pills at lunch, six pills at dinner). On Saturday, by far the most helpful aid in my recovery arrived in the form of Clancy, Louise and Jenn, all the way from Chokwe, who reintroduced me to the joys of food in Maputo. On Tuesday, a week after I was first admitted to the hospital, I went back to the clinic for a final blood test. It tested negative for malaria.


But even this experience is not the REAL malaria experience.

I, as an American citizen and a Peace Corps Volunteer, am an exception. From the beginning, I'm given a prevention pill that is practically guaranteed to keep me malaria-free - so long as I remember to take it (and believe me, I will never forget again). I had, for all practical purposes, a personal doctor who covered me in cold compresses and literally held my hand throughout the whole ordeal. I went to a hospital where I was served food and had nurses and multiple physicians checking on me constantly. After that, I was put up in a hotel and given money for food and transport in order to recover, and received follow-up testing.

When most Mozambican citizens get malaria, they first have to find a way to get to a hospital or health center - which can involve countless hours or even days on public transportation. Once there, they sit on a hospital porch with sometimes up to 100 other people for hours to wait to have a hospital technician give them an instant but not always accurate malaria test. If they are positive, they are handed a prescription for pills. They get the pills at the pharmacy. And then they go home.

And that's the best case scenario. Unfortunately, it's not always the case, as we learned in our training sessions.

  • Malaria is responsible for 20 percent of all childhood deaths in Africa.

  • 10,000 pregnant women in Africa die each year because of malaria-related causes.

  • Malaria is responsible for 30 percent of all hospital deaths in Mozambique.

  • There are between 300 and 500 million clinical cases of malaria each year, resulting in 1.5 to 2.7 million deaths.

  • More than one million children die of malaria in Africa annually - that's an average of 2,800 a day.

  • About 80 to 90 percent of the world's malaria deaths occur in sub-Saharan Africa.

*statistics courtesy of the World Health Organization

My First Visitor!

After a year of nagging her, I finally convinced Kris to come visit. And despite what she might tell you, it wasn’t even under false pretenses.

Our adventures started when I picked Kris up at the airport in Johannesburg, after a 12-hour trip from my home in Mozambique. From there, we drove to Kruger National Park, and within thirty minutes of entering the park, we’d seen these… ... and these… …and these…
…and we were pretty excited.
We stayed in huts like these – don’t be fooled, they have hot running water, electricity and generally put my Moz home to shame. On the second day, we took a sunset safari and even saw some of these. In fact, they surrounded our car, then hung out all over the road to soak up the heat of the concrete. On the third day, Kris and I turned off the nice paved roads with the nice white English-speaking South Africans on holiday in their SUVs and campers…and we went to Africa.

Using a recently-opened and apparently not-often used border with Kruger’s Mozambican cousin, Parque Nacional de Limpopo, we took the one road all the way through the park and headed to Chokwe.

After roughly six hours on trails that might have once upon a time been considered roads, we arrived safe and sound at home. Khani was glad to see us.

After convincing Kris that the terrifying natives would not eat her, we spent a day wandering around Chokwe, seeing the school and market and meeting friends.

And after that, we grabbed my roomie Clancy and headed on to the Bilene lagoon. Here, we encountered by far the strangest creature of our journey – the Aggie. Complete with a boat called “The Spirit of San Jacinto,” a brand of Texas on his chest and a tattoo that says “Howdy” on a place other than his chest, the Aggie greeted us with a warm handshake and a glass of an ice cold local beverage that can only be described as Texas-sized. He and his Zimbabwean counterpart, Joe, hooked us with kayaking, snorkeling with sea horses and endless dirty pirate songs and jokes on the lagoon.

And there was plenty of time for this, as well. At the end of the day, we walked down to the market for fresh shrimp, cooked with lemon and garlic over charcoal right on the porch. Beats any hibachi.

Alas, our adventures came to an end, and we returned to the Johannesburg so Kris could catch her plane back to civilization.

You, too, could be the proud owner of photos such as these! Contact your local travel agent and book your next flight to the magical land of sub-Saharan Africa.

Water, Water...Where?

Up until moving to Mozambique, clean water had always been my right as an American citizen.

When I came here, suddenly, it became a privilege. And like all privileges, it must be earned.

To have readily available clean, safe, water is to not think about it. Never before has water been a chore. It has never gotten me out of bed at 5am so I can fill up as many buckets as possible before it shuts off. I’ve never become sweaty, sunburned and physically exhausted from having to pump it out of the ground before carting it back home in a wheelbarrow. I’ve never before pulled a back muscle because of water, or had a crick in my neck because I didn’t center the jug perfectly on the top of my head. I’ve never accidentally dumped a bucket of water on my roommate’s head while trying to get it on my own (sorry, Clancy…) I’ve never included boiling water as part of my morning and evening rituals. Nor have I ever had to drink hot water while sweating on a 100 degree day just because I was too thirsty to wait for it to cool. I’ve never kept a full Nalgene bottle permanently in my purse along with my wallet and house keys. I’ve never before had to settle for a simple “rinse off” shower because it’s too dark to go to the pump for more water. In short, I’ve never had to work for water. Never even had to worry about it.

All this complaining, and I’ve actually got it good compared to most.
Our source of water has never been constant – at one point, it ran three times a day, directly to a faucet on our back porch. When that didn’t happen, to the pump we went with our jugs and our neighbor’s wheelbarrow. We fill up our jugs, then take them back to our house and fill up our big barrel – which apparently was used by something called “Protea Chemicals Inland” in its previous life. Not sure what that’s all about.

Now, when water runs, it starts somewhere between 5 and 6 in the morning and runs for about twenty minutes. There’s a spigot behind our house we share with our neighbors, and as soon as you hear the noise – that unmistakable noise of pipes hissing to life with water – we all roll out of bed with our jugs and wait our turn in line for the next bucketful of clean, fresh, water.
I never really noticed back in the states how much water I use in a day. Oh, there are all kinds of statistics meant to make you feel guilty and whatnot, and I know I take way too long in the shower, but I’ve never been more painstakingly aware of how quickly it disappears as I am here.
But just in case you ever find yourself in a similar situation – i.e., no running water, but functioning internet so you can reference this – I’ve included a handy-dandy How To Live Without Running Water Guide Below.

How to Shower:
1. Fill bucket or basin with water from water source/storage of choice.
2. Bring bucket/basin to drainable area (casa da banho, latrine, sheltered back porch, etc.)
3. Using small cup, dump water from bucket/basin over head and body.
4. Shampoo hair.
5. Wash body. Use more cupfuls of water if drying occurs between steps 4 and 5.
6. Rinse and repeat until you run out of water or the water collecting at your feet ceases to be brown and sandy.
• Note: In winter, you might consider heating kettle of water on stove before use. Especially when shower is outdoors.
• Note: For uncovered shower areas, showering during a rainstorm can be economical, but is discouraged during thunderstorms.

How to Wash Dishes:
1. Fill two basins with water halfway.
2. Select the least dirty dish to dip into first basin.
3. Using sponge or cloth and soap, wash first dish.
4. Rinse first dish in second basin and set aside to dry.
5. Wash, rinse, repeat.
6. When water in first bucket ceases to be transparent or a liquid, bring basin to back porch, check for neighbors in line of fire (chickens and children are OK), and toss dirty water. Note: If water is not transparent, use hands to ensure no dishes remain in water BEFORE tossing). Refill with water from rinse bucket, and continue. How to Use the Bathroom: (special for Clancy and Val’s house – we have a toilet!)
1. Fill large bucket with clean water and bring to casa da banho.
2. Have smaller empty bucket beside water bucket.
3. After using the toilet, use a cup to pour water first over one hand, then over the other, so that the water falls into the second bucket.
4. Put cup aside, use bar soap on hands.
5. Using cup, rinse hands one at a time so water falls into second bucket until hands are no longer soapy.
6. When hands are clean, dump second bucket down toilet to flush. Repeat as necessary.