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.

Malaria.

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.

Whew.




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