I stared at the lean Ugandan doctor standing in front of us, unsure the proper response to his monologue. Because how do you properly respond to someone who has just told you all of the ways you could die in your new host country?
Do you thank him solemnly? Or with a smile of gratitude for the morbid information he’s just imparted? Do you ask him for a few more details? Or pray that if you’re unfortunate enough to catch one of the many diseases, you remain blissfully ignorant as to what is actually happening to your body?
Growing up with a physician for a father, I am all too familiar with gruesome discussions over the dinner table. I learned from a young age that the more red or “blood-like” our dinner menu (think spaghetti), the more likely we were to hear about chainsaw accidents or DIY home improvement projects gone wrong. It was part of my father’s sense of humor — one that I appreciate and miss being so far away from.
I was truly fascinated by the Ugandan doctor’s speech. My father had warned us about many of the diseases we might come in contact with — yellow fever, typhoid and malaria, to name a few. As unpleasant as they are to discuss, I think it’s important to have awareness. Choosing to be ignorant will not make these diseases any less prevalent in this part of the world. And understanding them can help you get aid faster (or help others).
There were a few lesser-known diseases that my father did not warn us of — diseases most physicians outside of Africa have never encountered. Diseases like Schistosomiasis (or bilharzia), caused by parasitic worms that live in tropical and subtropical regions. You can get bilharzia from swimming in fresh water, such as the Nile… an activity we did only a few weeks ago.
The parasite can stay in your body for years, damaging organs before you display any symptoms. Fortunately, bilharzia can also be prevented by taking a simple pill (for those of you concerned about us).
Perhaps even more terrifying than parasitic worms in your gulliver is the cordylobia anthropophaga, or mango fly. These parasites bury themselves in wet laundry left outside overnight. When the clothes are later worn, the parasites move to human skin and lay eggs. The larvae eventually hatch, causing a tumor to form on the skin. Eventually, if not treated, they break free from the skin and drop to the ground to find other “hosts.”
What I find most terrifying about the mango fly is the removal procedure. Because they need air to breath through your skin (ewww), you rub a thick cream like vaseline on the area where they are burrowed. Then you place a piece of tape over the cream and go to bed. The worms gradually — how do I put this in the nicest way possible? — make their way to the top of the skin, suffocating and searching for air. When you wake up, you remove the tape and they should be stuck on the other side.
I’m pretty sure if I ever get mango flies, I’m going to pay a physician to knock me out for 12 hours while they extract the little buggers. I don’t care how much it costs.
Above every disease and disgusting parasite we’ve learned about, the Ugandan doctor (and my father) stressed the seriousness of malaria. It is common, easily spread if the right precautions are not taken, and deadly if not treated properly.
But it is also very curable if caught early.
Cases of malaria had been popping up around campus. We had been fortunate enough to not have any serious illness in our house. A few of our girls were feeling under the weather. One had a mild fungal disease on her skin. Another had ringworm. But otherwise, they were doing well.
I wasn’t too concerned about our own health, despite not taking the "right precautions" to prevent malaria. Others on campus were a bit worried about its sudden appearance. None of the mzungus were taking medicine to prevent malaria, as it is bad to do so over a long period of time. Our options included doxycyline (an antibiotic that also makes you sun-sensitive — not ideal for living on the equator), and malarone (a drug that can give you strange dreams and is not recommended for people who already dream vividly, like myself).
With the unwelcome malaria visiting campus, a few families decided to start taking preventative medicine. We did not.
It was Saturday and I felt completely at peace as I stared out at campus from my verandah. It was raining in Jinja-town, but the sun still shone on Amazima in Njeru and I soaked in its comfort.
Our girls woke up on time (even though it was Saturday). They were quiet and focused during their morning study hall. After study hall, they completed their assigned school-wide chores (working together as a team, and without grumbling). Then, despite not having assigned chores at home, they proceeded to mop and do laundry and dust. Last week we discussed the need for them to take pride in their school and it looked as though this week they had listened.
Everything had gone so smoothly. And as I moved to my hammock and opened a new book and started to drink my new guilty pleasure (a cinnamon ginger iced coffee, made by my friend and house help, Lenah), I considered if the day could be any better?
Per usual, a group of our girls gathered to sit with me and chat on the verandah. Some of them swung in the home’s other ENO hammocks. A few played a game of cards. I could hear others quietly singing to each other in their rooms, resting after a long week. Everything felt in place.
Which is why, when something suddenly felt off, I sat up in my hammock. Gabriel’s head turned as well to spot the student before I could. She stood off to the side from the others, leaning against one of the metal posts that supports the verandah’s roof. A few tears silently rolled down her cheeks.
“Marta, what is it? What’s wrong?” At Gabriel’s question, the quiet girl just pointed to her head as more tears spilled out of her eyes.
“You have a headache?” Another nod. “Have you seen the nurse?”
A sob broke out at this question, causing alarm to rise at her lack of speech. She moved from the verandah to her room and I quickly jumped out of the hammock to follow as Gabriel called the nurse. No more than two minutes passed before I was escorting her to the sick bay on campus.
As we walked, I asked her the standard questions — when did you first start to feel bad? Have you had an appetite? Do you feel cold, as though you have a fever? Have you been drinking water?
Already one of our most quiet students, she nodded or shook her head in answer to my questions. The only audible sound coming from her mouth was an occasional groan, denoting the pain she was experiencing.
When we arrived at the sickbay, the nurse examined her immediately. She had a fever of 38.6ºC, which meant little to me. But I could infer by the way the nurse said it that the temperature was high and she was very sick.
Marta asked me to stay with her. The circumstance was unfortunate, but it warmed my heart to know that, despite only knowing each other for a few weeks, she already looked to me for comfort when she was scared or not feeling well.
The nurse tested her for both malaria and typhoid. The tests consist of a finger prick to draw blood, which is dropped onto test strips held in individual plastic containers — similar to what an at-home pregnancy test looks like. A clear solution is added to the blood, and the moisture moves up the test strip as the paper becomes saturated. As it moves, a line appears. If only one line appears, the patient does not have malaria or typhoid. If two lines appear, the patient is infected.
Marta’s blood drew two lines on the malaria test.
Our skilled nurse jumped into action, retrieving the malaria medicine from a supply cabinet and immediately administering the first dosage. Marta’s entire body was shaking, trying to fight off the fever. The nurse gave me instructions on when to administer the following dosages — four pills, twice a day for three days.
We slowly walked back to the dormitories where I told Marta to rest and drink plenty of water. Since malaria is only transmitted through mosquito bites, it was OK for her to return to the dorm and the comfort of her own bed. The other students would have been no less at risk, had she been quarantined to the sickbay.
It was only a few hours later that she was up and playing with her friends, a 180º turn after getting the medicine in her veins.
Is there an endless list of things that can kill us in Africa? At least seemingly endless. Do some of those things scare us? At times. And the mango flies? Always.
But the fear is not a terrified feeling that we’re going to die — neither of us is afraid to die, because we know that what comes next is much better than this current adventure we’re on. The fear instead is a heightened sense of the heebie-jeebies, that feeling you get when you stumble upon a snake, or reach your hand in a cabinet, only to find a large spider inside. Or mouse. Or whatever it is that gets your adrenaline pumping.
We’re not called to live as slaves to fear. We’re not always successful, and sometimes fear does creep in. But we will continue to try and live fearlessly. Because fear and worry are only mental blocks that in the end, distract us from our work here. And distraction is one disease we’re not willing to live with.
A note from Sarah:
To protect the privacy of Amazima's students and families, we will not be using their legal names in blog posts. Unless we have permission to publish their story, aliases will be used.