Le palu

I read Chimamanda Ngozi Adichie's fabulous novel Americanah shortly before leaving the States. In one scene, the male lead Obinze casually tells a concerned friend, "I'm just tired. I think I'm coming down with malaria.

I have to apologize now to Ms. Adichie, and my parents, as I used the words of the former to quell the fears of the latter. When they asked me about malaria, I didn't tell them, "Well, it's the number-one killer of children under five in Cameroon," or, "The most lethal form of malaria, falciparum, is the most common in Cameroon." What I said was, "It's like getting a cold. People get it all the time and recover a few days later. See? This Nigerian guy isn't even concerned."

I'm sorry, Mom and Dad. I thought I was doing the right thing by trying to downplay the seriousness of it. Honestly, I don't regret it. My friends and family were concerned enough about my departure, as the vast majority of news that makes it from Africa to the States isn't terribly lighthearted.

One of the first things we received upon our arrival in Yaounde as trainees was tablets of doxycycline, a malaria prophylaxis, and training included hours of discussion about malaria, from prevention to treatment to how the disease incubates in the body, specifically the liver. Then people started falling sick. First two fellow trainees were admitted to the hospital, then others. At a certain point, I accepted that at some point during my service, I would get the disease.

Which isn't to say that I haven't been vigilant. While some people shun prophylaxes for their side effects, or due to fear of potential side effects, taking doxy has long since become a part of my breakfast routine. There is no standing water around my house where mosquitoes might breed. I tuck in my mosquito net, a sort of fine mesh canopy that hangs over my bed, every night before falling asleep. If I go out at night, I usually wear leggings or pants.

Of course, I'll never know exactly when or where some generous mosquito shared her parasites with me--the incubation period generally varies from one to two weeks--but I can't help but wonder if an all-night Halloween party in short shorts was my downfall. (Even if it was, it was totally worth it.)

 It started in the wee hours of the morning of November 9th, a little over a week ago. I awoke at about 3 AM wracked with nausea. Thinking it was merely indigestion, I took some Pepto Bismol and tried to go back to sleep. Instead the nausea worsened and led to vomiting. Of course, I stayed home from school that day, but at that point, I thought I'd come down with food poisoning or some sort of stomach bug, and assumed that everything would resolve itself within 24 hours.

Which, of course, it didn't. I traveled to the regional capital, Ngaoundere, on Thursday to purchase medication that would calm my nausea, but by Saturday, I was wrapped up in a blanket with only my face peeking out, fevered and shivering and aching all over. "Do you  need anything?" asked Candice (the Volunteer featured in my Teachers' Day post). "I'm fine," I said. "Wanna watch The X-Files?" And so I spent the next three to four hours trying to distract myself from my fever dreams of death with the adventures of Mulder and Scully. But to no avail. I finally called the Peace Corps nurse, who told me to get a malaria test as soon as possible. Candice and I (still wrapped in my blanket) went to the nearest pharmacy, but there were no rapid malaria tests to be had, so I bought paracetamol (ibuprofen) to try to treat the fever and aches.

Normally mornings are the bane of my existence, but after hours of fitfully tossing and turning, I got up at 6:30 Sunday morning. Candice, my unofficial motivational coach, accompanied me to the regional hospital, where after describing my symptoms to a doctor, I was told to take a malaria test.

The nurse who took my blood was a gorgeous woman wearing expertly applied eyeliner and an Afro. The test came back in only minutes, and she looked at me and said emphatically, "Tu as le PALU!" or, "You have MALARIA!" (It should say something that malaria is so common here that it has its own little nickname. In French, malaria is "paludisme," but everyone, even health workers, uses the diminutive "palu.") I'm still not sure why she said it that way--maybe my parasite load was high, maybe she was just really enthusiastic about her job. She didn't offer any explanation, just asked for the cost of the test (200 francs, about 40 cents), and told me to return to the doctor to get a prescription. In typical Cameroonian fashion, the doctor--a man in this thirties--asked me if I was single and why I wasn't married yet before handing over the prescription.

The treatment I was prescribed lasts for three days, but the first day showed little improvement. The first night, after taking my second dose of Coartem in addition to more ibuprofen, I lay in bed with my feet frozen but my forehead on fire and my entire body pulsing with aches and pains. In a fever-induced delirium, I thought to myself, "This is how I die." I summoned up a meditation technique I'd learned a few months before and eventually drifted off to sleep, only to awaken four hours later drenched in sweat and still in pain.

I allowed myself to sleep as much as my body deemed necessary that night, and astonishingly, awoke the next morning feeling not normal, but markedly improved. The improvement was dampened by the discovery that even a short shower could exhaust me, but I was happy to be free of the fever and ever-present aches.

Malaria is the most fluctuational sickness I've ever experienced personally. In a matter of hours, sometimes minutes, I could go from feeling almost normal to being unable to think about anything other than the symptoms I was experiencing. Day one was at times terrifying; day two was a reprieve; day three the pendulum has swung backward, but not nearly as severely. Today I'm merely contending with a headache, temperature fluctuations, and an overall sense of weakness. Insh'Allah, this will be over tomorrow, as I've taken my last dose of Coartem this evening, but I shudder for every child who has suffered or died of this illness, many of whom are too young to understand what is happening to them, and for the parents who have had to watch their children suffer, including some of my closest friends in Nyambaka. This is one of the many situations where I can't help but be recognizant of my own privilege, specifically when it comes to health, and while I am of course grateful for it, I am also ashamed that I should have this privilege when so many don't.

World Health Organization: Malaria

Against Malaria Foundation

Malaria No More