Fwd: The story of my first souvenir from Africa

Dear all-

What follows below is, well, I won’t even introduce it. Suffice to say
our sage traveler Jess – who has been living with me, mostly in
village, since Oct 22 – has produced another intriguing look at life
over here in Burkina, as discovered/discussed through the very
personal lens of contracting a life-threatening disease. Awesome! (NB-
She’s a-ok, and on her way home in 1 day….)
Nice to have someone to write these informative emails for me; I will
take this opportunity to publicly thank Ms. Lavash for her seminal
stay here in Burkina, and for the myriad and intensely important ways
she has helped start the re-integration process that awaits me
stateside.

As for Aaron, I head out of Burkina on the 15th of Dec, and touchdown
in Newark on Jan 18th. What’s in between remains to be seen, but
involves Europe, several friends, and a likely trip through the
Chunnel. I will endeavor to punch out a couple more e-mails before our
time is up, before brining this warped journey of idealism and
insanity to a partial close. There remain some details I’ve accrued
over the past two years that really deserve to be highlighted to you,
the esteemed reader.

read on!

I was able to pick up, hours upon stepping out of the plane, the most
memorable souvenir. Not just one thing really, but 1.5 trillion
things: locally known as palou. The number one public health souvenir
that a gal can get in Burkina Faso. Malaria. Yep, I decided to fully
embrace the African experience and do as the locals do. I got that
little blood-destroyer that could. And that can kill. But no need to
worry about me. Just read on, it’s a good story that has its origins
in the USA.

The travel doctor in Cambridge Massachusetts explicitly told me that
you need to have prophylaxis meds in your system before you arrive in
a malaria zone. I remember this clearly. Problem was…well, I forgot.
I was too excited to get to Africa to think about important details
like pesky little pink pills. I arrived on October 22 and was promptly
greeted in true Burkina style: with a gourd full of water, a
thoroughly amazing hug, and repeated bites from little insects. At
least one of those insects was carrying a parasitic load that was too
great to avoid sharing.

The cool thing (or one of the many cool things) about malaria is that
it’s a progressive sickness. It first starts by chilling in your liver
and having no external symptoms for about 2 weeks. Yeah, Africa was
awesome for 2 weeks! Then I started getting tired a lot. No biggie.
Soon thereafter fever. Headache. OK kinda weird. Let’s go to the
clinic and check it out. No problems…”she’s just not used to Africa
yet.” OK. Meanwhile, the parasite has moved to my bloodstream and
transfered to its trophozoid form. The one that takes over red blood
cells, reproduces in them, then explodes the cell and spreads the new
parasites into the blood stream. Over and over this happens over the
course of a week until my total parasite count reaches 1.5 trillion!
All in all a minor case really. It can get worse. Much worse. I
mentioned that it’s progressive: people can die from it. And here in
Burkina they do every year. But more on that later. Let me first
assuage your fears, oh dear reader!

I found out yesterday, due to a fancy lab test where my blood was
smeared across a microscope slide, that I was in fact “Palou positif.”
Now what? I think this is very treatible, right? Yep, no prob. Just
had to walk a block to the local drug store, any of which sport a huge
selection and quantity of malaria treatments. For about $10 I obtained
the 30 pills necessary to rid myself of any affliction in a mere 3
days. Breakfast and dinner just got more interactive! I’ll be well by
Monday! So simple!

But if it’s so simple, why is it such a deadly problem?? For infants
this is an easy answer. They’ve only got about 3 days left from when
they show symptoms. Adults have a couple of weeks on average, so
wherein lies the problem? My first guess was the cost. $10 may be no
problem for a nasaara, a white girl, like me, but for a
Burkinabe…that’s pretty darn substanital! But no! My friend Aaron
informed me about the truly impressive system going on over here. It
works something like this:

The government develops a list of essential medicines for the contry’s
most endemic illnesses – based on clinic data across the many
villages, finds the cheapest ways to obtain the necessary drugs and
buys them in exorborant bulk (often with the assistance of
non-profits, NGOs, and other aid organizations), and distributes this
all to the local level. International to national to regional to
local. Organized! Not the peacemeal and privatized mess that this
American girl is used to.

This system results in incredibly affordable and available medicines
right next to your donkey shed, anywhere in the country. The average
cost of malaria treatment when you’re not at a fancy Ouagadougou
clinic and pharmacy: ranging between $0.50-$1.25 a pop. Could this be
cost-prohibitive? Partially, but that’s not getting at the full story
here. Often, explanations make sense in terms of local culture, and
language is the perfect mirror of culture, so I’ll start there.
Evidence piece #1: Goodbyes in the local language, Moore (I know, I
know, you learned this all last email. It’s a different spin though,
so stick with me) Literal translation of possible goodbye options: May
God grant you good health. May God give you a healthy sleep. May God
be with you until later. May God give you long life…you get the
point. The language tells me that a lot is left up to providence in
Burkina, so proactiveness with regards to one’s health
is…uh…limited at best. Evidence piece #2: old habits die hard.
When a friend came down with malaria a few months ago, it was hard to
get him to go to the clinic. He first cited cost as a factor, but
later admitted that he planned to find 5 different kinds of leaves
perfect for making a sauce, one that would be effective if lathered
across his skin and if drank. “Bottoms up!” Traditional medicine is
alive and well; what worked for mom and grandma…why not, right?
Allopathic treatments seem to be a last resort, but with progressive
sicknesses like malaria, sometimes arrival at the local clinic is just
too late and the nurse is wont to say “le sang est fini,” or “this
blood is done.” Time for a transfusion at the hospital.
How widespread is the problem? Not sure the exact statistic, but you
know the old saying about statistics anyway… I’ll give a shot at
giving some scope to the problem. Heck, it gives me a great lead-in to
brag about my friend’s Peace Corps work! Here goes: In Sabce (his
village), the clinic is in charge of an area comprised of ~22,000
inhabitants. In 2008, about 9,000 people went to the clinic for some
type of malady. That’s about 41% of residents using the clinic per
year. Of those 9,000 consultations, more than half were malarial
diagnoses. That’s (roughly) more than 20% of people contracting
malaria in 2008. That’s one out of every five people. Think about
this. If one out of every five people that you knew got malaria every
year! By comparison, the WHO states that there were over 3.8 million
cases of malaria in Burkina that same year: 25% of the total
population. 2% of these people died, but 71% of these deaths were
children.
These figures were presented to me via Aaron. He works with malaria on
a tangential, yet direct manner. Tangential because he isn’t a doctor
or a nurse. Direct because, like me, he’s very social and likes
teaching people: he has taken up the cause of teaching people about
public health. Mosquito net education is part of his job: “no, don’t
use these as fishing nets!” As many of you fellow educators know,
messages are often simple and behavior change is the real kicker.
*Aside* no, I don’t want you all thinking that the locals are all out
fishing with mosquito nets. The nets are just too darn hot to sleep
under sometimes. But it’s happened.
So, dear reader, to you I apologize for the lack of new/fun stories
about my cultural foibles and faux pas across the village. Malaria
kind of kicked the energy out from under me this past week…just give
me until Monday and I’ll be pumping water and feeding millet stalks to
my cow with the best of the best. Until then, I hope that you’ve
learned something new from my strange, yet not-so-unpredictable
predicament!
Always an educator, always ready to share my experiences and stories
for the sake of learning-
Your Jess
Fun malaria facts (as ascertained via internet research)

Malaria is the ninth most significant cause of death and disability globally.
Each year, there are more than 250 million reported cases of malaria
It is reported to kill between one and three million people, the
majority of whom are young children
Ninety percent of malaria-related deaths occur in sub-Saharan Africa.

And some fun stats and graphs about malaria in Burkina, via the WHO:

http://www.who.int/malaria/publications/country-profiles/profile_bfa_en.pdf