Illness

Indwara

Illness

Today is World Malaria Day, and I want to take a break from talking about me and talk instead about some other people. 

About half the world’s population is at risk for malaria.(source) 

See, malaria doesn’t affect me directly. 

Thanks to Peace Corps, I have a good mosquito net treated with insecticide. In case that don’t keep me from being bitten by a malaria-carrying mosquito, I have a handy little pill that I take every morning, a prophylactic called malarone, that keeps me from developing a case. And, just in case I somehow still manage to contract malaria, I have a couple of do-it-yourself diagnostic kits and a round of malaria treatment, and, to be extra safe, I can get Peace Corps to come pick me up and take me to the infirmary, where trained medical staff will do a proper diagnosis and give me proper treatment and care until I’m well. 

If everyone had the same benefits, we’d be done with malaria. But they don’t.

There are an estimated 212 million new cases of malaria every year, resulting in 429 thousand deaths. 

(source)

During PST, my host mama got malaria. She was fortunate—the family is well enough off that they could afford treatment, and well enough off to be a single-income family, meaning that they didn’t directly lose income by her being unable to work for days on end. She recovered without any significant loss for her or the family.

For most people affected by malaria in Rwanda and other developing countries, the story is much different. They may not be able to travel to a clinic in the first place, much less afford diagnostic tests or treatment. During the time that they’re ill, they may lose income by being unable to work. 

Many Rwandans are subsistence farmers, and if they cannot tend their crops, they face huge losses. Younger people may miss school—devastating in a culture where education is one of the key steps toward upward mobility. 

All too often, a person with malaria dies.

80% of deaths from malaria are in children under five years old.(source)

Malaria may seem distant, but not that long ago, malaria was prevalent throughout Europe, northern Australia, most of Asia, and the western United States. In fact, as recently as the 1930s, around a million cases of malaria occurred annually in the U.S. 

So what happened? 

To put it plainly, well-off people in developed countries didn’t like malaria, and they did something about it. 

They combined research, efficient infrastructure, and affordable medical care, and by the 1950s, we had wiped out malaria in the United States.

Malaria is the leading cause of death and disease in sub-Saharan Africa, and the most affected people are young children and pregnant women. (source)

Meanwhile in Africa, malaria is generally a question of “when,” not “if.” The people I’ve talked to refer to getting malaria the way we might refer to getting the flu—a bad thing that will probably happen to you once in a while.

Why are malaria and death from it so common here? A combination of factors contribute:

  • The female Anopheles gambiae mosquito, which is the insect responsible for spreading the malaria parasite, lives here
  • The type of malaria parasite most common here is Plasmodium falciparum—which also happens to be the type most likely to cause death
  • The climate allows for year-round transmission
  • The lack of resources and socio-economic stability makes it difficult to prevent and control the disease

Let me tell you a few ways this last item plays out.

  • Lack of nets—One of the key prevention methods is the use of mosquito nets. Unfortunately, many people, especially poorer people in rural areas, don’t have access to nets and don’t have instruction on how to hang and maintain them. The government distributes nets, but there are always more people than available nets.
  • Lack of diagnosis—Many people can’t afford to go get a blood test done, as I mentioned, and in some cases doctors are not properly trained on how to perform the tests or analyse the results.
  • Lack of treatment—Many people cannot afford medicine.
  • Lack of accurate information—Information about malaria and its prevention, diagnosis, treatment, and effects may not be available for many people. In some cases misinformation is spread, leading to inaccurate ideas about the disease.

There is a strong correlation between poverty and malaria. In Africa, only half of people suspected to have malaria actually receive a diagnostic test. (source)

But should you really care about malaria? There are about a zillion different good causes floating around demanding your attention, and you don’t have the time or energy to care about all of them. 

I think the answer is yes—malaria deserves your attention.

Here are a few reasons you should be invested in the fight to eradicate malaria:

  • Malaria eradication is not another hopeless cause. Malaria is preventable. It’s occurrence and mortality rates are falling steadily—between 2000 and 2015, for example, mortality rates among children fell by 65%, according to UNICEF, and in 2018 the world’s first malaria vaccine will be administered in Ghana, Kenya and Malawi.
  • Malaria affects children. I’m not pulling a poverty-porn move on you; I’m asking you to think about the future of our world. Children will grow up to effect changes, to develop their countries, to participate in politics and economics and science and everything else. My students love to discuss ways to develop their country, help the ecosystem, and make a better world—but if huge numbers of children are dying before they turn five from a totally preventable disease, who will be our future?
  • Malaria could come back to the U.S. I don’t think this is a good reason to care, or even a particularly likely occurrence, but if you need a reason that it could affect you directly, here it is. The US has climates suitable to malaria transmission and there are instances of malaria in the US, even among people who haven’t travelled to malaria-prone countries. 
  • Malaria is expensive. It is estimated to cost up to 1.3% of African GDP and its costs include travel, medical supplies, public health interventions, lost labour, lost opportunities for tourism, and, sadly, burial expenses. More than that, it costs the global economy. When one country improves, everyone wins, and ending malaria would offer opportunities for development of new markets around the world.
  • Malaria evolves. The parasites continue to become resistant to various treatments. The longer we take to deal with this problem, the harder it gets to solve.

The good news is that there are small, significant things you can do to help end malaria.

One way is to donate to an organisation that works toward prevention and treatment of the disease. Here are three:

Malaria No More works to distribute nets and diagnostic tests in Africa

Nothing But Nets distributes mosquito nets—for $10 you can send a net to someone at risk for malaria

The Global Fund works with local experts in preventing, treating, and eradicating AIDS, tuberculosis, and malaria in affected countries

Another way is to spread awareness. I know you’re not all activists, but consider sharing a link to a malaria prevention organisation on your social media today in honour of World Malaria Day.

Better quality of life anywhere makes a better world for all of us. It sounds cheesy, but I believe it.

No Problem

Ntakibazo. 

No problem. 

It’s the unofficial slogan of Peace  Corps Rwanda. The number of things that are not a problem in this country constantly amazes me. 

Transportation is ntakibazo. 

When the bus takes us to the wrong place, when we spend three hours looking for a ride home, when a friend can’t find a bus to her site and needs to stay with me for the second unplanned night, when a four hour trip turns into an eight hour trip… Ntakibazo. 

 Integration is ntakibazo. 

When I’m alone in a new village without matches or charcoal, when strangers come to the door and I understand only a few of their words, when I cannot find the market for two weeks, when anxiety paralyses me in my house until my neighbour comes to my rescue… Ntakibazo. 

Teaching is ntakibazo. 

When I don’t know what classes to plan for until after the first day, when I can’t understand my students and they can’t understand me, when there are no textbooks, when I don’t know the rules, when my timetable changes for the fifth time in three days… Ntakibazo. 


I’ve come to understand that the reason so many things are ntakibazo is that no matter where I am or what predicament I find myself in, someone will help me. This is a culture that believes in fostering community, in supporting one another, in cultivating a strength that comes only from unity. 
Transportation is ntakibazo because when I cannot find my bus, a stranger will walk me across the bus park. Because when I don’t know my stop, the driver will point it out for me. Because when I need to be somewhere and the bus schedule is off, two competing bus companies will collaborate to get me to the right place at the right time. 

Integration is ntakibazo because when I cannot find the market, my neighbour will take her morning to help me shop. Because when I stop by the umudozi—seamstress—for cushion covers, she will introduce me to her whole compound. Because when I feel like a stranger, the little girls next door will teach my name to every child on our street. 

Teaching is ntakibazo because when I am lost, someone will show me to my classes. Because when one day the students are terrified and refuse to answer questions, the next day a few brave ones will speak up. Because I feel out of my depth at every moment, but together we will grow and learn. 

The day before school began, our Ed8 group chat exploded with texts about our fears, our doubts, our incredulity at the total lack of communication and the total impossibility of our job, and my friend Claire spoke up:

Y’all, we can do this. It’s no more absurd than the first day of model school, or the way they rewrote the TPI the day before, or when PC told us we were responsible for making our way back from site visit with barely any language training about transportation. This is not even the most ambiguous, stressful thing we’ve been asked to do in this country. We’re all gonna be alright.

And she was right. 

Because Rwanda has taught me that no matter whatnot gets thrown our way, when you support one another, everything is ntakibazo. 

I Am a Teacher

Ndi umwarimu. 

I am a teacher. 

This is a scary identity to claim. Teaching terrifies me for many reasons, not least because it’s a task in which I might fail in front of a large group of people and then have to face them everyday and in which my failure might significantly affect their success. 

I feel underqualified and overwhelmed at every step of the process. 

I’m about to start my second week of model school. Model school consists of several hundred students willing  to show up each morning for classes at a local public school. It’s theoretically mutually beneficial—we get to practice teacing and they get a little between-terms education plus a pen and notebook each. 

The first day felt like drowning. 
There was a time, once, when I was swimming and the waves were too high and my legs were top tired and it took every ounce of effort I had to catch one more lungful of air each time I bobbed above the water and to hold it as I sank under. That is how teaching felt on my first day. 

I stood in front of about ninety primary 6 students and tried to teach them something—anything—and my hands shook and my heart tried to escape my ribcage, and I thought, This was a mistake. I can’t do this. 

But the next morning I walked back into that classroom. The students didn’t understand me, and I didn’t understand them, and I felt ineffective and miserable, and it was hard.  But it no longer felt like drowning. 

And by the third morning, when the kids rushed in and took their seats in a mob of pushing hands and kicking feet and shouting voices, I recognised a handful of faces. And when I stood in front of them and they chorused, ‘Good morning, teacher!’ I was able to muster an actual smile. 

Over the course of the week, I learned more than I could’ve imagined. 
I learned that the little girl in the yellow shirt knows the scientific definition for every word but may not actually understand the question. 

I learned that the older boy in the back has some sort of learning disorder and that asking him to come up and answer questions is both ineffective and unkind. 

I learned that the girl in the burgundy sweater has a vision problem but can do any assignment I give if I make sure she can see it and understand the directions. 

I learned that teaching children entirely in a language they barely speak requires patience on my part and tenacity on theirs and that learning happens when we all bend a little to accommodate each other.

I learned that this was not a mistake, and that I can do this. 

By Friday, when I said goodbye to them, I had fallen in love with that mob of bright eyes and loud laughter. 

I love their high-fives as they troop out the door, and I love the kids who circle back for a second one. 

I love the little girl who passed in the door to wink at me and the one who caught me after class to ask if I would be at the same school next week so she could still see me. 

I love their enthusiastic shouts when they know the right answer. 

I love the courage in their stammering when they know the right answer but have to frame it in a language their tongues struggle to form. 

I love that they try anyway. 

I am a teacher—not because of a qualification or a job title, but because of those children. 

Because by the end of the week,  the desk of boys at the back, who didn’t seem to understand a word for five straight days, were able to create a group project with correct ideas articulated in understandable English. 

Because I saw shy girls answering by the end of the week. 

Because they left singing the songs we had taught them. 

I am a teacher. There’s a lot to this identity. There are fears and aspirations, beliefs and doubts. There are students in my past and students to come in my future, and there’s a world of new experience waiting. 
But whatever is still to come, this identity is mine right now, thanks to a roomful of Rwandan children. 

A Season for Rain

“Igihe cy’imvura.” 

“Rainy season.”

They told us when we came that it was the beginning of rainy season. 

When I first came home, my host father told me, “This is a season for rain.” 

He continued to tell me this whenever it sprinkled, and I, having seen after a week nothing more intimidating than a long drizzle, began to doubt that “a season for rain” in Rwanda had the same tin-roof-rattling, soul-drenching connotations as rainy season in Panama. 

On Saturday, though, this season for rain settled in with gusto. 

It pelted down, deafening on the rooftops. It killed the electricity for hours and drenched me on my sprint to the latrine before bed—a cautious sprint, because the water running through the compound had already made my flip-flops treacherous and left a sizeable bruise on one hip. 

It set the thick orange mud flowing.

In Rwanda, it seems, a fine layer of dust collects everywhere despite everyone’s constant sweeping and scrubbing. Everything looked clean until the rain hit, and then rivulets of muddy water streamed across the porch I’d thought pristine. The courtyard our umukozi scrubs every morning ran brown and yellow. Grit and slime collected in my shoes, between my toes, around my ankles. 

Now, in this second week with my host family, I think that dust has been collecting inside me, too—imperceptibly, in places I thought I’d kept clean. 

As the sunshine of my first experiences disappears behind dark clouds of repetition and exhaustion, it is a time for rain. 

As the raindrops fall, I see that tiny irritations I thought I’d brushed off have collected and now, brought to life, flood muddy through me. 

Things like having my food choices questioned solicitously yet relentlessly at every meal.

Finding that every conversation in Kinyarwanda is too many words beyond my comprehension. 

Feeling isolated by distance from town and lack of good internet to access my usual communication channels. 

Desiring to integrate yet needing to recharge alone. 

Fighting bugs in the latrine and stares on the streets. 

Hearing “umuzungu!” everywhere I go. 

Developing canker sores as a side effect of my malaria prophylaxis. 

They collect like dust in the crevices of my soul, and as the raindrops of tedium, weariness, and failure fall, they thicken, collecting in puddles and rivers until they seem to be everywhere. 

The mud in Rwanda is like no mud I’ve seen before. It’s bright orange and ubiquitous. It sticks to everything it touches, flicks up behind each step to speckle my trousers, goops between my toes, cakes my shoes. On rainy days, not only the dirt roads are muddy; the asphalt and concrete run with muddy water. There are no clean puddles to rinse my feet. The mud seems to be on everything—the roads, the walls, the people—until it’s all I can see. 

At first look, the rain doesn’t seem to wash clean anything that wasn’t clean before; it seems to merely spread the mud. 

But after a while, I can see where the rainwater has cleaned great patches of white concrete on the side of the house. I can see the trees gleaming, washed of the dust that muted their leaves. 

The rain accentuates the dust and dirt, but it also ultimately washes it all down to the ground. 

And with time, I can see that the rain in my life is washing away the muck. With repetition, I begin to see the clear patches. 

Finally mastering the art of walking to the shower without my igitenga slipping. 

Being one of the few trainees who didn’t experience unpleasant splattering or missing the hole during my first visits to the pit latrine. 

Understanding more and more words in my host family’s conversations. 

Hearing my host siblings say they love me. 

Being able to text my friends and family in the US as much as I want. 

Ordering food successfully in Rwandan restaurants.

Making brief friends with strangers on my long walk home. 

This is igihe cy’imvura—this is a season for rain. 

It soaks through my trousers, splatters on my hair, and turns the red dirt roads into an orange morass. It’s cold and inconvenient, but it washes down the houses. It nourishes the crops. It cleans the air. 

And it always ends. 

Soon enough it will be dry season. Dust will clog my nose and coat my shoes and rise in clouds from the roads, and it will bring its own troubles. 

So for today, I can only embrace this season of rain.