When I was getting ready to move to Kenya, I didn’t know what it was going to be like. I’d been to different parts of Latin America, slept on the floor of a church an hour up a dirt road off of the pan-american highway, eaten guinea-pig from a roadside stand with classmates in a charter bus, and still I didn’t know what I was getting in to.
I was most worried about the “bathroom” situation and the bugs. In my first week at training I had a massive GI bug, and so leapt the hurdle of pit latrines quickly and it simply became part of the landscape—really built up that quad strength.
But the bug thing.
It was still a thing.
I’ve always been a sweet enticement to mosquitoes.
One night while visiting family in Cocoa we went to go watch a launch at Cape Canaveral, standing on the side of the road looking across the Indian River, swatting the bugs that were pleased at the feast presented to them. The launch was scrubbed, for whatever reason, but my legs the next morning were a polka-dot compilation of pain and irritable scratchiness. My mom carefully put cream on each bite, counting as we went, and crossed fifty before we were done.
Mosquitoes love me.
So of course, the Peace Corps medical machine sends me to sub-saharan africa, where mosquitoes seek out everyone every night. And these particular mosquitoes carry malaria with them.
As we prepare to ship out in the midst of staging, every peace corps volunteer is given the baseline malaria prophylaxis. In 2006, when I began service, that medication was mefloquine, a noxious weekly medication that dropped my ability to sleep down to four hour segments on the first two nights after my dose, made me see things that weren’t there, and has a history of inciting suicidal ideation. This is the medication that was given to US military in malaria prone areas at the time as well. I don’t know current practices. It was cheap, and we’re volunteers.
Every volunteer was also given a bug net for their homestay. Volunteers were hosted, in Kenya at least, in homes of host country nationals, because training is scheduled during the local school term, so the families who have children away at boarding school have a bedroom available for the forty or so volunteers in training at the time. (It’s a great idea, actually, drop your volunteers into a home and have them deal with culture shock in the middle of training, because then you still have friends around and staff that can help you navigate this wholly new thing.)
So during training I learned more about malaria.
In South Georgia, mosquitoes are active all the time. It doesn’t matter when it is, you can get bitten. Sure, they might be happier and buzzier and swarmier at night, but any time of day is a good time of day for some tasty blood snacks.
In Kenya, the mosquitoes that carry malaria are active at night.
For volunteers, they are a nuisance.
For the families we stayed with, and the families we later worked with, they are a danger.
The denizens of Kenya, the refugees and the folks who live in the bush and the majority of all of the residents who call sub-saharan africa their home, don’t take a regular medication to prevent malaria. It’s a problem of access and longevity and cost and risk/benefit and a hundred other things.
Instead, they sleep under nets. Everyone sleeps under a net, unless you are in a climate controlled building like a hotel or an embassy building or a movie theater. I can count on two hands the number of times I was in a climate controlled space in Kenya.
Mothers and their children under five are given insecticide treated nets, where they share a bed and sleep, hoping there is not a new hole in the net and that the insecticide lasts long enough to stave off the next bite that could make them sick enough to threaten their life.
Because that’s the thing, malaria for children age five and under can be deadly. Yes, there is a treatment medication that was brand new when I was in Kenya, fifteen years ago, but it’s in pill form and I don’t know about you but have you tried to get a kid to swallow a pill recently? And anyway, it’s only available at dispensaries and hospitals and its difficult to get to those quickly, or at all.
In 2006 seven to nine hundred thousand people died from malaria, 90% of those in subsaharan africa, and two thirds of the people who died were five and under. That number was better this past year, dropping to half a million, but that’s still too many.
And so, it was with great joy that I heard this week that a malaria vaccine was approved by the WHO. This is huge. It’s not perfect, requiring four injections over two years, and only 30-40% effective at preventing symptomatic disease…
Which, when one is traveling by motorbike with a cooler strapped to the seat behind you, hoping that the families that were there six months ago are there again and have their cards with them so that their vaccine schedule is up to date… it’s a lot.
But it’s something.
And it still means the nets are necessary, and it still means that people have to be careful and tuck their nets in and watch for holes and treat their nets once a year or more…
But 30-40% effective means that a few hundred thousand fewer children might die.
And even though these are children that I might never meet, I still care. Black lives matter even if they are across the ocean. Every death is a tragedy, especially the preventable ones.
So I hope this vaccine is funded, and fast. And distributed quickly. Because God knows there are too many preventable deaths happening daily right now.
We have a 95% effective shot for another deadly pandemic right now… I’ll stand in line overnight if necessary for my kid to get it when it is approved. But I don’t have to, because we don’t have the same urgency or shared vision here. I kinda wish it was like the pesky mosquitoes, visible and irritating. We might be safer, then.
But I’m still glad for this hope.