Fieldset
malaria.

i am on my way back to sudan today after the six short days afforded for six months of work.

i am on my way back to sudan today after the six short days afforded for six months of work. the hardest part about returning is not imagining myself tossing and turning in my tukul, it is resisting the urge to keep on traveling, stifling the desire for movement, refraining from tapping the driver of the crowded mini-bus on the shoulder and asking, "do you speak English? how far can you take me?"

i know exactly how far i will go, exactly where i will be taken. there is none of that freeing feeling, and after a tiny taste, i miss it.

i have been in contact with the field, and things are well. the team is shifting again. a treadmill, msf. my friend, the oldest person in the mission, reto, is leaving. he may be gone by the time i get back. if so, then i am, i guess i should say we (you and i) are the oldest people in the mission. we will have the clearest understanding of what we've been through to arrive at the present moment. the people, the seasons, the crises. we'll know it best. i was told, way back in the beginning, that it would be like this.

so, soon back to work. i am curious what changes will have happened. while i was away, we had a visit from our coordination in Geneva. we had so many questions about the project, its necessary direction, its natural longevity. i suspect i will arrive to some answers, and with them, a more defined sense of purpose. to this point, the unanswered questions were a mire.

i was also glad to learn that a friend of mine has fully recovered from malaria. two nights before i left, he said "i feel warm". he was. he looked fine. i did a paracheck for malaria, listened to his lungs even though he had no cough. everything was normal, negative. i gave him some ibuprofen, and told him i would see him in the morning. when i did, he did not look fine.

i got malaria a few years ago, when i traveled through malawi. though well supplied with antimalarials, i had stopped taking them. i was staying on lake malawi, at a guesthouse. i remember going to bed with a low grade fever and an ache in my neck. i was neither particularly sick, nor particularly worried. i woke up in the middle of the night feeling incredibly cold. not cold, like a chill that a blanket would solve, but a teeth rattling cold that shook me through. it was like my bones were made of ice, and no matter how many clothes i put on, no matter if i doubled or trebled my thin blanket, i was sucking in all of the heat in the room and turning it out an arctic wind.

i had typhoid once, but this was different. when i was sick with typhoid, i had a fever for days. i felt like a radiator. i could put my hand next to my own skin and feel how hot i was. i glowed. i became a walking desert, delirious with a heat that burned even in my dreams. i felt like i would sizzle through an iceberg. now i was inside one.

this time, i couldn't tell if i had a fever and didn't care. i just wanted to be covered in the hottest, heaviest thing in the world to stop the shaking. kapucinski once describes getting malaria in a village in africa where they had no blankets to cover him. they put a wooden chest on him and patiently sat on it until the worst tremors had passed.

i lied there, sweating, chattering, freezing, with three pairs of pants on, not knowing what time it was, and waited for morning. once it was light, i decided i needed to go to the nearest hospital. i staggered into town, and climbed onto the back of a truck headed for mzuzu with twenty other people. people stood aside and gave me the space behind the cab where the wind was the least. it took an hour for me to get to mzuzu and i got off at the first stop. i saw a stand of cars and walked to the closest one. without speaking to the driver, i opened the door and lied down in the back seat. he climbed into the front and turned around to ask me where i wanted to go, and on seeing me, realized he did not need to ask. i remember the look of fright on his face, his wide eyes. apparently, i did not look fine.

he took me to the hospital, opened the door for me and helped me to my feet. he drove away without asking for money, relieved i was now someone elses's problem. i walked into the hospital, past the front desk, and down a hallway. i found a stretcher wedged in a corner, lied down on it, and covered myself from head to toe in blankets. i got up once to push it in front of a sunny window, desperate for more heat. the rest i don't remember. at some point (an hour later... more?), someone found me curled up and shivering. they called for the doctor. someone gave me some paracetamol, someone else took some blood. the doctor arrived as the paracetamol started to work, and the rigours settled down. he gave me a bag of quinine. he asked me if i wanted to stay in the hospital. i told him i did not. he told me that he has had malaria fifteen times and that it gets easier. he watched me take the first pills, making sure i did not vomit, then said goodbye. i found a taxi, took it all the way to my guesthouse. i lied there, limp, for two days.

one learns in school, and in books, about a plasmodium viremia – the parasite that causes malaria. he learns that the anopheles mosquito transmits it while she is having a blood meal, that a few tiny parasites from her previous infected victim fall into the new host's bloodstream. once there, they multiply a millionfold in the energy rich human body. he learns that different plasmodia create different malarias, their patterns of fever are different and unique, so much in fact that one call tell the species by the spikes and troughs of your patient's temperature. you learn that of all of them, the very worst, is plasmodium falciparum, the kind found in abyei and much of africa, that each year it kills a million people.

you can learn all of that from books. there is something that you can only know by experience. for instance, when someone writes "the plasmodium parasite multiplies itself several million times", what they don't know is that with each multiplication, the plasmodium produce a tiny shard of ice and in an instant, you are full of them. they dangle in your bloodstream, turning over and over like little icebergs, until your blood becomes so viscous it stops. you shake yourself to keep it going.

my friend in abyei is fine. he was fine by the next day, like i was. in toronto, if one sees a traveler with malaria, it is an event. medical students flock, case reports written. my one experience was important and rare enough for me to record with incredulity. but for so many people (most?), it is a regular part of their life. this rainy season, hundreds of people around abyei, and millions around the world, will turn cold, then start to shake. if they are lucky and have some access to health care, and they can afford it, they will get a bag of quinine. if the drugs are real, and they are given a proper course, they will be cured. if they are unlucky, they will suffer with it for days, missing work, the opportunity to care for their children or tend their fields. in addition to the human, individual toll, the absence of effective prevention and available, affordable treatment, is a missing rung on the ladder that most nations must climb to pull themselves from poverty. until then, i suppose, most have only the poor comfort that next time, it might be easier.