The Rains Down in Africa

Tonight as I write this, I am watching huge lightning flashes light up the sky to the south.  Directly above me, the sky is still clear, but a mass of clouds is moving progressively closer and appears to be slowly enveloping each of the stars in its path.  A cool breeze has started gently shaking the leaves of the mango tree and wafting the smells of my neighbors’ cooking through my open doorway.  Soon the clouds will be overhead and the rain will start falling, slowly at first but likely working up to a deafening drumming on my metal roof.  Tonight we are getting some warning before the downpour begins–some time for everyone without the luxury of a gas stove inside their house (aka probably everyone in this town except me) to hurry along their dinner preparations since cooking over an open fire is both difficult and unpleasant in the rain–but sometimes the storms seem to come out of nowhere.  One minute I am sitting on my front stoop in the company of my concession family, and the next I am struck by massive raindrops as thunder booms overhead.  I run inside to get my rain-collecting bucket and as I set it outside, lightning illuminates the silhouette of the unlucky 10-year-old who lives next door, shivering and looking like she wishes she was somewhere else as she fans the flame on the fire and tends to the pate that is still half-cooked.  The family has to eat, rain or not.  Or once, I was on the back of a motorcycle when the rain started.  Usually everyone will duck under some kind of shelter in this situation, but this time the rain refused to stop and we needed to get home eventually, so we decided to just go for it.  Naturally this happened on a day when I had brought my umbrella instead of my raincoat (the latter is infinitely more useful when riding a moto), and as we bumped along getting pelted by raindrops which were soaking through my clothes, I was surprised by how cold one could actually get in Africa.  I started feeling a little sorry for myself or at least cursing our bad timing as I attempted to wrap my shawl tighter around my shoulders, until I looked around and noticed that on both sides of the road were streams of women and children walking in that weather, carrying loads of crops from their fields on their heads.  And since we were in the middle of rural Benin and there is quite a distance between villages here, I knew that they probably had a longer walk ahead of them than I did a motorcycle ride.  Life here is like this.

Rain is nearly a daily occurrence right now, and while it is sometimes an inconvenience, mostly I treasure it.  It brings cool air to the hot days; it tamps down the dust that rises from the roads; and when I’m lucky, I can collect buckets of rain water that help increase the number of days I can go between trips to the water-getting place.  And since almost everyone I know here is a farmer on some scale, I praise the rain for its role in making things grow in a land without sprinklers, hoses, or other artificial irrigation systems.  I love waking up in the morning to a world shrouded in fog, seeing the trees emerge slowly from a blanket of clouds as I’m running along a road that continually looks like it disappears just a few yards ahead.

But rain here isn’t all good news and the inconvenience of getting a little soggy.  The rainy season also means more breeding areas for mosquitoes, and more mosquitoes means more malaria.  Right now, I’d say that about 8 out of 10 people who come to our health center are suffering from malaria.  There it is, written in the treatment log over and over: “Diagnosis: paludisme,” “palu,” “palu simple,” “palu grave,” “paludisme.”  It’s funny, though I know the statistics on malaria in Africa forwards and backwards, I still sometimes find it a bit hard to grasp the severity of it.  I think that as someone who is pretty well protected against the illness by my weekly anti-malaria prophylaxis and who has the comfort of knowing that if I do get it, I have the preferred treatment in the form of 24 neat little pills stored in my med kit at the foot of my bed, malaria can sometimes seem like a pretty abstract thing–something to be avoided, certainly, but not the end of the world if our paths cross.  But then here it is in front of me day after day–in the six month old baby, the gangly teenager, the pregnant woman, and the macho farmer; people with high fevers, aching bodies, terrible fatigue, and varying degrees of gastrointestinal issues.  Prick their fingers and put a drop of their blood into the plastic rapid malaria test, and in a couple of minutes one line appears, then another.  Palu est de dent.

Malaria is actually a lot like the rain that brings it.  It’s not too bad if it catches you when you’re prepared for it, but the thing about rain is that if it is unexpected and you don’t shut your windows fast enough, it can quickly flood your house and ruin your things.  It can come on very rapidly and it evolves quickly from a sprinkle [malaise] to a downpour [life-threatening illness].  But unlike the weather, malaria can be stopped in its tracks.  A few pills of Artesunate + Amodiaquine — a combination of drugs better known by the brand name Coartem — can often put the life back into a sick child’s eyes within a few hours.  Thanks to subsidies from the government and foreign aid, it’s not even that expensive, and right now pregnant women and children under five in Benin who test positive for malaria receive treatment free of charge.  It’s pretty cool–I think Benin is really using international resources/aid in the way it is meant to be used, and I see it in action every day.  And it is saving lives; people who otherwise might not bring their kids to the center because they think they don’t have enough money to pay for the drugs know that there is free treatment available so they figure there is no harm in coming to see if it is malaria.  And as I mentioned, it usually is.

Which makes it even more infuriating to me that in the middle of this literal and figurative rainy season, we have run out of Coartem.
“Come back tomorrow,” people are told as they walk away clutching pain relievers that will lower a fever and vitamins that will improve their long-term health but will do nothing to the parasite that is multiplying in their blood.
Sometimes if the malaria is severe, they are treated with an injection of quinine, a very old treatment that is usually avoided now due to its harshness on the body.  I mostly fix my eyes on the wall and will myself not to scream or throw things.  Somewhat surprisingly, none of the patients or their families make a scene.  I guess they are used to things like this and they figure that getting upset about it won’t help anything.  Which is, of course, true on some level.  But I come from a place where people get outraged when a blender they wanted to buy is out of stock and where making a scene often results in a reward of some sort.  [Sometimes I imagine trying to explain things like that to someone here…”What is a blender?” “And why does one need it?”  “It costs HOW much?” And then I stop thinking about having those conversations…]  The whole situation makes me really mad and while I’m doing my best to harass my coworkers into trying a little harder to restock quickly, I think there are a lot of factors that are out of their control and I feel pretty helpless and frustrated these days at work.

Of course, it just underscores what I have believed for quite some time, which is that prevention is the way to go.  If we can keep people from contracting malaria in the first place, fewer anti-malarial drugs will be needed, it will be less likely that the supply will run out, and it won’t be as severe of a problem if it does.  So now the issue is trying to figure out how I can work with people in my village to do this.  There is work to be done, it’s just a matter of starting to do it.

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