Two Tiers & Typhoid

In a twist worthy of a Victorian subplot, I spent the last weekend suffering bouts of intense abdominal pain and convinced myself that the challenge of locating a doctor in Musanze was somehow better than, well, dying. After a few medical tests, I was told, to my abject astonishment, that I had somehow contracted salmonella typhoid.

Typhoid.

You know, of Typhoid Mary fame. A disease that enjoyed malevolent notoriety throughout the Romantic and Victorian eras, into the twentieth century with the Great Chicago Fire and Women’s Suffrage. All worthy of a 600-page novel melodrama.

But it didn’t stop there. I didn’t just have salmonella typhoid. My blood work revealed a whole run-down of suspicious characters: my intestines, it seemed, were blitzkrieged by a sort of parasite keg party and all I got was the hangover. It wasn’t fun. Intensive cramps that came like lightening after I ate, rattling my whole body and leaving me curled in the fetal position, praying they would pass soon. Six distinct parasites were listed on the lab report. Even the venerated William Makepeace Thackeray, who succumbed to typhoid (or cholera) himself, couldn’t have come up with that list. And Elizabeth Gaskell threatened to kill off her Abyssinia-trekking, gentle-natured Roger Hamley, causing a panic among the good Gibson ladies when he falls ill with what is probably malaria. Only one diagnosis? Pansy.

[Side Note: You can thank my bachelor’s in English and Alan Belwell’s Romanticism and Colonial Disease for all the Victorian name-dropping. Truly, this collection of essays, including the exquisitely titled “Keats and the Geography of Consumption,” serves to warm my heart and increase my love for the strange tangents of bizarre academic inquiry.]

It’s easy for me to joke about this because, one week after my diagnosis, I’m sitting at home, working on a research article, preparing plans for the week’s training courses, and packing for my upcoming Zanzibar-Frankfurt adventure. Before coming to Rwanda, I had a course of vaccinations, adding to the laundry list of needle sticks gathered prior to first visiting Africa in 2006: Hepatitis A. Hepatitis B. Typhoid. Diphtheria. Polio. Tetanus. Measles, Mumps, and Rubella booster. Polio, again. Yellow Fever. Typhoid, again. This meant that my course of Typhoid Etc. was confined to abdominal pain as the bacteria partied in my abdomen, and I wasn’t in danger of succumbing to high fever and deathbed diarrhea. I visited the clinic, received my tests and diagnosis, purchased my drugs, and went home to wait it out. Out the door: less that $90.

africa map

Memory is a funny thing: it can be triggered by songs, smells, noises, even fleeting glimpses of colors or shapes that transport you back to another time and place like déjà vu. Rwanda is forever doing this to me, throwing me backwards eight years to my first experience on this continent. For those who travel, you know it’s impossible not to compare: this country to that, this culture to that, these buses versus those trains. Africa is anything but one large country, and Rwanda and Namibia are as different as Switzerland and Poland: same continent, very different places.  And memory plays a serious role here, picking and choosing the details that you compare (consciously or unconsciously) against the new input.

This week was a wander back into my poor memory, brought on by grapefruit and coconut scented Palmolive soap, washing my hands as I got ready to leave my house and hail a moto to make for the clinic in town. Eight years ago, I sat in another clinic.  

In 2006, I spent three months in volunteering at a program for township children in Windhoek, Namibia, and there are few moments from those days that I remember clearly. Helping to break down road-kill oryx to be stowed in the center’s deep freezer? Yes. I remember that in all of its bloody detail. The clinic in Katutura, waiting to take a boy to see a doctor? I remember it well, two sweltering hours seated among a mass of people, unable to comprehend the call system. Were we next? I didn’t know. I sat immobile on a hard wooden bench, reliving Catholic school memories, not celebrating advent mass but waiting with a malnourished Namibian boy, five years old but barely larger than my two-year-old nephew today, asleep with his head pressed into my clavicle. Sweat beaded between my legs and the wood bench, which grew harder and more uncomfortable with each minute, but I didn’t move, not wanting to wake the tiny sleeping figure curled against me.

In Namibia, I worked in Katutura, the township that provides the lifeblood to the capital city of Windhoek. Every day, we passed the buses coming to collect the workers, the house maids and street cleaners, the garbage truck drivers and the shop girls, some neatly dressed, others in the ubiquitous blue coveralls that signaled labor. The township (such a nice way to describe a slum area with thousands of people packed into a few square miles of dust and poor sanitation) was born in the days of apartheid, when Namibia was claimed by Afrikaner Zuid Afrika (South Africa) and was better known to the outside world as South West Africa, home to the vast, sprawling Namib desert and the southern diamond mines.

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The red sands of the Namib desert: Dunes near Sossusvlei

Namibia is a rainbow of skin tones, everything from pale Germans and Afrikaner colonists, to the Chinese and Indians who migrated to the continent, all mixed with the native Ovambu, Herero, Damara, and San. The Germans arrived during the colonial land-grab, with England claiming a few locations for the British Crown. Germany practiced genocide there, eliminating somewhere between 35,000 and 100,000 Herero and Nama peoples. Some call this the “practice” genocide, with the Holocaust a more concerted effort, but executed before Raphael Lemkin coined the term for the “crime without a name.” Following World War I, South Africa was mandated the country via the League of Nations, part of Germany’s punishment for warmongering. As South Africa descended into apartheid hell, beginning in the 1950s and 1960s, Namibia was divided into homelands and farming land was distributed among white farmers, with .2% of the population controlling 74% of arable land. I barely understood these factors when I was there: 21, just out of college, wide-eyed and naive.

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Two Windhoeks: Christuskirche in city proper (top) and a barber in Katutura (bottom)

Katutura, home to 150,000, bloomed under apartheid as the inhabitants of the city judged to be just too brown, is a name that means “the place we don’t want to go” in Herero. The fraternal twins of poverty and disease flourished in this place, as cultural groups that once organized African traditional societies broke down. When AIDS arrived, sub-Saharan Africa fell quickly, with areas losing entire age groups to the ravages of the disease, called the “thin” disease throughout the continent. In Namibia, this resulted in an orphan population that grew to 100,000- a large percentage in a country of just 2 million. This is one tier of population: the tier that operates within a cycle of poverty, unable to remove itself from the entrenching forces that prevent life from being anything but subsisting.

S. slept in my lap as we waited in one of the clinics found in the township, staffed (I learned from surveying the doctors’ name placards on the office doors) by Cuban doctors, not uncommon throughout Africa. Dr. Paul Farmer touches on this phenomenon in Mountains Beyond Mountains, noting that the U.S.’s sold enemy “…seems to have mostly abandoned its campaign to change the world by exporting troops. Now they were sending doctors instead, to dozens of poor countries” (Kidder, 2009, p. 194). Cuban doctors arrive in countries like Namibia; though they don’t have the same amount of academic schooling as their American counterparts, they are still well-trained to deal with the diseases that they most commonly encounter. They work in the clinics, not the nonprofits or NGOs, hence why S. was seen by one of these doctors.

The clinic smelled strongly of disinfectant, the kind used on floors, and I moved my face closer to the top of S.’s head to avoid it. Soap. He smelled like soap. Other volunteers at the nonprofit had bathed him, scrubbing away the dust with something like my grapefruit coconut Palmolive. His arms were stick-thin, as you see from pictures of famine. On his limbs were burns and scratches- S. was the victim of superstition, some member of his family believing him to be born under a bad sign and thus left him neglected (at best) or abused him (at worst). He was so small, so fragile, like a wounded bird. I barely knew him; the other volunteer and I were tasked with staying with the children at the clinic since we were warm, available, (but fairly unskilled) adult bodies. The doctor eventually called our number, and we filed into his tiny office. He tenderly prodded S.’s distended belly, observed the scars and burns, and wrote a prescription for anti-worm medicine. Hours of waiting, a few minutes in and out, with prescription in hand. The organization took care of the bill for the pills, helping one little boy out of the many who needed simple medicines to kill the worms that were distending his belly and sapping the little nutrition he received. It was a start, but wasn’t the solution to the problems he would continue to face.

Eight years later, I sat in a very different clinic, this one in Rwanda, this one engineered for those, like me, who live in a different tier than the populace of Katutura. The Musanze clinic is nearly empty- that’s one sign. I arrived, was checked in by two receptionists sitting behind computer screens, and was escorted to the office of a very competent, English-speaking doctor. Time was of no concern; following a blood draw, he worked down every test and compared my levels to those considered normal. Ten times he scrawled out the normal range for each test – and circled my results so I would understand. He showed me the words, salmonella typhoid standing stark among them. But he smiled at me, trying to calm my obvious discomfort and fear at hearing that word: typhoid. “It’s ok,” he said. “It’s common. Some medicine and you will be fine. No cause to worry.”

In developing nations, people die from typhoid. People die from cholera. Prior to arriving in Haiti in 2011, the country suffered another outbreak of the disease. While I was in Namibia, a polio outbreak erupted and the government vaccinated the entire country, medical staff canvassed the country, winding through the townships to issue droplets in mouths and mark fingernails with purple Sharpie to indicate vaccination against a disease that claimed more than 30 people during my months thereTo Westerners, these are the diseases of novels, history, and far away places.

And diseases that don’t kill you debilitate you, which I can attest first hand. I cancelled four classes, a presentation, and a training session for this week. I wasn’t able to work on an article that has an increasingly pressing deadline, and I could barely read. On a national scale, they slow productivity and hamper growth; on a personal level, you lie in pain and wonder what will bring relief.

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2006: A challenging (but typhoid-free) day

I’m fortunate. It took less than $100 to get adequate treatment, and, barely a week later, I was back to eating regular food and my usual level of cheery, pulsing productivity. The privilege of my tier.

In a place like Rwanda, rocketing forward with development, you quickly see the tiers. I went to the clinic and saw a doctor in moments; I paid for this immediate access, medical care which was fast and effective but according to my middle-class point of reference, carried a minimal price tag. Just down the road is the Musanze Hospital, a sprawling yellow building with lines of outdoor benches. This is where the other tier goes to sit, wait, and wonder. This is the place where I sat, years ago and a thousand miles away, with a little boy who needed medical attention even more than I did this week. In a country that continues to move forward, a few benefit, and the tiers are even more visible.

So, please, I’m fine. No mollycoddling needed, no sympathy desired. Typhoid defeated, amoebas slayed, and Leanne walks to school another day- thankful, but as with every day, maybe a little more aware.

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2 thoughts on “Two Tiers & Typhoid

  1. Hi friend: Wow. What an adventure! I am thinking of you and so impressed and inspired by your ability to balance our privilege by the memory of a tiny child whose head nestled under your chin. You are truly a gifted writer: I will never again be able to think about the smell of soap and the feel of skull against bone without thinking of your writing! Hope you are better! All the best, Cathrene

    Dr. Cathrene Connery Associate Professor of Education Ithaca College Department of Education 194B Phillips Hall Annex 953 Danby Road Ithaca, New York 14850 Cconnery@ithaca.edu

    Like

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