Malaria is rare in that it has stayed as deadly as it has always been. Between 250 and 500 million people are infected with the disease each year, about 1 million fatally. According to Doctors Without Borders, reported malaria cases quadrupled between the years of 1982 and 1997 when compared to the data from 1962 to 1981. We’ve been battling malaria for our entire existence as Homo sapiens and even before. Our distant evolutionary relative the chimpanzee chews the leaves of the mululuza shrub, which has secondary properties that ease malarial symptoms.
For centuries, people in the Andes had known that the bark of the cinchona tree had properties that could combat malarial fevers. It was the Jesuit missionaries there who brought the powdered bark to Europe in the early part of the seventeenth century. The bark contained a molecule called quinine, and while it doesn’t prevent people from being infected with the disease, it does soothe some of the disease’s effects by poisoning the malarial parasite when it attacks hemoglobin in the blood. Quinine was humankind’s best defense against malaria for centuries, although for a while it was a casualty of Catholic bashing, as people maligned it as “Jesuit’s powder” and an agent of the Pope. Poor Oliver Cromwell died of malaria after publically dismissing quinine as Catholic hoodoo.
Malaria research and prevention were front-page news in the late nineteenth century as teams of scientists struggled to decipher the disease. In August 1897 in Bangalore, India, a town about four hundred miles south of Hyderabad, Dr. Ronald Ross and his Indian assistants discovered that mosquitoes transmitted malaria. Ross gets credit for the discovery even though a case can be made for an Italian team led by Giovanni Battista Grassi. Ross killed his mosquitoes for dissection by puffing some of his cigar smoke into their test tubes, which for them must have been like drowning in a bubble bath. This knowlege led to the second method of combat against malaria: fighting the mosquito. In the twentieth century, people did this as well as fight the parasite.
Malaria treatment factored heavily into World Wars I and II. Forests of cinchona trees around the world became important military assets. Prior to World War II, German scientists developed a synthetic version of quinine, but didn’t use it because of its toxic side effects. Towards the end of the war, American scientists developed the same synthetic (corroborated by data found after the Allies captured Tunis). The Americans christened it chloroquine. This new drug was highly effective in preventing malaria, and people used it liberally, regardless of its toxic effects. Brazil even fortified table salt with it, which might sound extreme, but at the same time used similar logic as the United States’ widespread use of antibiotics in livestock. The problem, though, was that malaria is tenacious. Soon chloroquine-resistant strains of malaria began to appear.
World War II also led to the development of a unique compound, dichlorodiphenyltrichloroethane, which when used as a pesticide had both remarkable staying and killing power. After a single application, this compound, referred to as DDT, could be present and effective as a pesticide in the soil for anywhere from days to decades. It was also easy to make and spread. Factories could churn this stuff out in mass quantities, and it didn’t have the toxicity to humans that other contemporary pesticides had. In 1958, the United States (in a bill cointroduced by Senators John F. Kennedy and Hubert Humphrey) declared a global war on malaria, with an emphasis on killing the Anopheles mosquito, enlisting the new wonder pesticide known as DDT. The world’s health organizations banded together and decided that with DDT they weren’t just going to try to control malaria—they were going to wipe it from the face of the earth.
DDT’s longevity (a half-life of eight years) and its widespread use for all sorts of insect control proved to be its downfall. Though malaria had been scrubbed out of the United States by 1951, American farmers dumped the pesticide on their fields. DDT breaks down into compounds that nestle into fat cells, taking years to metabolize. So when insects began developing immunity, those immune insects would then be eaten by predators, and DDT quickly crawled up the food chain, making its debut in the US milk supply in 1952. “All the things that we find sinister with DDT today—the fact that it killed everything it touched, and kept on killing everything it touched,” Malcolm Gladwell writes in an essay in The New Yorker, “were precisely what made it so inspiring at the time.” Public outcry about the pesticide ended its manufacture in all but two countries, China and India. Roughly a dozen countries still utilize the compound today, as well as people who still champion DDT and claim it should be mentioned in the same breath as life-saving, world-changing penicillin.
It’s hard to overstate the effect malaria has had on human civilization. In her book The Fever, Sonia Shah points out that in the eighteenth century the British decided that due to the high rate of malaria outbreaks, sending their prisoners to Gambia was basically a death sentence, so instead they sent them to South Wales, Australia. She also notes that one out of fourteen human beings living today have genetic mutations that can be linked to the disease. Our history, genetically and culturally, is tied up with malaria.
There are two major kinds of malaria: Plasmodium vivax and Plasmodium falciparum, with the latter being more deadly. The disease incubates in the guts of the Anopheles mosquito, and once it matures, it makes its way to the proboscis. The thing about this parasite is that through centuries of evolution it has developed systems that affect the behavior of its host in order to prolong its own life.
As malaria matures, the chemistry of the mosquito is altered, making it less aggressive, thereby protecting the host. When the parasite has matured and migrated to the proboscis, the mosquito’s ability to create apyrase is decreased, which is the anticlotting agent that enables a mosquito to feed. Because of this reduction of apyrase, the host mosquito has to bite more often in order to be fully fed, providing the parasite with many more potential carriers. Over millions of years of evolution, a series of complex chemical occurrences has developed, facilitating this perfect relationship between host and parasite. The host becomes the servant to the thing living inside of it. Its behavior is changed to make it a more effective vehicle for the parasite.
When an infected mosquito bites you, thirty or forty parasites slide into your bloodstream, set up shop in your liver, and get busy multiplying. After a week to fourteen days (although there are reported cases where the infected person can go months before showing any symptoms), the disease hits a critical mass and releases into the bloodstream again, going after the hemoglobin, attaching to their studded proteins, and eating them from the inside. The fever occurs when the parasites excrete their waste after feasting on your hemoglobin.
The first symptom you’ll generally feel is a full-body chill. Your body will begin to shiver violently as the autonomic system tries to warm itself. Then the fever begins. This transition from chills to fever is the malarial trademark. The fever can rise to 106 degrees, boiling you from inside. Untreated, you will likely become anemic, slip into a coma, or die. The disease exhausts you, forcing you to remain prone and therefore easier bait for other mosquitoes. It’s a downward spiral from here, as the disease has your body release a pheromone that makes you a more appealing target for mosquitoes. During this time mosquitoes can attack you and spread the disease to as many as one hundred other people.
Malaria separates the native from the visitor. The native tends to harbor an immunity to the disease as a result of hundreds of thousands of years of evolution. (My favorite evolutionary adaptation is the production of blood cells that don’t have studded proteins. The smooth blood cells don’t give the parasite anyplace to hold onto, and malaria slides off these cells like they were made of glass to then be dealt with by the immune system. When this genetic trait is doubled in a person, it produces sickle-cell disease.) When we travel to places we don’t belong, even our blood is conspicuous.
My sister Betsy was at a Jungle Brothers show at a club in Maine in the spring of 1993. She was on a date with this guy named Eric, whom she had been seeing for almost the entire spring. She fain
ted in the middle of the show. Though my sister is six foot one, Eric picked her up and rushed her home. The next day Betsy went to a health clinic, where she told them she thought she had malaria. She had been in Kenya, but that was eighteen months earlier. Travelers are tentatively cleared for malaria-related illness three months after their return and by twelve months are fully cleared from the disease. The clinic disregarded her hypothesis, sent her home, and told her to return if she had a fever. The next day, Eric brought her back with a raging fever. A blood smear discovered the scribbles of malaria in her cells. The disease had incubated in my sister for a year and a half before emerging to ruin her date. For eighteen months she had walked around with one of the most deadly diseases lodged in her liver. Her heart bent toward Eric while her liver was full of parasites. Betsy got better, and Eric was at her bedside the entire time.
Betsy has a hard time showing weakness. She had played basketball in high school and then in college was a walk-on center. She ended up in the starting lineup. She believes that strength is a virtue, and because of this trait she can be a person easy to admire but difficult to feel close to. But when this disease came, she was gathered in Eric’s arms and nursed back to health with him nearby.
When malaria is inside the mosquito, it manipulates its behavior. I wonder what effects the parasite had on Betsy’s behavior. She played half a season of Division III ball while infected, and after a lifetime of indifferent dating, she fell in love while infected.
She dated Eric for ten years and then married him a month before I left for India. I can’t remember the ceremony because I was taking a drug to prevent malaria.
After being home for three days, I talked to Anne on the phone. According to my parents and e-mails in my in-box, she was my girlfriend. Her voice was faintly familiar, like the smell of the car heater the first time you turn it on in the fall. It was a sweet voice, with the vowels flattened by an upper Wisconsin childhood. I could not remember anything about our relationship, but the picture I pulled out of my desk back in my apartment in Hyderabad, the one with the girl with the wide-set eyes and sweet smile, turned out to be of her.
I had already learned how to fake recognition. It was a survival tactic in my tiny hometown, when walking across the street to the grocery store would involve running into eight people who knew me. The skills I used to get by on a daily basis are the ones used by any con man. I let the other person lead the conversation, and I agreed with whatever was said, adding bland rejoinders, if necessary. It was like having a conversation when your face is full of new stitches and you have to be careful not to split any of them with your emotions. I was a newly stitched-together doll of myself, and thanks to the Oleanz and Ativan, full of cotton batting.
The conversation with Anne felt like a spectator sport. I couldn’t believe she wasn’t aware of how far away I was. She was having a conversation with this effigy of me. She oozed care and goodwill, and I was suspicious of it. Was this all some prank that she was pulling? She said that she wanted to come visit. I listened as she said that Halloween weekend would work the best and that she’d found a good deal from El Paso—and she was supposed to fly into Columbus, right?
It was like watching a filmstrip in science class. What was on the screen was important and I’d be responsible for the information later, but at that moment it was all blurry, distant, and two-dimensional to me. I had a day left on the Oleanz, so I chalked up my grogginess and distance to the drug. I watched myself speak into the phone. I heard myself tell Anne that I’d be better soon, that I was looking forward to her visit, that if she sent me her details I’d pick her up at the airport. She told me that she’d been so worried about me. She told me that she loved me. I had a photograph of her, some e-mails between us, and this phone call. Whatever she had been to the old me, I couldn’t really make out. In all of the pictures from my sister’s wedding that August, Anne was in none of them. If I was in love with this girl, why hadn’t she been there? But here I was now, in trouble, and she sounded so worried about me, genuinely worried about my well-being.
I told her that I loved her, too.
Inside of me something felt like it was shifting, the way the wineglass must feel the moment right before the magician yanks the tablecloth from underneath it.
The first response I received from my mass e-mail was from a former professor. He told me he was sorry to hear about my incredible predicament and that, in unrelated news, he had been going downstairs to do laundry and tripped on the stairs, hit his head, and now had superpowers. He said that he’d been flying around his living room all afternoon and that he wished me the best. It was clear he had thought I was kidding.
Whoever I was before the incident, I had been a smart-ass. It looked like I was exactly the kind of guy who’d make up something like this as a prank. Just getting people to believe that this had actually had happened was going to be difficult. Whoever I had been was now preventing me from explaining to my friends what had happened to me. He was a guy who prided himself on never giving a straight answer.
It was like I was running down a long hallway, at the end of which was a figure, this person who I had been, who I was supposed to become again, but the hallway was dark, and I kept stumbling over things that the old me had placed in my way. I could hear him laughing as I tripped and fell down in the darkness.
Jon and Melissa, my best friends according to my parents, called me. There were loads of pictures of the three of us in a photo album I’d found in the attic. I had been the best man at their wedding. Jon and I had been roommates in college, and later I had lived with the two of them in a couple of places throughout North Carolina, one of which was condemned as soon as we moved out. I was remembering blips of things. Jon was tall, whip thin with a concave chest, while Melissa had wavy light brown hair and a nose ring. I remembered dancing with her at a wedding. She’d taken off her heels so she wouldn’t be taller than me, and she held them in her hands, which were around my neck. I couldn’t remember addresses we’d lived at or what either of them did for a living, but I remembered the way her heels bounced and clicked against my shoulders as we danced.
They were calling together, each on a separate extension in their condo in Raleigh. I was sitting in my dad’s bloodred office with the giant round red rug, the same room where I was said to have thrown a book and scared Mom. Dad’s desk took up most of the room. He had a great cushy leather chair, and I leaned way way back and propped my feet up on his desk.
“Just the sort of thing to happen to me, right?”
They laughed. “As soon as we heard, the first thing we thought of was Bob Trace,” Melissa said. “I told Jon that one of us is next.”
“What happened to Bob?” I asked.
“You don’t remember that? Bob Trace was in Berlin and took a bunch of acid and ended up running around the city naked until the police caught him and put him in a German mental hospital.” Jon cleared his throat loudly as he spoke.
“Der Krankenhaus,” Melissa said in a German accent.
“But I didn’t take any acid in India.” I wanted to word it like a statement, but it came out like a question.
“No. But we all did some crazy crazy stuff back in college. I wonder if this is all like a long-term flashback or something.”
“I wouldn’t have taken acid in India, right? I don’t do that stuff anymore.”
“No. No. You haven’t done anything like that for years,” Melissa quickly said. “You should call Bob Trace, though. It’s crazy that this happened to both of you.”
She gave me Bob’s number, which I penciled on the back of an envelope.
The phone call ended with Melissa telling me that I sounded okay, that there was probably no need for them to come and check up on me. I desperately wanted them to visit, but to say as much would have been to refute her claim that I was okay, and I needed to be okay. I had to be okay.
I agreed with her. Yes, I was fine. They wouldn’t have any fun on their visit anyway. All I did all da
y was sleep.
I hung up the phone and tore the envelope to shreds.
Combining Oleanz, Ativan, and jet lag is a good way to average roughly seven conscious hours a day. I slept like a teenager. I woke up to a stack of phone messages from concerned friends. The hours I was awake I spent rereading all of my e-mails up to October 16, the day I walked out of my apartment with the door wide open. I also scoured my computer for pictures of the last couple of years. I was chasing myself, tracking my whereabouts, hoping that I could reconstruct enough of a working resemblance to that old self to slip back into. It was like building a plane while flying it.
There were more pictures of Anne, as well as more pictures of the woman with the amazing nose. She was more exotic than Anne. There was nothing of the Midwest in her features. My mom said I had dated her for two years and that things had ended very badly. I vaguely remembered arguing with her in a restaurant. Memories were coming back, but they were still shadowy, and I had to work incredibly hard to recall what should have been the simplest thing: her name was Ariel.
I got an e-mail from a cousin. She said she was so sorry about what had happened to me and that she’d had such a great time talking with me at Betsy’s wedding; she was happy that we’d reconnected and really wanted to read some of my work.
I wrote her back. I punched letters on the keyboard and told this woman how lost I felt, how messed up I was, how I was wiped clean and struggling to remember anything, much less the people I talked to at weddings. I told her about prodromal, Lariam, and pleomorphic, this stupid vocabulary that I was thrust into. I told her that the doctor couldn’t tell me for sure if it all was going to happen again at any moment. This was rat-crap bottom, and I was grasping at anything to keep from slipping into total paranoia. I was still kind of convinced that God hated me and was disappointed in how stupid I was. The e-mail kept scrolling farther and farther down the page in a single unbroken paragraph of rage and fear and loneliness addressed to a woman I couldn’t have picked out of a police lineup of three.
The Answer to the Riddle Is Me Page 8