We went and visited Kwale, a relatively small community of Duruma and Digo in Eastern Kenya. I’ve been to so many of these African towns that I’m honestly somewhat bored. Five years ago, I might have been more excited. Perhaps I’m just tired.
People speak Swahili here. For real. In the rest of Kenya, Swahili is a language to connect disparate tribes, Kenyans happily mangle and make a mess of Swahili, but it does its job well enough. Here, I’m struck that even the kids speak Swahili, something you never see in other parts of Kenya.
I keep running into people who don’t speak anything but Swahili forcing me to communicate as best I can with my limited vocabulary. Fortunately, it’s all easy to understand out here.
But, to be honest, it’s quite boring out here. Life is fairly content, it lacks all of the huge and obvious problems of economics and health that persist in the rest of Kenya, and the ubiquity of Islam makes is a safe and tranquil place, if one is willing to ignore the oppressive patriarchy.
We spend the day at the hospital, meeting person after person. I’m growing agitated. Lunch is being pushed back later and later. I’m so bad at this, but its necessary and everyone is well meaning and kind.
Why are we doing this? All of Kenya’s problems are a failure of government. It’s not fashionable to say, but you can’t help but be annoyed when people spin the tired old narratives of colonialism and corruption. You guys voted these assholes in.
We finally get to lunch. I order pilau (mixed rice and beef) and some fried goat, knowing that it will be quick and we can be back on the road. Since he’s not paying, our Kenyan host orders to most expensive thing on the menu, the thing they never have prepared, the thing you have to wait an hour for. It’s hard not to be annoyed, but you just let it slide.
People are telling me what a great President Moi was, claiming that everything was ok during his reign. It was at the beginning, thanks to his predecessors, but his awful policies pushed Kenya to a horribly repressive one party state and spurred a complete collapse of the Kenyan economy, leaving the mess for his successors to clean up. In politics, timing is everything.
Now the entire health system has been devolved to the provincial governments. I’m thinking this is going to become a disaster of epic proportions. While the devolution of powers to local governments makes some sense in diverse and fractured Kenya, health problems usually don’t recognize political boundaries. A failure of health policy in HIV and malaria infested Nyanza could have devastating effects for Nairobi.
We’ve stopped in a tiny market center in the middle of nowhere. I say “shikamoo” to an old man, a respectful greeting reserved for elderly people. He asks me for 20 schillings. I’m having fun saying “shikamoo” to people younger than I am. It confuses the hell out of them.
The area is partially semi-arid and partially forested. Elephants come out of the national park and wander through the streets, I’m told. Baboons rifle through the trash. The areas close to the forest are doing better than the other areas, but there’s no real economy out here and the wildlife and igneous terrain prevent people from doing any substantial agriculture out here. The houses are in great shape, some even have power, but there’s malnutrition everywhere. The markets are mostly devoid of decent food outside of bags of rice trucked in from other areas. There are signs of American food aid and a World Food Program truck passes us.
A Japanese group is doing a survey on diet and malnutrition. It’s explained to me, but I think it’s pretty stupid. We already know that a lack of food causes malnutrition. They say they want to help. While I’m listening, though, I’m thinking that it’s a colossal waste of time and money. Perhaps it might be more helpful to come up with a better plan.
I realizing that this post is full of complaints, but here not every day is full of wonder and excitement.
We get dinner. It’s nyama choma (BBQ) again. I’m not disappointed but the conversation turns to Japanese academics. I can’t help but remark that I find a lot of it horribly uninteresting. I’m not sure why many of these groups do projects here, and even less sure what the tangible results will be, outside of raising the domestic status of ineffective Japanese researchers. Public health research really has to do one of two things. Either it should push science forward, or provide meaningful public health services to developing countries. The projects that are being described to me fail on both points. My anxiety level is high.
It’s time for me to stop complaining, though complaining is healthy and sometimes leads to substantive change. I’m getting ready to go to get some Ethiopian food at one of my favorite spots in Nairobi, Queen Sheba, which is run by Ethiopian refugees who fled the war there some years ago. Fortunately, it’s not expensive, unlike other places in Nairobi. See, the complaints never stop.
I’m having a hard time keeping up with the days. We’ve moved on the Kwale, located on the coast of Kenya, not far from Mombasa. I’m warned that this area isn’t safe for white people, but there seem to be an abundance of German and Italian tourists. I’m wondering if they missed that particular State Department warning.
There is no doubt that this area is filled with Al Shabab leaning fundamentalists, or so I’m told. There was a terrorist training center near here back in the 90′s. This is no joke. Mombasa is famous for terrorist attacks and kidnappings, but they don’t seem to discourage the droves of Western tourist which play an important role in the local economy.
We are hungry. The field manager, Juma, takes us to a place to eat along the beach. Apparently, this is where the rich from Nairobi come to relax and drink beer, but there’s no one here at all. As soon as we place our order, I realize what’s to come.
In Africa, if there are no customers, you will have to assume that the kitchen staff hasn’t cooked anything at all. You might even assume that they have to find, purchase, kill and feather a chicken for you. The wait might get so long that you begin to think that they are tracking down and slaughtering a cow for you. At the two hour mark, you start wondering if they might be raising the animal from birth, waiting until it gets big enough for you to eat.
And this is exactly what happens. We wait… and wait…. while listening to the torturous sounds of every Disney soundtrack reinterpreted by famous American R&B artists, or maybe these are the originals, I wouldn’t know.
Juma hates music. Juma is Islamic and makes sure to tell you about all of the hard and important rules of Islam whenever he can, which seem to mostly be about having sex with his wife. No dancing. No music. He claims that Christians are crazy and don’t value their wives. I agree that Christians are crazy, but keep my opinions on the craziness of Islam to myself. In listening to his constant moralizing, which rivals the constant moralizing of African Christians,
“He lives by the forest that runs along the valley.” These are apparently the lyrics to a song which was corrupting Kenya’s youth. He says he is lucky that his daughters are too young to understand it.
We can’t really figure out what he’s talking about and he can’t figure out why we don’t get it. But then I strain and finally realize what it means.
“Ahhh…” Still, I’m the only one who gets it.
This is a place where old Italian and German women come to hook up with large, athletic young Kenyan men. The signs are even in German. The roads are in great shape, until we get to the places that normal people live, the places I assume the “beach boys” live with their families.
We’re talking and It turns out that Shimada and his wife were communists who met while taking lunches to jailed student protestors in the era of the resigning of the military treaty between Japan and the US. I’m pretty impressed. I’ve never met anyone who was directly involved in the Japanese student protests of the 1960’s.
We stop by a drug and rehabilitation center to see a computer programmer whose help is badly needed. His parents have committed him because he cut his own throat after a week’s long bender. We actually stop by two of them. The first one is in town. There’s a Pakistani kid and two Kenyans there watching TV (though the Pakistani kid might be Kenyan, too).
While we wait they invite me to sit down and they start rattling off the drugs that they’ve done. I listen, somewhat fascinated by the variety of drugs available here. In the west toward Lake Victoria, it’s just alcohol and weed. Here, given Mombasa’s status as a major port city with extensive connections to the Middle East and Asia, just about anything imaginable is available. If the local addicts can’t find something better, though, they’ll just huff glue like they do in Nairobi.
These guys look really bad. They repeat AA slogans and talk of addiction, but it’s painfully rehearsed. I’m wondering what kind of shit they’ve put their parents through to have them stuck in a $700 per month rehabilitation facility, and then wonder if some of them might not be addicts at all, but rather just a nuisance to their families. It’s hard to say. I really hope these guys make it.
The second facility we go to is a bit more upscale. Someone is reading Sun Tzu’s “The Art of War.” I remember that I really don’t like addicts at all. I find the air of feigned sympathy distasteful, given the horrible wreckage they leave in their wake. Addicts can be emotional black holes, sucking the life out of everyone around them. They can’t be trusted, I remind myself. I want to get out of here as soon as possible.
I’m going to try to write this in the 15 minutes I have before I go check out the sunrise on Lake Victoria, one of my favorite activities. Last night, the magic was unfortunately blocked by an annoying Dutch guy.
A few things happened before then.
First, we’re pulling out of a Nakumatt in Kisumu and are blocked by a truck attempting to perfectly line itself up between two yellow lines. We attempt to drive around it, taking advantage of a tiny amount of space which leaves us cockeyed between the rows of cars. The truck stupidly backs into us and our driver jumps out, annoyed. An argument begins.
Eventually, it gets worse. A large woman in the passenger seat jumps out, baby in hand, screaming at the top of her lungs in a furious mixture of Luo, Swahili and English. It turns out that if Kenyans really want to insult one another, they’ll use English, after all, tribal languages are for families, Swahili is for brotherhood, and English is the cold language of business and government.
“You are a stupid and useless man!” I’m laughing at the comedy of the flailing woman and a crowd of men is quickly forming. This could get back really quick. I’m thankful that the angry lady hasn’t brought me into this.
I’m half asleep on the way back. Returning to Lake Victoria and Luoland is always exhilarating. People are so incredibly friendly out here, despite the poverty and decades of political marginalization. I’m hearing that support for Odinga is slipping and the Orange Democratic Movement, which once claimed unified support from the Luo, is set to split. This could be disastrous for one of the poorest parts of Kenya.
Still, it’s great to hear the sing song tonal sounds of the Luo language and it’s odd fascination with sleep. It’s a great contrast to matter-of-fact and mechanical Swahili.
It’s hot as hell out here. The contrast in weather from Nairobi to Nyanza is staggering.
I have to get to all of those other things that happened, but time’s up and I have to go and see the sunset…
It’s now 5:30 in the morning. Today I woke up and 2:30 rather than 2, a real feat. It’s hot, so I’m taking three showers a day.
I spent the day with the Japanese people, sitting at meetings and wondering why everything has to be so formalized, and why we have to endlessly repeat things that everyone knows. Can’t we just get to the point? Eventually, things relax and we start to talk about more interesting things.
I’m wondering where the tea lady is. In Kenya, there’s always a lady who brings tea. I’m feeling somewhat restless waiting for the tea lady, but this is Japan, not Kenya.
We discover that birth control works. The Luo in Nyanza are watching their fertility rates decline rapidly. This is a welcome change in one of the densest and poorest areas of the planet. My colleagues strangely believe that the respondents are lying because the health centers claim to be busier than ever. Fewer people are birthing at home, I say.
I run into my friend Kambe, a 67 year old graduate student and celebrity veterinarian. His father was the author of some famous Japanese children’s books. Kambe is great at self-promotion and appears regularly on Japanese TV as an ambassador of Kenya. We make plans for dinner at a cheap Ethiopian place across from his house.
I’m invited to go and see a presentation at the JICA headquarters. There’s about ten people there. I’m mostly ignorant of lab things, and hearing about it in Japanese makes me feel even more ignorant. Mostly, I find the lab sciences unnecessarily tedious. It’s a way of not having to do anything, while projecting the image of doing something.
This is all programmatic. I’m wondering what the conclusion is.
My friend Toda is presenting on a cell phone based reporting system. I’m interested, but curious about the anthropology of people who work in health facilities. From here, they are kind of faceless. They are looking for disease outbreaks. I’m wondering what defines an “outbreak” and who’s looking. I’m also realizing that Kenya’s devolved system of government is as problematic for public health and the US’ federalist system.
Kenyatta loved America. It’s why Kenya has a real economy, despite an ineffective government.
I go with a professor, another colleague and her son to eat Chinese food. We drive up and the gate to the restaurant looks more like a Chinese prison, miles of barbed wire and broken glass drape the 20 foot walls. Inside, it’s somewhat better. I hear a lady singing Chinese karaoke.
This used to be somebody’s house. The English wall paper betrays the house’s origins. Every group of customers gets their own room. I feel like I’m eating in an unfurnished Southern house.
I get up to go to the toilet, but really just want to check out the rest of the house. For some reason, the Chinese owners have decided to paint some of the walls blue. With the cheap fluorescent lights, it makes for a weird neon effect, like something out of a Wong Kar Wai movie.
There’s a beautiful young Chinese girl talking on the phone. She’s dressed fashionably, perfectly completing the Wong Kar Wai vibe. I’m wondering how people end up here, in Kenya. Where are these people from? What’s their story?
A Chinese kid with a mohawk keeps walking into our room. I’m betting he was born here.
We’re discussing JICA projects. The Japanese confirm all of my suspicions that people on the ground are vague on project goals, and often have to make it up as they go along. The rigid hierarchy prevents communication between teams, who often repeat each other’s work. JICA doesn’t engage other development groups enough. There are no Japanese NGOs because private industry refuses to fund them so JICA sits in its corner, alone.
Eventually, the conversation turns to film. Conversations with Japanese people can be frustrating. The conversation must be kept light, so I dodge the questions of favorite films and actors. Actually, I dodge nearly all the questions about nearly everything, something I’m good at.
Mostly, I’m not sure what to say.
I’m not sure why I number these from “1.” I must have a multitude of “1′s.” Perhaps I should just start a continuing, yet even more unsearchable, series.
It’s 4 in the morning, I’ve slept probably a total of 2 hours in the past 72 hours, but being awake after the stasis of international flights and the crossing of time zone is like a sleep of its own. It might be like that creepy Russian Sleep Experiment story, though, where you’ve stayed awake long enough to arrange your entrails on the floor in an artistic fashion.
What I did today. First day is always hectic, shopping to be done. This time it was a quest for hand shaking, an extension on a research permit to suck more blood from animals, a new phone and as many Remmy Ongala CD’s as existence would allow.
Remmy Ongala is a legendary Tanzanian musician. I was told that one has to go to a special part of town to get Remmy Ongala CD’s. The place where there are no pirates, but apparently, I’m not allowed to go. See, all of the other people on the street selling Jean Claude Van Damme films and Jay Z CD’s are pirates. The Americans can never catch them. Remmy Ongala, however, must have protectors everywhere, because his CDs aren’t available. At least not in the 99% of the country where the pirates live.
I get a call from my friend Tirus. He’s apparently gone to that-place-I-should-not-go and found everything (even a video) for the crushing price of $3.00. He asks me to pay double for his services. I talk him down to a total of $4.25. I ask him how the land of no pirates is.
I buy a new phone. My old one was terrible, though it was recommended by another friend, simply because he has it. It’s supposedly a “smart” phone, but it was one of the stupidest pieces of technology I’ve ever owned. Out of loyalty, I try to buy a Japanese phone, but find they don’t exist, so I opt for one of the former colonies, thinking that they must own everything anyway, kind of like how the Brits still own everything in Kenya (well, not really, but it sounded good).
The lady at the phone store knows everything about all of the phones she has. I’m impressed by the authoritative air with which she answers my questions and her insistence that I tell her what I hated about my other phone. I intentionally play a game with her, asking more and more difficult and probably unanswerable (or so I thought) questions and she doesn’t bat an eye. Best sales lady I’ve seen in a while.
You see, in America, they just want to sell you the most expensive thing they can and get you the hell out of the store so they can sell another. Here, a sale is a sale because there’s 500 more people within a 1 km radius selling the exact same thing for the same prices.
Tirus asks me about America and why it’s so hard to get a visa. I tell him that Americans are scared of Africans because they work too hard. I tell him that there are Americans who want to turn out the lights and force everyone to go back to the farms to keep them from selling cell phones and driving taxis and writing books and networking and succeeding in America or anywhere else because they are so good at all of them.
Though I’m half joking, I’m half serious, but half complaining and Tirus senses it. I buy a hat because I left mine at home.
Uganda has banned mini-skirts. Museveni is apparently paying a political price for refusing to sign the anti-gay law, so, like a good dictator, he’s turned to victimizing another group who can’t defend themselves. Hashimoto Toru would be proud. The irony, of course, is that the law merely makes Museveni even more powerful as Uganda barrels forward to becoming an frighteningly autocratic state.
The social conservatives are nodding their heads, saying that such a law was overdue. “The women are out of control. It’s time for the police to step in.” I remark that I’ve seen more evidence that the men are the one’s who are out of control. It’s amazing how deeply female sexuality is both respected and feared here. Fortunately, the voices are reason are screaming loudly, at least in Kenya.
We eat Nyama Choma (grilled meat). I eat more than I intend and have gained 10 pounds again. I blame the chips. Apparently, though, the big news is that Kenya is falling apart because someone is opening a restaurant which serves donkey meat in Naivasha. The Chinese are blamed. I remark that I’ve never seen a dead donkey on the side of the road (as opposed to dogs and cats) and ask where do those donkeys go? Everyone laughs.
I’m eating my favorite Salticrax. OK, back to bed.
Actually, looking at the large amount of material that doesn’t make it to this blog, I noticed that more than half of it deals with my personal experiences with poverty. It appears that I think on my experiences quite often, but I’m hesitant to share them. Perhaps it’s fear of being seen as wanting sympathy or just simply that I don’t want think about it. .
The intro to the article struck me:
“There’s no way to structure this coherently. They are random observations that might help explain the mental processes. But often, I think that we look at the academic problems of poverty and have no idea of the why.”
It’s quite easy for me to have an academic discussion of the causes and implications of poverty. In fact, it’s my job to. It’s much harder to talk about my own experience with poverty, as it’s a collection of disjointed, chaotic and often incomprehensible experiences that don’t fit well into a tight flowing narrative. I’m sensing that Linda feels the same way and wonder if my reticence might stem from the difficulty of making sense of the chaos.
Linda’s credibility has been called into question. The article that she wrote for her blog is being seen and a clever ploy to extract money from sympathetic readers to fund her dubious book project. To make matters worse, she is multi-lingual, attended private schools as a child and has run a political blog since 2011.
Now, I can’t really comment on what Linda’s goals were in writing the original post or whether her claims are true. I don’t know Linda and won’t embark on a mission to either support or discredit her. The last sentence in the above paragraph struck me though since it also describes the author of this blog (me).
I grew up in awful, awful poverty. The kind that doesn’t ring in pictures of well meaning, hard working folks trying to get by under challenging circumstances. No, my poverty is due to a long family history of abuse, irresponsibility, alcoholism, mental illness and violence. My story is so incredibly extreme that it doesn’t usually elicit sympathy, but rather disgust.
What Linda and I share is that we don’t fit the picture of poverty. We’re white, educated and have it together enough in adulthood to string a few sentences along and have people read them.
My “poverty cred” is often called into question. I think this is natural. In America, we have decidedly fixed ideas of what poverty is and isn’t. It’s hard for many Americans to imagine poverty, and wide collection of experiences make it almost impossible to adequately relate a concise narrative.
Honestly, I never know where to begin with my story of poverty, but my top class education and advanced degrees don’t erase it. My younger brother came from the same situation I did (though from a different father) but instead of collecting degrees, he’s in and out of jail (and the hospital when his girlfriend stabs him). I was extremely lucky.
What Linda and I do share is our teeth. My teeth are bad. I have too many of them for my small mouth and my family were too dysfunctional and mired in insanity to do anything about it. In America, bad teeth are like a glowing neon sign that says “I WAS POOR.” If you have bad teeth and are young, people know what’s up when you smile. (What a relief egalitarian Japan was, where even pop stars have bad teeth!) When you run into someone else with bad teeth it’s a moment of bonding, like war tattoos.
I used to be ashamed of them. Now I wear them like a badge of honor, like a middle finger to the world, irrefutable proof that these awful things happened.
I had planned some grand statistical analysis of this blog (such as that of post 100), but quickly found that 1) the text file version was too big to use and 2) stripping all of the complicated code from it is beyond my computer skillset.
So, I’ll celebrate simply by saying thanks to the four or five people who read this blog for, well, reading. Not much of what I say makes much sense, my politics are often vague and the themes are often haphazard and chaotic, but this remains an important tool for me. It’s not easy working through one’s thoughts and this give me a space to be incoherent, if not batshit nonsensical.
So thanks to all. It means a lot.
As, I’ve nothing else to say, here’s a run down of the top five posts:
1. African Conflict and the Murdock Map of Ethnic Boundaries At more than 15,000 views, this wins the top spot. It’s got pretty pictures and some suspect methodologies.
2. US Bombings in Laos 1965-1973 I thought this was a cool post. I went on a bender for spatial data on conflict for a while. It’s too bad I didn’t pursue it further. This one even came with a movie!
3. Andrew WK: How He Almost Became the US Cultural Ambassador to the Middle East No surprise here. It’s pretty easy to rack up hits on articles about rock stars. Global health… not so much.
4. Japan Earthquake/Tsunami Reporting April 7, 2011 I was downloading police reports of the number of dead and missing during the Tohoku earthquake/tsunami for a while. Then I went to Japan, didn’t have internet and couldn’t keep up with it. It was a valiant effort.
5. Lynching Data Are we starting to see a pattern here? I’m hoping that I haven’t put any misinformation out there with these odd data exercises. Unfortunately, my time is limited these days but it would be fun to get back into it. I was pretty wide-eyed and dreamy about data back then.
A couple of weeks ago, I was mulling over writing a book. Now that I’m fully disoriented from the ASTMH meetings and the submission of a giant NSF grant, I can’t really put my head together well enough to get it going.
So maybe I’ll briefly write about other peoples’ books instead.
As always, I’m reading several books at once. I’m usually horribly bad at finishing anything at all, and books are no exception. Right now, I’ve got the following on my desk:
1. Spillover: Animal Infections and the Next Human Pandemic (David Quammen, 2012) - Many human diseases actually have their origins in animals. HIV moved from primates to humans. All human influenzas are diseases of animals. Awful infections like ebola and nipah virus are, in fact, bat diseases. However, the story isn’t as simple as humans simply becoming infected through contact with animals. Complex dynamics of inter-species transmission can create a situation where a pathogen turns from benign to deadly. The future of infectious threats requires that we understand these dynamics and prepare for them, particularly as mankind urbanizes and human movement intensifies. A great and easy to read work that doesn’t sacrifice details. Highly recommended.
2. Why Africa is Poor and What Africans Can Do About It (Greg Mills, 2010) - A truly sensible assessment of the roots of Africa’s economic and development problems. Instead of looking backward to colonialism and ambiguous global threats, Mills picks apart what’s wrong with modern African states and pulls no punches. The solutions presented, however, mostly rely on sacking most of the present leaders of African states, a tall order for some places. Even more odd, however, is the glaring absence of the structural adjustment era which attempted to free African states from crushing bureaucracy by dismantling typical state provisions like health care and schools. A great read, though.
3. The Great Escape: Health, Wealth and the Origins of Inequality (Angus Deaton, 2013) Though the 20th century saw incredible advances in living conditions, sanitation and medical technologies which have extended and improved the quality of human life, the benefits have not been uniform. Deaton offers that inequality is not a given, but rather a consequence of progress. It is the case that health disparities between social groups are highly correlated with economic inequality. Health disparities, a consequence of systems which encourage political and social inequality, in turn exacerbate the gaps between the haves and the have-nots. Another great and easy read.
4. Exodus: How Migration is Changing Our World (Paul Collier, 2013) Economist Paul Collier takes on modern human migration, the extent of which the world has never seen before. He explores the political problems behind migration, the process by which people move from migrants to immigrants to citizens and the political implications of newly pluralistic states and an economically integrated world.
5. Asian Industrialization and Africa: Studies in Policy and Alternative to Structural Adjustment (Edited by Howard Stein, 1995) - It’s pretty much what the title says. There are several chapters tracking Asia’s move from a disastrous formerly colonized, agrarian area and poverty stricken area of the world to a powerhouse of industrial development and a major success story. African countries, however, have failed to develop as quickly, some even regressing economically during the 80′s and 90′s. The specific policies that allowed Asia’s success are contrasted with Africa’s failures and recommendations are offered to foster pro-active development in Africa. Asian policies, which were often protectionist and required the active hand of government but worked well at their particular stage of development, were at odds with those recommended during the structural adjustment era which recommended full privatization and haphazard relaxation of government controls.
I just returned from this year’s meeting of the American Society of Tropical Medicine and Hygiene (ASTMH). For us in the developing country health world, it’s the biggest meeting of the year.. yet surprisingly small. Once you go to a few, you quickly realize you know just about everyone there.
Unfortunately, because I was preoccupied with a crushing NSF deadline, I didn’t get to see many of the presentations. I did, however, get to see many of the great people I know and, despite the deadline pressures, managed to have a great time.
Some highlights (for the layman), though:
1. Nipah virus: This one’s a beast. With a 70% case fatality rate (7 out of 10 people who become infected die), contact with this bug will pretty much assure there’s no tomorrow. Fruit bats area known reservoir though they seem unaffected by the virus. They urinate on pigs who transmit it to humans.
Sometimes, the bats urinate in certain tree sap collection buckets. People drink it directly, fall ill and then transmit to their families and kill them, too.
Because of Nipah’s ubiquity in fruit bats, the ease of isolating and producing stocks of the pathogen and it’s potential for major public health damage, the CDC has listed the virus as a Class C bioterror agent. Wow.
2. Imported zoonotic pathogens: More than 200 transmissible pathogens have been known to be imported into the US via the illegal wildlife trade. Remember, that most living things are mini-ecologies of bacteria, virae and fungi (yes, you too). Those people with the exotic snakes they imported in their bag? They brought more than snakes.
3. Plasmodium vivax (one of the four species of malaria parasites) relapses occur, on average, 14 months later. I found it interesting that it wasn’t 12. My mental transmission model confirmed that a 14 month relapse cycle would be much more suited to sustaining the pathogen than a more predictable 4, 6 or 12 month cycle. I will have to confirm with real (not fantasy) math, though. As vivax is a cold weather malaria, it makes a huge difference. Mosquitoes aren’t nearly as active in the winter.
It turns out, though, that I’m wrong, or misread the presentation (See Update below).
4. Nets with holes might be just as effective as nets without holes. We can stop collecting all those old nets and setting them on fire, now.
5. No one can agree on what dose of Primaquine to use during mass drug administrations to eliminate malaria. It’s kind of important. People with a particular genetic deficiency react badly to the drug, i.e. their red blood cells explode and they sometimes die.
6. A vaccine for malaria is on the way. It’s like the “check’s in the mail” for several decades. You can’t fault anyone for trying. We need one badly.
7. The Burma Restaurant in Washington, DC is truly fantastic, particularly the green tea salad, which tastes nothing like one would expect.
Outside of that, it was great to see friends. I can’t wait to see them again.
A friend wrote me to correct me on the timing of a relapse of P. vivax (and I appreciate it). Actually, it turns out he wrote a paper on it:
“Here: The Plasmodium vivax that was once prevalent in temperate climatic zones typically had an interval between primary infection and first relapse of 7-10 months, whereas in tropical areas P.vivax infections relapse frequently at intervals of 3-6 weeks. Defining the epidemiology of these two phenotypes from temporal patterns of illness in endemic areas is difficult or impossible, particularly if they overlap.”
Here: Tropical P. vivax relapses at three week intervals if rapidly eliminated anti-malarials are given for treatment, whereas in temperate regions and parts of the sub-tropics P. vivax infections are characterized either by a long incubation or a long-latency period between illness and relapse – in both cases approximating 8-10 months.
And Here: Median relapse times for malaria caused by Old World parasites (tropical, 4.5 weeks [95% CI 3.6–5.4]; temperate, 8.5 weeks [95% CI 6.8–10.3]) were shorter than those for malaria caused by New World parasites (tropical, 27.5 weeks [95% CI 21.6–33.5]; temperate, 34.0 weeks [95% CI 32.0–36.0]). In addition, in both hemispheres, median relapse times for infections caused by tropical strains were shorter than those for infections caused by corresponding temperate strains, although this difference was not significant in the New World (Figure 3). The 95th percentile relapse times for the strain categories follow: Old World tropical, 9.5 weeks (95% CI 5.4–13.5); New World tropical, 40.3 weeks (95% CI 34.4–46.3); Old World temperate, 30.9 weeks (95% CI 19.9–41.9); and New World temperate, 97.7 weeks (95% CI 97.6–97.8). The HRs from the survival models (adjusted for neurologic treatment) follow: Old World tropical, 39.6 (95% CI 9.2–171.0; p<0.001); New World tropical, 0.93 (95% CI 0.36–2.41; p = 0.89); Old World temperate, 3.1 (95% CI 2.2–4.6; p<0.001)—all relative to New World temperate (reference).