Thursday, February 23, 2012

The Violation

Working many years in Africa is like eating the hottest pepper on the planet.  Throughout the horrific pain and the watery eyes there is something insidiously enjoyable and appealing about it.  And one year after you've sworn it off forever, you find yourself craving it again for no tangible reason.

I  worked in and out of Africa for about ten years in seven of the fifty-four sovereign  African nations.  Anyone who's worked in some of the more difficult regions of Africa, especially in the charity world, will tell you that work in Africa is not like being out on a rope.  Its more like what happens after you let go.  So much of your valuable time is spent putting out the fires on top of the fires until you lose sight of the initial blaze.  Still, it is an exercise in persistence and persistence will get you forward more times than it will get you dead.  If nothing else, character will be built and there will be permanent bragging rights.

I'm betting this Charity Worker stays at
The Hilton
There's a little trick I've learned on determining the level of executive position in any moderately sized charity or NGO (Non-Governmental Organization).  I'll pass this along  for free to those hoping to enter the rewarding field of charity work and public service.  The rest of you won't give a shit. It's a short equation I've developed that has fairly close to ninety-five percent predictive value.  When you meet someone who has worked in Africa ask them two questions:  What was the name of your hotel and how long did you stay there?  Anyone who can remember the name of the hotel and limited their stay to under three days is well up there on the ladder.  CEO, CFO, CMO,Sean Penn and Angelina (God bless them both).  Hit them up for a job. They hate being in the field, but they'd love for you to be.  Anyone who can't remember the name of the hotel, but stayed there for one week or less is in a mid-level management position.  He or she will not be able to guarantee you a job. He or she will, however, know whether there are a few more pennies in the budget to hire you for well less than you figure you are worth (in the name of charity, of course).   Anyone who laughs when you say 'hotel' and answers the length of stay question by counting the number of raining seasons is the guy or girl on the ground.  I, and many of my friends, are these people.  We will gladly refer you on for job as long as its not ours you will be taking.

I'm here to work.  Please direct me to
your shittiest Guesthouse.
We in "the field" live a life of filthy dark guest houses that smell like mold and old socks.  We sleep beneath ratty old mosquito nets spending long  sweaty nights under a single ceiling fan  that rotates painfully, ineffectively slowly.  We  wear it like a badge of courage.  Before leaving America I never anticipated living or thriving in such spartan conditions.  I was happy living the privileged life of a single doctor running amok in Los Angeles, California.  Roughing it was a night or two in a crappy Motel 6 outside of Fresno on the way to Northern California.   I pissed and moaned. Times changed.  I changed.

In 2005 I took a job in Central Tanzania with the daunting task of developing, from the ground up, a treatment center for HIV and AIDS .  I lived in a town called Illula.  Illula  is a sprawling dusty, drought-ridden village seven hours from the crystal azure waters of Tanzania's coastline in Dar es Salaam.  Illula is barely on the map.  You can't even Google it.  Up until then I'd taken a number of charity jobs in a lot of desperate African villages, but I'd only ever stayed a few weeks at a time. A little discomfort is easy to handle when  the end of it in sight. This job in Tanzania was to be my Swan Song. After it was over I could get the "survival chip" off my shoulder and finally get a real taste of "Dr. Livingston, I presume."  I planned to settle down and start a normal family life and get back to a  normal doctoring job in a semi-normal place (I was considering a move back to Los Angeles).  Today,  seven years later, as I write this from the middle of an Indonesian jungle and watch a large monitor lizard cross the hospital lawn, I can only shake my head and smile.

Main Street, Illula.  Rush hour.
The hospital in which I worked was a government facility. It was a series of crumbling buildings on a half-acre piece of land set off from the main road of the village. In the center of the land was an open yard of dirt and dust.  There were a few trees, a lot of chickens and an occasional wandering goat. The chickens crowed loudly each day at four AM, so I awoke each day at four AM too. An American Lutheran church had kindly adopted and supported our Illula hospital. Every year the Lutherans sent pieces of shiny new stainless steel equipment that shined brightly among the dust and old green paint of the hospital ward.  After a years of use, dust and harsh conditions, the lack of maintenance turned  the machines dull and rusty. They would fade into the background with the other equipment too old or too broken be patched or fixed.  

My house was a small brick building with a cement floor, an outdoor kitchen and a bedroom. My bathroom that had a toilet and a tub, but no running water).  There was a rusty blue refrigerator just inside the door to the kitchen. It had broken years ago and was being used as a cabinet.  My driver/assistant/food slaughterer, Abdallah,  turned a closet just off the living area into his bedroom.  We had electricity for most of the day and screens on none of the windows.  Each afternoon at sunset I would close the doors and windows and do a sweep of the room with an electrified tennis-raquet-type bug killing device I'd bought from a Bangkok street vendor for nearly three dollars.  The Malaria infected mosquitoes prefer to come out at sundown.  Everyone in Africa knows this.  It seems to be the  best time for seeking fresh blood.  These mosquitoes reminded me of the aging broken down expatriates trolling the girly bars in Bangkok during Happy Hour.  The  tennis raquet made a sharp electric SNAP and frying sound every time every time it made contact.  There would be two  to three hundred zaps every afternoon.  The nurses and administration workers from the hospital would come in to watch this event every now and again.  I was the only white man around for miles.  Watching me electrocute hundreds of mosquitoes was  the most interesting occurrence in the village at six PM every day.  After I was done with pest-clearing duties, Abdallah would routinely open the back door to the kitchen while slaughtering the meal for the evening (usually an anorexic chicken or a goat).  This invariably let just as many mosquitoes back in the house.  This was our routine.

This woman has not tucked in her mosquito net.  Poor technique.
My bed was probably constructed about the same time the roof was put on the house since the wood was exactly the same. An old mosquito net without too many tears hung from the ceiling just long enough to tuck under the mattress. The mattress was a fairly fresh slab of foam rubber set in a frame two feet off the ground.  You don't want to be on  the floor in Tanzania because of spiders.  If the spiders wanted me they would have to put some work in to get a fresh piece of me.  Getting in and out of bed was a laborious set of steps similar to getting in and out of an airlock in a movie about a deadly viral biohazard.  First, the mosquito net had to be unfurled.  Any creatures clinging sneakily to the inside of the net had to be sacrificed.  Next, removal of the sandals and the brushing off of the filthy feet.  Once the legs were safely inside came the meticulous tucking in of the mosquito net to prevent  sneaky insect attacks from below.  The foam mattress was too small for the bedframe so I would jam  three tee-shirts in the extra space to complete the seal.  Finally, a restful and protected night's sleep in the quiet African night.  On the nights where I'd drunk a few beers I would painfully hold my bladder for hours rather than repeat this process over and over again.

If you work in Africa there will be biologic hazards to  deal  with. It's not for everyone, but if you embrace it in a Bear-Grylls-way it can be exciting too.  In Abdallah's bedroom of a closet (or closet of a bedroom) the corner of the wall had rotted through.  If you stood at the right angle you could look straight into the African sky.  We would soon find out that the things in the African sky were also looking at us.  I asked Abdallah if he wanted to try to fix the hole, but he said no.  He said that it made the nights a little cooler.  He also said he didn't worry much about the mosquitoes coming in.  He was from Uganda and had had Malaria so many times that Malaria had grown tired of him. One night, just after dinner, as we sat in the livingroom we heard a loud THUD and a mad flapping sound just outside his room.  There on the ground was a dirty heap with grey fur and beady white eyes.  A bat as large as a small child had caromed into Abdallah's closet on an unintended flight path and rolled unhappily into the house.  He was confused and he was angry.  Abdallah said:

"Daktari, it is a bat."

Got Rabies?
I slapped myself in the head, metaphorically.  Rabies, I thought, goddamn Rabies.  All the vaccines, bug sprays, Malaria prophylaxis pills and protective routines I'd considered and I'd skipped the Rabid bat prevention scheme.  It was a rookie mistake, but there was no time to think about that.  We had to do something about the massive bat in the middle of the livingroom.  In a few seconds he was going to figure out that he could fly in here and he was too big to hit with my electric mosquito racquet.  I ran to the bathroom, grabbed a towel and heaved it top of the bat.  The bat instinctively bit down on the towel and chomped away.  Abdallah grabbed the end of the towel and dragged the big rodent through the livingroom like a big ugly dog on a leash.  He heaved the towel and bat into the front yard and eventually the bat flew away.  We had our bat attack protocol.  We would have the chance to use it three more times before I left Tanzania.  Abdallah would not give up his cooler nights in the closet bedroom.

At the end of six months it was time to go home.  I had a pregnant wife waiting for me in Bangkok and the project was completed in record time.  It is amazing how fast you can work when your unborn child and real Thai food wait at the tail end of a job.  Going home was not a direct route, but I did it as quickly as possible.  It was a seven hour drive to Dar es Salaam and a flight the next morning to Addis Abbaba, Ethiopia. I'd stay in Addis overnight and visit some friends.  After that, it was a straight shot to Bangkok on the Ethiopia Air  which, judging from the characters on the plane, seemed to be the most direct smuggling route to Asia.  By the time I got to Dar, I'd started scratching.

I had two bug bites on my back that were annoying the piss out of me.  I slathered on liberal heaps of cortisone cream every few hours and figured they'd go away.  It worked for a while, but the itch kept coming back.  On the final flight home I took cold drink cans from the flight attendants and sat against them to make the itch subside. This seemed to interest my fellow smuggler passengers as they thought I was working on a soda smuggling scheme.  I didn't care.  I was going home and that was all that mattered. If all I'd left Africa with was a couple of annoying bug bites I felt pretty lucky.  I got into Bangkok at midnight and was home, in my own bed, for the first time in six months, by two AM.  

I awoke the next day with the feeling of elated, giddy familiarity that comes with a good night's sleep at your own home.  In celebration I figured I'd take me, my wife and her baby bump out for a proper Bangkok breakfast.  I took a long and proper shower.  It was one of the first showers for me in a long time that did not come from a cracked plastic cup dipped into a bucket of cold water.  Sometimes it's the little things that mean so much.  I walked into the bedroom and started scratching again.  I tried to get a look at the bites in the mirror, but couldn't get the right angle.  I called my wife over to take a look.  She scratched at my back a couple of times and then said something that will stay with me until I turn senile:

"Worm!  Worm! Worm!"
"What the......."
"Worm!  I said worm!  There's a worm in your back."
I felt sick.
"Well get it out, dammit!"

She looked at me with disgust, like it was not part of her job description.   She ran to the bedside table to get her tweezers (every Thai woman has at least five sets of tweezers).  She started grabbing at my skin with the tweezer, pulled something out and then presented the prize to me. She held it in front of my nose.  Her face was one big grimace of disgust.

"Worm.  Ewwwwwwww.  It's moving!"

I had to sit down.  There on the business end of the tweezer was one small perfectly formed, wriggling, half centimeter bug larvae.  I wanted to vomit.  What is the most horrible thing someone could say to you after an experience like this?

"There's one more, you know?"

She went to work on the second one and after a few seconds of scraping she pulled a second larvae from my back.  I could swear I heard a little suction popping sound when it came loose, but that was probably just in my head.  

"Fucking Hell.  Are there any more?"  I asked.
"No.  Not for now."
"Ugh.  I feel so violated."  Like a good wife, she started laughing at me.

"Son, one day all this skin will be yours."
After the room stopped spinning I started to self-diagnose.  I knew what this was.  Myiasis.  Goddamn Myiasis.  Do yourself a favor and don't Google it--there are pictures you don't want floating around in your head.  I'll fill you in:  Myiasis is an infestation of the skin by developing larvae of a  number of different species of fly. It's also goes by kinder and gentler names like Flystrike and Botfly, but no matter what you call it, it is nasty, disgusting and something you'd wish on only the most exquisite of enemies. This is how it happens:  flies get into your clothes and lay their eggs.  You put on the clothes and the eggs slowly work their way under your skin.  The eggs grow inside your skin, hatch later and ultimately a perfect little fly leaves your body to seek his place in the world.  I felt hijacked.  I was some big, unwilling human incubator.  Just like John Hurt in the Alien movie, but without the blood and screaming.  I felt violated.
"Are you absolutely sure you don't see any more?"
"I think so."
"You think so YES, or you think so NO?
"No.  No more.  Unless they are inside you."

On the positive side, the itching immediately stopped.  I was left with two small holes in my back, but they would heal properly in time.  I made a couple of calls to a learned colleague.  He reassured me that once the bugs are out, they are gone.  As it turns out Myiasis can be prevented by ironing your clothes.  The heat destroys the eggs.  Back in Illula the woman who looked after our house would wash my clothes in a bucket and lay them out on the bushes in my front yard to dry. I never gave it a second thought.  I don't imagine there was an iron around for at least fifty miles.   

Africa under more biologically sound times.
During the following year I reached an epic level of bug paranoia.  Every time my skin itched from a mosquito, an ant or even just dry skin, I'd go manic.  I'd call my wife over to do a search and extraction.  She'd come over and wiggle her index finger like a big worm in front of my face just to wind me up.  I'm glad someone was enjoying it.  With time and the addition of newer exciting biological dangers in different countries, this particular paranoia went away.

I miss working in Africa, but I'm not rushing back to work the Dark Continent.  One day I'm sure I will again though.  When the routines were in place and environmental barriers were constructed it was  a simple and enjoyable time of work and  a test of tolerance at the same time.  For those of you who plan on taking on an environment more harsh than you are used to, let this be a lesson for you.  Bring what you need, ask a lot of questions and remain slightly, constructively paranoid.  Definitely bring an iron.  I came to Africa alone, but I left in a group:  me, my worms and my bragging rights.

Take me to your leader.

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