God Bless the Mosquito
In memory of Rwot David Oola
I’m lying in my tent near Joal, Senegal, serenaded by a chorus of high-pitched buzzing. Moving my arm near the mesh of the tent, a swarm of mosquitoes follows closely, the cloud of insects shifting in unison with my arm.
I’ve written previously that my two big worries concerning my health and safety on this trip were traffic and malaria. Traffic is a threat to cyclists everywhere in the world, it isn’t an issue specific to the African continent. My experience with traffic up until now has been positive. Outside of major cities traffic density is very low, and motorists give me a lot of space. Even in highly congested cities such as Dakar or Freetown I can tell people take extra care to make sure I am safe. The only two times I felt a little worried was in the Gambia when a truck swerved back in front of me too quickly, hitting me and pushing me off the pavement into the sand, and once on a road in Ivory Coast when a truck carrying tree trunks went way too close to the shoulder where I was at the edge. In the first case, I didn’t even fall off the bike. I just yelled at the driver (from a distance) and had a very mild scratch. On the second occasion, the truck driver stopped 50 meters further, got out, and apologized profusely (no hard feelings towards him). The one time I made the decision to take a shared taxi instead of riding into a city was in Conakry, and this is one of the best decisions I’ve made during the trip. As much as Guinea is wonderful, the traffic in and around Conakry is awful. It is basically pure chaos. Overall I’ve been able to avoid the worst, and it actually hasn’t been as bad as I expected.
Malaria on the other hand is something that one can take precaution for in other ways, but ultimately you never know when it may strike. Up until now I haven’t been affected by the parasite (actually the only time I’ve been sick at all on this trip was after eating a dodgy chorizo in Spain) but I’m prepared in case I do. I carry some Coartem tablets with me, and if ever I feel a fever my first plan is to visit a pharmacy or clinic, found everywhere. I don’t take prophylaxis for a few reasons. Prophylaxis means taking a pill daily or weekly, stunting the life cycle of the parasite and when no longer in an exposed area eventually killing it off. The issue with this approach for me is that I’m almost constantly exposed. One of the most used tablets is “Malarone”, and it is the most efficient with the fewest side effects. It is dangerous to take for extended periods of time, as it is a strong drug. It is also very expensive. Doxycycline is another tablet that one can take daily and is much cheaper. It isn’t as strong as malarone, but that is actually a positive for long stays on the continent. It does have pretty strong side effects, most notably heightened sensitivity to the sun. A fellow traveler started taking doxycycline in Western Sahara and has since remained for four months in Mauritania. It turns out that doxycycline intake and the Saharan desert sun don’t mix too well. The final option is Larium, which is in principle the best type of prophylaxis to take for extended stays as one only needs to take it weekly. This has by far the worst side effects. It is actually banned in the US, which says a lot as you can basically get heroin over the counter there. I used Larium for two months in 2013 and it messed with my brain. I felt like a zombie, never fully awake or present, with depressive thoughts. I wouldn’t recommend Larium to my worst enemy.
My solution has been (as for most people who stay on the continent for extended periods) to limit my exposure to mosquitoes at night as much as I can, and be prepared to seek help from professionals as soon as possible. During my stay in Uganda last year (2021) I caught malaria and it was the most powerful fever I’ve experienced in my life. I spent 4-5 days in bed delirious. Thanks to my host and boss Rwot David Oola and the medical staff at the local hospital, I recovered fine.
On this trip I haven’t met too many travelers, but within this small group of people many have had malaria in the past two months. Seeing them share their terrible experiences, I feel like its only a matter of time until I catch it again.
Malaria has been present on the continent for as long as anyone knows. In northern Guinea there was a tragic incident when I stopped on a hillside village. I was speaking with some people when calls and lamentations started coming from nearby. A distraught man hurried a limp body into a neighboring home. My hosts excused themselves, explaining that a child had died from malaria and they needed to go and show solidarity to the grieving family, sharing in their pain. Reality slapped me pretty hard. People live here with malaria everyday, and only privileged tourists and travelers such as me can afford to have the detachment and options that I presented in the previous paragraphs. Nobody here is debating whether to take Doxycycline or Larium…
Furthermore, it would not entirely truthful to say that malaria (and yellow fever, another mosquito-borne disease) has always been a problem on the continent. Up until colonization they were not problems, but simply part of life. This is actually an important distinction to make. These diseases became problematized when colonizers had trouble setting up outposts. Grand Bassam in Ivory Coast, for example, was one of the first French settlements, but was abandoned when diseases killed ¾ of colonizers. Expeditions inland on the continent had extremely high death tolls for Europeans. Malaria and yellow fever were preventing colonial expansion and exploitation, and were therefore a problem that needed to be solved by the colonizers. Colonization is “the state-sponsored construction of non-merit inequality for the benefit of one group at the expense of another.” (Bump & Aniebo 2022).
Bump & Aniebo (2022) state that “The study of malaria and its control were so closely tied to colonization that these two legacies cannot be separated … the reason to study malaria was that it was the largest obstacle to colonization.” The first time I thought of malaria in such a way was when recovering. In 2021 I was explaining my plans of this cycling trip to Rwot David Oola, who was a local king (Rwot) and the head of the Agoro International Vocational Institute where I did a three-month internship. I told him that my main concern was malaria, to which he chuckled, and said “God bless the mosquito!”. Where locals could stand malaria and lived through it, the whites could not. The mosquito, perceived as the plague of the continent was actually the ally of the people, helping protect them from another, more deadly disease. This discussion with David reshaped how I thought about malaria entirely.
The authors cited above continue their article by showing how the colonial project was intricately linked with “tropical medicine” research based in metropolitan areas of colonial countries since the late 19th century. Even if the colonial project has changed, global health remains strongly anchored to the colonial past. Malaria research is still primarily based in countries which are not home to malaria. The inequality is enormous, as 99% of all funds for malaria research are used outside of malaria affected areas.. The fact that the different drugs mentioned before are the main tools against malaria shows this as well, as they are made for people visiting the continent but not living on it. These drugs are in continuity with a colonial reasoning. Furthermore, Bump & Aniebo (2022) highlight that global health still operates within a paternalistic vision between “the Western world” and the “Third world” through humanitarianism, saviourism, and charity. The “problematization” of malaria as mentioned before (alongside other health-related subjects) justified the colonial presence as much as it permitted it to strengthen. “...metropolitan groups enhanced their own status by organizing around perceived health deficiencies of Indigenous people. These efforts fit colonial narratives of metropolitan superiority and charity as they sought to enhance the Indigenous labor force available for exploitation.” (Bump & Aniedo 2022).
Bump & Aniedo (2022) go on to show that malaria has historically been very widespread (notably present in the US for example), and was eradicated through environmental measures. In the case of the colonization of Africa however, research served only to protect colonial interests with no regard to the health of local people. Today, malaria research still neglects the lived experience of those who deal with it daily. Western institutions have aimed “...to focus attention on the disease, distracting from the environmental management and general development strategies that donors have used for themselves.” (Bump & Aniedo 2022).
Decolonizing malaria (and global health generally) is a mammoth task. It means a reshaping of knowledge acquisition and use, which are non-exploitative and do not serve one group of people over another. It means a reframing of dominant patterns and pushing towards new ways of thinking about health and not solely relying on current medical frameworks which, as much as they present themselves as apolitical, are steeped in exploitative colonial processes of power. For me, this means that on this trip that I am privileged to seek treatment which serves me more than it serves those around me, due to a colonial past and present.
Bump, J. B., & Aniebo, I. (2022). Colonialism, malaria, and the decolonization of global health. PLOS Global Public Health, 2(9), e0000936.
