Malaria 101

Plasmodium falciparum up close.

A map of Africa showing where malaria is prevalent.  The red indicates high likelihood of malaria parasites.

The mosquito net hanging above my bed during the day.  One of the methods of vector control. 

             Malaria is a disease that killed 650,000 people in the world in 2010.  It’s estimated that 560,000 of those deaths occurred in sub-Sahara Africa (including Rwanda).  While not as prevalent as AIDS (2 million deaths per year worldwide) or tuberculosis (1.8 million deaths per year worldwide), it is a very serious issue in sub-Sahara Africa. 

            The actual malarial disease is a parasite that infects and reproduces in red blood cells.  There are five types of malarial parasites, but the medical community is general only concerned with one of the parasites, named plasmodium falciparum.  This parasite is associated with comas, renal failure, enlarged livers, and death.  While the other four parasites can cause medical complications, they rarely will induce life-threatening illness.

Malaria is transmitted by a female mosquito sucking parasitic blood from an infected person and transferring it to a new host.  The mosquito is not the disease, but the vector that transmits the disease.  Therefore, when combating malaria we try to do “vector control,” which is limiting a mosquito’s access to humans.  Vector control is done by mosquito nets, bug repellant, removing standing water near homes and businesses, and wearing white clothing. 

There is no vaccine for malaria, but there are three very common prophylaxes used when living (or visiting) a malaria prevalent country:

Mefloquine – A drug taken once per week, this drug is cheap and highly effective against malaria.  The downsides can be mood swings, vivid and wild dreams, and is not recommended with people with psychiatric problems or heart issues. 

Doxycycline – A drug taken daily, “doxy” is cheap.  However, the drug must be taken at the same time daily and not before lying down due to possible heartburn-like symptoms and users must avoid prolonged sun exposure. 

Malarone – The Cadillac of malaria drugs, malarone can also be used to treat infected people.  This drug has basically no side effects (except possible canker sores, but these are rare).  The downside: malarone must be taken daily and costs $5 per pill.

Lake Bunyonyi

Hanging out on the deck of the geodome.

Canoeing back after a trip to the island to swing on the rope.

The open aired geodome where we stayed.

Flying through the air on a rope swing. 

A morning view of the lake from our room.

Swimming out by the dock and trying to get in some sun.


Two weeks ago I traveled with a few friends to a lake in southern Uganda called Lake Bunyonyi (bunyonyi is ikikiga [the local language] for “little birds”).  Lake Bunyonyi is now known as the premier lake destination in Uganda and in the past several years has raised their tourism profile with new and beautiful places to stay, eat, and have fun. 

            We stayed at a great place called Byoona Amagara, a resort owned by an American that is famous for the open aired geodomes.  The geodomes have solar paneled hot showers and a great view of the lake. 

            Lake Bunyonyi is a kind of alpine paradise where you can relax, canoe, hike, or even jump off a rope swing.  It was a great time, and sometimes hard to think that you are in Africa when you are in these paradises.  In addition, the people were very friendly and had great names such as “God” and “Apollo.”  Enjoy the pictures.

What's that white stuff on their heads?

When walking around the village, two things are common to see on children: white spots on their head and bloated stomachs. 

The white spots on their head come from poverty, but not directly from poverty as it relates to nutrition.  Bloated stomachs are due to malnutrition, pure and simple.  But the white spots?  What causes that?

The white spots are a fungus (basically a ringworm) that begins with a lack of bathing among the general community.  This causes a very small amount of people in the village to get the ringworm.  The main problem arises from the close contact that village people have with each other.  Rwandans generally sleep five to a double bed, so the close proximity of people sleeping to each other at night combined with sharing sheets and towels makes spreading the fungus much easier. 

You rarely if ever see this with Rwandans in the cities or of Rwandans with any means.  The white spots on the head are a direct marker that these children live in third-world poverty.   

Leaving Peace Corps, but staying in Rwanda

            Over the summer I was at a hotel with friends in Gisenyi and met an ex-pat working on the Kigali Convention Center.  We were discussing being engineers, and I must have made an impression because he called me shortly after about a job position.  After a lengthy interview and negotiation process, I decided to take a job with his British engineering/architectural firm.  As of October 4, I am no longer a Peace Corps volunteer.   

            Don’t fear!  I still live in Rwanda, and will continue to keep the blog going on a bi-weekly basis.  I thought the job would be a good in-between point.  I would still be in Rwanda, which would mean that I could still visit and help my village, while at the same time getting a different vantage point of Rwanda.  I will be able to see how ex-pats and Kigalians live while still having the view of a Peace Corps volunteer.

            The decision to leave the Peace Corps was difficult.  I have really enjoyed my time in the Peace Corps, but was growing tired of having so much free time.  During my Peace Corps tenure, I read 40 books and have watched more television in the past year than in the past ten years combined.  I still wanted to be in Rwanda, and I wanted to travel, grow, and develop.  I also wanted to be active and more centrally located.  This job seemed to be the answer to those desires. 

            With this new job, there are almost no rules to what I can do in my off time.  I still am required to conduct myself well and be non-political, but otherwise I am free.  This will give me the ability to discover a lot more about Rwanda and go see places I would have not otherwise done.  You might notice a few small changes to the blog, and those reflect changes now that I am a civil engineer and not a Peace Corps volunteer.  However, my inquisitiveness and attitude have not changed.  I still want to help Rwandans, and teach you about Rwanda and east Africa. 

            The next blog will be in two weeks.  Stay tuned… 

A Rwandan student's life

My 7th grade classroom.  There are 70 students in this class. 

The kitchen where all meals are prepared.  Those are some seriously huge pots and fires going.  Today's meal: rice and beans!

The living quarters of the students.

Indashakirwa College, the school I taught at for 2011. 

A student’s life in Rwanda can be quite demanding.  Wake up at 6 am, go fetch water, clean up, get to school, lunch, more school, then clean and get to bed.  There is only about an hour of free time for the students each day. 

Rwanda has two types of schools: boarding schools (where students live at the school) and day schools.  My school, Indashakirwa College, was a boarding school of about 300 students.  Class sizes range from 50 to 70 students, with students sharing desks to save space. 

The students do not get breakfast but eat a communal lunch provided by the school.  At 6 pm, the students eat a second communal meal.  Almost all meals are eaten in the classrooms and must be cleaned after the meal.  Their meals generally consist of rice, potatoes, and beans.  No meat, no fruit.  There is no privacy here: showers are communal, students share beds in cramped quarters, students share desks and even pens. 

The village has no electricity, so for two hours each night a generator is brought in to the school to light the classrooms to allow the students to study.  The light is poor and the students try to huddle together to get the best light each night.  While the students sit in the classroom all day and learn, they return at night to study in bad light. 

The school schedule is much different from America.  Here is a schedule of an 8^th grade class at my school: 

If you are keeping track, that is four languages, three sciences, and fourteen subjects total they learn.  Furthermore, the students’ native language is Kinyarwanda, but all subjects are taught in English.  Between the schedule, chores, and expectations, a student’s life in Rwanda is all-encompassing during the school year. 

Fetching Water

On our way down to the bottom of the valley.

The watering station where I get all of my water.  My house boy sits and waits patiently for the buckets to be filled up. 

A typical scene: farmers doing their daily cultivating down by the watering hole. 

Hiking back up to my house (the tin roof building at the top of the picture) with 55 pounds of water. 

In America, we’re so lucky with the basics of life.  We can wake up and get fresh, clean water easily from a tap, then go to the bathroom and easily flush it away.  That just isn’t the case in the rest of the world.  Here in Rwanda, we have to go fetch our water, or as they say “kuvoma” (coo-vo-ma).

For my house, fetching water is a major process, so I thought I would bring you along for the morning ritual of kuvoma. 

My house boy comes to my house around 7:30 in the morning.  After doing a few quick chores, he sets off with a 20 liter container and 5 liter container to fetch water.  These containers are sold as cooking oil buckets, but once the containers are empty, people all over Rwanda use them to store either milk or water.  They are ubiquitous in Rwanda.  The only problem is that these containers are used for years, so bacteria and diseases start to fester in these containers which begin to deteriorate the health of these people.

The house boy and I leave at 8:00 am exactly and depart down the steep slope to the bottom of the valley for water.  When we get to the water station we place the containers under the running water.  Fortunately for us today, we don’t have to wait in line.  In some other parts of the country you can wait up to four hours in line for your turn.  Also fortunately for us, this water station has flowing water year round.  In the eastern, and much drier, part of the country their water fetching stations will dry up.  This forces Rwandans to go much further distances to wait in what is likely a very long line. 

It takes only eight minutes to fill up 25 liters of water.  Once we’re done, it’s back up the mountain to my house.  My house boy takes the 44 pound, 20 liter container on his head and carries the 11 pound, 5 liter container in his hand.  That’s 55 pounds of water he is carrying up a mountain, about 1 kilometer in distance, back to my house.  It takes serious strength to do this, and these Rwandans do it EVERY SINGLE DAY.

Once we get to my house, that’s it!  We arrive back at 8:27 am, so it only took us 27 minutes total to get 25 liters of water.  We’re ready to use the water for flushing, cooking, cleaning, and bathing.  We are good to go until we run out of 25 liters of water and have to go back down the mountain, of course…

Kinyarwanda fun

Steve tries to teach a Rwandan boy how to skip rocks, in Kinyarwandan of course.

Kinyarwanda is a crazy language, and exceptionally difficult.  A future blog post will discuss the rules of Kinyarwanda and simple words, but for now I thought I would give you a sampling of some the fun words and phrases in Kinyarwanda.  Enjoy.

Kwandika umunani (kwa-ndi-ka  oo-moo-nan-ee)  Literally: “to write the number eight in the ground.”  Translation: to be drunk.

Umukobwa afite nyuma ya inzu  (oo-moo-ko-ba  a-feet-e  nee-oo-ma  yah  in-zoo)  Literally: “to have the back of a house.”  Translation: she has a big butt.

Umunyamashengo  (oo-moo-nya-ma-she-ngo)  Literally: clown

Ikibonko  (ee-chee-bo-no)  Literally: fat person

Ikibonko afite amtarasi  (ee-chee-bo-no  a-feet-e  ah-ma-ta-ra-see)  Literally: “the fat person has terraces.”  Translation:  The hills of Rwanda are all terraced in order to be able to farm on the land at steep slopes.  The back of a fat person’s head will have fat rolls that look like the terraces of the land. 

Ikirara  (ee-chee-ra-ra)  Translation: party boy

Umujama  (oo-moo-jah-ma)  Translation: gangster

Ikiguri  (i-chee-goo-ree)  Translantion: midget

Umusupastar  (oo-moo-su-pah-sta)  Translation: superstar

Umufubuzi  (oo-moo-foo-boo-zee)  Translation: gigolo  Literally: “a sexual technician”

Indaya  (in-die-ah) Translation: prostitute

Umupagani  (oo-moo-pa-ga-ni) Literally: “pagan”  Translation: One who doesn’t believe in God. 

Ingarama kirambi (in-ga-ra-ma  ki-ra-mbee) Translation: A man who should be married, but still lives with their parents and doesn’t have his act together

Kumviriza  (coo-mva-ri-za)  Translation: To listen to a man having sex to make sure that he is performing well

Gukama  (goo-ka-ma)  Translation:  To milk a cow with one hand

Kuvuruganya  (coo-voo-roo-ga-nya)  Translation:  To milk a cow with two hands

Nyamuryabana (nya-moo-rya-ba-na)  Translation:  A semi-mythical creature, normally a white person, well known for eating small Rwandan children.  It also has a secondary definition as a pedophile.

Ifigi  (ee-fee-gee)  Translation:  A rat that sneaks around your house at night eating your money that is hidden in your mattresses. 

Umukeba  (oo-moo-che-ba)  Translation:  A second wife

Igitangangurigwa  (ee-gee-tan-gan-goo-ree-gwa)  Translation: spider

Umukorerabushake ( oo-moo-ko-re-ra-boo-sha-chee)  Translation: volunteer

Gusara  (goo-sa-ra)  Translation:  To pray as a Muslim.  To go crazy.

Gusura  (goo-soo-ra)  Translation:  To visit.  To fart.

Umukekuru  (oo-moo-che-chu-roo)  Translation:  Old lady.  This is a term of respect in Rwanda.  Elderly ladies loved to be called old woman.

Gucira amazi  (goo-chi-ra  a-ma-zee)  Literally:  “To spit water.”  Translation:  She is so beautiful that everything that comes out of her mouth is perfect. 

Imbangukiragutabara (im-ba-ngu-ki-ra-gu-ta-ba-ra)  Literally:  “The thing that goes quickly to take you when you are sick”  Translation:  Ambulance

Umuhinzi (oo-moo-hin-zee)  Literally: A farmer who has a lot of fields to plow.  In this case, the farmer is a man and he has a lot of fields to plow.  These fields are women.  Translation:  Player

Vaccines!

The Peace Corps doctor's office in Kigali.

        Every Peace Corps volunteer is required to take vaccinations before and during their service.  Some have more than others, but I have been told that Peace Corps Rwanda volunteers receive the maximum amount of vaccinations.  Here is the list of vaccinations:

Before service

These vaccinations are required to be taken during the medical review process, which generally occurs three months to nine months before service:

Tetanus, Diphtheria, and Pertussis

Polio

Start of service

This vaccination is required to be taken upon arrival in Philadelphia, where all volunteers serving in Africa, Europe, and the Middle East meet prior to traveling to their country of service:

Yellow Fever

During service

These vaccinations are given by the in country doctors during their service in the Peace Corps.  Most of these vaccinations are given during the training period:

Flu vaccine

Hepatitis B #1

Hepatitis B #2

Hepatitis B #3

Hepatitis A #1

Hepatitis A #2

Rabies #1

Rabies #2

Rabies #3

Diphtheria and Tetanus

Meningococcal

Typhoid 

         For those counting, that is 15 vaccinations I took in a one year period.  The Peace Corps wants to make sure that you are protected as much as possible from diseases and infections due to the remote nature of our work.  In addition to the 15 vaccinations, I’m required to take a malaria prophylaxis every day (in the form of a pill) to avoid contracting malaria. 

Solar Panels

The breaker that protects the battery from the solar panel (above), the car battery, and the AC/DC converter.

The solar panel sits on the very top of the house. 

A typical Rwandan (and African) outlet I use to charge my electronics.

A store in Musanze that sells various sizes of solar panels.  They range from 20W to 150W output.

             Rwanda has an initiative with foreign companies to bring electricity to all Rwandans within the next two years.  A good portion of Rwanda has electricity, and many of the Peace Corps volunteers live in these villages with electricity.  However, several of the volunteers (including me) live in an area with no electricity.  So how do we charge phones and cut our hair?  Solar panels.

            There is a huge movement in Africa currently to supply solar panels to villages.  Several newspapers and magazines have run articles on this rural trend.  The reason is simple: it is the only direct way to get electricity in your village without having to wait years for the government to run power lines to your village.  People that have solar panels enjoy a business venture where they can run bars and restaurants, charging stations for phones and car batteries, and barber shops. 

            Only the church, one business in my village, and me have solar panels in a six mile radius.  So how does the solar panel work?  First, I have a 100 Watt solar panel installed in the top of my house.  This panel should face to the south to gain more electricity, but due to the constraints of my house it sits at the top laying flat.  The panel connects to a wire that runs to a charge regulator that protects the car battery from overcharging.  The battery is the stored electricity for the house.  If the battery is not charged, then there is no electricity.  The battery has a DC current, so the battery connects to an AC/DC converter which makes all of the electricity into an AC current.  All electricity in your house runs on an AC current, so we need to convert the power to AC in order to charge all your electrical components. 

            Now that I have an AC output, I need to wire the house for lights, switches, and outlets.  Once the house is wired, I flip a switch on the AC/DC converter and I have electricity.  However, electricity in Africa is 220V compared to 110V in America.  This can cause American electrical components to not work, or worse, overload and be permanently damaged.  In order to get American electrical components to charge, I have an Africa to America converter that connects to the African two cylinder prong outlet and change the voltage from 220 to 110. 

            This can be quite an operation and take a lot of time.  Here is a quick rundown on what it costs to get electricity to your house:

100W solar panel:                  $350

Car battery:                             $100

Regulator:                               $50

AC/DC converter:                 $50

Electrical wire:                       $25

Lights, switches, outlets:      $40

Installation of solar panel:   $40

Wiring the house:                  $60

Total:                                      $715

It’s expensive, but considering that I can now charge anything, not cook in the dark, and invite people over at night is more than worth the cost for two years. 

Rwandan Pets

            So you want an African pet?  Well, it’s as simple as going down the market and getting one, but not as simple as keeping one. 

            First off, Africans don’t have pets to have companionship or something to complain to with no backtalk.  Pets here have a purpose.  You want eggs?  Get a pet.  You want milk?  Get a pet.  You want to marry someone?  Get a pet.

GOATS

            Goats are probably the staple of the Rwandan pets.  They cost generally between $50 and $60.  If you want brochettes (meet on a stick, very popular in Rwanda) it is most likely goat meat.  If you go to any decent sized market on their market days, you can buy a goat or goat meat.  Also, goats are pretty low maintenance animals.  They’ll eat any greenery around the area.

SHEEP

            Sheep are popular, but not as common as goats.  They cost slightly less (around $40 for a good sized sheep) and are a little higher maintenance. 

CHICKENS

            Chickens are everywhere around here.  They are used from killing for meat (I’ve never met a Rwandan that didn’t know how to kill or gut a chicken), getting eggs, and taking care of nuisance insects in the area around the house.  They cost from a small chicken of $4 to a large one around $18.  Amazingly, chickens do not need to be tied up since they really never leave their home.  How this works is a completely mystery. 

ROOSTERS

            Roosters are somewhat common and you can see them roaming around a random road.  Roosters are used to come over the eggs and spray a scent that changes the eggs to chicks that will hatch.  Roosters generally cost about $15.

COWS

            Cows are the big animal around here.  They dominate everything from dowries to investments to food.  Cows start at a cost of $200 and can go up to $800 for a full sized female.  They can produce milk, manure for the fields, or better yet more cows.  Losing a cow can be catastrophic to a family. 

            If a man wants to get married, he will show his commitment (via a dowry) by giving a cow to the woman’s family.  There is a dowry ceremony that consists of the two families arguing how many cows and goats should be given up for the unmarried woman.  However, the generally accepted amount is one cow per woman. 

TURKEYS

            Turkeys are fairly common in the villages, but not as popular as chickens.  They can go from being unspectacular to massive.  Also, you can generally see a person walking a group of turkeys down the road to eat or be sold in a market.  Full grown turkeys generally cost around $15.

OTHER ANIMALS

            If you are wondering why Rwanda doesn’t have the same pets as America, there are some basic reasons.  Cats here are feral and the only people that keep cats are generally to ward off rodents.  However, some of our volunteers have cats as pets and love them being around the house.  Dogs have a much more macabre reason.  Dogs in Rwanda are generally feared and hated.  After the genocide, dogs were all over the roads eating the slain bodies.  Because of this, almost all dogs were killed in order to prevent them from being accustomated to humans.  They are making a comeback, especially in affluent families.  Unlike America, there is only one breed of dog that I have seen here in Rwanda.

Peace Corps Medical Kits

        Every Peace Corps volunteer is given a medical kit.  This medical kit stays at their site the entire time they are in the Peace Corps.  The purpose is to solve minor injuries and illnesses (or begin treatment of possible larger illnesses) without requiring volunteers to come receive medical treatment in Kigali every time.  This saves a lot of time and money for both the Peace Corps and the volunteer.  Here is what is in the kit:

Loperamide:  Used to control excessive diarrhea and cramps.  Used when a volunteer needs to travel on the bus.

Ciprofloxacin:  Taken when diarrhea is extreme and a doctor is concerned that the volunteer had dysentery.  This must be used in conjunction with major fluid intake. 

Sepasoothe:  These are sore throat lozenges for minor sore throat pain.

Miralac:  The tablets are taken for heartburn, stomach pain, and indigestion.

Diotame:  Used for nausea, upset stomachs, diarrhea, and heartburn. 

Aypanal:  A fever reducer and pain reliever. 

Diphen:  The pills provide relief for runny noses, sneezing, itching eyes, and general allergic reactions.

Cedaprin:  An ibuprofen that reduces fever and minor pains.

Swift:  Sinus decongestants for hay fever, colds, and nasal passage blockage.

Bismuth:  Pepto-Bismol tablets for upset stomachs, diarrhea, and heartburn. 

Sucrets:  Sore throat and cough formula lozenges. 

Rehydration Salts:  Mixed with one liter of drinking water, this is used for rehydration of volunteers during periods of severe diarrhea. 

Coartem:  Taken when volunteers feel that they have symptoms due to acute malaria.  This pill has significantly improved the recovery of people that are affected with malaria.  Prior to Coartem, recovery from malaria was much more extensive and difficult to administer.

There are other contents in the medical kit for various uses:

adhesive tape

malaria slide preparation kit

condoms

band-aids

gauze pads

anti-itch ointment

disposable thermometers

antiseptic

antibiotic ointment

floss

tick and insect repellent

anti-fungal cream

whistle

chap stick

tweezers

stool sample collection kit

iodine tablets for emergency drinking water

scissors

rubber gloves

    

           

My House

American Gothic revisited with my houseboy and chicken. 

The living room complete with a painted Rwandan flag.

Eating after English lessons with teachers from my school.

English lessons with some of the women from my village.

The dining room with a painted American flag. 

The study area where I keep all my work and books.

My bedroom.  The net above the bed is used at night to prevent me from insect bites (particularly mosquito bites).

The kitchen area.

Another view of the kitchen area.  The stainless steel item on the far right is my water filter. 

My shower area.  Just add a bucket of cold water.

Bathroom.  Due to this setup, I have forgotten how to flush a toilet. 

The courtyard where we keep our chickens protected.

Mama chicken with her baby chicks.

The baby chicks getting a drink of water before they go to bed.

Baby chick posing for her close up.

My two chickens that lay eggs everyday along with the rooster that wakes me up every morning.





            When you move to a village, you are given a handful of things including a primary assignment (job), a counterpart (someone who is supposed to help you adjust in your village), and a place to live. 

            By Peace Corps standards, my house is large and nice.  However, when I moved in the house was nothing but walls filled with half finished stucco and mud stained windows.  For the first two months, I sanded down the walls, painted the walls, cleaned the windows, brought in furniture, placed a solar panel on the top of the house and electrified the house, hung pictures and artifacts, and got a person to help me out with daily chores.

            The house has high ceilings which is ideal in the hot season when the house breathes well and doesn’t become a Turkish bath house.  Some of the volunteer houses have very low roofs and small rooms which make it almost unbearable to sleep in the hot season. 

            My newest addition to the house is two chickens that lay eggs every day.  My helper brought over his rooster (which loves to crow at about 5 am everyday).  Last week, I bought a mama chicken with her eight baby chicks.  For all the chickens and rooster, we built a chicken coup to hold the chickens and protect the chicks from hawks that would swoop down and take them when we are not at the house.  The chicks are great and growing fast. 

            My house has become a social center of activity.  I teach some of the local merchant women English, I have Kinyarwanda lessons twice a week, we watch movies with my neighbors every other week, and I invite my fellow teachers over every Wednesday for English lessons and lunch.  The house generally has a good amount of activity, including neighbors coming over to play traditional Rwandan games, look at magazines, or play darts.  It’s become a great place to host.

            My favorite parts are the American flag painted on one side of the wall along with the Rwandan flag painted on the other side, and my hammock that looks out over the valley from my porch.   Enjoy the pictures!