On Malaria, Drought, and the Personal Consequences of Greed

The asphalt stuck to my sneakers as I walked through the parking lot toward a squat, concrete building. It was midmorning in Santa Elena de Uairén, Venezuela, and hot. Inside the waiting room was a single wood laminate desk. Two men, one young and one middle-aged, were shuffling through a stack of papers while an old woman waited, her palm slapping quickly, unconsciously, on the surface of the desk. A sign on the wall behind her read malariologia in dark green letters.

“You have to come back after lunch,” the older man told her. “Her test isn’t in here.”

The woman passed me on her way out, her face tight.

“Name?” The younger one was looking at me. He seemed no older than 16.

“I already have our test results,” I told him, and thought back to the moment they had arrived. I was at home, trying in vain to bring my husband’s fever down with wet T-shirts and a small bowl of ice water. We had been without running water since the drought started in October, and it was April. The results had come in the form of a text from my brother-in-law. “There are two strains of malaria,” he wrote, “the nasty kind, and the deadly kind. Benjamin has both.”

“Are you here to pick up your medicine?” the young man tried again.

“We already did,” I told him. “But we were only given one blister pack of quinine, enough for four days. In the instructions, it said it’s a nine-day treatment.”

He nodded.

“We’re only giving out half the dosage so that there’s enough to go around,” he said.

“But,” I spoke softly, hoping to sway the men to my side, “my husband has Vivax and Falciparum. His skin is yellow.”

A hummingbird appeared, suspended in the open window frame. It made an exploratory dash into the room before flitting out.

The younger man looked at the older, who blinked slowly in exhaustion before speaking.

“The woman who just left,” he said, “her granddaughter is two years old. Everybody needs treatment. I’m sorry, you have to wait.”

The truck meant to deliver the medicine had broken down in Puerto Ordaz, he explained. “It should be here by tomorrow morning. Come early and wait.”

Back outside, I weaved through the traffic toward the main shopping street. The air was filled with exhaust from old cars whose tanks had been altered to smuggle gasoline over the Brazilian border.

Santa Elena de Uairén sits along Venezuela’s southeastern perimeter. Separated from the rest of the country by three million hectares of mountains and waterfalls known as Canaima National Park, the scrappy border town used to be a desirable address for those seeking to live closer to nature. The surrounding area has a dramatic, otherworldly beauty, with rolling green hills and tabletop mountains soaring into mist.

When I arrived there as a solo traveler in 2008, I felt I had stumbled into Eden. Now it was 2016, and Venezuela’s economy was spiraling out. Santa Elena had become a hub for illegal businesses like gold mining and the smuggling of government-subsided items—food, medicine, gasoline—into Brazil for a profit. Living on the border felt like clinging to the brim of a cup about to spill over.

The combination of deforestation and contaminated water waste created the ideal breeding grounds for mosquitoes.

I ducked inside a shady grocery stall and asked the shopkeeper if there was chicken.

Before she could respond, a man cut in front of me to place three stacks of cash next to the register, which the old woman weighed on a scale before pointing him to a wooden door at the back corner of the shop. The man knocked, and the door closed swiftly behind him, blocking my view of the room beyond.

“If you don’t see it, it’s not here,” the woman croaked, returning to my question.

Searching through one of the vegetable bins, I found a piece of ginger. It looked like a small, shriveled body. A grubby voodoo doll. I pressed my fingernail into its shimmery skin and inhaled. I bought it.

I used to love getting sick as a child. My mother would stay home from work, and I would sit on the step stool and watch her make carrot ginger soup, as dusk deepened into a cold autumn night through the windows over the sink. My mother’s enormously curly hair, recognizable from any distance in our town in upstate New York, was made even bigger by the steam from the pot, and it brushed against her cheekbones like a live sea creature.

Moving along the street, I stopped at the butcher to ask for chicken. “Whole chicken, or cut?” he asked.

“Whichever.”

“We don’t have either,” he said. “The truck broke down on the way here.” I imagined the poultry truck sitting lopsided next to the truck carrying quinine pills on a lonely stretch of road, the frozen wings softening in the midday sun.

Determined to make the soup without chicken stock, I stopped in another stall to buy carrots and squash. The saleswoman looked warily down at my forearm peeking out from under my long-sleeve shirt as she handed me my change.

“What is that?” she asked, pointing with a long, manicured nail. “Chicken pox?”

I looked down at the galaxy of angry red dots spread across my arm. I had nearly forgotten.

“Zika virus,” I said. “It’s not contagious, only by mosquito.”

“I had it last month and I didn’t look like that.” I thought about this for a minute.

“Maybe the rash looks worse on white skin.” She nodded. “No fever?”

“No,” I said, raising a hand to my forehead automatically. “No, I don’t think so.”

Outside I hailed a taxi, a 1970s muscle car as wide as a boat, its motor chugging loudly as I explained to the driver where to go. In Venezuela gasoline costs considerably less than water, and people have a special appreciation for vintage, fuel-inefficient cars. To this day, the town’s primary emergency vehicle is a 1973 Cadillac ambulance.

The taxi left me and my groceries where the sidewalk ended abruptly in rocky soil. I followed a steep, narrow road up the mountain, and turned left onto a dusty path choked with dry brambles. Before the drought, it was a tunnel of flowers, and at the end of that tunnel was the house where I lived. A massive pine tree rose out of a hole cut in the roof, as if the house were a treehouse that had grown too heavy and slid to the ground. When it rained, or when it used to rain, the droplets would meet in the creases of the rough bark to form rivulets, and puddles would grow on the cracked floor between the roots struggling to come up through the cement.

The tree was a sapling when I first moved in. I was 18, and it was a season of tropical storms. Benjamin and I would sweep the rainwater out of the kitchen with brooms. He was the one who had inexpertly built the kitchen around the pine tree, not wanting to cut it down. At night I would lie in his arms, feeling cool and scrubbed-clean from the roar of the rain on the zinc roof. Cracks of lightning would wake me, their bright flashes stirring me from my dreams, and I remember thinking it wouldn’t be so bad to die. My heart was full.

Then my mother called, long distance from home in upstate New York. The word—malignant—had to be a mistake, I thought. I was the one who had just dropped out of college. I was the one sleeping with a near-stranger in a distant country. She was supposed to be safe.

I carried the groceries all the way into the bedroom, where Benjamin lay, propped on pillows and with a wet rag wrapped around his head. The fever chills came every 36 hours or so, and in between he was supposed to rest. He’d tried reading but had given up—the pain in his head was splitting. It was all he could do to stare into space. I sat on the bed and tried to get him to sit up and drink some water. A nurse had told me that if he started to speak nonsense, it was a sign the parasite had breached the blood-brain barrier and a coma could be close behind. He tried to speak, and I held still to listen.

“Socks.”

He was already wearing socks, I said, worried. He took my hand and lay it gently against his forehead, then tried again.

“Put on some socks.”

I looked down. My ankles were bare and it was near dusk—the hour of the Anopheles mosquito, which carries malaria from one body to another. I went to the dresser and pulled on a pair of wool socks. He nodded, and leaned back against the pillows.
It was dark in the kitchen. I turned on the lightbulb that hung over the stove and brought the soup to a boil. Pieces of burnt onion unstuck from the bottom and oated chaotically amid the bubbles. The dogs’ barking alerted me to my mother-in-law’s arrival.

Benjamin’s mother, Zoraida, was the town’s herbalist and its contentious radio journalist. She was also our neighbor. Her skin was tawny and her enormous breasts threatened to spill out of the top of her shirt as she came through the front gate, carrying a plastic bag of leafy stems, and another stuffed with what looked like yards of purple taffeta.

“Look at this,” she ordered as she came into the kitchen.

She handed me the cloth, pulling it out of the bag so that pieces dragged along the ground.

“I found it at the stall of the woman who decorates quinceñera parties,” she said, excited. “It’s perfect. The same material as a mosquito net.”

I tried to hold him, to calm him, but his limbs jerked with improbable force, his intelligent eyes rolled back in his head.

I silently disagreed. The cloth was stiff, the holes looked too small for the air to pass through. I felt stifled by the very idea of hanging it over my bed. But it would have to do. The government ignored the malaria in our region because to admit the outbreak would mean to admit the illegal gold mines in the National Park, from where the disease spread.

The economic crisis had seen more and more people leaving cities to seek work in the hydraulic mines, and the combination of deforestation and contaminated water waste created the ideal breeding grounds for mosquitoes. In town we did not have the materials necessary to stop it, starting with quinine, nets, and fumigation chemicals.

We knew from reading the news that the severe drought was an effect of El Niño. We knew the increased temperatures had led to record-breaking numbers of mosquito-borne illnesses. Just over the border, Brazil was experiencing a crisis of its own, with Zika virus being linked to thousands of babies born with the malformation known as microcephaly. We knew from experience and Brazilian public service announcements how to eliminate mosquito breeding grounds—to take care not to leave tanks or buckets or trays of water uncovered.

But there was no information on the spread of malaria in southern Venezuela. A friend of mine, a journalist who lived in town, was trying to gather what data she could. Over the phone, she warned me that Benjamin’s case was considered high risk, as both strains of malaria were present. Two people had been confirmed dead from the illness that week, she said, and rumor had it the hospital was deliberately handing out limited doses of quinine to avoid people selling their medicine on the black market.

I told Zoraida about the pills. She said she’d go to the hospital herself tomorrow, and I felt reassured. She used to work at the hospital as a nurse and might know someone who could help.

It was night, and I was awoken by Benjamin shivering uncontrollably. I tried to hold him, to calm him, but his limbs jerked with improbable force, his intelligent eyes rolled back in his head. He asked why, why is it so cold? I bundled him in a down comforter, then dragged a quilt on top of that. The purple mosquito net fluttered in the air of the fan as he continued to shake, his teeth chattering loudly. I touched my hand to his forehead and yanked it back. I fumbled for the thermometer. The numbers read 41.2 Celsius. 106 Fahrenheit.

I flew down the mountain without a flashlight, instinctively jumping over rocks in the darkness. Zoraida was sleeping but became alert immediately. She gathered her supplies as I rushed her in a high-pitched voice I didn’t recognize as my own.
Back up the mountain path, and into the bedroom. Zoraida broke the top off a tiny glass tube and filled a syringe with its clear liquid.

She bent, making low soothing sounds as she injected her son. I stood behind her, shifting from foot to foot. The two figures, mother and son, were obscured underneath the veil of the taffeta. It looked like a shroud, undulating softly in the dark room. I tried to inhale, but the air was empty. Gasping, I collapsed into a chair.

__________________________________