On Shake-Shake Lane

When I walk by at 3 PM, the boys on Shake-Shake Lane are still inside, discretely taking pulls from their cartons and playing pool. A few "Hey, mama!"s and kissing noises escape as I walk past. These boys, they're full-grown, but they didn't come here to be grown-ups. They come to Shake-Shake Lane to be boys pretending to be men.

When I walk by at 5:30, the boys on Shake-Shake lane have spilled into the street. They sit on benches drinking their dinner and laughing at everything. I traipse over flattened cartons and am trailed by enough "Hey! Hey mamahhhhh! Heeey-ooooh! Hey sistahhhh! Hey!" to float a hot air balloon. I look straight and will myself to stoicism, but a slight smirk plants itself on my face. This is followed by a nose wrinkle as stale malt wafts up from the soaked sand. A few girls teeter by on sky-high heels, arm candy for the boys. The neighbor women nod, greet me as I pass, faces betraying little emotion to what must be a nightly ritual outside their homes. You could set your watch, serve meals by the routine of drunks on Shake-Shake Lane.

At 10:30 I ask Shari's guard to walk me home, and she sweetens the deal with the promise of coffee on his return. He brings a large stick and I wonder if it's for the men or the dogs. I expect racketeering as we leave the compound. Outside, though, there are only night noises. I'm enveloped by crickets and frogs, dog barks bouncing back and forth. In the states, in Dakar, probably in Lusaka, we would be far from the beginning, but in small K-town the night has already settled down. Shake-Shake Lane greets me with stock trucks and quiet bar tenders.

Arriving home, I thank the guard and go inside. Turning on my light and turning up my music, I start to tidy my kitchen. I pause to savor the moment -- this is the best part, feeling fully present in my own life. Soon I will split again - American/PCV/foreigner/professional. I'd considered adding seeker to that list, but I'm no longer sure that description fits. Best to let it be.

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I moved the weekend before last. I was expecting a month long, ache-ingly drawn out process, but a few days after I said that I loved the house, my landlord called to tell me to move in that day. And I do love this house. It's clean and tiled and I can do with it as I wish. The only downside is that the house is right off of what I've dubbed shake-shake lane - a row of greasy, seedy small town bars selling beers and shake-shake. I'm slightly fascinated. Repulsed, to be sure, but also fascinated.

There have been some issues with electricity in K-town recently. I've developed a pattern. When the electricity is going to be out all day, I get a little pouty and lazy and I sigh a lot. Then I go into the field and remember how good I have it and resolve to work around the electricity issues. When I get back, I try extra-hard for a good 10 minutes before falling asleep on my floor (it's all so tiled and cool and inviting). Upon waking, I feel bougy (bougie?) and bad about myself, at least until I see something like this. Then I don't know what to feel.

Whenever there isn't electricity, there isn't water (and when there is electricity, water still seems to be a crapshoot). I stand in my pretty little house, chewing my nails as I look at my (useless) shower... to an empty bucket... then back. Eventually I shrug and decide not to bathe. I could just fill the bucket from the tank 5 feet outside my front door and heat the water on my nice stove, but no. I decide instead to pout and feel bad for myself. A voice in my head mocks me, "Hooker, please. You just lived in a village for 2 years. Showers weren't an option. Getting water from a tap wasn't an option. What are you complaining about?!" I find myself trying to box up the things that I complain about, but it's difficult to delineate between first world problems and peace corps problems, living in Africa problems or just me being crazy problems. The more I have, the more 'developed' a place I'm in, the easier it is to complain and get upset when things don't work out the way I was hoping. I'm going to need to work on that. And now I've just used up a bunch of computer battery on an electricity-less day. Time for a floor nap.

Peace & Love
Elyse

Bootcamp, acronyms, and lasers

Have you ever taken a step back to evaluate how your life has changed in a year? The beginning of October in 2011, I had no idea that my life was taking me where I am now. Not only that, but I feel like my thoughts now occupy a very different space. Maybe I have grown up.

I'm on a plane soaring across Africa (fun fact, it takes almost 9 hours to get from Dakar to Johanesburg.) Even though it's the middle of the afternoon, the flight stewards have decided to make the plane dark and not bring me lunch - guess how happy I am about that. But I suppose it just gives me a good excuse to eat in Joburg. I've spent the last 10 days at Stomp Out Malaria bootcamp in Senegal. We spent every day (except for beach day) talking about anything involving malaria, from entomology to net distribution to co-infection, and doing skype calls across the world. It was long and my tired self wants to play it off, laissez-faire like. But truly, the training was a great experience and I have learned so much - many thanks to the trainers who worked so hard to make it all happen. So I guess this is my excuse to tell you all about malaria.

Almost 1 million people still die from malaria every year. Due to enormous efforts by organizations all over the world, the mortality rate has dropped by 25% since 2000. But I want to try to put this into perspective. More people than live in Alaska, North Dakota, Vermont, or Wyoming die a preventable death every year. Most of those are children. It's easy to make the statement at the beginning of this paragraph and not fully recognize its impact. Because these are not just numbers, these are people. Luckily, there are also many people working tirelessly to save that population, and I'm fortunate enough to work with them. There are a lot of organizations that have their hand in malaria. A short gamet - PMI, Global Fund, Malaria No More, United Against Malaria, Roll Back Malaria, and, obviously, Stomp and MACEPA. Big players that are making large impacts.

I'm going to take a rather large pause to explain malaria itself. Malaria is a parasite that is transmitted between humans and anopholes mosquitoes. The parasite goes through a 2 week long (ish) cycle in the mosquito and then uses the mosquito saliva transferred during a mosquito bite to enter the human. Once in the human, the mosquito goes through another cycle involving your liver and blood stream. Once in the human, the parasite stays in the liver for a while before making its way into the blood stream and attacking red blood cells. This is where the infection happens. Malaria is associated with (among other symptoms) fevers and chills that come in waves - you might feel horrible in the morning and then absolutely fine in the afternoon, making you think that you got over whatever it was you had until the fever comes back the next morning. The infection is more dangerous for anyone with a weaker or weakened immune system - children, elderly people, pregnant women, and people living with HIV/AIDS, for example. Malaria is also strongly associated with anaemia - it's dangerous for those who are already anaemic, and it can make a person anaemic because of the rates at which it kills your red blood cells. These videos are quite helpful if you're interested in any of the plasmodium falciparum (parasite) life cycle.

So what are the organizations involved in malaria doing? A lot of them can be divided into groups giving technical support or groups providing a financial backbone (or both), most of which is funneled into interventions for malaria control and elimination. There are different kinds of interventions. The first area is known as 'vector control,' which means dealing with the parasite-carrying mosquito. Distribution of ITNs, or insecticide treated nets, is probably the most important aspect of this. Nets cost less than $5 each and have been shown to significantly reduce malaria infections. The other major vector control initiative is IRS, or indoor residual spraying. In normal words, spraying chemicals on walls. Different chemicals can be used - DDT is the most common because it lasts longer and is a little cheaper, but many places are showing signs of resistance. On my good days, I'm a hippie, and I can imagine every hippie I know shuddering at 'DDT'. We'll have to get to that some other time; the point is that it's safe and it makes a difference. When you spray, the rates of infection drop significantly. There are other forms of vector control - larvicide, or treating water where mosquitos breed, is one - but ITN distribution and IRS are the key vector control interventions.

Other interventions focus around case management - RDTs, ACTs, and IPTps. My life is so full of acronyms these days, it's a miracle I can still form real words. The major prevention techniques focus on using rapid tests (RDTs) to confirm malaria cases and then correctly treat those cases. Previously, the only way to test for malaria was using microscopy. As you can imagine, this causes a lot of issues out in rural Africa (yep, generalizing). The majority of cases coming through rural clinics were diagnosed as clinical malaria - malaria without any sort of test - and treated as such, resulting in over-treatments and a higher risk of resistance. For a few years now (I want to say since 2007, but I'm not sure if there's any truth in that), RDTs have become available and made everything much easier. ACTs, or artemisinin-based combination therapies, are the drugs most commonly used to treat malaria. They're often provided for by donor groups, making them free for clients. The last group of letters at the top of this paragraph (IPTp) stands for intermittent preventative treatment in pregnancy. Placental tissue provides a new site for the parasite to breed, so even if a woman has built up resistance to the parasite, she and her fetus won't be resistant during pregnancy. Infection can cause anaemia in the woman and interferes with the transmission of nutrients, oxygen, and general growth in the fetus.

The third group of interventions are labeled as 'supportive interventions.' This includes things like surveillance, behavior change communication, and supply chain management. We aren't going to go into any of those right now.

The problem with these interventions is that they are not permanent. You cannot have a big push to get nets to every sleeping space and IRS in every house and then call it good; you cannot just go treat everyone and walk away - history has taught us that this can and will lead to a resurgence of transmission and infection. Instead, it's necessary to have a 'scale up', where intervention is kept at high levels over a long period of time to control the parasite or, better yet, eliminate transmission. This kind of scale-up is not simple nor cheap, but it is arguably necessary.

As I started writing this (a couple days ago - I'm now sitting at my desk in Kalomo), my intention was a short blurb about the basics of malaria. Instead I've ended up skipping over quite a bit of information in the interest of keeping you all riveted (are you riveted!?) There's a lot more to say, but I don't want to make this post too long. You'll note, I'm sure, that I haven't touched on specifically what Peace Corps is doing, or what I am doing. Lucky for all of us, I'm spending the next 10 months thinking in terms of malaria acronyms, and you get to be along for the journey. Don't panic, this will still be chalk-full of anecdotes about my life here, - not like I'm running out of material - I'm just trying to throw in a little education.

Speaking of, lasers. How cool is that?!

Peace & Love
Elyse