The Community Health Worker and the Worms

This is literally 3 months old. I wrote it midway through my first semester at Columbia and had honestly forgotten about it until now. My apologies.

I fell asleep two nights ago reading about onchocerciasis and woke up in Mali, covered by a yellow mosquito net and unable to fall back asleep because of the guinea hens. I got up and went about my routine getting ready for class, as if I wasn't half-way across the world as I did so. It happens less the longer I've been away, but there are days that Mali is draped across my shoulders like a cloak, and I have no way of shaking it off until it is ready. I spent my first class trying desperately to discuss treatment as my mind wandered off in search of the name of the man who offered me those pills.

He showed up at my gate and called out a couple of times, too polite to enter the courtyard uninvited. Pagne wrapped securely, I stepped out to find the community health worker standing with a notebook and a long stick covered with circles, dots, and lines. "Cootie shots?" I asked dryly before launching into a litany of Bambara greetings. Those finished, he held his stick up to me and announced, "worms!" I nodded, aware that there were worms that hid in the cakey clay dirt, in the sand, in the mud. There were worms in stagnant water, some in fast moving water. Worms found you through snails, files, and the mangy dogs begging for scraps. Those tiny parasitic beasts may be invisible to the naked eye but are adept at taking over and ruining your body. So yes, pills for worms.

I vividly remember him standing there with the stick, his goofy grin, the rhythm of us conversing in a mash of French and Bambara - a mark of someone who would have excelled in school if there had been one to excel at. I remember my cat, Basil, angrily crying for breakfast, and that he had just eaten a suspiciously similar worm pill the previous week. I remember the scratchy air, the feel of that creaky gate in my left hand, and that I was supposed to take two pills (based on my height, prescribed by the stick), but I can't remember if I took the pills and I can't remember his damned name. Details are bound to fade, but I hate it when I can't remember their names.

I never knew which worms those pills were for until two days ago, reading about mass treatment campaigns and coming across a photo of a community health worker in an unnamed African country, holding one of those sticks. For a split second, I was sure it was my friend, my home. that's what tripped me up.

Onchocerciasis is more commonly known as River Blindness and is considered a neglected tropical disease. It's neglected because it is no longer common, thanks to the (accidental) development of a treatment drug by Merck 35 years ago and the subsequent mass treatment campaigns in affected countries. Without those drugs, the worm (which enters a human-host through a fly bite) will grow under a person's skin and release its millions of babies to swarm the body, causing such severe itchiness that people kill themselves to get away from it. Those babies - microfilariae, if you must know - can make their way to a person's eyes and eventually cause blindness. According to the WHO, roughly 37 million people are infected worldwide. It is baffling that those 37 million could be easily treated, but that the treatments aren't getting to them. Unfortunately, this is the case for many diseases. A deceptively simple problem, I expect swaths of my career to be devoted to trying to answer it in one form or another.

Tonight, I am supposed to move on to study other issues, build on my own understanding of the complexities of global public health. But the words in my readings are breaking apart in front of me as I search not for public health strategies, but for one man's name. As often happens in my reminiscing, I vainly wish that I'd taken more photos, that I had taken his photo that morning. Maybe then I could remember, feel that I wasn't losing them with time. Maybe then it would be easier to put my memories back in their boxes.

Peace & Love
Elyse