By Cara Lopez Lee
Special to The Times
November 23, 2003
I couldn't resist telling and retelling a travel tale that involved actual skin-tunneling worms. In turn, my friends couldn't resist shifting their weight back just a hair, although they insisted they understood there was no chance of worms leaping from my body to theirs.
Catching schistosomiasis, also known as bilharzia, requires snails and a body of fresh water. The squirming creatures hunted me down a couple of years ago in Malawi, a country in southern Africa that offers a useful word for such situations: zimachitika. Loosely translated from the local language, Chichewa, it means: "It happens."
I learned the full meaning of that word a couple of years ago on Lake Malawi, the third largest lake in Africa (after lakes Victoria and Tanganyika). The lake covers one-fifth of the country. I'd been traveling with a friend in Tanzania and Zanzibar; when she got homesick and flew back to the U.S., I continued alone to Malawi, which guidebooks call "the friendliest place in Africa."
My first few days were spent at a laid-back lakeshore guesthouse on Nkudzi Bay called the K Lodge. The lodge sits next to Mwanyama, a poor but pleasant village of thatched huts, where I watched women giggling at the town water pump and children playing ball with a sphere of wadded paper.
It looked like a Hollywood movie set. I found it difficult to imagine any danger could lie squirming beneath the surface.
The K Lodge's owners, a South African couple, assured me there were no worms at Nkudzi Bay, and the water looked irresistible, more like a tropical ocean than a lake. I barely hesitated on the slender beach before swimming out to the diving float. I jumped repeatedly into the water, fearful only of water up my nose.
At the lodge I met a group of English schoolteachers on holiday from Blantyre, Malawi. They gave me a quick lesson in the country's culture, which readily accepts life's risks along with its joys. One woman explained that the word zimachitika embodies a pervasive attitude that can apply to anything, from a broken dish to the death of a loved one.
On my last day, Greg, one of the lodge owners, told me that he thought he'd caught the night guard sleeping on the job early that morning. "But when I shook him, he was dead," Greg said. "Oh, that's terrible," I said, groaning. This seemed to surprise him. It was apparently unnecessary to be so effusive regarding such a common event. Odds are that the guard died of either malaria or AIDS, both rampant in Malawi. Most deaths are simply explained by the single heading "fever." The average life expectancy is 37. I began to understand how easy it would be for Malawians to embrace the fatalistic view of zimachitika.
As a backpacker who had learned to expect the unexpected, I decided that this would be a good attitude for me to adopt too. I had no idea how soon it would come in handy as I hitched a ride north to Cape Maclear, a scruffy backpacker's resort on the lake. I was looking for Kayak Africa, a company that offers trips to luxury camps on two of Lake Malawi's lovely islands.
My guide, Mariot, and I shoved off the next morning in a double kayak and spent two hours paddling the six miles to Mumbo Island. As we paused along the way to watch fish eagles circle above Thumbi Island, I apologized for stopping to pull my camera out of my dry bag. Mariot shrugged it off, saying, "There is no hurry in Africa." Mumbo Island is tiny — easy to circle in a single kayak in about 45 minutes. The camp sits on a tall outcropping of rock, linked to the main island by a wooden footbridge. Each walk-in tent commands a different view of the lake and has a deck with a hammock. There are only five tents, so there are never more than 10 overnight guests. Each day was a lazy collage of lying in the hammock, kayaking, snorkeling and swimming. Each night we ate gourmet camp cuisine in the open-air lounge, bathed in the soft glow of hurricane lanterns.
But this paradise hid a few demons. It was at Mumbo that the worms attacked. The wicked little flatworms, called schistosomes, penetrate the skin and float through the bloodstream, growing and laying eggs. The eggs then travel to the bladder, intestines and liver. Symptoms of infection, such as fever, chills, cough and muscle aches, are caused by the body's reaction to the eggs.
Among parasitic diseases, schistosomiasis ranks second only to malaria as a threat to public health in tropical and subtropical areas, says the World Health Organization. The disease is common in 74 developing countries and infects more than 200 million people. Travelers are becoming infected more frequently as it becomes more popular to travel off the beaten track. Staying out of lakes and rivers can help prevent it. But it's possible to get infected by simply using fresh water for drinking or showering.
The bad news: Symptoms often don't appear until the disease has done irreversible damage. The good news: The disease can be detected by a blood test and is easy to cure with a two-day course of pills.
When I first read about schistosomiasis I was sufficiently disgusted to decide that I would only kayak and not swim. But that was before I saw Lake Malawi. I'd never imagined a lake could have water so clear or fish so unusual. There are more than 600 species of tropical fish in Lake Malawi, and many don't exist anywhere else in the world. Some have spent so many generations evolving in one group of rocks that their species can never venture more than a few feet from that spot. I felt privileged to have seen these colorful rock-dwellers, called mbuna.
On Day 3 , the worm turned. That afternoon I hiked to a secluded rocky beach, where I stepped into the water among tiny toe-nibbling mbuna, then swam away from shore and out to a small rock to sit in the sun. I was pleased with my solitude, until I felt something tickling my hand. When I glanced down I was horrified to see several minuscule red worms crawling there. They were so tiny, if they hadn't been red I might not have seen them. I quickly brushed off the creatures in disgusted panic.
But not all of them came off. I noticed that at least one was already starting to tunnel under the skin of my knuckle. My survival instinct kicked in. I dug in and tore off a piece of perfectly good skin in my revulsion and desperation to get the thing off of me.
The crystal clear lake suddenly lost its appeal. I gazed down at the water in terror for a moment, realizing I had to jump into it again to swim back to shore. Then it dawned on me that the worms might live on the algae-coated rock. I scrambled off the rock and swam about 15 yards to the beach. When I reached land, I quickly dried off, wildly performing the "yuck-I'm-so-grossed-out" dance.
The next day my guide returned, and we kayaked back to Cape Maclear. Three days later I was back in Denver. The U.S. Centers for Disease Control and Prevention advises waiting six to eight weeks after exposure to schistosomiasis before taking a blood test. Through the wait, I wondered whether there were worms swimming in my bloodstream, whether they'd laid eggs, whether nests of larvae were nursing on my liver.
When I finally visited my doctor and explained the test I needed, he had to excuse himself, pull out his medical text and look up the disease. The lab technician didn't even know how to pronounce schistosomiasis. The test came back negative, but my confidence was low.
Two months later I went back for another test. It was also negative. But I don't think I'll feel totally secure until I've gone at least a few years with no sign of dissolving organs.
Cara Lopez Lee is a Denver freelance writer. Next year she's traveling to Scotland, where the only lake creature she hopes to encounter is the Loch Ness Monster.
Copyright © 2013, Los Angeles Times