Mosquitoes Don’t Discriminate

Susan Zakin is the editor of "Naked: Writers Uncover the Way We Live on Earth."

Shooting pains in my head were just one hint that my anti-malarial medication couldn’t stand up to the mosquitoes of Sierra Leone. The pains weren’t bad at first, just faraway flashes like heat lightning. There were other signs, such as dizziness, but I thought I was just reacting to the stifling humidity. The muscle spasms in my right calf must be lack of exercise. I’d been in Freetown a month. After a 9-year civil war, the capital city of the West African country barely has electricity, much less Pilates.

It does, however, have a malaria rate among the highest in the world. Not just malaria. Falciparum malaria, also known as cerebral malaria. Also known as “the bad kind.”

Like most Westerners traveling in malaria-ridden countries, I was taking a preventive drug called Malarone, which is highly effective and without too many onerous side effects. But any illusion of safety disappeared when I saw the look of recognition in Dr. Pumba’s eyes.


“You have malaria,” he said.

“But I’m on Malarone,” I said.

“This is Sierra Leone,” he said.

Right. The country the British used to call White Man’s Grave. The lower third of Sierra Leone is a swamp. I hadn’t met one person who hadn’t had malaria. Falciparum malaria.

“It’s an endemic area,” said Pumba, peering at me to make sure I’d understood. There are strains of malaria here that don’t exist anywhere else.

He prescribed Arinate, a derivative of a Chinese plant in the artemisia family, and something for the head pain, manufactured in Pakistan. I desperately hoped it was made from opium.

After two days of taking Arinate, I felt like my head was made of cotton wool, pierced by the occasional knife thrust. On the second night, I was convinced my head was no longer made of cotton wool but of a rapidly expanding flammable substance that was going to blow my skull apart.

As my temperature rose, so did my panic. I sent someone from the hotel to find a thermometer, but apparently there were none in the entire city. Everybody told me I would be fine. They’d all had malaria, every one of them.

The Africans at the hotel had taken Arinate, but no one I spoke with had completed the course of medication; they stopped taking it when they felt better. I tried not to think that I’d contracted an Arinate-resistant strain of the disease. I was too weak to be angry at a whole country.


It would be the wrong country to be angry at, in any case. Arinate cost me 20,000 leones, about $8. Many people in Sierra Leone -- and other parts of Africa -- die because they can’t afford a drug that costs less than most people’s insurance co-payments in the U.S. And, frankly, I would have appreciated it if the pharmaceutical companies had developed a malaria vaccine instead of dumping millions into high-priced, redundant drugs for overweight Americans.

I kept trying to figure out what to do if my fever truly got out of hand. In the U.S., I would have high-tailed it to an emergency room. Everything I’d ever read about cerebral malaria recommended hospitalization within 24 hours. But when I mentioned this to a doctor’s wife on the phone, she laughed. “No, no, no, no, no. You don’t want to do that.” I believed her. I’d seen hospitals in countries like Sierra Leone.

I had to do what the Africans did when they got malaria. Soak towels in cold water, place them on my head and sweat it out.

It worked. After an hour or so of the laying on of towels, my fever broke. I could think again, more or less, and I could sleep. The next day I could barely make it up the stairs, but I felt like myself again. I had the sense of a narrow escape, as if the roof on the next building over had collapsed, but not on me.

When I saw one of the maids the next morning, she asked how I was feeling. Better, I said.

“Praise be to God,” she said.

Secular humanist that I am, I stiffened. Then I smiled and nodded. For once I understood why Africans believe in spirits, whether Christian, Muslim or animist. There are no atheists in foxholes.