It starts very small.
A tiny, pregnant mosquito lands on your arm. She pierces your skin with a terrifying six-pronged mouthpiece called a proboscis, which roots around under the surface for blood vessels to drink from. She finds blood. She drinks.
Blood dries when it touches air. And so this tiny pregnant mosquito uses one of her six straw-like skin-piercing appendages to drip a little anti-coagulating serum into your bloodstream. Just enough to keep the blood from drying out until she's had her fill. She's gentle. This doesn't hurt.
But every once in a while, she gives a little more. Inside her tiny body are even tinier little things, microscopic single-celled organisms that work their way into this don't-stop-bleeding-just-yet sludge. Things like parasites. Things like malaria.
Malaria isn't really the parasite's name. Malaria's just a broad term for a handful of mosquito-borne illnesses caused by a small family of parasites. This parasite, its name is plasmodium falciparum.
When a mosquito carrying plasmodium falciparum lands on a person and feeds, as few as twenty of these little guys (each, again, just one single cell, several orders smaller than the dot atop this i) might slide down chute number six of the mosquito's proboscis. They'd find themselves in a strange new host, a markedly larger host, a host with an aggressive immune system coming right for them. Most of these plasmodia will perish in minutes.
But a lucky few will make it to the liver. They'll hide out there for a week or two. Eleven days, to be precise. They'll regroup and regenerate and grow from just a few lone eukaryotes to an army of hundreds of thousands. And then, with strength in numbers and a patient lay of the land, they'll attack.
Of course, I'm dramatizing. I'm anthropomorphizing too (and I'm not a biologist, so I'm probably misstating a few facts above or below). They're pretty simple things, these parasites, and they don't really have war strategies and tactical aims. They just do their thing, the same thing they've been doing for a very long time, and they do it remarkably well.
Mostly, their thing is making a human feel really, really, really awful. The other plasmodium of the malaria family, p. vivax and p. ovale and p. malaraie, cause flu-like symptoms and general fatigue that can last, untreated, for weeks or months. But the body tends to figure these intruders out after a while. The immune system can actually rid the infection on its own.
P. falciparum, rather, is out for blood. Quite literally. After incubating in the liver, it floods the bloodstream and eats a person's hemoglobin. Humans need hemoglobin to survive. Left untreated, p. falciparum will kill. It's the perpetrator of virtually all malaria deaths worldwide. It's severe. It leaves its hosts bed-ridden and likely feeling weaker than they ever have.
So, there's that.
I spend Friday night shaking and sweating and unable to regulate my body's temperature. The air conditioner is on full blast and I'm mildly aware that the room cannot be more than 20C, but it feels like a sauna. I feel like I might vomit but do not vomit. A few times during the night, I rise to use the toilet, and walking to the bathroom next door feels like a Herculean effort.
I toss and turn and feel an ache in my bones. I think about how we sometimes say that we can feel aching in our bones to express how sore we are, but like, right now it really feels like the marrow inside me is boiling. It's not a dull, too-tired sort of ache, but the active, acute, it-hurts-all-over kind.
I start treatment. Lauren and I are both carrying Malarone, which can treat malaria, but we'd actually both been taking it (me a little less consistently) as a preventative, rendering it less effective as a cure. Thankfully, Cassidy and Sarah have packed Coartem, and Cassidy starts me on a three-day dose, four pills every twelve hours, right away.
In the morning, I don't exactly feel better. It hurts to move, both to toss and to turn. I eventually wander out to the living room to say hello to everyone, which I must do in a horizontal position from the couch. After a short time, this becomes too exhausting and I retreat to the bedroom.
Everyone else is going on an excursion today. They're taking a boat to an uninhabited island on the lake. They'll go snorkeling and feed eagles and have a picnic. This sounds, abstractly, like a fun idea, but at the moment the thought of sunlight and/or heat and/or being on a boat and/or food and/or standing upright feels like death. I wish everyone a good time and sleep until they get back.
On Saturday the nausea begins. It doesn't necessarily replace the fatigue and aches, but rather compounds it, making even sleep unpleasant. I'm too nauseated to read or listen to a podcast or watch anything, so I just pass the day staring at the wall, not doing much at all. I hope maybe if I stay very still, I'll have enough energy to sit at the dinner table this evening. Not to eat (I haven't the slightest appetite), just to spend time with everyone.
In the evening, when folks return, I venture out to the living room to hear about their day. Dinner is being made. I talk to the kids for ten minutes and maybe Lauren for another ten, and then my energy is spent and I retreat to the bedroom once more for sleep.
The parasites' regeneration process works in cycles. They hang out in the liver and then swarm the bloodstream and later return to the liver. For me, this cycle loops around every six hours; for others, it could be every eight (it depends on one's Circadian rhythms, interestingly enough). I feel broadly awful all day, every day, but the worst comes right on schedule: 6AM, noon, 6PM, midnight. That's when the fevers are greatest, the nausea most severe, the fatigue most debilitating.
Saturday ends a little better then Friday ended. Sunday ends a little better than Saturday. By Sunday, the nausea is mostly gone (replaced by diarrhea and intense abdominal pain) and I'm able to even sit at the dinner table for a short while and eat a few forkfuls of pasta. Though everyone has taken a day trip to Cape Maclear and I slept through the entirety of their excursion, I am one of the first to head to bed.
Lauren also isn't feeling great. Fortunately it isn't malaria, but a stomach bug that's been bothering her for a day or so now. We are in pretty poor condition. Libby and Brian headed back to Lilongwe this afternoon and Sarah, Cassidy, and the kids will begin the long drive to Lusaka tomorrow morning. They've really kindly offered us a ride back to Lilongwe, and Libby and Brian have really generously offered their home while we recover. It's one plan until we get mended.
There are a few plans to choose from. The second is, of course, just to begin biking back the way we've come. Not to Lilongwe, but to Salima, roughly where we caught the ferry taking us to this corner of the lake, and cycling north from there. The third plan, I guess, is to take the ferry that way, back to Senga Bay, then cycle north. And then there's a rather appealing fourth option.
Here's the thing: it's hot. It's really, really hot, and it's been really, really hot since leaving Maun way back in northeast Botswana. I'm a little tired of cycling in 37C heat and camping in sticky, sweaty conditions. We both are. We thought Lake Malawi would be refreshing, and it is while we're actually in it, but the elevation here is low, and the humidity high, and actually cycling along the lake at this time of year isn't feeling enjoyable. Especially with my malaria and Lauren's stomach bug.
In the middle of Lake Malawi, there's a small island called Likoma. We've been told it has a really beautiful beach, and Africa's second largest cathedral, and baobabs, and views of the Mozambique coastline. The ferry stops there for seven hours on its northward journey, just enough time to explore. But it's, like, quite a ways from where we are.
Taking the ferry to Likoma, then on toward the mainland at Nkhata Bay, will shave a few hundred kilometers off our route. We'll be confronted with a steep climb out of Nkhata Bay, but then we'll be back at a decent altitude and cooler temperatures through (most of) northern Malawi and (most of) Tanzania. We'll eliminate three or four or five days of cycling through the (allegedly monotonous and inarguably steamy) lowlands. We'll have a few more days to recover while on the boat. And we won't have to worry about extending our visas past their thirty-day validity.
Oh, and we'll get to ride the Ilala again! That was fun.
This seems like a good plan.
The Ilala doesn't leave Monkey Bay until Friday. It's Monday. We're looking for a nice relaxing place to spend a few days while I get over the rest of my malaria. A place to sit around, eat, and maybe do some kayaking if we're up for it.
We have a place in mind. A few weeks earlier, I'd messaged a backpackers in Cape Maclear asking about kayak rentals and camping. Jen, the friendly manager, wrote back informing that they did rent kayaks, and with some kind words about our trip, and also with an offer: would we be willing to write a guest post on their site about our stay, in exchange for free camping and free use of all the watersports equipment? It sounded like a fair deal.
And so we set out Monday morning with fifty kilometers to cycle before an alluring three days' rest at the Funky Cichlid. Just fifty short, quick kilometers. Just fifty stretches of one thousand meters each. Nothing we can't handle.
Just fifty kilometers, recovering from malaria.
Fifty kilometers, without having eaten in days.
Fifty kilometers, in the 37C heat.
Fifty kilometers, past villages that smell like dried fish.
We begin cycling, and I realize very quickly that we've made a grave mistake.