Doctor V Goes Over The Sea

The thing about mosquitoes is that they are so wily.

Mosquitoes rise to unfathomable heights of wiliness with their crafty attempts to suck your blood and cover your body in enormous, itchy welts. They find you no matter how secure your mosquito net, no matter how long your clothing, no matter how high the altitude to which you climb…. They will find you!

Wait a minute, you don’t get a golf ball-sized lump wherever you are bitten by a mosquito? Your eye does not swell shut if cunning wee buzzers bite you anywhere on your face? You don’t get bitten by mosquitoes at 8,000 feet above sea level? Or on planes?

This is an example of my relationship with mosquitoes. The snapshot was intended to capture my sparkly teal eyeliner for a Friday Fluff Feature. In the same moment the photo was taken, a mosquito landed next to my eye and bit me! You can see it there! Of course, this caused my eye to swell shut immediately. (Fashion tip: Teal eyeliner does not look as good when your eye is swollen shut.)

Once upon a time, when I sharing a flat in Mexico City with two of my female friends, I woke up in the middle of the night because a mosquito had bitten me on the lip. (Mind you, this was an urban highrise in which mosquitoes were not expected to invade the 25^th floor flats.)

In my sleepy swatting and attempts to figure out what was going on that had awaken me and was making it difficult for me to move my lips, my poor bedmate was also forced out of her dreams. Even in the darkness, she could see that something had gone terribly wrong with my lower lip (ala, very, very bad collagen implants.) As I stumbled to the bathroom to try to look at myself in the mirror, I accidentally woke up my other friend, who noted across the dark room that my lip was swollen up like a large piece of fruit. “What is wrong with your mouth?” she called from her bed.

Confronting the swollen disfigurement of my face in the mirror (Permanent duck face! Except with apricot-sized lips!), I had only two thoughts: First, I was beyond thankful that my big presentation at the international AIDS conference had taken place earlier that day. Speaking at a massive conference with this kind of deformity would rattle even the smoothest public speaker. Second, I began to realize that my tongue was swelling too, and that this could eventually cause bigger problems than the insult to my vanity. Benadryl to the rescue to keep me breathing! (And some middle-of-the night calculations about the best way to get myself an epi-pen at 3am in the Centro Historico of Mexico City, if it came to that.)

The wily quest of the mosquitoes to feast on my flesh is not a myth. Mosquitoes really do prefer some people to other people. And we don’t know why! You can read all about the science of why mosquitoes hate me in Don’t Swallow Your Gum.

The other thing about mosquitoes is that, in some parts of the world, they carry around this terrible little parasite that causes malaria.

Because mosquitoes love me with such an undying, passionate love and because they are wily enough to find uncovered parts of my skin across dozens of countries and several continents and even on airplanes, I have to think quite a bit about malaria.  (I also have to think about malaria because I see children die from it, but I thought, “Why not leave the blog free of stories of dying and sick children for today?”)

When I am in Kenya, I take a medicine every day to protect me from getting malaria. I use a bednet that really does keep out most of the marauding mozzies. And in the parts of the country in which there are swarms of wily, vicious, relentless attackers, I coat myself in thick DEET repellant. These things work! In my 9 years in Kenya, I have never gotten malaria. (Because of my tendency to acquire sicknesses and minor injuries, especially in Kenya, my closest doctor friends will tell you this is an amazing accomplishment.)

Here is the thing to remember on World Malaria Day 2013 — we know how to prevent malaria! We know how to wipe it out. We used to have malaria in the United States. In Ithaca, New York, for example, (home to my much-loved alma mater of Cornell University) malaria once plagued the banks of Cayuga’s waters, but we wiped it out with proper sanitation and insecticide treatment.

We know how to prevent malaria, and we know how to cure malaria. As an HIV researcher, I long for the day when I can say the same things about HIV.

We could make Africa as free of malaria as upstate New York. I believe we must try to do this. Because 660,000 people still die every year from malaria and most of them are children under 5. Africa bears the brunt of this disease; 90% of those 660,000 deaths were in Africa. 219 million people get sick from malaria every year, some of them very, very sick. I don’t think that is ok when we know how to prevent and cure a disease.

Yes, I would enjoy a respite from my itchy, deforming welts. But what we really need is NO MORE CHILDREN DYING from the parasite inside these wily buzzing pests.

Bednets. They keep kids alive and smiling.

We’re working on it. In Africa, malaria deaths have been cut by one third in the last 10 years. In countries where access to malaria control interventions has improved most significantly, overall child mortality rates have fallen by approximately 20%. Less dying children is good for the entire world. There is no better investment.

Invest in the future: defeat malaria. And mosquitoes too.

It turns out there are not the right words to describe heartbreak. Broken-hearted. Crushed. A hole in the heart. Shattered.

When it happens to you, you struggle for the words to describe, even just to yourself, this empty, hollow, wretched state. There are not words for how you mourn as you breathe in and out. There is no description for the way your mind twists around the losses now and the losses for the future.

Even as the sadness weighs on you, you squeeze what hope is left into putting one foot in front of the other, in getting through this day, and then the next.

Vivian’s heartbreak came with a small, pink slip of paper on which the words “PCR reactive” were written. She thought she could feel her pulpy, pumping heart slow and harden and stop beating as the words came out of the counselor’s mouth, telling her that she was infected with HIV and so were her two daughters. She thought of them, beautiful and bright, in between the slowed beats of her heart. Monica in a red dress chasing little Deborah outside of the house that morning, a 5-year-old mother trying to lift her baby sister in skinny arms.

Vivian felt her hopes for herself and for her girls spilling out of her heart and onto the floor. She had hoped to live to see her grandbabies. She had hoped that her daughters might make it all the way through high school, and even through university. She had hoped that her small business along the roadside selling milk and eggs and fresh vegetables might do well enough that she could have a shop of her own and finance all of these dreams. Big to small, drip drip drip spilled the hopes.

The man she called her husband left several months ago. She had been hoping that he would return soon, that everything would be ok. And now, in between the  slow heartbeats, she started mourning the loss of him as well. This was why he was gone, she knew now. And her hope for him dripped to the floor as well.

Sometimes, our patients come in so sick that they need to be carried, with bodies as frail as the pages of an ancient book that crumble as you try to turn them. Sometimes, our patients come in so drained of hope that their hearts are even more feeble and frail than their bodies.

I have good doctor plans for restoring Vivian and her daughters, Monica and Deborah. Medicines, food, exercise, work, school – all the day-to-day menders of broken bodies and, sometimes, of broken hearts. You can have many years, I tell her. There is reason to hope again.

But how to ease the weight when your love has left you? When your life may, indeed, be cut short? When your dreams for your children seem so much more impossible? When you have struggled your whole life to carve out these dreams despite the grinding poverty of life on $1 a day?

I don’t seem to have much luck scooping hope up off of the floor, so this is my motto for the week. (Thanks, Momastery)

What can I do in the this beautiful and terrible world? I can try to figure out how to help Vivian and her daughters navigate this world with more hope and less fear. I can try to figure that out for myself and for  our families in Kenya who walk with this particularly terrible virus. And I know lots of families are trying to figure this out for their own battles against the parts of their worlds that they are finding terrible and frightening. How to cling to the beauty. How to find the hope.

How do we do it? How do we manifest hope, a little more each day? For my program in Kenya, I’m working on my toolkit: Shared stories. Counselors. Support groups. Tools to connect you to other families, other patients. Better medicines. Money to make our programs more effective, more accessible.

Hope takes many different forms. We walk together. And I still believe that love wins.

Tonight at 9 p.m., Ryan White’s mother, Jeanne White Ginder, will be featured on the Oprah Winfrey Network series “Where Are They Now?” discussing the many ways that she continues to share Ryan’s story, including her partnership with the fabulous Indianapolis Children’s Museum.

See a sneak peek: http://bit.ly/11sgRMj

(Because there is too much serious shit going on.)

If the police were sweeping our neighborhood right now, this is what they would find in the alley behind my house:

An abandoned shopping cart by a dumpster.

Even better, mushrooms!

I should note that I observed what I am certain was a drug deal in this exact location within a minute of taking these photos. I would bet that particular exchange of money and a small, mysterious package through a car window would not have occurred if the police were sweeping. Why the mushrooms did not factor into this trade, I do not know. They were left behind.

You should be really excited right now. Fountain Square — we have mushrooms! Matthew Tully is excited about Fountain Square. He wrote all about it in the Indy Star. Not only do we have mushrooms, we are “on the verge.” Hooray!

In my family, being “on the verge” meant that something was about to spoil or go bad. Milk, it seemed, was often “on the verge” — a frightening phase accompanied by much sniffing, the occasional tasting, debate about whether it really was “on the verge” and murmuring among ourselves about whether the milk was still safe for consumption. When it comes to city neighborhoods, “on the verge” apparently does not mean that you are rotten. It means that we are a walkable, growing, quirky, fun neighborhood with lots of great restaurants that might just be the next big thing. As we do not really have a grocery store within walking distance, the mushrooms’ origin remain a mystery.

But I do love my Fountain Square.