The Fever: How Malaria Has Ruled Humankind for 500,000 Years - Softcover

The view through the mosquito net is blurry, but I can see the

thick skin of grime on the leading edge of each blade of the

ceiling fan as it slowly whirs around, keening alarmingly.

This is how it was every summer when I visited my grandmother’s

house in southern India. While my cousins snore on the bed mats

laid across the floor beside me, glistening bodies bathed in the warm

night breeze, my sleeping mat is ensconced in a hot, gauzy cage. The

mosquitoes descend from the darkened corners of the whitewashed

room and perch menacingly on the taut netting, ready to exploit any

fl icker of movement from their prey within. It is hard to fall asleep

knowing they are there, watching me, but eventually I drop off and

my tensed body uncurls. They sneak into the gaps my protruding

limbs create, and feast.

In the morning, all my hard work of trying to fi t in, to overcome

the Americanness of my suburban New England life, has been

undone, for my Indian cousins are smooth and brown while I am

speckled with bleeding scabs. My grandmother vigorously pats talcum

powder over my wounds, the white powder caking pink with

congealed blood, as my cousins snicker. I don’t understand how they

escape unscathed while I am tormented. But incomprehension is part

of the package of these childhood summers in India. Just outside my

grandmother’s house ragged families huddle in rubble along the road

and use the train tracks as their toilet. They wave their sticklike arms

in my face and moan woefully when we pass by on the way to temple,

caricatures of beggars. One boy’s leg has swollen to the size of a log,

and is gray and pimpled, from some disease brought on by a mosquito

bite. My grandmother tightens her grip on my hand. We give

the children nothing. I can’t understand this, either. When we get to

the white marble temple, it is full of incense and golden statues

encrusted with diamonds and rubies—to my seven-year-old mind,

the very picture of prosperity.

Part of me despises my estrangement, my incomprehension, the

fact that I must sleep under the suffocating net and take the malaria

pills while my cousins don’t. But part of me is secretly glad. The boy

with the swollen leg frightens me. The family who lives on the curb

frightens me. India frightens me. These fears, for the girl who is supposed

to be Indian but isn’t, are unspeakable.

When no one is looking, I crush the mosquitoes’ poised little

figures with my palm and smear the remains on a hidden seam in

the couch. Our Jain religion forbids violence of any kind. No eating

meat. No swatting flies. My grandmother wears a mask over her

mouth while she prays, to protect airborne microbes from inadvertent

annihilation in her inhalations, and considers walking on

blades of grass a sin. Meanwhile, there I am in the corner, cravenly

pulverizing mosquito corpses behind my back, blood literally on

my hands.

Back home in New England, the mosquitoes still bite, but there

are no nets at night, no pills to take, no scary beggars on the side of

the road. We shop for forgettable plastic trinkets at the mall. My fear

and loathing of the mosquito are blunted into games of tag. My father

calls himself Giant Mosquito, undulates his fingers like proboscises

and chases me and my sister. It’s scary, but fun-scary. We screech

with glee and stampede through the house.

· · ·

Thirty years later, on the S-shaped land bridge between the North

and South American continents, I meet José Calzada. Calzada is a

mosquito stalker of sorts, and I, the mosquito hater, have come to

learn about the local mosquitoes and their exploits. A parasitologist

from Panama City, Panama, Calzada spends his time rushing to the

scene of disease outbreaks across the isthmus. The mosquito-borne

parasite that causes malaria, Plasmodium, is one of his specialties.

It is April 2006. For most of the past century, there hasn’t been

much work in this fi eld for people such as Calzada. Panama prides

itself on being one of just a handful of tropical developing countries

to have tamed its mosquitoes and nearly conquered malaria. American

military engineers built a canal through Panama in the early

1900s, and forced malaria to retreat to the remote fringes of the

country. Since then it has stagnated, primarily in its most benign

incarnation, vivax malaria, which is rarely fatal.

But things have changed in recent years, and Calzada has agreed

to show me some obscure signs. He emerges from the imposing

Gorgas Memorial Institute, Panama’s sole health research center.

Clean-shaven and trim, Calzada has a slightly worried look in his

eyes that is off set by high cheekbones suggesting a perpetual halfsmile.

I wait while he meticulously changes out of his work clothes—

button-down oxford shirt and slacks—and into a T-shirt and jeans.

Climbing into my diminutive white rental car and tossing a baseball

cap on top of his backpack in the backseat, he patiently directs me

out of the labyrinthine metropolis. Navigating Panama City’s congested

streets, past shiny skyscrapers and packed cafés, is a task that

challenges even my well-honed Boston driv ing skills.

After twenty minutes heading east out of the city, the road turns

quiet. It’s a lovely drive, with hills in the distance, verdant pasture

and scrub unbroken save for a few elaborately gated houses set far

back from the road. Colombian drug lords, Calzada says, by way of

explanation. Another hour passes, and the road rises, a glittering

lake coming into view, just visible through a tangle of jungle. As we

near the water, the pavement ends, and we pull over.

Here, at the end of the road, is the town of Chepo. From what I

can see, it consists of a wooden lean-to facing a sleepy roadside café.

Two police officers amble out of the lean-to, which turns out to be a

checkpoint. They take my passport and vanish, leaving Calzada and

me to buy a cold drink at the near-empty café. As we sit, I can just

make them out in the murk within the lean-to, inspecting the blue

passport with great care, turning it over and over in their hands as if

for clues to some baffling mystery.

Inspection completed, Calzada leads us on foot behind the road.

Th e hillside is green and lush, with a slick red clay track leading to

the crest. He heads up and I follow gingerly.

At the top of the hill lies an improb able settlement. Packed

together, not ten feet apart, are dozens of hand-built ranchos, their

thatched roofs sitting on top of roughly hewn wooden poles. More

arbor than hut, some of the structures rest on concrete slabs, with

airy wooden-slat walls on three sides, but most are fully open-air,

situated directly on the packed dirt. Inside the ranchos, smoldering

fi res are encircled by battered metal cooking vats, parrots sit on overturned

baskets, and hammocks sway from high rafters.

From the road, Chepo seems abandoned, but in fact, three hundred

of Panama’s indigenous Kuna people live here, tucked away.

It starts to rain, and we duck under the eaves of a rancho. Women

pass to and fro in bright puff ed-sleeve cotton blouses with patterned

molas tied around their waists and elaborate beaded anklets that

reach up to their calves. They are cutting plantains, carrying plump

naked children. One puts out a giant metal vat to collect the rainwater

sliding off the thatch. A rooster strides by purposefully.

A half-dozen boys clad in saggy cotton underwear and wearing

shell necklaces happily kick a defl ated green soccer ball. One boy,

around eight years old and wearing cracked red plastic flip-flops,

gnaws on a green mango pit while absentmindedly pulling on his

penis. A little girl walks by holding a baby covered in a rash, whom

she hands to me easily. It is a tranquil scene, earthy and ripe, this

hidden place at the end of the road.

It is soon apparent that most of the residents are in one of the

larger ranchos, sitting around a smoky fire. Peeking in, we see them

singing softly and dancing. A few are sprawled on the clay floor,

facedown, passed out. We’ve arrived in the midst of a fiesta, Calzada

whispers to me. A local girl has recently menstruated for the fi rst

time, and so the community has spent the day drinking chicha fuerte,

a brew made from fermented corn. As we watch, a woman and a

boy lift a comatose mud-caked man off the ground and drag him

home. Two women from inside the rancho follow them to the doorway,

smiling. Aside from a few furtive looks, they ignore us almost

entirely.

It wasn’t like this the year before, when Calzada first came here.

There is no En glish-language record of what happened to Chepo’s

Kuna community in 2005, save the one you are reading now. The

mosquitoes that hatched from Chepo’s stagnant puddles, the edges

of the lake below, in the open-water cisterns, had gone on a rampage.

Contaminated with the most malevolent malaria parasites known to

humankind in their spittle, they alit on the exposed and unclad Kuna

around them. By the time Calzada and his team arrived, nearly half

of the settlement was fevered, terrified, immobilized in their hammocks.

After days of triage, Calzada brought samples of the Kuna’s infected

blood back to his lab at the Gorgas Institute to analyze. The

most common malaria in this part of Panama is the relativ...