The Hill of God - Malaria "Ground Zero"
When we sat down with Paul and talked about the time he contracted Malaria while shooting a documentary in Sub-Saharan Africa, we were floored. It was one of those tales that leaves you thinking "You can't even write this shit". Well in Paul's case, he did. I am ecstatic to present Paul's never before read essay on the time he went to the "ground zero" of Malaria and got bit by the wrong mosquito.
The Hill of God
One Hundred Years Battling an Ancient Illness in Northern Zambia
Story and Photos by Paul McNeill
As I looked back over my shoulder through a vine-framed window in the dense woven canopy that hugs the steep slope of Kalene Hill, I felt an unnatural chill in the seething tropical heat that forced me to take a knee next to the rugged grave of Dr. Fisher, the first Christian missionary to this remote corner of Zambia. The inscription chiseled into the granite headstone reads: Walter Fisher - Departed To Be With Christ - 30th December 1935 Aged 70 Years - A Servant Of All, Wamba Ya Wantu Ejina.
I snapped a few photos and immediately appreciated why he chose to be buried in this spot. Extending to the horizon is an Olympian view over an immense mat of African bush, which is blemished only by the glint of the mission hospital’s tin roof, the dusty scar of a simple grassy airstrip and a serpentine track of dense darkened brush, hinting at the meandering path of the Zambezi River, which is fed by the tributaries surrounding this very hill. I tried to stand, but my legs were unsteady, and I had to brace myself against the headstone. I immediately diagnosed myself with a case of dehydration. The evidence was all around me; it hung from my waist in an unopened bottle of water and clung to my skin in a saturated quick-dry shirt, and a khaki ball cap, now a damp shade of brown.
Chiwaya, a young Lunda boy who eagerly joined my hike after I found him trying to persuade a mango tree to unhand its last fruit with a handful of stones, gave me an odd look. “You tired?” he asked. “I take your bags?” Stubbornly, I smiled and shook my head. “No thanks,” I said. “I’m just hot.” I then failed miserably at trying to explain what tropical humidity is, and how foreign it is to a Canadian. I rambled on about water in the air, and became uncharacteristically agitated when he blurted out, “Rain!” I tried again, “No, not rain,” but Chiwaya had tuned me out. He had noticed a hidden and heavily burdened mango tree at the top of the hill near the ruins of Dr. Fisher’s original dispensary.
I shut up and leaned against a large stone as Chiwaya searched the tall grass for projectiles. I noticed a couple of ripe mangos on a flattened grassy patch of a long forgotten tennis court and slowly trudged over to collect them, dropping one in each pocket of my baggy shorts. As I returned to my resting spot, I caught a concerned look from Chiwaya. Did I really look that bad? Chiwaya used his teeth to tear open a massive mango he had found and exited into the thick underbrush. I took a swig of water, followed by a deep breath of the heavy air, and followed him on wobbly legs.
Medical confirmation wouldn’t come for almost twenty-fours hours, when I learned that as that pathetic scene played out at Fisher’s gravesite, hundreds of thousands of malaria parasites were bursting like an asteroid shower into my bloodstream and voraciously consuming my red blood cells. I had come to this isolated region of southern African to do research for a documentary about a deadly and ancient illness, but that illness had found me first, and I still had a four-kilometer trek back to the Kalene mission hospital.
There are no vacancies at the Kalene mission. Visitors are either the guests of missionaries or bedridden patients. I was soon to be both. The original hospital, a simple collection of mud-brick huts, was situated at the top of Kalene hill. Due to a lack of water in that location, it was abandoned soon after Dr. Fisher’s death and moved to its present location in the shadow of the hill. The current 160-bed hospital is a humble building of cracked brick and peeling pastels. The hospital’s Nightingale-style layout allows hygienic breezes to drift down long narrow hallways and flow through hanging mosquito nets. Every night, the open courtyards glow with coal braziers and bustle with patients’ families, who amidst the roar of countless crickets turn the hospital into a temporary village.
The mission is situated in a periscope of land that juts up into the extreme northwest corner of Zambia, as if the British colonizers of what was then Northern Rhodesia wanted to keep an eye on neighboring Portuguese Angola and the Belgian Congo. Another theory I devised during my malarial fever was that in the late 19th century, when the colonial rulers were meeting at the Berlin Conference to carve up Africa and its 10,000 kingdoms and tribes into barely 40 colonies, the cartographer hit a knot of wood on the table, looked around to make sure that all the bigwigs were too preoccupied with their beer and schnitzel to notice, and carried on.
Regardless of how or why this odd strip of land exists, the simple fact that it does has been a blessing to the Lunda people. Prior to colonization, the Lunda were primarily hunter-gatherers, whose docile and timid nature preferred them to European, Arab, and African slave traders. Their territory stretched from a central chiefdom, just south of Kalene, north and west into present day Angola and the Democratic Republic of Congo (Zaire), two countries plagued by civil wars since their independence in the 1960’s. The comparative peace of Zambia, anomalous in the region, has provided the Lunda with a safe haven, and it has been a place of healing ever since Dr. Fisher and his wife Anna arrived over a century ago.
From the very beginning, patients have trekked to Kalene’s door over vast distances, crossing borders, rivers, and war zones. “Many people who come to this hospital come two to three days journey,” says Dr. Davies, a Welsh missionary doctor at Kalene. “Some come on bicycles propped on the back in a makeshift chair. Travel up to 100 miles, 150 miles, it’s very humbling to see that—and they arrive, and they don’t complain.”
Over the past century, Kalene has been the destination of escaped slaves, pregnant missionaries, malnourished refuges, land mine victims, and even an errant bombing run, which failed to detonate (the mission quickly painted “Kalene Mission Hospital” on the roof to prevent an encore). But through all the wars, droughts and plagues, the greatest killer by far of the Lunda, and of all Africans since time immemorial, has been the mosquito.
* * *
I first arrived at Kalene strapped into the co-pilot seat of a six-seater Cessna. It was a three-hour flight, weaving through a patchwork of tropical thunderstorms, over absolutely nothing but vast swamps, swollen rivers, and thick bush. From this vantage point I could see that the rainy season had really lived up to its name. Record rainfall had caused massive flooding all across Zambia, destroying villages and crops. The large pools of stagnant water left behind created the perfect breeding ground for the female Anopheles mosquito, the one genus of mosquito that carries the deadly malaria parasite, Plasmodium falciparum, the cause of 97 per cent of all malaria deaths.
The deadly mosquito is always a she, a mother trying to nourish her eggs with a drop of blood. In Zambia alone, she kills between 32-50,000 men, women and children every year. The parasite she carries accounts for 4 million clinically diagnosed cases annually, out of a population of 11 million, and she’s responsible for almost 50 per cent of all hospitalizations and outpatient visits in the country. Pregnant women and children are undoubtedly the most at risk when bitten, their vulnerable immune systems often incapable of any sort of defense. Three thousand children in Africa die from malaria every day, and in Zambia, it kills 20 per cent of all children before they reach school going age.
At Kalene, patients have a 50/50 chance of malaria parasites entering their bodies from the saliva of the Anopheles mosquito’s proboscis, even if they are hospitalized for another ailment. But I wasn’t bitten at Kalene. Malaria takes between 10 to 14 days to incubate and multiply in the liver before any symptoms are noticed. I worked out that I was probably infected while visiting the Chikankata hospital in Zambia’s Southern Province. I remember standing in a field of premature maize at dusk, stubbornly waiting for the perfect sunset shot along a silhouetted hilltop footpath while my bare ankles were attacked by swarms of mosquitoes.
In a nation where HIV and AIDS has already devastated a generation, where a 17 per cent HIV prevalence rate has contributed to causing the average life expectancy to drop to 38 years, the malaria parasite is profiting from the weakened immune systems of its human hosts. “The constant barrage of messages gives a picture that more people are dying of HIV/AIDS than malaria, which well is not really true,” says Malama Muleba, the Executive Director of the Zambia Malaria Foundation. “There are more people dying of malaria than AIDS. AIDS does not necessarily kill you, what kills you are the opportunistic illnesses due to your immunity being weak. And malaria is one of those that really kills a lot of AIDS patients.”
* * *
At Kalene, I was the spoiled guest of Dr. Davies and his wife, Chris. Thirty years ago, fresh out of medical school, Dr. Davies and his young family spent three years working at the Kalene Mission. “I was quite a rookie doctor,” he says. “And we eventually returned home for family reasons, never ever dreaming that someday we would be coming back to the very same place.” In fact, at one stage Davies made an oath that he never would.
Then, five years ago, Davies recanted that oath and took an early retirement after 24 years working as a family doctor in the UK. “I had a feeling that we would have a God-led calling somewhere, just to help out somewhere in the world, never ever dreaming it would be Kalene,” he says.
Over the past five years, Davies has toiled for long stretches as the lone doctor and acting hospital administrator, with only two registered nurses. “The downside of being here by yourself,” he says, “is that the locals suffer when you’re ill, because there is no other doctor, but you also suffer as an individual because sometimes you have to do things because there is nobody else to do it.” On two occasions, Davies has had to perform emergency surgery during an attack of malaria. “You just grit your teeth and get on with it,” he says in a self-effacing tone, then in true missionary style, he quickly finds the spiritual in the struggle. “I honestly feel that you are given strength particularly for that job, because I remember in both situations I was in a sort of slight window of the illness, and I got on with the operation and collapsed afterwards.”
Thankfully, another doctor arrived recently to help carry some of the burden. Dr. Woodfield, a highly-skilled New Zealand surgeon in his forties, is a self-proclaimed visionary with the goal of turning the Kalene mission into a training hospital for doctors wishing to work in the African bush. “We can’t get doctors from the West to come to Africa,” he says. “The issue here is that to work in a rural African hospital you have to be able to do a bit of everything—deliver babies, do a spinal anesthetic, caesarean section, look after sick children, manage malaria, TB, HIV infection, fix a hernia.” In today’s highly specialized and over-litigated Western medical system, it is difficult to find a doctor with this range of skills, even more so to find one willing to give up the prestige and pay that comes with being a physician in the West.
Along with about a dozen other expatriates at Kalene, the Davies are following in the footsteps of over a century of missionary doctors, nurses and midwives who, with minimal sponsorship from their congregations back home, have heeded the call to help the people of central Africa. This unbroken commitment started with the Open Brethren movement, which separated from the established Church of England in the 19th century. “They were in disillusion with the pomp and ceremony and what they considered to be a divorce from the simplicity of the Christian faith,” says Davies, “so they tried to revert to the very basic of New Testament behavior, and they started very simple church gatherings. They had no leading clergy people, no priests, they considered that any person who had faith was entitled to be a priest in the sense of praying individually to God.”
This enduring care and sacrifice through many generations, with the bare minimum of proselytizing, has endeared the missionaries to the Lunda people. Dr. Fisher is still revered by the Lunda as “Ndotou”, meaning a respected doctor, a title that has been permanently reserved for him, like a sports legend who has his jersey number lifted to the rafters, never to be worn again. “The past history of white people here has been associated with helping people, and this present generation of white people benefit from that reputation,” says Davies. Nothing represents this relationship better than the Lunda word for a white person, Chindelli, which means, “Respected one,” making Lunda quite possibly the only language in Africa in which white people are described by something other than the color of their skin.
The small expatriate community of healthcare workers in Zambia continues to be vital to the wellbeing of all Zambians. Currently, 90 per cent of Zambian doctors and 80 per cent of Zambian nurses leave the country within five years of graduation. “It’s sad to say, but as we speak there’s at least 2,300 Zambian-trained, Zambian nurses in the UK alone,” says Davies. His attempts to explain the downside of life in the UK to recent graduates have failed to curb the exodus. “Yes doctor, I know it’s cold and expensive,” he says, imitating their responses. “But I also know that my friends did it and now they have come back and they own a house in the city with a swimming pool.” He shrugs his shoulders and leans back in his chair. “How can you blame them?” he continues. “It’s a very, very big temptation.”
* * *
“In Zambia, in the villages, people are still primitive,” says Chief Nyakasaya of the Lunda tribe. “Some people have been receiving their information,” he says. “But. a person who has never been to school, it is a problem to understand what malaria is. So it’s my duty to teach, to sensitize so that they know what malaria is. You know, we have lost many lives because of ignorance. We didn’t know that malaria is a killer disease, all we knew was that when someone dies he has been bewitched.”
The chief is a young, educated man in his mid-thirties, wearing a gold patterned dress shirt and a leather cowboy hat, who recently acceded to the throne after the death of the previous chief. He sat clutching his ornamental cane in an armchair of woven bamboo, flanked by his two anxious handlers who sat on the floor as we talked at length about his chiefdom and his goal to educate his people. “You can find someone who has died of malaria, and then they will say, oh he has been killed, bewitched by his grandfather,” he says, raising his staff.
The Chief was very supportive of my plan to return to shoot a documentary on malaria during the next rainy season, and he believes that education and superstition are the major issues that need to be addressed. As we parted ways, he threw out an offer of land if I returned, and then he paused and said matter-of-factly. “But the tradition of witchcraft is there. Wizards are there. Sorcerers are there. We know this.”
These parting words played over and over in my mind as I lay drenched in a malarial fever staring at the dawn after the longest night of my life. Watching daybreak, I realized that when the Fisher’s and their followers ventured into the area, they must have seen Kalene hill silhouetted every morning in the eastern sky. It’s no wonder that they chose to stop there after a long trek through uncharted land. “They felt it was more secure on top of the hill. There was certain amount of visual warning they could have in case of attack,” Dr. Davies explains. “Also, at the top of the hill, and this became vitally important, it was relatively free of malaria, not completely, but because of its height they had a certain amount of freedom.” This fact was vital, becauseon the journey they had already lost many members of their group to malaria. “When the whites came here they had no immunity at all,” Davies says. “And it was a major contributory factor why central Africa was called white man’s grave. Dying of malaria and yellow fever was the common thing.”
* * *
During the three days that I spent lying on the Davies’ couch recovering from my bout of malaria, I would occasionally gather my strength and venture to the front veranda for some fresh air. Over the treetops lining the Davies’ property, Kalene Hill rises up dramatically over 400 feet. Though the hill is very prominent, it was not given a name until Dr. Fisher arrived. He named the hill after Chief Ikelenge, a local warrior and elephant hunter, who lost his eye in a fight with a lion. But Kalene Hill isn’t really a hill, it’s actually the end of a long escarpment that stretches south for miles. In the local mythology, an ancient chief created the long hill when he discovered a massive swamp blocking his way. He dropped handfuls of magic powder along his path while invoking the ancestral spirits, and dry land burst up from the marsh. The current line of the escarpment marks the steps of this magical journey, and Kalene Hill is either where it ended or where it began, no one is really sure.
Though myths about geological formations have lost credibility over the years, remaining only as cultural artifacts, the myths surrounding malaria are still widespread. “There are four main myths in malaria,” says Malama Muleba, shaking his head. “That malaria is caused by eating immature sugar cane, drinking dirty water, eating cold food and getting soaked. None of that is true. Those are myths that are strongly entrenched in our culture.”
Not only are the causes of malaria still not fully understood or believed by some villagers, many don’t immediately go to the hospital when they get the symptoms of a malaria attack. “A large portion of our community, possibly about 50 per cent, could be more, they go to traditional healers. That’s the first point of contact for a health matter,” says Muleba. “The way malaria manifests itself, you think possibly the person is possessed.”
In reality, this bewitching is the sign of cerebral malaria, the deadliest manifestation. It’s still unknown why it attacks the brain, but when it does it is quick and deadly. “They can survive and suffer no signs of brain damage,” says Dr. Davies, “but you have a percentage of people that survive cerebral malaria and are brain damaged for the rest of their lives, and that’s a tragedy.”
When Dr. Fisher started to make contact with the villagers from his simple mission at the top of Kalene Hill, he was immediately confronted by the power that superstition has over the locals. The Lunda around Kalene hill were particularly scared of the mystical Ilomba, a “spirit enemy” in the form of a water serpent that inhabited the surrounding rivers and streams, and was blamed for every drowning in the area. At one point, some puzzled patients watched Dr. Fisher place a harmless grass snake he found on his walk into his rock garden. The rockery was bizarre enough to the villagers, but the addition of the snake was a sure sign that Dr. Fisher was growing his very own Ilomba.
Their fears were confirmed when Dr. Fisher ordered a baptistery to be built by damning a small stream at the base of Kalene Hill. To the superstitious Lunda, Dr. Fisher was obviously preparing a home for his growing Ilomba, and the act of baptism was surely a trick to get them in the water and in the grasp of the deadly soul-eating serpent. When a severe epidemic of influenza killed seven of the first fifteen baptized, attendance at church meetings dropped drastically for a few weeks. When Dr. Fisher finally found out why people were not attending, he simply kept on as though nothing had happened, and the rumors withered away with time.
Though this belief in the supernatural has also diminished over time, it’s still entrenched in the psyche of all Lundas and most Zambians. In my travels around Kalene Hill I heard many people talk about the “eating of the life.” This occurs when a person uses his or her supernatural powers to summon a “spirit enemy.” This enemy might be the Ilomba, but it could also come in the form of a goblin or a spirit lion, to attack and “eat the life” of the selected victim.
The Zambian government is trying to stamp out the practice of outing these “evil” supernatural practitioners at funerals. It is still very common for the family members of the deceased, or their cronies, to carry the coffin through the village, as if the deceased is leading them. Those unlucky enough to be bumped by the coffin must pay a fine for hexing and therefore summoning the “spirit enemy” that caused the death of whomever is in the coffin—in Dr. Fisher’s time, the punishment was often death.
This unlucky bumpee is, of course, invariably someone who has some money, or is disliked by those carrying the coffin. In a country where the average income is around a dollar a day, most people chosen by the coffin bump are the unwanted of the village, usually cranky old widows who have no family left and are becoming a burden.
“It’s hard to appreciate how powerful their fear of witchcraft is,” says Dr. Woodfield. “The physical ailment always has a metaphysical reason.” He then shares a story about an old lady brought in a few weeks before who had been severely beaten by her neighbours. A child in the village had been bitten by a dog, and eventually died of rabies. The grieving family blamed, and then beat the old lady. “The old lady was controlling the dog!” exclaims Dr. Woodfield.
Malaria, drowning, children falling from trees, dog bites – everything can be pinned on a curse, and the only one who can remedy a curse is a witch doctor. Today, in cities across Zambia, witch doctors can even be found advertising in the classified sections of major newspapers. Lost love, more money, exorcisms, a passing grade, the witch doctor will come to your house in a fancy sports car and fix all that ails you.
Such is the enduring influence of bush medicine that the government established the Traditional Healers Association of Zambia in an effort to incorporate witch doctors into front line of health education. These “traditional healers” are formally educated about malaria, and many now refer patients to clinics or hospitals when they see the symptoms.
But because of Kalene’s isolation and uneducated population, the problems of bush medicine still persist. “We regularly see a catalogue of catastrophes caused by these local medicines, which are pretty strong things,” says Dr. Davies. “And because they’ve got no means of titrating the strength, they can cause terrible trouble.” And this problem doesn’t stop with malaria. “There are many, many other facets of local life that are adversely affected by mistruths that are being passed on from generation to generation about illness,” says Davies.
Not only are untruths hampering the fight against malaria, the misuse of resources, especially the iconic mosquito net, has become a contentious issue. “It’s meant to protect us from mosquitoes, but you find that some people use it as a fishing net, which is a total disaster,” says Muleba. “But you’ve also got people that use the net as a wedding veil and a wedding dress. People are practical. You can’t really blame them.”
* * *
As I left the Northwestern Province of Zambia, I was still lethargic but on the mend, and at that moment I was probably the only person on the planet secretly grateful to have had malaria. I was one of the lucky ones—I was staying in the guest room of a missionary doctor with 30-plus years experience fighting the disease, not trapped in the trance of a witchdoctor, miles from a clinic. Dr. Davies was quick to test my blood, diagnose, and get me onto a course of Coartem, a 3-day, 24-pill dose derived from a 2,000 year old Chinese cure.
“This may sound a hard thing,” Davies told me. “But whenever a visitor comes from overseas, I feel intensely sorry for their suffering. It’s not a pleasant illness, but it’s got one or two good spin-offs and one of the biggest is that then and only then can you appreciate what Africans suffer and consider to be part of their lot in life, something we’d kick against.”
When I arrived in Zambia, I was surprised to discover that most Zambians have had malaria many times, so many they don’t even bother guessing a number when asked—they just smile and say, “oh, many times, many times.”
As word leaked to friends and family back home that I was recovering well from malaria, a common response was, “That still exists? I thought we got rid of that?” It’s true, we did. Although malaria ravaged the armies of the American Civil War, the citizens of ancient Rome and Greece and was almost as critical as oil reserves in both World Wars, prosperous countries eradicated malaria in the 1950’s. But malaria is still the curse of the poor. It’s endemic to just over 100 nations, and half the world’s population, but only the poorest half, the forgotten billions.