Eli, the Rough Guide to Malaria

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Sooner or later, everyone who consciously wants to travel to Africa will have to consider this topic. Malaria, the infamous infectious disease transmitted by mosquito bites, is widely spread in (sub-)tropical areas and some of the worst types are likely to be found in the Forgotten Continent. As in severe cases an untreated infection can not only cause fever and headache but lead to coma and death, it is highly recommendable if not essential to try and prevent contamination, means reducing the risk of mosquito bites to the absolute minimum.

We thought we were well prepared. Cautiously, we always sleep under mosquito nets, we use a lot of repellent, we avoid exposure at dusk and we mainly wear light and long clothes. Furthermore, we take Malarone for prophylaxis, which is said to considerably reduce the probability of an onset in case of contagion. And the methods turned out to be successful. Since our arrival to Africa, Steffen and I hardly got more than 5 mosquito bites, and Eli – even more thoroughly applying the preventive measures  – just has been bitten once at the beginning in Dar Es Salaam. And anyway, malaria usually breaks out at least one week and up to three months after a bite, so we could go to our safari without worrying at all. An extremely unlikely case of malaria would definitely not occur during the rides through the national parks before reaching a rather developed civilization again.

Unfortunately, we soon had to realize that this feeling of security was not justified. Actually we were not well prepared at all. Or to be more precise: We knew how not to get malaria, but we had no idea how to behave and what to do if you do get it after all. On the last day at Katavi National Park, Eli began to feel very tired and later became sicker and sicker, with increasing fever and a painful feeling. First, we were convinced this would be due to the consequences of a sunstroke, but we decided to be on the safe side and drove back to Mpanda to have her make a malaria test. At least we knew that it is advisable to go and have malaria tested whenever you have fever in such areas. And then came the big shock: The most improbable explanation for Eli’s ill-being had become true. The diagnose was positive, with a level of 7 malaria parasites per 200 white blood cells.

Apart from the advice that if you have malaria you should go to some local doctors who know what to do, we had no idea of the correct behavior in such a situation. What did the concentration level mean? Was it really high or rather low? How can we treat the symptoms and eventually cure her from the disease? Especially for Eli, who had heard many horror stories about the course of malaria, this was a very tough time. Her panic was growing because literally she feared she could die in the following days. She truly had some terrible hours.

To make things even more complicated, we were at the most remote place of our whole safari. Obviously, the doctors had never had a white patient before and did not really seem to know what to do. They appeared to us rather surprised why Eli felt so bad, they recommended taking some painkillers to lower the body temperature (which indeed was a good idea and helped improving Eli’s state), but they were totally astonished that we would take Malarone for prevention. They told Eli now to take a higher dose, but we saw that this was simply a wild guess. Using a tediously slow internet connection, we managed after several hours to contact Steffen’s family and via them a doctor. He informed us that if you take Malarone as prophylaxis, it is important to change the medication for the therapy.

Later, our guide Hussein (who during all this period was an important support for translating, organizing and comforting) explained us that from birth on, each African normally has a steady concentration of about 10 parasites per 200 white blood cells and that for them, malaria starts being a real issue when the level increases to around 20 parasites. That was the reason for the doctors to be so confused about Eli’s state, they could hardly understand what was going on with this white person who did not have anything but a normal, not alarming result at a malaria test. So the next morning, we decided to take the 700 km looong and exhausting bus ride to Mbeya, where we would encounter the first hospital with much better educated doctors.

Thanks to painkillers, Eli could bear the main part of the ride without bigger problems, but the last hours became quite difficult for her. Nevertheless, we finally arrived to Mbeya after 19 hours in an uncomfortable bus, delayed but alive. We headed straight to the clinic and were attended directly by a friendly and competent doctor. For the first time, we felt ourselves to be in good hands. The doctor had had experiences with white patients before or at least perfectly knew how to treat and cure the infection. He prescribed 3 doses of quinine (the stuff Tintin already had given to some Congolese and which is also used in Tonic Water), which Eli had to get injected in 8 hours intervals. Afterwards, she was given other tablets, Artequick, which she took the next two days. For the whole investigation and all medicaments, we had to pay 16 €. And as promised, she completely recovered from the disease – the ultimate test resulted in negative. She had some tough side-effects, but it is wrong imagining her lying in a hospital bed. Already after the first injection, her state improved considerably and there was no necessity for taking painkillers. She relaxed one day in the hotel room, then we had a half-day long bus ride to Ruaha National Park and the last day of her treatment she spent on the safari, adoring lion babies.

What we have learnt: Understand that in Africa, malaria is part of the everyday life and that locals will be more tranquil about this issue. But for Europeans, malaria is serious and you should not take it easy and be casual about it. Protect yourself as much as possible from mosquito bites. Instantaneously go to a good doctor for further examination whenever you feel symptoms like headache or fever. But don’t freak out if despite the measures you should still get this infectious disease. Panic and horror stories are never helpful, keeping calm and serene is a lot more important in such a situation. Well treated, malaria is most likely to cure without lasting consequences. Yes, approximately one million persons die of malaria, many of them being African children. But we saw where they come from and where they live. In Ikola for instance (the village where we disembark the Liemba and where Eli took the cute picture with all the children), the next medical facility is at least perhaps 3 walking days away, people don’t have the time and the money to take their children there and in most cases a fever would not even be noticed.

Before we finish, we would like to thank all the persons who, near and far, helped us dealing with the situation. Thanks to our guide Hussein for always being present, missing his deserved meals and his night’s rests. Thanks to Damaris, Jochen and Dr. Hachmann for the assistance, guidance and all advices sent from Germany during a sleepless weekend and thanks to Karli for maintaining the remote communication online and for the mental support. A special thank you goes to Nadja who had given me a realistic and first-hand estimation on the actual course of the disease but also a valuable and reassuring opinion about prevention and treatment. And admittedly, we have to apologize for not having sufficiently informed ourselves about malaria and for simply having hoped not to get it.

Tanzania’s Wild West

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We had not come to Kigoma just to experience an exciting bus ride. The city was the base for our trip to Gombe National Park, which is located at the coast of Lake Tanganyika, about 2.5 hours by boat north of Kigoma. Already before starting our adventure in Peru, we had organized our safaris and prebooked a guide, Hussein. So now we were in the quite new position of not having to plan anything – it was nice after all not to have to worry about how to go on.

Our aim in Gombe was to see the chimpanzees. We were told that you have to walk 2-3 hours trough the forest and that sometimes you need a second try the next day. Usually you only get a glimpse of them while they jump through the trees. So we started our long walk. After maybe ten minutes our guide asked a researcher, who was responsible to keep track of the chimps, whether he had an idea in which direction to go to see them. He simply nodded indifferently towards a trail 20 meters away: a whole family was sitting here, perfectly visible on the ground and relaxed. At least since Jane Goodall this group is used to humans, so it turned out to be pretty easy to watch them. In fact, they are fascinating animals. They just sat there, the babies climbed onto the adults, they played and picked the fleas. Chimpanzees are flexible when it comes to food: they eat plants, fruits but also some baby baboons. They even mix meat with some vegetables, so their menu is much more sophisticated than in any Tanzanian restaurant. Sometimes, they eat Amarula, a fruit that makes them drunk and helps enjoying their time even better. They have such a relaxed life that we wonder which of the chimps was the first to have the stupid idea of starting the evolution towards a human being …. Given we achieved our goal that quickly, we spent the rest of the day walking to a waterfall and lying at the wonderful beach near the research station. Continue reading →

To Kigoma with “Adventure Connections”

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In the previous post we had already announced to have a looong bus ride to Kigoma ahead. And we were not to be disappointed, the journey was exactly as adventurous as it should be when you go to the place where Stanley met Livingstone. We had to be at the bus station at 5:30 in the morning, where the bus would leave at 6. This was approximately the time when nearly every other bus at the terminal left. But ours took time until 7 to appear. Then we needed an hour to embark because passengers had too much luggage with them and it was total chaos. Each thing they do here you have the feeling they do it for the first time. Eventually we started our 1500 km trip.

We lost one hour in the traffic jams around Dar Es Salaam, another 30 minutes at several police check points and the same amount of time at various bus stations on the way, where they were forced by law to make pretty senseless halts. Yet the best was still to come: Around midday, not more than 200 km away from Dar, the bus had a breakdown. We waited and waited and were quite surprised that after another hour they managed to repair it. We were supposed to arrive in Kahama at 5 in the afternoon to spend the night there and avoid a night ride. We estimated how delayed we actually would arrive but all guesses were much too optimistic – we reached Kahama at 1:30 in the night, after some horrible hours for Eli (who otherwise proved to be very brave). The next bus would go at 5:30 and all hotels were closed, so we slept on the dusty ground directly at the bus station, in the cold and with the music of the adjacent “Chipsi Mayai” restaurant. Continue reading →

Ramadan in Zanzibar

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Considering our experiences with Ethiopian, one could expect we would have been happy to leave the country. The contrary is the case. Back in Addis Ababa, we even regret not to have more days there. Our great couchsurfing host Ahmed turned out to be such an interesting person that we would have loved to spend more time with him, listening to and learning from his stories. He actually is from Yemen, but grew up in Quebec in Canada. After finishing his studies, he managed to make his jobs follow his way of life – and not the other way round. Working for NGOs, development or environmental companies or foundations, among others he has lived in Brazil, France, Israel, Gaza, Sudan, Djibouti, Somalia and currently is in Ethiopia. He had so many things to tell about the experiences he made from all over the world, and even better he was still really down-to-earth and interested. We enjoyed the short but great time we spent together, are very thankful about his awesome hospitality and definitely hope to meet him again – wherever it may be.

Before seeing the “real” Tanzania, our next destination was Zanzibar, island famous for its paradise-like beaches, birth-place of Freddy Mercury and also known for its infamous history as center of slave-trade. We had expected Zanzibar to be rather unauthentic and “made” for tourists, but we were positively surprised and in fact are glad to have been here. Of course, there exist expensive beach resorts and the typical souvenir-streets with some touts hanging around. Yet, the island has not given up itself and kept a lot of its authenticity, tradition and charm. The atmosphere in Stonetown was quite relaxed and calm, especially due to ramadan. Nearly 95% are Muslim and Islam plays an important role, influencing the everyday life of the population. During the day, all local restaurants were closed and most inhabitants tried to find some seat in the shadow to have a rest or talk with friends. But in the evening a bit before sunset, it was like the whole town would wake up and prepare for the big event to come. You could smell the freshly cooked food at each corner and feel the anticipation that fasting would be over soon. Also at the main park, street food vendors built up their selling stalls and then started selling some specialties to the tourists. Even if – compared to the remote untouched areas where the locals meet – this place was more touristy with slightly higher prices, the ambience was still nice and enjoyable, mainly because here the tourists seem to be keen on having a local experience and mixing up with Zanzibar’s people. Continue reading →

Yet Another Complex Country to Sum-Up

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Unbounded Possibilities, Limited Realizations

No, this is not a story about starving children. We know that this is the picture many Europeans have of Ethiopia, but it is a pretty unfair one. In fact, Ethiopians have lots of reasons to be proud of their country. It is often ignored that Ethiopia has one of the longest and most interesting histories in the world. Although not everything they sell as history is true – probably they do not host the “Ark of Covenant” and their kings did not descend from the biblical Salomon – what stands the test of science is still impressive. First, it is the cradle of humanity and the place where Lucy was found. The old kingdom of Axum (in northern Ethiopia) was considered to be one of the four most important empires of the first centuries, together with China, Persia and Rome. Later the Ethiopian kingdoms had relationships to Portugal and France, defeated both the Ottomans and the Italians and remained the only African country to resist colonization.

The landscape here can take your breath away, too. Usually it is nice, friendly and green, but also spectacular canyons and mountains are on offer. You see so many diverse wild animals and for ornithologists it must be paradise. It often is a nearly perfect idyll: there is no motor noise, donkeys, mules, cows and sheep cross the streets and farmers plow their fields with self-made wooden plows and two oxes. Further, everyday life is full of culture and Ethiopians know how to have a good time together. They have their own music and dances and are ready to smile and laugh. Ethiopian food is very special and tasty, you find good pastries but they also skilfully adapt international cuisine – preferably from Italy – and you do not get sick of it. Even the smallest and cheapest café is carefully furnished and will have some charm. And definitely it will have a professional coffee machine to achieve the high standards of Ethiopia’s aromatic coffee culture.

Ethiopia is a dynamic country. They have doubled their GDP per capita in the last ten years, houses and roads are built everywhere and Addis Ababa is growing as fast as any Chinese city. Ethiopians are enthusiastic about the new Nile dam they are about to build and that will solve almost all of their electricity problems. Sudanese and Egyptians are a bit less enthusiastic.

In general, people turned out to be really polite and surprisingly well informed. They’re very open, you easily get into a conversation in a café or elsewhere, small children love greeting and waving to foreigners and the quite high level of most Ethiopians’ English skills facilitates communication. Usually the ordinary street vendors accept a polite “No, thank you”. Especially after Nepal and India, the overall atmosphere is calm and agreeable. However, mainly two problems make travelling through Ethiopia a bit hard and sometimes annoying. One is rather technical and might change over time, the other is deeper rooted.

First, there is nearly no infrastructure for tourists, above all for backpackers or budget visitors. It is complicated to get reliable information about sites, distances are large and just a few main roads are paved. Still worse, government regulations sometimes make travelling even harder by forbidding to use the infrastructure which is existing. Excursions we were interested in were usually tailormade or at least had tailormade-like prices. Maybe it is much easier to travel here with an organized tour, but then you can be sure that the wrong people will get the money. And if you are willing to pay incredibly high prices, it is often better to do it somewhere else because most sights do not justify such expenditures. If you can afford it, maybe it is best to explore Ethiopia with a hired vehicle to be independent and have time to see the countrysides.

The second thing is that Ethiopians are very proud of their hospitality. Honestly, there is no reason for this and in fact, Ethiopia competes with Nepal for the last place in that ranking so far. “I like foreigners because they have dollars” one of our bus drivers said to us, and that might be the best definition of Ethiopian hospitality. Yes, as said before, they are polite and friendly and will help you with anything, for example by translating in a shop. Unfortunately, then you will pay more, and not just 10% to 20% but the threefold or fourfold. With the remarkable exceptions of cafés and restaurants, everywhere they will demand “faranji”-prices and they will tell you almost anything to make you accept their demands. We argued a lot about fair prices and almost never received support from some locals (really different from India, by the way). When it comes to ripping off a foreigner, they usually stick together, and you have dozens of Ethiopians lying to you. Only once or twice some passengers in the bus helped us and told the driver not to overcharge us – and these people then made our day. But generally speaking it is like this: in China, where they also had a different language and a different alphabet, they doubled their efforts to help us when they realized we were not familiar with the country. In Ethiopia they double the prices.

Perhaps it is too hard to say that there is no hospitality. Perhaps they simply forget it when they are tempted by foreigners’ money. Again, we are aware that we must appear incredibly rich to them. Even though we have not seen extremely dire poverty, the country is totally underdeveloped and life must be harsh. It is cold in the mountains and fuel or wood is rare for heating. The next town may be a day away by walking. Cultivating fields appears idyllic but it is physically exhausting, like most of the work here. Nonetheless, we think that hospitality has little to do with income. In fact, our great couchsurfing host Ahmed could tell us from experiences he made in Somalia and Sudan. There, the clans and locals did everything to treat him as a guest and refused to take money. Here, normally the beggars and cheaters are not the poorest in the country. They are bus owners, well-dressed touts, children asking for a new football or young students requesting at least a 200 EUR scholarship per month for their education. In Ethiopia, more than in any other country we visited, they are deeply convinced that it is the white man’s burden to give the black man money. They expect it from us and are truly disappointed when we do not give anything.

Hidden in the countryside, surely most people do their hard work. But in the cities and tourist spots, too many people here hold this truth to be self-evident that work is not a mean to get rich. Working is something for women and old people. Those were the ones we saw carrying the heaviest weights and simply doing their work without complaining, and moreover they were smiling and greeting friendly. Contrasting this, lots of young men hang around idly, some of them waiting for a tourist to rip off. It is not that they are lazy, they invest a lot of effort in overcharging us, but they have no initiative in building up something with a larger time horizon. There are so many things we happily would have paid for, unfortunately no one had the idea of earning money with these services. The only touristy infrastructure that really exists are the officers standing at each tourist spot, even in the middle of nowhere, demanding quite high entrance fees. Maybe corruption discourages potential entrepreneurs, perhaps it also is just more accepted to rip off “faranjis” than providing services for them.

To conclude (*sigh*): Ethiopia is the first country where we are truly not sure whether one should visit it or not. Elsewhere, tourism had side-effects, but it provided income to many classes of people and it enlarged the horizon of both the travellers and the locals. Here, mainly the wrong persons benefit from it and tourism enhances the demands more than income, making people less satisfied than before. Given that honesty and fairness seem to be high values, we had the feeling that our presence rather brought out the worst out of Ethiopians.