Vectors and Volunteering

 I hesitated before swatting the mosquito on my ankle. It’s not that I like mosquitoes or I have some weird masochistic fetish about itching and things sucking my blood; I wanted to identify it. It was an Aedes aegypti, the species known to transmit the disease yellow fever.

Aedes aegypti on my finger

Yellow fever is a virus that manifests itself in the same way that zombies or the “possessed” are portrayed in horror movies. The initial stage begins with the common “flu-like” symptoms that are characteristic of many viruses, but then the disease rapidly progresses and the tell-tale symptoms present themself. One of the first signs/symptoms that distinguish yellow fever is intense body pain, often described as if your body is being slowly broken in two. This pain is often accompanied by pronounced psychiatric symptoms such as extreme irritability with restlessness. Soon after, your eyes go bloodshot and the liver begins to fail. This progressive liver failure causes jaundice, the yellowing of skin and eyes, for which yellow fever gets its name.  Around this time, hemorrhagic symptoms occur and blood usually begins to ooze from the eyes, nose, gums, and mouth. In its final stages before death, internal hemorrhaging spills blood into the gut causing the characteristic “black vomit” clinically known as hematemesis. I find this progression easy to visualize due to such movies as The Exorcist and 28 days later. Think about it: the yellow skin, violent jerking, projectile black vomit, irritability, weeping blood – if I were living in the days before  “germ theory”, I could see someone calling a priest to “exorcise the demons”.

Yellow fever is a vector-borne disease, meaning that it is not directly transmitted from human to human. In fact, in the early days of research people would volunteer to sleep in the black vomit covered beds of yellow fever victims in order to further the scientific knowledge of this disease’s transmission. In order for this virus to be spread, a vector is needed; in this case the vector is the mosquito. I have never actually seen a person suffering from yellow fever and I’m thankful for that. The vaccine and persistent vector control measures have done a good job of subduing this disease. Nevertheless eradication is nearly impossible because the virus has a reservoir. In terms of infectious or communicable disease, a reservoir is an organism where a disease can live and multiply while waiting to be transmitted to another population. In the case of yellow fever, the reservoir is certain species of monkeys. In forest and logging cultures there are oral traditions that warn of the dangers of felling a “quiet” forest. This is because mosquitoes that kill monkey populations with yellow fever remain infectious for their lifetime. Thus logging activities can easily bring those mosquitoes to ground level, subsequently causing an outbreak.

Prior to joining the Peace Corps, I worked with the San Diego County Vector Control and Surveillance Program (SDVCSP). Although there has not been a large outbreak of yellow fever in the Americas for over 50 years; San Diego and much of the U.S. battles with periodic outbreaks of mosquito-borne encephalitis viruses, such as: West Nile Virus (WNV), St. Louis encephalitis (SLE), and eastern equine encephalitis (EEE). This class of vector-borne fevers has the potential to be life threatening in vulnerable populations; however, many healthy adults that are infected only suffer from a flu-like illness and recover without out knowing they ever had it. Some others become very ill and die.

The study of vector-borne disease transmission is fascinating and plays a much larger role in human history than many realize. For example, when Philadelphia was the capital of the U.S. it was completely abandoned due to an outbreak of yellow fever where it has been estimated that ten percent of the city population died. Legend has it that even George Washington fled the city in fear and that he alone returned on horseback to pronounce the city safe again (for more read: Bring Out Your Dead by J.H. Powell). The slave revolt on the Amistad is speculated to have happened because many of the captive slaves had acquired immunity to yellow fever in their childhood, while the slave traders had not. Likewise, many of the important battles in world history were decided based on who was hit hardest by a mosquito-borne disease, mainly malaria. During WWII, General Douglas MacArthur said himself that at any given time, two-thirds of his fighting men in the South-Pacific were debilitated by malaria. In response MacArthur would seek the aid of Dr. Paul Russell, the leading expert on vector-borne disease. After a rapid assessment, Russell found that the military had all it needed (training, prophylaxis, etc.) to effectively combat malaria. However those who were trained in the task of fighting mosquitoes were seen as peripheral to the war effort. In addition he noticed troops were not taking their prophylaxis. Russell’s basic recommendations were that commanders be responsible for troops taking the malaria prophylaxis and mosquito fighters be given logistical priority. MacArthur issued an executive order based on these recommendations and soon after the malaria rates declined and US troops became healthier than their foes. (For more read: Mosquito, Speilman and D’Antonio, 2001)

I’m in West Africa now, the veritable motherland of mosquito-borne disease. In pre-colonial days this region of the world was known as the “white man’s grave,” due to the high probability of outsiders becoming infected and dying of the endemic vector-borne diseases. Fortunately, I have all the vaccines and prophylaxes to help prevent most of these illnesses. Unfortunately, our local friends and neighbors are periodically subjected to bouts of these often fatal illnesses.

Anopheles larva in the village

Showing the children

 So as a fieldworker and Volunteer in the United States Peace Corps what exactly can I do to help? 

What most fieldworkers do is to go to the field with a grounding in the theory of the discipline, especially in the sub-area of their interest, and with as much knowledge of the region as can be derived from secondary material. The field then takes over, and the outcome depends on the interaction between the fieldworker and the field. (Srinivas et al., 1979 pg. 8)

… and especially the rural people who live there.

Only three-months in and I’m starting to understand the Peace Corps mantra: “The hardest job you will ever love”

It is and will be challenging work. I have been educated and trained for this. I have many “sub-areas” of interest that relate directly to present issues of environmental health, anthropology, and development; but most importantly I take comfort in the fact that I enjoy what I’m doing.

Mekyiamu (Greetings)

In the time since our arrival, we have had a very busy schedule.  My day begins at 5:30am. Monday, Wednesday, and Friday I usually go for a 30 minute jog with another volunteer, Ryan Amico. Afterward, I eat breakfast and take a bucket bath. The bath, for which I do multiple times a day depending on the heat, is one of my greatest pleasures here. There are few things more revitalizing in this tropical weather, than a good cold water bucket bath.

After the morning bath, Malia and I sit for breakfast which is prepared for us by our home stay mother. Mama Ofrewa. Her hospitality, good nature, and cooking has made the monotonous Peace Corps training more than bearable.

Our household is made up of six individuals that “live” here on a regular basis. Kofi is our homestay brother. His age remains a mystery, but he assures us he is somewhere between 24 and 26 years old. He is a handsome young man and his personality reminds me of many people I know back home, it’s nice to be able to laugh when the subtle similarities present themselves.  

Grandma or “Nana” (a title of respect based on age), is a feisty 78 year old woman who is still very active and strong. If not at the homestead yelling at goats, chickens, and children; she is most likely at the farm working. An aunt and her granddaughter live here as well.

Nana Grace

 Lastly there is Ama, the orphaned child of some extended family members. Ama Is no more than 9 years old, but has a demeanor and sense of responsibility greater than many twenty-somethings I know in the U.S. Unfortunately the life of an orphan here is a difficult one, but relative to other orphaned children I have heard of, she is happy and well taken care of.

Ama

The workday begins at 8 am and ends at 5pm, six days a week. I won’t go into the details for both your sake as a reader and my sake as a trainee on his day off. The training has had its ups and downs. It is often frustrating, but what is important is that the trainers here care about their jobs and us and it shows.  We are also the first group to be put through this specific training schedule, so many of the “bugs” have yet to be worked out. This is understandable and perhaps, the most practical form of training – lessons in patience and flexibility.

One Note: I won’t be updating the blog too often while in training due to time constraints. I will also add more photos when I get to a location where the internet connection is faster. 

Staging Complete

Today we had our Peace Corps staging event. Our cohort met for the first time and as a group reviewed the mission, core expectations, and fundamentals of Peace Corps service. Staging seemed to be an "essential formality" and I'm sure in the past it was more critical.
Prior to the event Malia and I did some exploration of old Philadelphia. As we explored, I noticed many familiar faces from Facebook and knew information about many of the volunteers before we formally met. It was an interesting phenomenon to see someone in passing, 3000 miles away from home, and know fairly intimate knowledge about them without ever actually meeting them. I kept wondering if social media, the internet, and our level of electronic communication, essentially made the staging event obsolete. I'm certain it is not what it used to be. However, the sensation of meeting complete strangers with whom you are going to travel across the earth may not be as dramatic, but is no less important than it was in '61.

EcoHolos

My friend and classmate Dr. Nathan Daley recently contacted me. It jarred my memory about his views, efforts, and experience with medicine. Health, plain and simple.

Check out his website : http://ecoholos.com/

Waiting, Packing, Thinking...

In our final month before departure, the Peace Corps correspondence has dramatically increased. Our cohort is posting daily with various questions and concerns about departure and packing. I imagine that this is typical. We are also receiving numerous emails from the Peace Corps, ranging from travel arrangements to dress code for staging. A recent email was about blogging, a portion reads:

You will have good days, and you will have bad, and you will be communicating through them both. The message you portray through your correspondence with your family and friends is open to a wide range of interpretation. They are thousands of miles away, and they have not had the same experience, so what will become normal to you may be interpreted much differently by them. Whatever you write will be viewed by more than just your family and friends, so it is very important that you consider what you say and how you say it before you send it. Consider the following examples:

A. You have just witnessed a group of children take slingshots and shoot a cat.
B. Your host mother works from sunrise to sunset making meals, washing clothes, and farming while your host dad sits under the hangar drinking tea.
C... and so on...
This statement is very true. It also reminds me of a book I skimmed a few months ago called, Hint Fiction.

Hint Fiction is a collection of short stories in 25 words or less that tell a tale by enticing the reader to fill in the blanks. I like anything thought provoking... I'll give it a try.

Hunger Pangs by Luke Campanella

"We're out of food," he said. In the distance, a group of children take a slingshot and shoot a cat.

Invitation: GHANA

In the time since our nomination to the Eastern Europe region I have had: 4 teeth pulled out, gone through a battery of medical examinations, and experienced a form of psychological warfare that is predicated upon a long dance between high expectations and uncertainty.

On Friday, we received a call from our placement specialist (PS) in D.C.

We were asked (again) about our commitment to the Peace Corps. As if having 4 teeth pulled wasn't enough, they wanted to hear you say it! - We are TOTALLY committed.

Our PS then went on to ask about our "willingness to serve in an area without running water or electricity" - No problem.

PS:"Do you have any problem with biking or walking as your primary mode of transportation?"
 - We can't wait to get away from our cars.

PS: "Ok - the region you were originally nominated for has been filled"
- YESSSS!!!(but we didn't say that).

PS: "So we have openings in Sub-Saharan Africa.Is this ok with you?"
- YAY!

PS: "Great you are invited to serve in Sub-Saharan Africa"
-Great!!!, Where exactly?

PS: "Oh we can't tell you over the phone, your going to have to wait for the invitation kit. We will mail it Monday"...

I think she forgot that the following Monday was a fed. holiday. So, after an additional week and a half we got the package.

It reads:

Dear Luke and Malia:

Congratulations! It is with great pleasure that we invite you to begin training in Ghana for Peace Corps service. You will be joining thousands of Americans who are building stronger communities around the world. This call to action gives you the opportunity to learn new skills and to find the best in yourself...


 GHANA!!!! Of all the places in the world. Peace Corps sends us to the one country where one of my best friends is living - Douglas La Rose.

We have shared an unforgettable experience in the Western Solomon's together and now we will meet in Ghana. With the help of our friend, I truly believe we will be able to hit the ground running and accomplish our goals.