New arts and old instincts
On Africa, mysteries, trade-offs, balance, and boosters for all
My body started hollering at me in 2004. I was a Peace Corps volunteer, living alone in a mud hut in Samogohiri, a small village in the southwest corner of Burkina Faso in sub-Saharan West Africa.
I woke in the middle of the night one night, four months into my time there, with a burning in my chest. I’d never felt anything like it. I thought I might be having a heart attack. The next morning, I rode on the back of a villager’s motorbike over a hole-pocked dirt road to the nearest town with bus service. A day later, I arrived in Ouagadougou, the capitol, where I began a weeks-long journey to uncover the cause of my sudden and ongoing pain.
The journey would eventually find me medevac’d from the country and deposited in a hotel room in Washington, D.C. Government doctors poked and prodded me, ran tests, and eventually concluded the valve between my stomach and esophagus had gone slack, allowing acid to flood my chest, and my thyroid had sputtered out like a dead battery. No one could tell me why.
In the meantime, the doctors kept me on a steady stream of strong painkillers. This was before the opioid epidemic reached its tipping point, when anyone reporting any kind of discomfort was immediately and unquestioningly handed large doses of Oxy or Vicodin. I got Vicodin.
Soon I was lying in bed all day in my Peace Corps-funded hotel room, staring into a kind of inky despair I’d never before experienced. It seemed to thicken as I got closer to the bottom of the prescription bottle. Each pill brought, not relief exactly, but a welcome blankness, like a candle being snuffed out. After my diagnosis, they decided I wasn’t fit to return to Burkina, and I was sent home to Minnesota with more prescriptions: acid-blocking pills and synthetic thyroid hormones.
The belongings I’d left behind in Africa arrived weeks later in battered cardboard boxes.
It’s November 2021, just six months since the great swelling of optimism that accompanied the mass rollout of the COVID-19 vaccines we thought would deliver us from evil, and once again the mood is grim. Cases are rising even in places with high vaccination rates, hospitals in Minnesota are again teetering on the brink, and people are rushing back to pharmacies and clinics to re-up their protection with boosters.
There’s a feeling all around that I recognize faintly, like an old acquaintance. This feeling of looking to the experts with an urgent question: “Tell me why! Why is this happening? Why this sickness, this suffering, this fear? What is going to happen next? Isn’t there anything that will give me back a sense of control?”
In the face of uncertainty, we in the western world reach instinctively, and primarily, for pharmaceuticals. If a little didn’t work, maybe more will. Beats doing the harder work of seeing what else might be out of balance. Beats grappling helplessly with the overwhelming, underlying mystery.
A mystery: Why does Africa, the continent with the lowest COVID-19 vaccination rates, seem to be skating through the pandemic relatively unscathed?
The Associated Press reports:
“There is something ‘mysterious’ going on in Africa that is puzzling scientists, said Wafaa El-Sadr, chair of global health at Columbia University. ‘Africa doesn't have the vaccines and the resources to fight COVID-19 that they have in Europe and the U.S., but somehow they seem to be doing better,’ she said.
“Fewer than 6% of people in Africa are vaccinated. For months, the WHO has described Africa as ‘one of the least affected regions in the world’ in its weekly pandemic reports.”
The night I arrived in D.C. from Burkina Faso, I stood for a long while in my hotel room’s kitchenette, bleary-eyed, turning the sink faucet on and off. This thing I’d grown up taking for granted — clean, drinkable water on demand — seemed suddenly like a miracle.
In Burkina, I had to walk to the village well with a bucket, and try to avoid sloshing its contents over the edge as I hauled it to my hut. There, I’d boil it, store it, ration it carefully. The only water I didn’t have to boil was that I used to bathe in the outdoor latrine, pouring it and sponging it over my body in the hot sun. The prophylactic malaria pills I was on made my hair come out in clumps on the rare occasions when I tried to wash it.
Despite my efforts, I still got giardia (intestinal parasites) and a series of bacterial infections that required a more or less constant stream of antibiotics to treat. By the time I flew home, I hadn’t had a solid BM in months. My gut microbiome had been thoroughly decimated. I felt strange in my own skin, hollowed out, and very, very sad.
In The Sleeping Beauties and Other Stories of Mystery Illnesses, Irish neurologist Suzanne O’Sullivan writes:
“Paralysis, blindness, headache, dizziness, coma, tremor, or any other symptom or disability one can imagine has the potential to be psychosomatic. Despite the ubiquitous nature of these disorders, many people still doubt them, considering them somehow less ‘real’ than other sorts of medical problems. I admit, I struggle to see where this underestimation comes from. I am aware of all the ways in which my own body speaks for me, often unbidden.
“My posture changes with my mood. Poorly controlled facial expressions inadvertently reveal my opinion to others. It doesn’t seem a stretch, therefore, to suggest this embodiment of a person’s inner world has the potential to extend into illness. That the body is the mouth-piece of the mind seems self-evident to me.”
It’s maybe a little ironic that I was serving in Burkina as a health volunteer.
My fellow volunteers and I traveled around to various villages, teaching people how to use special straws to avoid contracting guinea worm. Guinea worm larvae are consumed when people drink unfiltered lake and pond water. The larvae then grow into long, thin worms in the gut and burrow outward to the extremities, where they emerge through the flesh. The pain is excruciating. The only thing that helps is submerging the affected body part in a body of water, where the protruding worms deposit their larvae. And thus the whole cycle starts again.
Burkina was full of contradictions to my American eye. It was then the third-poorest country in the world (only behind its two immediate neighbors, Mali and Niger). I was regularly shocked by scenes of desperate poverty and sickness: polio-stricken, disabled adults; severely malnourished children; skeletal people with AIDS in the streets.
And at the same time, there was an easy joy and relaxation that permeated society. People were so open and warm, so quick to laugh, so quick to give and share whatever they had. There was never any question of leaving anyone alone.
When I was in training and living with a host family just north of Ouagadougou, the matriarch of the family (the eldest wife, of many) was almost totally blind. She didn’t speak any French, and I didn’t yet speak much Mooré. But I tell you, we loved each other. We’d grasp each other’s hands every morning and evening and do a sort of mutually improvised dance while singing each other’s names ( o-MO, o-MO, o-Mo, Suz-ANNE, Suz-ANNE, Suz-ANNE), laughing and laughing.
Contrasting with the sickness I saw all around, there was also a glowing, robust health that was truly astonishing. Women effortlessly carrying huge stacks of wood, with buckets of water balanced on their heads and babies strapped to their backs. Men who wouldn’t have been out of place in Calvin Klein ads, swinging scythes like feathers.
Sometimes I felt like it was breaking my mind: the poverty and the abundant joy; the deprivation and sickness, right next to radiant health and strength. All in one inscrutable tangle. How could it be, how could it be?
When I got back and was rattling around D.C. for weeks with nothing to do but kill time between doctors’ appointments, I went a few times to a nearby shopping mall. I’d sit on a bench and look at the slick linoleum, the fluorescent lights, the isolated shoppers, the nauseating excess in this temple of consumption. I’d never felt so lost and confused.
The chronic diseases that dominate western countries aren’t seen much in non-industrialized parts of the world: autoimmune conditions, type-2 diabetes, asthma, coronary heart disease, obesity, hypertension, cancer, allergies, anxiety, depression. We have, however, largely eradicated many infectious diseases in the west. Not many kids in Europe or the U.S. die of malaria, pneumonia, measles, or diarrhea.
This is, obviously, a blessing. But I’m not the first to note that there’s a trade-off here. The hygiene hypothesis (and its more current version, the old friends hypothesis) posit that with increasing hygiene and lack of exposure to common pathogens and friendly bacteria, our immune systems tend toward dysregulation. One of the circulating theories about why Africa isn’t experiencing mass morbidity and mortality from COVID-19 is the prevalence there of malaria, which may have a protective effect and help prevent hyperactivation of the immune system following infection with SARS-CoV-2.
I keep thinking about this quote from Ralph Waldo Emerson:
"Society never advances. It recedes as fast on one side as it gains on the other. It undergoes continual changes: it is barbarous, it is civilized, it is rich, it is scientific; but this change is not amelioration. For everything that is given, something else is taken. Society acquires new arts and loses old instincts."
I think one of the things we’re being asked to sit with, like a sickly, sad returned Peace Corps volunteer on a bench in a shopping mall, is the notion of trade-offs. Whether more is always better. How to get a sense for when enough is enough. Whether balance is possible. And if so, what it might look like.
Here’s the truth: I wanted to leave Africa. I felt my uselessness there like an anvil. My mind and my heart were being stretched to their breaking point, and I did not feel like I was helping, and I did not feel like I could make it through two years. But I’m fucking stubborn and proud, and I wasn’t about to give up. So my body did it for me. I’ve never said it out loud before, but I knew it even then. My body was the mouth-piece of my mind. I wanted out.
It took about a year for me to wean myself off all the meds they told me I’d probably need from then on. My thyroid autoimmune condition remains, but I’ve been able to manage it with diet and lifestyle, despite a number of doctors telling me that was impossible. My reflux sometimes flares like a signal on a dashboard when I’m out of balance. I’ve learned how to heed its warning and self-correct – without acid-blocking meds. I had to learn how to do all of that on my own (with the help of holistic providers and nutritionists) after conventional doctors proved useless.
I’m grateful for the pharmaceuticals that helped stabilize me when I got home. I’m grateful for the protection from the vaccines I’ve received. But I can no longer unquestioningly accept that more is always better, or necessary.
There’s a moment from my time in Burkina I’ll never forget. I walked out the front door of my hut at my host family’s compound, and saw my favorite little girl sitting there in the dirt. Her name was Sandrine. She always ran to sit on my lap. She was quick and bright and charming. Her family saw how much I connected with her and kept offering to send her home to the U.S. with me.
This day, I walked out and saw her sitting there, clutching her leg to her chest and crying. There was a big, open wound on her knee, and it was crawling with maggots. I crouched down, I looked, I held her. She looked at me with giant, teary eyes, and I thought about the Peace Corps-issued First Aid kit I had in my room. It had antibacterial cream, bandages, everything I needed to fix this.
But then I remembered what they had told us early on in training: We must not share our First Aid kit with anyone else. It was for us and us alone.
You see, it wouldn’t be sustainable for us to swoop in and try to fix all the problems, all the individual wounds and diseases. We were there not to give a man a fish but to teach him how to fish. If we started trying to fix all the open sores around us, the First Aid kit would quickly run dry, and then what? No one would know how to help themselves, and how would we help ourselves? We had to look out for number one.
So I stood up, and found Sandrine’s mother, and told her about the wound, and how she really should take Sandrine to the local clinic. It seemed unlikely that she would. I kept walking, leaving Sandrine and the stupid, useless First Aid kit behind, and something in me broke.
That broken place aches now like an old, angry injury amidst this massive push for booster shots for even young and healthy Americans. All these invitations to share selfies of yourself getting a third injection, with the hashtag #MinnesotaHero. As if this is morally unambiguous. As if the way forward for “good people” is indisputable and clear. As if there are no trade-offs here.
(It’s easy to miss in the constant drumbeat of encouragement to “get boosted,” but there’s active disagreement even in the scientific community on the wisdom of this approach. The top two vaccine experts at the FDA recently resigned, citing political pressure to authorize boosters for all against their best scientific judgement. They just put out this op-ed in the Washington Post about why universal boosters are not only unnecessary but potentially counter-productive.)
It’s been nearly two decades since I walked away from that injured kid, since I got so sick, since I found myself suddenly struck by the miracle of clean, running water and appalled at the isolating excesses of the society that provided it. I’ve learned a thing or two about attending to my own moral compass, and my own sense of what it means to be well. I’ve learned about weighing input from the authorities (who are always so sure, until they’re not), and then deciding for myself.
So, no. I can’t bring myself to #GetBoosted. I’m protected enough, at least for now. I’m as safe as a person can be in this world.
We each need to do what feels right. But let’s not pretend we’re not blindly groping our way forward through a mystery. And let’s not forget that the sturdiest thing we have to hang onto is still each other’s hands.
Trade-offs and balances. "For everything that is given, something else is taken." This is my instinct with regard to medicine's primitive, but ever-burgeoning attempt to "protect" the immune system from its job - negotiating hazards. Every prevented encounter with hazard - not a simulation of hazard, but real hazard - corresponds to a degree of competent function not attained. Life without risk is life without reward.
My cousin was in the Peace Corps in the early 80's, in Sierra Leone. She had some wonderful as well as scary stories. She's one of the few people I know with whom I can talk about alternative views of what is happening now. She is not firmly entrenched on a side. Thank you for this piece.