IT HAPPENS – The Trouble with Worms in Africa

“It’s not contagious,” I repeated, as friends backed away from me in horror.

I couldn’t resist telling a travel tale involving skin-tunneling parasites. In turn, my friends couldn’t resist shifting back just a hair, although they insisted they understood there was no chance of worms leaping from my body to theirs. It didn’t help to explain that I wasn’t even sure I had schistosomiasis.

“Schi-what?”

Catching schistosomiasis, or bilharzia, requires snails and a body of fresh water — where worms can swim from snail hosts to human hosts. In 2001, the creatures hunted me down in Malawi, a country that offers a useful word for such situations: zimachitika. Loosely translated from Chichewa, zimachitika means, “It happens.” This word reflects the easy-going attitude of Malawians, known in guidebooks as “the friendliest people in Africa.”

Zimachitika means “It happens.” It reflects the easy-going attitude of Malawians.

I was eager to meet people with such an open-hearted reputation. I was equally eager to visit their legendary lake, which covers one-fifth of the country: Lake Malawi.

Lake Malawi covers one-fifth of the country.

I spent my first few days on the hushed, sandy beach of Nkudzi Bay, at the laid-back K Lodge. The K sits next to Mwanyama, a poor but pleasant village of thatched huts, where fishermen repaired hand-carved wooden boats, women giggled at the water pump, and children played soccer with a sphere of wadded paper and plastic. It looked like a Hollywood set.

In the village of Mwanyama, fishermen repaired hand-carved wooden boats.

The irresistible water appeared more like a tropical ocean than a lake. I found it hard to imagine danger could lie squirming beneath that perfect surface. The South African lodge owners assured me that Nkudzi Bay had no worms. So I barely hesitated on the slender beach before swimming to the diving float. I jumped repeatedly into the water, fearful only of water up my nose.

Back at the lodge, a group of English schoolteachers from Blantyre gave me a quick lesson in Malawi’s culture, which accepts life’s risks along with its joys. They explained that zimachitika doesn’t simply mean, “It happens,” but embodies a pervasive attitude of acceptance that can apply to anything, from a broken dish to the death of a loved one.

On my last morning, Greg, one of the lodge owners, said he thought he’d caught the night guard sleeping on the job. “But when I shook him, he was dead.”

I laughed, thinking he meant “dead to the world.” Then it dawned on me, “You mean dead dead?!”

“Yeah.”

“As in no longer living?”

“As in heaven and hell,” a young woman guest from South Africa offered, pointing up and then down to emphasize the idea.

“Oh, I feel bad. I misunderstood you. That’s terrible!”

Greg seemed surprised by my dismay over such a commonplace event. “Yeah,” he said casually. “You know the average life expectancy here is only 37.”

Odds are the guard died of either malaria or AIDS, both rampant in Malawi. Most deaths are explained by the simple heading: “fever.” I began to understand how easy it would be for Malawians to embrace the fatalistic view of zimachitika.

As a backpacker, I’ve learned to expect the unexpected. So I decided zimachitika would be a good attitude for me to adopt, too, as I hitched a ride to Cape Maclear, a scruffy backpacker resort. There, I hooked up with Kayak Africa for a paddle to a luxury camp on one of Lake Malawi’s lovely islands.

I hooked up with Kayak Africa for a paddle to a luxury camp on one of Lake Malawi’s lovely islands.

Mumbo Island was tiny, easy to circle in a single kayak in about 45 minutes. The camp sat on an outcropping of rock, linked to the island by a wooden footbridge. Each of the five walk-in tents commanded a different view of the lake and had a deck with a hammock. There were only two other guests. Each day was a lazy collage of lying in the hammock, kayaking, snorkeling, and swimming. Each night, we ate gourmet camp cuisine in the open-air lounge, bathed in the soft glow of hurricane lanterns.

The camp sat on an outcropping of rock, linked to the island by a wooden footbridge.

It was at this paradise that the demons I’d forgotten attacked. The wicked little flatworms, called schistosomes, penetrate the skin and float through the bloodstream, growing and laying eggs. The eggs then travel to the bladder, intestines, and liver. Symptoms of infection, such as fever, chills, cough, and muscle aches, are caused by the body’s reaction to the eggs.

Among parasitic diseases, schistosomiasis ranks second only to malaria as a threat to public health in tropical and subtropical areas, according to the World Health Organization. The disease is common in 74 developing countries, infecting more than 200 million people. Travelers are becoming infected more frequently as it becomes more popular to travel off the beaten track. Staying out of lakes and rivers can help prevent it. But it’s possible to get infected simply by using fresh water for drinking or showering.

The bad news: symptoms often don’t appear until the disease has done irreversible damage. The good news, at least for an American with insurance: the disease can be detected relatively early by a blood test and cured with a two-day course of pills.

When I first read about schistosomiasis, I was sufficiently disgusted to decide I wouldn’t swim in Lake Malawi. That was before I saw it. I’d never imagined a lake could have water so clear or fish so unusual. More than 600 species of tropical fish live in Lake Malawi, and many don’t exist anywhere else in the world. Some have spent so many generations evolving in one group of rocks that their species can never venture more than a few feet from that spot. I felt privileged to see these brightly colored rock-dwellers, called mbuna.

On day three, the worm turned. I hiked to a secluded rocky beach, where I stepped into the water among tiny, toe-nibbling mbuna. Then I swam to a small boulder, where I climbed up to sit in the sun. I felt pleased with my solitude. But I was not alone. Something tickled my hand. When I glanced down, I was horrified to see several minuscule red worms crawling there. They were so tiny that if they hadn’t been red I might not have seen them.

I quickly brushed the creatures off in disgusted panic. But not all of them came off. At least one was tunneling under the skin of my knuckle. My survival instinct kicked in. I dug in with my nails and tore off a piece of perfectly good skin in my revulsion and desperation to get the thing off me.

The crystal clear lake lost its appeal. I gazed down at the water in terror for a moment, realizing I had to jump into it again to swim back to shore. Then it dawned on me that the worms might live on the algae-coated boulder. I scrambled off the rock and swam about 15 yards to the beach. When I reached land, I toweled off faster than ever before, wildly performing the yuck-I’m-so-grossed-out dance.

Three days later I was back in Denver. The U.S. Centers for Disease Control advises waiting six to eight weeks after exposure to schistosomes before taking a blood test. Relatively early detection now seemed relatively interminable. Through the long wait, I wondered whether worms were swimming in my bloodstream, whether they’d laid eggs, whether nests of larvae were nursing on my liver.

When I told my doctor the test I needed, he had to pull out a medical text to look up the disease. The lab technician didn’t even know how to pronounce schistosomiasis. The test came back negative, but my confidence was low.

Two months later I insisted on another test. It, too, was negative. But I won’t feel secure until I’ve gone at least 10 years with no sign of dissolving organs.

Zimachitika. It happens.

8 thoughts on “IT HAPPENS – The Trouble with Worms in Africa

  1. Alexandra Weldon

    Cara, thanks for writing in such detail about schistosomiasis. Please have a look at our website and the work SCI (Schistosomiasis Control Initiative) is doing to prevent transmission and the debilitating effects of schisto and other neglected tropical diseases. Our website is packed with info http://www.sci-ntds.org.

    If you really are worried please take praziquantel. If you’re not infected and take it it won’t harm you or have side effects. The only thing you must do is make sure you take the medication on a full stomach otherwise you’ll feel very sick.

    Good luck!

    Reply
  2. Jen Reeder

    I read this post with interest, not just because of your vivid descriptions (so glad your test came back negative – yikes!), but because we’ve been doing some pro bono work for a cool nonprofit called Youth of Malawi, which seeks to bring joy to the orphans in Malawi (as you said, many parents have been lost to AIDS) through recreation. They’re actually having a “Malawi Beach Party” this April on Lake Malawi, bringing 300 orphans to the lake, which they’ve never seen despite living just 2 hours away from it. I’ll be sure to warn them about the red worms! If anyone would like more info or to sponsor an orphan, they can visit youthofmalawi.org. (Sorry for the shameless plug but I don’t know too many people who have been to Malawi! Wow!)

    Reply
  3. Cara Lopez Lee Post author

    Alexandra, Thanks so much for posting that link. It’s heartbreaking that people still die from this disease when it’s so easy to cure.

    Thanks for the advice, too. Although I do think about it sometimes, I figure that since it has been about 8 years since my exposure, I’d have seen symptoms by now. Is it possible the disease could lie dormant for that long? If so, any idea how I would go about getting a prescription for praziquantel if my Dr. tells me I’m fine?

    Reply
  4. Cara Lopez Lee Post author

    Jen, Thanks for your link to the site for orphans in Malawi. AIDS is leaving so many African children without parents.

    When I was in Malawi, I met several health specialists who told me they were still trying to dispel terrible myths that contribute to the spread of the disease. Some people still believe witchcraft can cause or cure AIDS. And some young men believe they can cure themselves of AIDS by having sex with a virgin.

    It’s great to know that someone is giving a chance for fun to some of the children of Malawi, one of the poorest countries in the world. I tried to send a soccer ball to the kids in Mwanyama, where they were kicking the wadded up ball of paper and plastic. But I never heard back, and I have the feeling it might have been pilfered by their postal workers and sold for cash. I hope not. But then, one soccer ball is just a tiny drop in the bucket.

    Reply
  5. Tracey Bester

    Hi Cara
    I was saddened by your story claiming you had caught Bilharzia on Mumbo Island, because, since we first built our camp there, the scientific staff of HEEED Malawi have conducted yearly tests to see whether there are any of the host snails which carry the schistosoma haematobium parasite. The results have ALWAYS been negative. This is because Mumbo Island has never been inhabited and the parasite needs both a human and snail host to complete its life cycle.

    I am so very sorry that you had a negative experience on our island. Thousands of guests have come and gone since without ever glimpsing the mysterious red worms you speak of. I can only hope you will return one day and replace your unhappy experience with a more universally held one, which is that Mumbo is one of the last remaining true paradises on earth.

    Best wishes from the warm heart of Africa to you.

    Reply
  6. Cara Lopez Lee Post author

    Gee Tracey,

    Sorry if it sounded like I had a bad Kayak Africa experience. I actually had a fantastic time. I loved Mumbo Island, and I would go back in a heartbeat. The worms were just an interesting story, and worth a warning to travelers to be careful.

    I never thought that worms crawling under my skin was anyone’s fault but my own. I got so relaxed in my surroundings, I didn’t heed warnings. The guides had only told me the water was safe for kayaking, or snorkeling with a wet suit. But, after swimming in parts of the lake with no worms, I got lulled into a false sense of security. Anyway, I wiped the worms off in time and didn’t get bilharzia.

    It might not surprise you to know that travelers like me who visit third world countries aren’t usually scared off by such stories. We’re too intrigued by the opportunity to see things like the rare mbuna. Added risks only inspire our sense of adventure.

    I would definitely recommend Mumbo Island. I would only warn people to ask their camp hosts where its safe to swim before going in the water. 🙂

    Happy trails to you,
    Cara

    Reply

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