IT HAPPENS – The Trouble with Worms in Africa

Jan 7, 2010 | Advice for Adventurers, Africa, Danger Zones & Dark Sides, Girls Trek Too

“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.

About Cara

Cara Lopez LeeCara Lopez Lee is the author of They Only Eat Their Husbands. She’s a winner of The Moth StorySLAM and performs in many storytelling shows, including Unheard L.A., and Strong Words. Her writing appears in such publications as Los Angeles Times, Manifest-Station, and Writing for Peace. She’s a traveler, swing dancer, and baker of pies. Cara and her husband live in the beach-town of Ventura, California, where they enjoy tending their Certified Wildlife Habitat full of birds.
Cara Lopez Lee

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