The Miraculous Fever-Tree: Malaria, Medicine and the Cure that Changed the World. Fiammetta Rocco
talking to boys or fraternising in any way with the outside world, St Joseph’s positively encouraged a spirit of independence in its young men.
During the time that my father’s friend concluded his business, I wandered down a long corridor, the walls of which were covered in small photographs of all the priests who had ever served St Joseph’s abroad. The early ones were sepiatinted. Gradually they became black-and-white. It was there that I realised for the first time that pulling up your roots and embarking on a new beginning was something people had always done. Though they knew they might never return, like my grandparents those priests had rolled the dice and boarded ship.
St Joseph’s Foreign Missionary Society, or the Mill Hill Fathers as they are commonly known, now has missions in nineteen different countries, stretching from Brazil to St Helena and from Brunei to Sudan, which is impressive in our secular age.
At the end of the corridor was a large wooden door which led to the Society’s chapel. On a stand to the left of the altar I found a red leather-bound Roman missal. It was open at the page of prayers for persecuted Christians: ‘Father, in your mysterious providence, your Church must share in the sufferings of Christ your son, give the spirit of patience and love to those who are remembered for their faith in You, that they may always be true and faithful witnesses to your promise of eternal life.’
Faith was what had inspired the Mill Hill Fathers to go across the seas. Yet when I sat in the pew of their little chapel and looked around the walls, I realised that it was not a weakening of belief, nor persecution, that killed their priests so often and so young – but disease: overwhelmingly malaria. Running along the top of the wall, just under the eaves, was a stone course carved with the words: ‘Pray for the Souls of our Dear Brethren, the Diseased Missionaries of St Joseph’s Society.’ Beneath it, covering all four walls, were stone slabs listing the names of the hundreds of missionaries who had died in the course of doing God’s work. The first slab covered 1872 to 1905, the years of the Society’s earliest ventures abroad. On it were the names of thirty-two men, starting with the Reverend Cornelius Dowling, a doctor as well as a priest, who died of malaria in Baltimore on 9 August 1872, at the age of thirty-one.
Like the Reverend Dowling, two-thirds of those commemorated in the chapel had died before they reached the age of forty. They succumbed, far from home, in India, Kashmir, Borneo, Italy, France, Uganda and Singapore. As the years progressed, the ever-expanding array of places where the Mill Hill Fathers passed away is proof that sickness and death did nothing to quench their Christian fire. By 1917 the missionaries were dying in the Congo, Borneo, Uganda, the Philippines, the Punjab and on the Isle of Wight. By 1925 it was Sarawak, Madras, Kisumu in western Kenya, and in the dry north of the country, the bleak and lonely Kavirondo Gulf. The dangers they faced were multiple, yet according to the records, fully three-quarters of them died of the same thing: Roman or intermittent fever, tertian ague, or as it later came to be known, malaria.
It took a special kind of courage to leave home and travel to Africa in the nineteenth and early twentieth centuries. Not only were the distances enormous and the prospects of return uncertain, but Europeans thought of Africa as a kind of wild and unpredictable beast that had to be beaten into submission physically, morally and politically.
There were dangerous animals, savage tribesmen and, always, the threat of disease: sleeping sickness, river blindness, yaws, leprosy, trachoma, typhoid, tick fever, filariasis, beriberi, bilharzia, kwashiorkor, rinderpest and East Coast Fever were just a few of the ailments waiting in Africa. Of the many illnesses threatening both man and beast, though, none seems to have preyed on travellers’ minds as much as that which became known in many parts as the ‘pioneer shakes’ – malaria.
Some diseases were terrifying simply because they were deadly. Yellow fever and malaria’s cousin, blackwater fever, which turns your urine the colour of dark Burgundy and your kidneys into fragile sacs that can burst at the slightest movement, are like poisonous snakes: they kill in a matter of hours. But there is something particularly insidious about the way malaria stalks its victims, the way its parasites lurk within the body, hiding from its immune system and lying silent for years until you think you have finally shaken it off, only to find that it always returns, driving you mad with fever, shivering, delirium and pain, weakening you more with every bout before, often, it eventually kills you. As the malaria parasite reproduces in your blood, it swells and bursts out of your red blood cells, leaving in its wake a sludge of wrecked haemoglobin. Some of this material ends up in the liver and the spleen, causing them to swell and turn black. In the unlucky few the parasite accumulates in the capillaries of the brain, causing the cerebral malaria that kills so fast.
Of the thirty-six girls in my primary school class in Kenya, eleven were dead before the age of forty. Five were killed in car accidents, most of them by hit-and-run taxi drivers, who are paid by the journey and drive as fast as they can. One died in childbirth. But four died of cerebral malaria, caused by the deadly Plasmodium falciparum parasite, which kills so many people in Africa. Perhaps, as I had done when I was eighteen, they had become cavalier about the dangers, and didn’t take their anti-malaria tablets; perhaps they were just unlucky, and failed to get adequate medical treatment in time. Between them they left nine orphaned children.
Daily life in Africa is so harsh that there is often little time to dwell on the nuances and inequities of history. Uppermost in the minds of Europeans who travelled there, from the earliest years, was how to overcome disease before it overcame you. Many who live there today still think of malaria as a ghostly presence in their lives; something that visits and revisits with the advent of the rainy season, and from which you never quite escape. In the nineteenth century Henry Morton Stanley, who reckoned he caught malaria more than two hundred times during his exploring years, carried his own cure, which he called a ‘Zambesi Rouser’, made of powdered jalop, calomel, crushed rhubarb and quinine, ‘to be taken with a little water whenever an attack of malaria threatens’. My father is more circumspect. He takes his weekly pills in silence, and only ever talks of having a ‘touch’ of malaria, or even a ‘go’ of it, as if loudly to invoke a more severe diagnosis might in some way be calling down the fury of the fates.
Fourteen miles from my grandparents’ farm, on the other side of Lake Naivasha, is the small district hospital. Thirty beds are divided between three wards, but in the rainy season, when malaria can reach epidemic proportions, patients have to queue up to be admitted. Even in the dry months a steady stream of people, most of them women with small children, line up at what passes for an outpatients department round the side of the hospital. Most of them will have travelled in a hot bus or walked many miles to get there, and they sit, uncomplaining and undemanding, beneath the sprawling pepper trees while they wait, sometimes for hours, to be seen by a doctor.
‘No wonder they’re called patients,’ laughs a nurse holding a blood sample. She appears cheerier than she ought to be, considering the long hours of work that still lie before her. She and three doctors will see about 180 patients in a morning, spending enough time with each to give a quick diagnosis, offer a prescription or decide if further examination is needed. There is none of the smart whiteness of Dr Saio’s office at the main hospital in Nairobi, though the work that is done here is very similar.
The hospital in Naivasha is run by local community doctors. The consultation rooms are spotless and the walls are papered with educational posters about AIDS, safe sex and the importance of using clean water for mixing infant formula. Everyone pays fifty US cents to see the doctor, the same again for a blood test, and between ten cents and a dollar for medicine. A limited range of drugs is supplied cheaply by the Anglican Church which, despite its charity, is Protestant enough to have concluded early on that people value something more if they have to pay for it, no matter how small the sum.
Outside the door is a hand-painted sign with a message from the first Book of Peter, a reminder that so much in Africa is still a matter of faith. ‘Cast all your cares unto Him, for He cares for you,’ it says. Cheap and simple to run, the clinic is more effective than one might think, given its simple furnishings and tiny annual budget. For many Africans, this is the very best medical knowledge they will encounter.
A woman in a red patterned skirt and a white headscarf enters the consulting room. Asked what her name is, she mumbles ‘Grace’ in a