I wouldn’t describe myself as a risk-averse person, but I am terrified of getting malaria. I hate spending time in hospitals and even the thought of intravenous treatment makes me uneasy, so I take many precautions to avoid the possibility of getting infected. I have a lot of friends who have gotten an inopportune mosquito bite, and they tell me stories of fevers that soar well above 100 degrees, spasms that cause muscle cramps, delirium and jaw chattering cold that causes people to roll under five layers of blankets in tropical heat. It hurts to feel breezes on exposed skin. I wear bug spray and long sleeves at night, I lay waste to my room with insecticide an hour before I sleep, and since I first started coming to Africa five years ago I have always and consistently taken prophylaxis.
Over the years I’ve taken a huge variety of anti-malarial drugs. The pharmaceutical options for preventing malaria sound like planets from a sci fi cosmos…there’s Lariam, Atovaquone, Malarone or even Doxycycline for those who are bold of heart and thin of wallet. These pills all need to be taken with strict frequency, and have the same side effects in varying degrees. They all cause sun sensitivity, loss of appetite, night sweats, and crazy dreams. To take anti-malarial drugs entails signing up to live in one world by day and another strange and unpredictable world by night.
Lately I’ve settled on Malarone as my drug of choice, because it’s cheap through my insurance plan and it’s effective at very short notice. I get prescriptions from my primary care physician, Dr. Kremlin, a Russian doctor who I see for roughly fifteen minutes every year and a half but who knows my travel habits well enough to give me prescriptions over the phone. The pills are flat, round and orange and must be taken daily. I take them every morning after breakfast and they taste like nothing, but after a week or so I begin to feel the effects.
At first I begin to sleep fitfully. It takes me a long time to fall asleep at night, and then I drift between unconsciousness and awareness, occasionally rolling over to check the time and seeing my watch advance from 12:41 to 2:19 to 5:06 and finally my alarm trumpets me awake at 6:30. After a week of anti-malarial treatment I begin to have absolutely bizarre dreams. The dreams are so vivid that it’s hard to disentangle them from reality; they’re hallucinatory and shamanistic but also feel completely plausible at the moment that I have them. It’s not unusual for me to experience some indescribable scenario and then find myself on my back in bed somewhere in West Africa trying to parse out what’s true and what’s illusion. The dreams are bonkers.
The other night I was riding a horse down a very wide boulevard that was bordered by low and handsome buildings and flanked with trees on both sides. I had a lance and I was jousting with massive piñatas that came galloping at me over the horizon, but my aim was true and they crumpled and exploded before my lance. Fleet shadowy people wove and whispered through the alleyways between the buildings either side of me, but I only saw them in my peripherals because I was focused on the next parti-colored target loping up to meet me. Another night (or maybe the same night?) I had a terrifying dream that I was kidnapped by some separatist group who hid me out in the desert. I must record a video that will be sent to my family and the rest of the USA to ask for ransom, and they made me speak French so they knew what I was saying. I remember saying my date of birth and passport number in a calm, clear voice so that I could be identified, and when I slid into wakefulness a bit later I pulled out my passport and checked. The number I had said in the dream was correct, although when I’m awake I don’t know my passport number.
Another night I was Lionel Messi and I was astonished by how easy soccer was. I slapped passes and assists out to my teammates as easily as a pinball paddle slaps away ball bearings, and notched fine goals myself. In one dream I was going to be flying out to Burkina Faso in the afternoon, and even though it was that morning I had procrastinated and not packed anything. I don’t know why I delayed so much but eventually the stress was just intolerable and I knew I had to get my things in order NOW before my flight. I came to consciousness in a shipping container in a village in western Burkina Faso, both feet out of bed and on the ground, ready to start throwing my clothes into a duffel bag. Another time I was furious because my friend PM and I were herding goats in the mountains and whenever we got most of the group together one would shoot off, and then when I got him the rest of the flock had scattered. I was in a bad mood for most of the morning, frustrated that the goats wouldn’t behave until I shook it off around lunchtime.
Look, I’m not losing my mind or anything like that. These medications have little effect on me by day, and I know from experience that after I’ve been off them for 72 hours my sleep schedule goes back to normal. I’ve taken anti-malarial drugs over 5 years in 8 different African countries, and by now I can anticipate the effects and keep it together when I wake up at 3 AM and need to determine if I’ve been kidnapped or if I’m in bed. The distinction is harder to make than you might think.
I had the weirdest dream of all. Much of it adhered to reality. I was in Guatemala, a trip I’ve made twice before in real life, and I was going to visit my friend JW. JW worked in a tiny village in the Mayan highlands, and the only way to get there was to take a boat across a huge lake that was rimmed with the crenellated peaks of volcanoes that showed smudges of lava at the peaks when the night fell. This is true: in full control of my faculties I have made this trip across the lake and in the dream it was much like how I remembered it. In this particular dream I wasn’t able to distinguish between food and language. I had eaten a lot before I left the US and by the time I got to Guatemala I was full of Spanish, which was tasty and easily digested and reminded me of other dishes I’ve eaten in the past. I shared some of the Spanish I’d brought with me with the people at the airport, and at the counter where I changed money, and with the bus driver who carried me up a winding road into the highlands. By the time I got to the shore of the lake I felt lean but not malnourished. I negotiated passage across the lake with the boatmen, and because I was unaccustomed to digesting Spanish and because I hadn’t brought as much with me as I had hoped, by the time we had settled on a price of 20 quetzals for the passage my stomach was rumbling and my vocabulary was exhausted.
I got onto the boat and took a seat at the stern, where I was sheltered by the tarps that protected passengers from the spray off the prow and from the everpresent mist over the lake. I had snacked in the offing and was replenished with Spanish, but it was not on the menu on that boat. I found myself the only gringo facing 5 rows of people wearing colorful cloth and eating a meal of Tz’utujil, the Mayan dialect, which they shared with each other in low voices. Their food looked good but I couldn’t understand it at all, although it sounded flavorful and communicative to my tired ears. Everyone else helped themselves to that common meal, and I didn’t mind that I wasn’t invited. I understood, and I wasn’t too hungry because I could burn fat that I had accumulated during years of speaking English in a colder land that seemed very far away. The boat took half an hour to chug across the lake, and I got off and walked up the cobblestones to the coffeeshop where JW was waiting for me and we shared familiar food in joyous tones.
And then I woke up.