A Journey into Uganda’s Deadly Malaria Zone

The buses going upcountry in Uganda are bright, advertisement-covered spectacles that rattle through landscapes of cassava, banana and coffee farms. When they stop for a moment, hindered by traffic, wandering livestock or passengers seeking a bathroom break, people who live in the small towns and villages along the road run to the side of the vehicles and set up a mini-market. They’ll try to sell you anything- livestock, goat meat, glass bottles of Fanta soda–even after your bus starts moving.

Sometimes, the bus will lurch forward as you make your well practiced bargaining pitch. You find yourself scrambling to reach your prize– goat meat on a stick, golden and dripping with grease, throwing coins down to your seller’s hands, while your neighbor pulls a loud, distressed chicken through the window.  It’s awkward, but the bounty is worth it.  Even as I write on my laptop in New York, thousands of miles away, I still feel hungry thinking about it.  Goat meat is fairly easy to get in my Queens neighborhood, but it just doesn’t taste like it did on a bumpy, late-night bus ride along a dirt highway in East Africa.

It was not a likely place for a girl from Long Island to be going, that’s for sure.  Most of my classmates from high school were probably speeding along the Long Island Expressway, or going out to Jones Beach.  But I was making my way to northern Uganda.  I had visited the country several times over the past year and a half, and had been working as a journalist for a daily newspaper in the capital, Kampala.  But I had never spent more than a couple of days in the north.  When you live in Uganda, the north feels like a different country—as if you might need a visa stamp to drive the five or six hours from Kampala to Lira or Gulu, the major Northern towns.  The rest of Uganda is generally perceived internationally as stable, democratic, a loyal friend of the U.S.  The north is a historical and present-day landmine, where more than a million people have been displaced by two decades of civil war.  Even though there is a ceasefire now, and a peace treaty is being negotiated, the region is devoid of almost any effective government, cut off from many services.  Among all its other crises is a world-class killer: northern Uganda is the deadliest malaria zone in the world.

I had been assigned to go to Lira and interview children who had been traumatized by the recent war.  The war in northern Uganda was different than most conflicts, because it relied heavily on child soldiers.  Almost ninety percent of the soldiers in the rebel army were children abducted from Ugandan families, forced to fight against their communities and the Ugandan government.  The use of child soldiers made fighting against the rebel group, called the Lord’s Resistance Army, difficult—any battle against the LRA was often considered a massacre, since most of the casualties were children who didn’t want to be there in the first place.

Although there was a ceasefire now in Uganda, many of the children had not been freed yet, and those who had came home to communities that had been attacked by the very army they had been forced to join.  Boys and girls were both captured by the LRA, and the girls, despite their young age, were often forced to serve as ‘wives’ of the LRA commanders, basically sex slaves.  Many became what are called ‘child mothers’ in Uganda, or young girls who became pregnant by rape when they had barely reached puberty.  The child mothers were still forced to fight against the Ugandan government, and they carried the babies on their small bodies from battle site to battle site.  When the government was really cracking down on the LRA, the rebel army forced them to flee to the Sudan, where the Sudanese government, angry with Uganda for supporting Sudanese rebels, gave them a base from which to launch attacks against Uganda.

Many international journalists have gone to Lira or Gulu to interview and catch glimpses of the child soldiers.  Those who have escaped present compelling stories- their reunions with communities they thought would reject them, child mothers escaping on foot for hundreds of miles to reach home, and complex, difficult ways of learning to forgive those who had abducted them.  But New Vision, a national daily paper, gave me a unique story assignment—I would interview both child soldiers and children not captured but affected by the war, and tell their stories through the newspaper’s pullout on children so other Ugandan kids could get a glimpse into their lives.

I was eager to tell the silent stories of war-affected children, who might not have been abducted but lived one evening at a time, not sure if they would survive another year without being abducted, or their family’s fields or store looted by rebels.  Although many journalists wrote about child soldiers, no one really wrote about the kids who weren’t abducted, but were afraid.  Those children had to cope with the fact that the rebels looked just like them: small, afraid, living evening by evening.

I didn’t know what to expect.  I had been to northern Uganda so briefly before, and if I hadn’t known the history of the region, it would have looked like any other part of the country.  Cassava, coffee, and peanut farms, farmers living in huts made of mud and wattle.   Kids who waved excitedly when they saw you.  One-story homes and the smell of charcoal from cooking stoves.  This time would be similar, since I was still just going for two nights.  But this time, I planned to immerse myself in the place where I would be going: Lira, a devastated farming town trying to rebuild after decades of terror and violence.

I was nervous going on the bus ride, unsure how the interviews would go.  What if I couldn’t find any child soldiers, or children who had been impacted by the war, who wanted to talk? What if I re-opened memories that were better left unsealed? After all, many of the kids, as well as the adults, suffered from post-traumatic stress disorder.

Of course, there were other worries, too.  The one that felt the most intimate had to do with the slight itching on my left leg.  I feared the anopheles mosquito, which spread malaria.  Rumor had it that it hit foreigners twice as hard as Ugandans, since we lacked centuries of immunity built through our family blood lines.  Even with some immune resistance, malaria is the number one threat Ugandans face when it comes to their safety- not rebel armies, or HIV.

Malaria is the top killer of Ugandan children, and a major killer of refugees from other countries, as well as internally displaced people.  If you walk into a major hospital in Uganda, twenty percent of their admissions are malaria-related.  Every year, between 70,000 and 110,000 Ugandan children die from malaria, according to the health ministry—or between 190 and 300 deaths a day on average.

Unfortunately, I knew this intimately.  About two weeks before I left the United States to work in Uganda as a reporter, I called my boyfriend, who lives in Kampala, and he told me that his six-year-old stepsister had died from the disease.  When I called his mother later that day, she told me that his sister developed a rare form of the disease called cerebral malaria, which can kill almost instantly.  The malaria went straight to her brain, and she died shortly after.  That type of malaria was rare, but not rare enough for most Ugandan families.  Cerebral malaria is the number one cause of malaria deaths, and is any Ugandan mother’s worst nightmare.

In Kampala, where I had been working, the malaria rates were significant, but not as high as they were in northern Uganda.  Many of the districts within northern Uganda are part of significant water basins, which attract mosquitoes in drove, and the whole region lacks basic health infrastructure.  In one district in northern Uganda, called Apac, residents suffer a breathtaking 1,568 bites from malaria-infected mosquitoes a year.

As an ivory-skinned, wimpy American with virtually no immunity to the disease, I often felt like a beacon in Uganda, calling all mosquitoes to deposit their deadly parasites into my bloodstream.  I had been wimpier than my American colleagues when I studied abroad in Uganda the first time around, picking up as many as twenty mosquitoes bites when we went hiking.  That time, I took medicine daily to prevent malaria.  The other college students would get one bite here, one bite there.  We would walk through eerily beautiful forest landscapes, and while other students would take pictures of waterfalls on their digital cameras, I would be scratching my legs.  Even as I write this, I still have faint scars on my legs from mosquito bites I really shouldn’t have been scratching.

While I was attracting mosquitoes working and studying in Uganda, many of the Ugandans around me were less worried about the disease than about the latest campaign against malaria – a national program to wipe out the mosquitoes by spraying the indoor walls of people’s homes with a pesticide, DDT, which was banned in the United States. Which was a greater danger, many of my friends wanted to know, the disease or the possibly carcinogenic cure?

I would put my fears aside, play the situation by ear, and call my editor if I encountered problems.  The newspaper had been surprised that I even wanted to go.  Wouldn’t it be better to stay in Kampala, where things were safe? But I wanted to cross the boundary between what felt like two countries, and see what Uganda was like when you crossed that invisible line between north and south. It’s why I hopped on the bus from Kampala to Lira.  Now, who knew what good stories were waiting for me?

****

On my way north, I had sat next to a young man who was unusually quiet, almost New York City subway-passenger quiet.  He looked about seventeen or eighteen, and who knows, maybe he was actually a New Yorker, because he didn’t greet me or glance my way, even though we were crammed into two seats by the window. He was a skinny guy, but he seemed to need two seats, because with each turn, he would slam his body weight against mine. He kept quietly shoving me against the bus wall, until I gave up half of my seat and he stretched over one and a half. Definitely, I thought, a secret New Yorker. I could easily picture his slender frame, jeans and cotton t-shirt on a subway in Manhattan, perhaps the 2 train.

I declared defeat, silently of course, and looked out the window, watching the sun set into Uganda’s dark green hills in the distance. Our bus left Kampala around four p.m., and around six, the sun went down peacefully over the endless acres of farms and hills, and I wondered how the bus driver could see the dusty road without street lights. Some questions, of course, are better left unanswered.

I was going to see my friend Zack, whose work in northern Uganda had given me a news peg to get a reporting assignment upcountry. Zack was an unusual guy. He had graduated from a private high school in Los Angeles, a school that the Olsen Twins had gone to, and then headed off to college in Colorado, where he developed an interest in Africa through some classes he took.

Most people would stop there, but Zack boarded a plan to Ghana and then Uganda, feeling as comfortable in places like Lira as he would at an upscale neighborhood in L.A. The year before, we had attended the same study-abroad program in Uganda, and during our visit to rural eastern Uganda, Zack had built a mud-wattle cottage by himself, slaughtered chickens, talked about politics, and had drunk from a grainy, communal alcohol pot with about twenty men, each with their own straw. The boy was far from L.A., and he didn’t want to go back. The next summer, after a year of fundraising using his family’s connections, he raised about $30,000 and decided to hold a three-day conference for former child soldiers in Lira.

By the time the conference was held, I’d be on a plane back home, but I wanted to see how his preparations were going.  I thought the work he was doing was both important and gutsy.  The twenty years of civil war killed between ten and twenty thousand people, and also displaced hundreds of thousands of peasant farmers. They were tired of being attacked and abused by the government and rebel forces, each of which accused the farmers of collaborating with the other side.  For Zack to pick up his bags in L.A. and move to Northern Uganda, I thought, was pretty shocking.

Both of us had entered Uganda at a time when the government was stirring up more resentment when it started spraying inside people’s homes with DDT, a program supported by the U.S. Agency for International Development and the World Health Organization. Environmental groups and organic farming organizations had sued the Ugandan government, and a court injunction had temporarily stopped the spraying, but the region, as well as the country, was locked into a fierce debate over whether it was safe to spray the pesticide, even in small doses. Some Ugandans, paranoid after decades of living under dictatorships, thought the government might be attempting to wipe out the ethnic groups of northern Uganda through the allegedly carcinogenic chemical. Others wondered why the United States would fund the spraying of DDT after the chemical had been banned in America in the 1970s.

Dichloro-diphenyl-trhichloroethane, or DDT, remains one of the most controversial chemicals in existence. The synthetic pesticide became popular during the second half of World War Two, used to fight malaria and typhus, and caught on during peacetime as an agricultural insecticide. DDT wasn’t always a dirty name; in fact, a chemist from Switzerland won the Nobel Prize for his work in using DDT as an insecticide.

Othmar Zeidler, a German-Austrian chemistry student at a university in France, first created DDT from a mixture of alcohol, chlorine, and sulfuric acid. However, Zeidler didn’t realize the potential that the compound had as an insecticide, and DDT was largely unused until a Swiss chemist created the same compound on his own when trying to create a pesticide. The chemist, Paul Müller, found the chemical to be effective in killing house flies during the first chemical trial, and DDT products were soon developed to target mosquitoes, lice, and some other pests.

In the 1940s, DDT was celebrated internationally as the super chemical that would wipe out everything from malaria to bedbugs, cockroaches, and the common household fly. It was also believed that DDT would protect the world’s crops from debilitating insects.

After World War II, the U.S. government used DDT to control pests on crops and forestlands, and people used the chemical in their own homes and gardens. In 1955, after Europe and the United States used the pesticide to eliminate malaria from their own countries, the World Health Organization started a program to eradicate the disease worldwide, relying mostly on DDT. The WHO eliminated malaria in Taiwan, most of the Caribbean, northern Africa, and much of the South Pacific. It also had some significant successes in reducing malaria mortality in Sri Lanka and India. WHO did not really attempt to wipe out malaria from sub-Saharan Africa, however, stating that the lack of public health infrastructure on the continent was too limited, and the life cycle of mosquitoes too long, to make DDT effective.

Eventually, the United States came to have second thoughts about DDT. In 1962, Rachel Carson published Silent Spring, a book that launched the modern-day environmental movement by triggering public interest in pesticides and pollution. Carson said she did not advocate banning the use of pesticides domestically, just using them in a well-managed way. Her book generated a public uproar, however, and DDT was banned in the United States in 1972.

Many other countries also decided to ban DDT, sometimes with critical health consequences. Zanzibar, an island that is part of Tanzania, had used DDT to bring rates of malaria drastically down to 5 percent, but after its ban, the malaria rate in Tanzania rose, until between 50 and 60 percent of the population suffered from malaria for at least a year.
When I first started traveling to Uganda in 2007, the government hadn’t started spraying inside of people’s home yet, but newspaper editorial pages and radio talk shows were debating the proposal.

Malaria was constantly on my mind, and my parents were even more worried about my decision to visit a malaria zone. After all, the disease hits hardest those – like me – who have not developed a resistance to it.

I already had habits that drove my parents crazy. I rode the subway late at night, I forgot to carry cash on me, I would always lose my keys and wallet.  How could I be trusted to take precautions against malaria? My father became addicted to Google, and he read about the ins and outs of the disease, the proper prophylactic treatment (the nasty drugs that make you sick from the side effects, but keep you disease-free) and the mosquito nets.

During that first trip to Uganda during a college study abroad program, I took an expensive little drug called Malarone, which cost $6 a day to keep me malaria-free.  The drug gave me weird, eerie dreams, but those were nothing compared to the dreams that my colleagues on Larium, a much more toxic drug, were having.  For Americans interested in traveling to major malaria zones, Larium can be tempting.  It is much cheaper than other malaria drugs, and doesn’t need to be taken every day.  One dose of Larium every 7 days is all you need.  But the side effects are notorious: visual disturbances, vivid dreams, and anxiety attacks.  In the long-term, Larium can damage both your liver and your eyes.

Although I stuck with the Malarone when I was in Uganda the first time, when I came back to work for a daily paper, I knew there was no way I was taking any anti-malaria drug.  If I got malaria, I decided, I would go to a clinic, take a couple of shots, swallow some tablets, and take a day off from work.  This is more than what most Ugandans would be able to do if they came down with a malaria spell, and I figured I would be okay.  However, as I sat on that bus to northern Uganda, I knew that the region had the worst malaria rates in the world, and that the mosquitoes would be more intense.  The one good thing was that I was traveling during the dry season. If it had been the rainy season, the road could have been washed away, and thirty to forty bites could have been easily waiting for me.

As I sat on the bus, watching the sun set over Uganda’s dark green hills, I thought about my first week in Uganda, and my first night with my homestay family.  Living them had changed my attitudes towards malaria, how it could be viewed almost in the way colds and flus were seen in the U.S.  Even if the disease was a deadly killer.  During that first night, I was navigating both the time change, anti-malaria drugs and cultural shock.  I was a twenty-one-year-old New Yorker, a coffee-drinking, 1-train hating, fast-talking, skittish female. I was in a Kampala suburb called Kanyanya, a semi-rural town that juxtaposed cell phones, American hip-hop fashion, and bootlegged Indian movies with roosters, cows, and red-brown dirt roads that turned into tiny, messy rivers during the rainy season. My home-stay family had volunteered to adopt me for three months and teach me how to survive, to bargain, to speak in conversational Luganda, and to learn the polite decorum of the society.

My Ugandan family was initially skeptical. I had been told to dress up for my first meeting with them, and when they saw my business attire and huge suitcases, I later learned, they predicted I would head back to the United States in less than a week. They were, of course, wrong. As I was trying to absorb my introduction to Uganda, learning new words and seeing new things, my Ugandan family became more relaxed – and my American family more nervous. At night in Uganda, I would collapse as soon as my mosquito net was tucked into my mattress. At night back in the States, my parents lay sleepless.

I was living in a typical home of a middle-class Ugandan family. The unpainted walls were covered with colorful newspaper pages. The furniture was simple. I slept in a guest room with two beds. Bright light emanated from an energy-saving light bulb dangling from the ceiling. There were two trunks filled with school papers and saved writings on one side of the room, and I had stacked my own green suitcase on top of the trunk. The family I had temporarily joined offered me four coat hangers, which I had to use as efficiently as possible.

I could dimly hear the sound of the TV coming from the room of my home-stay mother, Justine, an accountant working in Kampala’s city center. She still volunteers to host American students when they attend a grassroots development studies program at Makerere University. The houses in Kanyanya are built close together, and I could hear the sounds of conversation in Luganda coming from the neighbors’ houses nearby. I could also faintly hear the sound of the woman sleeping in the bed next to mine.

In Ugandan families, it is bad luck to sleep alone. Many Ugandans grow up with six to ten or even twelve brothers and sisters, and rarely spend time alone. Some feel anxious at the thought of being by themselves, and if guests visit, it is considered rude to give them a room for themselves. After all, wouldn’t your guest be lonely? The cultural differences made me smile; as an only child of divorced parents, I was used to my own company. On my first night with them, my family had the mother’s niece come and sleep in the bed next to mine, so I could have a roommate who also was my agemate.

The next night, I shared the room with the family’s oldest daughter, a ten-year-old girl named Jaliah. Both Jaliah and the niece were experts at using mosquito nets. They knew how to tuck their nets in, or re-hang them from the ceiling if the net slipped from its hook. Like most Ugandans, they had had malaria countless times; the symptoms usually begin within four weeks of infection, when the sufferer develops high fevers, shaking chills, muscle aches, and tiredness. The nets offered some protection from the potentially life-threatening mosquitoes, and saved the family’s pocketbook from a treatment that would take any money they had planned on using for groceries or transport that week.

Once, I made the mistake of putting down my mosquito net when there were already two mosquitoes circulating around my bed, and I trapped them both inside my net. I had been exhausted, and fell asleep almost before my head touched my pillow. I awoke two hours later, covered with swollen bites, and attempted to chase the mosquitoes away from my bed, lifting up the net. The family’s electricity had gone out, so I swatted my hands aimlessly in the dark.

That first night in Uganda, my mouth was dry. I didn’t like the taste of the family’s drinking water. They collected rainwater in a large, rusty, blue-red bucket that came up to my waist. They then boiled the rainwater on a charcoal stove in the kitchen, the room next to the guest room. There was a vague scent of charcoal in the guest room. I reminded myself to buy some bottled water the next day.

The blanket was wool – hot and itchy. The net kept me sweating, trapping hot air over my bed. I kicked off the blanket and slept under only the sheet. I had to go to the bathroom, but I was scared of using the latrine, where there was no light and just a small hole that went down 20 feet into the ground. It was very dark. What if I dropped something by accident, and it rolled into the hole? Where, exactly, did I put my flashlight? The last time I had tried to use the latrine in the dark, earlier in the evening, I had missed the hole and peed on my feet. Plus, going to the latrine at night meant I might get bitten by more mosquitoes. I was learning quickly: during my time in Africa, the threat of malaria would accompany me everywhere.

In Uganda, poverty and malaria are inextricably linked. Many poor, tropical countries suffer immensely from malaria. Poverty both causes and is caused by malaria. Poor countries are less able to devote precious public resources to the disease, and spending money on disease treatment can wipe out a family’s savings, or put it into debt. In one year, a poor family in Uganda can spend as much as 25% of its income on malaria treatment. The rainy season in Uganda, a critical time for agriculture, often causes higher rates of malaria, and farmers lose time they might spend working recovering from the disease.

Malaria also causes absenteeism from school, since children suffer six cases of malaria a year on average in Uganda, and affects school performance when children make it to the classroom. For pregnant women, malaria becomes an even more serious disease. The health ministry estimates that malaria causes 60% of miscarriages that Ugandan women experience, and the disease frequently causes low weights in newborns, as well as stillbirths.

Malaria is spread by anopheles mosquitoes, but the root of infection are the malarial parasites that feast on their victims’ red blood cells. When a mosquito bites an infected person, it consumes a blood meal full of malarial parasites. It will take a week for the mosquito, now infected, to be able to transmit the disease to another human being. If the mosquito lives another week, it becomes capable of transmitting malaria to everyone it bites.

Let’s say it bites my Ugandan home-stay sister Jaliah, when she gets up in the middle of the night. She lifts up her mosquito net, picks up the kerosene lantern next to her bed and goes to use the latrine. As she walks to use the toilet, a mosquito could bite her. If the mosquito carried the malarial parasites, they would be passed through the mosquito saliva into her body. About ten days later, Jaliah could wake up with a high fever, terrible chills, and nausea. If she was already malnourished or suffering from HIV, the disease could be lethal, particularly if her family could not raise the money in time for her to get treatment.

The best solution, of course, would be to remove the mosquitoes from Jaliah’s path.  In 1998, the World Health Organization, many African governments, and charities launched a campaign called “Roll Back Malaria,” which planned to halve the number of malaria deaths worldwide by 2010, through a combination of mosquito bed nets, insecticides, and medicine for patients when they did fall sick.  However, in 2007, a million people died of malaria, and 500 million people were infected with the disease.

Five years into the program, malaria deaths were actually increasing worldwide, though countries like Rwanda and Eritrea had made significant strides in fighting the disease.   Roll Back Malaria struggled with four major leadership changes in five years. Also, it was difficult to find a baseline measuring how many malaria deaths occurred each year. A misestimate in 1998 could make it appear that malaria was on the rise, when actually doctors, scientists, and public health advocates were simply recording deaths more accurately.

Another critical problem with Roll Back Malaria was that donors gave tangible commodities, such as bed nets or medicines, when many countries lacked the public health systems to effectively deliver either.  During British colonialism, the Ugandan colony had invested in the health infrastructure of the central Buganda kingdom for decades, but had neglected many other regions of the country, such as northern Uganda.  The Buganda kingdom was considered pivotal to the success of British colonialism in East Africa, and its people had more access to education and civil service jobs.  On the other hand, northern Ugandans were restricted to only joining the military or working in agriculture.

The neglect in infrastructure, resulting in everything from lack of jobs to poor education and health facilities, caused people to migrate to Kampala, where the poor built huge slums in swampy, low-level parts of the city. This rush to Kampala, particularly during the war in northern Uganda, overwhelmed the public health systems that had been relatively strong.

In April 2008, the Ugandan government began a new strategy. Coordinating with and using the funds of the World Health Organization (WHO) and USAID, it began spraying DDT in Oyam and Apac districts, two districts in the north. Once again, all did not go smoothly. Three weeks after the spraying began, the government began to squabble with exporters of organic products in Uganda, which sell organic crops to Europe and the United States. A group of organic companies filed a lawsuit against the government, arguing that Uganda had violated the WHO guidelines for indoor residual spraying, doing the spraying in a way that could contaminate the Ugandan food chain.

Although the European Union had said it would continue to accept Ugandan exports as long as the standards of WHO were met, organic companies were afraid that they would lose their market, worth about $500 million a year, if traces of DDT were found. Even British American Tobacco joined the group, stressing a potential health risk if traces of DDT were found in its tobacco products.

On May 30th, the Ugandan High Court called for a temporary halt to the use of DDT in the districts that had been scheduled for spraying, even though the WHO and Ugandan Health Ministry reported significant drops in both malaria cases and deaths in the communities they sprayed.

The Ministry of Health has been trying to have the DDT ban overturned, but faces strong opposition, particularly from Ken Lukyamuzi, a popular environmental and political figure in Uganda. The DDT spraying has been halted. More expensive, but less effective insecticides are being used for indoor spraying.  USAID continued to support the spraying, stating that DDT had now been endorsed by the World Health Organization as an important tool in the fight against malaria.

My journey to northern Lira took me into the center of this bitter debate.  And when the bus pulled into Lira, I didn’t know what to expect.  It was almost midnight, and there were almost no streetlights in the town.  All I could think about was the recent war, and how it had affected Lira.  I remembered a BBC article I had read about a massacre in Lira in 2004, when the rebels attacked a refugee camp outside the town, and the government fought back.  The civilians were the ones who suffered, with 200 people dying in the crossfire.  Many people died in their grass, homes at the camp when rebels lit the makeshift structures on fire.  The name of the camp was Barlonyo, and it had suffered the most devastating attack in northern Uganda in ten years.  Now, the war was over, but I wondered how much the memory of the attack on Barlonyo lingered.  It had only been four years ago.

As I checked into a hotel after leaving the bus, I couldn’t help but realize how far I was from the refugee camps where the displaced Northerners lived.  Not in terms of physical distance, but in the emotional distance between the hotels that had started to spring up in the wake of the ceasefire as people began to travel again, and the million people who would never go on vacation, or even just return to the simple homes they left.  The hotel was called the White House Hotel.  Though it would have been a modest motel in the United States, it felt like a small castle within the small, farming town.

I entered the small room I had booked for two nights, and was relieved to see that it had a mosquito net already hanging from the ceiling. I thought of the time I went to a shopping mall in Kampala, and saw a worker who had been mopping a floor drop her mop and collapse against the wall.  Sweat dripped down her forehead, and she held her hand to her forehead limply.  When I asked her if she was okay, she told me she had malaria, and indicated that she had a terrible headache.  And I knew it hit foreigners much worse than Ugandan.  Just thinking about the disease made me shudder.

I thought about this as I turned on the shower handle, and watched steam come from the water.  Forget malaria, I thought, I have hot water! I had been living in an apartment in Kampala for several months with only cold water, which had had a tragic effect on my hygiene.  I had started to bathe every other day, and my showers lasted about thirty seconds.  Sometimes, I would heat water in a small percolator I bought at Uganda’s version of Wal-Mart, fill a bucket, and take a hot shower that way.  But this, an overhead shower? All thoughts of malaria were gone, and I was overjoyed.  I stood under the hot water for over thirty minutes, feeling the tension of the bus ride eased from my body.

When I got out of the shower after flooding the bathroom, I hung my mosquito net over the bed, climbed underneath, and reviewed my questions for the next day.  I had general questions about Lira that I could ask anyone I talked to, whether they were a farmer or shopkeeper, and questions that were specific to children who had been kidnapped and forced to serve in the LRA.  But soon, I closed my eyes and fell asleep instantly.  Outside of my mosquito net, there was a faint buzz, but whether it was part of a dream or the Lira experience, I wasn’t sure.

The next morning, I joined a mixed group of middle-class Ugandans and expatriate American charity workers for a breakfast of white toast, passion fruit juice, and scrambled eggs.  “Where is the coffee?” I asked the kitchen staff, trying not to sound too anxious.  I was a terrible coffee addict.

“Over there,” a cook said, and she pointed to a small container of Nescafe instant coffee.  I pounced on it, dumped a huge spoonful into the boiling water they had given me to make tea, and asked for some milk.  Most Ugandans drank their coffee black, with about four to five spoonfuls of sugar, so the staff was a bit puzzled.

“Do you want a glass of milk?” they asked.  I gave up and drank the coffee black, which gave me a little bit of a stomachache, but I felt relaxed and happy to finally be out of Kampala.  I loved the capital, but sometimes you needed a break from the pollution, crowdedness, and traffic jams.  In Kampala, when I would sneeze, I would fill a tissue with black specks of dirt from the pollution and smog.  As I knew from health reporting, the city was a nightmare for asthma patients.  But in Lira, at least, the morning air seemed perfectly clear, as if a car or truck had never passed through.

My friend Zack met me out front, and he agreed to give me a tour of the town.  “I’m really happy you’re here,” he told me.  “Sometimes it gets really lonely.”  He told me about the preparations he was making for the child soldier conference. The children would attend workshops and talk about transitioning to life back home, but a major point of the conference was for the kids to have fun.  Most of them had missed out on their childhoods, forced to work as sex slaves if they were girls, or to fight their own families and communities, regardless of their gender.  There were stories of kids forced to kill their own parents, and loot the stores of their parents’ neighbors.  When it was over, they were told by the rebel commanders that they would never escape—their communities could never forgive them.

Zack and I headed over to a charity where he had worked as an intern when we studied abroad together, a charity started by a Ugandan who came to Europe as a refugee after being tortured during the former President Obote’s regime. The man, Nicholas, named the center after his wife, whom he met in Belgium when he fled Uganda, and the two resettled in Lira, where they work with disabled children, war-affected children, child mothers, and child soldiers.

As we walked to his charity along a dirt road where men offered bicycle rides around Lira for a low cost, we stopped in a small, tidy market full of vendors selling red groundnuts, cassava and mangos. Zack bought some groundnuts for his Ugandan “mom” in Lira, a friend he made during his first trip up there. We then stop at a vendor who sold a cheap meal of fried dough; called chapatti, eggs, and tomato slices, wrapped together to create what is called a “Rolex.” Not a watch, but a cheap, fattening dish, delicious because it’s a combination of fried dough and a lot of oil.

We then passed a large field full of homeless children, skinny and wearing ripped t-shirts and pants, who were kneeling near a tree, sniffing plastic glue containers for a high.  The field was mostly empty, but at the end there was a water pipe, where children came to fetch water and carry it back to their homes in large plastic containers.  Although I was used to seeing extreme forms of poverty in Kampala, which has been stripped of any semblance of social welfare from years of economic structural adjustment, I wasn’t used to seeing overt drug use by kids, who were looking for a moment of relief from a cheap high.  I wondered if any of the kids had been abducted by the LRA, or if they were suffering from post-traumatic stress disorder.  One thing was for sure, though, they had all been impacted by the war.

We visited the charity where Zack had worked, a rehabilitation center for disabled and war-affected children, and then went to a nearby school that had been created for former child soldiers.  The school looked like other high schools in Uganda, but a little nicer.  It wasn’t as crowded as other schools, and the facilities looked clean and new, though modest.  On a wall surrounding the school, the children had painted a mural of how they saw themselves as adults, and what they wanted their lives to be like.  Pictures of smiling lawyers, judges, and nurses decorated the wall.  Some of the children, of course, were already young adults in their twenties, trying to finally go to school after spending so many years abducted in the bush.

Zack had been to the school frequently to organize his conference, and he explained the kind of reporting I was interested in doing to the school’s headmaster.  The school was called Rachele, named after an episode in 1996 when 139 girls from a girl’s boarding school in northern Uganda were kidnapped by the LRA.  The college’s vice president, Sister Rachele Fassera, an Italian nun, offered her life to the LRA in exchange for the girls’ release.  The LRA decided to spare Rachele and gave her 109 of the abducted girls, but kept 30 of them hostage.  Five of the girls died in captivity, and 21 eventually escaped.  The Rachele School was set up, coincidentally, by the editor in chief at the newspaper I worked for, a Belgian journalist who wrote a book about the incident, called the Aboke Girls.   Sales from the book, and my editor’s fundraising, helped her put thousands of former child soldiers through school.

That day, visiting both the rehabilitation center and Rachele, I interviewed about ten children for my newspaper, and more than half had been abducted by the LRA.  The children at Rachele were very open in talking about their experiences with me, and used to having international visitors come to the school.  I interviewed a former child soldier named Bunny, who gave me his e-mail address so we could stay in touch, told me about his attempts to reconcile his former life with his current life.

The LRA had broken into Bunny’s home when he was a child, stolen his family’s few possessions, and abducted him and his brothers.  In order to be initiated into the LRA, they were whipped and beaten extensively, and forced to travel on foot for hundreds of miles to attend the LRA’S military training camps in Congo, Uganda, and Sudan.  Bunny and his brothers eventually escaped, but Bunny never prepared himself emotionally to run into the soldier who had kidnapped him.

Bunny had been in Lira when he saw the kidnapper, a young adult in his twenties. All the memories of his capture came rushing back.  I thought he would tell me then that it had been traumatizing for him to see his former captor, or that the encounter gave him nightmares.  But he didn’t.  Instead, Bunny told me that he went up to his former captor, and told him he was glad that he had escaped.  His captor, like him, was not an enemy—he was another child who had once been kidnapped and forced to serve under the LRA.  Seeing his captor in town, watching him attempt to build a life again in Lira as well, was a turning point for Bunny, who still remembered each detail of his capture vividly.

When I would go back to Kampala, Bunny’s story resonated with me, as did the story of a boarding school matron named Margaret.  Born and raised in Lira, she now worked for a rehabilitation center.  Like most northern Ugandans, she loathed the LRA and the Ugandan government in equal measure.  Both had been attacking the people in towns like Lira for two decades, each accusing them of collaborating with the other side.  But to Margaret, neither the LRA nor the Ugandan army was the largest threat to her children’s safety.  What Margaret feared was malaria.  A mother of ten, she had lost her four-year-old daughter many years ago to the disease.

We had sat in a small office room at the rehabilitation center, which had a map of Uganda neatly taped to the wall, and two large benches for guests to sit on.  Initially, Zack had had to convince her that I was not, well, a spy.

“She really doesn’t like me,” Zack whispered before he introduced me to her.  He also told me that the charity had basically run out of money three months before after Christopher, the founder of the center, got in a fight with their donors, and Margaret hadn’t been paid in three months.  Christopher and his wife had just opened a bar in Lira, planning to fund their operations by selling drinks to charity workers and farmers in the small town.  Donors be damned.

Margaret didn’t like me at first, either.  She scowled when she saw us, and reminded Zack that she hadn’t been paid by Christopher in months.  Zack responded sympathetically, then asked if I could interview her for a story I was writing about the recovery of northern Uganda, and the impact that the war had had on children.   A journalist.  Margaret gave me a disgusted looked after seeing that I had been stupid enough to wear my New Vision t-shirt around Lira—why not just wear a gigantic sign, that says, I’m a spy? After all, New Vision was partly owned by the government.  But she gave in, and told me what it was like to live in LRA in the 1980s and 1990s, when your children might be abducted, and you could never travel at night.

As we talked, Margaret told me that she hated the DDT spraying, and didn’t want them to spray her home.  She was worried that it was dangerous, or that the government knew it was dangerous and did not care.  She didn’t understand why the UN, after two decades, couldn’t round up the LRA, which consisted of about two thousand soldiers, most of them abducted children.

Even though she was against the DDT spraying, Margaret told me in detail about how the disease had killed her daughter, and how her other daughter suffered from a case of cerebral malaria, which didn’t kill her but left her physically and mentally retarded.  She blamed herself for the impact malaria had on her family, for not having enough money at the time to get treatment for her children, and told me she always kept malaria drugs in her home now, just in case.

“I feared that disease for so, so long,” she told me.  However, the DDT frightened her just as much, and she was afraid the chemical would hurt the children she still had.
I did interviews with Ugandans throughout the weekend about the effect the war had had on them, and how those who had been abducted by the LRA had attempted to rebuild their lives.  On Sunday, I caught a bus back to Kampala, and wondered what stories the other passengers carried quietly with them.  Were they like Bunny, making peace with their escape, as well as their captors? Or Margaret, afraid that the government would poison the Ugandans who had survived the decades of war?

I stayed in Uganda for a few more weeks, working as a reporter, but none of the stories compared to those that I encountered in northern Uganda.  I wondered if Margaret had ever been paid, and thought about her daughter, wasting away in Margaret’s village, unable to do basic activities at the local primary school.  The twenty mosquito bites that I had picked up in Lira faded into my skin, and I never developed a fever or chills.  I hadn’t been taking prophylactics, but I was lucky.  The mosquitoes that bit me were malaria-free.

Soon, it was time for me to head back to New York and finish a master’s degree in journalism that I had started at the City University of New York in Times Square.  I came back in August, and moved to a small room in Queens while I finished my degree.  Zack eventually came back to the United States in November, but he felt unfocused, still thinking about what would happen to the child soldiers that attended the conference he organized.  The rebel government was unable to sign a peace agreement with the Ugandan government, but they didn’t begin attacking Uganda either.  News from Uganda in the international press was dwarfed by the conflict that began to explode in Congo, Uganda’s neighbor.

But at night, when I tried to imagine my future, I couldn’t see myself working at a paper or news website in the U.S.  I had started an internship with the Queens Tribune, a weekly paper in New York City, but I checked Ugandan news websites more frequently than I did my own paper.  Somehow, I knew, I had to get back North, and I didn’t care about the threat of malaria.  I had dodged the malaria bullet, and I could do it again.  I had to go back, and chase those stories in Uganda.  All I needed was a notepad and a good mosquito net.