22 January 2024 The world’s first malaria vaccine programme starts in Cameroon, a revolution in health for Africa. Cameroon alone had 6 million cases in 2022.
October 1982 I arrive in Nairobi on my first journey outside the UK, having come overland from Cairo.
I got the guesthouse address from Geoff Crowley's classic guide, Africa on a Shoestring. It was a bungalow belonging to an elderly Polish lady somewhere near the Aga Khan hospital in Nairobi, a tiny house, but always with room for one more. I got the bed in the kitchen. Having come from Cairo through Sudan then Uganda which was in a state of war, I felt I could hold my head up among all the seasoned backpackers: some of them crusty types who looked like they'd been on the road since Kerouac. It was 1982 and the Hippy Trail to India was still alive although anyone who had ended up in East Africa was clearly lost.
I was feeling good, if a little thin. I'd started out with £300 in travellers cheques and had managed to survive for over a month on about £50. I'd eaten street food, slept in doorways and abandoned huts, and walked a lot. Now however I felt like splashing out: I wanted to drink beer, catch a train to Mombasa and swim in the Indian Ocean. At the Polish Guesthouse I soon made new friends and we hatched a plan to go down to Mombasa, then we walked into town and bought railway tickets. I've still got mine, since it never got used: one of those thick carboard tickets no bigger than a couple of postage stamps, bearing the legend, "Nairobi - Mombasa. Single. Adult."
Now for the beer.
My only contact in Nairobi, in fact in all of Africa, was Uncle John. Not my uncle but that of my girlfriend back in Britain. He was an architect, she'd told me, and would definitely like to have a visitor who wanted to drink beer. I rang him and he offered to pick me up outside the Post Office at noon. "We can go to my club for a beer," he said, adding a little anxiously, "You do drink beer, don't you?"
At 12 I was there waiting. I had a blue shoulder bag containing my camera which was a hefty Mamiya SLR, plus a Tamron telephoto lens which weighed even more. Not only that, but all the films I'd shot up to that point, my notebooks and all my remaining money. I had carried the bag all the way up the Nile, but suddenly I became aware of its weight. It was ridiculously heavy. I put the bag down on the kerb.
Almost immediately a man accosted me from the side. "Hey Sir, Imawanna.. whereina.. hellugo..." He was right in my face, a lunatic, spitting and frothing. I pushed him away, and to my surprise, he ran away. I looked down. My bag was gone.
Instantly I understood what had happened. An accomplice had snatched the bag while I was distracted. I shouted, "THIEF!". A passerby pointed to the corner of the GPO building and I ran. Fifty yards down the street, a man was sprinting away with my bag. I went after him. He took a left turn. When I reached the corner, he was strolling nonchalantly along, my bag on his shoulder. He had clearly decided that a clean getaway had been successfully accomplished.
I charged him from behind, knocking him down. He didn't fight, just cringed, hands over his face. I yanked the bag off him and walked away. It was now ten minutes past midday and I was concerned that I would miss Uncle John and my beer.
Back at the GPO, I took up station again, this time bag firmly on shoulder with hand on strap at all times. I must have been standing there for only a couple of minutes when a mob came around the corner, dragging my thief by the collar. His face was bloodied. They threw him down in front of me. "Is this the fellow who stole your bag?"
"Yes."
Then they set about killing him. Kicks went flying in, punches, a belt. He was screeching like a trapped animal. I pulled a couple off him, shouting for them to stop. That caused consternation. "Is it not him? What do you want?"
"Call the police?"
"They are here."
I hadn't even noticed, but there was a policeman watching. He stepped forward. "Is this the man who stole your bag?"
"Yes."
The policeman started kicking the thief: big black leather boots going in with horrible thuds. The crowd cheered. Once again I found myself protecting the thief. "Do you wish to make a statement?" the policeman asked, a bit bemused by this strange foreigner who objected to justice. "You must come to the station and press charges."
I looked down at the poor miscreant: caked in blood and dust, clutching his ribs. There was a car pushing through the huge crowd that had gathered and I could see a pale-faced man at the wheel, looking a lot like an architect called John. "No," I said, "He's been punished enough." To be honest, all that mattered to me was that I'd got my bag back.
I waved at the man in the car, he waved back. It was Uncle John. I got in. "What's going on?"
"Please just drive."
I looked back. The thief had got to his feet and was leaning against the GPO, eyeing the crowd warily, but they had lost interest. He was going to survive.
We went to the Muthaiga Club. I managed one beer and a game of snooker, but I felt very peculiar, something I put down to the attempted robbery. We went to visit some wealthy Indian friends of John’s who served us curry and told stories of their escaped pet leopard. He was outside, somewhere in the extensive garden. When they put a live trap out for him the day before, they’d caught a leopard - but it wasn’t their leopard. Now the children were afraid to go out and play.
Before sunset Uncle John dropped me on Moi Avenue. I didn't want him to see where I was staying. Once he had gone, I breathed a sigh. I was so tired. In fact I was exhausted, I suddenly knew I had to sit down or I would fall over. I looked around. There was nowhere to sit. I sat down in the middle of the pavement. Then I fell sideways and the convulsions started.
I was completely awake during the whole episode. I saw people step over me and hurry away. Then two people were kneeling beside me, "Can we help?"
It was as though they were on the other side of thick glass. I could not speak. The convulsions subsided and they helped me up. I managed to stagger a block, then I knew I could go no further. We were outside the Nairobi Hilton so my rescuers took me inside and sat me down in the lobby. Almost immediately I felt a great pressure down on me. I slid down the leather armchair and my legs kicked up crazily. Froth was coming off my lips and a pair of pneumatic hammers were excavating a hole in each temple. I remember thinking, "Am I dying?" and "Where's my bag?" I was 22 and my experience of illness was that it was, on the whole, a good thing: it got you out of going to school. You didn’t die.
When the convulsion stopped, a Hilton employee came over. He didn't speak to me. I was slumped in the chair, shaking with cold. "Get him out of here," he hissed at my rescuers. "Now."
After that my memory of the episode becomes patchy. There was a doctor's waiting room full of pregnant women, all staring at me. A man in a white coat appeared. "I can't help, I'm a gynaecologist, he needs to go to a hospital."
Then the Aga Khan Hospital. "Fill in this form. What's your medical insurance number?"
I didn't have one. I couldn't hold the pen. Beyond the glass I could see a world of cleanliness and science, but I didn't have enough cash in my bag to enter it. I was unhealthy and unwealthy. I had joined the majority of the human race.
There was only enough money for a blood test so I handed over some cash and they took a sample.
Next thing I was in the kitchen of the guesthouse. All the crusty hippies were standing over me, visibly unimpressed by my condition. "Typhoid's worse, man. I had it in Thailand. I nearly died."
I felt like another bout of convulsions would finish me off. Then my whole body started into a spasm and I blacked out. When I woke up, I felt better and the old Polish lady was waiting to feed me cabbage soup. "Your test came back. You've got malaria, but you'll be okay now."
The aftermath of a serious illness has its own progression and stages. First came a feeling of absolute stillness. I lay in that kitchen bed and watched the daily business of the house. I heard the drip of the tap and scrape of a chair. Cabbage soup tasted like nectar; other things tasted vile. I developed an intense admiration for the steady stoicism of the old Polish lady. She was a survivor too. Robberies, sickness, loneliness, poverty: she just got on with the cleaning. I can see her now, standing at the sink in a threadbare floral apron and slippers, glancing down at me with a kind but firm expression. "Have more soup, now pay me the rent."
Three years later I was living in South Sudan when malaria came calling for me again. This time I was alone, but I knew my enemy. The dreadful weariness collapsed into a banging headache, then came the shivering fits. I lay in my hut and people came to see me, but did not offer much sympathy. Their attitude was, 'You have malaria. So what?' In this remote outpost, you caught malaria as a child and if you survived then it never came back as bad. It was like a common cold. Every few weeks I'd come down with it. I learned to stop mentioning it. If I needed a reminder that I was the fortunate one, I could cycle 25 miles through the bush to the nearest 'hospital' at Nzara and one day I did exactly that.
In the dark filthy rooms people lay dying. There was a young man who had cut his foot badly while digging with a mattock. The wound was infected and now there was no foot to see, only a huge distended black sticky mass. He had no money. His face was glistening and his eyes dull.
I went outside and cycled down to the market. Traders spread their wares on cloths on the ground: small piles of peanuts, a few woody bananas and grubby bottles of termite oil next to a measuring tin. These things were always available, but on one side were the more ephemeral offers: a ladies white brassiere, a can of Australian cheese or a grisly pile of smoked monkey flesh. Among these things were the drugs, all past their expiry date and most of them useless, the cast-offs of Western society. A man came up to me: "My wife has a tumour, will this help?" It was a glass vial filled with brown liquid labelled, Vitamin B12.
I stared into his desperate face. Perhaps now I would calculate that a placebo might help a little, and B12 wouldn't do any harm. But then I was a simpler, more straightforward, creature. I told him no. It would be a waste of his money.
Further along the line of traders I spotted some small glass vials: penicillin that was only a few months out of date. I bought them. At one of the Arab shops - a tin shack - the owner had a some unopened disposable hypodermic syringes.
I went back up to the hospital and prepared the first injection. The young man looked scared. "My friend, you must know that I have no money." I injected the first vial into his thigh and gave strict instructions what he had to do. Then I quickly left. I couldn't bear the looks of the other patients, the ones who had no hope.
Three months later my wisdom teeth became infected and my whole face swelled up to the point I could no longer eat. I went back to the hospital. The young man was gone and no one could remember him. An orderly who claimed to be a dental assistant sat me in a metal chair caked in old blood. His breath reeked of aragi, the home-made hooch that everyone drank. He jabbed a dirty needle into my gum. I hit the roof.
In the market, I found a few more vials and took them home to inject myself in the thigh. There was no way I was going to allow that orderly to remove my wisdom teeth.
Penicillin injections are not pleasant. The needle goes in, but then the thick syrup has to be forced through the needle. The pain is intense and it's hard to apply sufficient pressure when it's your own leg. I remembered that poor young man with the infected foot, how he never made a sound - unlike me. The daily ritual of the injection soon became a torment. My hand would tremble and I would struggle to get the needle in. I hated the sight of penicillin, but the swelling in my face went down and I could eat again.
I developed a lifelong admiration for well-run, well-organised, clean hospitals with trained medical staff who are not drunk. I reminded myself that in Nairobi, two people had helped me while only one had refused. And I never forgot the feeling that swept over me when I was not allowed to enter a hospital because of my financial status.
I cut my finger badly recently and had to get it strapped up. If I'd known I was about to almost sever a finger, I would have cleaned the axe, but I hadn't. The nurse treated the wound with swift efficiency. I was pathetically grateful. The British NHS is a marvellous institution. No money changes hands. No one pulls rank. No one asks for your insurance number. They simply do their best for you. If I hear people bemoan and denigrate it, I switch off.
The nurse pulled the two bloodied edges of flesh together and glued them. "We'll have to give you a tetanus jab and penicillin," she said. More than forty years after that Sudan experience, my stomach dropped and I felt the hollow shiver of fear. Then she fetched the tablets.
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