To Africa, With Love

Feb. 8, 2006

Have you seen John Robert Williams lately? He’s a changed man. He smiles a lot, shrugs off annoying people, and says things like, “You know what? White people don’t have any problems. They make their own!”
Williams is a Traverse City photographer and best known for his commercial and portrait work. He’s also a bit of the “town clown” of Traverse City, coming up with those hysterical Williams Brother floats for the Cherry Festival and co-founding the Traverse City Film Festival.
But all that was thousands of worlds away on his recent trip to Malawi, a small country in Southeastern Africa. Williams was there to take photos of Dr. Terrie Taylor, a Traverse City native, who is working to unlock the puzzle of why malaria kills so many African children—about one million each year.
And you do need photos to wrap your brain around this world, it is just that different. As Williams said, “Nothing is the same in Malawi. It’s a land of huge contrasts. The haves and have-nots. They drive on the other side of the road; you wouldn’t recognize 90 percent of the cars on the road. Most everybody walks or rides a bike. Most locals are thin and taut—they look like gazelles. Many don’t have electricity or running water. There’s only one white person for say, 10,000 black people. The only thing the same is the sunlight and the air we breathe.”
Taylor’s life is dedicated to the Blantyre Malaria Project and revolves around the small, black children who lay motionless on the beds in a corner of the Queen Elizabeth Central Hospital in Blantyre. They are the sickest of the sick and often have malaria and AIDS.
“Malaria is one of the oldest scourges and yet the doctors still don’t know exactly why it kills you. Many of the children get cerebral hemorrhaging and then they die,” Williams said.
Malaria is transmitted through parasite-carrying mosquitoes. Once you are bit, the parasite enters your body and gestates in your liver for four days and then it begins attacking your brain and other organs. Adults typically can live through a bout of malaria, perhaps because they have had years to build up a resistance, but children often succumb to death. Taylor leads a group of international clinicians, doctors and students who care for the children and monitor their status every 15 minutes. At every bed is a very weary mother or father.
In addition to saving lives, the clinicians also autopsy some of the children who die to investigate how the parasite attacked them. To date, Taylor has conducted 89 autopsies and has discovered that the parasite also lives in the back of the eye.
Taylor works half the year in Africa as leader for the malaria project, funded mostly by the National Institute of Health. The Bill and Melinda Gates Foundation, which has pledged to end malaria in 10 years, paid for the construction of the clinic offices. Taylor spends the other half of the year at Michigan State University where she serves as a distinguished professor. In fact, MSU students intern at the clinic for six weeks at a time.
I’m with Williams at his photography studio as he clicks through pictures of Taylor and a group of doctors on their rounds. He pulls up a picture of a sweet boy, his lips full, his dark, glossy eyes looking directly into the lens with a quiet look on his face. Taylor has a grin on her face, clearly pleased. She has used blood transfusions and a mixture of different medicines to bring a child out of an almost comatose state.
“She just pulled this kid out of the grave. When they’re on these beds, in this section, they’re at death’s door,” Williams said.
Other cases, obviously, don’t end as happily. Williams recalls a time they were eating at an Indian restaurant when Taylor took a call that a toddler had died. It was 8 p.m. and she had to leave immediately to get permission from the girl’s parents for an autopsy.
“It’s never the same. Sometimes it’s a mom or a dad. Sometimes it’s an aunt or an uncle,” he said.
Williams tagged along and took pictures of the morgue and the autopsy itself. The room is bare bones and the smell overwhelming, similar to spoiled meat. The team took tissue samples and placed them in what looked like a large muffin pan. They were then sliced, placed on glass microscope slides and preserved in a liquid nitrogen tank. Throughout the four-hour post-mortum, Taylor talked and taught, something she does constantly. The little girl was laid out on a white porcelain cadaver bed, her body stitched back together for burial by her family.
“She came in really sick and responded to treatment. She was conscious and they thought she was going to make it. But then she threw up and passed away very soon afterward.”
The work sounds gruesome, but it is key to Taylor’s work of trying to break the code of this disease and how the parasite kills.
We move from graphic pictures of the girl’s brain—it looked normal, which puzzled the clinicians—to a fresh air reprieve: outdoor photos of Ndurandie, a section of Blantyre, that accommodates about 360,000 people in two square miles. Really just unimaginable, Williams said.
Right away, you see that there’s a bit of Traverse City here. Nielsen Design, hired by Taylor, created the logo for the Blantyre Malaria Project. And there are photos of Hamilton Banda, a sculptor whose work is sold at the gift shop in the Dennos Museum.
Interestingly Williams said he had to turn his camera off when reality turned too grim. No one here can imagine the “human suffering and the sacrifice of what people will do to eat and live,” he said.
For example, take electricity, rare in many neighborhoods. The vast majority of people burn coal for energy and Williams describes the day of a guy who sells it. He gets on a “crappy one-speed Chinese bicycle” and rides maybe 40 miles through the steep hills the size you see in Kentucky and Tennessee. Then he loads on about 200 pounds of coal on the bar of his bike, and walks the bike back into town, using his bike as a wheelbarrow. The families buy the coal to cook their food, and then they take the hot embers and put it in an iron to iron their clothes. They have to press their clothes because when they hang their clothes out to dry (no one has dryers), putsi flies land on them and deposit their larvae. If the larvae gets on your skin, it burrows in, and you get a large, pussy, festering boil out of which emerges an inch-long wiggly black worm, that keeps you company during the day. Taylor said the worm disgusted even the visiting doctors.
“They just didn’t believe they had to iron everything,” Williams said.
For food, people eat cornmeal, dried in a way similar to potato flakes. They sprinkle on water and the hottest Nali hot sauce. And that’s what they eat, three meals a day. Except for the extremely wealthy, no one smokes, drinks, or take drugs—they’re all impossible luxuries. Speaking of wealthy, Malawi is a world of about 1 percent haves and the rest have-nots. There are very, very few people in the middle class.
There is no running water in the homes, so people don’t bathe like we do. That combined with the humidity and the smell of mold—well, think of a public bathroom, only in the steamy tropics.
In the morning commute to work, the streets overflow with walkers. Very few people have cars and “you just hear the hum of humanity.” Along with the walkers was the constant presence of beggars. Williams found it unwise to hand out money because he would be completely swarmed and unable to drive forward.
He described the downtown as a wall of people. Wages are so low that the city uses human parking meters; a person writes down the time you park and takes the money when you leave.
Nearly all the businesses are owned by Eastern Indians, and the native black people serve as clerks. Store clerks dress formally in a shirt, tie and lab jacket. Most all the stores display and sell large knives—and yet no one ever picks one up and goes on a rampage, Williams said.
“The people are just that warm and caring and respectful,” Williams said.
Speaking of knives, Taylor’s house, which she shares with several other staff people, comes with a groundskeeper. He doesn’t use a lawnmower, but cuts the grass with a large knife and sweeps the lawn everyday with a bunch of sticks tied together.
All this, plus the unrelenting, humid heat may cause you to think that Malawians are in a really bad mood. In fact, they seem happy and relaxed. They also take great care in how they dress and speak.
“It’s as if you’re listening to the BBC. They speak well, the Queen’s English, and they dress amazingly well. They are gracious almost to a fault; these people are very proud.”
Malawi calls itself the “warm heart of Africa,” in part, because it’s close to the Equator, but also because the people—mostly Muslims—are outgoing and friendly, showing great respect to white strangers visiting their city.
“It’s almost as if they see you as a savior, as if you’re a ticket out. Nelson, who drove me around, until I insisted on driving myself, told me he has a dream of becoming a truck driver in the United States. But I told him, ‘No, you’ve got it so good here. It’s so harsh in the States, very course.’ You hit the boards running in the morning and go, go, go. We’re insulated a lot more from each other. Maybe it’s because they walk everywhere. We’re in our cars, in our homes. We don’t walk together, block after block like they do. Maybe the social glue has gone out of our relationships.”
Wiliams is one of several of Taylor’s friends and family members who have ventured to Malawi, and they all seem to come back a little wiser, a little less willing to indulge in stress. So, relax mon and start walking.

If you’d like to contribute to this project, please send a check made out to the Cerebral Malaria Research Project and mail to:
Michigan State University, Paula Holzheuer, Department of Internal Medicine, 309B West Fee Hall, East Lansing, MI 48824