There comes a point in relationships when you must decide whether to continue using protection or assume the risks that come along without it.  Of course, I’m referring to the decision of whether or not to continue taking malaria prophylaxis when you commit to a long term stay in a malaria prone country.  Uganda and I have been together for quite some time and, despite my diligent usage of pills, I ended up impregnated with little baby phylum Apicomplexa aka malaria parasites.

For the first time in high definition, the moment of conception has been documented (WARNING:  The following contains explicit material for parasites under the age of 18—please have your parents’ permission or close your eyes, that is, if you are even evolved enough to have them)

Following my spell with malaria, despite my usage of prophylaxis, my dilemma was this: should I continue to take something or just accept my inevitable fate?  There are only a few malaria prophylaxis options.  I had been taking Doxycycline when I contracted it and that can only be taken for 6 months.  My other option was Malarone, which is effective, not known to have side effects and also very expensive.  At $300/month (more than half of my salary) this did not seem like a feasible option.

My only other alternative: Larium.  Amongst its side effects, known to be severe and permanent are the following: depression, insomnia, hallucinations, anxiety, paranoia, confusion and suicidal ideation.  I had taken Larium before without experiencing any of these side effects but now knowing the extent of them it was all I could think about.  Was my dream about talking animals normal because dreams are inherently strange or was that the Larium?  Am I thinking today was a bad day because I have Larium induced depression or was it just an awful day?  Or no, wait.  Why am I overanalyzing my every action asleep and awake???  Dear God, it’s because paranoia is also a side effect of Larium.  I had become paranoid I was becoming paranoid.

Needless to say I was going bananas, but if there is one place to do it, it would be here because it seems Ugandans have also gone bananas, maybe just not in the way I did.  Bananas are a staple crop throughout East Africa and have been integral to its cuisine throughout history.

They are eaten ripe but also while they are still green.

Peeled and steamed, they are known as matoke—along with beans and malakwong (more on that later!) they are part of my daily lunch

Since, as we discussed before, Uganda is the home to nuts and bananas, I decided to combine the two.

Banana Nut Bread

Makes Two Loafs

5 Cups Sifted All Purpose Flour
2 Teaspoons Baking Powder
1/2 teaspoon baking soda
1 1/2 Teaspoon Salt
1/2 Teaspoon Cinnamon
1 Cup Softened Butter
1 1/4  Cup Sugar
1 1/4 Cups Milk
4 Large Eggs
5 Bananas, Extra Ripe
2 Cups Chopped Walnuts

Preheat oven to 350 F.  Grease two loaf pans and line with parchment paper.

Combine all the dry ingredients. Mash ripened bananas with a fork and set aside. In a separate bowl, cream together butter and sugar.  Add in eggs, one at a time and then the mashed bananas.  Alternate adding the dry ingredients and milk to the banana mixture and mix until combined.  Add in 1 cup of chopped walnuts and pour into the lined loaf pans.  Sprinkle the remaining walnuts on top and bake until a knife inserted into the center comes out clean, about one hour.

A Side Note:  I only lasted a month on Larium, stopping after listening to this episode of This American Life.

It’s a dilemma all good hostesses face:  how do you politely get rid of guests you no longer want?  Hurting someone’s feelings is something I often go to great lengths to avoid, rather than asking someone to leave I sometimes end up with guests that seem like parasites.  And other times with guests that are in fact parasites.  Lesson learned: this seemingly cute message is the entirely wrong approach to take with mosquitoes:

Because bite me, they certainly did.  Unbeknownst to me prior to my arrival, northern Uganda is the malaria capital of the WORLD. On average, a person can receive 500-700 bites per night and in some areas 6 of those bites will be from malaria infected mosquitoes.  Knowing that many forms of malaria here are resistant to prophylaxis, I knew my encounter with malaria was inevitable.

So what’s for dinner when these unwanted guests appear?  There are a variety of malaria diets.  Mosquitoes are apparently a gluttonous group, preferring to feast on meat with the skin still on:

After my bout with malaria, I was hungry for comfort food.  And what could be more comforting than macaroni and cheese?

Mac-n-Cheese
Serves 4

3 Tablespoons unsalted butter
2 Tablespoons all-purpose flour
2 Cups Whole Milk
1/2 Teaspoon Nutmeg
2 Cups Grated Cheddar Cheese
1/4 Pound Elbow Macaroni

Topping:
1/2 Cup Bread Crumbs
1/2 Cup Grated Cheddar Cheese
4 Plum Tomatoes, Sliced

Preheat oven to 375°F.

Cook macaroni in boiling and salted water until al dente. While the macaroni cooks, melt butter and stir in flour and cook until lightly browned.  Whisk in milk, salt, pepper, nutmeg and simmer until thickened—about 2 minutes.  Stir in cheddar cheese.  Add macaroni and mix until coated.  Transfer into greased baking dish, top with bread crumbs, remaining cheddar cheese, sliced tomatoes and bake until browned, about 25 minutes.

A Special Note:  Some things are funny, some things are serious, and some things are seriously funny.  I’ve always treated everything in my life with a dose of humor (and in this case a couple of doses of Coartem, too!)  But I also recognize that for many, malaria is no laughing matter.  Each day 320 people die from malaria in Uganda alone.  If you feel like this is something you are interested in being more active about, whether just through personal awareness or prevention and treatment campaigns, I’d encourage you to look into researching organizations and finding one that is ethical and responsible to support!