I am a person who for many, many years loved nothing more than going barefoot through the pastures of my childhood. I delighted in the cool grasses and would even walk through clover patches filled with bees or into a barn filled with decaying manure. I liked to feel the earth beneath my toes; to gather all there was to know through the senses of my feet.
I remember a college professor telling me that if I lived in the south, I would get hookworm. I was sitting in a large classroom and he told the whole class that if Sarah lived in a warm climate, she would have worms by now and everyone turned to look at me but I shrugged and kept going barefoot. The possibility of a worm entering my feet without me knowing seemed as impossible as a man, several years later, going to the moon. I was pretty sure he just didn't want me barefoot in his classroom and failed to pay close attention to the life cycle he was trying to illustrate through my bare feet.
But now, when I see a child barefoot in the dirt, I am alarmed. I see Milove, yesterday, her toes brightly painted with nail polish I had found, going barefoot. I know she does not have a latrine and has no water for over a mile. I know they all live in a very small, mud house and I know her two year old son has repeated infestations of hookworms. I want to see. "Milove, wear shoes' but I know too that they must be saved for going out somewhere and not around the yard.
I never go barefoot outside anymore and most often wear shoes inside as well.
I have come to carefully consider the life cycle of this parasite and its effect on the women and children here. I know now that the eggs leave the human body through a person's feces and become larvae in the warm damp soil of tropical climates. Once they enter a barefoot, they travel through the vascular system, into the lungs where they are coughed up and swallowed and begin to complete their life cycle in the guts of 600 million people world wide, by sucking their blood" voraciously" and laying 30,000 eggs per day.
When a woman is in labor, I see the trails and tunnels on her feet. Sometimes I take them in my hands and hold them there so that they can rest awhile.
I can not see the worms. What I see is a chronic cough, anemia, premature babies, small babies, swollen children and malnutrition leading to a host of other complications. I see children who already can not find enough food, unable to fully utilize the food they get because they are competing with hookworms who are devouring their stores of iron and protein.
I think of the worst, scariest science fiction movie in which aliens invade the body and grow inside an unsuspecting hero. The problem is that these real life aliens live in the soil and come back over and over and over again.
When Dafka's Dad, has to go to his brother's funeral she spends the night with us and her diaper is filled with worms. Dafka can barely put any weight on her tiny legs let alone walk barefoot but she can get them from care givers who do not wash their hands after going to the bathroom. Dafka is in the less than 0% for weight for a baby her age and that is with our volunteers bringing her formula. (Dafka's mother dies shortly after she was born so she can not be breastfed)
Our protocol is to give all pregnant women in the third trimester abendazol to kill potential worms and hopefully prevent the complications related to severe malnutrition and anemia. It costs about 10 cents a mother. The World Health Organization believes that of the millions of people who are infected with hookworm, only about 8% are ever treated.
I lie in bed and try to think about other things. I wonder what I use to think about but I cannot remember.