Mal Aria- bad air- the title says it all. This is a story, set in Brazil, of how a fit young European woman contracts malaria. It is the story of her descent into pain and delirium, alone and far from home, while the malaria goes undiagnosed and untreated. It is a story of doctors, being human, following patterns of preconceived ideas and not thinking outside the box. But it is also a history of the illness itself, thought at first to derive from the foul air of the swamps ( mal’ aria ) and taking many twists and turns before being finally understood.
Carmen Stephan has boldly chosen as her narrator the mosquito which bites our protagonist, also called Carmen. Now, this may sound weird and certainly surreal, but it does work. On one level, the mosquito simply assumes the role of the omniscient narrator, telling us what is happening from day to urgent day- and the narrative is divided into 13 sections, covering one day each- and driving on the plot. Having bitten her, the mosquito hangs around and is sort of on her side; desperate for her illness to be diagnosed she engages in all sorts of antics to help the penny drop that it’s a case of malaria. On the other hand her ruminations ( and it is a she) explore the dichotomy between humans and nature: are we a part of nature or above it? can we control the sheer force of nature when disease rips through us or must we succumb to it?
The second narrative function of the mosquito is to give us the history of the disease and its spread. The foul air theory gave way in the 1870s to an explanation involving bacteria and just shortly afterwards advances in the development of the microscope enabled living parasites to be seen in the blood of sufferers, which led to a better understanding of the role of the mosquito in the spread of the disease. Stephan embeds her accounts of individual scientists and their work in the national cultures and competitiveness of the various periods and her jaunty tone in these passages is entertaining and reminiscent of Kehlmann’s ‘die Vermessung der Welt- Measuring the World’. But not for long- this lighter mood quickly evaporates in the very sad accounts of the suffering caused by malaria. For example the account of the skeletons of tiny children found in a grave in Italy, their limbs clamped down by heavy stones placed there by their parents, so that at least in the afterlife they would have some peace from the demons constantly rattling their arms and legs.
The third narrative strand is the intense inner monologue of Carmen herself as her illness takes hold. By this stage her boyfriend has returned to Germany after she appeared briefly to be improving and the intensity of these passages only underline how utterly alone she is. In her delirium she recalls her grandparents’ home and her grandmother’s stories of ‘Vertriebensein’- being driven from the east at the end of the war. She dreams of running barefoot through the snow at home and collapsing laughing with her family in front of a huge open fire. She has terrible nightmares and hallucinations and all the while goes from hospital to hospital and from doctor to doctor because no one recognises her disease for what it is.
So this dense and compelling slim novel is an illness narrative but also an account of malaria. The false leads and detours taken until the origin of the disease is understood are mirrored in the labyrinth of tests, hospitals and wrong diagnoses endured by Carmen. At the same time we are drawn into her suffering by the power and intensity of the writing- I read this book in one sitting from cover to cover.
Standing apart a little from this text we should not forget that malaria is still one of the world’s most intractable killers. According to WHO, in 2013 584, 000 deaths were caused by malaria, mostly of African children. Though Mal Aria is the story of just one European, the terrible trajectory of the disease depicted here describes the suffering of hundreds of thousands of people afflicted each year . Everyone should read it- in German if you can but if not in English when it is translated- as it must be soon.