Populations: Essay

Dhaka is one of those cities hidden in plain sight. It holds 14 million souls, give or take a couple of million, but because they are almost without exception poor, and because their country, Bangladesh, is without “importance” either strategically or economically, very little news escapes its gravitational field.   

Dengue fever, likewise. It infects between 50 million and 100 million people annually, but they’re almost all poor and distant from us. (Since dengue only spread widely after World War II, it doesn’t even star like malaria in the novels and memoirs of the colonial era.) There’s nothing else that I can think of that causes so much trouble while raising so little fuss. I’d devoted, maybe, ten seconds of my life to thinking about dengue fever, and most of those had been devoted to wondering how it was pronounced. (Rhymes with BenGay, as it turns out.)   

All of which explains, at least in part, why I was standing by my bed in Dhaka one night in the summer of 2000 watching sweat roll off my arm like rainwater off a gutter spout in a thunderstorm and wondering, cluelessly, what on earth was going on. A feverish naiveté.  

I’d come to Bangladesh to write about the effect of global warming—that is, to write about what would happen as climate change raised the level of the Bay of Bengal enough to cause widespread flooding across the delta nation. But it was hard to get anyone to talk about that because such devastation is still some decades away, and in the meantime there were other problems.   

Like, for instance, Aedes aegypti, the mosquito that carries dengue. Horrendously magnified pictures of the creature filled the front pages of the Dhaka papers virtually every morning that summer. The city was experiencing its first large-scale outbreak—dozens of people were dying, thousands were sick. The city’s blood banks were overwhelmed. (In a severe case of dengue, the patient’s blood thins so dramatically that it begins to ooze out from the skin, and through the mouth and nose.) Still, even in Dhaka it seemed somehow distant and unreal. The worst of the epidemic was confined to the city’s massive shantytowns. In those acres of hovels, lacking drainpipes and sewers, the water from the summer rains lay in puddles, breeding mosquitoes. It’s the same the world over— dengue has become largely a disease of the urbanized poor, a marker of the lack of sanitation.  

But, as the summer wore on, the Dhaka Star noted the disease was striking “more and more people… including those in posh localities.” Including, eventually, me, sleeping under a mosquito net in a grand four-poster bed in the house of the country’s greatest poet. Once I was sick, I expected treatment. But there is no treatment—mostly, you either get better or you die. And so I got to experience the classic symptoms: the incredible fevers, the blinding aches (dengue is sometimes called “breakbone fever”), the eventual remission into the single most goddamned siege of itchiness that I have ever imagined, as the dead platelets collected under my skin. And I had a relatively mild case.  

I was not alone in my ignorance about dengue. As soon as I got back to the States, I went to the emergency room. The doctor had never seen a case of dengue, and so soon I was surrounded by medical students, each clutching a text and comparing my symptoms with the pictures in the book. Yep, they concluded. Dengue. Not much to be done about that. (Except send me a bill for $1,800—but that’s a different story.)   

Dengue, and many other vector-borne diseases, may be about to re-inject themselves into the obtuse consciousness of the affluent West. West Nile virus is a kind of trailer for this coming blockbuster—the planet is now warming fast, and the big winners in a hot, wet world are mosquitoes. There may be some kind of faint, poetic justice in driving ourselves toward our next great epidemics in our fleet of carbon-spewing Ford Explorers—even now dengue is becoming common in south Texas. But it is an irony, I can assure you, lost on the people of Dhaka, and all the other places like it that exist beyond the reach of our concern and our notice.