Mass Hysteria

[Photo: 9 girls, 6yo-16yo, possessed by who knows what?]

5 March 2017

Chiwoze Bandawe is the Psychologist in the Department of Mental Health. He’s also, I believe, the only PhD psychologist in Malawi. Plus, he’s a very well-known figure as he has a regular weekend column in the largest circulation newspaper in the country, The Nation, and has published several books. I was riding in a cab in Lilongwe in August and chatting with the cabbie. He wanted to know what I was up to in his country. When I told him I’d be teaching at the College of Medicine in Blantyre, he asked if I knew Dr. Bandawe. Yes, he’s my Malawian counterpart here, I replied. How did he know him? The Nation

Chiwoze was contacted by the Deputy District Medical Officer for Mangochi,  the name for both a district and a largish town sitting 3 hours to our north at the southern tip of Lake Malawi. It seems they had been investigating an outbreak of mass hysteria involving 70 children in a school which serves several rural villages 1 ½ hours to the northeast of Mangochi on the border of Mozambique. The outbreak has been ongoing since October. Would the Department of Mental Health at the College of Medicine like to help them with it?

Would we? A resounding, “Yes!”. So 5 days ago four of us set off at 5:30AM on the drive to Mangochi where we’d be met by a Land Rover cum driver and several health officials to accompany us. Our group included Chiwoze, myself, Stefan, and Lucy, Stefan’s long-time partner and an accomplished investigative journalist. We felt like we had the bases covered. Ghostbusters!

As we dropped 3500 feet off the plateau on which Blantyre sits, the temperature rose 10 degrees. In addition to the malaria and crocodiles to which I alluded in my last entry, Mangochi is hot, pretty ugly, and seriously lacking in amenities for the Western traveler. More of that later.

We drove into the Mangochi District Hospital grounds where the hospital sign assured us that it was a “Child Friendly” hospital. What, no leopards, no hyenas, no puff adders? It is not a place I’d take my child to make friends, what with the power and water shutoffs and the rampant diseases for which people are hospitalized.

We met with our counterparts (3), climbed into the Land Rover “ambulance” (no stretcher, no oxygen, no medications, just bench seats along the sides) and sped north. After the tarmac ended we had another 45 minutes on a soupy, deeply rutted mud track—a challenge to navigate—leading to the village. On arrival we discovered that they thought we were coming tomorrow. No, today. But they had received no confirmation of our ETA. We waited outside the simple brick three room building for the Health Surveillance Assistant to gather people from the two adjacent villages. The HSA is a crucial figure in village healthcare; with minimal training, they know what is up, healthwise, in a village and communicate it to district officials.

Since 90% of the “victims” are girls, the concrete benches in the main room were packed with girls and their mothers. As Chiwoze and the HSA began to explain, in both Yao and Chichewa, who we were and why we were there, girls began keeling over like tenpins.  Tellingly, no one hit their head or was injured. Mothers brought their daughters to the front of the room and gently lay them on their side as a real-time demonstration of their plight, straightening their garments out of modesty. Pretty soon 9 girls lay on the floor, eyelids fluttering. Occasionally one would shriek briefly. Another might have a limb twitch. Like dancing, there are individual stylistic differences to this “fainting”. After 20-30 seconds, the littlest girls, looking to be 5-6yo, would spring up smiling, as if to say, “I did it. Just like the big girls.” and return to sit beside their mothers. The older girls lay there for up to 5 minutes before returning to their seats.

As we gathered information from the mothers about it, there was a striking cessation of the episodes. As soon as we began to reassure them that there was nothing wrong medically and that it would go away by itself, the little girls began to drop again. Finally, after we proposed a solution, answered last questions, attempted to interview 5 girls in a separate room by themselves to little avail, and prepared to leave, everyone filed out of the room onto the dirt road in front of the building. Lo and behold, 5 girls fell out on the road, as if to demonstrate how real this was and how powerless we were to stop it. We drove off.

Our “solution”, which has been used elsewhere, is to isolate the girls who are falling out from one another until they stop. That is, out of school for a week, no contact with friends who also fall out. It isn’t easy to pull off in a tiny village which has one common bore-hole from which all water for the households is drawn. A woman proposed taking her daughter to visit relatives in Mozambique. Another mother, looking anguished, cried, ”But we don’t have any relatives in Mozambique!”  The Deputy District Medical Officer, Stalin, will keep us apprised. A recent review article on the subject correctly said don’t waste time and money and resources doing medical workups. 22 of these girls had extensive workups, including spinal taps. It is helpful to identify and isolate the “Index Case”, ie the first child to have a spell. Generally, they have a lot of exam or home or personal stress and the other girls follow suit. A diversion in the humdrum of village life with considerable attention and notoriety as secondary gain.

Since it is increasingly dangerous to drive between cities at night, we were put up at the Villa T… in Mangochi, which is a crumbling, decrepit hotel right on the Shire River. A sign at the water’s edge says, “Do not swim. Crocodiles.” You could imagine it was a place of local indulgence and intrigue in former days. Now, the silverware is dirty, there was a cockroach in Chiwoze’s cooked vegetables (We all paid the same price, shouldn’t we all get some extra protein?) and my room was amazing for its lack of comfort. The mosquito netting was for a single bed so it slanted inwards, necessitating propping up or it sagged onto my face. There was no soap or shampoo and no dish in which to hold it anyway, either by the sink or in the shower. There was no hot water, so cold showers for me. The toilet didn’t flush—no water came into the tank, so it was unpleasant as I left it. There was a flat-panel TV of the miniature variety but I didn’t attempt to see if it worked. We had been subjected to a soap-opera on TV during supper. A man was cheating on his wife. Both she and the “other woman” looked to have Borderline Personality Disorders, with massive breakage of glassware and a large flat-panel TV, histrionic rages, threats to kill themselves, etc. A real busman’s holiday. The place is owned by a professor at the College of Medicine, presumably as an investment. I feel for him.

We were so happy to return to our respective homes, Mission Accomplished. Maybe we’ll write the incident up for publication, if only in hopes that someone who reads it will not do spinal taps on groups of school children in the grip of an epidemic of hysteria.

A side note. Our new digs are so much nicer, if more modest, than the other house. We’re down to one bathroom and about ½ the square footage in the house, but the yard, garden, quiet, privacy, and feng shwei of the place make it feel like a home.  Whew!