The Kissing Bug

by Daisy Hernandez

  No one knew at the time that kissing bugs were guilty, that they carry in their guts the parasite Trypanosoma cruzi, that this parasite is found only in the Americas but has a cousin, so to speak, in West and Central Africa called Trypanosoma brucei gambiense. The T. b. gambiense parasite jumps from tsetse flies to humans, sneaking into a person’s central nervous system and causing human African trypanosomiasis, or sleeping sickness, a disease that left untreated leads to paranoia, coma, and ultimately death. The disease killed more than a quarter of a million people in Uganda in five years at the start of the twentieth century, and because it threatened the supply of rubber and ivory from Africa to Europe, Belgium and Britain declared war on the parasite during those years. The London School of Tropical Medicine made sleeping sickness the focus of its research agenda. The Liverpool School of Tropical Medicine sent a team of scientists to the Congo and Uganda. By 1908, a Sleeping Sickness Bureau opened in London, and when international conferences convened to discuss the matter of this deadly parasite, all the imperial powers arrived: Belgium, France, Germany, and Italy.

  It is strange to think of it this way, but Tía Dora was battling a parasite whose cousin tried to take down the European empires before the First World War.

  …

  By the start of the twentieth century, Brazil, like other countries at the time, was contending with a number of diseases in its port cities: malaria, yellow fever, the bubonic plague. It waged a public health campaign in Rio de Janeiro for several years, mostly vanquishing yellow fever and establishing a state-of the-art research lab known today as the Oswaldo Cruz Institute. In 1907, when the Central Railroad Company began installing tracks in the countryside, hours north of Rio, and workers contracted malaria, they reached out to the institute, which sent them Dr. Carlos Chagas. In his late twenties and only four years out of medical school, the young doctor had already gone after malaria in São Paulo and had succeeded in bringing it under control.

  In pictures, Dr. Chagas is almost as skinny as Tía Dora. He has a nose so long it drags the rest of his face into a state of melancholy. Or it could be his eyebrows. They dip at the end, making his face look longer, más serio, than most. His mustache is perfectly groomed. He wears a shirt with a starched high collar tightly buttoned under his chin and a thin tie that makes him look more flaco, but also compact and efficient.

  Leaving Rio de Janeiro in 1907, Dr. Chagas may have passed through the city’s business district. Its streets had been paved and widened recently to resemble Paris. The new buildings gleamed in the sunlight: the National Library, the Monroe Palace, the Municipal Theater. The battle against yellow fever had served as the pretext for destroying the old homes and businesses on these streets and erecting the new Parisian-style buildings. Starting in 1902, health inspectors began barging into the homes of poor families in Rio, searching for possible breeding grounds for mosquitoes linked to yellow fever. When inspectors declared homes unsanitary, city officials slated the apartments for demolition and pushed out the families. But it did not happen without resistence. In 1903, one group of neighbors protested the displacement by throwing stones at health inspectors until the men left.

  On the train that day, Dr. Chagas slept and maybe dreamt of small monkeys. The train pushed on for another two days, reaching a part of the country so rich in iron ore that it was called General Mines. He arrived in the town of Lassance, where the main street ran parallel to the train tracks. There was dust and heat and horses. The men had named one street after knives and another after gunshots. There was a brothel and bars for drinking, but also families who lived in homes with walls made of mud.

  Dr. Chagas set up his office in a train car and began implementing anti-malaria measures. After the outbreak was under control, he spent another year traveling ahead of the railroad construction, looking for possible malaria hotspots. One day, an engineer pointed to an insect the workers called “the barber” for the way it sucked blood from them at night while they slept. In those days, barbers performed minor medical procedures including bloodletting. The barber insect was a kissing bug known today as Panstronglyus megistus, and when Dr. Chagas sliced it open and examined the insect’s digestive tract under a microscope, he saw a parasite, a trypanosome, like the one that causes sleeping sickness in Africa. He shipped several kissing bugs to the lab in Rio, where his mentor had the insects feed on monkeys. The animals became infected with the parasite and later died. Dr. Chagas named the parasite Trypanosoma cruzi after his mentor, Oswaldo Cruz.

  In the spring of 1909, Dr. Chagas took blood samples from people in Lassance: men, women, children. He found evidence of T. cruzi, but the people were healthy. In one house, where he had discovered an infected cat, however, he witnessed kissing bugs bite a two-year-old girl named Berenice. Two or three weeks later, when Dr. Chagas returned to the house, the girl was running a fever. Dr. Chagas began to examine her. The toddler’s face was bloated, her skin waxy. He pressed his hands to her belly and rib cage. Her spleen and liver were swollen.

  Berenice’s mother must have held the feverish child so that Dr. Chagas could stick the syringe in her arm for a blood sample. The child would have cried and stared in horror at the man with the mustache.

  Back in his boxcar, probably somewhat anxiously, Dr. Chagas placed a slide with Berenice’s blood under the microscope and peered into the lens. He saw the culprit magnified: T. cruzi. The parasite that had killed small monkeys in the lab in Rio was here circulating in the body of this sick child. The parasite resembled the one that causes human African trypanosomiasis. He named the disease American trypanosomiasis.

  It was a heady moment for Dr. Chagas and by extension for Brazil’s medical and scientific community. All sorts of serious white men were hunting deadly microbes around the world, and here in Brazil, Dr. Chagas had found a parasite no one knew existed. But while he could link T. cruzi to fever in a toddler and the deaths of laboratory animals, he could not prove that the parasite led to severe illness.

  …

  The men who chased after the pathogens causing yellow fever, malaria, and sleeping sickness already knew what damage these diseases could inflict on the human body—the body on fire in the case of malaria, the mind taken hostage in the case of sleeping sickness. These germ hunters knew the illness and set out to find the complicit parasites, bacteria and viruses. Dr. Chagas had discovered the parasite and proven that in the lab it could kill marmosets and guinea pigs, but he was not sure, early on, about the parasite’s effect on people.

  Berenice had had a fever and swollen organs, but she was only one patient, and she returned to good health after two weeks. Her fever faded, and Dr. Chagas could barely see the parasite in her blood samples. Berenice was out of the acute stage of the infection and into the chronic one.

  Then Dr. Chagas had the chance to autopsy the body of an infant who had been infected with T. cruzi and died. After carefully removing tissue samples from the baby’s heart, Dr. Chagas shipped them to Dr. Gaspar Vianna, a pathologist at the Oswaldo Cruz Institute, who located the parasite in the tissue. Dr. Chagas carried out other autopsies and came to understand that the parasite leaves lesions on the wall of the heart. If a person lived in an area with kissing bugs and had heart problems, he realized, they most likely had the disease in its chronic form.

  As much as he tried, Dr. Chagas could not prove that thousands of people in Brazil were suffering from the disease. He was nominated twice for the Nobel Prize but did not receive it and died in 1934.

  In the 1940s, Dr. Salvador Mazza was able to find more than a thousand cases of the kissing bug disease in Argentina. He did it by screening patients with a particular combination of symptoms: fever, fatigue, and irregular heartbeats. Dr. Cecilio Romaña, who worked with him, figured out that if the parasite enters a person’s eye by way of the conjunctival sac, the eyelid can swell and turn the color of violets, or a shade of pink. The swelling is distinct—a giant marble under the eyelid. This symptom, now called Romaña’s sign, indicates the acute
stage of the kissing bug disease. It can last more than a month before the person moves into the chronic stage.

  How does a parasite end up in a person’s eye?

  After the kissing bug bites a person (or any mammal), it defecates. This is critical because the parasite is bundled in the insect’s feces. A person can rub their arm or face where the kissing bug attacked and defecated, then touch their eyes with the same hand, effectively transferring the insect’s feces and T. cruzi.

  With this new information from Argentina, doctors all over South America, Central America, and Mexico looked for the kissing bug disease in rural areas where the triatomine insects make their home. By 1985, more than seventeen million people were thought to be infected with the parasite.

  …

  Berenice, the toddler, lived for decades with T. cruzi. When reporters tracked her down in the 1960s, she was in her early fifties. She had kept a doll and a medal that Dr. Chagas had given her and also this memory: the man with the long face had wanted to take her to Rio de Janeiro to become a scientist. He had apparently harbored a dream that the patient who had made it possible for the world to know about this parasitic disease would one day work in medical research. Her parents, however, did not let her go.

  Berenice lived to be seventy-three years old. She died, apparently unharmed by the parasite, in 1981, the same year I turned six and stood in my family’s living room with a nurse, translating for my auntie.

  …

  Tía Dora did not know this history of the disease, and I did not know it either when she was alive. We did not, in general, discuss her illness. Then again, maybe we didn’t have the time. We were always fighting.

  PELEAS

  My first fight with Tía Dora occurred over love. It happened in 1981, after her initial surgery. She felt well enough to slip my baby sister, Liliana, into a summer dress and push her in the stroller down our block in Union City. My sister looked like baby Jesus with my auntie as the virgin mother. They were a minor sensation in the neighborhood. The Cubanas loved seeing them, and my sister, as a newborn, looked a lot like Tía Dora, with the same dainty lips and button nose. Both wore summer dresses as if cotton had been invented for their bodies.

  No one mistook me for Tía Dora’s child.

  My eyes, round and long-lashed, did not belong to her, and my lips were too full, and also I was inclined, even at the age of six, toward hard corners. I stuffed Barbies into a toy car and sped them down hallways to see them crash. I played catch with the boys until a baseball smashed my eye and blood gushed from my nose. I insisted on crossing the street solita without holding anyone’s hand. Everyone could see it in me, especially Tía Dora: I intended to swallow the world whole.

  Back in the apartment, Tía snuggled with Liliana on her lap. My mother had covered the red sofa with plastic like every Latina family we knew in the early eighties in Jersey. I poked at the hard plastic and screamed at Tía Dora to stop paying attention to my sister, to play with me instead.

  Tía giggled and turned to my mother. “¡Tiene celos!”

  I cried that I was not jealous, and I don’t know what I did after that. Maybe I threw the Barbie at the floor. Maybe I begged. All I know is that we never stopped fighting.

  …

  From Tía Dora’s perspective, she did not demand much of me. She simply wanted me to be like my sister, who did not argue with her. Liliana agreed to everything over the years: the pigtails, the itchy school socks, the cereal bowl with too much milk. She knew how to go along to get along, and since we did not have other siblings and all our cousins were in Colombia and Cuba, my sister and I became a painful study in contrasts for my auntie.

  To the same degree that my sister charmed her, I horrified Tía Dora. I did not want her combing my hair and I would not comb it when she told me to. I did not smile at her when I woke up in a foul mood. I joined adult conversations, scowling when I disagreed. I said what was on my mind and I didn’t care what anyone thought. I behaved, in other words, like a boy.

  When we moved a few miles north from the apartment in Union City to the house with the kitchen-garden, Tía Dora came with us. My parents worked in textile factories, and so it was Tía who poured orange juice for us, who walked us across the street to school—Liliana in first grade and me in sixth. One morning, Tía Dora explained, “When you hear your name called, you say, ’Señora?’”

  “That’s ridiculous,” I said.

  Why should I say “¿Señora?” the Spanish equivalent of “Ma’am?” when someone came looking for me? It made more sense to reply, “What do you want?” Tía Dora glared at me. When she was angry, her long chin looked pointier, and she drew it in as if I had offended that part of her face. It was like watching a silent movie. Her chin pulled in. Her forehead creased. Her eyes slowly moved toward the green apples on the kitchen wallpaper. She’d had enough of me. I was dismissed.

  …

  Some years, we had ridiculous arguments. Tía Dora wanted me to walk into the kitchen in the mornings, see her at the table, and greet her with a kiss on the cheek and a “Buenos días.” Apparently, this was what all well-behaved teenagers did in Bogotá. It was what my sister did in Jersey. I was the only one having a problem with good manners.

  “Buenos días,” Tía called to me from the kitchen table.

  I grunted and reached for the cereal box. She turned to my mother and declared, in Spanish, “La india is in a bad mood.”

  When a Colombian auntie calls you an Indian, it means you’re behaving badly. Tía Dora gave me a long look, then pursed her lips and turned the conversation to monkeys. “Tiene el mico,” she said, as if I weren’t in the room. This was her go-to phrase: the Colombian equivalent of saying, “You have a monkey on your back.” It drove me crazy: the constant commentary on my moods and movements, even my facial expressions.

  Liliana knew to stay in our living room, focused on cartoons. Already she was afraid of me, afraid of how I stomped up and down the stairs, of the way I had learned from my father to curse in Spanish. She was learning to be like my mother, una muñeca, and to stay out of the way.

  Tía Dora rose from the kitchen table and called to my sister, “Liliana.” My sister, her hair in pigtails the size of dark plums, sweetly replied, “Señora?”

  …

  For years, when friends complained to me about domineering mothers, I said nothing. My mother hemmed my school uniform skirts and cleaned the kitchen and mostly let me do anything I wanted. I wore bright red lipstick. I convinced Mami to pay a lady in the neighborhood to give me an at-home perm. I wore an off-the-shoulder T-shirt like Madonna and breezed past my mother’s silent, pained face.

  But the longer my friends lamented about mothers who tried to micromanage their lives, the more their complaints felt familiar. I thought about Tía Dora. I realized I had that mother too.

  …

  One topic we never argued about was the kissing bug disease. Tía Dora insisted on silence about it, and I agreed. She hid it from her new friends in Jersey, and when she received her teaching certification and landed a job teaching Spanish in an elementary school, she did not tell her coworkers. No matter how mad I was, I never snitched. It was her secret, and at the age of thirteen, I knew not to betray her. Besides, most days, she was fine. Flaca but fine.

  I thought of the disease as solid and inarguable, like the periodic table that hung in the science classroom at my high school. Who debates helium? Nickel or cobalt? I accepted without question that each element has its structure, its name, its place on the table and on the planet. I felt the same about the kissing bug disease and Tía’s body. It was a matter of fact.

  And we also never argued about the man who proposed to marry her.

  …

  The man from Peru who wanted to marry Tía Dora wore ironed slacks and polo shirts. He had a luminous, indigenous face, and a thick set of glasses that made him look like a scholar. He and my auntie met in an English class, a year or two after her surgeries. Tía liked that he read
the newspapers, and that when she called his name, he dutifully replied, “Señora?”

  The other aunties and my mother whispered that he had been a radio announcer in Peru. In New Jersey, he worked at a printing factory, carting home bundles of discarded paper for typewriters. He gifted me the empty pages, and though his name was José, I think of him now as Tío Papeles, the Paper Uncle. I stacked the pages on my corrugated wood desk and waited for a story to write.

  Tío Papeles was not like the other men in our family. He stayed away from beer and ate in moderation. He enunciated his words. He did not work every day of the week. He drove a Chevrolet. Because of Tío Papeles, we traveled by car to the supermarket, the shopping mall, and Bear Mountain State Park. Because of Tío Papeles and his Nikon camera, photographs document our childhoods: my sister and me with Tía Dora on the Palisades and at the Christmas tree at Rockefeller Center and at the park under the George Washington Bridge. Because of Tío Papeles, we had a father during the Reagan years when Papi worked long hours at the textile factory and chased after side jobs on his days off.

  I was nine the summer Tío Papeles and Tía Dora took us to a lake in Jersey. Giant coolers dotted the grassy area and burgers sizzled on the grills. Shirtless, Tío Papeles looked like a god from the Inca Empire. I followed him into the lake filled with children and grown-ups bobbing in the water and tossing beach balls. Tío put his leg into the water so that his right thigh was at a ninety-degree angle. I climbed onto his leg and stood up, my right hand on his shoulder, the lake spreading before me like a massive blue sheet. My tío told me to dive. I hesitated. He said, “Aquí estoy. Brinca.” His voice sounded so confident, and his shoulder firm like dry land, so trustworthy. I jumped.

  My chin dipped into the cool water. Then my nose, my cheeks, my forehead, my chest, my belly, tumbled. I sank, untethered, and the silence startled me. The children’s laughter vanished. My tío’s voice, gone too. I reached out for something, anything, but finding nothing, I flailed my arms. Then, as if he truly were an Incan deity, Tío Papeles plunged his hands in and plucked me up and out of the lake. I loved it: the adrenaline, the rescue, the safety of his arms.