The driver, Alberto, turned out to be a hefty man with a reliable pickup truck. He steered slowly down the mountain on a dirt road that at times narrowed so much I had the sensation we were about to drop off the face of the mountain and into the canopy of trees miles below. I focused my attention out the passenger window, where orchids hung like jewels from the mountainside. After a while, we approached a valley. The land unfurled around us. We passed tobacco fields, mango groves, and mandarin, banana, and lime trees. Once in a while, homes with tin roofs and handmade bricks came into view, nestled in that green land.
The health outreach workers were coming to this vereda and others like it every two weeks to check on people with the kissing bug disease. They dropped off educational pamphlets. They inquired about the health of each person they checked on, and noted if the person’s insurance had authorized the needed lab tests. They fumigated.
We stopped at a house tucked among lime trees. It reminded me of the childhood home Maira had described to me. There were a series of rooms filled with beds, but family life took place outdoors. The kitchen table was outside with caña brava—thick, long reeds—supporting a tin roof. Tropical fruits scattered on the wooden counter: lemons and limes and an overripe mango.
A boy was watching television in one of the bedrooms and told us that he didn’t know when his grandmother would be home. After a moment, we spotted her: Aliz, a woman in her fifties, maybe early sixties, emerging from a crowd of trees, hoisting a pickax on her shoulder. A good straw hat protected her face from the sun. When we sat to talk about the kissing bug disease, I asked if she had any symptoms.
“Yes, fatigue.”
“When?”
“Mostly when I walk uphill or when I carry something heavy.”
I told her I’d seen her carrying a pickax.
“Eso no es nada,” she said, grinning, her square glasses firmly on the bridge of her nose. “For those of us who have to work in the campo, that’s nothing.”
Aliz used to be able to carry a crate of mangoes out to the road. It was how she and her husband made a living, selling produce to people who then resold it at markets. About five years ago, she had started feeling fatigued. All she knew of the kissing bug disease at that time was that a friend of hers had died from it. He was forty-five. She didn’t consider getting tested until three years ago, when she started hearing more about the disease over the radio. She thought: I must have it. As a child, she had seen kissing bugs huddled in the corners of her family’s home.
Aliz described to me what Charles Darwin noted in 1835: a kissing bug grows fat after it feeds on a person. “They looked like small balls full of blood because you’d go and smash it and a lot of blood would come out,” she told me.
These days she didn’t see as many kissing bugs, but they still showed up in her home. Not too long ago, the bugs bit her grandson three nights in a row. He ended up with welts on his back where the insects had bitten him. Fortunately, he tested negative for the disease. Her husband, too, was negative. Both her sisters had the disease, which made me think they had all been infected when they were girls.
The doctors had told Aliz that she already had signs of heart failure. “My heart is moving too slowly,” she said. “It’s possible that with time, they might have to put in a pacemaker.”
She was worried that the pacemaker wouldn’t let her work in the fields, and she was waiting for the insurance company to authorize the blood work she needed before the doctor could start her on nifurtimox.
To see a doctor in Soatá, she had to hitch a ride, pay for the travel expense, and lose a day of work. She admitted she had traveled to Bogotá, more than five hours away, and spent a significant chunk of her earnings to see a man who said he was a doctor and sold her pastillas, or pills, for the disease. She showed me a bottle of selenium. She had spent her money on a dietary supplement that had never been proven to work against T. cruzi.
Her grandson, around eight years old, tiptoed around us and quietly whispered to Aliz, who startled and asked, “You don’t greet the people, m’ijo?”
The question reminded me of Tía Dora’s efforts to teach me good manners, of those mornings when I would bounce into our kitchen-garden in Jersey, eight years old, and Tía Dora expected me to greet her with kisses and pronouncements of “Buenos días, señora.” I almost opened my mouth to tell Aliz that he was just a boy. He didn’t have to talk with us. He didn’t have to pretend. The good manners would come later.
Elizabeth rushed to explain that the boy had greeted us when we first reached the house, though I honestly could not remember if he had. “Do not worry,” she assured Aliz. “He was very polite. He greeted all of us.”
Aliz looked dubious but relented. Her children, all five of them, lived in Bogotá. She had brought this grandson here since otherwise he would be home alone in the city while his parents worked.
Now her grandson wanted a sweet drink. He eyed the mango on the counter.
“No, m’ijo,” Aliz said. “I didn’t make juice.”
…
I spent two days in Soatá, and it surprised me that, as in the United States, both patients and doctors there were only beginning to learn about the kissing bug disease. Local doctors explained that they hadn’t learned about it until they completed their “rural,” the colloquial term for a program that sends newly graduated medical students to rural areas around the country to serve as doctors for a year. The disease wasn’t taught in all medical schools because, as one physician in Soatá told me, “It’s not a disease you see nationally.”
Elizabeth listed for me the other diseases Colombia was tackling in 2018: dengue, the Zika virus, and chikungunya. Zika had grabbed international headlines, but she pointed out, “There are still children dying from dengue.” She understood why pictures of babies with Zika caught the world’s imagination. She understood, too, why I was writing about the kissing bug disease. “Until you experience the disease, you don’t pay attention to it.”
Outside the town’s city hall, I met a group of técnicos who had been hunting for kissing bugs that morning after getting a call that the insects had been spotted. The town’s pest control team, they had completed an “active search” at a house, lifting up beds and pushing aside picture frames and wall calendars, looking for kissing bugs. They had inspected a dog’s bed. Nothing. At a neighbor’s house, they did the same. Nothing. But one of the families kept about thirty hens in two coops in the backyard. From those coops, the técnicos had plucked eighty-six kissing bugs.
“Where did you take them?” I asked.
One of the men opened a plastic bag he was carrying. Inside were several jars filled with dozens of kissing bugs. The men had tossed the insects into these clear jars with holes punched into the lids so the insects could be checked later for T. cruzi.
I did not flinch or step back or think about bug spray. I had spent a lifetime in terror of this insect, witnessing what it had done to Tía Dora and our family and now other families too, and there I was standing next to a man with almost ninety kissing bugs in a plastic bag. It was so absurd that I peered at the jars and asked if I could see one of the insects.
The technician dug into the bag and pulled out a jar that had a single kissing bug. It was the species Triatoma dimidiata, and it was beautiful. The orange stripes at the edge of its abdomen gleamed in the morning light. The more I looked at the insect, the more it struck me as a practice in contrast: the bright stripes alternating with black, the six legs at perfect angles, two dark spots, like teardrops, above its belly.
In Colombia, the insects are called pitos, which is also the word for whistle, perhaps in part because when a kissing bug feeds, it fattens up, taking the shape of an old-fashioned whistle. The woman whose chicken coops had housed all these kissing bugs did not have to worry about eating an infected chicken. Birds are resistant to T. cruzi. But the woman was surprised to learn the bugs had made their home so close to hers.
“She said she had never found one,�
�� said Johana Cobos Pinzon, the town’s veterinarian, who went on the hunt with the técnicos.
“Maybe she didn’t see it because the pitos were feeding on the hens and the dog,” Juan Carlos Bermudez, a técnico, suggested.
Luis Ladino Martinez had seen worse. Before the town carried out these searches and fumigations, he said, “You used to find three hundred pitos in one house.” Still, he preferred working on the kissing bug disease over dengue. “With dengue, it’s constant,” he said, referring to the monitoring of mosquitoes that required him and the team to spend hours looking for places where water could pool and become breeding grounds for the mosquito species carrying the virus. With the kissing bug, it was easier, he told me. He waited for the call. The work to control the disease “depends on when someone reports the pito,” Luis said.
Searching for the kissing bug was his job, and in a strange and very different way, it had become my job too. It was work that felt necessary to me, work that connected me with Tía Dora and the immigrant community that had raised me. It was work that made the world not free of disease, but at least informed. And it was work that kept my grief in its place.
MY OTHER TÍA
Margarita. She was the auntie who stayed in Colombia, the auntie who was diagnosed with the kissing bug disease around 1981 and lived another fifteen years, her heart slowly dying.
I have no memories of this tía. My mother and I stopped traveling to South America after I turned seven. Tía Margarita, then, was the auntie in stories, the auntie who had married my mother’s older brother and been very beautiful. Often, I pictured Tía Margarita in Colombia alone at night in an armchair with doilies on the end tables and all the lights turned off—a woman, a mother, trying to bargain with her heart. Tía Margarita sat upright in that armchair. She sat perfectly still. She added a pillow behind her back. She stared straight ahead with eyes half-closed, and she did this because the alternative was worse: if she tried to lie down, her heart would suffocate her. That’s what Auntie Biblia said.
It was never clear to me what was true about this other auntie, but when I heard Carlos say that he had felt like he was drowning with his own damaged heart, I realized what had happened to Tía Margarita: her heart, ravaged by T. cruzi, couldn’t pump the blood that came from her lungs.
What I knew about Tía Margarita’s life felt like fiction. Her husband, my Tío Guillermo, was himself a short story. When I was in my early twenties, a few years after Tía Margarita died, an auntie brought Tío Guillermo to New Jersey for a visit. With his generous belly, my Tío plopped into a chair in our kitchen and started telling jokes and spinning stories for anyone who would listen. His stories sounded good. He was the wry observer, the omniscient and trusted narrator. His confidence was staggering. In a foreign country, in another man’s house, he sat in that kitchen, not like he owned the place but as if he were truly comfortable and pleased to be there with us, and somehow that pleased us too.
Tía Dora, Auntie Biblia, and my mother scurried around the kitchen that night. They made tinto. They heated arepas and rice and soup. I could not remember having seen the women in my family so animated. This was their big brother and here he was for the first and only time in Jersey.
Tío Guillermo told stories and my father drank and laughed. When Tío Guillermo learned that I was an aspiring writer, he turned to me and said, “¡Anotalo!” Write it down! My father, drunk and delighted finally to have such a man in the house, thought this was the funniest instruction he had ever heard. “Write it down!” he cried, laughing.
My uncle had, at one point, been a bus driver and a taxi driver, and he had brought news from small towns in Boyacá to the state’s capital in Tunja, news about men who killed other men, or buses that erupted into flames. The news he brought, like his stories, had the flair of fiction. His marriage sounded like another cuento: Tío Guillermo had loved a woman whose heart turned into a rock inside her chest.
He and Tía Margarita spent their last years together in Tunja, a city only a few hours from Soatá, where I was interviewing patients and doctors. While my uncle had died years after Tía Margarita, their children still lived there, and when I phoned, my cousins insisted that they had a room waiting for me.
…
I arrived in Tunja, and my cousins immediately took charge of my days. The youngest of the six, Juan Carlos, drove me around with his wife and young children to the old colonial towns flourishing as tourist spots. Martha showered me with stories of the city’s most infamous woman, Inés de Hinojosa, who in colonial times had allegedly kept multiple lovers, including a woman. Yalile hosted me, turning her daughter’s bedroom with its twin-size bed into a guest room for me, and when I asked to see pictures of her mother, she pulled out the photo albums and we huddled together at the dining table in her fifth-floor apartment, her lapdog barking at every passing neighbor.
In pictures, Tía Margarita had a stunning face that made me think of geometry, of exact angles, a face built to clear and demanding specifications. Her cheeks were pale and expansive, her brown eyes deeply set under evenly matched eyebrows. Her jawline was precise, serious, and determined. Tía Margarita, it turned out, had been a child of La Violencia—a ten-year civil war in Colombia that started in the late 1940s between the country’s two political parties and led to the murders of more than two hundred thousand people.
“They killed her father during The Violence,” Yalile told me.
Tía Margarita survived that war and made her way into a secretarial job at the tax collector’s office in Ramiriquí, the town where Tía Dora and my mother were born. Margarita was seventeen years old, and according to my cousin, she worked her way up over the next twenty years until she became the town’s tax collector. Soon everyone knew her, including the men with considerable property holdings.
“What she said was law,” my prima Martha had told me, and though she had been speaking of her mother’s role at home, I wondered if the same might have been true at her job.
Tía Margarita married my uncle, gave birth to five children, and kept her job. In the sixties and seventies, women in general, and especially in small towns in Colombia, did no such thing. But Tía Margarita did, hiring women for childcare and housekeeping. Decades later, my cousin did not resent this. She remembered that she and her siblings were treated by their mother to special lunches and plates of cookies for their birthdays.
The last pregnancy came in 1981. After she gave birth, Tía Margarita developed a cough that grew worse. She had a fatigue she couldn’t shake. A doctor explained that it was her heart. She was only in her forties, but her corazón was failing, and so she traveled to Bogotá to see a team of cardiologists. They took X-rays of her chest and saw that her heart had begun to lose its shape. They told her she was infected with T. cruzi, but none of her children were tested.
The town of Ramiriquí, where Tía Dora spent the first years of her life and where Tía Margarita lived for so long, was too cold for kissing bugs. After doctors made a list of all the places where Tía Margarita had ever lived or visited, they concluded she had encountered the kissing bug in Villavicencio, where, in recent years, she had spent almost a month.
Villavicencio was some seventy miles south of Bogotá and had a warmer climate. “That could be where Tía Dora got infected too,” I said, surprised because my auntie had never speculated to me about where she may have come into contact with a kissing bug and none of the women in my family knew either.
“She would have gone to Villavicencio,” Yalile said of Tía Dora. One of our uncles lived there for decades.
Yalile was a very thin and elegant woman with a straight back who kept an immaculate apartment full of gleaming wood furniture. At her dining table, she told me she had been in her early twenties when her mother was diagnosed with the disease. She remembered the doctors saying that no cure existed and that her mother would die in fifteen years. Of course, they did not say it that way, but this was what Yalile remembered, what she held on to. Her mother had
a baby boy and a death sentence.
The news devastated Tía Margarita and my uncle, and for more than a decade, she pursued alternative medicine, mostly homeopathic remedies, hoping that she could prove the doctors wrong, that she could stop her heart from unraveling. Sometimes the remedies offered relief. She’d get a bad cramp, and they would ease the pains. But overall her condition worsened.
Still, she didn’t stop working. When her youngest—the one the aunties in New Jersey called “el niño”—turned seven, she sent him to live with Yalile so he could have the advantage of a city education. This surprised me. The way Auntie Biblia had told the story, the kissing bug disease had left my cousin, el niño, motherless. But that was not true. Tía Margarita had done what so many women all over the world have done: she sent her child to what she thought was a better school, a school in a place where she did not live.
A decade after receiving her diagnosis, Tía Margarita’s symptoms intensified: the sensation of suffocating, the straining to catch her breath. When the doctor took an X-ray of her chest, “you couldn’t see her lung,” Yalile told me. The heart, so huge, covered the view of her mother’s left lung.
Tía Margarita and my uncle moved to Tunja, near their children. As with Tía Dora, the trips to the emergency room grew in number and frequency. Yalile, in her thirties, didn’t know what to do. Her mother was dying, but she couldn’t think of it that way. No one could.
One night, after midnight, her mother, already hospitalized, began having trouble breathing. Tío Guillermo, asleep at home, didn’t hear the phone ring. Yalile got the call but when she arrived the doctors barred her from the room. She could hear her mother say, “I feel like I’m suffocating.”
The Kissing Bug Page 19
