I always thought you have to travel outside Nairobi or get into contact with people outside Nairobi to get malaria

- Mwende, Interviewed by Ann Soy for BBC, 2013

The above excerpt is from an interview conducted by Ann Soy for BBC. Mwende was astounded/appalled to be told that her child was suffering from Malaria in Nairobi, yet they had not travelled out of the city. Through her experiential knowledge, she mentioned that since she had not travelled out of the city, she did not understand how her daughter was diagnosed and eventually tested positive for malaria. She further brought forth an interesting perspective: the belief that the only other way the daughter could have contracted malaria was by having been in contact with someone who had recently travelled outside of Nairobi.

Perceived malaria in Nairobi was often related to travel from the malaria-endemic areas. Nairobi is considered a malaria low-risk area due to its location. The city is at 1700 meters above sea level, and has cold seasonal temperatures. Moreover and the urban habitat limits the development of the dominant vectors that transmit malaria. The city, however, experiences high malaria incidence rates, which are believed to be a result of circular mobility from the city to the malaria-endemic hinterlands and back to the city. People whose origins are from the malaria endemic rural areas move from the city during holidays or to attend several kin ceremonies such as weddings, circumcision, and funerals. As people move to the city they do not disconnect their relationships and contacts with kin in the rural areas.

All this while, as I grew up in Nairobi and visited our grandparents in the village located in the rural malaria endemic region, we would have several bouts of malaria. Our parents taught us that malaria is a killer disease; hence, we had to know the symptoms. Whenever the headaches started, we would be given paracetamol immediately. If the headache persisted, coupled with other symptoms like fever and joint pains, we went to hospital and were treated for malaria. The malaria treatment was given after a history of travel was taken, and tests were done to rule it out. However, with time, we started buying the medications and treating ourselves since we knew the treatment for malaria symptoms. The chemists would just sell the medications to us and direct us on how to take them, and we would be fine after the treatment

- Informal conversation with a 29-year-old female

Everyday language is used to express illness experiences. Illness experiences are expressed through symptoms, feelings and other ways that are acknowledged by society members. From the above conversation, the symptoms for perceived malaria were unanimously agreed upon guided by previous experiences and knowledge that had been passed on orally. The dynamics of illness and experiences among people who keep moving from the city to the hinterlands are influenced by both places. My research under the Urbanities Project focuses on how cultures, especially health beliefs from both the rural and urban spaces, impact on illness experiences and eventually the health-seeking practices. This work acknowledges that as people move from the city to the rural spaces, and back, cultural assimilation takes place. The type of cultural assimilation experienced is a two- or more-way exchange of cultural influences, layering upon each other in complex processes of power, loss, and production. The exchange of cultural influences explains the need to acknowledge the influences of both the urban and rural cultures in the expression of illness experiences. My research, thus, argues that it is inappropriate to reduce patient histories and symptoms to mere biomedical aspects that need biomedical care. It acknowledges that physical symptoms, moral order and social events work together to give meaning to perceived malaria in Nairobi.

Dr Agnetta Nyabundi is a postdoctoral fellow at the Centre for the Advancment of Scholarship, conducting research as part of the Centre's Urbanities Project and funded by the Mellon Foundation. 

Disclaimer: The opinions expressed in this article are solely those of the author and do not necessarily reflect the views of the University of Pretoria.