The Kissing Bug Read online

  It was a mild day in Bogotá, around sixty-four degrees Fahrenheit, but when the student pushed open the door to the bug room, it could have been summertime in North Carolina right after dusk. That is, the room was dimly lit and warm. Immediately, the student shut the door behind us, explaining that the room was temperature-controlled. I knew from reading articles that kissing bugs like the temperature to be between sixty-eight and eighty-six degrees Fahrenheit. In that temperature range, they’ll feed about once a week. If it gets warmer, they’ll want to bite a person, or any mammal or bird—what’s called the host—more often. The lights had to be this dim too. Kissing bugs hate sunlight. They are nighttime feeders, and while other assassin bugs have curved proboscises, the kissing bug has a straight one, a needle-mouth it draws out to feed.

  The room had three long wooden shelves filled with glass jars. Someone had folded black filter paper and stuffed it into each jar, then covered the tops with cheesecloth. The graduate student picked up a jar, and at first, I couldn’t see anything inside. The student twirled the jar. The filter paper moved slightly, and a kissing bug poked its head out between the folds. To my surprise, it didn’t look like a cockroach but rather something more substantial, perhaps a cross between a cucaracha and a beetle. I strained to see the colorful markings on its abdomen, but in the dark I could not see any distinguishing detail, just a six-legged bicho.

  The kissing bug began crawling along the filter paper toward the lid of the jar. I froze, the notebook in my hands a necessary anchor as I stood, watching its six legs, its splayed antennae, its terrible four eyes. The first pair, located on the sides of the head, are the compound eyes insects usually have. Behind this set are another pair that can scan large areas.

  A second kissing bug appeared between the folds of the filter paper, then another. They all climbed methodically, patiently. I stepped back. The graduate student turned the jar so I could see more kissing bugs hiding, their wings carefully tucked on their backs. Some were Rhodnius prolixus, less than an inch long. Some were nymphs but that didn’t make them any less lethal—nymphs, too, can transmit the parasite for the kissing bug disease.

  “What’s at the bottom of the jar?” I asked.

  The grad student peered closely. “The ones that died.”

  Every jar was a neighborhood of kissing bugs, and the bottom constituted an entomological cemetery littered with wing fragments and carcasses.

  The room had been designed to please the kissing bugs: the dusky lighting, the warm air, the folds of paper in which they could hide. I began to appreciate that kissing bugs are homebodies. They make their homes near their supper, whether that’s a human or an opossum or a German shepherd.

  I knew from reading science articles that kissing bugs are not born with T. cruzi in their guts, but pick up the parasite when feeding on an infected host. It occurred to me that kissing bugs are innocent. They can transmit T. cruzi, yes, but they can also feed on a person or a family dog or a wild mammal, acquiring the parasite in the process. Kissing bugs are also the only insects known to transmit T. cruzi to people. Bedbugs can harbor the parasite, and in the laboratory, they have been shown to pass it along to mice, but scientists have not been able to explain why they don’t do the same with humans.

  The kissing bugs in the jar looked like they were walking with purpose. The graduate student smiled at me weakly. “They think we’re going to feed them,” he said. Their dinner? Chicken blood.

  The graduate student had a kind, round face. “Are you scared of them?” I asked.

  “I’m scared of Panstrongylus geniculatus.”

  “Why?”

  “It’s long. It’s like the length of my finger.” He scanned the shelves as he said, “I’ll show you one.”

  I wanted to tell him that it was fine, that I didn’t need to see it, that I believed him. I was looking at his fingers to see if they were longer than mine when he said, “Here’s one.”

  The jar looked a bit wider. He lifted it more carefully than he had the first jar, as if this giant kissing bug had already ripped the cheesecloth and was waiting for this moment to take flight from the jar and stab us with its needle-mouth.

  The insect was longer, probably more than an inch. I couldn’t make out any markings on its body. It hovered on the filter paper close to the bottom of the jar and looked half-asleep. I waited for it to move, to scuttle up the filter paper, to hunt for its supper, but the bug did not stir. I wondered if it was still satiated from its last blood meal.

  …

  Professor Guhl told me that battling the kissing bug means constant vigilance. A one-time fumigation of a rural house is not enough. In 1995, when forty-two scientists and researchers from fifteen countries gathered in Ecuador to discuss the insects and the disease, Guhl reported one of their conclusions: rural housing conditions have to be improved so kissing bugs don’t have easy access to people.

  Still, South America was winning the war against the kissing bug disease. According to the World Health Organization, the number of people infected had been steadily decreasing. In the nineties, between sixteen and eighteen million people were thought to have the kissing bug disease in Latin America, but today fewer than six million are infected. Maybe the decrease in infections was due to migration. People in Latin America, like those in the rural areas of the United States, were increasingly moving to the cities and away from the insects. Maybe it was due to a series of government initiatives that had begun in South America in the nineties and had raised awareness of the kissing bug disease and provided funds for fumigations. Maybe it was due to Doctors Without Borders and other nongovernmental organizations that had spent years in the region working with health ministers and local health care providers to make it possible for people to be tested for the disease and for children to be treated (children, for reasons doctors do not fully understand, can often be cured of the kissing bug disease even after the acute phase though the same isn’t true for adults). Maybe Latin America was winning the war against the disease because the international health community had, at the start of the twenty-first century, begun paying attention to neglected tropical diseases in general. Experts convened conferences; declarations were issued. A list of neglected diseases was created. The list included the kissing bug disease as well as rabies, sleeping sickness, river blindness, leprosy, and leishmaniasis.

  …

  When I left the insectario, I did not think of staying in South America to write about the kissing bug disease. I was raised by an immigrant family in the United States, and the story I knew best was the one of migration, of negotiation, of borders that are imagined and frequently in flux. At the time of my visit to Bogotá in 2014, more child migrants were arriving at the US-Mexico border. Phil Gingrey, a congressman from Georgia, wrote to the CDC that summer, asking officials to “assess the public risk” the children posed with respect to diseases and to “provide guidelines to the public about how to protect themselves from potential infection.” He told an NBC reporter that Border Patrol agents were worried about Ebola, tuberculosis, and the kissing bug disease. In the town of Murrieta, an hour north of San Diego, Americans turned away buses filled with migrant children. One picture taken by a Fox News photographer showed a woman with pale skin wearing hot pink shorts, holding a sign that read: “Save our children from diseases.”

  I stared at that three-letter word, the possessive pronoun “our” as in our children, our health, our country. The historian Alan M. Kraut calls it “medicalized nativism,” when immigrants are linked to a disease and stigmatized. It worried me that this could happen with the kissing bug disease even though most people only become infected from direct contact with the insects. It would be like blaming people from Connecticut for Lyme disease. But the kissing bug disease is mostly found among immigrants from Latin America. That could make a difference.

  There was another reason to return to the United States: the kissing bugs themselves. The insects are native to this country. Historically, they have bee
n found in warm spots like Texas, Arizona, California, and Louisiana. I began to wonder about the history of the disease in the United States, and then I learned about the medical experiment carried out in Texas on a young Black man.

  AUSTIN STATE HOSPITAL

  In the medical sketch, the young Black man has a shaved head and a clear face. He is twenty-four years old, almost six feet tall, and his left eye is closed, the lid swollen. His right eye stares at the artist.

  I imagine that this young Black man is defiant, that he knows a part of his face is being documented, that he has something to say about it. Other times, I look at his eyes and can only consider the reality of his Black body, of what the white male doctor in South Texas did to his body, and then I believe that the young man in the sketch is thinking only of his left eye. He wants the swelling gone. He wants the fever to end too and his armpit not to bulge like a water balloon. He wants his body back intact.

  It is the only image I find of him.

  …

  The sketch was included in a 1943 medical journal article titled “Infectivity of the Texas Strain of Trypanosoma cruzi to Man,” and it was published by the American Journal of Tropical Medicine and Hygiene. When my university library sent me the article, I had not expected it to come with an image of a young Black man’s face, but it did, and I spent hours, then days, then weeks, looking for his name. I turned up nothing. But the article’s acknowledgments and a review of the author’s archived correspondence revealed that the young Black man, in all likelihood, had been a patient at the first hospital in Texas for the mentally ill: the Texas State Lunatic Asylum.

  The young Black man may have ended up in the asylum for any number of reasons. Since the institution’s opening in 1861, people had been committed for drinking too much or being promiscuous or writing bad checks. By the late 1930s, about 70 percent of the patients were diagnosed either with schizophrenia or what is now known as bipolar disorder. The asylum’s name was changed to Austin State Hospital, and by 1940, it had close to three thousand patients, housing Black patients in one ward and whites in another, and also separating them by gender. Distinct kitchens provided meals for white and Black patients. “Even the filing system was segregated,” a social worker reported decades later. When the hospital first opened, Black patients slept in the basement.

  One day in the winter of 1940, the young Black man from the medical sketch most likely joined a line of other Black men for breakfast. He wasn’t the only patient in his twenties. There would have been others his age, as well as men in their fifties and older, all of them in Black pants and button-down shirts, the bowls in their hands wide enough for a cup of rice. Most likely the young Black man did not know what would be done to him that day. It was simply another Thursday morning in December. Perhaps he ate quickly while thinking of Christmas and the long stretch between what he wanted to buy for his family and what he could afford. He might have been a father, but I thought of him in relation to younger siblings: a sister he doted on, a brother he teased. The Second World War raged that winter. Maybe he overheard hospital workers talking about the Germans bombing London, first during daylight hours and then at night. Maybe he thought about the draft. It was new. Maybe he wanted to serve.

  In Alabama, the Tuskegee syphilis study was underway that December. Federal public health officials were lying to Black men and their families, telling them that they were receiving treatments for “bad blood,” as syphilis was called then, when in reality doctors were not treating them at all and were, instead, monitoring them for how the disease progresses in the Black body untreated.

  At Austin State Hospital, the young Black man was taken to see a researcher who worked for the US Public Health Service, the same agency conducting the Tuskegee syphilis study. The researcher, Ardzroony Packchanian, had been asked to come to Texas to see what he could find about the kissing bug disease.

  …

  Packchanian was born in Armenia at the start of the twentieth century, so when he landed in New York City in 1921, he was still a young man. He may have considered himself lucky. He had not lost his life in the 1915 genocide that killed more than a million Armenians in the Ottoman Empire. He also arrived in the United States when the door was still open to immigrants. A few years later, Congress passed annual quotas on immigration limiting the entry of Armenians to a mere one hundred people (the quota for Germans numbered at more than twenty-five thousand). Packchanian’s arrival in the United States then was marked by those bitter bookends: genocide and xenophobia.

  Like so many immigrants then and now, he seems to have slipped into the racial category of whiteness with all its demands and benefits. He enrolled at the City College of New York, then studied at Columbia and Yale until he landed at the University of Michigan. He completed his doctoral work on sleeping sickness in animals.

  By 1940, Packchanian had shifted his focus to the kissing bug disease and shown that a species of kissing bugs native to Texas could carry T. cruzi and transmit the parasite to mice, guinea pigs, and rhesus monkeys. News of his research had appeared in the New York Times. Now Packchanian wanted to know if humans could also contract the parasite from these local kissing bugs and develop symptoms.

  …

  Maybe the young Black man looked at Packchanian suspiciously. Maybe he wondered why the researcher was listening to his heart and noting that there was no sign of an irregular heartbeat. Maybe he kept an eye on the researcher’s white hands.

  Packchanian had collected kissing bugs of the species Triatoma heidemanni (now classified as T. lecticularia) from a town more than two hours south of Austin. In his makeshift laboratory, he crushed one of the kissing bugs. The insect’s needle-mouth, its translucent wings, its abdomen and six legs—all were pulverized. Packchanian knew that an infected kissing bug in South America could transmit T. cruzi to humans. He knew, too, that at its worst the parasite could devour the human heart.

  Packchanian pulled up the young Black man’s left eyelid and forced part of the crushed insect into his eye. Less than an hour later, he also infected three mice and two guinea pigs.

  Almost two weeks later, right before Christmas, the doctor could not find any sign of the parasite in blood samples taken from the young Black man, but the twenty-four-year-old began running a fever. The lymph nodes in his armpits ballooned. His left eye, suddenly bloodshot, pained him. He developed pink eye. His left eyelid swelled shut.

  Forty-eight hours later, the swelling of his eyelid vanished. The fever persisted for another two weeks. And the parasite? Shortly after Christmas, it could be seen under the microscope vibrating in a droplet of the young man’s blood.

  …

  It’s hard to imagine that Packchanian explained the disease and the experiment to the young Black man. Harder still to imagine that the twenty-four-year old, perhaps diagnosed with schizophrenia, perhaps suffering from depression, perhaps guilty of nothing except being Black and male in South Texas, would have agreed to offer his body to science.

  …

  Six weeks later, in the middle of January, Packchanian placed several kissing bugs in a container covered with a cheesecloth lid. These were healthy insects. He had reared them in the laboratory and monitored their blood feedings. Since a kissing bug has to feed on an infected host to catch T. cruzi, Packchanian must have felt confident. These kissing bugs, all of them nymphs, were free of the pathogen.

  He strapped the container filled with the nymphs to the young Black man’s forearm, and the insects raced toward his flesh and stuck their needle-mouths through the cheesecloth and into his skin, sucking up his blood.

  When Packchanian dissected the insects and searched, he found the parasite. He repeated this test a week later and got the same results. It confirmed that he had infected the young Black man with T. cruzi from kissing bugs native to the United States.

  The lymph nodes in the young man’s armpits remained swollen for months.

  …

  While researching, I thought about Tía Dora
and how she had been surrounded all her life by her sisters and me and my sister, and I wondered about the women who had loved this young Black man. His mother, maybe an auntie or a sister. Did they visit him for Christmas and worry about his fever? Did they bring him gifts? A new pair of socks? A hand-knitted cap for his shaved head?

  …

  In 1941, a year after he infected the young Black man, Packchanian could not find the parasite in the man’s bloodstream. Almost two years later, the doctor declared him free of the parasite and also the disease.

  It is difficult to find T. cruzi in the bloodstream once a person is in the chronic stage of the disease. The search has to focus on antibodies. In the 1940s, though, such antibody tests did not exist for the kissing bug disease. Maybe the young man lived unaffected by the parasite. Or maybe the parasite had found its way into his heart.

  …

  Packchanian went on to enjoy a long career as a professor at the University of Texas Medical Branch in Galveston. He had professional contacts with physicians from Argentina and Brazil who devoted their lives to the kissing bug disease, men like Salvador Mazza and Emmanuel Dias. And he spent a decade looking for people who had contracted the kissing bug disease in Texas, but he failed, it seems, to find a single one.

  At first, I thought Packchanian had experimented on one patient. Then, after a librarian emailed me his medical correspondence, I found a letter from Garland G. Zedler, a doctor who had worked at Austin State Hospital that winter in 1940. He wanted to know what had come of Packchanian’s experiments on hospital patients. Packchanian replied that he had not kept track of those cases, but, he wrote: “I am enclosing here a reprint describing one of the patients.” The reprint was not included, but the phrase “one of the patients” jolted me. The young Black man had not been the only one.