The Best American Travel Writing 2014 by Paul Theroux Read Free Book Online

attention to weeds. When asked what they thought caused the disease, they immediately said water: more people got sick in the parts of the village that were prone to flooding, and fewer people were getting sick now, because of improvements to the water system. They noted that the disease didn’t affect anyone who lived in the hills, with the exception of women who had grown up in the lowlands and had moved to the hills only after getting married. We heard something similar in another village, where a man with BEN , who had lost his father, his aunt, and three siblings to the disease, told us about a neighbor who had no BEN in his family. “You see, he comes from the other side of the street,” the man said. It emerged that every house on one side of the street had one or several cases of BEN , but the other side, which was on slightly higher ground, was almost completely free of the disease. Annie Pfohl-Leszkowicz, a proponent of the ochratoxin theory, has cited similar patterns as evidence that BEN is caused by a fungal toxin: the healthy side of the street, she proposes, gets direct sunlight, which discourages the growth of mold.
    In Odžak, my father and I met with Enisa Mesić, a nephrologist from nearby Tuzla. A magnetic presence, with a large head, copious dark hair, a deep voice, and piercing gray eyes, Mesić told us about the bureaucratic obstacles faced by BEN researchers. After the war, political power was decentralized in order to preserve equilibrium among different ethnic groups. As a result, Bosnia-Herzegovina now has no fewer than 13 ministries of health: one at the federal level, one for each of its 10 cantons, and one each for the self-governing Brčko District and the Republika Srpska. The two major centers for BEN research, in Tuzla and Sarajevo, are in cantons outside the endemic region, which means that before researchers can actually study any patients, they must submit requests to two different ministries.
    Because of the war, nearly every patient’s file is missing at least four years. There is no central BEN database, and establishing one would require the cooperation of all 13 ministers of health. The municipalities used to have local databases, but these were discontinued after the war. When asked what had happened to the databases, Mesić ticked off their fates: “In Bijeljina, the archive probably still exists, but it’s difficult to access. In Å amac, it probably doesn’t exist anymore. In Odžak, it was destroyed in 1992, together with the hospital.”
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    Early in the 20th century, after the fall of the Ottoman Empire and the ensuing chaos in the Balkans, a new verb entered the English language: “Balkanize,” defined by the OED as “to divide (a region) into a number of smaller and often mutually hostile units, as was done in the Balkan Peninsula in the late nineteenth and early twentieth centuries.” Most European languages have an equivalent: the French
balkaniser,
the Italian
balkanizzare,
the German
balkanisieren,
and the Russian
balkanizirovat'
—attesting to the special relationship between the Balkan Peninsula and the human tendency toward division and faction. It’s an apt word to describe the study of Balkan nephropathy, and its fragmentation along geopolitical, ethnic, religious, linguistic, and even disciplinary lines. Researching the disease requires expertise in a wide range of fields—nephrology, epidemiology, genetics, oncology, microbiology, hydrogeology, botany, toxicology, biochemistry—each of which can be as hermetic and insular as a tiny country, with its own language, customs, and sovereignty.
    The basic philosophical question surrounding BEN is whether it’s a big problem or a little one. For Arthur Grollman, BEN is part of a worldwide crisis of aristolochic-acid nephropathy: a story in which the true culprits are government agencies that fail to regulate herbal medications. When I met