Tuesday, February 17, 2009

unfortunately, no medical excuse for gin and tonics

When I woke up last Thursday, I knew something was off. My neck was stiff and my body ached. Helen calls this a cellular ache. Everything hurt—my eyeballs, my liver, my back, my hair. But that was all that seemed wrong. I figured I’d go to work and come home if things got worse. I lurched out of the car and sat down in the office, assessing within the first five minutes that I needed to go back to the house. Once I got home, the chills set in—it was at least eighty degrees outside, and my nose was cold. Anything touching me was painful, but it worse to be out of the sheets. I tried to imagine being suspended in warm air. The door to my room seemed to zoom in and out, and time slowed to crawl. I tossed and turned, sleeping on and off in the morning and awaking once the chills diminished and my temperature went over a hundred and two in a frighteningly short amount of time. At this point, I took some Tylenol, which dropped me down to a comfortable 99.9, lessened the aches, and brought back a bit of an appetite. It also makes you sweat like crazy, so I spent the afternoon drenched and stinky. WALL-E restored some comfort as well, until my computer battery crapped out. I made the mistake of picking up a book we have at the house that talks about all the various diseases that you can catch in Africa, which gave me several hemorrhagic fevers, infections, parasites, and typhoid as possibilities, though I was pretty sure this was malaria. I’d stopped my anti-malarials, figuring that nine months on antibiotics that make you photosensitive would be a bad idea. I had a treated mosquito net and tried to wear bug spray, but that wasn’t enough, even in the dry season. My dad later called me an idiot, which I guess I had coming.

The volunteers came back, and Helen and I decided it would be wise to get a malaria test the next day. I spent the night mostly awake, running to and from the bathroom, which was neither pleasant for me or for Helen, who woke up every time I got out of bed due to the loud creaks the slats make. She was a wonderful nurse, advising me on what to take, giving me the oral rehydrating salts and Tylenol that I of course did not bring myself, making me drink fluids, flipping my mattress, and even offering to give me a sponge bath (I declined). After spending the morning completely limp and wiped out, I somehow climbed into the Land Cruiser, dizzy from being emptied out, and went to the hospital, where our office neighbor told me that she would “pray for my life” so that I could return to my family in the US alive. This was not reassuring.

Helen I went to the Rayan Laboratory with an order from our Medical Director for blood tests for typhoid and malaria. The building was run down, with peeling paint and the black patches of mildew that gather on all walls in tropical climes. There were horrific posters of the oral sores that most often manifest in HIV-positive patients on the wall. I was a bit nervous, given the infection control methods and bedside manner I’d witnessed in various healthcare situations I’ve experienced here, but the receptionist was fast and efficient. I didn’t even wait five minutes before I was sitting in a high chair (I felt like a small child at the dinner table again) watching the lab tech pull out a fresh pair of gloves and a syringe in a sterile package. Helen looked on with hawk’s eyes, which was reassuring. He pulled the tiniest piece off a cotton ball and swabbed my arm. When he put the strap around my upper arm, he apologized. Please excuse, he said. He found my vein faster than any other nurse, doctor, or blood mobile technician I’ve ever had take my blood, apologizing again—excuse—before sticking me. I was struck by how polite this was—so much better than having someone say Ok, you’re going to feel a slight pinch. He then pulled off another tiny piece of cotton and a tiny piece of cloth tape and bandaged what would become a very nice track mark. Despite the fact that there was no sharps container, everything was done very nicely—labels on the vials, new gloves, needle opened in front of the patient, irreproachable bedside manner. The only scary part came when Helen said, just before he stuck me Are you OK getting blood drawn? I thought this was a polite way of saying This guy did something wrong, which was not exactly soothing as the needle was coming closer, but it turns out she meant Are you going to pass out? Which I did not. The results came back a few hours later—right on time, shockingly—as P. falciparum, the most common, most dangerous, and most responsive to treatment of the four strains of malaria. Falciparum can cause brain hemorrhaging if left untreated but is not recurrent.

Contracting malaria made me think about several things. First off, malaria is strange as a concept because it can be taken so seriously and so lightly. At home, malaria is thought of as some terrible, debilitating illness that leaves the victim in a hallucinatory, feverish nightmare. In Sierra Leone and probably most malarial zones in sub-Saharan Africa, malaria is commonplace, something that makes you feel bad for a bit, but not a big deal—people here will often come in to work, and many won’t use bed nets because they are too hot (true) and claustrophobic.

What malaria should be seen as, for both the US and Sierra Leone, for the Global North and the Global South (or developed and developing countries—there is no good term for this), is as the great killer in Africa and in tropical zones around the globe. Malaria kills more frequently in places like Sierra Leone because health and nutrition are already poor and because people who contract it cannot get to health centers or buy treatment, either because they’re too remote or too poor or both. Malaria is not as much of a problem for me, for example, because I have easy access to transportation, several nurses and doctors, and medicine. I’m well fed and in good health. I could probably buy most medicines without a prescription here because of my skin color, for that matter. Malaria does not need to be thought of with panic (I’m afraid my dad was not so happy when I told him I had it), but it does need to be taken seriously. Malaria kills, but it would kill less frequently if there were more health clinics, or if the roads were better, or if hospital visits were cheaper. Or if children could get enough to eat or weren’t sick most of the time with other things—worms, chronic coughs, malnutrition, diarrhea, etc, etc, etc. Malaria can still kill a well-fed, healthy individual; don’t get me wrong. It’s just that everything becomes so much worse once you add in the factors that put Sierra Leone at the bottom of the Human Development Index this year.

After my results came in, the Medical Director told me what to buy (no prescription needed) at the pharmacy. The man at the pharmacy started when I asked him how to take the Artesunate tablets. He laughed, explaining that he thought I was a doctor, and then advised, once he realized I was the patient, that I should be on anti-malarials and sleep under a bed net. Thank you. Even one pill later, I felt better. I’m still not one hundred and ten percent yet, but I’m getting there. The child of one of our patients came down with an undiagnosed fever yesterday, almost burning to the touch and crying out of discomfort. Her mother sharply told her to quiet down.


  1. Is it bad? I mean, I HATE the antimalaria medicine and I am sort of banking on not using anything when I go back. I spent the whole summer with some cloud of depression over my head. Can you tell me how your bought with malaria is standing up against months of depression? (My dad would also not be pleased if I called and told him that news!) PS - Thanks for all your work on fistula!!!

  2. Just as a note to everyone, I am not medically trained. The experiences and choices I'm relating are my own--and what might work (or not work) for me isn't going to be the same for someone else. But to respond to Seth (do you have a blog up?), my case was not bad--I had a very low parasite density, which will not always be the case for everyone, and still, it was not a pleasant experience. I was taking doxycycline, not lariam, because I've had a negative experience with it in the past (scary, very realistic dreams). I am contemplating returning to the anti-malarials now instead of waiting for the rainy season to recommence, but regardless of whether I do or not, I will be sleeping under an insecticide-treated bed net at night and using 30% deet and wearing long sleeves and pants during evening times. But I'm not a doctor and I don't know your story, so I feel reluctant to give out any advice. Lariam does suck, though--I feel you on that one.

  3. Hey Julia, I do have a blog. I am bit (a lot) behind in postings, but you can see it here. http://www.operationof.org/OperationOF/Blog/Blog.html