Maladie (Thursday, 2010 July 1)

July 6, 2010

So many things to write about. But for right now let’s focus on the big one: being sick.

Discussion of the activities of my bowels follows. Please make sure you are not eating and are proximate to a shower before reading this. The sections about my bowels will be called out.

The day before yesterday, we were wrapping up the workshop with our community hosts when I realized that every time I drank water, I had a little bit of a stomach cramp. I resolved to monitor it, but, since we’re in Africa, I had long since given up on ever feeling completely healthy. Since school got out a bit early, naturally I went to the cybercafe, the market, and the bar with some other trainees. Then, later, when I got home, I realized that the way I was feeling was not typical "fuck this country is too goddamned hot and I’m never going to have a proper shower again" crappy, but more of a "hey I think I have a fever" crappy. And lo and behold, I was at 102 F. Cool beans.

Next paragraph: bowels.

But the medical manual basically says "Hey, most fevers go away within a couple days so hang in there!" I wouldn’t have worried overmuch except the following day we were supposed to go on site visit with our community hosts. So, time passes, diarrhea happens, and the morning of the alleged departure I evacuate my bowels again and this time I get lightheaded in the bathroom, lean against the wall for support, and later realize that I am now on the floor and that I might have blacked out for a second. That caused me a little bit of alarm because if I seriously hurt myself in one of those rooms, I am not sure how long it would take for my host family to discover and get help. Anyhow, I chalk it up to dehydration and resolve to drink a ton of water despite the cramps.

Nevertheless, I am too stubborn to quit, and naturally I have packed my bags for a few days’ journey. So I bring my bag down to the "staging area" (N.B. this is a pun; "stage" is French for "training") and say "Listen, David [training director], I am not feeling very well and I am not sure I am well enough to go on this trip. But then again I might be fine." David asks whether I would ilke to see a doctor, which eventually becomes "You are going to see a doctor". Everyone else leaves on their delightful voyages; my community host seems pretty bummed but also manages to leave; everyone verifies to their own satisfaction that I am being managed; and I wait.

There are two hospitals in the area of training — the Catholic hospital, and the Provincial (government-run) hospital. Apparently there’s one doctor who works at both. I’m not sure if he’s the only doctor, or merely the only doctor that the Organization approves of, but in either case we had to find him, so after first going to the Catholic hospital, we go to the other one, find him, go through a certain amount of medical rigamarole (my current weight is approx 79.3 kg. It’s approximate because I didn’t write it down and didn’t pay close attention because I was suffering from the ague). He prescribes some lab work that has to take place at the first hospital, including blood work, including malaria slides, because every fever in a malarial region is potentially malaria, and also a stool sample if possible.

Interestingly enough, nobody took my temperature at either hospital; I’m guessing sanitation is such that you can’t re-use thermometers, and economics are such that you can’t really use disposable ones. A bright Cameroonian could make a certain amount of money solving this problem. On the other hand, the apparatus to withdraw blood was pretty familiar, but although the nurse said "This will hurt a little bit", it actually hurt like fuck, much more than the needles back home. Duller or perhaps bigger needles? No idea.

Anyhow, the doctor pre-emptively (i.e. before the results came back) prescribed anti-malarial meds, because every fever in a malarial region is potentially malaria, and also an anti-fatigue medicine, because if you can’t treat the problem, you may as well treat the symptoms. I didn’t get all of this the first time around, so we went through a round of sending someone to the pharmacy to figure out what the various medicines were and what they did, and then visiting me at my host family’s, lying crosswise in bed because getting all the way undressed seemed like too much to ask. At this point I was entitled to call the Organization Medical Officers, who have a duty line that is 24/7 for Serious Emergencies, but business hours only for non-emergencies. Naturally it was just after business hours when I earned my 102 F fever, so I had decided to wait it out, but it was business hours now. Anyhow, I got ahold of Chad, who is the best medical officer, perhaps because he is the only American medical officer. He directed me to not fill any prescriptions yet, since we’d be getting the malaria results the same day, so why rush? I didn’t have the capacity to argue with that so that’s where we left things.

Oh, I should interject that by this point I was up to 104 F and had decided that acetominophen was probably something I could work on. Chad agreed; lots of fluids and tylenol every 4-6 hours.

If you are not interested in reading about my feces, you may want to skip ahead until the section marked "Later".

I hadn’t eaten anything since the night before (i.e. since the last time I had diarrhea) but somehow I found it in myself to produce a stool sample. In my medical journal this is recorded as "Shat my brains out. Shat my underwear. Broke the toilet lid. Acquired stool sample." It’s fair to say this was not my finest hour; I was afraid of falling down again so I tried to wait until I felt fairly stable before I stood up, and while I was waiting I leaned back against the toilet lid, which is only a bit of plastic and doesn’t have anything behind it like a toilet tank or a wall, and naturally it broke. I remember staggering back to my room in barely-decent attire including the aforementioned soiled underwear, losing at least one of my flip-flops, perhaps finding toilet paper, lying down on my bed for a minute, hearing my host sister "flush" the toilet (which, remember, is a manual process here) and then say "Ethan, your flip-flop", realizing what a disgusting mess I had created/was a part of, dragged myself out of bed, and attending to myself. Also: realizing that I had been wearing the underwear backwards to begin with.

(After leaving the bathroom here, it is important to "flush" the toilet, i.e. dump some water into the bowl and let it drain — the quantity of water depends on how solid the waste is — and then replace the lid and shut the door on your way out, by way of odor control. I had done none of these things. But I did have a stool sample.)


At about 4 we went to the hospital to receive results. The doctor was not impressed with the fact that I hadn’t taken his pre-emptive malarial meds — in fact he did a completely typical "I’m a doctor and you think you know better than me? Fuck!" thing that was completely intelligible cross-language-barrier — but offered a diagnosis of typhoid fever. Basically: intestinal infection. It sounds grave — or I guess it must sound grave because people keep saying "oh my God, I’m so sorry", but in fact it’s pretty treatable. In my experience I’d say it’s on par with salmonella. So, one for the scrapbook.

Anyhow the doctor decided to prescribe altogether five medicines: the same antimalarial, the same anti-fatigue, because after all if you’re taking five medicines you’re going to be wiped out!, something for typhoid (an antibiotic called "thisbactin"?), an anti-worms drug, and an anti-diarrheal. I asked if I had malaria and he said "Well look, in order to reject the diagnosis of malaria, we need to do slides two times a day for three days, and because we’re in a malarial region, we treat every high fever as though it is malaria, and in other regions like in France that may not be necessary, because there malaria is the exception rather than the rule, etc." And for the worms medicine he said it was standard operating procedure to prescribe worm meds for anyone who complained of abdominal pain in this region (remember: worms are too numerous to mention here).

So I called Chad again and he said: first, that the multiple-malaria-slides thing is a crock of shit, and since I’m already on malaria prophylaxis, medically I’m a completely different animal; second, that the worms thing is equally implausible without evidence, and if he had evidence of either in the bloodwork or the stool sample, he would have said so; third, that guess what, typhoid also gives you a super-high fever; fourth, that there was a (different) antibiotic being kept with the training staff for such a case like this, and if I got ahold of them, I could get my dosage. Chad agreed that it was probably typhoid, and he prescribed also lots of fluids.

So, somehow I made it through the Cameroonian medical system, with a lot of assistance from the Organization. The final diagnosis was typhoid fever. I am now on Ciprofloxem 500mg 2x daily for 7 days, and I feel a lot better (this morning: 98.6). Huge thanks to Mauro the driver (at least, I think that’s his name), who went above and beyond in helping me cope with a medical establishment in a language I just wasn’t up to coping with.

I’m always fascinated by which things people feel necessary to explain to me and which ones they don’t bother. For example, the doctor needed to explain that if we couldn’t find the medicines at the dispensaries under the names he’d given, it might be sold under a different "commercial name", and we could call him for assistance. Well, obviously. But nobody explained why I had to go to the first hospital to get blood drawn.

And as for typhoid: it is a bear of a disease. Last night (after the first dose of antibiotics!) I really wanted to brush my teeth, but couldn’t really talk myself into it. I managed to get as far as finding my toothbrush and toothpaste and placing them on my desk before deciding that really I wanted to lie down again. It was not awesome. I was a little bit worried there. I have memories of thoughts like "What the hell am I doing here? I want to be home. I want to be safe. I want to be with my girlfriend. This sucks."

I think I scared the utter shit out of my host family. Claude went so far as to explain that here in Africa, if you’re sick and you sleep a lot, people take that to mean that it’s a very grave illness. Whereas of course I was operating according to the rules back home — if you’re sick, you should sleep to conserve strength and get better faster. My host mother even said that she didn’t sleep at all last night, and in fact cried because I was so sick. My host family insists that typhoid is only acquired through contaminated water, but the medical manual says food, water, or milk, and everyone’s been trying to figure out how it could have happened. The answer: it’s impossible to say. There just isn’t the sanitation or oversight here that it would require in order to try to narrow it down. I’ll try to clean my filter more often, but I’d put money against it being that.

On another subject. Fun French for today: instead of "collecting" or "picking up" your wages, you "touch" them. "Je voyage pour Yaounde pour toucher mon salaire" — I am going to Yaounde to collect my salary. It’s important to touch your salary because there may not be banks where you live, and besides, you are frequently going to bigger cities to do shopping or otherwise. Also you may not trust the banks. Who knows?

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