I knew things were bad, but coming to from yet another bout of fever, with chills, sweating, exhaustion, headaches and explosive muscular pains to see a priest at the foot of my bed did nothing to still the fissures in my long suffering mental stability.
“My son, are you Catholic?”
Nerves already frayed to threads, there was but one reply. A lie.
“Yes Father, I am a Catholic.”
I would be sure to amend this heinous act of blasphemy later. Right now I wanted a cure. I would suffer the consequences of this barefaced lie at a later date. Right now, I needed all the help available to me.
It all began in May in the state of Bahia, Brazil. Now, in August, I was laid out surrounded by Nuns in Medellin, Colombia. Malaria and dengue and some peculiar decisions had brought me some 3000 miles. “Malaria and dengue?” you say. Indeed, I had the pleasure of not just one of the two, but both, at the same time. Bingo.
Hiking in the Chapada Diamantina – a beautiful yet foreboding national park famed for steep climbs, crystalline rivers and marihuana – had been a trial. Try motivating a group of English teenagers not keen on pushing themselves and idle on the back of a tremendous experience helping to reforest part of the Bahian coastline. Until this point well fed and cared for, they now found themselves stumbling over rocks, negotiating perilously slippery river crossings, setting up camp in torrential downpours and in the company of an expedition leader who was attempting to keep things together while worrying belatedly about this unshakeable fever. To put it simply, we were all out of our comfort zones.
There is little if no medical assistance to be found in Lencois so I just sat back with one aim, to survive a fraught and delusional eight hour return trip by bus to Salvador. Mildly concerned students in my keep have since reported that I chatted aimlessly to a hapless Brazilian campesino who clearly had no idea what I was talking about. Of course, my hazy memory does not even extend to these finer details.
The hospital in Salvador diagnosed the dengue and wrongly stated that I could return to work. The following day all was normal, the fever subsided and it felt good to be lucid once more. Little did I know that this is exactly what the dengue does. It comes on in force, sweats, chills, joint pains and then disappears for a day before coming back with renewed vigour and fury. And a fury it unleashed, the following day on an arduous bus journey to the surfing community of Itacare. Fortunately the stranger to my right on this journey was asleep as I curled my body as tightly as possible to retain the heat from the freezing conditions I was experiencing. Despite the 30 plus degrees outside, I was wrapped in my winter gear, complete with a woolly hat, all the while vomiting straight green bile, not dissimilar to Mountain Dew, into a carrier bag.
Moments later, I was stripping down to as few items of clothing as I could manage without losing what little dignity remained. My colleague Helen procured a small bag of ice from a rest stop and I wedged it under my baseball cap to attempt to keep my forehead from spontaneously combusting.
Knowing Itacare and the surf community thereabouts I was also aware that medical facilities there would be minimal. It would be imperative that I alighted somewhere that contained even the suggestion of a working hospital. The town of Itabuna it was to be. I was vaguely relieved to see taller buildings, in my altered state this represented a certain level of modernity that in turn suggested 20th Century medical facilities.
I was mistaken.
Made to wait while the ER inexplicably closed for the afternoon, and further promised by the receptionist that when the facility reopened at 7pm, I would be the first to be seen, I set about trying in vain to make myself comfortable. Concrete benches lined the walls, filth was smeared on the floor, previous waiting room victims had unceremoniously urinated all over the bathroom. This was a dump.
7pm rolled around, the ER was reopened, a needle was forced into my vein for the second time, a drip placed in the other arm and I waited alongside an elderly lady with breathing difficulties brought about by an unknown allergy. She breathed with difficulty, her rasping voice muffled by swollen glands.
Yes, I had dengue. This I knew, this they re-diagnosed, and was released with a prescription for Tylenol to try and manage the fevers when they kicked in. As yet, no one had mentioned Malaria. A night in Itabuna beckoned and then I would be on my way to meet my group once more so I could earn some money while combating the Dengue. After all, they were set to do a surf course and so my participation could be reduced to that of the recovering invalid sipping fresh coconuts and watching from the shore.
This was not to be. I reached Itacare and almost immediately took a corresponding bus in the direction from whence I had come. Escorted by Helen, I was admitted to the dengue clinic in Ilheus.
Yet another needle in my arm, several drips, the pressure test to reveal black staining on my forearm concluded once and for all that I did indeed have dengue. No, according to the Doctors, there was no chance of Malaria, there is no malaria in the state of Bahia they informed me. It did not matter in the least to them that I had recently been leading an expedition in the Amazon and the Pantanal. No no, just dengue, a bad case of it, particularly strong, but no malaria.
Ilheus may be the romantic and passionate centre for famed Brazilian novelist Jorge Amado’s Gabriela, Clove and Cinammon, but I was experiencing none of it. Gabriela in the novel works as a cook, and torments the hearts of men with her sensuous and pure nature, while she delicately touches the revolving life of the city. Nothing so glamorous or romantic for me. I was tormented by an illness. So, Ilheus represented a prison, a sweaty cell of personal isolation where pain and Tylenol were meted out in unbalanced measures. Tormented, yes, as I lay on the plank in the hallway listening to the screams of ailing patients, sobs of hysterical children and tried to avoid the glare of the flickering strip lighting.
That night was the worst night of my life. On my plank attempting sleep while a lone mosquito whined nearby, the strobe light flickered all night and occasionally when I managed sleep I would then be brusquely awakened as another nurse would yank one drip out and jam another into my arm, or tighten the chord round my bicep in preparation for the next siphoning of my blood.
Then Doctor Lenin arrived. Dr Julio Lenin, a Cuban whose father was quite clearly a believer, became the very personification of my saviour. After two interminable nights on the plank with no glimpse of natural light, Dr Lenin had me moved me to a bed. I thought this would mean company, perhaps even cable TV. Alas the good came with the bad. I was interned in the room for coma patients…I later found out that they had feared due to the rapid increases in my temperature that I would become a full resident in this room.
But I had a bed, a cushion, a bed pan and a code word for the nurses when the bed pan was full.
And before long a nurse would shuffle my way with the unenviable task of empty out my urine. Why they had me shout “parrot” was never clear, perhaps it was their own way of lightening the mood. Having an invalid gringo bark oddities must have been relatively amusing. I can see the humour in this now.
A week in the coma permitted rest and a form of recuperation. Although, by this stage my veins were consistently collapsing with each new location for the drip. The days took the same routine, several calls of Papagaio, a visit from the physio, and for entertainment a sponge bath by three Brazilian nurses, all set to the soundtrack of the heart monitor strapped to my chest.
Yes, every cloud has a silver lining, a sponge bath from three Brazilian nurses! Wonderful you think. As did I initially. But the sponges were cold, and as I prepared myself for the first occasion with fantastical images in my mind, I then realised that I had inadvertently and unknowingly crapped myself a few hours previously during a particularly unpleasant period of thunderous convulsions. It just went from bad to worse.
Friends and family pleaded for me to return home. Home to London where the Medics would diagnose these vile ailments and cure me. They had a point, being hospitalized in strange places with no one to visit is an unpleasantly lonely and sobering experience, but overall they are wrong. I may have been interned in a wretched hospital in the middle of nowhere, but, upon reflection where better a place to be where they treat such ailments on a daily basis with confidence and frequency?
Later that week I was released, healthy, at least Dr Lenin believed that I was on the comeback trail to wellness, despite not being able to walk and due to such low levels of energy and strength was required to use a wheelchair.
After a night of unrivalled excesses in the form of vomiting, diarrhoea, fevers, sweats and hallucinations, I was rushed to another hospital by the staff in my hotel.
There’s no doubt about it, this hospital was better, still in Ilheus, but an improvement in that I had roommates who could make conversation, still no television, no sultry Gabriela, but one thing remained the same, Dr Lenin worked the rounds at this hospital too.
“Is there any chance you may have come into contact with rat’s urine?”
Dr Lenin’s question came out of the blue. I know now that he feared that I was suffering from leptospirosis, a rare but severe and contagious bacterial infection caused by exposure the bacteria found in fresh water contaminated by animal urine.
Permanently fatigued and frankly pretty fed up with my state of affairs I snapped back:
“If I have it was never my aim.”
The nurse took more blood, Dr Lenin smiled and I was left alone again.
My dengue was gone he later informed me, but the reason it had been so severe was that I had Plasmodium vivax malaria as well. He himself was not at all familiar with malaria, but had spoken to a colleague in his motherland about my symptoms and apparently my jaundiced Simpson-like appearance was a dead giveaway. Apparently I could feel grateful that I had not contracted the lethal Falciparum strain that may cause kidney failure, seizures, mental confusion, coma and then death.
This time I was rigged up to a plasma drip and had a telephone at my disposal. Calls from the 24hr assistance line my company used were relatively common. They could explain to me clearly what my Portuguese speaking Doctors could not. No, I would not die now that the causes of this fever were identified. So starved was I of conversation that I found myself keeping complete strangers in the call centre on the line with trivial small talk concerning the weather back home and other irrelevant chitchat.
The voice from London informed me that Vivax malaria strain has dormant liver stages that can remain silent for years and the carrier is likely at some point to suffer relapse. Surely this would not happen to me, after all, my run of bad luck surely had come to an end. I was now being treated and would be back to full fitness before long.
How wrong could I be?
Another week interned and I was released. But to go no further than Ilheus since the Bahia state medical authorities needed to treat the malaria, take frequent blood tests and monitor my progress. I spent a far from riveting week in Ilheus, for the most part bedridden due to lack of strength. Dubious high points included watching the prison riots in Sao Paolo state unfold on live television and attending the premiere of The Da Vinci Code movie at the local cinema. Before Tom Hanks took to the screen a mini reunion of sorts occurred since Dr Lenin and a gaggle of my nurses had come to the cinema too. The seemed approving of my progress and warned that too much activity could cause further problems. We parted ways after the film, all under whelmed by the feature.
It seemed that things were on the up. I was permitted to return to Itacare where I started a steady regimen of light swimming, paddling on a surfboard and healthy eating to try and regain some of my perished body mass. I became the “ill guy” in traveller’s folklore at most meeting points, people spoke in hushed tones of my experiences. Initially I revelled in the attentions , but then my interest in recounting my episodes waned and so when the Bahian official declared me fit enough to leave with care I set off the very next morning.
It seemed that it was all over. I continued through northern Brazil, French Guyana, Surinam, Guyana and on to Colombia, tired, but with no further complaints.
110 ten long days after I gave up alcohol and coffee I declared myself fit enough to enjoy some rum with friends in Bogotá. It was wonderful, and tomorrow I thought, I’ll have a coffee. Prime Colombian roast, no Nescafe, only the best to ease me back into these toxins. It was beautiful, an elixir that stimulated and jangled my taste buds.
Two days later I found myself hospitalised for the third time, this time in Medellin and with a Catholic Priest at the foot of my bed. Colombian friends have told me that it is normal to have a Priest visit, but my only knowledge of such a visit comes directly from the screen, when a victim is having his last rites read. I was petrified. Nobody would tell me what was going on.
Finally Dr Ana Maria Gomez appeared. It turned out, after the ubiquitous blood tests and experiments that I was experiencing a nasty relapse combined again with another bout of Dengue which I must have picked up somewhere along the coast.
“Possibly,” said Dr Gomez trying to be friendly, “you are the unluckiest man alive. But you are alive.”
So this was rock bottom.
This second case of Dengue was far more serious than the first. Since one never builds up any sort of immunity to dengue despite having been affected by it, each time it occurs the gravity of the situation increases. This time I was suffering from a different strain, haemorrhagic dengue. The merciless Aedes aegypti, a domestic day-biting mosquito, had got me again.
With my red blood cells being battered by the malaria and my platelets decreasing rapidly due to the Dengue, I knew I had to be in good hands. Attention was constant and effective. Fortunately, although I was suffering from haemorrhagic dengue, I was not actually haemorrhaging, my platelet levels remained marginally above the point where a full blood transfusion is required.
Another week, another hospital. This institution was high in quality though. No further meals of cold overcooked broccoli or fried liver, here I was treated to roast chicken and chick peas, not to mention there was a TV with cable and working remote to boot! Even watching Fox news reports was a comfort!
Finally, I was clear of the immediate problem, the Dengue. The came a fortnights course of Primaquine to eliminate the malarial parasite from my bloodstream and annihilate the remaining schizont cells from my liver. Access to the Primaquine drug in Colombia is neither easy nor straightforward.
Due to the ongoing conflict in Colombia, drugs used to combat malaria are zealously guarded by the Government. Under no terms can these treatments fall into the hands of the Guerrillas. Of course from the Government’s point of view this makes clear and perfect sense since most of the FARC and ELN strongholds are in jungle areas with high incidences of malaria. I guess it can be reduced down to being considered as another angle of attack in their long running and destructive civil war.
Since my last period in hospital I am happy to report that there have been no further relapses, my Colombian Doctors believe that I have likely rid the Vivax from my body but urged me in all seriousness to leave the tropics. I flew to Chile in midwinter with snow on the ground!
The World Health Organisation estimates that 50 million people are affected with dengue worldwide each year, I am just another case, nothing special. Malaria in turn kills between 1 and 3 million people annually.
I hear you say, “Surely you could have taken drugs to prevent the malaria?”
The short answer is that for five years working in areas with malaria, I never took any drugs, this year, due to insurance issues within the company I worked for, I was obliged to take a course. None of the drugs are 100 per cent effective as I can tell you from experience. As for Dengue, vaccination treatments are in the process of being made, but as yet have not been tested on humans.
(This piece was written in 2006 on a brief stint back in the UK before moving to Colombia. Yes I defied my Doctor’s orders. Since then I have had no further relapses of Malaria but due to the fact that it is incubated within me I know that I have to take things easy.)