Bakau, The Gambia. It's early, and the sun has just barely begun to creep through the blinds. I can feel the strange burning sensation behind my eyes before I even open them. Oh no, I know this feeling. I stumble to the bathroom to take care of the morning's business before rummaging through my first-aid kit. There is a lot in here: pills, potions, unguents, salves, creams, ointments, bandages, slings, solutions, needles, syringes, and various other instruments used to poke, prod, and otherwise violate yourself back to health. It takes a minute to find what I am looking for. Lying back in bed I pop the digital thermometer into my mouth. I don't even need to look. BEEP! 1020F
Being sick in Africa is a bit like being in an elevator that's plummeting from a great height - things happen really quickly, it's incredibly scary, and without a fair bit of luck most of your organs will probably end up liquefied. African diseases are unfathomably frightening. Reading about them before the trip one almost begins to regret being literate. They are often described like so:
Meningococcal Leptoschistopoliomyelitis
Signs and symptoms are initially nonspecific (fever, skin lesions, rash, edema, or lymphadenopathy) or entirely absent; however, the infection may progress unnoticed until suddenly, one day, while taking a pee, your penis suddenly slides off into the toilet.
Obviously this is a bit disconcerting. For one thing there aren't many toilets in Africa, so your penis might fall into a bunch of poison ivy. Now you have two major problems. What is even scarier about some of these diseases is the banality of some of the initial symptoms when weighed against their eventual outcomes. This is a verbatim passage from Lonely Planet:
Trypanosomiasis (Sleeping Sickness)
Found in most of West, Central, Eastern, and Southern Africa. Spread via the bite of the tsetse fly. It causes muscle soreness, headache, mild fever, and eventual coma.
Self-treatment: none.
An eventual coma is the end result of a headache and mild fever?! It's enough to make even the staunchest critic of hypochondria sit up and take notice. Unfortunately, due to the paucity of health care in most of Africa one of the first things you tend to do is flip through your guidebook and self-diagnose. So it was that I found myself laid up in bed thumbing through a gruesome collection of horrific ailments. My symptoms were definitely vague. Fever aside the only other indication of illness was muscle soreness. However, that could easily be explained by the fact that I had spent the previous day furiously dismembering a coconut. I carefully weighed my options. As luck would have it we were in the one of the most developed regions in all of West Africa, the Gambian coast. The beaches here are spectacular and dozens of resorts have sprung up to gorge on a steady diet of bloated European tourists. I'm not one to criticize, though. Without resorts where would we keep our luggage when we were scuba diving? The influx of euros has allowed the area to develop a bit but it's still in puberty. Amongst the handful of towns around the coast one can find basic hotels, simple restaurants, and several Internet cafes. From time to time there is even electricity to power them. More importantly, there was a British-run medical clinic a few minutes from where we were staying. I checked my temperature again. BEEP! 1030F
I hailed a taxi over to the massive gated campus, where the guards promptly stopped me from entering. It was early Saturday morning and the clinic is closed on weekends, no matter how many severed limbs you are toting around in that garbage bag. I was instructed to come back at 6am on Monday morning if I was still breathing. Wonderful. I headed back to the hotel to write my will. Thumbing through my guidebook again, I found some information on a nearby testing lab. They only tested for malaria but it was a start. I decided to check my temperature again before heading out. BEEP! 1040F
The test came back negative. I can't say it was much of a relief. With malaria at least I knew what I was dealing with. Now I worried that I might have one of those diseases where you die while still trying to figure out how to pronounce it. A touch dejected, I headed back to the hotel room. Xander left to try and find a phone so he could inquire about other health centers. He returned a short while later with directions to a clinic in the nearby town of Serekunda and notice that it would close in thirty minutes for the rest of the weekend. We got there as quick as we could. This was definitely a local's clinic. Dozens of weary looking women toting ailing infants packed the halls, while busy nurses scuttled about and directed traffic. Before long I was sitting in a room with a stern looking man in a white coat and explaining my symptoms. There was no examination. "You have malaria", the man said definitively. I protested, explaining how my tests had come back negative. "You have malaria," he repeated, "they get those tests wrong all the time." He began to rattle off instructions. I had done a lot of research on malaria before my trip, so I was well aware of the various treatment options. At first he prescribed Chloroquine, a treatment that is considered ineffective due to malarial resistance in the region. When I mentioned that I was taking the anti-malarial Malarone he changed his mind and suggested that I take the treatment dose of it instead. After all, I already had the drug on me. I wasn't positive but I was fairly certain that you were never supposed to take the same drug you had used for prophylaxis as a treatment for the disease. This made me extremely skeptical. I had a sneaking suspicion that if I mentioned I also had a bottle of Ibuprofen and several cans of sardines that he would have incorporated this information into his prescription. "Stuff five Advil tablets into the belly of an oil-soaked sardine and swallow whole. Repeat until malaria subsides or you run out of fish." I asked him a few more questions but I wasn't particularly satisfied with his responses. He handed me his card when I walked out the door. In the taxi back to the hotel I took a closer look at it: Dr. Momodou Samateh, Assistant Gynecologist.
Back at the hotel I decided to take the emergency standby treatment of Doxycycline and Quinine, as prescribed by the CDC. I still had no idea whether or not I had malaria but I felt I had little choice. With the British Medical Clinic (BMC) closed until Monday morning and no other clinics around, I had to take matter in to my own hands. My fever was still spiked at a 1040F. Wrapping myself in a wet bed sheet, I turned on the fan, lay back in bed, and tried to sleep. Monday couldn't come quick enough.
By Monday morning my fever had declined to a much more palatable 1010F but I had developed a sore and swollen throat. White pus had appeared along my tonsils. I got up early and headed over to the BMC where the guard proffered a gate pass and asked me to follow him. I was led in the dark down a dimly lit path. The campus was obviously huge, though I couldn't see the breadth of it at that moment. He led me to the triage area, an open-air concrete platform with a corrugated steel roof, and directed me to sit on one of the long wooden benches. Despite the early hour there were already dozens of patients waiting to be seen. We bunched up shoulder to shoulder as the benches rapidly filled up. If I wasn't sick before I was certain I was going to be now. Many of the people seemed horrifically ill. It was an incredibly sobering experience. Horrible coughs, wheezes, and cries abounded. I saw a child with a dreadfully scabbed, pus-filled face dangling limply from her mother's arms, low groans escaping her lips. Another woman was collapsed in a ball on the floor. The man next to me had a rattling cough that shook his whole body and seemed destined to tear him apart. A triage nurse slowly worked his way along the benches, sending people off for tests or treatments. After an hour I was approached and asked to describe my symptoms. I told him my whole story: the fever, my throat, the malaria test, the doctor in Serekunda, and my decision to take the standby treatment. He shook his head disappointing and said, "If you hadn't taken the Doxy I would send you for a blood smear but now we won't know if you have malaria." Taking Doxy obscures the signature that identifies the presence of the bacteria. Wonderful. I was told a second opinion was needed and to wait by a door at the end of the platform.
After another hour I was sent in to see a doctor. She was patient, thorough, and seemed extremely knowledgeable. Blood work was ordered - a prick on the finger and a smear on a slide. After another hour I was brought back to the doctor. No malaria was present but a bacterial infection of unknown origin was found. She prescribed a ten-day regiment of Amoxicillin, Parcetemol, and vitamin C tablets. Total cost for triage, blood work, diagnosis, and prescription drugs: $6. Not dying of a tropical African disease: priceless.
Posts
I decided to explore this bastion of unspoiled wilderness before it was gone for good. My specific destination: Corcovado National Park. As is often the case, the journey is half the trip. Getting to the Osa from Denver takes two full days of travel, and I was going it alone. After landing in San Jose the passengers deplaned directly onto the tarmac. The humidity hit me in the face like a wet mop, and my clothes were soon drenched in sweat. My pores opened up so wide that a small bird flew out of my beard. God knows how long he had been in there, but at least now I know why I always wake up with the taste of eggs in my mouth. I spent the night in an unremarkable pension in a small town on the outskirts of the city. 
