Thursday, October 5, 2017

Kiss of the Nile

So this is what it feels like to be dying.

It was a peaceful thought, one that just kind of gently floated in and out of my head, one that I took as fact.  It felt almost comforting, like everything would be okay if I just slipped into unconsciousness and let it all go, succumbing to the mental haze that was descending and crushing me but was simultaneously lifting me up and taking all my weight and worries away.

The thought itself didn’t scare me, I’m not afraid of dying, but I am afraid of dying on a toilet.  There are many more dignified ways to go; the least I could do for myself was to pull my pants back up.

I zombie-walked from the washroom back to the house, ignoring the greetings of the neighbor’s kids (“I eat mango!”), but I couldn’t make it past the step outside the front door.  I requested a basin and proceeded to throw up everything while all the neighbors stood around and watched.  One of them cornered Josh later and, waving a finger at him, said, “You see! I told you she was pregnant!”

I kind of remember being shuffled into the back seat of our friend’s car and being confused at why everything was so hazy when I looked out at the other trucks and bodas on the road.  More shuffling into the hospital, into a doctor’s office, back to a lab for blood tests, back to the waiting room, back to the other waiting room…  

I didn’t care where I had to go, as long as I could be horizontal.  I felt like I was going to black out any time my head was higher than my stomach.  And I couldn’t breathe… my chest was just slowly going to cave in on itself until I’d quietly suffocate on the floor.  That sounds kind of nice, actually.  Let me just curl up under this wooden bench, let me lay here for a few minutes and close my eyes so I can stop breathing and thinking and just enjoy the feeling of energy and life dripping out of my skin with every passing minute…  Then someone wearing menthol rub would walk by and I could catch my breath again, only to have it taken away as soon as they passed.  What a terrible tease.

The doctor that ordered the blood test called us back into his office.  Josh was antsy, he could barely sit down or stand still.  Another nurse kept popping her head in and looking at me and telling the doctor, “She’s really sick, we need to prepare her a room.”  I just wanted to lie down.  The doctor looked at me, looked at the lab results, looked back at me, and folded his hands under his chin: “Tell me again how you are feeling.”  I muttered something and went back to concentrating on staying upright in the chair.  There was some other back and forth and I said a word in Luganda in response.  His face lit up, “Ahh! You speak Luganda!”  

That’s when Josh interjected: “Does she have malaria or not? She’s really sick!”  I think he expected me to keel over and die at any minute, and this doctor was wasting precious time.  Josh told me later that my eyes were sunken so far into my head he was afraid they’d never go back to their normal eye/face ratio again.

The doctor didn’t so much as bat an eyelash in Josh’s direction.  He sighed and smiled and asked me, “Have you heard of de Kiss of de Nile?”  I just stared at him.  He continued lazily: “Yes, you do have malaria. And eet ees very bad. We can give you de pills, but sometimes, dey don’t work so well and you might have to come back. Or we can give you de stronger IV dat will take care of eet.”  

“GIVE. ME. ALL. THE. STRONGEST. DRUGS. NOW.”  I don’t think that’s exactly what I said, but it was something along those lines.  They shuffled me into an adjacent room (with a bed! finally!) and two nurses spent ten minutes trying to find a vein.  “Oooh, your veins are also very sick.”  

————

There are no curtains in Ugandan hospitals; no smoke & mirrors, no measures to give you a false sense of privacy.  The doctors don’t wear coats, the nurses don’t have uniforms.  I actually couldn’t tell them apart from the patients or from the janitor.  While I was in a daze waiting for the meds to start taking effect, a couple walked through my room to visit the doctor that had a small office on the other side of the wall partition.  She was pregnant and they were having complications.  I heard the whole conversation and the details of the exam in English.  

And the nurses don’t get the IV ready behind closed doors, they bring everything they need in a metal tray and slap it on your bed next to you.  They hum to themselves as they snap the little glass vials that hold the liquids they have to mix together.  They ask you to hold this, shake that, hand me that other thing.  One nurse’s young daughter would run around the hospital, in and out of rooms, having excited one-sided conversations with people before she’d dart off to chase the stray kitten that was also running around the hospital.  The nurses are just normal people and so are you; you just happen to be sick and they just happen to be the person to stick you with things.  

————

To this day, I have no idea what was in the IV.  I can’t read the doctor’s handwriting on the notes, and when I asked later, I couldn’t understand a single word they said.  But God bless it, whatever it was, I started feeling better within ten minutes. 

I had to get IV injections every few hours, so they kept me overnight.  We were moved to a private room (with a real toilet! No toilet paper or hand soap or towels, of course, but I was happy as long as I didn’t have to squat over a hole in the floor; I was so weak I didn’t think I’d be able to stand back up again).  Josh pulled up another hospital bed next to mine and we camped out for the night under the mosquito nets.  Although he said he doesn’t think he slept between checking every few minutes to see if I was breathing and contemplating what he'd say to my father on the phone if I didn't wake back up again.

Josh only looks like he's playing on his phone at the hospital. I'm sure he was actually very worried.
The doctor came in every few hours to do more IV injections.  At one point he asked me, “Are you okay being treated by a Ugandan doctor?”  I balked at the question.  I didn’t say this, but honestly, if he were a monkey in a lab coat I would have been okay with him treating me if it would make the malaria go away.  I asked if people came into the hospital and refused treatment from him.  He said it happens all the time, tourists or volunteers come in and request a white or Indian doctor (it’s a privately-owned Indian hospital).  They say they don’t want to be treated by an African doctor.  I told him I was really sorry people did that.  

Side rant:

I’ve blogged about this before here: yes, I do have alarms and bells that go off when I’m in certain situations because of the race/ethnicity of the people that I’m interacting with.  I have racist thoughts.  A lot.  More than I’m comfortable admitting.  But I really work hard on not letting them affect how I treat people or talk to them.  Tourists are actually the most easy-going, but it’s primarily the volunteers and the missionaries that talk to African adults like they’re children.  It’s really horrible to witness and I feel so ashamed to be a fellow mzungu.  I’ve run into a few Western missionaries who are really unhappy here.  They hate Africa, they hate how long they have to be here, and when one British missionary referred to Ugandans, he called them “these people” and chewed the words with such distain and spit and spite that I couldn’t tell if he was sweating from the heat or because he had worked himself up so much.  And these are the people that are supposed to be sharing the love of God with those less fortunate.  

Churches, please spend your money on something other than missionaries who live like kings and send their kids to great private schools while not loving and creating true Christian relationships with people here!  It’s very complicated and I’m very fired up about it right now, and there are many many wonderful missionaries and well-intentioned Western church programs here, but I digress…  The real point I’m trying to make is: if you go to Africa and get sick, don’t stick your nose up in the air when an African doctor walks into the room!  There’s a good chance they’re better educated than you are.  And there’s also a good chance you’ll meet them again in heaven, so you might as well save yourself some divine embarrassment later and be civil here and now.  Sound good?  Good.

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Before I was discharged the next morning, I had a visit from the head doctor.  He was an Indian, and in his wake trailed a handful of African doctors and nurses and I think maybe even a janitor, although I have no idea who the woman really was.  While he looked over my diagnosis and treatment chart, everyone else stood around and dutifully looked at their feet, having somehow lost all the confidence that they were so imbued with the night before as they tried to make small talk with me while I tried to keep from falling over.

The Indian doctor looked at me with big eyes and said, “You were VERY sick.”  I felt like he was trying to convince me of the fact, like I wasn’t there myself, so I widened my eyes too and nodded solemnly back at him.  He barked some questions to the attending staff, who shyly mumbled replies.  He complimented the attending doctor on the course of treatment I had been prescribed the night before and said it was exactly right for how bad the malaria had been.  Then he handed the clipboard to someone and said I was good to go after one more IV injection (and then six more, twice a day for the next three days—you try getting chores done around the house with an IV stent sticking out of your wrist without knocking it against stuff all the time, it was terrible).

Everyone in the room slowly dispersed, except for one new doctor that stayed to administer the IV.  He was chatting with Josh, as Josh had been my unofficial medical decision-maker the entire time we were there.  I think I might have said only a handful of words to the doctors and nurses in the past 24-hours since I was so weak and since most questions were initially directed to him anyway.  All tests, diagnoses, treatment, bill payment, and follow-up medication instructions happened without me and in another language.  And I was totally fine with that.  I was dying, and now I’m not, and Josh will tell me what pills to take and when; what more do I need to know in this situation?

I found out later that this African doctor that had been chatting with Josh asked him if I was okay being treated by a Ugandan.  Josh said of course I was, and the doctor was surprised.  Ugh, don’t get me started on this again…

————

The next three days consisted of going back to the hospital twice a day for more IV fluids.  Sometimes I’d ham it up for the nurse as I could feel the stronger fluids inch through my vein like a nice razor blade/ice water cocktail all the way up my arm.  She’d laugh, but she knew it hurt and she’d rub my arm to get it to move faster.

Ugandans don’t exaggerate or hyperbolize.  They especially tend to downplay pain and sickness.  So I knew I must have at least looked REALLY sick when random people I don’t remember kept popping their heads into my hospital room where I sat with the IV, each one with the whites of their eyes so big and smiling, “Eh! You are okay! You are looking SO much better dan you did!”  Geez, how close was I to decomposing?  I must have looked awful.

Confirmed! I looked terrible.
I have to say the worst part of everything was taking the pills after the IV injections stopped.  I had to take three rounds of pills three days apart.  That week of medication, I had no energy, no motivation, and no personality.  It sucked not being able to stand up for more than a few minutes without feeling dizzy, or to try to make small talk with people and not even being able to smile or maintain eye contact, or to not have anything to say back to them; my mind was a blank slate and the brain fog was overwhelming.  My stomach was sensitive for months afterwards and it took a while to mentally and socially feel like myself again.

The expats here understand.  When I mention that I got malaria, they ask if it was my first time.  I say yes, and they immediately become some version of a doting grandmother with that look on their faces and they say something like, “Oh honey, it’s always so bad the first time. Don’t worry, since you survived this, it’ll never be that bad again.”  And then they reminisce and tell me all the details about when they got malaria the first time.  And sometimes the second, and the third.  And then we compare how much weight we lost from the lack of appetite during recovery.

Locals I tell fall into two categories: they either don’t register anything I said and just stare at me half-lidded, or they very dramatically widen their eyes and take a step back looking aghast like I had just slapped them.  And they say, “Eh! You are okay! Africans, we always survive de malaria because eet ees in our blood all de time-a, but YOU! Eh. Mzungus die all de time from de malaria because you are not used to eet.”

People at home responded accordingly.  My mom immediately sent me a photo of the last time I was hooked up to an IV for an extended period of time, when I was two years old and had a septic hip.  My friend Caroline told me I needed to drink more gin & tonic, since tonic water used to have quinine, an anti-malarial, in it back from when the British were occupying India and the government needed a sure-fire way to get the soldiers to take their malaria meds (read: mix it with alcohol!).  Tonic water doesn’t contain quinine anymore, but still, I’ll run with it.

Two-year-old sick Hollis is much more photogenic.
In the end, I LOVED getting to continue my informal study of the East African healthcare system: how doctors behave in front of patients, how protocols are organized & executed, the out-of-pocket costs of everything, all of it.  It’s such a different system than in the States, and it’s extremely African and messy, but part of me enjoys it much more because of the transparency.  Oh, and the total bill for the hospital?  All the tests and doctor consultations and a private overnight room and three more days of IVs and another week of drugs after that?  Total bill was $89.  We paid in cash.

As for the malaria, I guess the Nile tried to kiss me and I slapped it right back.  Take that, Africa!  Ha!  What else you got?!?  (Actually, no thank you, please don’t throw anything else at me, I’m fine, I’ll shut up.)

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