Africa Is Not For Sissies – Part I
Something to keep in mind before you read the following post: what you are about to read is normal for life in this part of the world. All of these events happened one year ago, and everything is fine now.
I looked at the number in my hand – 54. This would not be a short wait. I looked up and out into the parking lot. Jes was waiting in the car, listless with fatigue and Angele waited by her side, hand in hand. A glance around the waiting room of the Institute Pasteur was a look into the face of one of the great equalizers in a country of marked inequality – sickness.
About a week prior Jesenia had developed a sore throat that seemed to get better after a few days, with the exception of the fatigue. Since we both had already had malaria and were familiar with the overwhelming tiredness that it brings, we had a goute epaisse, a blood smear. They can be performed at any pharmacy for about two dollars. The pharmacist pricks your finger and squeezes out a thick drop onto a glass slide. Under a microscope they can count the number of malarial plasmodium and ovum per milliliter. The numbers indicated the beginning of a flare up. As a precaution we both took the three day treatment regimen that normally beats the numbers down to something your body can manage on its own. Mine went away, but her symptoms curiously worsened. Since much of the malaria around here has become drug-resistant, our visiting physician put her on a stronger dose of pure quinine. Quinine in any form is a vile drug. One wonders if the disease itself isn’t a better alternative. It makes your ears ring and everything you put into your mouth tastes like metal. Delirium is a common side effect. It was a difficult week, but the doctor urged us to let the quinine do its job and then make a decision.
After an insufferable seven days of the bitter tonic, her condition still had not improved. In fact, she had developed severe diarrhea, vomiting and painful stomach cramps. She couldn’t keep anything down and hadn’t eaten in days. The mere smell of food brought up bile and nothing else. I found myself waking at night every few hours just to watch the sheets rise and fall. We needed to get to the bottom of this, now.
That bought us to the Institute Pasteur. I was glad Jesenia was waiting in the car. We had come to the finest private clinic in Bangui, just a half mile from Bethel, and yet the waiting room was still a depressing site. This room was full of Bangui’s wealthy, those who could afford the few dollars for an exam or a vaccine. All were nicely dressed and a little plump, despite their illnesses. The room was soon filled, so I stood along the wall to make room for a woman who walked in with her child. He lay in her arms, and his face was covered with perfect little beads of sweat, like the dimples of a golf ball turned inside-out. He shivered with fever, even as the temperature rose in the stuffy room. A French nun fumbled with her rosary and looked at me. She mouthed a silent “bonjour” before looking back at the floor.
I glanced at the people behind the window and, for just a moment, allowed myself to be angry with them. Couldn’t they see the people suffering here? Didn’t they know my wife was one of them? If they didn’t quicken the pace I would probably have to carry her in here. I wanted desperately to force my way to the window and appeal to their sense of mercy – we were visitors, missionaries, unfamiliar with the endemic diseases and badly in need of an answer. But I held back. I could see everyone else was in the same predicament. Besides, we’ve noticed how people here tend to notice our skin color before they notice us. Whites are always given preferential treatment, so to counteract this trend, Jes and I do our best to be self-effacing and patient. Though we probably could have charged ahead and demanded service, she wanted to wait.
Were they counting backwards now? No, it was a different window. The window adjacent to the one I was waiting for had been reading off names all morning – the individuals concerned would approach, provide proof of identification, and receive a sealed envelope with the results of tests done in the days before. Every third or fourth person was called by a number instead of a name. Later, I inquired as to why. The number preserves the anonymity of those who are retrieving the results of an HIV test. AIDS is racing across Africa like a savanna fire. Reportedly, one town north of here has tested 50% positive. In Bangui, the number is around 18%, one in five, but this number doesn’t include children or the elderly, so likely the percentage is much higher.
Finally! I approached the window and called Angele on her cellphone. As we led Jes into the exam room the doctor looked at her, then at me. With a calm yet stern voice, he said, “When someone is this weak you skip the line.” Yes sir. He palpated her abdomen and she winced. One word came from his mouth. “Typhoid.”
The typhi bacterium is a relative of salmonella. More accurately, it is its big brother, all grown up, with tattoos and lots of pent up anger. Supposedly, the body can fight the disease on its own, but it is a painful, five week process. If the bacteria migrate into the bone, it can take even longer. The intestinal cramping can be so severe that it risks twisting and perforating your bowel.
Typhoid (not to be confused with typhus) is endemic in Central Africa and epidemic since the coup. A diagnosis carries with it the disturbing revelation that at some point previous to the ten day incubation period, you ate or drank something contaminated with someone else’s poo. Africans are very friendly and love to shake hands, another common vector of the disease. Until now, I hadn’t thought that it could even be a possibility. We are extra careful with everything we eat and drink. We had received a battery of vaccinations before leaving, and had been washing our hands nonstop since we arrived. Typhoid? Really?
The doctor made up his mind. They would give her a blood test, a Widal. It tests for salmonella antigens in the blood, which indicates a typhoid infection. The Widal would take 24 hours. A stool test would determine what drugs the bacteria were resistant to. In the mean time, we had to get some electrolytes and sugar into her blood. We left the Institute for another private clinic where she could get an IV drip and start a steady diet of antibiotics to start working against the typhoid until we had confirmation. The clinic is owned by Suzanne, a gregarious Nigerian, and her husband Paul, the resident physician. It is clean by African standards and they always give us good service.
Suzanne put us in a room by ourselves with a private bathroom. It had a little bistro table outside and a window that opened into a yard where men were repairing motorcycles – not good for sleeping but entertaining nonetheless. The mattresses sagged, but the mosquito nets were clean and so were the sheets. The nurse came in quickly and began mixing all the components of the drip: ampoules of glucose, vitamins, salts, antibiotics. And just for good measure, quinine. I left Jesenia with Angele and went home to pack a suitcase, since we would probably stay the night.
As I pulled out of the clinic I saw a familiar site, the furniture store across the street. Bangui is peppered with carpenters, all nailing together the same rough sawn wood into the same furniture. A few finished pieces sat out front showcasing his talents, a bed, a bookcase, a sofa with upholstered cushions. Inside the shop sat a large stack of coffins, a result of the collision of two undeniable truths in the developing world. First, death is all around you. Second, people make a dollar any way they can. Fifteen years ago, no one bought a coffin until it was actually needed by a member of the family. To do otherwise was asking for misfortune. Now, making the ornamental boxes is big business and embellishing them is an even bigger one. You can rent the flowers and even the mourners. According to the latest census, the average lifespan of men in this country hovers around 39; women add two more years. You see this when you walk into a Kingdom Hall in Bangui. At first, you are pleasantly overcome with the amount of children. Our meetings effervesce youth and vitality. Slowly though, you begin to see the lack of elderly – perhaps only two or three have actually reached gray-headedness.
Back at the clinic, the antibiotic was injected directly into the bloodstream, via the veins on the back of her hand. It is not a pleasant process; there are two injections a day for ten days. After a week, her hands and forearms were covered with the tiny scabs and blue blotches characteristic of typhoid treatment. I must have made a funny face, because one of the nurses asked me if this was how we treated typhoid in the United States. How do you even answer that question?
Slowly, the fever was coming down and the cramping waned. But salmonella typhi is a clever bug. The whole time it’s mobilizing its attack on your liver, gall bladder, bowel and bones, it carries a secret weapon, and waits until you start treatment to use it. It can actually sense the antibiotics in the blood and defend itself by secreting a neutralizing enzyme that, as the bacteria’s thuggish lackey, latches onto the antibiotic and rides with it down to the kidneys where it’s mistaken for waste and eliminated. By this time, you’ve killed the weaker bacteria and the stronger are free to continue the forward assault. Jes’s fever had started to rise again, so they began mixing her injections with another compound, one that would put the defensive enzyme thugs in a full-nelson and take them to the mat.
Finally, we started to see some sustained improvement. I no longer had to carry her to the bathroom and the heaving had stopped. She got up to take a shower and I knew it was my moment. I had to act quickly and decisively to make this work. A man who loves his wife and suffers when she suffers knows that the time will eventually come when he must put aside his masculine routines and preconceptions and do what must be done, regardless of his habits. He must summon from deep within himself all of his knowledge, strength, leadership and love, and channel them into the task at hand. My baby needed me, and there was no way around it – I would have to cook.
She hadn’t had any real food, at least that didn’t come in a dripping tube, for two weeks and since I hadn’t left her side that whole time, neither had I. We both looked pretty slim. I figured she could tolerate some rice. Just in case, I would fry up some beef medallions in olive oil and throw some sautéed onions on top. It was quick, easy and savory. One pan, no mess. The problem was the rice. Remember, Jes is Puerto Rican – it had to be perfect. Thank goodness for YouTube.
She got out of the shower and her look said it all. Beneath her wet curls her big dark eyes opened and I could see she was hungry and ready for a meal, even one cooked by an amateur. We said a prayer, thankful for so many things, and scarfed the food down, barely coming up for air. I could see the color coming back into her skin and her energy level rising. It looked like we were finally winning the battle and it would be smooth sailing from here. She even said the rice was perfect.
I won’t bore you with the details surrounding my attempt at housekeeping. Suffice to say, it was much more difficult than I had imagined, despite having watched it for so many years.
This incident was really very minor in comparison with what many of our brothers are dealing with here. We are fortunate enough to be in the city where health care, though primitive, is at least available and competent to a certain degree. They are very good with tropical diseases and since most doctors have studied in France or Russia or Japan they can identify kidney or coronary problems or even cancer. The problem is that they can do little for you. Not long ago, a brother brought his newborn baby in from one of the provinces. He had ridden in the back of trucks and bush taxis for hundreds of kilometers to seek help for his son who was born with his heart outside his chest cavity. The doctor refused to operate until payment was collected in full and all of the surgical tools had been purchased by the patient’s father (more about this practice in the next post). By the time the brother had collected the $72 in surgical fees and medical supplies, the surgeon fessed up that he was not equipped to do such a complicated surgery on a tiny heart. Without losing any more time, Bethel did all they could to arrange for transport to France. Unfortunately, the visa was refused. India was pursued as an option and it looked like the paperwork would go through. But before the visa was approved, the child succumbed to infection. C’est l’Afrique. That’s Africa.
Later, I got my own special opportunity to commiserate with Jes. Just this week, I’m finishing up a series of injections for typhoid fever, including the IV’s, or as I like to call them, “breakfast in bed”. This immersion into African health care has been a learning and growing experience. It has helped us to appreciate just how much we have in the developed world and how vast a divide separates the haves and have-nots. Connecting the two sides requires a bridge that can be engineered by no man, only God’s Kingdom.
It took about a month for Jes to fully recuperate; you have to slowly ease your stomach back into digesting heavy food. Everyone was thrilled to see her return to the Bethel dining room and the laundry. We settled back into our routine, comfortable and relieved, not knowing that within a few months I would have my own run-in with Bangui’s hospital system . . .
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