Tales & images from life as me…

Archive for May, 2013

An African Problem in England. Malaria: A TIE Tale!

Being an ex-pat renders you a permanent visitor in the country you live in, but what I was (perhaps naively) not prepared for was the fact that I would begin to be termed as no more than a visitor in my own country, particularly when I arrive bearing foreign parasites!

Having spent three days with a headache and then woken at 3am with a fever that left me shaking, I decided that I should probably get myself checked out. I went to my GP the following morning, the same practice I’ve been registered with for almost 30 years, only to be told I was ‘not British enough’ (by a doctor whose accent revealed she had earned her ‘British-enough’ status within her lifetime). “Leave it 3-5 days and if it gets worse come back” was the advice (genius!). I was left untreated but didn’t let it worry me as I was feeling better, and Damien was arriving that day.

Sadly he pretty much arrived just in time to make the decision that I needed to go to A&E.

Hospital Stage one
The receptionist’s face was a picture when I checked in saying “I think I may have malaria.”

“Oh really! And what makes you think that?” She responded, with an eyebrow raised. But once I’d established my evidence they moved pretty fast. Here in the UK malaria still comes under the realm of infectious diseases!

I was greeted by an enthusiastic nurse who was excited as she’d ‘never seen a case of malaria before’. Having consulted with the Consultant (guess that explains his title) she needed blood from me. But my fever was too high and despite two holes in each elbow joint she couldn’t access my veins. From here things went downhill and so did I. The room was freezing, my fever was spiking, Damien was trying to entertain me between needles by trying out every piece of NHS equipment, and finally the fourth medic opted to get blood from my groin – an excruciating process.

I was informed the malaria test had come back negative and that they would continue to assess and investigate the following day. More holes were then made in me as a saline drip is put into the back of my hand (on the third attempt). I was also given a dozen or so pills in an effort to treat possible malaria, typhoid and a chest infection (?!).

At 11pm I was moved to an open ward for critically ill patients. It’s honestly one of the most frightening places I’ve ever been. I was wheeled in past people who looked as though they may not survive the night. From a room in the corner a woman groaned repeatedly ‘please, will somebody help me?’; another woman vomited into a cardboard bowl she had been hovering over; and opposite me a old lady slept sitting bolt upright, evidently her back was being kept rigid for some reason.

Luckily, I was so exhausted that I slept and it was only at 3am that I was reminded of my circumstances. It was dark and cold. There were beeps from monitors, no other sounds, and I was shaking. Violently. I was so cold I couldn’t even speak and I had no idea where the button to call the nurses was. I lay there for quite some time, like an epileptic fish out of water, before a face appeared. She was very kind, brought me blankets and stayed with me for an hour while I shook.

It was only the following morning when I woke (at 7am to a nurse whipping back the curtains giving me a blast of bright sunshine in my headache-cracked face!) that I established that the woman who had helped me was not a nurse, but a massively depressed patient complete with nappy!

At this stage I was feeling less than confident, hadn’t eaten for 24hrs and was very concerned that my head might explode. I had been given only paracetemol for my pain and the light was unbearable. I began to puke. Once I’d started I couldn’t stop.

They finally moved me into a dark little side room. That day was at least a week long. I was literally begging for pain killers and finally, once they’d established that codeine wasn’t cutting it, I was given morphine. The waiting had reduced me to tears and I was still being sick. I couldn’t have visitors until 3pm and the hours were filled with more blood tests, temperature and blood pressure checks, and being told off by literally every nurse for not having taken Doxy whilst I tried to explain that I live there, I wasn’t just on holiday and being irresponsible.

Finally, that afternoon a positive malaria result was confirmed and later they identified the strain is the one that poses the possibility of cerebral infection. At this point the quinine seemed to be talking effect, though. I was rallying and things were looking up, but that’s the nature of the beast of course.

Stage two
The evening’s visitors bring grapes (a hospital cliché I always thought odd, but now fully understand – grapes were the one thing I felt like eating!) and big juicy strawberries. My sister, brother, his girlfriend, dad, mum, Damien and Alice huddle under the sign that says ‘Please note: two visitors per patient at any one time’. They are heartened by my improvement and I am hoping to be sent home the following day, but the night is terrifying.

I wake with the pressure in my head at such a level that I would do anything to relieve it. I am suddenly very conscious that people die of malaria. I have been flippant about it in the past. We have to be, it’s something we live with. Most of us have experienced it in some form. But my previous encounter was mild and manageable, whilst this is in a league of its own. Eventually I sleep in a morphine haze.

In the morning I am relatively clear headed and find that Damien has bribed the nurses with croissants to let him sneak into my room out of visiting hours and bring me breakfast. He is a very welcome sight and I bite into my croissant with more enthusiasm than I’ve raised in a few days… only see it, fat and feathery, in a cardboard sick bowl a few minutes later. By this stage I have been sick in every colour of the rainbow as I have tried to eat various morsels and instantly purged them again. Strawberries were especially not-pretty!

Anti-sickness medication is now added to the second tube on my drip and slowly the vomiting eases.

During the morning I finally receive a from a Registrar who is more able to answer some questions and allay some fears. He recommends a lumbar puncture and wrinkles his nose unhelpfully! He’s actually extremely kind; experienced with malaria, having worked in India; and prepared to take the time to explain how things will go. So, I am psyched up for my lumbar to be punctured (couldn’t they choose a nicer word – unlike a tyre, I do not carry a spare spine!). This test will allow them to see if the malaria has got into my brain juices (technical term) and if there are any further infections. He’ll be back in half an hour.

I send some texts, update Facebook, killing time before the big nose-wrinkling op. The nurse explains some more unsettling LP (as they call it in the in crowd) details such as: ‘they sometimes hit bone if they don’t get the space between your vertebrae first time and that can be very painful’ and then she advises: ‘but it’s far better if you relax’ – ha ha! Suddenly it’s been an hour and half and still no sign of the doctor.

Another three hours later a girl, considerably younger than me, pokes her head around the door and tells me the previous dr is dealing with an emergency, she’s a junior dr and will be carrying out the LP!!! I’ve had four hours to consider this and now… I take a deep breath, knowing it’ll be worse if I’m freaking out.

As it turns out she’s amazingly good at this procedure and the Registrar does actually make in time to oversee it all anyway, so it’s actually not nearly as bad as I’ve spent most of the day worrying about. I get yet another plaster and bruise combination to show for my efforts (at this stage I have plaster/bruise pairings on both elbow joints, the backs of both hands, my groin and now my back!) and she disappears with three vials of clear spinal fluid.

That afternoon my headache returns in force. It has never gone, but recedes occasionally to bearable levels. It is now day seven of the headache and I am at my wits’ end. Damien sits with me. I can’t move, I can only listen to everything going on around me. Just outside my door an old man visiting his wife in the ward is busy explaining to a nurse. “So they think my wife’s had another stroke and she’ll be staying in. I just wanted to explain, I always give her hot milk with her Wheetabix in the morning. She likes that. And she can hold her own tea if you give it to her in her left hand. I’ve been caring for her for 12 years since the first stroke, see. I know how she likes it. Could you pass that on?” It made my eyes fill up with tears. I wanted to run out there and tell him I’d do it, I’d make sure she had her hot milk and tea. It still chokes me up writing it now. It made me reach out for Damien who’d been so incredible throughout this whole adventure: liaising with my family, shopping for me, thinking of things I might need, helping me shower, and even dancing with an (empty) sick bowl on his head!

That evening, the headache improving though feeling thoroughly sick (even with the meds), I finally agree to try to eat something. A tray is brought in with a flourish. I lift the lid… What is the worst thing you can think of being given if you are feeling sick?… they’d brought me egg sandwiches! And for dessert… rice pudding!! We left it quietly outside the room, untouched!

Over the next couple of days I maintained a normal temperature and managed not to be sick in spite of the excruciating headaches. The LP came back clear and I was finally sent home with an enormous pile of medicines, an intermittent headache and a chronic case of tinnitus (resulting from the quinine) that sounded, ironically, like a swarm of mosquitoes.

The recovery is slow. I have spent most days since in bed. I am currently typing this at the London hospital for tropical diseases where I am waiting to be checked over by an expert and still feeling pretty pathetic, though also very lucky.

Was it better to have been through this here in England? Yes, in terms of having my family around, a hospital that doesn’t have a coffin shop outside and the care I was given. But I honestly have no idea if the East African doctors would have known what to do faster. I know they would have had access to the new Chinese drug which is not yet approved by the FDA here (though perhaps there is good reason for that?) and that I could have made greater demands, expected faster blood work etc. But I do think, overall, I was lucky to have been in the Western world. At least these days they don’t stick malaria patients in isolation and only let them talk to visitors through the door (as happened to my poor brother-in-law aged 13).

If this post is a bit long for you and you only read one paragraph – read this one!

Let my tale be a warning, readers. I was careless. The night I believe I got bitten by the malaria carrying mosquito I was wearing a skirt, it was 2am and I had not repeated the application of repellent (or ‘dudu dawa’ as we call it there). I was bitten over fifty times and hadn’t noticed until I started itching the following day. This is not an illness to be careless about. There are over 1 million deaths every year in Africa from this strain of malaria alone, and over 500 million cases in total. Even without that statistic, it just isn’t fun. My fellow ex-pats, if you’ve become a bit relaxed about the whole affair, please think again. Check your nets, make sure repellent is in date and keep an eye on your loved ones for any signs of fever or ongoing headaches (they’re the two most consistent symptoms apparently). There’s no need to get crazy and I’m the first person to be cross with doctors who pointlessly terrify potential visitors, but taking sensible precautions can only be a good thing.

Thanks to everyone who sent me kind messages over the past ten days, and everyone who’s bothered to read through this particularly long post (hadn’t intended it to be such a marathon when I sat down but I rarely edit blog posts so you’re getting the full monty!). I do plan to be back in Mwanza on the 11th, just in time for my birthday – though I probably won’t be able to drink ☹.