My Malaria and No Hospital

That, my dear reader, that was an Adventure! Both in an amazing sense as in the experience as such, having lived through it, and also how it put my feet steady on the ground to relate the same experience as what people live through every single time. That story I would like to share.

It was 2008. I and my team/class from college had an intern in various African countries to work at a school and learned how to teach the hard way. Overcoming obstacles and using all pedagogic, didactic and psychological skills we already had learned to be able to teach in rural African countries. Our team was divided over 3 countries, Mozambique, Malawi and Angola. Together with a teammate, I went to a school in Angola.

Angola, in 2008, was just six years free of a 30-year civil war. That wrecked the country, all is completely lost and as many know that Angola, and Africa even as a continent, is very poor for the most of the people. In the area I was, there were no roads, no running water, not enough nutritious food, not enough schools, not enough teachers to fill the schools that were there, less fertile lands for farming, no forests, some streams that become large rivers downstream, no cars, no bikes, few motorbikes, long distances by foot, no proper shoes, almost “no to all” as what we have.

Yes, they did have plenty of landmines. Yes, they did have plenty of the most deadliest diseases, without proper hospitals. Luckily the civil war prevented HIV/AIDS to spread as Angola was pretty isolated, but at the borders, it is on the rise. Tuberculosis, Hepatitis A and B, stunting, and worms were all readily available to pick and choose from. Many people have either one of them or several at the same time. Also, the biggest killer of all, malaria, was available in abundance.

Malaria is a parasite, transmitted by mosquitoes, that grows in the liver and each 2nd day it feeds on and breeds in red blood cells. Generally spoken that is, as I can write an entire blog post purely on malaria itself. There are 4 types of malaria and the deadliest is the most readily obtainable in sub-Saharan Africa.

Let that be the one I have gotten. For 600.000 people, mostly children under 5 and elderly, one bite of that mosquito equals to death. One such mosquito also stung me and marked the beginning of ‘my malaria and no hospital’.

Halfway during our time in Angola, we had meetings at another school near the capital where we as team Angola came together to see how we were doing. All is well at “home”. I had my systems, bed net, anti-malaria medicine, kitchen, money for basic things, bathroom, toilet, etc, to keep well organized and healthy. But, during traveling, I was way more vulnerable. Where to get food from? Is it safe? Is the water good to drink? Do I arrive somewhere before the mozzies come out? Where is the toilet? How clean is it? Is the driver not drunk? Is the van not that rotten that it crashes in 1000 pieces? And this vulnerability got me. At night at a stopover in another school, the mosquito net was not tight as it normally is, my arm was touching it and a mosquito bit me through it. Nasty, I remember waking up from it. It was one of the first bites I have gotten and it turned out to be wrong in the first go.

After some days, back at ‘my’ school, I started slowly to feel worse and worse. In the mornings I couldn’t get up, to being more tired throughout the whole day, to being out of breath more often, to getting cold and wearing sweaters, to feeling really very miserable. The walk from my room to the classroom was less than 2 minutes, but, it felt as I ran a marathon! Completely out of breath! I did not cough, I did not have the fever, I did not have liquid in my lungs. I did feel that my lung capacity went down dramatically. All of us thought that I caught a cold, maybe ate something wrong, anything but malaria as I didn’t have the classic symptoms of shivering followed by a fever explosion.

The village I was near to didn’t have a well-educated doctor, didn’t have a hospital, just a small not so well maintained building (which I found out later) that serves as a health post. Language was an issue too! My Portuguese is nowhere near good enough to express how I felt. Angola was a Portuguese colony and I still was learning the language. By the time I was so far down, which took about 3 weeks between getting bitten and going to anything medical, I decided to travel to a bigger town or the capital of the province. There was a Ukrainian doctor who spoke English in a ‘private clinic’. Then it felt more trustworthy going there instead of the health post.

After having told mine complains he asked me if I have had a malaria test. No, I did not, as I didn’t have the symptoms belonging to malaria, at least, so I thought. That test was the first one he did. A drop of blood and pats, bingo. I had malaria. The doctor told the medical terms and from that, I didn’t know how severe it was, yet. I only got explained that it was the most dangerous version and that the characteristics of that type of malaria are that it sticks to the blood vessels. So, the more malaria one has, the more it sticks to the vessels, the narrower they will be and once blood cannot flow people die. The narrowest blood vessels are in the brains and in the lungs. Luckily for me, it got stuck in my lungs, not in my brains as that leads to way more serious problems and death would be nearly guaranteed. This did explain why I was out of breath all the time, I simply couldn’t get oxygen in my blood! I simply was suffocating, slowly but surely.

The assistant to the headmaster was in the same town and she picked me up from the doctor. I showed her the medical paper and it did make sense to her and she started to worry, more than she showed. By the time we got to our village, the pharmacist has closed already. I was so tired (4pm only) and I so badly wanted to sleep; I didn’t want to pass the school first to go to the village, to the health post at the other side of it, get the initial pills, over all those bumpy roads, going through deep mud. I just wanted to sleep. Relax, get my breath back again, hoping not to feel as miserable as I were in the car.

I told her that and she slowed down, turned her head towards me, pointed at me, with her finger just not touching my nose and literary screamed at me: “IF YOU DON’T GET YOUR MEDICINE NOW, TOMORROW YOU CAN BE DEAD!!!!”

Thaaaaaat was pretty convincing to do go to the health post getting the initial medicine to be honest. For my feelings, it took ages to be in bed again, while in reality, it was an hour or so.

Quinine is sometimes seen as ‘the last resort’ medicine to treat malaria. That I got instantly. It is a concentrated natural product from trees in Latina America. The Spanish actually ‘discovered’ it and used it to treat malaria, then they took it to Africa so the colonizers actually could stay and survive malaria. That pill is utter, disgustingly, terribly, bitter! If there is a taste I never ever want to taste again it is bitter. Also now just a bitter lemon already gives me the creeps. The side effects were heavy: loss of hearing, near vomiting all the time, sleepy, no mood, no concentration, weird stools, headaches, I simply was even more sick of the meds than of malaria. Those pills I had to take every 8 hours for 5 days straight.

Some days after finishing the treatment I didn’t feel well. Yes, I could breathe properly again, could think about work, walk, talk, even give a smile, but generally, there still was ‘something’ that didn’t belong to/in me. At the local health post (this time I did go there) they took another test and malaria still was in my body. Okay… next medicine, some kind of modern combination whatever it was. That too didn’t kill malaria and I still was sick. Now we are already a month further in time. On my birthday I went to the health post again, and still, it was there. That darn malaria loved me too much!

I was weak, tired, miserable, didn’t like my “malaria birthday present” at all, and had like, whatever… Too many medicines, too long not well, too long not enjoying anything, except for the holiday in which I thought I was improving. The ultimate solution was being administered in the health post. Getting a cannula in my arm and let the medicine run through. They had me convinced going to the health post as the real hospital was too far away. There were no nurses or whoever to take care of you, that had to be friends/family and in my case my teammate. It was too impractical for her travelling back and forth multiple times a day. So… the health post it was.

It is good for you to know, I never ever had been to a hospital, never broke a bone, never was sick, never had an accident, never had a cannula, never stayed overnight at a medical facility. Not for myself or to be with someone else. Never have taken medicine either besides a common painkiller. Yes, I have been a blood donor, but that’s sitting in a chair for a bit and done.

There I was, nearly as a local, in a local health post getting the same experience all the people there are getting. Normally I would have the feeling that ‘I cannot be harmed’ that my luxury was an escape back to the west, back to Europe, back to civilization I knew best. But not now. Now I couldn’t be moved, couldn’t go out and had to surrender to local Angolan treatment. At least, treatment locals can pay for. Even though all is that cheap in my eyes, it still is like being uninsured for Americans in the USA needing a big affordable treatment. That lack of financial resources kills more people than the disease itself as many are treatable no matter how dangerous they are.

That building was deterioratingly new. It wasn’t clean, open windows, no doors, no mosquito nets over the simple wooden beds without a real mattress. The floors were sandy, no running water, no soap, no towels, none of all that one never thinks not being available at a health post. The only luxury thing I had was to be put on a bed right next to the entrance, “alone” (as in no other patients but medical staff going in and out) on a real hospital mattress. It was also the only room with a TV and electricity.

I needed to stay 24 hours. 4 hours glucose, 4 hours dextrose with quinine and that 3 times. The first cycle went fine as it was in the daytime. The cannula was put by an English speaking assistant to the Cuban doctor (nobody knows where he was). He had an assistant too and the assistant of that assistant checked on me. Confused yet? They asked me where I wanted to have the cannula. Either in my underarm or on my hand. I never had one before so I was thinking about the movies and there it is in the arm so there it was. What I didn’t know is that I wasn’t allowed to bend my arm when I was sleeping as the liquid wouldn’t run through properly.

The medicine hit me hard. Instantly all the side effects were back, in tenfold. I was just a scared zombie blindly staring at the wall in front of me. No thoughts, each whisper was too much to handle, nobody around, lonely, helpless, not being able to do anything. On top of that, as is was the only room with electricity and probably one of the few TV’s in the village, 50 kids came yelling watching a show that was put on ridiculously loud. 100 eyes, 50 looking at me (what’s that white man doing here?!?!) and 50 to the TV and switching all the time. I wanted to scream, wanted to chase them all away, wanted to disappear, wanted not to exist. But I couldn’t move, not even my smallest toe.

At night the new cycle began, and with the glucose, I felt a bit better, children out, my teammate was there for a bit and had left and later at night, the medicine came back. I couldn’t sleep but after they connected the medicine I did fall asleep somehow, of course, to bend my arm. Very early in the morning (sun was up) I woke up to see the medicine not have run through! Over half was in and it wasn’t dripping anymore. With one hand I squeezed the feeder and with the other, I pushed all the liquid in my arm. God that hurts!! But, it was running again. Just after that, the assistant to the assistant of the doctors assistant came in to check. He saw that the bag wasn’t empty. So he put the tab full open and the medicine ran into my body. I already felt I was dying but now I REALLY didn’t have it anymore! On top of that, I had diarrhoea.

So. I got out of bed (don’t ask me how), closed the tap, took the bag in my hand, asked for toilet paper. They didn’t have that so I got some bandage instead. I walked out of the building to the only toilet that was there and 100 people or so were staring at me, observing me, all eyes following me all the time till I disappeared in the toilet. No light. Grr!! Door a bit open to having some light not to fall over all rubbish that was there. No water in the tank to flush, okay… bucket with water to flush. Back outside 100 eyes again, inside to my bed, hung up the bag, opened the cannula again, squeezed all liquid through and laid down again. That happened 5 bloody times in 1 morning!!

Of course, the cannula didn’t drip anymore after the fifth time and my arm looked like there was a tennis ball under my skin. Around that time the doctor’s assistant came and started hitting on it trying to make it run again. PAIN!!!!! but no success. Panic was raging through me, adrenaline pumping, huge eyes and I so wanted to pull the needle out and simply run out! The assistant called the school and soon my teammate and the assistant to the headmaster were there. They tried to keep me there, to put the cannula at another place, to let me finish that treatment. Hell no. No no no no no no and no. Either they took the lot out or I’d done it myself. No single second longer in that place. “Daniel, don’t be so emotional about it!” I heard my teammate saying. Yeah, right, switch place?

In the end, they gave up, took the cannula out and let me go. But, I did have to take the pills again, quinine, double dose for a full week. Fair enough and so I went to my room again at the school. I did take that full treatment by pills, lost the skin of my tongue, near deaf, nearly vomiting all the time, couldn’t eat properly, diarrhoea, aggressive, passive-aggressive, calm, down, sleeping, and repeat.

After the treatment was finished I was in bed for a while longer to get healthy again and overcoming both malaria and side effects from the medicine. The recovery went well, I started to work again, at least what was left of it as soon there were exams and we had to go back to Europe again. My teammate and I left one week early to Benguela, the second largest city, where there never was a war, where it was way more developed to have a holiday.

One day before flying back I went again to a private clinic to have the final test and it turned negative. I was cured! and satisfied I was on the plane going home. Using my escape to be back in civilization I knew. Yet, leaving the poor behind, the people who we don’t hear, don’t see, letting them creep as I experienced. That still is very double, even today.