It all started w/ a broken juju: malaria upcountry

Trip Start Aug 26, 2007
Trip End Dec 16, 2007

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Flag of Gambia  ,
Tuesday, November 6, 2007

The following will be a shamelessly self-pitying entry. If you want a more objective one move onto number 11.

It all started with a broken juju.

Gambians believe strongly in Jujus, charm-like accessories that give different benefits to the possessor given the different materials in them. I'd had a very simply good luck juju around my ankle. It seemed harmless enough, just a stitched leather strap with a little shell on it. But then the strap broke, and everything went downhill after that. I had my phone stolen, then things got progressively worse when we saw a young child get hit by a car. And for a very disturbing climax, while we were down by the river one day, unbeknownst to us, a little boy drowned. Other smaller misfortunes followed, but the one I'm going to delve into with plenty of self-pity is about my own health.

We left for a trip up country on Monday, to visit different villages and see rural life, looking specifically at education and development efforts. The opportunities to meet with the village leaders (alkalos), look inside the communities, and to just get out into the breathtakingly beautiful, diverse countryside were amazing. Unfortunately, on Wednesday I started to show symptoms of malaria (bad back and joint pain, weakness, and a fluctuating fever). The lack of fans, comfortable beds, and often, running water or electricity started to seem much less charmingly bucolic at this point. I was starting to worry I would have to cut the trip short to go back to the city for treatment. Luckily, the fever lowered by later the next day and the back pain wasn't so bad, so I didn't bother going to a clinic. I was more or less fine as we moved on to other villages, but on Saturday things got worse again, this time with a throbbing headache that made me very faint. After a long, bumpy bus and ferry ride back to the island where we were staying I was ready to pass out, but Baboucarr (our wonderful Wolof teacher and guide on the trip) insisted I go to the clinic. It turns out there was only one clinic on the island, with only one doctor. I'm still not quite convinced the guy I saw there was a doctor, he was very young, dressed in an old t-shirt, there were no certificates on the dirty walls, and at first I'd assumed he was just leading us to the real doctor. But either way, he asked my symptoms and informed me that they didn't have any sort of lab, but that he was going to clinically diagnose me with malaria. So, I popped down a series of pills, got my first shot of chloraquine, that dreaded drug us 12 St. Mary's students have had far too much experience with. Because there really weren't any facilities to this 3-roomed building that smelled like urine (it really seemed more to me like a drive-through for prescription drugs), I was not going to be admitted like the others who'd gotten malaria. Instead, I got chloraquine in the more concentrated pill form. So I went back to the dark, mildew-y room I was staying in and fell asleep.
I'd seen other people on Chloraquine, but now that I was actually on it I realized how powerful of a drug it is. It does strange things to people's minds, besides having a series of other side effects. Some of the others in the group got a little delirious, some couldn't remember chunks of the day, and everyone had very strange, vivid dreams. I got a mix of these symptoms, and looking back on it the whole experience was just a strange, semi-delirious mess of waking-dreams. Also, by Sunday I became very, very nauseous. Throwing up into a toilet that doesn't really flush is an experience I never want to repeat, but that I repeated several times over the next day. Ironically, I couldn't take any of the medication -- the painkillers, vitamins, Chloraquine, or even the anti-nausea medication I had - on an empty stomach. This created a very unpleasant situation, however, because I couldn't keep any food down. But I found myself taking my last dose of chloraquine on Monday morning, the day we were leaving to head back to our compound at Kanifing. So I loaded up onto the bumpy, crowded bus with anti-nausea medication and white rice, in the hope that it would be the first food I would be able to keep down. I was not. I ended up throwing up in the garden of a women's group we had stopped by at for lunch. That was also a rather embarrassing experience that I do not want to repeat. After a long, long, nauseas, semi-delirious trip we were finally back at our happy compound. My body was completely worn out from the malaria, the drugs, the lack of food, and the long trip and I wanted so badly to pass out in my own bed. But our program coordinator insisted I go to the dreaded Lamtoro clinic (the location of the past malaria horrors, including general bureaucratic inefficiency, misdiagnosis and almost-fatal overdoses of chloraquine). This was especially illogical because the malaria would have been completely wiped out by the chloraquine, or, if it were chloraquine resistant, would not show up again until my fever came back in a day or so. But I went, against all my better judgment and desires.
I had not been the only sick one on the bus trip, Sunday night Jenny had developed some malaria-like symptoms, and we were able to wallow in our discomfort together. So we both made our way to Lamtoro, and after waiting a while we saw the doctor. This doctor, Dr. Emanuel, was one of the truly horrible characters we have met here. He had that tendency we've seen of a complete lack of ability to listen to what others say, he was racist (he became indignant when our Sierra Leonean friend Muhammad tried to come into the room, but welcomed the very white Bryan), and he radiated incompetence. After starting to spell my last name (Minor) L-e-n and continually forgetting what we'd told him about our symptoms, he made us go through more tests than the simple malaria test we had asked for. Then, when looking at the tests, he was able to say that there wasn't malaria in either one of our blood samples. But, rather than let us leave at this point, he fumbled through our results and decided to diagnosis both of us with another illness and prescribe us a slew of drugs. Jenny and I, pissed off, tired and nauseas, tried to argue with him, especially because the drugs he was prescribing for us we already had with us from our local (competent) doctors. After several minutes of him getting increasingly flustered, he said he would let us go if we would come back the next day with our prescriptions. And to show us clearly that the clinic was just trying to drain us of money, the receptionist tried to make each of us pay 1,200 Dalasi, even though our insurance was also billing them the money. Through the ensuing argument I was running only on anger.
The next morning, still tired and weak, I made my way back to the clinic-3 different taxi rides and about a mile and a half walk. I was alone this time, because, to top everything off for Jenny, it was her birthday, and it seemed too cruel to make her go back to Lamtoro. After the usual period of waiting that is characteristic of this inefficient clinic, I was finally able to see a doctor. I was initially as short with her as I had been with everyone else, until I realized that she was not quite as unprofessional and inept as all those around her. After looking at her charts she confirmed, as we already knew, that the doctor had misdiagnosed us, and she apologized for our experience. However, I still needed copies of mine and Jenny's results (luckily there is no conception of patient confidentiality). This seems like a very simple objective, but not for Lamtoro. Apparently, there was only person who was capable of using the copier, and though she was supposed to be in hours ago, she was not. After they refused to let me use their copier, I convinced the security guard to go with me to the nearest copy place to make copies. But, of course, their copier was broken and the security guard couldn't go any further because he had to get back to watch the clinic, seeing as his partner had not shown up for work that day. So after insisting the receptionist call the copy-woman, it was back to the waiting room for me. During this time I also got to argue with the receptionist that there was absolutely no reason for me to pay 600 Dalasi for this visit before finally getting my copies and leaving.
The most frustrating about this entire experience was the complete lack of logic or reason that transformed an unpleasant experience into a maddening one. Gambians are able to accept this and so much more with a light-hearted smile, but I've yet to master that gift. In a few days I'll be able to laugh about the more ridiculous parts, but until then I'll just be the angry white girl in a clinic.
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