Saturday, January 19, 2013

A Bit Green in Malawi

January 16, 2013

You may have noticed my lack of posts in the last few months. Here’s why I’ve been a blog slacker!

DISCLAIMER: If you have a weak stomach, you should just skip this entry. If at any time you have found me attractive and want to maintain that image of me, you should just skip this entry. Mom, you should probably also just skip this entry. Actually, all parents of PCVs should skip this entry. You know, if you even know me in person, go ahead and just skip this entry. Also, I apologize in advance for the graphic detail (but I typed that with a very sweet smile).

Once, I prided myself on my strong immune system. Since childhood I’ve done my best to shun antibiotics and flu shots, relying instead on my body’s strength and a healthy, balanced diet. When I came to Malawi I expected to have a few stomach issues, maybe a flu or two (remembering that when I moved to Spain and exposed myself to new germs, I did come down with one or two major health problems). However, with MY immune system and a healthy, active body, I never expected to fall into the crevasse of chronic poor health I have experienced here. I no longer have a strong immune system. The combination of poor diet, extreme weather conditions, terrible sleeping habits, and, especially, high stress, leads to susceptibility to the germs I already had no tolerance for. My energy is low and my fatigue is constant and most dangerously, healing and recovery is very, very slow…almost impossible.

In November I contracted bacterial dysentery (AGAIN) in Lilongwe, the capitol city (why in Lilongwe and not the village? I handle my own food and water at home, instead of trusting restaurants to provide clean food and drink). When I say dysentery I think most people (my age) laugh at the memory of the Oregon Trail computer game we played in elementary school and assume I’m a weakling about a little bitty insignificant gastrointestinal issue. Let this be heard: bacterial dysentery is like NOTHING in our pampered first world. The reason it killed your character in Oregon Trail is because it KILLS PEOPLE.

I fear I can’t explain this well without getting a little TMI vivid, but frankly I have very little modesty left after 19 months in rural Africa. So, imagine this:

You wake up with a little nausea, a little cramping, and you wonder if you should eat at all. You drink some juice instead but it is quickly released. Then things accelerate furiously; it hits so quickly that it’s only after your 22nd mucus-blood-liquid bowel movement do you realize that your fever has hit 103 within 3 hours of that little inkling of initial nausea. Your body is wracked with chills up and down, deep inside and out, so intense that it’s as if a strong being is scraping through your body with long fingernails. Yet you’re burning hot, thrashing on the bed trying to find a cooler spot, a warmer spot, a drier spot as you sweat through your pillow and simultaneously freeze. Somewhere in the back of your mind you know you need to find medicine, call the doctor, take something to reduce your fever, but you dream you’ve already done it and cry when nothing improves. Even if you managed to make a call, no one can come to help you. You hear yourself whimpering from far away, inhuman sounds that belong to some dying animal in the road. Your mind grapples for sense, it’s just fever, it will pass, it will pass, it will pass. But your body cannot understand. It twists in the bed and cries, humiliating you, failing you, calling for the mother that once carried and cared for it. And then the cramps hit again, sickeningly painful, rolling through your abdomen, a knife, a hooked knife, and poisoned. You stumble up and make the run, that familiar lap, the routine you make again and again to poise, faint and fevered, to surrender more precious liquid. Again, again, again, again, again. You crawl to your rucksack for salt sachets and mix oral rehydration salts into your last bit of safe water and you try to sip apple juice and take aspirin and check your temperature and remember your antibiotics somehow between bouts of fevered madness. In the back of your mind you know if you neglect the antibiotics you will continue this cycle until you collapse from dehydration…and then how long until someone discovers you and finds you medical assistance?

Soon, you can walk again, sort of, and then eventually your desperation to get home and back to work leads you to risk the trip home. Maybe you pay your dues to the oopsie poopsie club on the first 8 hour bus, or maybe you get lucky. You don’t fully recover your energy and within 4 days discover why: you are now suffering a relapse. This means you’ve got giardia and your other antibiotics were essentially useless.

Now you’re at site in hot season and your 103 degree fever is matching the 103 degree weather. You’re too faint to stand. Now you have no toilet, just a dirty bucket in the courtyard that you have to crawl to at all hours of the day and night since the chim is simply too far away and you can’t crawl through the jungle yard in the dark. It’s not so bad, you tell yourself, because your movements now are essentially just water and a little mucus. You haven’t eaten anything but rice and broth and apple juice in 10 days now yet your body is trying to expel everything inside of it. You cancel work, you cry in frustration and exhaustion and pain, you wake up moaning, you can’t stop sweating in the heat, you have to use diaper rash cream and carefully ration the last of the toilet paper, you dizzily treat your water and find you are too weak to lift the bucket to the filter, you have to sit on the ground to bathe when you have the cognizance to do so, you have nothing in your house to eat that will be gentle enough on your system and you can’t manage the sweaty walk to the trading center for rice or bread, so you just keep drinking water, ORS, room-temperature chicken bouillon, wishing someone, anyone, were there to reassure you that you were going to survive. Eventually, after another massive dose of antibiotics and several days, your body calms. But it never, ever recovers its energy. You NEVER fully recover, and your digestive system stumbles and blunders through its job.

At home, in the first world, we have comforting assistance for our ailments—tea, blankets, air conditioning, heat, cool yogurt, popsicles, ice cream, homemade soup, our mommies, cold sprite, friends, fans, dryer-fresh sheets, extra pillows, television, clean bathrooms, safe water, ice, toast—we are deprived these comforts here. Nothing is ever comfortable when you are ill, but it is much worse here. Not everyone in Peace Corps Malawi has such intense experiences with illness, and of course some people suffer worse—Malaria, Cholera, serious mystery illnesses. I have had dysentery and/or giardia 3 times now, not to mention such gastrointestinal problems as food poisoning, chemical poisoning, stomach flu, salmonella, and parasitic intestinal worms (I know, super cute, right?), and I currently weigh less than I did in high school. You would think I’d be happy! It’s not a weight loss I’ve enjoyed, however. The lapse in exercise regiment due to heat and sickness has left me soft and weak, out of shape and flabby where I used to have muscle, and my poor diet (largely carbohydrates, little protein, few fruits and vegetables) leaves me listless and exhausted, hampering my motivation for work or even fun events. I can see myself aging rapidly—wrinkles and sun spots and, infuriatingly, at 27 years old I am finding my first gray hairs! It has all made my self-esteem plummet and my attitude darken.

Of course once your health is compromised in this way it opens the door to everything else your brain is generally better at ignoring—chronic infections, tendonitis, IBS, rashes, hypoglycemia, anxiety, back problems, allergic reactions, flus, colds, coughs, chronic sore throats, just to name a few. Also, after some serious bacterial or viral invasions, apparently, the body struggles to give up the symptoms even after the infection has passed, leaving you puking during Christmas dinner or tolerating nausea for the better part of your Zambia Safari Adventure. Isn’t that ADORABLE?

I will say, we do have a good medical staff and we are equipped with antibiotics and are educated and guided in safe self-treatment. The system does work. Unfortunately, simply, there is no prescription for invincibility.

It is now January and finally, finally, I am beginning to feel human again. It’s only now, with most of this mess in my 3 months past, that I feel comfortable writing about and sharing (but really, how comfortable can you ever be posting the status of your bowels on the world wide web for everyone on the globe to read?). Please understand I’m writing this to share a vital part of my experience in Peace Corps Malawi, not to scare people at home or terrify potential PCVs or worry my family. The whole time, I promise, with the exception of a few bad days, I’ve been smiling! With the restoration of some of my energy I am back to my usually optimistic self, loving Malawi as usual, looking forward to the last seven months of my Peace Corps service and approaching them from the health defensive. I’ll be taking my vitamins for the next 30 weeks or so, thank you very much.

Besides, I’m a grown woman, and I can admit that if I’m careless enough to drink from a pitcher of water on a table at Sana Restaurant…well, I deserve a stomachache for that!

1 comment:

  1. I take that last comment back! You are strong like CUB! If you need me I will come. Have plastic WILL travel!