Just a Drop

Before we headed off on assignment to Africa, we were given a number of warnings and advice to take heed of. Among the screeds of literature there was a small, red-covered book, The TRAVELWELL Self Assessment and Treatment Guide. It’s still sitting on the shelf here beside me. It’s a comprehensive book and despite the dubious advice for a lion attack recommending to allow the animal to chew on an arm or leg in the hope it will become bored and not become excited by any efforts to fight it off, there is very sound and worthwhile advice. We referred to it many a time!

After five years, back home and back working at the nursery, out of the blue, I began to feel crook. It felt like the onset of malaria, I knew it well enough, I had it three times and it felt like I was in for another dose. I was working at the potting bench by myself, and knew I was in a rapid decline. I called one of my crew to tell him that if I didn’t head home now, I doubted if I would make it!

I lay on the couch until Mags came home, and because it was a Friday evening, she carted me off to the emergency doctor. I told him I suspected malaria and wanted him to take a blood sample. Something I had learned, was that if you take malaria medicine before a blood test, the results will likely show positive anyway. Doesn’t sound logical but myth or not, I wanted an accurate test. I still had a dose mefloquine at home and no matter what the doctor said, I was going to take my dose when I got home. The poor old emergency doctor was no phlebotomist and made a bit of a mess of my arm trying to extract his sample, but he’d never seen a malaria case and I tried to tell him the rules according to me.

The mefloquine didn’t do much, but my ever-hopeful mind was saying the opposite! By Sunday night I was in a fairly bad way and rang our own doctor at his home, he suggested the usual, paracetamol, drink lots of water and see him in the morning. He couldn’t tell what was wrong, so he sent me for a laboratory blood test which came back the next day saying I had far too many white blood cells, but still he couldn’t figure out why. I could hardly stand, so at home I went to bed. During the night one of my lungs collapsed causing my breathing to become shallow and crackly. Another blood test the next day showed more white blood cells than the first time.

Mags rang the Agency’s doctor, an expert on tropical medicine, who couldn’t give any answers without actually seeing me and she was in Wellington – I was hardly going to make it there! Four days down the track and I was just getting worse. My collapsed lung wasn’t treated because it wasn’t the primary cause of my condition. The pain in the muscle at the top of my right shoulder was getting worse too, it was like a red hot knife being turned in there. Every hour or so, Mags had been flicking through the small red book, it suggested that pain in the right shoulder could signal an amoebic abscess on the liver. The swollen liver resting on the diaphragm causes the pain to shoot up to the shoulder. She phoned the doctor and he said to go straight to Dunedin hospital for a scan.

The radiologist, cold gel at the ready, asked me what she was looking for. I told her about the suspected amoebic abscess on my liver. In no time she said she had found it, a hole in my liver four inches across! She didn’t wait for a doctor, she sent me straight down to A & E, where they gave me morphine to ease the pain. It made no difference. I was bunged into an isolation ward, because they weren’t sure it the tropical disease was contagious. They did more tests, took more scans and checked the internet for the appropriate treatment. An amoebic abscess was well outside local experience.

The plan was to put me into the donut scanner-thing so they could see the needle when they jabbed it into my liver to suck the gunk out. ‘The liver has no nerves so it wouldn’t hurt’. I was told. The first needle was too thin or the gunk too thick, so they had to find a fatter one to do the job. They managed to suck out just over four hundred millilitres! The surgeon took a whiff, saying he didn’t want to gross me out but he thought it important to smell it in case he struck the same sort of thing in the future. The internet said the gunk should be the same colour as anchovy sauce, but nobody knew the colour, so someone was sent to the supermarket to secure a sample. It wasn’t a match so they cultured the gunk to see what would grow.

Back in the ward, they gave me five times the normal dose of Flagel, the drug given to treat giardia. It leaves an awful, metallic taste but I wasn’t fit to complain. They told me amoeba divisions could spread into my heart or brain so I was to keep taking the drug until they imported a special drug from USA that would clean any remaining amoeba from my body. Meanwhile, the hospital also housed a medical school, so I was a point of interest for student doctors who checked me out from time to time. I was told later that the only treatment for amoebic abscess available in Africa was Flagel and at the time it had only been available to them for five years, prior to that patients simply died! Sobering.

The doctors had me up and about as soon as possible, but I was weak, I could only walk twenty metres along the ward, which was a square configuration. It was a week before I made it around the whole square. All my waste was taken away to check under a microscope and bombard with chemicals in case it posed a danger. My enduring respect to those young women in the lab! It doesn’t take for reality to kick in, there were three guys in the ward who were far worse off than me. They didn’t survive. One guy had internal bleeding and knew he was doomed, but he was bright and accepting. He was a hymn writer and he wrote me a poem suggesting in the circumstances, I shouldn’t ever return to Africa. I did, but that’s another story.

I’d only been home from Africa a few weeks when I took crook, so wasn’t entitled to any sick leave, however the nursery owners each week sent me a basket of fruit and nuts and they paid me in full for the eight weeks I was off. Even when I went back, I wasn’t quite right, my confidence was shot and I shouldn’t have been driving the tractor or forklift so soon. Anyway, the old liver is an organ that repairs, and the final scan showed that the scarring had gone completely.

Where did the amoeba come from? Undoubtedly dodgy water. No, I didn’t drink dirty water, I was always very careful about water. We boiled all our drinking water and if we had salad, we washed everything in boiled water. I never ate salad anywhere else unless I knew for sure how it was washed. I always drank sodas or hot tea out in the villages. Most likely the amoeba was in a droplet of water on a dish, a plate or a cup that had been washed in tap water that hadn’t been boiled. As for fruit, I followed the rule, if you can’t wash it or peel it, don’t eat it.