Before you come, everyone and everything you read warns of it, such that it seems inevitable: disease and suffering. You cannot work in the poorest country in the world and expect not to contract something exotic and possibly deadly. Parasites. Amoebae. Killer mosquito and insect-borne viral infections, cerebral malaria, diarrhea, dysentery, fly bites that cause comas; beetles that secrete skin-blistering toxins. A few weeks ago my boss quietly sent me to the World Health Organization headquarters in Juba to check on reports of a possible viral hemorrhagic fever outbreak up north, in an area where we have staff. The disease is also known as Ebola, named after a river in Congo, next door to South Sudan. People were bleeding from orifices and dying, but it turns out it was probably something else, my WHO contact said. They were investigating and would let me know.
And then I took ill. It started with upper back pain, followed by a pink rash, on the same sore part of my back. The pink turned to bright red, and clear white blisters popped out and marched toward my underarm. The back pain intensified and moved under and down my right arm, girdling me, radiating into my chest. The blister rash spread along the same front, and I began to worry. I knew it wasn’t malaria – there’s no rash involved and I assiduously take a malaria prophylaxis every day, even though hardcore aid workers out here make fun of me for it. Better to get malaria occasionally and gut it out, they say, than spend the money on expensive meds which mightn’t work anyway.
I didn’t think it could be diphtheria, tetanus, typhoid, yellow fever, polio or meningitis, either, because I got boosters or vaccines for all six of the above before my first trip out, two years ago. Which also makes me a wussy, I guess, if a fairly well protected one. I hoped.After three days I was worried enough about the rash and internal pain, which now included headaches, to consult my Kenyan friend Esther, a professional masseuse. I showed her the angry rashy wasteland that was my upper right torso, and told her about the stabbing nervey soreness bubbling underneath my skin, on top of the bone.
“Nairobi fly bite, I think,” she said before turning to leave, quickly, in case it was something else, catching. I looked it up online and yes, there is a black-and-red flying beetle, common in Juba despite its eponymous name, that excretes something called pederin when touched that leaves a nasty bright red painful blistery rash.I was secretly delighted.
A Nairobi fly bite, imagine that! Mom and dad will be horrified and tell all our relatives! I can blog about it and impress everyone! Tahra can shock our friends with the news at PTA.I wanted a second opinion, though, so I showed my boss. She’s been here a lot longer than me and is from Bangladesh, which has its fair share of third-world health problems.
She poked it.“Does it hurt?”
“Yes. When you poke it especially.”“I think it could be Nairobi fly. But why don’t you go to the clinic and get it looked at, instead of just complaining about it?”
The next morning I presented myself at Unity Clinic, a clean and efficient Aussie-run shop in Juba that few people other than ex-pats can afford. They take only cash, only U.S. dollars, and it costs $125 just to get in the door.A Scottish nurse with a clipboard and a stethoscope asked me about my problem.
“Two people have told me it’s probably Nairobi fly,’’ I said, hoping to influence her diagnosis.“I don’t think so,” she said after a quick look.
Oh man, it could be something juicier! Maybe they’ll have to Medevac me.“It’s a virus called shingles. It’s related to chicken pox, which you must have had as a kid." The virus stays in you, it turns out, and can erupt when you're stressed or tired. My wife, who is a very skilled Web-based medical sleuth, had arrived at the same diagnosis a week ago, though I rejected the suggestion that my illness, contracted in South Sudan, could be so un-exotic. Also -
“I thought that’s for older people?” I asked the nurse.
"Generally."I got some pain meds and anti-virals. Apparently I’ll be better in two weeks.