Tuesday, January 22, 2013

Viral By the Nile

I finally got sick in South Sudan.

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.
I got some pain meds and anti-virals. Apparently I’ll be better in two weeks.

Saturday, January 12, 2013

What's Upstairs

I got in from Nairobi and reached Gate F5 in Schiphol Airport a bit earlier than usual for my next flight from Amsterdam. Went through the X-ray machines and handed my passport and boarding pass to a young KLM lady behind the counter. She scanned me in and I saw red text blinking on her screen: “SEAT CHANGE * SEAT CHANGE’’ and number 75J pop up. Whereas I had previously carefully selected seat 11C, an aisle seat in Economy Comfort toward the front of the plane, for the long leg to the U.S.

I hope you’re not changing my seat, because I reserved an aisle…..
Yes sir. You have been upgraded to Business Class.
Gulp. I admit, as much as I travel, until that moment I didn’t really know what Business Class was. Certainly I had HEARD of Business Class. I knew they didn’t ordinarily let people like me sit in Business Class. I don’t own a briefcase. I never took Accounting. Sudoku scares me, and I don’t have an iPhone. All I knew was this: the Business Class people always go first on the plane, I think even before people in wheelchairs and moms with babies, and then you don’t see them again, ever, and that when they walk by the rest of us sweaty impatient Economy people massed near the door, we hush down and step aside, and they walk coolly past on their cells, selling off chip-maker stocks and smelling of expensive lotion while we stare and wonder how they came by so much money.
I didn’t want to appear over-anxious, yet was the first passenger on the plane. I could feel the lowerclasses staring and wondering at me as I boarded. They think I am an American Internet wizard, that’s why my face is unshaven and my clothes are cheap….they likely think I am friends with Mark Zuckerberg. Perhaps they think I am an actor – several people have said I resemble Rick Moranis. I feel sorry for them. They will not be on the plane first and they will be so cramped, poor things. Umm....
Imagine my surprise when the flight attendant, instead of pointing left or right, pointed up the stairs. Business Class as a metaphor for heaven? WOW. Never have I been upstairs on a plane.
At the top of the stairs I turned left, and beheld a scene of great comfort. The seats were as large as Aunt Joanne’s and Uncle Reggie’s La-Z-Boys back in West Virginia – possibly larger. Grey wrinkly soft leather, or it could have been really nice fake leather that was just as comfortable as leather. Real arm rests, roomy and flat, with space for two or three cocktails at once – no elbow fights up here. The seats all had something that looked like levers sticking out of them on their right sides, at about head-height. I wasn’t sure but guessed they had something to do with turning the seats into beds. It smelled comfortable, too. Maybe they filter the air, or just do a better job cleaning the bathrooms, but there was not the usual stuffy urine-tinged-and-many-other-nervous-people plane smell that is common among the commoners – I mean, in Economy. Hey CHECK OUT THE HEADPHONES! After figuring out I didn’t have to pay for them, (they looked like you should have to pay for them), I sat down in my cavernous aisle seat and tried to reach them, new-looking and packed in plastic in the back of the seat in front of me. I had to get up, though, because the magazine holder in front of me was so far away. Is there such a thing as too much legroom?
I began experimenting with the lever sticking out of the seat by my temple. I yanked it up – nothing. Yanked it down – nada. Tried rotating it gently in clockwise and counter-clockwise motions. Maybe it was broken – nothing I tried with the lever would turn my seat into a bed. After puzzling over it for several minutes, I realized it was a reading lamp. So I turned it on and pretended I knew what it was all along, as I explored the 10-button electronic seat massage system.
They give gifts, too, in Business Class. First I got a spiffy black pouch filled with toiletries including a tiny tube of toothpaste and a toothbrush, as well as warm soft socks and a silky sleeping mask. But the coup de grace was the tiny Delft ceramic Dutch rowhouse replica, about the size of a saltshaker, containing a shot or two of expensive Dutch gin. When the stewardess came by with it, I had no idea what was happening. She looked at me, and I looked at her, so she positioned her tray a little closer to me, expectantly. I picked up the small house, looked at it, and put it back on the tray.
It’s very nice, I said.
She waited.
Is it...for me? I asked.
Yes. It is a gift.
What is it?
It is very good Dutch gin in a tiny Dutch house. You can collect them.
Of course. My kids will love it. Thank you.