Three Cheers for the Plague

            For those of you planning your first trip to the developing world, you will undoubtedly be advised by a well-meaning healthcare professional to visit the International Travelers Clinic.  Here is my advice.  Don’t do it.  Trust me, when it comes to tropical diseases, ignorance is bliss.

At the clinic, I was deluged with inoculations, pills and warnings about the many health hazards awaiting me should I be so foolish in Tanzania, as to perhaps, eat something, drink water, go swimming, have sex or be in the wrong place at the wrong time, which in the developing world, is just about anywhere, anytime.

I left the clinic loaded down with paperwork about "health precautions" and "disease risk summaries" for East Africa that I made the mistake of actually reading.

Diseases carried by insects included yellow fever, which is endemic, dengue fever, and trypanosomiasis or African sleeping sickness, caused by the bite of a tsetse fly and fatal if left untreated. I made a mental note to pack a few more long-sleeved shirts.

Next was filariasis, something I'd never heard of, which is "prevalent" in East Africa, not a good sign. Also listed was leishmaniasis, both "cutaneous" and "visceral." While I was completely unfamiliar with leishmaniasis, I was equally concerned that I didn’t know what cutaneous or visceral meant.

Onchocerciasis or river blindness is “epidemic” in parts of East Africa. No problem, I just wouldn't plunge into any rivers. But then I learned that just being near flowing water is all it takes if one is unlucky enough to be bitten by an infected female black fly. I decided I would do well to avoid rivers and streams.

The food and waterborne illnesses category was also disturbing. The fact that the food and waterborne diseases were all "highly endemic" was not comforting in the least, since there was an excellent chance in the coming year that I would be eating food and drinking water. These included the "usual" diarrheal diseases, giardiasis, typhoid fever, cholera, viral hepatitis and something called echinococcosis. To be helpful, the handout explained that echinococcosis is also known as hydatid disease. Of course, the famous hydatid disease, that certainly clarified things.

Then I came to malaria. I remember thinking that malaria wouldn't be so bad to catch but then I learned that it’s a leading cause of death in Africa and kills roughly one million people each year worldwide. Malaria turned out to be nothing to trifle with, which is why I decided to spend $400 on mefloquine despite anecdotal warnings of side effects such as "debilitating neuropsychiatric adverse events" and "suicidal ideations". 

Dracunculiasis was next. Described as "widespread", I immediately wondered how something I'd never heard, something that no doubt involved vampire bats sucking on the necks of unwitting foreigners, could possibly be "widespread?"  I didn't want to think about it so I moved on, but I wasn't quite through with the medieval diseases.

The next disease jumped off the page at me, "plague." Wait a minute. This couldn't actually be The Plague, the kind carried by infected rats, causing inflamed armpits and groins, with corpses hauled away by the cartload by toothless, hunchbacked men through dark alleys to nameless mass graves, could it? Is it possible the travel doctors at the clinic threw this one in as a sick joke?

The plague is a bacterial infection, cured by antibiotics if caught early, but somehow this disease sounded the worst. Imagine calling home:

"Hi Mom. Oh yeah, things are just great here in Tanzania except, well, I have, um…I have the plague."

I'd never live it down. My fifteen minutes of fame would never end. I'd inspire dread and repulse every person I'd ever meet for the rest of my life. Forevermore I'd be known as the person who'd had the Black Death and lived.

The final catchall category, "other hazards", as if enough hadn't already been mentioned, included HIV, measles, leprosy, elephantiasis, diphtheria, polio, influenza, parasitic worm infections, meningococcal meningitis, tuberculosis, schistosomiasis and trachoma.

Good Lord, what sort of Dark Ages nightmare was I plunging myself into?

Grasping for any faint ray of light at the end of a long, dark, disease-ridden tunnel, I took great reassurance in the fact that I didn’t see the Ebola virus listed anywhere. Besides, I'd already sold my house and taken a one-year leave of absence from my job so it was too late to back out of my volunteer commitment.

So in the spirit of fearless explorer Dr. David Livingston, I gambled away any hope for longevity and got on the plane.  But little did I know that I was to learn of yet another disease that was missing from the reams of paperwork I'd scrutinized before leaving.

The third day in country, our group of thirteen volunteers, eleven Americans, one Brit and one Canadian, still dazed from jet lag, attended a health lecture given by a Tanzanian doctor.  Much of the talk concerned malaria and the other diseases I’d already read about, but then the doctor’s talk shifted to what I’d previously believed to be a mundane subject, washing clothes.

The doctor explained that when washed clothes are hung outside to dry, something I would likely do since clothes dryers in Tanzania are mighty scarce and I hadn't brought enough clean clothes to last for 365 days, then, something very bad happens. An insect, never specifically identified, lays eggs inside the clothes. When the clothes are worn, the larva burrows into your skin and forms pus-filled pustules that can ulcerate and become gangrenous at which point that exceedingly unlucky body part falls off or rots away until amputated.

As Dr. Doom was describing this little journey through pestilence and perdition, I looked around the room. Our thirteen faces had changed from masks of polite boredom to utter horror. So assuming I didn't catch a fatal illness, which was suddenly looking quite attractive, the best I could hope for was to return home a hideously pockmarked shell of my former self.

 The doctor kept talking but I was no longer listening. I was thinking about catching the next flight home. But then, almost as an afterthought, he waited until the end of his lecture to tell us that simply ironing clothes kills the little wadudus (bugs) dead. I bought an iron within the hour.

As the year turned out, I had never been healthier, succumbing to just one case of the common cold, certainly nothing to call home about. Perhaps just one bout of the plague wouldn't have been so bad after all?