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?
