January 25, 2005

Triple Diagnosis, Tanzania Spring 2001

“You have a lot of friends in there,” he announced, referring to the critters living in my gut. I was sitting in a relatively comfortable and clean front room of a Tanzanian clinic in Arusha, when the squat, Indian doctor came back with his diagnoses. Too ill to be amused or surprised, I wearily accepted the prescription he handed me and left to fill it before falling into bed to recover over the next week. How did I get there?
The fun began one day when, after living for two and a half months in a rural homestay and in our tents, Stephanie and I decided to take a break from the world surrounding us, and pay to spend a day in shwank, luxurious, quiet, pool-side solitude. We paid dearly. Not only did we shell out our two thousand shillings for the touristy privilege but our crisp crimson sunburns mocked our attempt to shirk the cries outside the Novotel walls for mzungu (white person) to buy “batiki”, or for “sistah” to take a “tax”. As good-humored gals, we were able to laugh off the pain for the first couple days. Until we ran out of aloe. And until I was awakened one night by Stephanie’s concern,
“Amana, are you okay?” I drowsily roused myself from my half-slumber state and as I put conscious effort into comprehending Stephanie’s question, I winced in pain from the burn on my back, and wondered why so many dogs were barking and howling outside.
“You were moaning, Amana, are you okay?” she repeated.
“Oh, I’m sorry. Yeah, I’m okay, my back just hurts.”
“It’s alright. I just didn’t know if you were in pain or what. I thought maybe you were just listening to the dogs.” I tried to figure out what the logic of her statement was as I settled myself down to the rest of the still, sharp night.
Next morning we were up early to meet the other 18 students, the drivers, and Reese, our academic director, at the office so we could leave for Yaida Chini where we would spend three days with the tongue-clicking, hunter-gatherering Hadzabe. On our walk to the office, the long rains began, which made Stephanie and I late. While every Tanzanian in Arusha ran for cover, she and I plodded along, ears back like the uncomfortable pack-laden donkeys we walked past in the streets in the downpour. Thus we began the drive soaking wet. The interminable drive. For hours, the worst part was feeling my back sear with pain every time we hit a divot in the tarmac road, as it hit my seat back. My burn was taken to a new high—or low, depending on your perspective—and it felt like I had ten billion paper-cuts where my naked skin had dared to show itself to the sun in this modest country. In addition to the sunburn, I was tired and sore from trying to sleep the night before in one position in my cheap, concaved, mosquito-netted cot to avoid agitation and more whimpering. So I slept in the front seat of one of the four land-rovers. This meant that when we left the tarmac, only an hour into the drive, my head hit the ceiling and the window every third second as we swerved left and right to avoid the unavoidable potholes, water runoffs and ditches. When we stopped for lunch, at a dusty, tin roofed duka (store), my classmates piled out to enjoy a tepid Fanta passion in the shade, and some maharage na wali (beans and rice), but I spent the time taking advantage of the metal box in the sun as a bed. It was hot personified, but at least it was still, and I could stretch out in the back seat.
On the road again, my car mates decided to test the reactions of Tanzanians as we drove past, waving frantically with both hands like we had seen plenty of kids do to us. There was a rainbow of expressions shown to our display; from drop-jawed disbelief at the crazy wazungu (white people), and smiling faces and friendly waves back, to kids booking it across fields toward us to whistle and scream and wave back at us as their herd of goat and cows moseyed off in the opposite direction. Fun as that was, it didn’t last very long. We stopped one last time for gas in a place that looked to me like a western ghost town suddenly populated by Tanzanians for a movie. At the gas pump, a man attempted to barter with Reese for one of us.
“Either give me five hundred shillings, or give me one of the wazungu for a wife.” Right. (What kind of a deal is that?) Off we drove, none of us newly betrothed, into nowhere.
There are two kinds of mud in Tanzania. The good kind looks like terracotta earthenware and driving on it is like driving on ice. As the rain cloud moved steadily in front of our caravan, we were rudely provided with a constant track of this slick, ice-like road. We’d fishtail one way then the next, the driver swerving left and right just to stay on the road, and all the passengers staring open-mouthed, wide-eyed, and white knuckled at the fact that we managed to avoid sliding off the road and flipping the land-rover. From our ice-like roads, we came to a river, the opposite bank of which was made of the other kind of mud, misleadingly called black-cotton soil. Such a name conjures thoughts of warm winter nights by the fire in brand new fuzzy black cotton flannel pajamas. The soil is not comforting like that. It is infamous for reaching towards unsuspecting wheels driving on compact, dry, hard land and ripping them mercilessly from this luxurious state of driving into utter land-rover hell. Once a vehicle enters black cotton soil, only the best driving, the most pitifully pleading prayers, and good luck can get it out again. So, on the relatively safe, red, icey-mud side of the river, the drivers poised their automobiles to survey the situation. Together, they sighed heavy deep breaths, shook their heads, looked at the far bank, discussed possible maneuvers, and looked disapprovingly once more at the inevitable. Each car took a deep breath on our side of the river, and then plunged down the bank, forded the river and gave its all up the other side. Not that this tactic actually worked. No, we spent a good half-hour diving the four cars one by one into the mocking black mud that merely spat back in our faces and pulled the car treads deeper. Eventually, via the aforesaid talent, prayers, and luck, we all managed somehow to clamber up the hellish river banks and continue on toward camp in Yaida Chini where our other academic director, Anna, was waiting for us.
The next obstacle was a stretch three hours long of roads filled with cobbles and boulders. Some of that section was flat, but I remember most of it crept steadily downward so that it seemed like there was no way out of where we were headed. We slowed to a crawl, but the cars still creaked and groaned with every meter forward. The same crunching shudder of school buses was echoed in my head, as my brain crashed against my skull with every lurch of the vehicle. Just as I started to close my eyes against the interminable jarring,
“SPRANGK!” exploded one of our shocks. With one shock missing, the jarring became more intolerable and irritating and then,
“SPRANGK!” again thirty minutes later. Every half-hour, a shock exploded on the steep bumpy path, until, what do you know, there were none left. We all felt like popcorn in a hot buttered skillet. Just when our eyes became accustomed to darting up and down and side to side in anticipation of the next lump in the way (to keep vision level), we came to flat, open bushland. Acacia thorns tore at anything that dared to leave the safety of the car interior, and we were again driving on ice-mud again, but other than that, it was a welcome respite from the bouldered road.
We came to a puddle, as we’d come to many before, but it was deeper than most and the petrol-engined rover managed to promptly splash some water up into itself and stall out. To the rescue our vehicle came; good, trusty and exhaust billowing diesel-engined land rover! We push-started the petrol car and proudly the caravan trekked for another hour in the waning sunlight of the day. And then we hit what the drivers explained as a dead end (it looked like the rest of the bushland to me) and realized that we had taken a wrong turn back by the random acacia, and so we had to retrace our steps for another hour, as the sun set on the horizon.
At this point, sunburn was forgotton, obstacles we had passed through were forgiven, but my carmates and I were so tired, cramped, weary, hungry, and worn-out; all we wanted was to find camp, eat some grub and crash out in our tents. Suddenly the land-rovers all stopped and we had a brief moment of elation as we prepared to grab our tents and sleeping bags to set up and go to sleep. But we were not at camp. The night was silent and dark, and there was no welcoming smell of food. The cars had stopped, and the lights had been turned out and the engines had been shut off. But the reasoning was not that we had found camp, rather that we were a long way from the middle of nowhere and still had not found it. The drivers hoped to hear camp, or see a light from it, with the cars dark and quiet. Thus we sat deaf, dumb, and blind in the night, except for the thick umbrella of starlight above and surrounding us. After several minutes of not hearing or seeing the camp, but enjoying the nighttime sky, we left. I don’t know what prompted the drivers to continue into the hinterlands, but their intuition was rewarded because we shortly saw a lantern! Everyone clapped and celebrated. And did so again! And we almost did a third time but realized that if the light we saw was really a lantern light-beacon, we’d be there by now. Alas, after ten minutes of driving toward the light, it became two lights and half an hour later we were reunited with our beloved Anna, who had come to find us in her land rover. From then, the drive only took an hour and a half into camp where we exhaustedly set up tents and fell into them.
Everyone slept long and hard, except me who longed to sleep but hardly did. Come morning, I blundered to the food tent, wanted to vomit at the smell of breakfast, blearily declared myself unfit to go hunting and gathering with the Hadzabe, and crawled back to my sleeping bag. I checked my temperature—oh, wow, 103.5oF, no wonder I feel like there is an axe in my skull—and slept. Once the other students went off into the bush with a short man who carried a bow and wore only an ochered loincloth, Reese got me to move my bag to the food tent so that they could keep an eye on me, and so the camp cook could make me some ginger tea. I had had the tea once before during my time in Tanzania when I felt a bit under the weather in Tarangire National Park. The strength of the tea is akin to body odor, although not as repulsive—just strong. I drank what I could, but most of it came back up. At one point between hot and cold spells I awoke to see a Datoga lady standing nearby decked out in all her finery: brass ankles half-way to her knees, ivory bangles and rings on both arms and hands, beaded bicep wraps, more arm brass bangles, a comb in her hair, and large scarification marks encircling her eyes. Anna took a picture at the woman’s request, so I’m fairly sure it wasn’t just a fever-induced hallucination. I vaguely remember Reese and Anna discussing how little water there was here in at camp, and how if I were really sick for more than a few hours, they wouldn’t be able to keep me hydrated. Next thing I know, we’re back in my favorite place, the car, and we’re headed to Haydom 3 hours away—the nearest hospital. Another girl, Elewa, joined us because she had a headache, and the academic directors didn’t want to take any chances since only one car could afford to leave the group. A small Hadzabe man showed us the way. He sat in the front seat with the driver, bouncing in his seat, clasping his bow and poison arrows, pointing this way or that around bushes and trees as I slept in the back. I woke up drenched with the sweat of my fever breaking—my sleeping bag was soaked through—and headed into the Lutheran Missionary Hospital for diagnosis, as Reese gave the Hadzabe man some coins and his thanks. (I wonder how the man got back home? It took us several hours by car to get here, and there were no buses back to the man’s homeland. I suppose he walked, and I feel bad for that). I find it amusing that, as the daughter of an emergency room physician, I had not yet had occasion to exploit the services of a hospital as a patient, and that my first such experience was literally in the middle of Africa. Where exactly?!?
The moment we stepped inside, the smell of humanity hit us over the head like a ton of bricks: that putrid smell of body odor, vomit, smokey-goat, fecal material, urine and bad breathe all rolled into one. Ah, yes, the smell of humanity. Nothing quite like it. Hmmm. Quite different from the sterile, metallic smell I usually associate with hospitals. There were people crammed into the first room. One man lay across the bench with a puddle of his vomit under his cheek and caked on the floor where it had dripped. A woman with a raffia-looking skirt made of thing strips of leather bawled and moaned in agony. A comatose man on a stretcher lay oblivious to everything else. He had an IV, and his fluid bag was held up by a knocked-together wooden stand. People swarmed around me as I struggled to stay upright in my delerium. A nurse called us into a room, before others, probably because we were wazungu, and asked me what was wrong in Kiswahili.
“Mimi ni mgonjwa sana” (I am a very sick person), is all I could muster, and Reese filled in the details. I remember her writing my name on a card to file. She spelled it all wrong, Emlisisrm Pole (Pole means empathy), but I didn’t correct her since I doubted they would ever have to get my file out again for another visit.
It was Sunday, so no doctor was on duty. Thus, they could only do lab-work. I sat on the stoops of the lab building for a few minutes watching two amputee eight year olds have a mock sword fight with their pink-bandaged stub arms. They seemed to be the happiest people there. Inside the building, the lab man lead me to a table, and then scrounged around in an aluminum box of sharp implements. Nothing was sterilized or at least packaged separately. I reasoned that viruses like HIV can’t stay alive outside the body in dry conditions, and anyway, the blood that the piercing object would be touching would be squeezed onto a slide anyway, and so I allowed him to prick my finger with a scalpel blade for a malaria spot. I collected a disgusting sample of my stool and gave it to the lab man. He checked me for malaria and ameba (both negative) and I was sent away. Wary of bringing me, a sickling with diarrhea, back to camp where water was inaccessible, Reese decided we should just go back towards Arusha. And so our sixty-six mile journey to Babati began. Only sixty-six miles! But it took us seven hours. The entire road from Haydom to Babati was atrocious; made of ice-mud, two-foot deep ruts to get stuck in, and potholes that would break our shocks if we had any. I slept—to the amazement of my companions—but was vaguely aware that at one point the land rover fell into the wheel ruts that our driver had been so carefully avoiding by driving with one wheel on the median between the ruts, and one on the banks of the road. The land-rover was nearly lying on its side, the ruts were so deep. When it happened, it was dark, and we were in bush country. Nonetheless, within twenty minutes, two men appeared from nowhere and helped us dig the tires out with sticks and hoes. I was still in the back seat, sliding off the seat in my sleeping bag as they rocked the rover to safety. Several more hours later, past midnight, we arrived at Babati where a gracious hotel manager made us ugali (Tanzanian play-doh-like porridge) and maharage (beans). That night at the hotel I came to a definite conclusion: you know you are sick when your urine is brown and your stool is yellow and watery.
The next day, the roads weren’t nearly as bad, and we had tarmac to drive on for the last hour. Once in Arusha, we stopped at an Indian doctor’s clinic where they used more sterile means to extract blood from my finger, and collected another disgusting sample of my stool. I sat and leaned against the wall in the lobby, waiting. The little old doctor emerged in his white coat, and declared, “You have a lot of friends in there. We saw ameba, giardia, and shigella (bacterial dysentery). No wonder you are sick!”. With drugs in hand, I settled into bed to get well at the South African owned Outpost. Two or three days later, the other students came back and trickled in to see how I was faring. One was terribly upset.
“Reese says you have Typhoid fever!! I’ve been so worried!” I wondered how Reese could get the diagnoses so wrong, and assured her that I didn’t, that it was only three other ailments at the same time. Besides, it would be another whole month before I’d come down with Typhoid.…

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