29 November 2005

My Malaria Tales

In 1976, I got a chance to do linguistic fieldwork in Papua New Guinea. PNG is a malaria zone, so I tried to get antimalarials before I left, but hardly any doctors in Honolulu knew about either malaria or PNG, and they wouldn't prescribe anything unless it was for treatment, not prevention. So my first day in Sydney, en route, I went to a public hospital and waited a long time to see a doctor. (Australia, like Canada, gives free but limited medical coverage to everybody.) When the doctor finally saw me, he asked me all sorts of questions about PNG because he was to spend part of his residency there, but he said state policy was to give only one week's worth of medicine at a time free. So I got just two Chloroquine pills, one week's prophylactic dose. I was due to arrive in PNG within the week.

In PNG I had no trouble buying Chloroquine at a local chemist (pharmacy) and took them faithfully every Sunday. For months, I was fine. The only problem I had was early on, when my intestinal flora were changing to accommodate the local diet. I got the runs one night really bad. The village was maybe 100 yards from end to end, with the women's outhouse out over the water (flushed twice a day by the tide) near my end of the village and the men's outhouse clear at the other end of the village, across a coconut log bridge over the stream that served as the village's only supply of fresh, cold mountain water. The men's bathing hole was upstream from the women's bathing, laundry, and dishwashing area, and people were really careful not to shit near the river. That night, I must have walked through the dark village 6 or 8 times, setting off the dogs each time, but not always having much to feed the fish with by the time I climbed up into the four-hole outhouse and squatted over the ocean. So, before long, I'd start the long trek back, setting off the dogs again.

I slept under a mosquito net in the village, although not always when I took trips to the neighboring village where several kids from my host family went to school. (They boarded there.) One day during August (I think), I felt really feverish, with flu symptoms, but the next day I felt better, so I let the village boat, with its loud, 2-stroke, Japanese Yanmar diesel engine, leave for town without me. It was an 8-hour trip up the coast to Lae, where the boat would sell its catch of fish, fill up with ice for the next catch, take on supplies and passengers, and be back in a week. That evening after I went for my customary bath in the stream, I couldn't stop shivering. My hosts built up the fire and I hunkered down next to it until the shivers turned to sweat. By that time, I figured I'd better take a treatment dose of Chloroquine: 2 pills every 4-6 hours, rather than 2 pills every week. In a day or two the flu symptoms abated and I broke out instead with intense itching under the skin of my hands and feet. It hurt to walk over the rough path to the bathing hole. So the next time the boat came back to load up and take more fish and passengers, I was on board.

The doctor I saw in town thought maybe I had reacted to the Chloroquine, so he put me on milder Camoquine and, sure enough, the next time I came down with malaria symptoms and took a treatment dose, at least I didn't have that horrible itch. (By now many strains of malaria in PNG are resistent to both.) But the timing was bad. I had come into town about Thanksgiving time, and my host, an American with an MA in ESL from Hawai‘i, had fixed up a real American meal with turkey, deviled eggs, and pumpkin pies. My throat was swollen, it hurt to swallow, and I was too sick to join the crowd for dinner, so I went off to bed. That night my fever broke and I soaked the sheets. The next day I felt much better--and ravenous. Fortunately, there were leftovers of everything except the deviled eggs. I ate a lot, but swallowed carefully.

Back in Honolulu, I got another severe bout of malaria. By this time, I knew the whole cycle real well--24 hours of fever and chills followed by 24 hours of dull headache. It was sure to be Plasmodium vivax, according to Merck's Manual, so I managed to get referred to a Dr. Berman, the only civilian doctor in town who knew much of anything about malaria. (He had seen plenty of it as an Army doctor in Vietnam.) So I drove to the emergency room of the hospital where he was supposed to start a shift at 7 pm. He took a long time getting to me and I spent the whole time shivering under the air-conditioning vent in the examination room, trying to cover myself with little hand towels.

When Berman finally saw me, I made the mistake of telling him I was suffering from P. vivax and asking for a treatment dose of Camoquine or its equivalent. He sent me for a blood test, but couldn't find anything, so he sent me away for another 48 hours until I would be in worse shape again. When he couldn't see anything in that sample, either, he told me to come back when I was really in the throes of fever and chills. So at the peak of the next 48-hour cycle, I was driving shakily through traffic to his downtown office. This time, he managed to find the little buggers under the microscope. He returned with a sarcastic "Congratulations, Dr. Outlier. Your diagnosis is correct. It's Plasmodium vivax." Whereupon, I let him have it, telling him each of those 3 lab tests cost me $24 that my grad student health insurance didn't cover, and that I had been through a week's worth of the symptoms a 3rd time now, thanks to him. I think he ended up waiving any of his own fees above what my health insurance covered. He also prescribed some very powerful drug that was supposed to clear the creatures out of my liver as well. I've never had a relapse since then.

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