Things I Have Learned About Malaria

By the next afternoon, Ruby was sitting up next to me on the bed as I worked, playing Uno with Zola, and then putting make-up on him because she was so bored with resting. It seemed she’d returned to full force, just in time to go back to school. But Monday morning her fever was back. Jules popped in at lunchtime and told me that the nearby clinic was shut between 12 and 2. At 2pm Ruby wasn’t keen to walk 200m up the road there – it was staggeringly hot (pre-storm) and she said she didn’t think she really needed the doctor, she didn’t feel that ill.

Zola doing his Naomi Campbell impression

Storm clouds piling in over the truck

She slept most of that day and spent the night on my bed, happily polishing off an enormous helping of rice and dahl at 1am. Tuesday she ate well all day and seemed nearly back to normal. I thought it was all over. Wednesday, her temperature was back up to 38.3˚C. That’s when I started to really worry.

Storm clouds over Grand Drewin

Jules escorted me to the clinic to make enquiries and the Infirmier (male nurse) Assalé came back to have a look at her. The first thing he did was suggest another test for la paludisme. We thought it was unnecessary, but went along with it – and couldn’t believe it when it tested positive. Sampson immediately did one of ours again, which now agreed. Of course she had malaria, and two strains, P. falciparum and P. vivax.

He swiftly got the coartem out and gave her the first dose of four pills. Nurse’s aide Mme Koné assured us Ruby would be right as rain in three days following this tried and tested treatment. We humbly shook hands with Infirmier Assalé and off he went. It was 11.30am. Sampson was editing surf clips, trying to pretend he wasn’t worried. I was sat on the bed watching over our daughter, worrying silently.

Huge thanks to nurse’s aide Mme Julienne Koné and Infirmier Amangoa Assalé for their timely intervention

You can’t argue with that.

By 12.15 Ruby had gone from looking a bit pale and feeble to looking sickly and clammy. The clinic, of course, was closed from 12-2. By 1pm her temperature had risen to 39.3˚C and she was complaining of severe pain, in her stomach, in her spine and then in her head. I was sitting next to her under the fan, alternating applications of the two cold gel packs we have on her head and neck, and cooling her down with a wet flannel in between times, while waiting for the gel packs to chill in the fridge. The Infirmier had told me not to give her ibuprofen with coartem. She couldn’t have more paracetemol till 3pm.

Storm coming closer

At 1.30pm she started hyperventilating and I wasn’t far from it myself. She was burning up, too weak to get in the shower and I was feeding her spoonfuls of water between her dry lips and murmuring reassuring words while internally fearing the worst. At 2pm, I sent Sampson down to the clinic, and the 20 minutes it took for him to come back with Infirmier Assalé were amongst the loneliest of my life. M. Assalé confirmed: yes, this was not normal for coartem – it should bring the fever down, not take it up; yes, we should go to hospital; yes, now.

Gulp.

Sampson scrambled to strap down loose stuff on the roof. Ruby was in too much pain to sleep, although she’d semi-pass-out for 5-10 minutes sometimes before she started groaning again. At 3pm she was still 39.3˚C and I tried to get her to sit up to take the paracetemol but she went white as a sheet and absolutely couldn’t.

Bouncing up and down on the edge of the bed, as Big Reg careered down the dirt road back to Sassandra somewhat too fast, with my foot wedged against the side of the shower to stop me falling off, I wasn’t thinking “We should never have come on this trip” but I was thinking “If she lives, will she ever forgive me for putting her through this?”

Things I have learned about malaria:

1) It doesn’t look as serious as it is at first. Last September, Ruby was very ill in Brazzaville, with fever, vomiting and diarrhoea caused by a local virus. She didn’t get out of bed for a week and the first couple of days she could barely stand. With its reputation as a killer, I expected malaria to be far more serious with more severe symptoms. It is, but it doesn’t START like that. A gentle fever arrives, then ebbs and flows. It creeps up on you, and by the time you realise what it is, the parasites have nobbled all of your red blood cells and you’re a gonner.

2) Don’t listen to your tweenaged daughter or give up trying to reason with her because it’s easier to let her have her way, especially when she’s not feeling 100%. And stubborn. Listen to your gut. For goodness sake, who’s in charge here?

3) It’s the one thing in life it’s best not to err on the bright side about. When it comes to malaria: if in doubt, assume the worst. Don’t believe a negative test. The first test we did was negative because, growing up in an area where malaria is not prevalent, her immune system had not recognised the parasite, and no antibodies had yet been triggered. It’s the pattern you have to recognize – if there are cycles of fever, including being perfectly ok in between, then it’s malaria. That aspect had not been underlined for me. Everyone here knows it, but in S.A. we don’t see it much, so we’re ignorant of how it progresses.

It was only 8km to Sassandra Hospital, but bouncing around in the back at only 15kmph it seemed a lot longer. We asked directions and a muscled man in a white vest and mirrored shades offered to jump in and escort us – he was an off-duty soldier and didn’t trust the locals… The white and blue painted hospital buildings dotted about on top of the steep hill above the town were so cute and clean, they looked like they were made of Lego. A wheelchair was brought, and Ruby was whisked into an air-conditioned room.

Sassandra Hospital

I was immediately reassured by the calm demeanour and obvious capability of Mme Docteur Baki, whose authority was unquestioned by her dedicated team of nurses. Infirmier M. Loukou took Ruby’s blood for testing, set her up on a drip and gave her an injection against the second strain. She cried with the pain, but her temperature dropped almost immediately and she fell fast asleep. I sat rocking Zola on my lap, crooning songs to her, the ones I used to sing her to sleep with when she was a baby. I have never felt so glad.

Pale poppet

Sampson and I did shifts, one inside with Ruby, one outside cooking in the truck, putting Zola to bed. Only after we’d both eaten supper, back alone together in the room with our sleeping daughter, did I allow myself to have a little sob on my husband. I was so angry with myself for not acting sooner; the diagnosis was so obvious in retrospect. The thought of what that night might have been like if we hadn’t gone to hospital – nursing her in the truck back in Grand Drewin, mopping her down as she got weaker and weaker, without any clinic or cell coverage… it doesn’t bear thinking about even now.

Thanks for the bed Mr President, war crimes notwithstanding

Ruby had been put in a room on her own, with two beds inscribed “Gift of President Laurent Ggbagbo” and fierce aircon. I’m not sure why she warranted this treatment, as the ward next door was shared by several others, but it was blissful for her, so I wasn’t arguing. I couldn’t handle the icy aircon so Sampson stayed with her, on the other bed, and I slept with Zola in the truck outside. At 3am, I woke from a dream about her and knew I wouldn’t sleep until I’d gone and checked. As I entered, she looked straight up at me and said “I’m hungry Mummy”. That’s when I knew she was definitely going to be fine. I brought her a midnight snack and she chatted away with her usual energy. Relieved, I went back to the truck, sms’d my Mom, and went to sleep.

Our berth in the hospital grounds

We were fascinated to hear on the World Service this month about the latest research breeding 95% GM male mosquitoes, which could wipe out malaria in six generations http://www.bbc.com/news/science-environment-27765974

The next day, when test results revealed how high the levels of microbes were in her blood, Ruby had to have a second injection and a second drip to nail it. It gave her another day in aircon to rest, and I was glad as it was so stiflingly hot outside in the truck where Zola and I were making a desultory effort to do school.

The hospital was in the prettiest setting we’d seen since Lambarené – high on the hill overlooking the lagoon between the Sassandra river and the sea, with a wonderful breeze, which sadly didn’t penetrate much. I discovered that Ruby had been admitted as an emergency case (hence the room), so her initial treatment was free. The costs for a full set of blood tests to make sure there were no complications, plus her second treatment, came to 10000FCA (R200). Pregnant mothers and children under five also receive free medical care. Impressive.

The view from Sassandra Hospital

During the doctor’s rounds at 7am, I found out that Infirmier Loukou had been on duty 24 hours and congratulated him on his freshness and stamina. Mme Docteur Baki laughed and said it was because he was in love!

Blessings on the team l to r: Garçon de sale Awedé Abonja, Infirmière Albertine Kouau, Infirmier Kouassi Loukou, Docteur Rolande Baki and Infirmière Kouadio

At 8.30am Jules and his brother Samson came to visit, and at 10am Infirmier Assalé from Grand Drewin also popped by to see how Ruby was doing. How kind!

Zola, Infirmier Roger Bomisso, Ruby and Infirmier Gninhouagnon Ouattara

We were able to leave about 4.30pm, just in time to snap up some bargains at the market and fill up with water thanks to Issa at the petrol station. This always causes a minor riot as Sampson ‘pays’ for the service with a little show, which today drew considerable crowds. It was interesting how far less sulky the attitude and hostile the attention of Sassandra’s inhabitants seemed on this occasion compared to the last time we passed through. We were in such a joyful relieved mood, we felt like hugging the whole world.

Celebrating being alive at Sassandra service station, everyone waving to Ruby on the bed

We got back to Grand Drewin around 7pm. I climbed down from the cab to help Sampson negotiate his way under a low wire by relaying Zola’s progress in coaxing it over the roof rack. As night fell around us, and the stars came out, Jules came to meet us and I hugged him like a shipwreck survivor. It felt like we’d been away an age instead of just over 24 hours.