Things I Have Learned About Typhoid

We spent a week recuperating Chez Jules. We parked the truck right next to his boma so all Ruby had to do was crawl outside and lie in the shade. After the two intravenous drips at the hospital, she now had to finish taking the course of coartem pills, but became mobile surprisingly quickly. She was also thrilled that Docteur Baki had told her there was no longer any point taking her daily dose of the prophylaxis doxycycline which so often made her feel sick.

Ruby's first day out of hospital

Ruby’s first day out of hospital, mostly lying down

Second day: dominoes!

Second day: dominoes!

Hooray!

Appetite back to normal: hooray!

Jules’s children Grace aged 9, Ange 8 and Princesse 6 rapidly became bosom buddies of our two. They hung out after school, or even during the day when their teacher went to town instead of coming to work…

Grace, Princesse and Ange

Grace, Princesse and Ange in their school uniforms

Ruby entertaining the troops

Ruby’s beauty salon

Fun for everyone

Fun for everyone

Jules is a special guy. For those of you who knew Emmanuel, he has the same winning ever-optimistic aura. He is so charismatic, he can wear a lady’s top with a faded flower pattern and crop sleeves and make it look good. Mind you with a torso like his… He’s so gentle, the messianic quality of his inspirational leadership has birthed a tight community. You can feel the power of the group. It’s all for one and one for all.

Sampson and Jules filtering oil

Sampson and Jules filtering oil. Torso no contest.

His band of brothers work hard and play gently. First thing every morning they would spend a heavy couple of hours hacking and clearing the bush around the extensive plot, burning weeds, or trimming the lawns by hand. Around 9am Jules’s wife Emma would serve a communal meal of bean stew and attiéké (the ivorian word for gari or grated manioc).

The whole gang: Emma, Jules, A, Marco, Jean and Sixco

The whole gang: Emma, Jules, Armond, Marco, Jean and Sixco

The rest of day was spent in the shade, chatting or silently watching the surfers, receiving visitors, drinking fresh palm wine or reflecting with a little herbe. Another intense period of work would follow about 4pm. One day I watched Jules carrying a whole tree trunk back for firewood, balancing it on his shoulder like it was a twig. Only on close inspection did the beads of sweat on his brow betray the effort. He spent 6 years as a professional chef before buying this land 14 years ago. His dream is to host a pan-African surf event at Grand Drewin. What do you think Deon Bing, Will Bendix, AVG?

Local charger Wilfred

Local kid on windsurf board with no fins

making do with donated boards

Local charger Wilfred making do with a donated board

Sampson thanking Jules for his hospitality by fixing the dings on the crew's boards

Sampson fixing Jules’s crew’s boards with his Ocean&Earth ding repair kit thanks to Grant at Reef Wetsuits

The fishermen of Grand Drewin were also unique amongst all those we have watched and lived among from Cameroon through Benin to Ghana. They could not be matched for both the level of their fitness and the degree of their team spirit. On that first Sunday, Sampson had watched them conduct a service, blessing their boat before pushing it together into the water, singing in chorus as they crested the waves, roaring a challenge to the power of the sea. He said it was like big wave surfers amping themselves for a life-threatening ride. The village kids are brought up around the boats in the water, and seem utterly fearless in the pounding waves and treacherous currents.

Grand Drewin fisherman load their boats with idols of every description

Grand Drewin fisherman load their boats with idols of every description

Look at what the sea has thrown into the roots of this tree

Look at what the sea has thrown into the roots of this tree

M. Sam K

The captain who braces the stern of the boat on his back, M. Sami Kokou hard at work

with his sons

with his sons Ange and Juen

daily task of mending nets by hand

at their daily task of mending nets by hand

The muscles of Grand Drewin have to be seen to be believed. They say a nine year old boy is the closest thing in nature to perpetual motion, and up until now, Zola was the only person I knew with zero fat on his body, his bones merely upholstered with trim muscle. But these boys bring a whole new meaning to the concept of ‘taut’. I watched six little lads playing on a windsurf left behind at Jules’; the line-up of their behinds hanging off the board shone in the sun like tortoiseshells. And as for the men – chiselled abs is one thing but chiselled butts? Please note: I’m not perving here, just fascinated in the sense that Henry Moore might have been – these men were living sculptures.

The local kids are constantly playing on any board available

The local kids are constantly playing on any board available

Catching the swell

Catching the swell

in between dodging incoming boats that were themselves dodging the breakers

in between dodging incoming boats that were themselves dodging the breakers

requires timing and practice

requires lots of practice to perfect the timing.

Grand Drewin dawn patrol

Grand Drewin dawn patrol: Kwamadou, Kokoutouja, Ako, Femiyeh, Kuntu, Kodo, Asif

Inspired, Zola surfing on his body board

Inspired, Zola surfing on his body board

Zola with his pals Main and Willy

Zola with his pals Mian and Willy

On Wednesday, the children don’t go to school, so we did another show but with Ruby this time. Sampson invited the fishermen too and a jolly time was had by all.

Humid enough for giant bubbles

Humid enough for giant bubbles

Enjoying the juggling

Enjoying the juggling

Ruby back in the mix

Ruby back in the mix

Sampson doing close-up for the elders

Sampson doing close-up for the elders

Sampson matriarch doing her thang to Peggy Lee's Fever

Pearce doing her thang to Peggy Lee’s Fever

Parafina finale

Parafina finale: Firestarter by the Prodigy

Grand Drewin was the first time on this whole trip we paid for a campsite (excluding Nana’s visit), and it was worth every franc. Jules was such a sensitive host, attentive without being in your face. One day he brought us some cocoa fruit to try. Côte d’Ivoire leads the world in production and export of cocoa beans but we had never seen the fruit before. I was shocked to discover that the delicious segments inside tasted like litchi! Ruby didn’t like its slight sliminess but Zola and I sucked away happily, enjoying the vitamin C. Cocoa beans are in fact the seeds within the segments that you spit out and dry in the sun.

Cocoa fruit as harvested from the tree

Cocoa fruit as harvested from the tree

Who knew?

Would never have guessed it looked or tasted like this!

May blessings rain on the Ineka family: Emma, Jules, Grace, Ange and Princesse

May blessings rain on the Ineka family: Emma, Jules, Grace, Ange and Princesse

We're missing you already Jules

We’re missing you already Jules

On Friday night we left for Sassandra because we’d offered to do a thank you show at the hospital. Every Saturday morning, they host a support group for HIV-positive children, and Dr. Baki had asked Sampson if he would perform there. It has to be the most rewarding show we’ve done so far.

Watching the bubbles

Watching the bubbles

It was jaw-dropping

The juggling was jaw-dropping

Loved the kids

They were delighted to see the kids taking part

Check that out!

Ta-daa!

Everyone was so keen to join in!

Everyone was so keen to join in!

It was

It was…

just the best fun!

just the best fun!

Group coordinator Madamoiselle ‘Tante’ Santiane put our energy levels to shame. After the show she did another two hours of games, and she’d spent an hour checking their weight and meds beforehand.

Mme in the background

Mlle Santiane in the background

so dedicated

She was so dedicated to her charges

Wow

It was awesome to witness the group in action

Wow

Thanks for having us!

After lunch, we drove on up the coast, through San Pédro, which boasted the biggest puddle I’ve ever seen in on a main ring road in the centre of a town, and a street market with delicious produce twice the size and half the cost of everything in smaller Sassandra. And LETTUCE. Yum.

Traversing San Pédro roundabout

Traversing San Pédro roundabout

Things you can buy for 100FCA (R2) in Cote d’Ivoire: 1 small green pepper or 5 small aubergines or a frilly lettuce; 3 oranges or a third of an imported apple; 1 avocado or 1 small imported carrot; 2 ripe tomatoes; 1 bagful of bissap tea. Ripe mangoes or pineapples are 200FCA (R4) each. This is all much cheaper than Ghana where mangoes were 2Cedi each (R10).

In the evening, we arrived in Grand Béréby, another surf spot that Eric and Adam Dewé had recommended we check out before leaving. Béréby was smaller than Sassandra; life appeared harder and the partying was too. We’d inadvertently parked outside the town’s main nightclub, and at 2am I insisted Sampson drive us up the road to park outside the Sous-Prefecture so I could get some sleep – party people kept banging greetings on the side of the truck.

Sunday morning, we drove around the coast until we found a spot by the beach, not far from the Hotel Baie des Sirènes (Mermaid Bay Hotel), the third largest in Côte d’Ivoire. I thought where we’d parked was an unusually wide bush path to the sea; it turned out to be their airstrip!

Our berth at Grand Béréby

Our berth at Grand Béréby

with a view of the fishing boats

with a view of the fishing boats

The expansive hotel had been officially closed since 2002 because of la guerre, and la crise of 2011 hadn’t helped the Swiss owner speed up the refurbishment. Only 10 of their 60 chalet rooms were operational, but the UN were still having a party there the day we arrived.

Sampson was thrilled to see the surf peeling and got the ‘wet box’ open as soon as we arrived. Zola and he entertained the fishermen with their bizarre antics. The majority of the inhabitants of the nearest settlement seemed to be from Ghana and Liberia, and had quite different manners from the rest of gentle Côte d’Ivoire. The parade of fascinated gawkers from dawn till dusk was quite wearing despite being well-intentioned.

Who is this loony and what on earth is he doing?

Who is this loony and what on earth is he doing?

Locals checking out the swell

Locals didn’t think the swell was up to much

Many flags jaunty on the boats, but the Black Star still the most popular

Many flags jaunty on the boats, but the Black Star still the most popular

Along with inscriptions in Twi: Blessings from God

Along with inscriptions in Akan: Blessings from God

We were also befriended by Mohamed, a tall multi-lingual Guinean who’d attended school in the Gambia and worked as a lorry driver in Liberia before coming to Côte d’Ivoire on a construction job. He showed us the best place in town to buy chicken and shared his dream of getting to Europe, and making enough money to come back and get married. I shared my knowledge of how badly immigrants get treated and encouraged him to invest his energy in Africa.

Ruby had missed nearly two weeks of school due to malaria, but I wasn’t too concerned – she had after all caught up five weeks’ worth last term. However, it was difficult to motivate her when she had dumb questions such as this in her Grade 7 Comprehensive English Practice book to deal with:

Write brief paragraph about being either:
a) A jewelry shop window shattered by a thief. How do you feel as you see the brick flying towards you and the burglar climbs through you? Do you seek revenge in some way?
b) Takkies on feet of the fleeing bag-snatcher. What make and colour are you? Why are you running?
c) The false moustache used by the bank robber. What do you look like? Do you ‘stick’ around to see the outcome of his 100th robbery?
d) The fingerprint that is being dusted by investigator. What surface do you appear on? How does it feel to be covered in powder?

How do you make a ‘gob-smacked’ face on this keyboard?

e) The policeman’s doughnut about to be eaten. Are you a cream doughnut? Do you have sprinkles on top? How do you feel as he picks you up in his podgy hand?
I AM NOT MAKING THIS UP.

Sampson started off surfing keenly, but got more and more tired. He hadn’t been feeling 100% since hanging out with Ruby in the bruising aircon of Sassandra hospital – all of us took a bit of a knock there – but he just wasn’t coming round. After two full days in bed, he still wasn’t feeling better, so on Sunday morning I insisted he go for blood tests. Béréby Hospital referred us to the path lab at the carrefour clinic 8km away where the lovely biologist M. Manzan works 7 days a week.

M. Mayeuil Manzan in the path lab

M. Mayeuil Manzan in the path lab

Fully equipped and very professional

Fully equipped and very professional

Sampson waiting for the verdict

Sampson awaits the verdict

Half an hour later, M. Manzan came out to us having lunch in the truck to tell us the result. It was a bit of a shock to discover Sampson had typhoid, especially as we’d been immunised against it before we left. Apparently, the inoculation against the bacterium salmonella typhi is only 75% effective, unlike e.g. yellow fever, which is 99%. Initially I was just relieved it wasn’t malaria.

Thanks M. Manzan!

Thanks for the super service M. Manzan!

So, we trundled back to Béréby, and Sampson spent another week resting while ingesting a 10 day course of antibiotics.

At this point the rain began in earnest. In many ways, far from engendering a more difficult set of circumstances, the onset of the rainy season has been a relief, providing a welcome break from the relentless sapping heat we’ve experienced these last few months in ‘the armpit of Africa’. I wouldn’t fancy dealing with it in a tent, mind, but in the truck, we’re cosy.

Before

Rain 1

Rain 2

Rain 2

Rain 3

Rain 3

The wild flowers now blooming in abundance as a result are reminding me of Cameroon, and the biting bush flies are reminding us of Gabon. Me and kids have an ongoing discussion as to where’s the worst place to have a furiously itchy mossie bite: Zola says on the nipple, Ruby says on the sole of the foot, but for me it’s on the knuckles – one of mine has been at three times its usual size for a couple of weeks following a repeat offender.

Blooming marvellous

Blooming marvellous

The rain came down increasingly heavily that week. The cloudy days of relative cool in between were a blessing but I was feeling rather muggy in the head and had a bit of a cough in the night. I didn’t know whether the damp was getting to me, as I was sleeping later than I expected and feeling more tired than I should be. I wasn’t feeling up to doing yoga. The kids and I would take a short walk along the beach every morning to the hotel and I might do a little gentle T’ai Chi between showers. In hindsight, it’s amazing that my body knew better than me what was going on.

A bit of fresh air between downpours

Getting a bit of fresh air between downpours

The kids were also a bit ‘teasey’ as they say in Cornwall. I was worried that Ruby looked a bit pale and wasn’t getting back to full health like I thought she would with this extra week of rest. So on Friday morning I popped off an email to my friend Doctor John Parker. It was only from him that I found out that confusion was one of the first signs of typhoid – but as he said, “with Sampson, how could you tell?”

That night, I woke at 3am feeling grim, with a low fever and pain in my lower back, and realised at last that something was seriously wrong. We packed up and left first thing Saturday for the clinic. As I’d had diarrhoea that morning, Sampson thought I had gastro, and was shocked rigid when M. Manzan revealed I had typhoid as well, and that my bacteria load was much higher than his was a week ago. Obviously we had got sick at the same time.

We then got the kids tested as well: of course, it was a full house. Far from being horrified, I was relieved – a diagnosis is always easier to deal with. And now I knew why Ruby wasn’t bouncing back and why Zola had been complaining that his glasses were giving him headaches.

We’d assumed Sampson had got typhoid because he’s so gung-ho about eating street food, and had demolished a bagful of griddle-fried mini manioc crumpets on our way to Sassandra hospital for the show the week before. But now we all had it – how? I doubted very much that Jules, a longstanding chef, would have neglected to wash his hands before preparing crayfish for us. Then Ruby admitted that sometimes she was too lazy to wait for the slower-running drinking-water tap, and may occasionally have filled the kettle for our rice with the less-stringently-filtered washing water… Aaarrgghh.

Things I have learned about typhoid:

1) It isn’t serious at all for the first couple of weeks. Typhoid is even sneakier than malaria. They call it la fièvre typhoid but none of us had any fever at all for the first two weeks of the disease. Sampson just got a nasty headache and felt tired. My symptoms weren’t even that pronounced, I just wondered why I wasn’t feeling tip top. I didn’t even realise quite how foggy I was until the first day of antibiotics completely cleared my fuzzy head. The kids felt mostly fine. If you don’t spot it by the third week, you can end up with a perforated intestine or internal hemorrhaging. Nice.

2) Don’t trust your tweenaged daughter. Don’t assume just because you’ve had first aid training all together before embarking on this trip and you’ve talked a lot about hygiene, your kids will truly understand the implications of non-potable water. Rather underline it with threats involving taking away treats for several weeks to ensure it’s sunk in…

3) If one of you is diagnosed with typhoid, get everyone in the family tested immediately. You all eat the same meals, so it’s very likely you’ve all got it. That’s pretty obvious, but if you’ve got typhoid, you’ll probably be feeling too confused to consider it.

4) Some strains of typhoid are drug-resistant. Sampson didn’t respond well to ciprofloxacin so was given a second course of cefixime. Relapse is common, so don’t assume that getting antibiotics is the end of the story. One in ten people continue to be carriers, and we can’t find out for a while because antibodies stay in the blood for more than a month. There’s a reason typhoid has the reputation it has.

5) Neither typhoid or malaria are anywhere near as debilitating as M.E. (when arrested before the final fatal stages at least). This has been a real revelation to me. I’ve never had a recognised serious illness, except for the glandular-fever-followed-by-dysentery combo that triggered my M.E. in the first place, so I’ve not had anything to compare it with. On a day-to-day basis, chronic M.E. is far more enfeebling and difficult to live with. For the majority of the seven years that my life was severely constrained by M.E., I felt worse than any day I had typhoid. It is so obvious to me now how valiantly my immune system was fighting something that cannot yet be seen, in vain, and exhausting me in the process. But doctors kept expecting me to ‘just get up and make an effort’.

We didn’t want to go back to Grand Béréby for a third week, so we set off back to San Pédro, so we could feel we were moving in the right direction at least for the road north to Liberia. Thank goodness we had been granted a court sejours visa for Côte d’Ivoire, giving us three months from application rather than a one month stay, which was all we’d requested. We found a pharmacy next to la grande marché and submitted scripts for medication for everyone plus iron syrup for Ruby – malaria plus typhoid equals almost certain anaemia.

Sampson was overly exhausted after two hours’ drive, and I was flat out in the back, but thankfully Ruby’s French was now strong enough to help her Dad get directions to the beach. They negotiated their way down several kilometres of extremely bumpy road, but finally lucked onto a wonderful open spot by the sea. More on this anon.

Arrival in San Pédro

Lucky find in San Pédro

Thanks so much to Doctor John for his telephone advice late on a Saturday night. I was a bit scared I was going to have as severe a reaction to the ciprofloxacin as I had when I attempted doxycycline last year, but Infirmier N’Sou at the Béréby clinic had proscribed an extended release capsule for me, which made it less of a shock to my system. I was so surprised to feel so much better the next morning!

Of course, the heavy meds took their toll after the first few days. Only Zola has managed to stay mostly on his feet. The good news is that it’s rained heavily every day except one since the diagnosis three weeks ago, so if there was ever a time to be lying down recuperating and not driving on these roads, this was it.

Locals are telling us that usually it only rains two or three times a week in the rainy season but the situation has been worsening steadily for the past few years and this non-stop downpour must be due to climate change. Twenty-three people have died in landslides in Abidjan in June.

The silver lining to this cloud has been that San Pédro has relatively good internet connection. As the children have finished term and been waiting for exams to arrive from school, paradoxically it’s been typhoid that has delivered me that promised fortnight to catch up on the blog that I’ve been waiting for since March! Hence the flurry of posts. Finally I am back up to date.

I’ve also been doing a fair bit of research on the latest situation in Liberia, Sierra Leone and Guinea: http://www.bbc.com/news/world-africa-27902139http://edition.cnn.com/2014/06/26/health/ebola-outbreak-west-africa/
http://www.who.int/csr/don/2014_06_24_ebola/en/ – check out the last two lines Mom: no travel restrictions recommended by WHO.

Rest assured, I have no intention of entitling the next blog ‘Things I Have Learned About Ebola’.

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2 Responses to Things I Have Learned About Typhoid

  1. You’ve been through the mill a bit lately! Certainly good lessons to tuck away in case of a next time, especially the one about getting everyone tested (and NOT using the non-potable water for cooking…)

    Ebola, though, I’d just as soon remain ignorant.

  2. John pearce says:

    My goodness you all copped it proper bad! I love the term’ infirmier’!! In between the malaria and typhoid you seem to be doing well. sampson’s shows seem very well received hope you have some video footage stashed away. Take cre I imagine that full recovery from malaria /typhoid is not achieved quickly so do not over extend yourselves.

    Love Unc John

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