Things I Have Learned About Having Malaria and Typhoid At The Same Time

Dear Mom,

WE’RE ALL ABSOLUTELY FINE. Now.

I’m sorry I didn’t tell you at the time, but I thought you’d had enough to fret about this month, what with Ruby in hospital and all four of us down with some unspeakable Victorian-era lergy and then the truck nearly tipping over and all. I’m sorry that, when you phoned me last week, I sidestepped your enquiries as to my health and asked instead to get the latest World Cup/Wimbledon update from Dad ‘cos I needed the laughs.

Most of all I’m sorry that Big Reg hasn’t make it to Europe as originally planned in time for your 70^th birthdays this month. I had been so looking forward to a classic family reunion party with all the birthday peeps, H and Ruby and you two, and I feel I’ve let you down. I’ve not sent you a present or even a poem as we’ve been so under the weather this month, in more ways than one. Forgive me. I promise I’ll make it up to you when we finally meet again.

A week last Sunday, I really struggled to load the blog ‘Things I have learned about typhoid’. It was just taking me way too long to edit and I couldn’t seem to resolve the conundrum of several sentences and in the end I just bodged it. As I posted it and dragged myself up to cook, I had to acknowledge to myself a) I was feeling as confused as I felt when I first went to the clinic for my typhoid test and b) those tell-tale acupuncture kidney meridian points in my lower back were shouting at me again and c) I’d been feeling steadily worse for the last few days, teasy with my husband and generally Not Good. Meanwhile Sampson still had such a headache he was lying down zonked out every afternoon.

I couldn’t believe it was already a whole week since The Tipping. The previous Sunday, after Zola’s triumphant birthday chicken meal, Big Reg had limped into the Oil Libya petrol station about 9pm, and I’d asked the attendant if we could spend the night in their lorry park. A friendly passer-by asked, in English, if we needed help. Bright-eyed and bushy-tailed Mazen turned out to be a gift from God to reward us for the travails of the day. A Liberian-born Ivorian of Lebanese heritage, he was so enthusiastic about our trip, he invited us to get Big Reg checked over at his Dad’s truck repair workshop.

We first spent two days at Oil Libya, ostensibly waiting for the water supply to come back on so kind M. Keita could give the mud-encrusted chassis a power wash before making a mechanic look under the truck. But mostly we were just getting over the weekend, waiting out some more heavy rain, and reveling in the fact that our beds were back to 180˚.

Fun at Oil Libya with kind Keita a.k.a. M. Bill in the middle

Thanks so much for the hospitality!

I was determined, while physically in Côte d’Ivoire, to witness at least one World Cup match featuring Les Éléphants. We’d been too sick to go see the first two group games, although we were keeping track of the results: I was woken at 3am by distant cheers after they beat Japan and the singing and drumming went on till 5am. After their defeat by Colombia, there was only glum silence.

The flag was still flying despite stormy skies

By Tuesday evening, we’d pulled ourselves together, and I decided we just couldn’t miss their final group match. Sampson drove the Big Green Truck round the corner to the big screen at Patisserie Eva, where we were joined by Sticker.

All ready for le big match

Sampson and Sticker

Go Côte d’Ivoire! Go L’Afrique!

Surfer Sampson doesn’t really get team sports, and at half time – 1-0 to Greece – was ready to go to bed. The kids and I howled at him. When Les Éléphants pulled one back and we all leapt up and hugged each other, he started to understand the excitement. Côte d’Ivoire only had to draw to be the first African side ever to make it through to the last eight. When the controversial penalty was given for what looked like a dive on the scale of a Greek tragedy, we were all gutted.

The staff of Patisserie Eva were beside themselves

Although my Dad tells me I’m wrong, on seeing the replay it did feel like Les Éléphants got carved up. It was like the Berlin Conference all over again. Later Daniel seemed to sum up the general feeling: “They will never let an African side reach the final stages”. When M. Tepi arrived, he held up his hand “Don’t talk about it!” he said, “Think about something else…” Wise words.

On Wednesday, we gave up on waiting for water and went to Mazen’s Dad’s garage. Mr Nassir Charafeddine’s business, Liberia Product Industry, owns a whole fleet of Mercedes trucks that they hire out for transport. After a chat with the charming and softly-spoken Mr Charafeddine, we came out of his office and walked straight into M. Brice. He works here! So when he phoned his boss about the Caterpillars, it was Mazen’s Dad he was talking to! I love it when lovely people come together…

Brice and Mazen, our Good Samaritans

The LPI family took such great care of us. Brice and the team of mechanics checked everything underneath around the wheels that had been so yanked about. They fixed the snapped 4×4 gear linkage as well as some headlights, re-attached the bull bar and greased everything. They removed and refurnished the steering rack to combat the wobbliness we’d been feeling since The Tipping, until it was working even better than before. Mr Charafeddine employs a team of 60 fulltime to keep his Mercedes trucks ploughing up and down between here and Liberia, so we’re confident Big Reg is ready for the challenge.

A warm welcome from the LPI family: security guard Mme Angeline and personnel manager M. Joseph are to the right of Sampson

These guys know their stuff – we are so lucky they are helping us

On Thursday it was raining so hard, we didn’t even try to leave on a test drive but just sat in the truck with the kids doing end of term projects and exams. Thanks to the kindness of M.Mohamed, Brice took me out in a chauffeur-driven car to buy veg and drop clothes where they could be dried at his local launderer. I felt like the Queen!

Rain in the yard

Heavy

Zola and Dad’s end of term Science and Technology project showing its strength

Mr Charafeddine is such a wonderfully warm and genuine guy, you can see why his son Mazen has such a giving spirit and why his workers are so cheerful. But that afternoon, he shared a very sobering insight with me. While asking him whether he identified as African, he told me that he was born here and has spent his whole life living and working in West African countries from Liberia to Cameroon. As a young man, he said, he was proud and confident of his African-ness. But in latter years, even before the civil war when ‘foreigners’ were chased out, he has realized that the pale colour of his skin ultimately condemns him to be an outsider. He feels he can never truly belong to Africa, and he has warned his four sons never to assume they do. I felt he was as sad to acknowledge this as I was to hear it.

On Friday there was miraculous sunshine, and everyone felt in a better mood.

How a bit of sunshine can lift hearts and puddles

Sampson celebrated by giving an impromptu show…

…much to the workforce’s incredulity

Heartfelt thanks to M. Nassir Charafeddine and his wonderful team – chief mechanic M. Sila on the far right

We spent the day missioning to get tyres pumped and wheels aligned which was all very reassuring, although we failed to get the one overstretched airbag mended.

Bit of a tight squeeze for Big Reg in the alignment shed

Finally we headed back to Oil Libya to fill up with water ready to set off at long last for Liberia. But when we got there, a fellow driver told us that a bridge had collapsed just out of town making the road north impassable for now. I have to admit to a feeling of relief. I wasn’t quite 100%. Whether it was the relentless rain, the strain of the Tipping or the dogged attempt to catch up with the blog, I felt needed another couple of days’ rest.

We didn’t dare launch an assault on the pitted dirt road back to Gora Beach, so drove along the tar in the other direction. San Pédro may only be Côte d’Ivoire’s fifth biggest city but it’s the second port after Abidjan and all the cocoa gets exported from here. That explains the parlous state of the roads in this town. We drove around harbour warehouses full of damp cocoa beans and marooned lorries.

This is San Pédro’s main road – the good one

– which is why we’re staying off the bad ones for now

Big Reg pulled off on a quiet boulevard in the business area, between a banking office block and the sea, next to a rather bashed-up monument poignantly (given the recent history of the country) trying to spell out ‘Love, brotherhood, peace’. I was feeling similarly battered myself. I couldn’t believe we’d reached another weekend – the third since diagnosed with typhoid – and Sampson and I were still feeling so wiped out.

Parking off at the monument

Unutterably sad to contemplate

Serendipitously, we’d parked near to the brand new Palm Rock Beach bar and hotel, which not only has pizza (gasp) and free wifi, but TV and pool tables as well. The kids were delighted to avail themselves of the facilities while their parents lay prone in the truck, and German host Frank even gave sent them home with cake!

Wet welly walk down Palm Rock’s stretch of beach

Zola got his sock soggy for the sake of this photo – didn’t see the drainpipe till too late!

So, on Sunday evening, I managed to post my seventh blog of recuperative June. But when I woke at 5am, desperate to eat an orange, I knew I needed to see a doctor. Monday, Sampson got a recommendation and directions from Frank and off we went for a check-up at the Nouvelle Clinique des Rochers.

Dr. Ballo of NCR

The lovely Dr Ballo was so patient with me as I struggled to communicate our symptoms in French because my head was so bloody foggy. He was not impressed with the drugs we were given at the Béréby clinic for typhoid, preferring to prescribe the latest expensive European drugs – or the half-price generics we plumped for – feeling that the bacteria were possibly resistant to ciproflaxin. He also pointed out that malaria presents in different people in completely different ways. We decided we’d both better have blood tests:

Result 1: Sampson has malaria. He could have had it for weeks and weeks because the doxycycline he takes daily as a preventative has been masking it and delaying its progress. It’s possible that the headache that started in Sassandra hospital could have been that. The good news is that his typhoid levels are back down to ‘probably just had it’ so it looks like the double dose of antibiotics he had did the business.

Result 2: I have malaria AND typhoid. My bacteria levels are back up to what they were when I first got diagnosed with salmonella typhi, plus I have a second strain Paratyphi C, so I must have relapsed or failed to overcome a drug resistant strain. The good news is that I’m in very early stage malaria, nowhere near as affected as Ruby was by the time we got her to hospital, so scarcely feeling it.

Sampson was in shock (and hopefully feeling a bit sheepish as he’d made me cook the night before because he so “desperately needed to lie down”…) but Dr Ballo seemed remarkably unconcerned. After all, in a paper bag next to him, just bought from the pharmacy, he had the very medication he was recommending for me ready to take home for his pregnant wife. Malaria is a fact of life here, not a threat of death. The meds are brilliant, you’ve just got to take them in good time.

He said Sampson could start on his three day course of coartem straight away, but having listened to my medical history, rather recommended a 5 day course of intramuscular injections for malaria for me, plus a 5 x twice a day intravenous treatment for typhoid. All this would avoid putting stress on my damaged digestive system by delivering treatment directly to the bloodstream.

My stash for the week

So my rear end has suffered the ignominy of 5 injections. But paramedic M. Maiga put what they call a catheter and what Sampson calls a shunt in my left hand to avoid having another 10 injections in my arm, and so I could still type.

Typhoid injection no.1: flat out

Things I have learned about having malaria and typhoid at the same time:

2) Whoooooooooooooooooo. Drugs in combination. Whooooooooooooooooooooo! The dreams are mental. What? Whoooooooooooooooooo! Oh, is it time to eat? Thanks. Mmmmm, loving this mashed potato, what a treat. Nice job, kids. Whoooooooooooooeeeerrrrr. What? Time for another injection? Oh ok….

1) It still doesn’t seem serious enough. I’ve had no fever. None. Diarrhoea yes; confusion, blurgh, lots; light sensitivity. But no seriously disabling symptoms. I can walk if I have to, I’d just rather lie down thanks… Ow, watch the tender buttock…

3) It’s nowhere near as bad as you’d think. Whooooooooooooooooo! The last time I felt like this was Oppi Koppi ‘97…

2a) I drafted half of this blog at 2am on the second day of treatments COMPLETELY WIRED. This is a woman who can’t sleep if she drinks a cup of decaffeinated coffee after 4pm. (Yes, decaffeinated. There’s about 5% caffeine in decaff. Normal coffee’s like crack for me.) I mean, can you imagine? I’m rushing here. (Re: process, Bronwyn, I got so much written between 2-5am, it was awesome!)

4) I’m stronger than I thought. If I can handle this amount of medication and still write up two blogs while under the influence, I think I’ve proved to all of us I’m much hardier than I was twenty years ago. So you can relax now. The worse we’d feared has happened: it didn’t hospitalise me; I’ve not lost weight; I’m over it. So ‘just breathe, just be’, it’s all gonna be fine!

5) M.E. is still worse.

So I celebrated 1^st July, our first anniversary of leaving on the trip, not by writing a quick commemorative blog, as I intended, but with having my first day of combination therapies and being quite out of it. At least we had mashed potato.

The poor kids are having the worse school holiday of all time. This is their fourth week mostly stuck in the truck, in the rain, with two fuzzy-headed parents. The tedium has only been occasionally relieved by trips to play table football at Palm Rock Beach and visits with a kind American Baptist missionary family, the Cuthbertsons, who let them play with their 12 children, 2 horses, 2 dogs, 9 puppies, 2 cats, 2 kittens, 2 monkeys, 1 baby monkey, a gazelle, a civet and a hawk!

Family photo of the Cuthbertsons: like the Waltons, only more so

To save having to live outside the clinic, Sampson asked the paramedics to teach him how to administer the typhoid doses through the IV. After being supervised giving it to me twice, we only had to go there once a day instead of three times.

Sampson’s supervised typhoid injection, day two

I think this is the definition of trust!

Easy does it big feller

On the second day, after 2 palu treatments, and 3 typhoids, my head started to clear and I took note of the fact that Zola was still not back to being up first in the mornings. In the light of my recent lessons I decided to a) not err on the bright side and b) get everyone tested just to be sure where we are. Ruby kicked up a right fuss, having by now got a complete phobia about injections, but M. Maiga is the gentlest ever taker of bloods and she had to admit through her tears afterwards that he hadn’t hurt her a bit.

Merci mille fois to the gentle M.Maiga

As the costs are mounting up, we are so incredibly relieved we have LIBERTY HEALTH BLUE PLATINUM pan-African cover. At a time like this, when you’ve already gone over budget this month with an unplanned truck rescue mission, you don’t want to have to hesitate to get another set of blood tests done for the kids, to make 100% sure they’re clear of any need to go to hospital in the near future, before entering the Ebola zone.

Result 3: Ruby’s fine. Her malaria’s gone. Her typhoid antigen levels are still active, but low. We have to keep an eye on it to make sure the antibodies are on the way down not up, but the Doctor assured me it would be ill-advised to give her more strong meds now if she doesn’t need them.

Result 4: Zola’s typhoid is gone, but he has malaria. The good news is his parasitic load is at a very low level, obviously being kept at bay by his weekly prophylactic Mefliam.

So, that’s four out of four: everyone’s now had both malaria and typhoid, or typhoid and malaria, back-to-back in the same month; only I’m outdoing myself by having them simultaneously.

Things I have learned about kids having malaria and typhoid at around the same time:

1) If they’re still tired and/or teasy, get ‘em tested again. Don’t hesitate.

2) When you’re travelling longterm in Africa, especially with children, my recommendation is to avoid taking antimalarial drugs. (Unless you’re planning to be in an area without competent medical attention when you might prefer to put off dealing with the illness till later). With all this rain, it became a matter of not if we would get malaria, but when. In retrospect, all the prophylaxis does is delay the progress of the parasites, and goodness knows what damage may have been done to Sampson and Zola’s liver/kidneys because they’ve have been lingering there biding their time to pounce when the immune system was compromised. All three Sampsons have been on antimalarials since Angola, loading up their systems with ill-advised amounts of medication, in Ruby’s case with detrimental effects (see https://africaclockwise.wordpress.com/?s=Good+Vibrations). Yet in the end, we all went down with malaria in the wet season anyway. It’s better just to get educated about symptoms and prepare yourself to deal with it when it happens, as it inevitably will. Those coconuts are gonna fall!

3) You can’t rush the recovery. Keep an eye out for relapse and watch out for anaemia. Ruby’s haemaglobin is on its way back up but she’s not back to full strength yet.

Zola was outside kicking his football against the clinic wall when Sampson came out with the results. His energy levels seem scarcely to have been affected by typhoid or malaria. He’s had no fever, no lethargy, nothing. He’s just been sleeping a little later than usual in the mornings, breaking into a sweat perhaps a little more easily than usual and had a look around his eyes that I wasn’t 100% happy with. I’m so glad I wasn’t being paranoid.

He had to take his 3 coartem tablets, twice a day for 3 days, crushed up in water as he struggles to swallow pills, but apart from that, suffered no discomfort from the treatment whatsoever, and enjoyed the motivational biscuits.

On day three, things went a bit pear shaped, as the load of meds in my system reached critical mass. When I told Dr. Ballo how I was feeling – nauseous, dizzy, toxic, with a headache and increased heart rate – he told me to continue with the daily malaria injection but allowed me to drop the typhoid dose back to 1g per day rather than trying to take it twice a day in half the time the pills took.

This was also the day Dad phoned me worrying about Ebola and offering to fly us home, and I reassured him that we had no intention of eating bat meat or performing ablutions on infected corpses so we were unlikely to risk infection. On hearing BBC reports about the Accra WHO conference, Sampson and I had discussed alternative options, but driving through Mali to avoid Liberia, Sierra Leone and Guinea still seems more risky. Foreigners are being targeted for kidnap in Mali; Ebola is far less likely to affect us if we can stay out of public hospitals along the coast.

By day four, we’d established a more comfortable pattern. I would eat lunch as early as possible, Sampson would prepare the typhoid injection and I would lie down and press it into the vein in my hand as slowly as it took without making me feel unwell, usually over two to three hours – rather than the 10 minutes the paramedic took, which had put me into slight shock. At 4pm we’d go to the clinic for my malaria injection.

Sampson has become quite a twitcher this week – check the malachite kingfisher guarding his territory

He’s had some interesting chats with passers-by: this is Ahmed Aljeed from Yemen and a Bangladeshi colleague from the UN – sorry I missed talking with them

Yesterday was day eight, and having finished the malaria treatments two days ago, I felt up to taking two typhoids. I gave myself the last injection last night while watching The Dam Busters. Let that music play in your head now and you’ll have some idea of the heroic sense of achievement I was feeling.

There’s only one bomb left Gibby. Dah-daarr-da-da-der-der-der-dah…..

Mom, please remember this reckless confidence I have is inherited. When you were my age, I remember you once went to the shops to buy socks and came back with a motor scooter. You were a Deputy Head then and, Dad said, old enough to know better. You defiantly rode it to work until winter. And only the week before last, because you hate routine so much, you got on your pushbike the wrong side deliberately, just to challenge yourself, and rode straight into a wall. You didn’t tell me you had to go to hospital because a) you didn’t want me to worry and b) you were ashamed, admit it. And don’t get me started on the standing-up-to-bullies-despite-being-only-5’2” stories. Genes will out.

So sorry for not ‘fessing up earlier. But thanks for phoning so regularly. It’s been so comforting just to hear your voice, even if I couldn’t bear to tell you.

Happy Birthday Mom and Dad. The sun is shining and we’re going to find out now if the bridge is open and when we can get on the road to Liberia at long long last. We’re getting closer to you all the time. Nie worry nie.

Your ever-loving
Dort xxx

This was taken this morning: see, we’re fine!

P.S. I finally got to meet the Cuthbertsons this morning, and it’s all true! Ruby wasn’t making it up and I wasn’t hallucinating, they really do have that many animals and they really are the kindest people you could hope to send your kids off to without knowing them at all! Mrs C made me promise to mention that “Jesus is the truth and the answer”, and you know, considering the likelihood of finding such a lovely family within walking distance of the clinic, I’ve got to admit I’m thanking God right now.

The magnificent matriarch Joan Cuthbertson and Gideon – who was the baby in the family photo above – with her own mother behind her

Pastor Daniel and Sampson

Beautiful Esther and the kittens

Susanna and her friend the civet

A little monkey, holding a baby one