Sickness in Mali - In All the Gory Details

*Disclaimer: I’m giving you my real experience here. So if you don’t want to hear all the finer points of various illnesses, skip this post.

Being sick in Mali sucks. I mean, it really sucks. Being sick anywhere sucks, but in Mali it could be one of a million things most people have never even heard of. It’s a wonder PCVs make it through service without becoming hypochondriacs.

      “Oh my god my head hurts!! I must have malaria!!”
   “Oh no, my pee is red! I have schisto!!....Oh wait, I ate beets tonight.”

 Plus you don’t have the comforts of home, like vegging on the couch in front of the TV, toast, the sick blanket, easy-to-make-soup, temperature control, and a proper toilet to be sick in.

I made it 6 months without anything more than a cold, which I felt was pretty successful, considering the amount of germs that are passed around in a society where one of my main roles as a health educator is teaching people to wash their hands with soap. I hadn’t even had diarrhea once, a major feat!

But when it rains, it pours.

Sickness #1

All the PCVs in my group went to Bamako in June for 2 weeks of In-Service Training. Post-IST, many of us went to Manantali, a town in the southwest of Mali, to celebrate the 4^th of July. I’ve written a little bit about that experience. Tragically, I got sick the day Michaela and I left Bamako to go to her regional capital, Kita, and then on to Manantali. In a country with no roadside rest stops, being sick while traveling can be pretty terrifying. Luckily I was able to sleep most of the way to Kita, and Michaela The Pharmacy gave me some Imodium to get me to ‘Tali. The Mr. D (as PCVs fondly refer to diarrhea) tapered off for my vacation, which I was incredibly thankful for!

But it never really went away… I continued to have on-and-off Mr. D, mostly on, for the next 8 weeks. I woke up several times during the night to throw up my dinner. To be honest, none of this ever struck me as odd. I figured it was just my time to have the real Mali experience. PCVs are so constantly in a state of not-so-perfect health, that it really just becomes our way of life. So my gastrointestinal issues never really registered, until about 6 weeks later. Actually, Cisse, the CSCOM’s (health center) head doctor’s wife, noticed first. I was over at her house one day and she kept asking me what was wrong. I said I was fine, and she responded that I was quiet and something was wrong. I was annoyed by her persistence, but as it turned out, she was right. I was falling sick with my first major Malian illness.

A few days later I went to San for a Girls Night, a party to welcome our newest San volunteers, and several PC-related meetings. I was supposed to be gone for 4 days. That night I started to feel even more unwell than I had the previous weekend, and although I tried to go to bed early, it turned out I couldn’t sleep at all. I was unbelievably hot, later sweaty, with stomach pains so bad I couldn’t fall asleep. I was up until 6am when I finally managed to catch about an hour and a half of sleep. The next day I was on and off functional. Sometimes I felt ok, sometimes I couldn’t even sit up. Unfortunately, that was the night of the party to welcome the newbies, so all the San Kaw volunteers were at the house so we could do one giant meet-and-greet. It was pretty overwhelming, but I managed to buck up enough to chat with everyone. I did get some sleep that night, and in the morning I felt great, and was totally ready to go back to village the next day.

But then the next day came and I could barely move again. For the next 4 days I planned every day to go back to village, then realized I couldn’t eat, was barely sleeping, and for most of the day could barely walk to the bathroom the every hour that I needed to go. Life quickly got more miserable.

A silver lining, I discovered yet again what great friends I have! Where else can you find a group of friends willing to discuss with you the best way for taking a stool sample, and who will continue to give advice during the process? Or who will then transport your sample 8 hours and 3 days away for testing? Much love, San Kaw! :D

My first real Malian holiday, Selini (celebrating the end of Ramadan, the month of fasting) fell on a Tuesday, and I really wanted to be in my village for the celebration. I was determined to go no matter how I was feeling. Four of us were in the house together, and we made plans to take early-morning transport to our sites on Tuesday. Of course, it never once occurred to any of us that there wouldn’t be any transport on one of the biggest holidays of the year. We were sadly disappointed when we walked to the bus station early in the morning, only to find the doors locked, the benches put away, and not a soul in sight. I ended up celebrating the holiday by cleaning the house, which was probably for the best as I could still barely walk and would’ve been pretty miserable trying to celebrate with my village.

I finally made it back to my village after 10 days in San, rather than the original 4. I was exhausted – that sort of sickness just drains you – but I thought maybe I was doing better. The PC doctors in Bamako, whom I’d been in contact with, thought I was doing better. But for 3 days I basically slept at my house all day, only venturing out to have lunch at the CSCOM. That 3^rd night was another sleepless night, and unfortunately a rainy one, which meant I had to sleep inside where it was excruciatingly hot and humid. That was also the week I had my first and only mouse in my hut, so I heard it rummaging around in my trash a foot from my head (I was on the floor, safely zipped in my bug hut) the whole night. At 3am a migraine hit, and I finally passed out around 3:30, probably to escape the pain. When I woke at 7 the headache hadn’t passed. This was the last straw for me. I called the doctors and we agreed that I needed to come to Bamako. My village was great in helping me get ready to go. They had, of course, been checking up on me everyday. Djeneba sent Alima over to help me get my house ready to go. The women’s doctor came over with 2 malaria tests to make sure I didn’t have malaria (I didn’t). The head doctor came to check up on me. I was in San by early afternoon, and the next morning I left for Bamako.

As it turned out, I had somehow contracted both amoebas and amoebic cysts. Amoebas come from ingesting unsanitary water or food, and in the lifestyle we live here, that could have been any number of things. Amoebic cysts form when amoebas are in a hostile environment. They basically roll into a little ball and hibernate until they deem they can survive – which means if you don’t know you have them, you can suddenly get sick at any time. I finished a 3-day course of meds for the amoebas and started a 10-day course for the cysts. They do a number on your system, but it’s all worth it in the end! Most PCVs in Mali end up with amoebas at some point or another. The good thing is I now know the symptoms and can hopefully catch and treat it earlier next time – the bad thing is, I can almost be sure that there will be a next time. =/

The doctors continued to check up on me until I was totally better. I’m thankful that they understand it’s cause for celebration when you have your first solid bowel movement in 3 weeks!

Just as a side note, during my amoebas stint, my scalp started coming off in chunks for awhile. Never did figure out what that one was…

Sickness #2

In mid-November, only a few days after the biggest holiday of the year, Seliba (for which I WAS present!!), I was marveling one day at how great it was to be healthy again. Amoebas and I just did NOT get along. But as fate would have it, I visited a friend in a nearby town for a day, came home, chatted with my family, and in an instant, fell sick. I’ve never experienced such a rapid change, from healthy to sick. All I could think was, “I have to get home, I have to get home.” This sickness was different than the last time. All of a sudden I just felt off. My body hurt. I got hot. I barely ate that night, and sleeping was also a challenge.

But in the morning I felt great, only slightly off. I was hoping my sickness of the night before had been just that – the night-before only! I went about my day just fine, until late afternoon, when again, my body just sort of suddenly shut down and my temperature rapidly shot up. When that happened, I thought I knew what was wrong – malaria. Malaria is a tricky disease. The symptoms are cyclical, meaning, as in my case, you can feel perfectly healthy during one part of the day, such as the mornings and early afternoons, but feel awful during another part of the day, such as late afternoon and evening. By the end of the day I was pretty much non-functional. My fever would spike quite high and my body ached so badly I could hardly move. Alima came over that afternoon to get my water as usual, took one look at my courtyard, and admonished me for how dirty it was (not so much “dirty,” just leaves everywhere). I told her I couldn’t sweep – I couldn’t even stand – so she immediately got my broom to do it for me. My host brothers came over to sit with me while I layed on the ground, immobile. It was actually quite sweet; I’d explained to my family that one of our volunteers had recently been sent home to Amεriki because she was sick all the time in Mali. My brother Shina asked me if I had to go to Amεriki. I promised him that I didn’t, but when he asked if I had to go to Bamako, I said I probably would have to go, and he looked sad.

Sure enough, morning came and I felt just fine. I went to the CSCOM (health center) first thing to ask for a malaria rapid test, but we just so happened to be out of them. And so I was on the first transport to San. I actually started to wonder in San if I was imagining things; if I was just nervous about something or imagining symptoms that weren’t there. But I went to the CSREF (hospital) and had a blood smear done. (I was SO proud of myself for navigating the CSREF with my Bambara!) And sure enough, I tested positive for malaria. Crap.

Funny side note, several years ago I was on my way home from a 2-week visit to Niger (Mali’s neighbor to the east) when I became really ill. My symptoms indicated that I might have malaria, but in my town in Ohio, doctors aren’t really trained to read malaria blood smears, so we had some trouble getting lab results for awhile. Here in Mali, any doctor, even those with limited training, can read a malaria blood smear. It’s as common here as something such as strep throat is in Amεriki.

I was really annoyed that I had managed to come down with malaria. I’m quite good about taking my daily prophylaxis on a regular and consistent basis. I sleep under a net at night, and I often wear longer clothing to cover more skin. Plus, I’d really been trying to make this my longest run at site without leaving – 23 days!! That may not seem like much, but remember that I have to go to San to buy food at the market, which runs out within 7-10 days back at site. This was going to be a big challenge for me, requiring creative problem solving to find ways to eat. But nope, a mere 10 days in, and I come down with malaria. Go figure. (Chrissy and I later decided Allah did not agree with my plan for creative cooking).

Ironically, I’d just received a package from my sister as well as a few letters, all of which were written during my amoebas phase, and all of which wished I was back to good health! Whomp whomp.

Those malaria symptoms are just so peculiar. I didn’t have much to do to get ready to go to Bamako, but I procrastinated a bit (shocking, I know) and around 4:30 I suddenly started to feel the aches and knew I had to run to get all of my tasks done. Sure enough, I was hobbling before I was finished, and by 5 I was on the couch, immobile for the next several hours. The PC doctors knew I’d tested positive, knew I was coming, and so had started me on the prescribed treatment for malaria, Coartem. It didn’t kick in that first night but by the second day I was functional at night, and by the time the weekend passed and I saw the doctors on Monday, my blood tests came back clean and I was able to go back to San the following day. A miracle drug, for sure!! I’m extremely thankful I caught the malaria early and was able to start treatment early. I’m sure I saved myself a lot of pain that way. Again, I’m even better prepared to recognize the malaria symptoms next time, although unlike amoebas, I’m not as likely to get malaria again. Fingers crossed!

Malaria side note: During this sickness, I ended up with a boil on my arm. I had no idea people other than witches and Biblical Egyptians get boils. They are not cool.

Sickness #3

For Thanksgiving, over half of the PCVs in country met up in a city in the southeast of Mali called Sikasso. Chrissy and I stayed in San for the actual holiday, where we celebrated family-style with 6 other people, but went to Sikasso the day after to meet up with the other 80+ volunteers for an Amεriki-people fix. It was a great gathering; some people I hadn’t seen since IST in June! On Saturday, one of our girls was leading an overnight trip to her site, to see nearby gorgeous waterfalls. It was totally worth the horrendous 3 hour bashe ride with the Shaggy album on repeat. For me, anyway. Probably half of the 30 of our group were sick by the time we arrived at the falls, and most people spent the afternoon lounging and snoozing at the base of one of the falls. Some elected to go home in the afternoon, the rest of us spent the night at the base of the falls. It’s amazing, we could hardly believe we were still in Mali. So different from San!

By the time we got back to Sikasso on Sunday, more people were sick. It was starting to get suspicious. We spent the rest of the day just hanging out catching up on Internet and Grey’s Anatomy. It was a great, restful day. The next morning Chrissy and I woke up early to go back to San. I actually woke up really early, and rushed straight to the bathroom. Mr. D had struck again. To make a long story short, for many reasons, that day was by far my worst travel experience in Mali. And as you’ll realize in an upcoming blog, I’ve had a lot of not-so-great travel experiences here. While it had only taken less than 4 hours to get to Sikasso in a PC car, it took 8 hours by public transport.

I could barely walk by the time we got to San. Chrissy took pity on me and carried my second bag on her head, and we started off slowly walking toward the house. Unfortunately, the road we have to take is very uneven, and with the bag on her head, Chrissy misstepped and twisted her ankle, an ankle she’d previously broken. She landed on the dirt road, unable to get up. I could barely get myself home, let alone her and our bags, so I left our stuff with her and hobbled off in search of help. Thank Allah one of our house guards was just getting off duty, saw me, and came over on his bike to greet me. I pleaded with him to help us, and of course he did. With Jean-Baptiste’s help, Chrissy and I managed to make it home where we both collapsed onto couches and barely moved for the next 3 days. Turns out I ended up with an intestinal bacterial infection – aka food poisoning. Something at one of our group meals in Sikasso must have not been fully cooked or something, because so many of us ended up sick in that 5-day window. Although much more short-lived than the amoebas or malaria, this sickness was by far the most painful. But at least it didn’t have any side issues, like scalping or boils! Just Chrissy, equally as pathetic as me. :)

Overall thought: after all of those Infectious Diseases classes at BU, now I’m experiencing them…that makes me more legit, right??

Fingers crossed for staying healthy!!