Health Saga

Note to readers: I preface the following story with an assurance that I am writing from my home in Boulder, CO, and that my condition is (hopefully) improving.


For nearly a year I have not been perfectly healthy. The strange symptoms began in India last winter, and their cause remained mysterious to me until I returned to the US in the summer and discovered I was playing host to four different parasite families. Unfortunately my body seemed to make a comfortable home, and evicting the new tenants was a long and taxing process that included beefing up the good bacterias in my body (to make the living situation a little less hospitable) and taking several different medications to kill off the ones who refused to leave peacefully. To this point, everything “abnormal” I had been feeling, including dizziness and fatigue, was attributed to the work of these strange little beings. Thankfully, when I left for Costa Rica I was declared parasite free, and I expected for my health to dramatically improve. When I continued to have prolonged spells of dizzy/foggy headedness, combined with spotty vision, and the feeling that I might black out, I figured it was a good idea to see a doctor.
The doctor asked probing questions, trying to decide whether I was happy in Costa Rica, with my family and friends there. Apparently my symptoms indicated depression as a possibility. When I assured him that I was excited to be there, and was not having any large personal problems, he recommended that I go to a lab and get tested for glucose levels, anemia and some hormone testing. When all of these tests came back normal, I still had no idea of what was causing my symptoms. The closer we got to our trip to Nicaragua, the worse I felt. I was sleeping more often, feeling more run-down and fatigued, experiencing dizzy spells often and a heaviness set in, which made walking a chore. Some days I would wake feeling fine, and then a sudden wave would wash over me, knocking me flat and unable to concentrate on my work. Despite this deterioration, I pushed on without sharing with any of the staff at the center or my Costa Rican family. I did not want to alarm anyone, and I felt that I would be able to make it to the end of the semester and address the problem when I returned home in December.
The night before I left for Nicaragua, for what was scheduled to be a two week trip, I called my friend Barbara in West Virginia. Barbara is a nurse, and a trusted friend. I had finally reached the point of concern that I wanted an informed opinion. On the phone, I described my symptoms and fears to Barbara. My tearful sharing was cut short when the time ran out on my phone card. For hours Barbara tried to get through, each time the operator told her that all international lines were blocked. In those few hours, the wave passed, felt a little better, and resolved to go through with a trip that I considered essential for the depth and breadth of my independent study project of Nicaraguan immigrants in Costa Rica. I wanted to understand the conditions of life in Nicaragua through my own eyes and experience. I often feel this picture is missing for those who discriminate against immigrant populations. They do not consider why people have chosen to leave, where they have come from, and what their lives were like there. I had read that in Nicaragua 45% of the population lives on less than $2 per day, making it one of the poorest countries in the region - only Haiti is poorer. These figures, black and white and dead on the page, told me nothing of the story of the people. It showed me no pictures, no individuals, no homes or hungry bellies or men carrying dirty water up the side of the mountain for their families to drink. These figures didn’t tell me the dreams of the children, or how their parents struggled to give them a chance at a better life. The numbers, no matter how grave, are easy to ignore. I wanted the evidence of the numbers, the images that I would be unable to forget until they were changed. I wanted stories from the other side of the border that would inspire compassion in those who read them, and an understanding that there are real people represented by the numbers.
Okay, let me pause here. I am getting sidetracked from the main point of the story. For the reasons above (and more) I chose to go on the trip, despite the state of my health. I took the 10 hour bus ride, was one of the lucky few not to get ripped off by the money changers on the border, and arrived at the hotel in Managua exhausted. At 10pm that night, I was awoken by a knock on the door. The woman from the front desk was looking for me, I had a phone call. Still feeling as though I were dreaming, I picked up the phone. It was my mom, calling from my dad’s house. Poor dad had tried to call the hotel earlier, but when he couldn’t speak Spanish, was put on eternal hold. They were worried. i could imagine them all there together, talking it over.
“Maybe you should come home,” mom and Angela said.
“Don’t be brave,” dad said. After hanging up I couldn’t sleep. Was leaving giving up too easily, or the prudent thing to do. Had I already pushed myself too far, and what I really needed was rest?
In the morning I woke early to find Ileana, the leader of our trip. She and Sarah (a professor) were sitting at a table in the garden drinking coffee. I sat down with a purpose, and before I could say anything, I burst into tears. They looked alarmed. I explained everything from the beginning, India, my battle with the bugs, my slooooow recovery that seemed to have taken a turn for the worse, my concerned parents, my desire to continue the trip. What should I do? Ileana suggested that we go to the clinic to get another parasite test, and that I could switch groups if I wanted, to make sure that I didn’t miss the community projects if those were the most important.
In a few short hours the results were in. They had found evidence of an amoeba, and prescribed me more drugs. I took them, not knowing what else to do, not feeling sure that we had found the problem. Soon the group was off to meet the Sandinistas, and I was on a bus to the beautiful colonial city of Granada. Nicaragua looked different from what I expected, a glossy finish obscures the rampant poverty beneath. On the (pothole free) road, I took in the casinos, shopping malls, business plazas and restaurants. I thought to myself, there’s more development here than anywhere in Costa Rica, how does that happen? And so much for the Costa Rican stereotype of the plebeian Nicaraguan. It reminded me that in so many countries there exist two worlds, that of the rich and that of the poor. In Nicaragua, some people live off of two dollars a day, and some live well according to the highest of standards.
In Granada I was reunited with my friend Susana, our translator and fellow Coloradan. She agreed to share her room with me, and became my caretaker and ally over the course of that night and the next day. That evening, my neck seized, as if gripped by a vice. I couldn’t move my head very well, and all positions felt uncomfortable. When I closed my eyes, the room began to spin. I got up and paced, Susana tried to think of ways to help. eventually there was a release, and I was able to rest.
In the morning we left to visit schools and then houses of some of the children. This was what I had been waiting for, and didn’t want to miss. We met the principal of the school, who was in charge of three schools and earned a little more than $4 per day, almost twice as much as teachers. She spoke of the hardships of the school, and her family, and she cried. She said she had dreamed of sending her son to University in Costa Rica, but that she couldn’t, and here we were, all living her dream. The children put on a show of traditional dance in traditional costume, and afterwards each of them kissed each of us on the cheek. They were beautiful.
I went to the house of a twelve year old girl, Soraida, who told me that she wanted to be an engineer when she grew up. Her house was in the mountains, and everyday she left the house at 4:30 to walk to school. She was one of the top in her class. She lived with her mother and 16 year old brother, though she was the youngest of 10 children. Most of her siblings lived in shacks close by. In her house, her brother worked because their mother no longer could, and her mother never left the house. Their house was shanty of salvaged materials, pieced and nailed together, leaving gaping holes. They had no electricity, no running water, the floor was dirt and not even smooth. She and her mother shared a room, two bed frames, no mattresses, no blankets. Everything was dark and hard, including her mother, a woman with no husband, no support and no more dreams. Soraida sat in a chair by the door, quietly looking out to the horizon. I wonder what she saw there?
After we left I learned that Soraida was sick. She couldn’t hold down food, was very thin, and no one knew what was wrong with her. Our group was paying for her to get a test done, looking at the inside of her intestines. The test cost $20, whih wa far too much for her family to afford, and only the beginning, for if something was found, it would cost much more for the treatment. This is something that I thought a lot about in the following days, that Soaraida had no choice and I had so many.
That afternoon I felt exhausted, and the vice was back on my neck. I decided to write to Barbara, who had been sharing my emails with an infectious disease doctor at WVU. I felt that the stiff neck symptom was something to worry about. She wrote back almost immediately, telling me to call the embassy and find the best hospital close by, so that I could be re-examined by a doctor. One of the sicknesses the infectious disease doctor was worried about was Meningytis, something that should be treated quickly. I found Susana in our room, and took her downstairs to read the email. We debated over the best course of action, should I go to the doctor in Nicaragua? Should I return to Costa Rica and go to the doctor there?
“Excuse me,” said the woman sitting next to us. “ I have been working in preventative medicine for several years, and if you think that you have Meningytis, that is serious. You need to get to a hospital right away. There are strains of Meningytis that can kill you in a day.” She looked me over for signs of a rash. She looked in my eyes to see if the pupils were different sizes.
“Are your eyes sensitive to light?” Sometimes they are, more than they should be. “You’re probably okay, but if it is Meningytis it is better to go to a marginal hospital here, now, than wait to go back to Costa Rica to get to a better hospital.” With that everything sprang into motion. The people at the front desk sent us to Hospital Japon Amistad, the best in Granada. “Ask for privado,” they said as we rushed out the door.
In the taxi I cried. “I can’t believe this is happening.” Susana squeezed my hand, was so thankful to have her there with me. At the hospital, they sent us to emergency, and privado meant that I was seen by a doctor in a small office, partitioned off from a large dormitory room. The doctor we saw was kind, and Susana carefully translated all of my symptoms and fears. He checked me over, and said it wasn’t Meningytus, but that he wanted to do a blood and urine test, as well as take x-rays of my neck and chest, looking for lesions that could be causing the pain in my neck, and pneumonia in my lungs. He lead us into the lab where first they took a blood sample and then sent me to the bathroom for the urine sample. The bathroom was dirty and smelled because none of the toilets flushed. Not wanting to sit on the seat, I manuevered akwardly, dropping the cotton ball that was covering the area where they had drawn blood, without any pressure, blood trckled down my arm. I went to wash it off, and discovered there was no running water in the bathroom. I emerged with the sample in one hand and smeared blood all over the other.
“You straightened your arm, didn’t you?” Asked the technician. I nodded, and she cleaned me off with cotton and alcohol, then led me to the sink where she turned the spigot on a large water container. “The water gets turned off during the day.” No running water? In a hospital?
Back in the privado room, the nice doctor looked over the x-rays, and said they were normal. We were just waiting for the test results.
“I think it’s Dengue,” he said. Oh lord, we had been actively avoiding Dengue all semester. “I would like to admit you to the hospital for further testing.” Susana and I looked at each other.
“How do you feel about that?” She asked me in English.
“I don’t want to stay here,” I said, looking around at the chaos. Piles of papers and supplies covered every surface, there was no order, I thought back to the bathroom.
As we were discussing what to do, the ‘specialist’ doctor came in. He came up very close to me and said in loud, choppy and robotic English.
“Hello, I am doctor (I cannot remember the name), what is wrong?” He appeared to be looking over my right shoulder, as he inclined his head to hear me. I realized in a few moments that when it seemed to me that he was looking away from me, we were actually making eye contact. I flashed back to a class with a substitute teacher with a similar eye condition that worked in my middle school. No one ever knew to whom she was addressing the question, because when she looked at you it appeared she was looking at the person naxt to you. “Who, me?” was the most common question asked in class. Although Susana began describing my symptoms to the doctor in perfect Spanish, he continued to address us in English.
“So, did you feel these things after yesterday?” He asked. Susana and I looked at each other, that would be today.
“Do you mean before yesterday?” She asked.
“Yes, yes, before yesterday, how was you feeling?”
“ Well, I have had some symptoms for a long - “
“I mean were,” he said, correcting his incorrect tense. Was he listening to anything I was saying? I had run across people who wanted to practice English before, in sodas, pulperias and librerias, but I wondered why, in this situation with a more than capable translator, he insisted on doing so.
“You can ask her questions in Spanish, she can understand.” Susana assured him. He went through the process again, of listening to my heart, checking my pulse, bending my head, and testing my legs. He truned off the overhead light and flashed the light in my eyes. He agreed with the other doctor, that it was not Meningytis, probably Dengue, and that I should be committed to the hospital for three days.
“There’s no way I’m leaving you here,” Susana said, as she went with him to see about the test results. A doctor from the dormitory room came in, there was a telephone call for the gringa. To get to the phone I had to step over a puddle of bloody water on the floor.
“Oh my God sweetie, what’s going on?” It was Ileana on the line. I tried to explain to her the situation, and noticed the dried bloody footprints leading away from the puddle near my feet.
“Can I speak to a doctor?” She asked, I went to look for one. In my old room, Nice Doctor was seeing a new patient, and Weird Doctor and Susana hadn’t returned yet, however Antonio (another teacher) was there. He took the call, having briefly spoken with the doctors. The decision was made that I would be taken to Managua, to a better hospital, where we could get a second opinion. If I didn’t have anything highly contageous, I would be sent home in the morning.
Susana, Antonio and I sat on a bench outside of the room, in an open courtyard. I took a breath of air, no Meningytis. Weird Doctor passed,
“Do we have any results?” Antonio asked (in Spanish).
“Yes, it’s Dengue, “ he said (in English). We all looked a each other in surprise. I had no fever, which seemed to be a major symptom of Dengue Fever. We thanked the doctors, paid a total of $30 for the consultation and x-rays, and went back to the hotel so that I could pack my bags and say goodbye.
Word travelled fast, and by the time I had spoken to my mom and made it back to my room, the knocks started coming. Everyone looked as comfused as I felt.
“You’re actually leaving,” they kept saying. It was hard for it to sink in for me as well. They sent me off with hugs, kisses, and a sweet card.
“I feel like my mom is sick,” one of the girls said to me. I guess that’s what happens when you’re one of the oldest in a group.
“Do you want to talk about it?” Susana asked in the cab. What was there to say? I was so confused over my condition, and all I could think was that if Soraida ever made it as far as the hospital, she would go to the one that wasn’t good enough for me.
In the lobby of the Hotel San Juan, the receptionist greeted me with a smile, “How do you feel?” She asked. With all of the calls I had recieved and the swirling concern, I was well known to the whole staff there. The lobby was soon full of the other half of my classmates, dressed in their pajamas. I had just enough time to put down my bags and hug everyone before going to the next hospital.
We pulled up in front of a very new, white building. It looked sterile, and nondescript, just like the hospitals at home. Susana and I bid a tearful goodbye. i thanked her for being with me through the whole ordeal, I wouldn’t have been able to do it otherwise, and Ileana and I went into the emergency room. There were no other patients, only several nurses and staff ready to attend to me. I’m sure this was the nicest hospital in the country, only a year old, with all new equipment and the best doctors, and yet there was no one here. It was quite a contrast from the chaotic bustle I had just come from. All this expertise, medicine and machinary and I, the student from the United States, seemed to be the only person with the means to take advantage of it that night.
They put me into a nearly empty, white room. No papers or supplies to be seen anywhere. I lay on the bed, and waited for the nurse to wheel in a metal cart with several individually wrapped packages of needles and viles. The new doctor, Dr. Porras, agreed that it could be Dengue, but that we should test for a whole lot of things. Several viles of blood were drawn, though they had trouble finding a place to draw from that hadn’t been recently punctured.
“Eva, sin sangre (without blood),” Ileana joked, and I marvelled over how much blood could be given without damaging the body. They decided to keep me for the night at least, for monitoring, and that I would see the neurologist in the morning for an examination. They changed me into a hospital gown (I hadn’t worn one of those for awhile) and wheeled me, in my bed, through the hospital to a private room on the third floor. I was so exhausted that I fell to sleep, and the nurse had to shake me awake in the morning to take my blood pressure and change the i.v.
The day passed, full of testing. After my appointment with the Neurologist, I was wheeled through the hospital for an MRI test, taking pictures of my brain, as well as a test of my brain activity, which involved attaching eloctrodes to my head and flashing lightbulbs. Thankfully all of these tests ruled out the worst of all fears, and by the end of the day I was diagnosed with Citomegalovirus and a urinary tract infection, both of which could explain the recent deterioration of my condition, but not the persistent symptoms.
A visit to the hospital had been scheduled into the day’s activitied for the whole group, and so after the Free Trade Zone and a tour through Cupid underwear factory by a woman from Oklahoma, the bus pulled up to the hospital door, spilling the students into the lobby and cafeteria. In groups of five, they came up to my room. The first group recounted their experience in the maquila, mocking ‘Daisy Mae’ from Oklahoma,
“Can you believe that they work twelve hours a day for 33 cents an hour? And yesterday these men picked up and moved this machine that must have weighed 1,000 pounds just so that they could keep working, imagine the dedication. You know they work twelve hours and then they walk home!” I don’t know what is worse, the fact that she sees no problem with the fact that people work so hard for only 33 cents an hour, and that she loves her company, or that when you add up that salary, the maquila workers are earning more than teachers.
During this conversation, the nurse changed my iv, which made one one my classmates so squeemish that she moved toward the door and fainted at the foot of the bed. None of us knew whether to laugh or cry at this scene.
“Should we get the nurse?” Asked Sarah, who was holding her head in her lap.
“No, this happens a lot when I’m in hospitals, I’ll be fine in a minute.” They told me that two others had fevers and were in the ER getting tested for Dengue. I had started a panic attack, and everyone was mis-informed. No one really knew what was going on with me, including me. The important thing was that I was no longer afraid that my life was being threatened. I spent one more night in the hospital, was discharged the next day, spent the afternoon sleeping in the hotel, and the next morning I was put on a flight from Managua to Denver via Miami. I arrived safely on Saturday night, a change that was so abrupt that my first instinct was still to respond in Spanish. I have been resting for the past few days, and trying to reflect on what I have learned from this experience. Rather than feeling disappointed that I am missing the end of the semester in Costa Rica, I am trying to look at the positive aspects. Obviously my bosy needs rest, and my immune system had been compromised for a long time. This is the safest and calmest place for me to have that recovery time. It is wonderful to be surrounded by people who love me, and I will still be able to complete the semester from here. I am tired from the writing of this tale, so I will continue with more thoughts a different day.