Typhoid Maggie

I think I jinxed myself. A little over six months ago I wrote about how I am often kept awake at night by the thought of what I would do in the case of a medical emergency. That was no exaggeration or story made up to prove a point, I really did think through what I would do if my (or Jason’s) appendix dramatically burst in the middle of the night. This of course meant that when I did get sick, it wasn’t dramatic and didn’t follow any of my plans – it was with an illness that while common in Ethiopia, most Americans have only read about in history books or while playing the Oregon Trail computer game. The story of my bout of typhoid and first-hand experience with the Ethiopian medical system was comical (okay, maybe not at the time), made me ponder the issue of trust, and led me to re-visit my thoughts in the aforementioned blog post on the Ethiopian medical system. 

Before I start the story, I’ll let you skip ahead to the last page of the book – I’m not writing this from my deathbed, but am in fact on the road to recovery, though I’m unfortunately still dealing the after-effects of the illness. The recovery period is a story unto itself, and will have to be saved for another day.

Back to the story of Typhoid Maggie. In the past when I’ve gotten sick, which I must say I truly excel at, there was only one occasion where I have ever questioned a doctor. Beyond that, when a doctor says I have a sinus infection, I don’t question the diagnosis, the tests done to reach the diagnosis, the medicine given, or in general, the doctor. Yet, when I got sick in Ethiopia I found myself doing all these things, and it made me in turn question my lack of trust and the motives for those sentiments: was it because of all the negative things I had been told about the Ethiopian medical system or simply because the doctor was Ethiopian? And if I didn’t trust a doctor purely because he is Ethiopian, was I really better than all the people who make snap judgments about me just because I’m American?

A few weeks after returning from mid-year seminar in Israel I found myself exceptionally fatigued and inappropriately taking my clothes off. Let me explain: when I got this placement it was made to seem very relaxing by other expats in Gondar –you get lots of sleep and watch tons of movies –and while that is certainly true, many of us here often comment that day-to-day life (harassment, language and culture differences, etc.) is so exhausting that we often feel more tired than we did in the U.S., despite the increased sleep. However, I was feeling more tired than usual, and as for the stripping, I would find myself taking off layer upon layer of clothing and pulling anything out of the freezer to hold to my skin (often a bag of chocolate chips –an ice pack and a snack!), and yet, I thought nothing of all this because the temperature had begun to rise and everyone was complaining about the heat. Then one day I was sitting at home, chocolate chip ice pack in hand, and realized that while I was burning up, no one else sitting with me felt the heat. I started to wonder if something was wrong.

After a phone consult with Dr. Rick Hodes, I headed to supposedly the best private clinic in Gondar for some tests, and was joined by a new friend, a wonderful American pediatrician, Neela, who was working in Gondar University Hospital for three weeks. I had Neela come into the room with me when they did the test because I wanted her to watch and make sure everything was sterile. Neither of us said anything when the technician drew my blood without gloves on (and with a giant needle – no up-to-date tiny needles there!), but mentally I was panicking. When the technician told me the test for typhus was positive, I laughed – of course I would be the one to get some weird disease. I immediately called Rick, who asked me to find out whether I was running a fever at that moment. I was at the best clinic in Gondar, so no problem, right? Wrong. The clinic’s one thermometer was not working, so Neela and I hopped in the car to find a clinic across town with a working thermometer. When we found one, I watched the nurse disinfect a tiny portion of the thermometer, and just as she was about to take my temperature, I started thinking of all the sick people in whose mouths that thermometer had been, and suddenly I burst out: “shouldn’t you clean more of that if you are going to put it in my mouth?!” Giving me a look, the nurse informed me that she was going to measure my temperature from my armpit. Of course. Why was I second guessing her? I had no fever. Rick’s assessment was that I didn’t have typhus, which was seconded by Neela, who said that while she was no expert on the illness, I just didn’t seem sick enough to have typhus. On our way home, we stopped for WiFi and she looked up the test they had done, only to find that it is so unreliable that we no longer use it in the US. So, I wrote to my parents and told them that while my blood work indicated I had typhus, the consensus was that it was a false positive. Maybe I shouldn’t have said anything, but really, how often do you get to tell your parents that you have typhus? Hoping that I had managed to keep my parents from going into full-on panic mode, I went home, made a lasagna, and laughed the whole thing off.

But a few days passed and I wasn’t getting better, and despite telling my parents not to panic, I started to worry myself. What if I really did have typhus and I ended up dying from it because I trusted the American doctors and not the test? So, I went back to the clinic with no thermometer and asked them to run both the typhus and typhoid test, since I heard typhoid had been going around as well as typhus. Once again, the typhus test came back positive, while the typhoid test came back negative. When the nurse showed me, I let out a massive groan. She giggled. Worried, I asked for JDC to find me a doctor to see in Gondar.  It was quite the process: I had to go to the hospital, find a pediatric resident, call another doctor and have him give the name of his recommended doctor to the resident, who then called the recommended doctor to see if he was available and eventually walked me to his office. Turns out that the recommending doctor had the phone number of the recommended doctor the whole time, so why he couldn’t just call, I have no idea. Just another T.I.E (This Is Ethiopia) moment. The doctor, who spoke excellent English, pleasantly surprised me with his jolly attitude and big belly. All he was missing to be Ethiopian Santa Claus was the beard. I digress. He suspected it was typhoid, but asked me to meet him at a private clinic later to get more blood work done.

When I arrived at the clinic at five o’clock, I realized that the doctor had never told me his name and so I had no way of finding him. Eventually I managed to figure out the name, and asked the lab technician whether the doctor was there. “No, he must be late from the hospital, but you would know if he was here. He’s huge! You can wait for him outside.” But as I walked outside, the technician followed me, repeating “he’s huge, gigantic, you won’t miss him!” Okay, thanks, I got it. Even though all the benches at the clinic were filled with sick people both young and old, all of whom had been waiting much longer than me, when Dr. Ethiopian Santa Claus finally arrived I was brought in to see him first. As much as I complain about being treated differently for being a ferenji, I shamefully admit that with no place to sit and feeling too weak to stand, I didn’t turn down the special treatment. The test came back positive for typhoid, which the doctor said is common after an initial negative test, so he prescribed me a strong dose of anti-biotics and sent me on my way. I should note that yes, I did get the vaccination, but I got it regardless (of course). As I paid for my test, the people around the desk started talking about me in Amharic, and then after realizing how intently I seemed to be listening to them, asked one another if I knew Amharic. A slight nod with my head, shock in their eyes. With that small victory, a bottle of antibiotics, and reassurance that I should be feeling better in a matter of days, I thought the typhoid story was at its end. But I promised comedy, didn’t I? So clearly this story is not at its end.

After a week of antibiotics, I really did feel much better, but was still having some issues. When I went back to see the doctor, he suggested that I consult with two visiting British doctors. I had a hard time not laughing at the way they voiced their opinions on my illness (“one might think that it could be a stomach problem,” or “one might suggest different medicine”… was I unknowingly speaking with the Queen of England?) and did laugh out loud when they asked if I had gotten any imaging done.  I struggled to find a working thermometer and they were asking if I had gotten a CAT scan? Turns out it is possible to get some imaging done in Gondar, so off I went to another clinic, which my friends warned me did not have a good reputation.

I should preface this story by saying that I am pretty sure that the Ethiopian medical clinic was one of Dante’s circles of hell. The clinic was dark and filled with people draped over rows of benches, all of whom stared at me as I made my way to check-in. There I met with a receptionist and a nurse who didn’t speak enough English to explain to me why they were charging me more than the listed prices and why they wouldn’t give me a receipt for my payment. The nurse took me upstairs, past more benches filled with waiting patients, to my own room to wait, a sunny office furnished with a desk and two chairs. Clearly the nurse believed that as a ferenji I could not wait with everyone else. Rather than leaving me to wait, the nurse sat down with me and launched into an attempt at a conversation in very broken English. I went along with it because I try to make an effort to be friendly to everyone who is friendly to me, but about thirty seconds into the conversation he asked where I am from immediately followed by whether I have a husband. I don’t like to lie to people, but I knew where he was going and I didn’t hesitate with my answer.  My pretend husband didn’t deter him and he continued to ask whether I would find him an American wife or a sponsor. Even when I tried changing the subject by asking him what he’d done with my referral paperwork, he continued to ask how he would communicate with me after I’d left the clinic so that I can find him an American wife. To my somewhat relief, a man sitting outside the room had been eavesdropping and jumped in the conversation, asking how I found Gondar (I always want to answer this oft-asked question with “on a map”), followed how I find the air-condition, a term that for a while I incorrectly thought meant that everyone in Gondar secretly had air-conditioning but me, but later realized meant weather. I replied and asked what he thought of the weather: “it is suitable for human beings,” he replied. BEST. ANSWER. EVER. If anyone ever asks me about the weather again, I will be using his answer.

The doctor returned from what seemed like an eternal lunch, and once again, I was taken in to see him before everyone else who had been waiting. Again, I am not proud of it. Unlike the rest of the staff at the clinic who I had encountered so far, the doctor spoke excellent English and we chatted as I laid on a bed that smelled like it had never been cleaned and he did the test. At one point, he informed me that I was “not that fat,” and even though that was the cherry on the self-confidence sundae after a week of Ethiopians touching my newly acquired acne and saying “what’s wrong with your face?”, I burst out laughing. He asked for words other than “fat” that doctors might use in the U.S., so I told him that although no expert, I believe the terms “obese” or “overweight” are used in the U.S. instead of “fat.” “Oh, okay,” he said, “well you aren’t that obese.” Nope, definitely not any better.

After the test was finished, my favorite nurse returned to escort me downstairs. Ignoring my objections, he kicked a teenage boy out of a chair so I could sit in it. To pass the time before the next test, I stared at everyone who was staring at me until they looked away. When it was my turn, the medical technician, a man, led me into a very seemingly soundproof room and told me I had to take my clothes off for the test. Given the test, the request was somewhat reasonable, but with no gown to cover myself and only the two of us in the room, my trust issues came screaming to the surface again and alarm bells were ringing so loudly in my head I’m surprised the technician couldn’t hear them. This time I didn’t ignore them and politely refused, which ended up not being a problem. After the test I resumed the staring contest in the waiting area, listened to the technician and receptionist talk about me (pretty obvious when they kept referring to me as “the white person” in Amharic), and eventually tried to ignore the drilling sound and horrible smell as the latrine was emptied. Just as it was all becoming too much, the test results came back, and I hurriedly made my way past the staring eyes to the outside world, from which it seemed like I had been absent for years.

Around the time of my visit to the clinic, my mom started pushing me to come back to the U.S. for medical treatment. Despite all my apprehension of the Ethiopian medical system, all of the sudden I had doubts about American doctors as well.  While most American doctors have probably never even seen a case of typhoid, their Ethiopian counterparts see it every day, so was I truly in the best hands in Ethiopia? Yet when I asked a friend who works in the medical field in Addis about a private hospital there, which is supposedly the best in the country, he said that he did not rank it highly in cleanliness or competence.  So I revisited the thought of returning to the U.S., only to realize that even with good health insurance I would pay hundreds, if not thousands of dollars for tests and medicine that I could get in Ethiopia for less than ten dollars. Although the tests might be the same, there was no doubt that the quality in Ethiopia was lower (for example when I was getting tests done at the clinic the technician struggled to finish because of power issues) but at the same time, in the U.S. I would be paying that high bill wondering about questions of the inflated costs of healthcare. Recently I read a New York Times article which described several deaths at Children’s Hospital in New Orleans from a flesh eating bacteria that had spread through the hospital undetected because of unsanitary linens. Guess the question of sanitary conditions can’t be solely relegated to Ethiopia. Now questioning both the Ethiopian and American medical systems, I was between a rock and a hard place.  So I decided to pay a visit to a person who has decades of experience with diseases found in Ethiopia, but was trained in the US: Dr. Rick Hodes.

I’d like to take a moment to thank Rick for his dedication and persistence in the face of a clear lack of necessary medical supplies, even in Addis. As he treated me, Rick was honest about certain areas in which he felt his medical knowledge was limited, which I appreciated. His openness made me realize that even in the U.S. doctors don’t know everything. Even in our top-notch American medical system, doctors make preventable mistakes, hospitals aren’t sanitary, and errors can occur in lab work. I realized that while I certainly don’t need to be the annoying patient who pretends to know more than the doctor because I read a few articles on WedMD, I shouldn’t take everything the doctors tell me as the undeniable truth. In order to look out for myself, I need to bring a small amount of the skepticism I had so clearly demonstrated with the Ethiopian medical system back with me to the U.S.

And what about that skepticism of the Ethiopian medical system? As I recovered, I thought about my roller coaster ride through the Ethiopian medical system and was really troubled by all the doubts I instinctively had about those who had been treating me. The thought that I was discriminating against these people really bothered me, as this would make me no better than all those I lambaste for mistreating me for being white. Why had I been surprised when Neela had told me that the attending pediatricians at Gondar University Hospital were so knowledgeable and capable? After pondering this, I realized that for seven months I had heard stories from visiting medical professionals of unsanitary conditions, incorrect diagnoses that had gone undetected, doctors that had failed key medical and English language exams but had been allowed to continue to practice anyway, and many other horror stories, some of which I had witnessed myself while visiting the hospital. Yes, I had also heard stories (and met for myself) doctors who were caring and knowledgeable. However, I think when I went to the best clinic in town and saw that it wasn’t all that clean and that they lacked basic necessities like a thermometer, the negative stories seemed to be confirmed and the positives went out the window. I also think before I got sick I was very frustrated with Ethiopia and Ethiopians (as evidenced by some of my prior posts) and had gotten to the point where I assumed the worst from everyone. While in some cases my concerns were justified, my immediate negative assumptions made me realize that I needed to take a step back, remind myself of the positives, and give the people and community I was living in a second chance.

Beyond the long-lasting typhoid antibodies that I’m told will hang around in my blood even after I’ve fully recovered, this run-in with illness in Ethiopia has provided me with important insight into the way I view the American medical system as well as those around me in Ethiopia, lessons which will certainly outlast those pesky antibodies.