There aren’t many things worse than having a problem and not knowing what caused it. But one of them is having a problem in Africa and not knowing what caused it. There are just a whole heap more potential reasons why something can go wacky with your body over here. Really, really scary reasons. So this is why I found myself scouring my bed yesterday morning at 4:30am, hoping desperately to find bedbugs.
I awoke with a start in the quiet pre-dawn, scratching my hands feverishly. The itch was tremendous, like a thousand mosquito bites covering every square millimeter of skin. My first reaction: cripes, my bed has been invaded. I sleep under a mosquito net hung from the ceiling and tucked underneath my bed each night, so a swarm of mosquitoes wasn’t an actual possibility. Now we were getting into viscerally grosser territory. I put on my glasses and turned on my light, scratching all the while, nervous but determined to face what I was sure was a massive infestation of creepy-crawlies. Little spiders if I was lucky, littler (and more disgusting) bedbugs if I wasn’t.
A fifteen-minute thorough inspection of my sheets though yielded nothing. I even checked along the mattress seams, searching for bugs burrowed there like we were shown in our session on parasites and skin afflictions. (Another of the less-than-glamorous aspects of being in the Peace Corps — trainees receive an extremely comprehensive set of workshops and lectures detailing all of the different ways that your life can be made miserable, ways that you are assured you will, not can, experience first-hand as a volunteer. I kid you not, earlier this week we had back-to-back sessions on the high percentage of HIV-positive persons in Zambia, then what to do if you are bitten by a snake/scorpion/rabid dog. And this was tame compared to the session on parasitic diseases — with pictures!)
So there weren’t any bugs in my bed. In fact, there weren’t any bug bites on my hands, either. What was at first relieving was now worrying. Because if there wasn’t an external, physical cause for the itching, that meant there might be an internal, psychological reason. But Matt, you have the epitome of a rational and emotionally balanced psyche, everyone who knows me cries out. Believe me, I know, I retort back, feeling that rationality that comes with knowing yourself very well (or at least thinking you know yourself very well) start to become shaky. Enter Mefloquine.
Since we first landed deep in the heart of sub-Saharan Africa, the area with the highest prevalence of malaria in the world, we have all been taking malaria prophylaxis. Now, malaria is serious business, so you might imagine that a medicine designed to combat malaria must be pretty potent itself. One of the other common prophylaxis options causes your skin to burn through clothing. Mefloquine, the one that I’m taking, is not given to anyone who has ever seen a counselor for any reason because it, my words, not theirs, screws with your mind. And even though this is a very rudimentary and not exactly accurate way to assess mental stability and strength, I guess they just figure it’s better to cast the net widely. An actual partial list of side effects:
-intensely vivid dreams (like Inception, dream-within-dream level stuff)
I had taken my Mefloquine the night before, and so because I had been the picture of healthy and hale up until this point, my next assumption was that I was experiencing an odd side effect of the drug. I dug up the pamphlet and found, buried deep within the list of possible side effects, skin rash and irritation. This theory was borne out later in the morning as I realized that thinking about feeling itchy made me itchier, while not thinking about it made the itchiness subside. Being able to control a physical symptom psychologically is a new phenomenon for me, and I was momentarily thrilled. But then I started feeling feverish and getting chills.
To fully understand the significance of chills, it helps to know that I have not felt cold for one second since arriving in country. In fact, I may have appeared thus far to have a bit of an obsession with my sweat. So shivering in my rain shell and gardening gloves while everyone else was wearing short sleeves was my first clue that I could actually be really sick, not just experiencing a side effect of the malaria prophylaxis.
I called the Peace Corps Zambia medical office, figuring I’d just be sent home to rest. I forgot one small detail — this is Africa. We have malaria here. I could have malaria. I’m not normally a hypochondriac, but I’d be lying if I said the thought didn’t cross my mind. About fifty times over the next hour. Especially when I was assured that my symptoms were not indicative of typical Mefloquine side effects. Next thing I knew, I was on a Land Cruiser headed for the clinic in Lusaka. Once I arrived, I was interviewed, poked and prodded, given a malaria test (negative!), and then waited a few hours for the blood tests to confirm this prognosis.
I whiled the time chatting with three LIFE volunteers in Lusaka for their Close-of-Service medical examinations. I’m one of those annoying people who’s always asking volunteers for the 2-minute summary of their service, its impact on their personal development, and hindsight big-picture things that they wish they had known or focused more on earlier in their service. The juxtaposition between these volunteers, having lived in Zambia for 26 months, and me, one month into training, was fascinating to me. I received some words of wisdom and a healthy dose of perspective.
My blood test came back. The second malaria test was also negative, and the doctor had done more research and was now retracting her earlier assurance that this was not a side effect of the prophylaxis. Apparently it’s very rare, affecting only 1% of all Mefloquine users, but the psychological itchiness, the fever, the chills, the weakness were indeed possible side effects. Already riding the instant I’m-not-going-to-die wave of happiness from the negative test results, I accepted a pineapple Mirinda from the driver (in a country where virtually nothing is cold, frosty sodas are pretty much pure bliss) and headed back to Chongwe in much more chipper spirits.
The story doesn’t end there. The only thing I’ve eaten since yesterday morning has been a handful of French fries (skipped lunch and dinner yesterday and breakfast today — I think my host mom, heretofore blessed with an American with a singularly voracious appetite, just about died from surprise when I refused food), I slept 13 hours last night and four more hours this afternoon, and I’m still, incredibly, cold. And this is probably the most miserable I’ve physically felt in years.
But I don’t have malaria. So look at that! The Peace Corps is making Americans more appreciative of what they have, er, don’t have, one sick trainee at a time.