Published: June 13th 2010June 12th 2010
One night I played tennis and immediately afterwards found myself incredibly exhausted. So tired I couldn't keep my head up at dinner. I was resting it on the table while I ate. I assumed this was just normal from the exercise in the heat. But I awoke around 1 AM in the morning, unable to sleep. I fell back asleep, only to wake up a few more times. About the fifth time I awoke, I realized something was wrong. I was hot. Really hot. And I felt ill. That feeling like when you have the flu and you just feel sick in the head and the body. I took my temperature and it was 102.6. I can’t remember the last time I’d had a temperature that high. I realized I must be fairly sick. I took some ibuprofen, hoping that would bring down my temperature. I had a severe headache and every part of my body ached badly. It hurt to walk on the bottoms of my feet. It hurt to wiggle my fingers. My head was heavy.
I got back in bed and tried to fall back to sleep. But I couldn’t. I had all sorts of awake-nightmares about
being really sick and being stuck in Luang Prabang without a good hospital. I got extremely cold, even though the early morning temperature was about 30C or 90F. I turned off my A/C, put on a long-sleeve shirt and pants and bundled up in all my blankets.
Around 4 AM I called my family back in the US for their advice. We decided I should head to the local hospital, the Chinese Hospital, (the one I previously wrote so glowingly about), for an initial check-up. I also packed a bag, money and my passport so I could take a tuk-tuk right from the hospital to take the first flight to a good hospital, in Thailand, if it turned out I was really sick. I wouldn’t stick around at the hospital in town.
With my backpack, I walked up to the main street around 5 AM, the earliest time when I thought tuk-tuks would be available for the ten-minute trip to the hospital. I felt pretty sick to be walking down the street, but also a bit tough and capable to be able to take care of myself. After about five minutes of walking, a tuk-tuk came by and
I hopped in, now hot and very relieved by the cool breeze blowing by.
When I arrived at the hospital, I felt a little bit like I was overreacting because I was able to walk myself in, I wasn’t bleeding, I didn’t have any visible bruises. How sick could I be? I say this because sadly, many Lao people only go the hospital when they are extremely sick and can’t walk or function on their own, because they can’t afford it. Often by then it’s too late, and they die from diseases that wouldn’t have killed them if they’d gone to the hospital earlier. Being very familiar with this terribly sad situation, I was at the hospital immediately, only hours after feeling sick (being a truly blessed person with money to pay a doctor).
Everyone at the hospital was still asleep; the unlucky ones sleeping in chairs, on counters or on the floors, the lucky, higher-ups sleeping in darkened rooms empty of patients. I knew this would be the case if I came to the hospital in the middle of the night, so besides from the lack of transport when I first felt sick, I also wanted to
wait to give the staff their sleep. Of course it’d be preferable if there was a night-time staff that was awake, but I knew their wasn’t and I knew it'd be better if I was seen by well-rested doctors (they need all the help they can get). Fortunately, Lao people wake up early, so arriving at 5 AM was just short of the normal time they’d wake up anyway.
I told the first man I saw in the hospital that I needed a doctor and he walked with me to a room to wake up the doctors sleeping inside. Right after these doctors awoke, the other students and nurses started waking up too, from their beds on the floor and the counter and in chairs.
I noticed, as I may have mentioned before, that all the rooms open on to an outdoor walkway flanked by a central outdoor courtyard. There are no mosquito nets on the beds. Some windows facing the exterior of the building had screens, some didn’t. Family members slept on mats on filthy floors next to their loved ones stretched out in patient beds. Trashes overflowed in rooms and in hallways, with dirty materials, bloody
Novice Monk Tying Numbers
on to a Christmas-tree like plant for a temple festival. People can come and pick one of the numbers and then take a prize according to the number.
tissues and towels, used equipment, some of what looked like hazardous waste.
Two male doctors asked me what was wrong and then instructed me to come sit in a consult room on a bed covered in a sheet that looked like it hadn’t been washed in weeks. In this same room, two patients slept uncomfortably, tossing and turning in the heat, with no fan, no mosquito nets and no screens in the windows. Although I‘d already been to this hospital, I was still surprised at the dirtiness and unkemptness of the room. It looked as though there’d been a breakdown of services and nobody was responsible for cleaning. (Actually though, a few minutes later, cleaners did come in and empty the trash and sweep the room. I don’t think they did as thorough a job as I would have preferred but I did see that cleaning does occur.)
Once I was seated, the doctors sat behind a desk and again asked me my symptoms. They recorded what I said and then took my pulse and my temperature. They took my pulse using a little machine that attaches to the finger, just like at home. They took my temperature
with an old-style thermometer under the armpit. When I saw them pulling out the thermometer I said um, is that clean, that’s not going in my mouth, as I saw it just pulled from a jar. But then the doctor said, no, no just under your armpit, and I thought oh, ok, there aren’t any diseases I can contract through my armpit, easily, are there?
A few sleepy students came to watch. They told me my pulse and my temperature were normal. I told them my temperature was not normal, as I’d been taking it all morning, and it hadn’t dropped below 101.6. They said no, no, your temperature is only 36C, it has to be at least 37 for you to have dengue fever or malaria. I said, I don’t know exactly what 36 is in Fahrenheit but I took my temperature and it was not normal. They said, oh 36 is only 106 in Fahrenheit, you don’t have a fever. This inaccuracy was some cause for concern, but what could I do? They told me they’d have to take a blood test to see if I had dengue or malaria, the two most likely suspects for my
Buddha Pulled Out of Temple
and beautifully presented for a temple festival
symptoms. I was well aware of these suspects as I’d heard about the symptoms from many friends who’d had these diseases before. They did not sound like pleasant diseases; sometimes people were sick in bed a month before getting better and there was little you could do to treat them besides rest.
The doctor comforted me, saying there’d only been one case of malaria in the past month. I personally knew of three cases, so again, we disagreed on something, but what could I do? I don’t know why he was lying, but I had heard of many misdiagnoses at the hospital, as well as misreporting of official statistics to adapt to official needs (Numbers are changed so things don‘t look so bad and officials don‘t get embarrassed by a lack of progress. Talk about a really unhelpful use of statistics).
Then the doctor woke up the blood taker to take my blood. It took a lot of knocking to get him up. He was pretty sleepy, but he pulled on a white coat over shorts and a t-shirt. I don’t think he even needed to wash his hands! He was ready to go! He was actually incredibly
skilled, putting me at ease about his hygiene with a completely painless and quick stick to my vein. I watched him take a sterile packaged needle, but he also cleaned my arm with a cotton ball floating in a small sea of alcohol in an open container that didn’t look uber-sterile, seeing as there were little bits and bobs and a few small flies floating around. But it was all in alcohol, right? I was delighted to hear that the results would take only 15 minutes, thanks to my early arrival. Usually it takes about a day to get results.
One of the doctors sat with me for fifteen minutes while we awaited my results. He wanted to chat. Whether it was because I was so relieved to be finding out what was wrong, or because he was trying to help me, I found my general well-being lifted and was able to have a civilized conversation. Fifteen minutes later, when the results came back, the two doctors consulted among themselves and then one set about writing out my bills, while the other watched intently. I had to interrupt them to ask for my results.
They said, oh, there’s nothing wrong with you. Your tests are negative for dengue and malaria. Just take some re-hydration salt/eleoctrolyte packets to balance your electrolytes and some acetometaphin when you need to lower your fever or ease your headache.
I said, well, I think something’s wrong with me. What do you think it is?
The doctor explained again that my tests were negative and the prescribed treatment.
I really wanted an answer though, to what I actually had, so I pressed him. Is it a flu? A normal flu? Or a normal fever?
He vaguely said, yes, just a normal sickness. If you’re still sick in three days, come back. He then walked me to the pharmacy and finance department, allowing me to ask questions, and answering them the entire time. I appreciated this extra time with him despite him being unable to give me a satisfying answer.
He spoke decent English and talked to me a lot about preventing dengue and malaria, and about advising my co-workers or friends to come to the hospital if they thought they had one of the diseases.
My medicines cost about $1, my consultation $12 and my blood test $6. These are foreigner prices; Lao prices are much lower. The only form of payment accepted was cash, Lao kip. The other doctor offered to give me a ride home on his motorbike when his shift finished shortly. I waited about twenty minutes but wasn’t feeling so great again, so I got my own ride home in a tuk-tuk. The two doctors were extremely nice, but I wasn’t very confident in their diagnosis. I was relieved I didn’t have to go to Thailand, pleased I could head straight home to bed, and happy I didn’t have malaria or dengue. But their lack of a physical exam was really concerning. They barely touched me. Just sat behind the desk and looked at me, and took my pulse, temperature and blood. There was no full physical exam. Imagine, they were doctors trained at medical school here! And they’ve been taught not to physically examine patients! They just looked at me, as if they could get the answers by looking at me. It is a bit awful to go to a doctor and not trust the doctor’s opinion.
For the next three days, I had a high fever, bad headache, severe achiness, no energy and pain in my eye sockets. My head and nose were stuffed up. The headache felt like intense pressure all over the front of my head. I lay in my bed but couldn’t sleep because of the pain. I rode my bicycle, ever so slowly, to get food and drinks, the pain in my arms and legs so severe I thought they would crack and break.
I stayed in bed or lay on the floor in the living room at my friend‘s house, where I was taken care of. By the fourth day, my fever, headache and achiness eased. I still couldn’t sit up for more than a few minutes, but I was feeling better. I traded for new symptoms, including puking and diarrhea. Throughout the illness, I retained my appetite and ate normally, though I did have a constant stomachache. On the fifth day, I became very depressed and the itching started; severe, severe, itching, all over my body, but the worst on my hands and feet. My hands and feet were so sensitive, I couldn’t actually itch them, although they were driving my crazy. They were so sensitive, but if I touched them they burned and stung. I would shower and just run cold water over them. They turned an unnatural, hot-pink color, became swollen and were covered in a flat red-rash.
Up until this rash, I had been convinced that I just had the flu by a friend. But I knew this rash to be a tell-tale sign of dengue fever, and now I felt justified in my earliest suspicions. I also felt myself extremely lucky, as I’d heard tales of dengue fever being much more severe and lasting much longer. By day 8, I was left with nothing but a light headache, a stomachache, itchy, swollen hands and feet, and depression. I felt truly blessed it had only been severe for three days.
Around day fourteen, I had to cross the border in to Thailand to get a new visa anyway so I made a visit to the hospital in Nong Khai, Thailand. This visit confirmed my belief that I’d had dengue fever. The only remnant, thankfully, at this point was a swollen liver that the doctor said should go down within two weeks.
I never remembered getting bitten by a mosquito, nor do I have any visible mosquito bites. According to something I read online, I am immune to the strand of dengue I had, as my body built up antibodies against it. The antibodies are currently so high that I’m also immune to the other strands of dengue for a temporary period. So that’s a great perk! I do plan to be more careful to protect against mosquitoes in the future though, wearing bug spray especially if I’m in the jungle.
I do have to say, even this hospital in Thailand, that is supposed to be vastly superior to the Lao hospital, I was not impressed by the quality of care. I was put in to a glass-walled V.I.P. room with A/C, flat screen TV and leather couch to await my blood test results and drink a delicious Thai ice tea. But I was also puzzling to the nurses. A pamphlet was finally pulled out, with three columns, each filled with more general tests than then next, plus a higher price tag. I was then asked which exam I would like. This method was unsettling to me, as I really prefer the doctor to tell me what tests are needed based on his/her expertise. For the record, I didn’t choose any column, I just said I’d like a blood test to know if I had dengue, and a physical exam to make sure I’m OK now. The doctor did give me a physical exam but it wasn’t thorough enough, lasting only about 2 minutes. The blood test did seem fairly thorough, testing about a dozen components of my blood, and confirming I'd had dengue and still had a swollen liver. When my bill came, it was about 2,600 baht, or roughly $86. Most of that fee was for the blood test. I was happy to pay for an exam at a hospital, although not perfect, where I felt vastly more confident in the results.
That was one week ago, and I feel myself fully recovered. Again, I think myself incredibly lucky to have had a mild form of dengue, as most people I know in Laos have had dengue before, and many cases were far more severe and long-lasting than mine.