Across in Addis Ababa, Ethiopia, only 1250 kilometres to our north-east, Barack Obama delivered a speech to the African Union, the first United States president to do so. He noted that with mobile phones and increasing access to the internet, Africans were beginning to ‘leapfrog old technologies into new prosperity’. Major progress was being made to allow Africa to finally utilise its massive resources, for the continent to become partners with other parts of the world instead of remaining merely a dependant. However, with the continent’s population set to double to two billion in the next quarter-century, with the majority of that growth among children under eighteen, it was, the president said, also a time of great challenges. Growth in training and employment needed to match the population boom, so that young people in Africa could lead a life that had dignity.
Over lunch in the Red Chilli bar, a crowd gathered around the television, hanging on every word. They applauded at the end of the speech. From an African perspective Obama had been an important president. With a Kenyan father, he was ‘proud to be the first Kenyan–American President’. The world was watching Africa, and Africa knew it.
Meanwhile, I was watching Sam, and Sam knew it. He became irritable, and so in turn did I. His maths lesson became a battle. What was going on? I put my palm to his forehead. He didn’t have a fever, and his pulse felt normal, but I started to become concerned.
‘I am sick,’ he said feebly. He lay down on the couch in the foyer and didn’t want to do anything.
Maybe he was getting sick. He was recovering from a bad cold he’d contracted a week or so earlier, but he seemed much worse than would be expected: crotchety mood, wavering concentration, a blocked nose and cough. Perhaps a new virus had piggybacked on the last?
I left him for an hour and a half to get some cash from an ATM. On my return, he was burning up. Oh, fuck, oh, fuck! Please don’t let it be malaria.
Sam was at a high risk for malaria, of that there was no doubt. His phobia of long sleeves put him at greater risk than other travellers, although less so in Uganda where it was too hot to wear long sleeves anyway. Mosquito nets were the problem. Despite my best efforts, he would inevitably end up twisted in the netting like a shark caught in a net, often with limbs poking out, exposed to the hovering buzzing mozzies. Occasionally he’d pull the whole net from the ceiling.
I whisked Sam into a cab and we headed through the traffic to a surgery recommended by the Red Chilli staff, where an expat British doctor worked. Sam lay on the back seat, listless and lethargic. In the consultation room of the smart-looking medical practice, the doctor, who had worked in Kenya and Uganda for decades, was curious about our trip and its purpose. ‘Blimey! Just the two of you, eh?’
He was very knowledgeable about tropical medicine, and not overly concerned about malaria. He was concerned about the possibility of Katayama fever, which occurs in response to a schistosomiasis infection. Schistosomes are parasitic worms that can penetrate the skin of anyone who swims in fresh water in sub-Saharan Africa and other parts of the developing world. Lake Malawi, where we had swum a month or so earlier, has been called ‘Schistosomiasis Central’.
While not life-threatening, schistosomiasis can make you weak, tired and irritable and complications can occur if it remains untreated long term. Katayama fever is an immune response to an early phase in the disease, when the schistosome eggs are first deposited into the body’s tissues. If this was what Sam was suffering from, it was better than malaria; schistosomiasis is usually easily treated.
The doctor felt further tests weren’t necessary but advised us to return if the fever continued. Still, I continued to be anxious. Sam’s temperature remained high through the night, but he didn’t look dramatically unwell. In the morning he was quiet and picked at his breakfast, happy to just lie on the couch and do nothing, but he responded appropriately enough when I spoke to him. Good—no signs of delirium.
Throughout the day, however, his fever continued. I decided I needed more reassurance and bought a malaria-testing kit from a pharmacy. I required three or four drops of Sam’s blood to do the test, which is to much to obtain from a finger prick. I attempted a venesection, which proved to be very difficult.
‘No! I don’t want this!’ Sam squawked, as I approached the vein on the cubital fossa, on the inner aspect of his elbow, with a needle.
‘Sam, we need to do the test to make sure you don’t have malaria,’ I explained.
‘I don’t want this, I don’t want malaria. Malaria sucks!’
‘Yes, malaria does suck, so we need to know if you have it. Malaria is very serious, Sam.’
As I stuck the needle in, he growled at me. ‘Malaria is more common in Malawi. They should call it Malawia.’
I eventually got the blood, despite the syringe plunger breaking halfway through. In a hostel room, with a pillowcase as the tourniquet, dodgy equipment and an uncooperative patient, all the while being filmed by the video camera on a tripod in the corner of the room, it was not my most professional venesection. But the test was negative.
I breathed a sigh of relief and let his anxious mother know via Skype, knowing Benison would be fretting overnight in Sydney otherwise. It didn’t rule out malaria altogether, but it was a reassuring indicator.
That afternoon, Sam deteriorated again. As his temperature soared, he looked worse than ever. ‘I haven’t got malaria,’ he said, twisting and turning on the soaked sheets, his cheeks red and eyes bloodshot.
I watched him anxiously. ‘I certainly hope not.’
He looked across at me. ‘It’s all right, Dad,’ he said, ‘don’t worry.’
I couldn’t help worrying. His skin was covered in goosebumps, but he didn’t have rigors, involuntary shakes. I checked him over for unusual rashes but could find none. This was Africa, after all, and there were other worrying infectious diseases besides malaria. Should I take him to the hospital?
I decided to see what he looked like after a dose of paracetamol kicked in. An hour later, the medicine did its trick, and Sam improved. His energy returned, and he requested something to eat.
But I remained unconvinced. I sat on my bed, looking across at him as he tossed and turned under the mosquito net. The last fever had shaken my confidence. He’d been febrile for more than twenty-four hours—and high fevers too. Bugger this.
There is a principle in general practice; it’s based on a driving analogy. Most of the time in my job you’re hitting the brake, telling people not to worry, that everything’s okay and nothing needs to be done. Only very occasionally it’s the opposite, time to hit the accelerator, to do something, to investigate, to refer.
I hit the accelerator. I ordered a cab to the International Hospital Kampala. The hospital was significantly more down at heel than the private clinic we’d visited earlier, but moved efficiently enough. Our consultation was paid for in advance, cheap by Western standards but expensive by Ugandan, hence the empty waiting room. We were straight in to see the doctor. I was unnerved that the doctor didn’t examine Sam physically, but the main thing was a blood film to look for malarial parasites, along with a blood count and other basic blood tests.
Despite the British doctor’s earlier words of reassurance, the two things I was really worried about were malaria complications and a serious bacterial infection like pneumonia or meningitis. There were other investigations I would have organised if I’d been in Australia, but these tests would give us the most important pieces of information. Malaria, caused by the parasite Plasmodium and transmitted by mosquito, can cause liver failure, kidney failure, cerebral malaria (infection of the brain that can lead to coma and death), severe anaemia and other complications, and quickly. The World Health Organisation estimates that there were 429,000 deaths from malaria in 2015 with over ninety per cent of these deaths occurring in Africa, mainly in young children.
I desperately hoped we could sort things out; this was as good as it got in Uganda, the next step would be helicopter retrieval to Jo’burg.
Sam tolerated his second venesection of the day much better than the first; maybe now knowing what was involved in it dampened his anxiety. The formal malaria film was clear. We were processed, door to door, including pathology collection and results, in under two hours.
As soon as I had made the decision to go to the hospital, Sam started to become more congested. By the time we left the hospital he was coughing, snuffling and sneezing. We finally had a focus, doctor-speak for an explanation for the fever. The blood count also revealed a profile consistent with a viral infection and unlikely to be a bacterial infection or acute schistosomiasis. Phew.
The next day Sam’s fever settled but I was over it all. The medical dramas of the last few days had exhausted us both. I was pining for home, for Benison, for my bed, for a half-hour hot shower, for the security of having a developed world tertiary hospital a short drive up the road.
Come on, James, I rallied myself, pull yourself together. Regroup. We are here to help Sam. I knew I’d have to pace it carefully though; Sam would take a while to recover. I decided to slowly reintroduce some school and neuroplasticity exercises over the next couple of days before we left on our trip to Murchison Falls National Park.
Judging him to be sufficiently recovered, I got Sam to write his second blog entry on his opinions of Africa. He wrote:
I would like to tell you all my opinion of Africa. I have being in Africa since 1 April 2015.
I’ve seen lot of things and met lots of people. It has been a tough experience.
I’d been in South Africa for nearly a whole month and I started off at Cape Town and Max the camera man had been there for filming us for the first 8 days in the whole trip and spent 6 days at Cape Town and then we went to Hermanus and stayed there for 2 days and Mossel Bay and Wilderness and Port Elizabeth and Chintza and Coffee Bay and Sarni Pass and Durban and then we travelled to Namibia.
The good bits were shops at Durban such as game shops, KFC and many more and also other things.
The bad bits were visiting and helping and saying hi to the Malawi children at preschool and African babies wah noises.
The thing that I enjoyed the most is going to the Durban shopping mall.
My blue DS is missing but they might find it eventually but Mum is going to give me another DS as a replacement or as well as the other 2.
Gabriel is a man we met in Namibia who has glasses and went to the desert in Namibia for 2 nights at a house.
I was happy about Uganda because it had McDonalds and KFC. I had a bad cough and bad sneeze for no more than 1 or 2 weeks. I got a fever for 2 days and I had being in Red Chilli for 9 days.
I met a guy named Mike who lives in Windhoek and I went to his house.
I have being in most rooms in Chameleon backpackers.
Overall, I liked South Africa the best.
On our last day at Red Chilli, before leaving for Murchison Falls, a sweet lady from the kitchen handed me the coffee I had ordered. ‘How is your Sam?’ she asked.
I smiled. ‘He is all better now, thank you.’
‘Ay-eh, he is a good boy. We are praying for him.’
It was four months to the day since we’d arrived in Africa. Cape Town seemed like years ago. It was time to get moving again.