TheBanyanTree: The Gory Details (for those who dare)

[apmartin at canada.com]

Disclaimer:  Includes graphic details on parasites.  If
you are on a diet, read this story before all meals.
It’s guaranteed to make you lose your appetite, and
maybe even your last meal.

               Third World Hazards

I was sick for three weeks with a terrible cough before
I accepted I wasn’t going to beat it on my own.  It
took a week in bed and five days of self-prescribed
Amoxicillin, (here in Guatemala you can buy it over the
counter) with no improvement to finally convince me.   

I didn’t want to visit a doctor in Guatemala; I was
afraid to.  Guatemala is a corrupt Third World country.
It’s the kind of place where someone, anyone, could
read a few chapters in a medical text, buy a forged
graduation certificate and start a practice, without
fear of being caught.  

Now, though, I had no choice; I was too ill.  Even
watching television took too much effort.  

My next-door neighbor, Jan, a young man from Germany
recommended Dr. Alvarado.  

“He can speak English,” Jan told me.  “I’ve been to see
him twice already; he’s good.  You should go.”

In Guatemala, there are only two seasons: winter (the
rainy season) and summer (the dry season).  Andrew and
I arrived on August 29th, in winter, when the days were
comfortably warm and humid.  Nearly every afternoon
there was a brief thunderstorm and downpour.  Low cloud
cloaked Acatenango and Fuego, two of the three
volcanoes surrounding Antigua.  Only Volcano Agua
directly to the south was consistently visible.

When I walked outside after a week in bed, I walked
into summer. To my surprise, all three volcanoes loomed
on the horizon.  There wasn’t a cloud in the sky. 
Fuego, very much alive, blasted smoke and steam high
into the air.  It was far enough away from Casa Hogar
that it didn’t concern me but I wondered how the Mayan
villagers who lived closer handled the threat.  I
paused, taking it all in.  The beauty of the natural
landscape inspired me, made me feel part of something
more.   

I caught a ride to Camino Seguro’s office in Antigua
and from there plodded to the doctor’s office.  The
waiting room was full.  There was no check-in desk so I
peeked behind the room divider that closed off the back
portion of the room.  The doctor, a middle-aged,
well-groomed Guatemalan wearing a crisp white coat was
just coming out of his consultation room.  I asked if I
could make an appointment for later in the day.   

“We don’t make appointments here, it is better if you
wait,” he said.  “I’m sorry.”  

So I joined the others in the waiting room, pulled out
some Spanish lessons and read them.  When the doctor
finally invited me into his examining room two hours
later, he offered me an apology.

“Sorry to keep you waiting. I’ve had a bad morning,” he
said.  “I was with a young man, only nineteen, with
hemophilia.  He was playing soccer and cut his head.”  

He gestured toward an older-style, worn examining table
and I stepped onto the stool next to it and sat down.  

“It took an hour and a half before I was able to stop
the bleeding so he could be transferred to the
hospital.  This country isn’t well-equipped to deal
with this kind of problem.  There is a good hospital,
but it is very expensive.  I’m worried about him.”

I recalled the young man with a gauze bandage wrapped
around and around his head leaving the clinic earlier. 

The doctor, I believed, was telling me that his patient
would likely die prematurely because he couldn’t afford
to go to the private hospital in Guatemala City’s Zona
10.  The cost to stay there, I knew, was approximately
$US12,000 a week— out of reach for the average citizen
with a daily wage of $5.00.  

I knew the cost because the same weekend I was in
Montericco, a teacher from Casa Hogar took some of the
girls to Panajachal, on Lake Atitlan for a fun outing. 
Jackie, a pleasant, sensible twelve-year-old fell out
the back door of the chicken bus, bashed her head on
the pavement and lapsed into a coma.  The accident
happened, no doubt, because the bus was overcrowded and
people were shoving to get out the back door.  Jackie
was lucky; she had a wealthy Guatemalan sponsor who was
willing to pay the bill for the country’s best
hospital; she might not have survived otherwise.  From
what Dr. Alvarado inferred, the young man with
hemophilia did not have the money to go there, and his
future looked bleak.                                   
                        

Dr. Alvarado introduced himself, smiled pleasantly and
said, “What is your name?”

“Pat Martin”

“Would you prefer to speak in Spanish or English?”

“English,” I said.

Dr. Alvarado asked me some questions about myself.  He
was very personable, and his English was excellent.  He
had studied in Texas, he said, and apologized for his
Texas accent, an accent that was not evident to me.    

“Now, what can I do for you?” he said.

“I think I have more than one problem,” I said, and I
must have rolled my eyes because he burst out laughing.
 

“Sorry, sorry, it was the expression on your face,” he
sputtered. He tried again.  “What seems to be the
problem?” 

“I might have parasites,” I said with a grimace, “and I
have had a bad cough for the past three weeks that I
haven’t been able to get rid of.” 

I pulled out a sheet of paper on which I had detailed
my various symptoms day by day.  

After reading it, Dr. Alvarado said, “I like this; you
are very organized.”

I smiled.  “That’s one of my strong points.  It’s hard
for me here in Guatemala because everything is so
disorganized.”

“Yes,” he said.  “If you need something by a certain
date, you have to ask for it to be ready a week
earlier.  Then, you’ll get it on time.”

We chuckled because we both knew it was the truth.
  
“Let me explain what happened to you,” he said.  “What
you saw were parasite eggs, so you do have parasites. 
This is a very common complaint in Guatemala.  A large
number of my patients visit me for this.

“You come from a clean country.  Guatemala is dirty.  I
grew up here and my body is used to it.  You are new
and you don’t have any defenses against these things.

“These parasites burrow into your small and large
intestines.  Sometimes they get into your bloodstream
and travel.  They go to your liver. The dry cough you
had initially was the parasites.  They were in your
esophagus.”

Horrified, I said, “You mean they (the worms) were in
my throat?”  I had never heard of such a thing. 

“Yes,” he said.  “That was the tickling sensation you
felt.”

My face, I’m sure, showed my revulsion.  (I’ve been
told I have a very expressive, easy-to-read face.)

“And the sore throat and laryngitis were caused by
them.”  He patted my shoulder.  “I understand your
disgust but many people get this.  Because your body
was using all of its resources against the parasites,
you weren’t able to fight the bacteria that invaded
your lungs.”
                                                      
I groaned.  Jan, my neighbor, had two bouts of
parasites in six weeks, I knew.  Another volunteer, an
attractive young woman from Holland told me she
expelled a tapeworm.  Many people had parasite stories,
but I had hoped not to have a story of my own.  

“You got the parasites from contaminated water or from
eating food that wasn’t properly cleaned, maybe in a
salad.  You must never eat from street vendors and you
need to wash the outside of fruit, even fruit that you
peel, like bananas.  It is very dirty here; there are
many bacteria and parasites.”

I had been careful; I never drank anything except agua
pura (purified water).  I always used waterless hand
sanitizer (a disinfectant) if I was in a situation
where I couldn’t wash my hands before eating.  I always
chose restaurants that catered to tourists; the prices
were a little higher but I felt that a better standard
of cleanliness was worth it.  Both Andrew and I had,
however, eaten with the children at Casa Hogar many
times before we discovered they didn’t use agua pura. 
And we suspected that some restaurants did not use agua
pura when they made coffee.

Dr. Alvarado was very attentive.  Although many people
waited, he didn’t rush.  During my 40 minutes with him,
we spoke of many things besides my health: Casa Hogar,
family values in Canada, politics, how I felt about
Guatemala.

“You are a very sensitive, caring person,” he said.  

“Why do you say that?”

“I can see it in your eyes,” he said.  “Be careful here
in Guatemala.  People will take advantage of you. 
Everyone here wants something for nothing.  And there
are many robbers.”

“I know,” I said.  “They robbed my husband.”  I told
him about the pickpockets on the chicken bus.

“They practice, you know, for hours and hours.  One of
my patients told me about it.  They place a stone at
the bottom of a fish tank, fill the tank with marbles
and practice getting the stone out.”  

As we talked, Dr. Alvarado took my blood pressure (a
low 100/70) and temperature (slightly below normal.) 
He listened to my heart and lungs.  Then, he asked me
to lie down on the table.   He made fists and used them
to rap different areas on my abdomen, listening closely
to the sound.

“You can tell if I have parasites by doing that?” I
asked.

“Yes, there is a different, high-pitched sound where
there is inflammation.”

He located an area just below my navel and tapped it
several times.

“Ah,” he said.  “Here.”

He stepped away from the table, and I sat up.

“Taking Amoxicillin was not a good thing,” he said. “It
would be the first choice medication in your country
but here the bacteria are resistant to it because it is
so easily available.  I have another drug to give you,
though.  Would you prefer a shot or pills?”

“Pills,” I said.  (I didn’t want to take a chance in
case he re-used needles.)

He left the room and returned with a glass of
orange-colored water and some packages of large white
tablets, popped two and asked me to drink them down
with all the water.  

“A double dose to get you started,” he said. 

“I usually take a stool sample to confirm the parasites
but I’ll give you some medication today that will kill
all types of parasites.  Here’s a package for your
husband.  He’ll have them, too.”

He filled a small bag with a box of cough medicine,
antibiotics and medication for parasites, and wrote
clear instructions in English on a piece of paper for
me.  We settled the bill.

“I’d like to see you in about a week’s time,” he said. 
“Just stop in and let me know how you are doing.”

I felt so sick and he was so caring that gratitude
filled me.  

“I was afraid to see a doctor in Guatemala,” I
admitted.  “That’s why I put it off.  But I feel
completely confident in you.  Thank you so much.”

We shook hands and he gave me a little hug before I let
myself out.  I hoped I would have a swift recovery.

=============================================

Note:  November 16 - Just back from doctor.  I have
still not recovered from my lung infection.  Trying
different medication now.  Cross your fingers for me.