Sublimity…

Before I begin, though the title may suggest otherwise, this entry has nothing to do with the new political situation in Canada (you poor silly people is all I can say for now, and no I didn’t vote so I realize it is a little hypocritical…). That whole can of beans is a different matter that’d I’d love to write more about, but it’ll have to wait. For now, Canada is still half a world a way, and while very much important to me, it’s not quite as important as my own current personal health, the real topic of this story.

So I left off on Friday saying that everything was feeling fine and that all signs pointed to a quick recovery, which appears to have taken place now, but it hasn’t been all good news as the route to my current state took a detour through feeling pretty lousy. As I wrote before, I was feeling fine on Friday and Friday night was no different (it was nice to be able to get a good nights sleep), and I woke up Saturday morning feeling quite well. My stomach was still feeling a little unsettled, and there was a minor headache, but they were only barely above normal and I certainly wasn’t worried about them. However, as a precaution I spent Saturday taking it easy here at the guesthouse, trying to give my body some R&R so it could completely fix itself. I had been sitting out on the balcony reading a micro-plan that had been prepared by a village in Orissa 3 years back with the help of some PSI staff (trying to get a sense of what it is that they expect us to present in the end), and since it was morning and somewhat cool, I was wearing some warm layers and feeling nice and warm.

Now before I continue, I have a bit of an admission to make. When writing up the last entry, I left out one little piece, partly because I didn’t want to admit it and partly because I didn’t want people jumping to scary conclusions. However, it now becomes important in this story, so here it is. For the last month and a half, I haven’t been taking my anti-malaria pills, and even for a couple weeks before that I wasn’t exactly regular about taking my daily dose. There were a number of reasons for this, including:

• One side effect of the medication is that it increases your photosensitivity (likelihood of getting a sunburn), and for someone like me who is natural very susceptible to the sun living in a country like India where the weather for the past 3 months has been nothing but pure blue sky and bright sun, this poses a major problem.
• The medicine has to be taken daily, is supposed to be taken at the same time of day (to maximize effectiveness), and has to be taken with food, so I was taking it with supper. However, especially while traveling, I would often go out exploring for the day, leaving in the morning and not coming back to my hotel before eating supper, so I needed to bring my pills with me everywhere – which I often forgot to do. Then when I forgot, I couldn’t make up later as I wouldn’t usually have any other food before bed.
• Malaria is only transmitted by mosquito, and with a few exceptions, I’ve seen almost none of the little suckers. It is winter here and (especially here in Dehradun) gets quite cold at night, and despite how tough mosquitos have shown themselves to be (I won’t forget those Arctic experiences), I couldn’t see how they could be out and about now (especially since the malaria mosquito only bites at night, when it’s coldest). To an extent, I figured “No mosquitos, no problem”.

So far there’s been no problems (actually benefits because I haven’t had to worry about it all the time, and haven’t had to deal with major sunburns), but when I described my symptoms to Sachin (my doctor friend) on Friday, his first question was, “Are you taking anti-malarials?”, and when I explained, he told me that there was a chance that what I had caught was in fact malaria. Dun-da-dun-dah… However, he quickly added that malaria is usually over-hyped, and that even if I did have it, modern medicines easily available here would quickly take care of it. Even still, and despite the fact that it was only one of several possible guesses he had, I’d heard enough horror stories that I still was feeling a little nervous about the prospect. Sachin didn’t seem too concerned though, and advised that I just take it easy, rest and drink lots of fluids, and see how things went. He said if I started to feel worse I should go get a blood test (to check for malaria, other viruses, or bacteria), but hoped I’d just get better on my own.

Anyway, back to the story… Late Saturday morning, sitting in the sun on the porch with my sweaters on, I started to feel warm, a nice pleasant feeling. However, after awhile, I noticed that my forehead was starting to feel particularly warm. With a little trepidation, I went inside and stuck my thermometer into my mouth, and 10 seconds later confirmed my fears – the fever had returned, and my body was currently running at 38.9ËšC.

When Sachin had told me of the possibility of malaria, I had gone back and re-read the information I had on the disease. At the time, I didn’t see any real correlation with my symptoms, but this new fever gave me one more piece of information, and suddenly things started falling into place. The major symptom of malaria is a regularly reoccurring high fever (around 40ËšC) lasting for 4-5 hours, with gaps of around 48-72 hours between occurrences. The fever can also be accompanied by extreme chills, shivering, vomiting, sweating, dihorreah and several other general symptoms, but outside of the fever periods, you feel pretty much normal. Though 3 of the 5 accessory symptoms had matched, I hadn’t been convinced I had a fever the first night, and with no reoccurrence, the pattern wasn’t there so malaria had seemed unlikely. However, this new fever made me realize that plain old blankets and sweaters couldn’t have made me feel as hot as I was on Thursday, and the lengthy period of feeling fine that had now ended by this new (high) fever sealed the deal for me. I decided that I had malaria – and so I needed a blood test right away to make sure.

This opened a whole new can of worms – the quality/safety of medical care in India. On our previous trip, I’d never been to a hospital (Karen & Pradeep’s house around the corner with two resident doctors in it was all we ever needed), but I’d heard horror stories about what conditions were like in the government hospitals (basically you only went there if you were too poor to go to a private clinic, and even then they were over-crowded, under-supplied and staffed with doctors of questionable training). However, private hospitals seemed about as common as cows in Indian communities, little clinics on every block, and like everything else in India, they fall across the entire spectrum of quality of care. Some places are just as good (or better) than what you’d find in Canada (and some of these have started offering package health tours to India – for one low price you fly over, visit the Taj Mahal and get your appendix removed etc., and people are doing it!) while at the same time, some of the clinics are scams run by “doctors” with little or no training who poke you in a couple of places and give you a few random pills, and pocket the money. So government hospital were automatically out (I’d promised my parents I wouldn’t go there, no matter what), and private hospitals seemed like playing the lottery (cross your fingers and pick a number), so all in all, I was feeling a little nervous about going to get a blood test done. Add in the general (un)sanitary conditions of India (a country where the sewer is often the uncovered ditch on the side of the road, garbage is thrown wherever people most feel like  – even if it goes first into a garbage bin, that just eventually gets dumped in on the side of the road or in an empty lot somewhere) and the fact that I was going to be having a needle for the blood sample, and I was even less confident. However, the alternative was to just sit at home sick (with malaria) untreated, which would certainly cause problems, so in the situation, it was better to play the odds…

I called Sachin up and told him of my new fever, and though he still didn’t want to make definitive diagnosis, he also suggested a blood test. When I asked him about a recommended hospital, he gave me a name, but said that his information was a little old and that I should ask around from other local friends to see what they would say. Based on this, I called Ravi who gave me the name of a local doctor he recommended, and then I talked to his American wife Jo who gave me another name as well as phone numbers for both people. I called the two doctors Ravi & Jo had recommended, and found that Ravi’s only had clinic hours that evening (and though he spoke perfect English, he said he had a sore throat and couldn’t talk much – a sick doctor, not a great sign, and I just realized that now while typing!) while Jo’s (Dr. Rakesh Gilhotra) was free that afternoon starting at 1:30 according to his receptionist (who only spoke Hindi). Partly because he was available first, and partly because I decided to trust Jo more (also a foreigner though she’s lived here over 15 years, and also a mother and comes across as more caring/concerned than Ravi), I booked myself in for a consultation with Dr. Gilhotra, the receptionist telling me 1:30 but not answering/understanding when I told her I wanted it a little later, so I figured I’d just show up a little late, no problem. Next I called Sunil (who was working despite it being Saturday – some special extra project our boss wanted him to do) and asked if he could come with me in case I needed any translation/cultural assistance, and just as a general precaution. He was quite concerned and immediately agreed to come (though it did also serve the purpose of getting him the break he desired), so everything was set – I was going to go see an unknown (but recommended) Indian doctor.

By the time Sunil escaped and we had eaten lunch it was a little after 2:00pm, but the doctor’s clinic was just down the street so it took us only 15 minutes to walk there. While waiting for Sunil, I’d taken a bath which felt great and had really cooled me down, so that combined with general passing of time meant the fever was gone and I was feeling fine again – though welcome, it wasn’t quite such a good sign anymore as it kept pointing at malaria. By the time we reached the clinic, it was nearly 2:30pm, a little later than planned, but I figured that it wouldn’t be a problem – especially in India. The clinic was located on the main road, towards the end of (but still in) the residential neighbourhood of Indranagar which is adjacent to Vasant Vihar. The building itself looked much more like an over-sized house than a hospital – the same blocky concrete design, but the pale green colour and the huge white sign with a red cross saying “Sanjivan Hospital” clearly marked it as something different. Walking in the gate also made the difference clear, everything was neat, clean and well cared for (a good sign), but there weren’t the typical flowers & gardens you’d find around a house. We walked up to the main door, and into the lobby, which looked a lot like a hospital to me. A large empty marble-floored room with chairs around the edges and the reception desk at the far end. I went over and told them who I was and asked to see the doctor as per my phone call, but the response I got was that I was an hour late and that everyone had gone on afternoon break and wouldn’t be back until 5pm – apparently hospitals are unlike most places here and things actually run on schedule. However, I told them I would really prefer to see a doctor before then, and after a few phone calls, I was told that someone would see me in about 20 minutes. However, before I went to sit down (and before I’d even glimpsed a doctor), I was asked to pay for my consultation, a total of Rs. 150. While it was a little more than I had been expecting even for a private hospital (all I was doing at that point was going to get a check-up and talk to the doctor), it was still only $3.75 and when you get what you pay for, I’d rather spend the extra money when it comes to my health. So I handed over the money (a little nervously as paying in advance in this country generally is just asking for trouble) and took a seat to wait.

Siting in the waiting room reading a news magazine waiting for a doctor made the whole experience seem very Canadian (especially when the promised 20 minutes had passed and I was still sitting there). There were a few other people waiting as well so apparently though I was outside visiting hours, that didn’t really mean the doctor didn’t see any patients. After about 40 minutes, I finally got up and asked the receptionist when the doctor would be available, and she told me that he was available right now, and I should just go down the hall. It struck me very odd that once I asked he was suddenly available, but at the same time, if I was comfortable waiting, so were they. However, when I entered the office, I found why, the doctor was just finishing with another patient, so I sat on a stool and waited. The office was nice – small and clean – and had a desk on one side and an examination table on the other. The man behind the desk was older, and between his white lab coat, glasses and the stethoscope around his neck, looked very professional and doctorly which was reassuring. The other comfort was that he spoke perfect English, something I hadn’t been sure of before and with all the receptionists speaking only Hindi, had been a little afraid about. I think I could have gotten on fine in Hindi (one of the units we did at Language School was on being sick – a common thing for foreigners in India hence important to be able to have a conversation about) but being able to talk in English made me more comfortable, and the fact he spoke English also indicated that he likely had been well trained at a prestigious place. I explained my situation and symptoms, and after listening to it all, he took out his stethoscope and listened to my heartbeat on my chest and back. In the end, his conclusion was the same as Sachin’s, there were a number of different possibilities and only a blood test would be able to figure it out for sure. With this, he pulled out his prescription pad, jotted down a note on one piece about the tests I’d need (recommended a urine test too), and on the other gave me a prescription for Paracetamol (Tylenol) to help the pain/fever, and a Gravol-like drug to quell the low level nausea I’d been feeling. He then looked at his watch and asked if I could come back around 6 to discuss the results of the tests, and quickly agreed. I’d been a little worried about how long the test would take to process, I’d had blood tests back in Canada that had taken several days (or was it weeks, I forget…) to complete (mind you they were more specialized tests, and just precautionary checks so of less priority) so I figured it could be a long process (hence I was eager to start), but if they were going to be able to get the results in just 3 hours, I wasn’t going to argue. Maybe there is some benefit to paying for private health care…

The actual blood sample was taken by a nurse out in a little glassed off area off the waiting room. My big concern was the needle, but it came individually wrapped and was opened in front of me so it seemed OK (syringe, wrapper and box all looked like what we have at home). The nurse seemed to know what to do and everything went pretty well, though I don’t think she quite hit the vein perfectly as the blood came out, but only slowly so even though it was a small sample, it took awhile to fill the syringe. However, it didn’t hurt at all, and though she had to wiggle the plunger a bit to clear air that had snuck in, it didn’t look/feel like I got any air bubbles in me (the biggest danger associated with injections/extractions as I remember), so I was happy. The urine sample was quick and easy (the hardest part being limiting myself so I didn’t overflow the little cup – once you get going it’s hard to stop), and so less than 10 minutes after walking into the doctor’s office, I was done. However, the blood/urine tests meant paying more money (Rs. 420), and the pills were another Rs. 50 (the Paracetamol was Re. 1 per pill, shows how cheap drugs can be here), so all in all, my trip to the doctor had cost me Rs. 620 ($15.50). I don’t know what the costs for a similar visit would be at home (good old universal health care means it’s free to me) but I’m sure it’s at least that much if not more – so I figured it was a pretty good deal.

At 6 o’clock, I met with Dr. Gilhotra again and got the results. I was a little nervous going in as this was going to confirm/deny if I had malaria (of which I was fairly certain), and it’s one thing to think you’ve got some bad disease, but quite another to find out for certain. However, to my (pleasant) surprise, the tests had come back negative for malaria. Infact, the test had come out within normal range for all the parameters, and so Dr. Gilhotra said he still couldn’t tell what was wrong with me, but recommended that I just continue to rest lots and drink lots of fluids, and just let my body fix itself. He said I should call him if my symptoms flared up again, and regardlessly I should call to checkin on Monday, but he thought I was going to be fine. I asked him a few more questions about malaria and whether I should be taking the antimalarial medication now in Dehradun, and he said I shouldn’t bother for at least another two weeks. Additionally, he recommended a different medication saying it was much easier (only twice a week and without enhanced sunburn risk) and more effective, so I was even happier (though I want to check this with a few other doctors before I switch from my Canadian prescribed one). Walking back to the guesthouse, there was a new spring in my step – I was feeling good and had nothing to worry about. While walking home, my parents called (oh wonderful cell phones) and so I talked to them for quite awhile, which meant I didn’t get back to the guesthouse until 7:30pm, where I found Sunil and Supna anxiously waiting, wondering what had happened to me. However, I told them the good news and that made them feel a lot better.

Unfortunately that’s not the end of the story, that night as I was going to bed, I started to feel warm again, and at bedtime when I took my temperature, it was 38.7ËšC. I took half a paracetamol as recommended by Dr. Gilhotra and tried to rest, letting some cool air into my sleeping bag, but my temperature just kept going up, and this time hit 39.4ËšC at which point my forehead felt like it was burning up. Lacking a facecloth (very high fever is dangerous, and a cool, moist cloth on the forehead helps drop the temperature a little and also just makes you feel more comfortable), I took a mis-matched sock (hence clean) and filled one of the bathroom’s dipper cups with cold water and used that combination to cool my forehead. It was kinda scary how quickly the sock would heat up once on my forehead, and after about 15 minutes, my water had become quite warm. I took another full Paracetamol because the first one didn’t seem to be working, and lay back down in the darkness, rotating the wet sock on my forehead and feeling pretty horrible. Additionally, the timing of the fever (exactly two days after the first) in combination with the severity of it both fit malaria symptoms perfectly, and even though the blood test that afternoon hadn’t found any sign of malaria in me, it seemed quite an odd coincidence to be having the exact same (slightly odd) symptoms due to an unknown bug, and I started wondering if maybe I did have malaria and they’d somehow missed it in the test. However, as bad as I felt, the sock treatment did cool off my forehead (it almost felt a little numb from the temperature change) and the Paracetamol started to take effect, and I slowly started feeling better, eventually falling asleep about a hour and a half later.

I woke up in the morning feeling perfectly normal (and this disturbed me a little more, it was consistent with malaria) but since I didn’t have any problems at that time, I decided not to bother Dr. Gilhotra and figured I’d tell him on Monday. So I sat back and rested all day Sunday, feeling fine the whole time, and Sunday night was no different. On Monday morning I was feeling quite well, so I decided to go to work as we were to have another day of re-orientation about micro-planning, and though I was dubious that it was actually going to happen (or if it did, whether it would be of any use), I didn’t really want to miss it on the chance it could be good. In the end, although we started an hour late, it was worthwhile, and I felt fine through the whole day. I called Dr. Gilhotra and told him about my Saturday night fever, but since everything had been fine since then, he said it didn’t really mean much and his suggestions hadn’t changed – rest and fluids. Monday night I felt a little nervous getting ready for bed, as according to the pattern that had been established, I would get a fever that night, but in the end it never came. I woke up feeling great on Tuesday morning – both mentally and physically, I’d broken the pattern which seemed to indicate that I was truly getting well – and when I still felt fine on waking up this morning, I cast of any doubts and celebrated – I’m healthy again. I still don’t have any idea as to what it was that was wrong with me, as I’ve said again and again, the pattern of symptoms seemed strange and I can’t think of anything abnormal I ate/drank/did right before getting sick so it’s quite a mystery. However, it’s a mystery that’s behind me, and for now that’s all that matters. I’m healthy again, and here’s to hoping I continue to stay that way!

This entry was posted on Wednesday, January 25th, 2006 at 5:26 pm and is filed under India. You can follow any responses to this entry through the RSS 2.0 feed. Responses are currently closed, but you can trackback from your own site.