Karen Unincorporated

This post starts takes up where my last post left off.  To get the full story, click here.

The next morning, the headache was, unbelievably, even worse.  But oddly enough, I didn’t have much of a fever.  Must be the Tylenol.  And now, a long debate began.  You see, the minute I stepped off the plane, my insurance coverage from my time in Africa ended.  And having just stepped off a plane 6 weeks earlier than intended, I didn’t have any insurance lined up in the US yet.  So, here I was, unemployed, uninsured, and very very sick.  Now if this was Africa, I would have had zero options.  None.  But this is the US, so I have Denver General.  And a credit card.  And a terrible sinking filling that this is going to be an expensive day.  At this point the headache was so bad I could barely move.  Every time I would try to re-orient myself, shooting pain would go up the back of my neck and wrap around my skull like I was being picked up by a junk-yard claw.  This must be what a migraine is like, I thought.

So my parents, in all of the joy of parenting, took me to the walk-in clinic at Denver General, having calculated that the clinic would most likely be less expensive than the ER.  You fill out a little slip of paper with your complaint, name, and social security number.  I dutifully filled in the space next to the word “Complaint” with the word “malaria”.  The question was whether a hospital in Denver would be equipped to accurately and quickly diagnose and treat malaria.  So we sat and discussed while we waited (a very long wait, but shorter than the wait in the ER because I didn’t have a gunshot wound).   When I finally got called, I was barely on my own power.  That short walk from the waiting area to the exam room was the last walking I’d be doing for several days.

When the nurse came in to see me, she took one look at me, told the PA to draw some blood to test for malaria, and told me to touch my chin to my chest.  I almost passed out, and it wasn’t the blood being drawn.  How many millions of times have I looked down?  Many millions, I’m sure.  Then, in what I thought was her taking pity on me, she asked me to lay down.  After the excruciating pain of changing my axis had passed, the real torture began.  She took me through a series of the most painful moments of my life, including such diabolical exercises as pushing on me feet, lifting my leg towards my chest, and, worst of all, asking me to turn my head.  Heartless, I know.

And then, she said the M word.  No, not malaria.  Meningitis.  I didn’t even know what meningitis was.  Some band once had a song about it, I’ve heard it’s not fun, but my expertise stopped there.  I also knew that all of a sudden, all of the staff in the clinic started taking pity on me.  But the nurse only suspected I had meningitis.  It would take two things to prove it, which are detailed below:

1. A CT scan.

This was to rule out a brain tumor.  OK, I’ve had a CT scan before, I understand what’s involved there.  A brain tumor however, that’s new territory.

Mike the radiology guy came to get me for my CT.  Mike made everything instantly OK.  If everyone had a Mike in their life, there would be no need for drugs.  He’s one of those balancing people who help tip the cosmic scales toward the good.

And, Mike had meningitis, so he knew, like the doctors didn’t, what was going on in my head.  He didn’t make me walk, or move, or flex one single muscle.  Nor did he ask me to touch my chin to my chest.  Thank you Mike.  And he had lots of good meningitis stories.  He waited 10 days (10 days, can you believe it!) before going to the hospital because he thought he just had a bad headache.  Wow.  To quote Bill Bryson, I felt like a cupcake.

Thank goodness, no tumor.  But Mike stopped by every time he was passing in my general direction to see how I was doing, commiserate with me, and tell the annoying woman across the hall to keep her voice down.  Ah, small mercies.

And now, the second definitive way to diagnose meningitis:

2.  A spinal tap.

A what?

Did you just say spinal tap?

And I’m guessing this won’t include bad 80s haircuts and even worse music.

No, we’re talking giant freaking needle inserted into the biggest nerve in your body to remove the fluid that keeps your brain from clonking against the inside of your skull.  That kind of spinal tap.

By the way, did I mention Denver General is a teaching hospital?  And you’ve got to learn to do a spinal tap at some point, right?

I did learn one very important lesson that day.  Actually, two.  First, a walk-in clinic in a big hospital is a fairly calm, well-staffed, sane place.  But the scope of what they can do is limited.  The ER however, is crazy busy, well staffed by adrenaline junkies (aka medical interns) who are eager to practice all that cool stuff they just learned.  And the second thing I learned is that if you ever get a spinal tap, it is very important that your hips and shoulders are in line.  It took 4 tries to figure that one out.   That equals 4 pokes with the most giant needle on the planet, which I never did get to see, but I’m sure is at least twelve feet long.  Finally, a doctor took over, got it down in one try, and removed what equaled about 2 teaspoons of fluid from my spine.

Since I’m the type who thinks that’s a lot of fluid to be pulling out of my brain, I did some research and discovered these fun facts:

A human being has about 140 ml of spinal fluid.  A couple of teaspoons is somewhere in the neighborhood of 10 ml.  So that’s about 7% of the total fluid.  This doesn’t sound like a lot, but when it’s no longer keeping your brain from clonking against the inside of your skull, it’s a lot.  So now, I had not one but two very distinctive headaches. One from a brain infection, the other from my brain sitting in fluid instead of being surrounded by it.

Another fun fact:  Your brain runs on chemical reactions.  Those chemicals are secreted into your cerebral fluid where the receptors in your brain pick them up and make you feel happy, or help you judge distance, or transmit feelings from your fingers to your brain.  So when you have meningitis, this chemical reaction gets interrupted.  I was really, really lucky.  People die from meningitis.  A lot.  And if you live, it can impact you for the rest of your life, not unlike a stroke.

And certain types of meningitis are very contagious.  So when the doctors were 90% sure I had meningitis but hadn’t confirmed what type I had, they asked me if I could provide a list of the people I’d had contact with over the last 72 hours.

Uh, ok, let’s start with everyone who may have crossed my path in the international airports in Kampala, Nairobi, London and Denver.  Right.  I think everyone breathed a deep sigh of relief when the lab came back that my meningitis was not the super contagious variety.

By this time, they’d found me a bed upstairs in the hospital instead of in the ER.  And since they still weren’t sure how contagious I was when they moved me, I got a room all to myself.  And a truly amazing view of downtown Denver.  Score.  I couldn’t look out the window during the day due to light sensitivity, but I sure could stare out at the night lights for hours.

So, three days passed in a haze of painkillers and tests.  Since I’d just been in Africa, they tested me for everything they  could think of.  And that’s a lot of testing.  At one point, a new-to-the-case doctor asked me, in all seriousness, if I did any drugs because of the number of needle tracks on my arms.  That was a good laugh.

And life goes on.  I got out of the hospital, I got rid of my headache through the unexpected combination of prescription sleeping pills and buckets of caffeine.  Oh, and narcotics.  And then, I started to normalize and sort through the leavings of meningitis, and see that when I emerged from the haze of drugs and pain, my whole life had shifted.  That going straight from a crazy, intense experience in Africa right into a hospital hadn’t given me any time to deal with the reverse culture shock, or the difficulty of a bad illness (or illnesses).  It was like I’d been staring at the same picture my whole life while standing on a very slow moving walkway.  My perspective over the years changed very slowly, but then, suddenly, I took a giant step, and the whole view shifted immediately and noticeably.  And now, I’m trying to make sense of that new view.

I set out on this journey, not that long ago, with a plan for a year filled with all the things I’ve wanted to do.  I was hoping it would change my life.  I had no idea how much it would.   The cosmos seemed to have a very different idea of what I should be doing.  Now, I just have to figure out what that is…

I wouldn’t call myself a hypochondriac.  I’d call myself a realist.  Who goes to Africa planning on getting malaria?  And twice?  Really?  So time to call it a day.  Or rather, six weeks.  Time to get on a plane, head for home, recuperate, and make a plan.  A plan that does not include any of the countries colored in red on this map.  Which are, by the way, all of the places I have any interest in seeing.

Places I Won't be Visiting for a While

When I got to the airport in Kampala at 4:30am, ready to hop a flight to Nairobi and then London, I had a headache.  I never get headaches, unless there are margaritas involved.  Since we’ve now established I’m a realist, I wrote it off as another bout of malaria.  I didn’t have a headache either of the last two times I had malaria, but who knows, maybe each iteration brings its own special characteristics as my body builds immunity.  Maybe this is some new strain of Malaria that rewards its victims with super powers, since the third time’s the charm after all.  Perhaps this is the ESP setting in.  Maybe next I’ll be able to turn invisible at will or gain the power of flight.  All I needed to do was take Tylenol to control the fever, buck up and get home.

I had a layover in London, and got to see my friend Lyndon, who rode, on a motorcycle, for three hours in the rain to come and hang out with me.  Talk about super powers.  Friends are an amazing thing in this world.  We went to the pub, had a beer and some good, familiar food.  Goat did not appear on the menu, and neither did matooke.  It was a good night.  But I couldn’t seem to kick the headache.  Fingers crossed for ESP or maybe even x-ray vision.

I got on a plane headed to Denver the next day.  The entire flight, my headache was getting worse and worse.  I couldn’t seem to get it under control.  I was so so relieved to step off that flight and take a deep breath of brown cloud, mile high air.

Until I came down the escalator into the pit of hell.  OK, so maybe it wasn’t actually hell, it was just the US Customs and Immigration Hall at DIA.  But the line for immigration was very, very, gaspingly long.  I thought I might pass out.  They guy about 20 people in front of me did.  It was a sheer act of will that got me through that line.  And the loss of any sense of queue propriety.  Everyone would shuffle a few feet forward and stop.  Shuffle, stop, shuffle, stop.  Shift from foot to foot, strike up a conversation with your neighbor.  I would shuffle, stop, sprawl shamelessly on the floor with head in hand, or stare vacantly at the ceiling and wish I were dead.  Good thing every one was too busy looking at the guy who passed out to notice me being very un-American by sitting while in line.

Finally, the front of the line.

Immigration officer:  “Welcome home.  What countries have you traveled to?”

Me:  “Uganda, Kenya, UK”

Immigration officer:  “Africa, huh?  Interesting.”  Stamp stamp stamp on my passport and customs form.  Weird.  I don’t remember getting that many stamps on my customs form before.

It took me another two minutes to realize that those extra stamps meant extra special attention in the customs hall.  Meaning every single check available.  Wait in line to xray every bag I brought, followed by waiting (and waiting and waiting) while every single bag was hand searched by the customs official.

Now a note about the customs officials.  I was grumpy.  I was sick (literally) and tired.  My gripes that day didn’t hold a candle to the gripes of that poor, put-upon customs official.  Imagine that your job, 8 hours a day, is to search through the dirty underwear of tired, grumpy, hungry travelers who have just sat in coach for the last 10 hours and have nothing better to do but take out their frustration on you, whose job is to keep our country free of drugs, weapons, and unfriendly bug species that want to ravage our crops.  I felt very bad for her.  And tried, through my headache, to let her know, as politely as possible, that I understood she had a job to do, but could she maybe search a tiny bit faster so that I could sit down before I fell over and made her job even more difficult by making her call the paramedics.  She, unbelievably, smiled a real smile, chatted pleasantly with me, and searched just a little faster.  Thank you customs lady.  Or maybe I just really did look that bad.

When I stumbled out of the customs hall nearly 2 hours after my flight had landed, still waiting for my x-ray vision, I was completely exhausted.  And my parents were there, ready to take my luggage from me, bundle me in the car, and take me home.  Home.  Something so familiar and yet so different than where I’d been the last several weeks, and had planned on being for many more.  So much to process through this splitting headache.  All I could do was tumble in to bed and try to sleep it off.  And hope to wake up with my new power.

Real time update:  Amie, Ned and I wanted to watch the US election coverage with the minimum chance of power or internet outage.  So here we are, holed up in the Sheraton in Kampala, where there is a giant generator, direct TV satellite coverage, and a nice hot shower.  This election is different.  The excitement in Kampala is palpable.  More to come…

Welcome to Uganda, where fuel is leaded and pedestrians live in fear.  Coming from the US, I’m used to a certain level of order in my traffic patterns.  Having traveled to Africa once before, I knew not to expect the same here.  The first day in Kampala seemed like chaos.  Blue and white mini-buses competing with SUVs for the same 5 feet of tarmac, wildly smoking scooters zipping everywhere ludicrously loaded with people and goods.  And among all the chaos, here’s me, trying to cross the street.  How hard could it possibly be?  I feel like every time I successfully cross the road here I’ve (barely) avoided death yet another day.

So here is what we’re contending with:

The Taxi

Called a taxi, but not actually what we would think of as a taxi.  More like a community mini-bus that travels a fixed route.  In the case of Masaka, there is one main paved road that goes through town.  The taxis drive that one road (see picture below).  Some go as far as Kampala or the Rwandan border, others just go from one end of town to the other.

In the picture below you can see the guy in the orange shirt.  He’s the conductor.  He’s responsible for yelling at the top of his lungs at all times.  I have no idea what he’s saying.  Nor do I know what he actually does.  Besides yell.

The Special Hire

This is what we would consider a taxi in the US.  It’s a car that you hire to pick you up where you are and drop you off exactly where you want to go without stopping in between.  Unless you want to be picked up or dropped off on any of the non-car worthy roads.  Which is almost all of them.  So most of the special hires end up driving the same routes as the taxis cramming as many people into them as possible.  I’ve been in one with eight people before, and that’s not at all unusual.  As a sidebar, the butcher gets his daily cow delivered in the back of a special hire.  Just line the trunk with banana leaves and let the legs stick up in the air, no problem.

The (Infamous) Boda-Boda

Note to my Mother:  I know you’re reading this entry.

STOP HERE

You will give yourself a heart attack.

There are two types of boda bodas:  bicycles and motorcycles.  The name comes from motorcycles that originally would drive from border to border, so through heavily accented English, the name became boda boda.  The motorcycle variety is by far the most popular here because it’s too hilly to manage a bicycle.  Some are scooters, some are dirtbikes, all are two stroke, none are more than 100CCs.  Think lawnmower.

The bodas are a cultural experience par excellence.  Every time I’ve ridden a boda, I can’t stop giggling uncontrollably.  Ask Amie, she thought I was going to fall off the back I was laughing so hard.  They are just so ridiculous.  And yet so much fun.  And so freaking dangerous.  And wearing skirts as often as not, and traveling with other women who wear skirts, I’ve ridden on the back of a boda, side saddle, with another woman, also side saddle, and the operator.  Women are actually encouraged to ride side saddle because if the boda driver takes a “wrong turn” (think human trafficking) you can just jump off.  Yeah, that’s not safe.  And by the way, I’ve never actually heard of anyone being trafficked here.  This is mostly urban legend, I’m told.

And the beauty of the bodas are that they go anywhere.  I routinely ride bodas that will take short cuts down foot paths.  They are far more practical than most vehicles on the road.  They also make up a fair number of the traffic related fatalities that occur in this country.  And by the way, traffic accidents kill more people in Uganda than infectious disease.  For a country that has weekly reports on the number of people dying of infectious diseases published in the newspaper (the number is in the hundreds), that is a big statement.

We were warned by our program that the boda drivers do not have licenses, there is no safety monitoring of the vehicles.  It is not unusual for the drivers to be drunk, stoned, or who knows what.  Having a trusted boda driver here is worth his weight in gold.  Fortunately, my host mom’s brother is a boda driver and is trusted to take the 4 and 5 year-olds to and from school every day.

There is no limit to what you can carry on a boda boda.  Note the sugar cane, useful for pole-vaulting over any particularly large potholes you may encounter.

Need to take the family to town?  No problem!  Might take a little while, but that’s what first gear is for!

I’ve seen pigs strapped to bodas.  Live pigs.

And finally, the most treacherous form of transport.

Your feet. Dangers include open sewers, goats, chickens, the most slippery mud I’ve ever experienced (helped by all the motor oil that leaks everywhere), manure, bodas, taxis, special hires, other people, little kids yelling mzungu, grabbing your hand and not letting go.

People say getting there is half the fun.  Here, it’s all the fun!

One of the things you never, ever see here in Uganda is ice.  No ice cubes in drinks, no slushies, no milkshakes.  Transportation here is slow at best and refrigerated vehicles are too expensive.  If something frozen does get here, the power is off almost more than it’s on, so nothing stays frozen for long.  Ice cream from the grocery store has been thawed and refrozen so many times that the cream separates from the flavor and the water and you end up with a crystalized, not very tasty mash.

So when Ned walked into the office with a snowball, there was great excitement. 

Where did that come from? There was a good deal of arguing over who should throw it at who.  But since Ned is over 6 feet tall and bigger than everyone, he decided the best place for it was down the back of Amie’s shirt.

Chaos ensued.  Ah the joy of a good old fashioned snow ball fight.