Women in Aid is pleased to publish this first hand account of Mandy George (@mandygeorge) and her harrowing encounter with malaria whilst working in Haiti. We wanted to publish this story in order for all aid workers (not just women!) to be aware of the importance of being prepared for any eventuality when it comes to your health. Do share any lessons you may have learned with your own experiences when traveling and taking ill.
Disclaimer: Please check your facts on strains of malaria in your working environments. We are not malaria/health specialists and the post below should not be taken as technical medical advice.
Mandy George is a humanitarian communications and accountability specialist. She most recently spent the better part of two and a half years working in Haiti until malaria ejected her from the islands and back to the UK, where she is now fully recovered and is working as an independent consultant until her next overseas adventure. Today, on the one year anniversary of being diagnosed with malaria, Mandy has launched a fundraising campaign for a UK based charity, MALARIA NO MORE.
December 2nd, 2012. On Sunday I was windsurfing. On Wednesday I was in Intensive Care. On Friday I was put into an induced coma. I very nearly didn’t come out of it. Almost four weeks later I left the Santo Domingo ICU, after what was heralded as a medical miracle. Or an act of God, depending on how you like to look at these things. What happened? Malaria happened.
Perhaps you didn’t know that Haiti has malaria. Or perhaps like me, you know but never thought it could be that serious. A combination of lack of accurate information with a heavy dash of “it-will-never-happen-to-me-itis”. Common practice among invincible aid workers, part foolhardy and part necessity to do these kinds of jobs and expose oneself to risks that are considerably more elevated than taking the Central Line to work every day.
I certainly knew something was wrong when I was hit out of the blue with acute headaches and a progressively intensifying fever. The lack of cold and flu symptoms led me to believe that I was indeed afflicted with some type of tropical ailment. Hmmm. Malaria or dengue? Let’s hope it’s malaria. At least then I can get treatment.
In many cases rapid treatment would mean no more than a minor concern, which is what I was feeling at the time. But there were two things I was unaware of at the time. One: there is another strain of malaria, falciparum malaria, which is extremely dangerous. Two: if you don’t get treated immediately, the chances of malaria killing you rise exponentially.
A series of unfortunate events led to my delay in treatment. Part complacency, part logistical. I was living in Haiti but on holiday in the Virgin Islands with my family. Despite the fever, I imagined that Haiti would know how best to treat whatever I had, plus I just wanted to get home, so off I went. Two faulty plane engines later, and a night in a Miami hotel, meant kilos of sweat and precious time lost before I was finally diagnosed with malaria in Port-au-Prince.
Despite the best efforts of the clinic that I was in, it soon became apparent that this case was too serious for them to deal with at the medical facilities in Haiti. The parasite was hard at work and jaundice and pneumonia had set in. Did you know that malaria can cause all your major organs to fail? I certainly didn’t. I caught a glimpse of myself in the mirror at one point. No wonder everything had a golden glow. My eyes were totally yellow, red, all the wrong colours of the rainbow.
I was working as a consultant and had my own medical and evacuation insurance. The few minutes it took to purchase the above online translated into one of the life saving elements of this story. But I was also lucky to be working with a team of colleagues who recognised the severity of my situation and were able to pressurise the insurance company to fly me out to the Dominican Republic that night. If not for them, I almost certainly would not be here telling this story now. I learnt that just having the insurance is not enough. If you are too sick to deal with phone calls you need to know someone has your back.
Once you are medevaced, your problems are not necessarily all solved. My friend who accompanied me on my one-way voyage was then landed with the task of finding me a bed in an intensive care unit, in a country she did not know, in a language she thankfully did speak. The first place I was taken to was full, and she was handed a list of hospitals to find me a place in. It was thanks to a helpful nurse that a good hospital was identified and off we went, a midnight tour of the darker side of Santo Domingo.
From here on things get blurry. I’ll give you the medical facts. The parasite attacked all my organs. My body went into septic shock – lungs, liver, kidneys, stomach – you name it, it failed. Even when the malaria was brought under control, I was left with all of the other problems. I swelled up to twice my size – or at least my legs looked that way. Everything went yellowish orange. Skin, eyes, urine. I had blood transfusions and dialysis. But for me the worst part was the feeling of drowning. My lungs were infected, filled with fluid. I was gasping for air even though there was air all around me. They were trying everything to make this better. All sorts of contraptions on my face, medication to inhale, balloons of air pumped into me. Nothing worked.
The last image I remember is having a mask on my face, trying desperately to breathe, drowning in my own lungs. To my right the head of intensive care is standing, staring intently at my screen. Arms crossed, serious expression. Behind this, my friend is standing, silent tears rolling. This is very serious, I thought. But I am not going to die. I am close, but it is not yet my time. Was I panicking? I was too sick to be afraid. I had no energy to worry. But there was a certain strength in my conviction that I would be OK. And then I slipped off into an induced coma. Relief.
Despite this conviction however, it is a good thing that I did not know exactly what was going on. A visit from the Ministry of Health shortly after, who were tracking my malaria progress with great interest given the rarity of this type of malaria in the Dominican Republic, led to the official commenting to my doctor that there is no way this girl will leave here alive. We shall see about that, said my doctor. The determination of this marvellous woman and her team was another factor that proved that official to be wrong. But only just.
The reason for knocking me out was so that I could be put on a ventilator that would breathe for me, until my body could manage on its own again. I’ve never see anyone on a ventilator although I do take more of an interest when this appears in medical dramas these days. Apparently it looks pretty shocking. The tubes have to be strapped across your face to ensure they don’t move around. The machine makes you rise and fall in an artificially eerie way. Add this to the vision of swollen infected me, and it’s not a pretty picture. At least this is the way that my friend who visited me described it. It shocked him so much that he couldn’t even approach my bedside. My heart goes out to my friends and family who sat by me through this horrific sight. When I think of the roles reversed, it makes me feel physically sick. What they went through I would not wish on my worst enemy.
Of the following week I remember very little. The faces of family and friends who came to visit me floated across my vision from time to time, like low budget 80s music videos, blurred around the edges and in psychedelic orange tones. Lots of voices telling me I have to stay calm, that I have a tube helping me to breathe, that I have to stay still. Not that I had the energy to move anyway. I didn’t feel any pain because of the heavy sedation, but I was in a very dark and uncomfortable place. I was fighting for my life.
At one point things turned around. Suddenly I was no longer getting worse, but began to show small signs of improvement. At some point around this time, I had to come off the ventilator, to prevent permanent damage being done to my body. I was given a tracheotomy. A small hole in my throat, and this became the place that I would breathe from over the next two weeks. Slowly I emerged from the coma, back into the real world.
But intensive care is not the real world. If you have ever been in there, or known someone who has, you will know what I mean. It is an oppressive, strip-lit piece of eternally beeping chaos. If there are ten beds, then there are ten machines beeping at infrequent uncoordinated intervals creating a hellish symphony of pandemonium. There are people dying and people crying. There is the 24/7 chatter of the nurses. Time stops. No windows, no daylight, no starlight. Just mechanical eternity. Minutes blur into hours into days into weeks.
Recently I read a statistic that up to 80 per cent of ICU patients are affected by delirium. I was one of those eighty percenters. For me this meant living in an alternative reality for a few days. An alternative reality that was nonetheless a reality because I experienced it as if it was real. It was full of fear and paranoia where almost everyone around me was trying to harm me. Have you ever had a nightmare where you never thought you would be able to escape, that it would last forever? That was what this was like. I will spare you the grim details of what I thought was happening to me, but let’s just say that I felt like I would be in this ICU hell forever. Every day they would try and remove the tracheotomy so that I could breathe on my own. It took a few days of attempts. I was starting to give up hope that I would ever leave. My family and friends were beginning to get very worried about my mental health. And then finally, they did it. And the minute they rolled me out of ICU into my own peaceful, quiet room, the alternate reality disappeared and I was back on the right side of the dark side.
Somewhere around this stage it became apparent that I was going to make a full recovery. Which was an encouraging piece of information to have because I could neither walk nor talk for about three more weeks. My vision remained blurry for one more week. My need to communicate increased as I went on recovering, and I must have depleted a small forest with the amount of paper I went through furiously scribbling notes to my family and friends. Slowly things started returning to normal. I took my first few assisted steps, just a few, that was all I had energy for. I began eating food again. It tasted so good!
Although I was getting better, this part was difficult. I could measure my physical progress and it was encouraging. One day I couldn’t sit up by myself in bed, the next day I suddenly had the strength to. But now that I was not too ill to think, my brain kicked into gear and I was hit with a barrage of realisations. I would not be able to return to my previous life in Haiti – at least not for a long time. In fact, I wouldn’t be able to do much of anything for a few months while I recovered. My wonderful doctor noticed this dip in my morale and stepped in to help me get it back. She would stick me in a wheelchair and roll me outside into the sunshine. Sunshine! After 4 weeks of windowless hell. It was blissful. She sent me out of the hospital long before my mother and I thought I was ready to leave – I still couldn’t walk or stand up on my own. But she knew I needed to get out of there and that I would find a way to manage. She was right.
Over the next two weeks I steadily improved and for my next check up at the hospital I was able to manage almost the whole day without a wheelchair. The nurses clucking around me exclaiming, “Thank God, it is a miracle!” To cut a long story short, lots of tests and one operation later to close the tracheotomy and I was finally allow to fly home. The rest is a progressive tale of slow recovery, patience, internal growth and reflection that leads me up to today, where I am back to my normal self. It took a good six months to feel good again. I underwent surgery twice to get rid of scar tissue build up in my trachea that was preventing me from breathing properly – damage from all the tubes in intensive care. That held things up a bit, but my doctor’s prediction of six months was very accurate. After three months I started working part time. In hindsight it was too soon and quite a struggle energetically. My brain was ready, but my body was not. Another three months later and it was a different matter.
You may ask, why am I telling this story? Fundamentally I hold the belief that illness is a great teacher and comes to us when there are things in life that we need to sit up and listen to, things we need to change and shifts we need to make. As such this was a profound learning experience for me and I’m sure this learning will continue for a long time. I can now understand Nietzsche’s words: “Only great pain…compels us to descend to our ultimate depths…from such abysses, from such severe sickness, one returns new born having shed one’s skin, with merrier senses, with a second dangerous innocence in joy, more childlike and yet a hundred times subtler that one has even seen before.” That said I feel that it is my responsibility to share this story because on reflection of the practicalities there are many things I did and didn’t do that both saved me and almost killed me. Hindsight always has 20/20 vision and the good choices seem more obvious to me now.
Here are some of the things I have learned the hard way:
· Don’t let complacency get the better of you. Low risk does not mean no risk.
· Take your anti-malarials, even if you are somewhere long term. There is no medical evidence to suggest that they are bad for you and they can save your life.
· Don’t get bitten. Use spray, nets, whatever it takes. Malaria is not the only nasty thing mosquitoes can carry.
· If you develop a fever or other symptoms get them checked out immediately – delay could be fatal.
· Have a malaria testing and treatment kit handy and if you can’t get to a medical facility immediately and think you might have malaria, take the medication just in case.
· Never travel to anywhere without a good medical system if you are not feeling well, even if it is the place you call home.
· Always have medical and medevac insurance. Carry the details with you and share them with your employer if you are a consultant.
· Just having insurance does not guarantee you will be OK if you get seriously ill. Check with your employer what will happen if you fall extremely sick and question this if you do not think it is comprehensive enough. Who will take responsibility for ensuring your well being? This is particularly relevant if you are a consultant and are ultimately responsible for your own health and medevac insurance.
· Keep fit – this could give you a few brownie points if you get majorly ill.
· When recovering from a major illness, listen to your body. If you don’t feel ready to go back to work, don’t. Health first, work second.
· Learn from what happens to you. Take the time to reflect on it. There is always a silver lining, no matter how traumatic the experience. You might even feel better afterwards.
If my experience can inspire just one person to make a change, then that is something. At the end of the day we all choose our own adventures. What path will yours take?