The Parasite Lesson

Here's a lesson about parasites. Written the best I can in Guatemalan English with tones of West African Krio. 

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Doc Salsa

Before the bug....

It was another day at the clinic in Waterloo. It was a pretty hot day and I was consulting patients- the sweat drops slipped down my forehead and onto my cheeks giving the impression that I was crying. “What happened, do you miss your family in Watermelon?” Watermelon was what my young pal from the nursery school calls my home, Guatemala. I smile and we continue the consultation, but I was more tired and sleepy than usual. "It must be the dehydration." I think out loud. 

Later that afternoon I decided to visit the local futbol field. The field is a big space of dry soil with goal posts made by narrow palm trunks joined by old thin rope. Some stones and half of a house with lots of piles of gravel surround the field giving it an unnatural shape. I walked towards a group of locals and I asked if was possible to play with them. They said yes and asked my name. “Sergio,” I answer. “Sercho? Secho? Sargent?” They guess. I´m used to that so I said, “You know Sergio Ramos? This player from Real Madrid? That´s my name.” Oh, yes of course! Welcome Sergio Ramos, and then immediately everyone on the funny shaped field introduces themselves with famous professional futbol player names. Even as I write this I am not sure if they were kidding or if maybe I actually played a match with with Cristiano Ronaldo, Messi, Ronaldiño and so on. I started to stretch the muscles when somebody threw a uniform to my face, “You must wear this and wait till the other team is ready”. I am confused. “Wait a minute, is this a friendly match or is it not?” A man named Magic, who is like a coach says, “Well this game is anything but friendly. We are playing the semifinal of Waterloo championship”.

Oh no… it was happening again.

Last month we wrote to you about a basketball odyssey, and now here I was about to play in the World Cup of Waterloo. I begin to get nervous about two things. First, even with the bad conditions of the field and the old shoes that almost everybody wears, these guys are a big deal. They start to play futbol at the same time they learn how to walk. Shoes or not, they play almost every day. Some of them are super skilled. Second, they kick the ball hard. And if they can’t kick the ball they will kick your leg and everything that is in the way. Violently.

I swallowed the last saliva I had before my mouth gets dry and I wait for the game to start. After some minutes a lot of people gathered around the field and a big sound system came from nowhere. The music was super loud as is traditional in Africa. The game commentator (yes, an announcer) proclaimed that the game would soon start. All the kids and people around started to scream “Eh docto, yu sabi play futbol? Eeeeeh bohboh!” I was very taken back that most of the kids around knew me. I was also taken back that after 10 minutes I was super tired and that I couldn’t run anymore. I started to see flashes of light and had some nausea. That was the moment when I asked to myself, "Am I an old man at 28 years or I do I just have malaria?" Ugh. My mind flashed, "Was I going to have to leave the match without any glory!"

I stumbled and I left to the ooohs and aaaahs of the crowd.

People were obviously disappointed but I was even more disappointed then they. I went to the clinic and made a malaria rapid test. Ugh again. I had malaria. I went home to nurse the coming fever.

By the second day I had no headache and that was strange; virtually all the patients I've seen with malaria have headaches. Plus that's what The New England Journal of Medicine says. No headache? I thought how this could be good.

But then my muscles started to ache and I was super tired. I started the treatment with Artemether 80mg plus Lumefantrine 480 and some paracetamol. Altogether I felt pretty good. I returned to my work at the the clinic. But then I realized more. Now is an endemic Malaria season and my kids lined up along the wall were proof of that. 4 out of the first 10 patients I saw this month had Malaria, and that day was not the exception. Some of the kids came vomiting, with strong headache, high fever, dehydrated, trembling and with all their hope put in my hands. I was suffering but they were worse.  Together we felt each others pain,  and because of this I worked as hard as ever. I was in their position, we were connected somehow by the sickness, I could feel their discomfort, I understood.  

Making the diagnosis. 

Making the diagnosis. 


Later that evening as I began to get worse, I came back to Freetown, the capital. I knew my body was preparing something for that night.  I took the treatment to help my immune system to fight thousands of plasmodium protozoans living in my red cells. I knew the climax of the battle would be that night so I was looking for somewhere safe if something happened. “Daniel if something happens you just hold my hand,” I joked with my fellow FTF FIeld Worker.  I joked more and acted as if I had terminal cancer or something even more rough than Malaria. We did this as good friends, supporting each other during bad times.

The third day of malaria found me waking up at 2am, my jaw shaking and all my body trembling. I was as freezing as a man without a shirt in a winters evening in Saint Petersburg. My lips were very dry and made it a complication to swallow. I took some pain killers and oral rehydration medicine that helps me but I could not sleep till 8 in the morning. I had to take the day off and try to rest but then time after time people kept knocking on my door asking for the doctor. They were sick and needed the doctor but the doctor was sick. I saw in their eyes they felt bad for me, and confused too. After that day I started to get better.

A couple of days later I talked with one of my patients. “I heard you were sick, for me was very difficult to believe because the doctors don´t supposed to get sick, they know what to eat” he said. I told him, “There are some things that are out of our hands, we are just humans like you my brother. Sometimes nature gives us some challenges to remember. Challenges to help us remember that we are mortals; to teach us humility and the value of health so we get better at treating you who are sick”. During those 3 days I learned more about parasites and malaria than a thousand pages of internal medicine books ever would teach me. Being an outsider can sometimes be easier than being a part of a struggling body.  I learned that a successful therapy begins by feeling deep empathy for others. Even against your will. 

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Sergio Castillo