The Mosquito's Venom

            After returning from our amazing trip to South Africa, I assumed that my last month in Luanda would be smooth sailing. But instead, we hit rough waters almost immediately. We hadn’t even been home an entire week yet when Adam said he didn’t feel well. Uh, oh! Adam isn’t someone to really complain about being sick, so I knew that if he said he didn’t feel well then something must be wrong. Jamil encouraged Adam to go to the clinic to get checked out because there had recently been an outbreak of malaria in Luanda. Adam reluctantly agreed.

            Omar, the office manager, picked Adam up and took him to the clinic after work. Adam called me a few HOURS later to check in. Adam still hadn’t been seen by the doctor because of the overwhelming flood of patients in the clinic. Mid-conversation Adam said, “Are you serious? I’m going to have to call you back.” Adam called me back a short while later and told me that they had “bug bombed” the clinic. I struggled to understand how “bug bombing” a clinic full of people made any sense, but quickly reminded myself where I was at the moment. There isn’t exactly a rhyme or reason behind a lot of the things that they do here, so no sense stressing about it. Adam and the other individuals in the clinic were forced to wait outside until the chemicals cleared.

            After five hours at the clinic, Adam returned home. He told me that the blood work confirmed his malaria. What now? Adam plopped down on the couch and handed me a white sack. I opened the sack to find glass ampules of medicine, syringes, cotton balls, a bottle of horse pills, and alcohol. I asked Adam why he had all of this stuff. He explained to me that he had been given a shot at the clinic and would need to have one shot every day for the next four days. Instead of going back to the clinic everyday, Adam told the doctor that I was a nurse and could give him the treatments at home. The doctor simply handed Adam all of the supplies and sent him on his way, no questions asked. What doctor does that? This would NEVER happen in the States.

            I took out all of the supplies and started looking everything over. The medicine was all foreign to me and of course nothing was written in English, including the prescriptions and dosages. I felt like I was back in nursing school again because I spent the next hour or so on the internet looking up anything and everything I could on all of the medications. As if I didn’t already have concerns about the medications beforehand, I was extremely worried after doing a little research. One of the medications had actually been banned in the States due to its severe side effects. I guess the less we know is sometimes better.

            I gave Adam the pain medication and fever reducer around the clock keeping him on a strict schedule to try to help with his horrific headache and alarmingly high fever. Even though the medicine didn’t help with his headache much, it did help to break his fever. And when his fever broke, it was like a torrential downpour soaking his clothes, bed sheets, blanket, and whatever else was in his path.

            When it came time to give Adam the shot, I gathered all of the supplies but couldn’t find the filter needles to draw up the medication from the glass ampules. I asked Adam if he left any of the supplies in the car, but he said that he had brought me everything that they used in the clinic. When I specifically asked about the filter needles, he replied, “the what?” I explained to him that it is good practice to use a filter needle to draw up medicine out of a glass ampule to avoid getting any glass shards in the injection. Adam told me that they didn’t use a separate needle at the clinic. Thinking that Adam’s fever was preventing him from remembering the specific details of the clinic trip, I decided to ask Adam’s dad about it. Jamil just laughed and told me that filter needles are non-existent in Africa. So, here goes nothing.

            I broke the top of the bottle off and drew up the honey thick, slightly yellow medicine. Adam told me that the nurses at the clinic said that it HAD to be given in the gluteus maximus. Perfect. I found a nice spot, cleaned it with alcohol, and on the count of three sunk the needle into Adam’s bottom. He praised my IM injection skills and told me that it didn’t hurt nearly as bad as it did when they gave it to him at the clinic. And this became our 5 o’clock routine for the rest of the week.

            After the first and second injections, I quit dreading having to give the shot and started dreading the side effects that would surely follow. About two hours after the shot, Adam turned into a completely different person. It was like I was living with Dr. Jekyll and Mr. Hyde. His fever would spike again, and he lost all ability to make sense. One night Adam kept saying to me, “chair, chair, chair.” He couldn’t even form sentences anymore. Instead, he would just say a single word and point to something. I was extremely confused considering we don’t really have any chairs in our apartment. We have couches and bar stools, but no chairs. After the side effects of the medication subsided, Adam explained to me that he was trying to ask for the blanket on the couch but couldn’t form the right words.

            After the course of treatment was up, Adam went back to the clinic to have more blood work done to ensure that the treatment had worked, ridding him of the nasty parasite that had been using his blood stream as an incubator for the past two weeks. As we were sitting in the clinic waiting area, I noticed the alarming number of sick people occupying the chairs around me. I watched as mosquitos flew around in the air looking for their next meal. I quickly started to regret my decision to not wear bug spray that day.

We got his blood work back and his malaria screen was negative. Great, right?! But as I was looking over the rest of the blood work I noticed that his platelet count was 66. Yes, 66! A normal platelet count is around 150, so you can see as to why this number was so disturbing. I made Adam ask about it. The doctor told us that low platelets are normal with malaria and not to worry because the number will slowly come back up. The nurse in me was already making a mental note to schedule a follow-up in the States as soon as we got back.

            My first run-in with malaria, the mosquito’s venom, was scary to say the least. I felt completely out of my element and uncomfortable with the foreign treatment option, not to mention their standards of practice. Thankfully everything worked out okay, and now Adam gets to hear my “wear bug spray” lecture everyday. Lucky him.