Thursday, July 10, 2014

break-bone fever, bent-back fever and malaria, oh-my!

When I first came to the DR ten years ago, I was given a course in tropical diseases - it was a general "going-overseas" course, so a lot of the diseases we learned about didn't even really apply to my part of the world, and really, THANK YOU WORLD. Some of those things - worms that bore through the heels of your feet and end up in your blood stream, scorpions that sting, snakes that bite - are enough to give the most seasoned outdoorsmen nightmares.

The Dominican Republic doesn't even have a malaria problem (though occasionally you'll hear of malaria in Haiti). As far as mosquito-borne illnesses go, malaria was the scariest for me. Afterall, I had recently read The Poisonwood Bible.

I have since learned that malaria is not nearly the most painful or even the most widespread of mosquito-borne illnesses. 

Dengue Fever - often referred to as break-bone fever - is common in the DR. It is transmitted by a special, of course, type of mosquito and everyone once in awhile the country's emergency rooms fill up with infected humans. It is marked by high fevers, diarrhea and vomitting and an intense pain in the joints and bones. There is no treatment, and is often deadly - especially for small children and the elderly. 

Doesn't sound terrible, right? Some fevers, dehydration, and in the end you (probably) live? Perfect.
Except you can't take pain killers stronger than tylenol, and the only other relief is simple re-hydration by IV. And the pain can last for days and days. 

Dengue hasn't reared it's ugly head recently - at least not in epidemic status.
No, in fact, I haven't heard one story of dengue for months, but mostly that's because a new disease arrived in town about two months ago.

Chikungunya Fever.
Lovingly referred to in Africa as bent-back fever because the pain is so strong it forces your back to hunch over. Bent-over. 

Same mosquito, different disease. Pleasant.
Not as deadly, apparently, as dengue fever, but far more uncomfortable - high fever, vomitting and diarrhea, intense pain in the joints and bones and, for added drama, a bright red rash that covers the body. 

We're not really sure if it's run through our house yet, but I'm going to bet on no. We all got some intense fevers, and I was pretty uncomfortable - but no rash, no intense bone pain. Amely, we think, had strep throat and so I'm sure that's also probably what Samil had. I probably just had pregnancy-whiny-ness. Katherine, Amalio's cousin, was down for the count for three days, but also didn't have the bone-pain. Amalio, of course, was left unscathed.

The gross-ness did make it's way through school - our attendance dove into the ground in June. I had parents in the office, waiting in line to tell me that their kid was sick. And our cook, our has-never-missed-a-day cook was out for three days because she literally could not put her feet on the ground to get out of bed. 

Earlier this week, a friend called to tell me that her two month old son had the chikungunya and could I recommend an ER? (Hi, Janet!) I recommended the ER I always use. I told her that I don't really buy into any of the pediatricians there, but we've always had a decent experience (with the exception of Amely's chicken-pox visit) with the doctors in this particular one - and as an added benefit, it's just busy enough to inspire confidence but not so busy to frustrate. 

I have never waited in this particular ER. ever.
I swung by on my way home from work, to check on her and the baby because medical care can be overwhelming here. I imagined she was on a bed, getting checked or waiting to get checked. She was standing in the triage area, with a thermometer under baby's arm because there was no where else to go. There were at least 25 people waiting in line - even pregnant women were waiting in line (unheard of for preggos to wait in ANY line in this country) because there were just so many people.

She was sent home with the indication to hydrate and continue acetometophen treatment. There's not really much else to do. 

I'm hoping to avoid being a statistic this time around - it's predicted the 85% of the island will be infected, and that it will be a worldwide epidemic, not limited to tropical regions. It's worse for newborns and the elderly. If you're traveling to the Caribbean, make sure to bring mosquito repellant and apply liberally to avoid bites. The specific "breed" of mosquito is more likely to bite during the day (instead of at dawn and dusk like "normal" mosquitos) and looks different than the mosquitos that most non-tropic-natives are used to (a little bigger, front legs are higher than hind legs, and are striped like a tiger). DO NOT take any pain medication except acetometophen (I don't know how to spell that), because Advil and others can make it worse. And, if you do get sick, hydrate, hydrate, hydrate!

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