(Amoebas – part 1)
Five years ago if someone had told me I would be sitting in front of a Salvadoran doctor today waiting for a diagnosis and treatment, I would have said they were crazy; I would NEVER go to a Salvadoran doctor. But as the adage goes, “Desperate times call for desperate measures.”
The cough, runny nose, and fever gave way to chronic and debilitating non-stop diarrhea. It would not allow for sleep. Knowing the risks of dehydration, I drank gallons of bottled water which only resulted in increased trips to the toilet, but I sure did NOT want to risk landing in a Salvadoran hospital with an IV stuck in my arm.
Generally my self-diagnoses are correct and today is no exception. I know gastro-intestinal diseases by amoebas (simply called “amoebas” here) is quite common in developing countries and we visitors from other areas are particularly vulnerable to it. For all intents and purposes, it could be compared to dysentery.
I remembered that our guest house operator has helped other guests with this malady other years so decided to catch her first thing on morning 3 of this and ask what the protocol is for diagnosis. She moves into automatic pilot handing me a container for a stool sample, has me write my name, and calls the local clinic. By 7:30 AM said sample is whisked away via taxi driver, Hector, to the clinic. At 10:20 the clinic called saying they have my results and I should come over NOW. At this point I have not been away from the toilet more than 3-5 minutes at a time night or day and I don’t know how far I am going on this taxi ride and if I can even make it. Fortunately, it is only a 5-minute ride.
Price list of charges posted at doctor’s office
I give my name to the nurse/receptionist manning the desk who tells me “Uno momento.” Moments later a guy exits THE examination room and the nurse instructs me to “Pass.” I barely had a chance to sit down.
The doctor has halting, but passable English, praise the Lord. He opens with unrelated chitchat. I quickly explain that I may need a “bano” soon and he points to his own personal bathroom right next door. How do I know it is his personal bathroom? Because within minutes I do need to use it and clearly it is the doc’s and not a public one.
Before giving me the diagnosis, he asks a series of clinically-related questions followed by confirming my suspicion – amoebas. Up on the exam table he takes my vitals, listens to my gurgly tummy and I return to hear how I am to proceed. He checks my drug allergies and at times when he is unsure of my spoken English, I write down the word in question which seems to help him.
This kind doctor clearly prints my prescriptions explaining the instructions for each clearly. He went a bit overboard emphasizing I not drink alcohol for the one prescription: “No tequila, no whiskey, no gin, no wine, no beer.” Geez, I get it; you don’t have to quote every liquor on the shelf! He entertains my questions and makes dietary suggestions. I am not rushed at all. He explains I probably contracted it 5 days ago and it may have come from a salad. The doctor bill for the exam and lab work was $32.
Hector is in the waiting room when I come out and walks us to the pharmacy next door to help with the transaction. This “pharmacy” in reality is a small walk-up neighborhood storefront that happens to carry drugs. No one goes inside; you can see outside the thick bars covering it what is available and ask the clerk for what you need. In our case, Hector slips the prescriptions under the bars, the gal pulls the drugs out of containers or breaks them off larger packets, puts them into a bag along with the doctor’s original prescription slip, we pay first, and then she slips the bag through the bars to us. It is actually a very fast and efficient system. No one stands back there re-typing all the information onto new bottles and we are not having to wait 30-40 minutes to get them like I do at home at my grocery store pharmacy. The cost of 5 prescriptions is $37.
Hector negotiating pharmacy needs
Back to the taxi with Hector and we return to the guesthouse. The whole trip took less than 30 minutes!
AMOEBAS – (Part 2)
Our normal custom is to begin each meal by thanking God for our food as well as asking His blessings on the poor living in the rural campesino communities. Today is an exception. There is one petition only and that is for my restored health, patience, and courage. My body is battling amoebas and the amoebas are winning. My weak and tired body has become a weak and tired spirit and I am becoming discouraged. The persistent diarrhea does not allow for sleep and we are now into day 5 of the medicine.
There is one final anti-amoeba tablet left and I am no better. I am concerned about what course of action to take if this final pill doesn’t miraculously cure me. I’ve added Pedialyte to my regimen to restore electrolytes to my system which makes me feel a bit better right after I take sips of it but doesn’t help my symptoms. I am weak and my veins are hard to find. I am in and out of reality. I am really scared and once again the threat of landing in a hospital looms greatly.
It is time to implement Plan B – getting a second opinion. Several concerned Salvadoran friends have been checking in and recommending their own personal physicians. This morning at 7:30 we decide to cash in the chips and ask for help.
By 10:30 Hector is driving us across town to a cancer hospital to see a gastro-intestinal specialist who agreed to see me at 11 AM. I have my trusty backpack with an emergency change of clothing, towel, baby wipes, copy of my passport, list of my medications, and prescriptions the first Salvadoran doctor has me on.
This specialist greets us in the waiting room by name and I thank him profusely for this special favor of working me into his schedule. He is an Argentine-born Italian English-speaking Salvadoran who is doing his best to alleviate my fears. “You think amoebas are bad here, you don’t want to go to Bolivia” he tells us and shares an anecdote about being a volunteer on a WHO (World Health Organization) team there watching a local woman dip water from Lake Titicaca to put into their drinks. He told his team, “We have 2 hours to get back to the bus” (assuming the anti-amoeba meds could begin their work then). I assured him I will just admire the photos of Bolivia and not travel there.
The doc took my history, reviewed my meds, and examined me. He blamed my higher than normal b.p. on the high sodium content in Pedialyte which children tolerate much better than adults. He switched me to Gatorade instead. He agreed that by now I should be much better. Although the drugs I was taking are “okay” his own personal drugs of choice are different and he explained the reasons for each. He instructed me to discontinue what I was taking and wrote out scripts for new ones instead.
When I complete this whole regimen I am to take 5 days of a probiotic to restore the good bacteria in my body. This involves dissolving the contents of capsules in water and taking every 12 hours. I also need to have 2 follow-up tests done when I return home a month after I first began treatment.
I told him how sore my bottom was from all this diarrhea and he winced in sympathy, “No paper; just shower” he instructed. He doesn’t know how rough the towels are in the guesthouse to dry said area. Baby wipes and Desitin are working better and he said that is fine too.
He wants to see me back in 2 days again. Hector is in the waiting area and is ready to walk us next door to the pharmacy. Cost of these three prescriptions is $66.60.
AMOEBAS – (Part 3)
The doc was running late today and he hurried in casually explaining, “fixing a stab wound.” Just an hour before returning to the doc today, I began having a somewhat formed stool. He is glad to hear things are turning in a positive direction. I share some final questions and concerns. He writes up a summary and the tests he wants done in the States.
On our way out at the desk in the lobby we ask him where to pay. “No charge” he tells us. I don’t know who is picking up the tab for two visits to a specialist – the Salvadoran health system, our friend who made the connection, or if the doc did this gratis. But we are certainly blessed. We tell Hector, “done; no more drugs” he laughs and drives us back to the guesthouse.
Hector, my hero
The owner there has been kind enough to make me anything that sounds remotely good. If I feel like soup, she runs to the grocery store for ingredients to make me homemade chicken noodle soup. If I want rice, bananas, and toast, she gets it; if I request yogurt, she asks, “What flavor?” She was catering to my every need of baby wipes, Gatorade, Desitin. I don’t know what I would have done without her.
A Healthy requested breakfast
As miserable as I felt physically, I could not have asked for better care by the medical community and compassionate people when I was so very, very sick.
Being at my most vulnerable point but being cared for by my Salvadoran friends and strangers was an experience I shall never forget. I have to wonder if my Salvadoran friends would receive the same compassionate loving warmth, comfort, and prioritized care here in the States if this happened to them traveling here.
Medication arsenal
