Ἰατρέ, θεράπευσον σεαυτόν

“Good grief, Ian, you look terrible. You’ll be frightening the patients!” said my supervisor.

Just to be helpful, my translator chipped in, “Yes, they think they will catch something from you. I blame this cold on you.”

I don’t spend a lot of time looking in the mirror. When I shave in the morning, the mirror is misted up with condensation following my shower. I didn’t notice a problem. But after work today, I reluctantly took a peak in the hallway mirror at home. My face and neck are pocked with a dozen angry red mosquito bites.

I seem to react in a strange way to mosquito saliva. At first the bites cause itchy red lumps often with a pale central area. Then after a day or so I get a tiny tense blister, surrounded by a halo of livid inflammation. Scratching the bites at this stage leads to a prolonged healing process, with oozing sticky plasma which sticks the surrounding hairs together with golden glue. I now have two ulcerating areas about a centimetre across on my inner right thigh. My body is putting up a fight. The lymph nodes in my groin are enlarged and each ulcer sits atop a 4cm disc of induration, which is really tender. Walking is uncomfortable.
The bites on my face, neck and scalp are at the early stage. I must leave these alone or I will be consulting with my head in a paper bag at the end of the month.

So how did I get bitten so much? Well, I have been ill with “man flu” for a week. But this is man flu with knobs on. I get drenching night sweats, waking up freezing cold. I feel hot in the early evening and go to bed with a fan aimed at my body. I use a sheet, which I fling off when I get hotter. When I wake up wet through, I get under the sheet and light duvet while my teeth chatter for a few minutes. When I overheat, I kick off the covers, until the next sweat. I reckoned that having a fan directed on me would waft away any hungry female mosquitoes. But I realised last night that they were biting my face when I turned my back to the fan.

I would prefer to sleep under a net, but no one else does. The rooms have gadgets filled with insect repellent which plug into an electricity socket. The liquid is vapourised by heat. I started using this when I first arrived, but the vapour irritated my eyes. It needs replacing every 45 days, but I neglected to do so.

Just to make matters worse, my big toe has a paronychia. I have a tiny bit of numbness in the left foot following a prolapsed disc at L4-5 in 2012. A few days ago, I cut my toenails and inadvertently must have ripped the outer edge of the big toe nail, which disrupts the seal with the skin. Now I have a massive whitlow which is making it difficult to get a shoe on. Everything here gets infected very quickly. Initially, I thought it looked like a staphylococcal infection, but no creamy yellow pus developed and the inflammation spread down my toe despite taking cloxacillin. So it is more likely to be streptococcal. I’ve switched to some co-amoxiclav which is going out of date soon. It still feels very boggy.

It is strange being ill overseas. Just like in UK, greeting colleagues with, “How are you?” we expect the reply, “Fine, how are you?” But if I say I am not fine, my colleagues, both local and expat, don’t really know what to say. If I just mumble that I’m okay, the more perceptive nurses may pause in thought, wondering what to say next. Earlier this week, the nurses working in outpatients had realised I was poorly and tried to take on more of the clinical work, to make it easier for me. At the end of one tough day, one even asked me if I was going home to UK.

I have been reluctant to take a day off work, because that’s the kind of person I am. Today, we were missing several nurses and a doctor, so it would have been unfair to the 300 plus patients attending the clinic if I had taken a sickie as well.

I have been pretty exhausted after work so I have been going to bed at 7pm and sleeping till 6am to try to recharge my batteries. I did very little at the weekend, and spent all day Sunday resting.

I normally have a healthy appetite, but I don’t really fancy food much. When I had my physical examination for MSF just after a particularly indulgent Christmas, I weighed a podgy 88kg. Now I am just a shade under 80kg. I have lost a mixture of fat and muscle. Partly it is because the food here is plain and unexciting. And I don’t need to eat much in the heat. Being unwell, I don’t feel hungry but I try to eat what I can.

As the most experienced general clinician in the programme, I am happy to take on the role of GP for the expats (they can see other doctors privately using medical insurance if they choose). My two medical colleagues here are drug resistant tuberculosis specialists. I certainly hope I don’t need their help! I should be able to sort myself out with common (clinical) sense, time and rest.

At least I am not as spotty as this lady (we have a mini outbreak of chickenpox at present).

Ἰατρέ, θεράπευσον σεαυτόν translates as “Physician, heal thyself” from Luke 4:23