Friday, May 12, 2006

Fever (and Xijiang)

Hello,

It's been a while since I last wrote . . . Anyhow, things have taken an unexpected (and involuntary) turn recently, and I now find myself back in Bangkok. My plans had been to remain in China through the end of June, with the intention of spending most of that time in and around Tibet. At the moment I'm not entirely sure where I'll be the next month or two; maybe home. As I said, there was something of an unexpected (and involuntary) change of plans.

Ashley, Sarah (Ashley's good friend from high school), and myself spent a pleasant almost-three weeks in a Miao village called Xijiang. The Miao are a minority people of southern China also found in the northern bits of Laos, Thailand, and Vietnam, though as I understand it they tend to be called the Hmong in those places. There are also noteworthy populations in Minnasota, Wisconsin, and the Central Valley of California, who emigrated as refugees in the aftermath of the Secret War in Laos. We were in Xijiang to teach basic English to some of the adults who run tourist-related businesses (hotels, local crafts shops) in town, as foreign tourism has been increasing in recent years. The people, especially our students, tended to be quite nice, and the setting was beautiful-- set in low mountains with terraced rice paddies carved out just about as far as one could see from the village. One my favorite parts of our stay there was that we were there during the rice planting season, such that over the weeks of our stay we were able to see the rice paddies converted from muddy, mucky brown pools to the early stages of the bright green fields that characterize rice fields in season.

I enjoyed the teaching, mostly because it gave us the chance to get to know a few people (mostly women) in town, and after dealing with 3-11 year olds when teaching in the Paharia village in India, adults made for extremely attentive students. By the end it started to feel a bit as though our students were coming more so as to not make us feel badly than because they were really interested, which was touching, though it made us wonder a bit how much our presence/efforts were of much benefit to anyone. Regardless, the main thing in my mind is that we got a chance to learn a thing or two about the people in Xijiang by spending a more extended period of time in their village.

One concrete way we know that our presence was felt was in stirring up the bizarre paranoia of the Chinese government, who apparently worked themselves into some kind of mild frenzy convinced that the three of us were from an 'international organization' and that we were trying to spread democracy or Western ideas or some such thing. The police never confronted us directly (though apparently they sat in on a class or two, without our realizing); we heard about all this second or third hand. The grand culmination of this came after our departure from town with their confiscating the one computer with internet access in Xijiang, on which we tended to spend a little time each day. The owner of the computer was a woman who ran a hostel on the main street in town who also happened to be one of our students. A motherly kind of figure, she was really sweet to us throughout, and it was really terrible to hear that her computer had been taken away because we had been using it. All because we came to teach a few women who sell silver jewelry and/or run guest houses how to say phrases such as 'I am fine, thanks' and words like 'bracelet'!! I haven't heard yet whether it got returned to her, though when I found out about the incident it sounded like it would.

The picture at left is from the good-bye feast some of our students treated us to our last night in Xijiang. One of the really great things about the Miao (at least in this region) is the way the women present themselves: shirts made from a velvety material that are black with a band of floral decoration (seen here) or single bright color, lots of beautiful silver jewelry, and hair worn up in buns, usually decorated with a flower in front and a comb made from wood or water buffalo horns (or plastic, for a more casual look) stuck into the bun in the back.

I'll now try to follow up on the teaser that I started with about changes in plans, but lacking distance from all of this it's hard for me to separate what's worth including and what isn't. So forgive me if I'm over-technical or, alternatively, provide too little information for the explanation to make any sense. That said, I've written this with those who I think would like to know some of the particulars in mind; most of you will probably want to do some substantial skimming.

One evening a few days before we left Xijiang I came down with a fever, but was fine the next day and didn't think much of it. I felt a bit fatigued occasionally over our last days there but seemed to be mostly okay. Once we left Xijiang, I continued west on my own towards the mountains, with the intent of eventually making it into Tibet; Ashley and Sarah were headed to Hong Kong and then India to do a backpacking course with NOLS in the Indian Himalaya (which is where they are now). To cut to the chase (in this one instance), less than a week into my travels westward I couldn't maintain the illusion-- made possible by days of seeming wellness consistently falling between days with some pretty bad fevers-- that I was getting better. I went to see a doctor in the local hospital, he proscribed me with 5 different drugs without examining me after I told him I'd been having some fevers. I was skeptical but decided to do as he said and see what happened. The next morning I happened to run into a pair of English women who I had spent some time with somewhere else about two days before. As both of them happned to be doctors, when I told them about my visit to the local doctor the day before and what he had proscribed, they immediately dismissed it as crap and said they were going to accompany me back to the hospital that afternoon and see to it that I got some blood tests. Thus began the saintly deeds of Rachel and Sunita, the English doctor ladies whose selfless kindness to me I can barely comprehend.

They did indeed return with me that afternoon. They got me my blood tests and then waited with me for what felt like hours for results to come back. As it turned out, my white-blood cell and platelette counts were really low. On account of a weeklong holiday happening at the time, the hospital couldn't conduct further tests and anyhow the place didn't seem to have the best facilities, so we called the nearest US consultate, who recommended that I get to the reasonably large city of Chengdu, which apperently had a pretty good hospital. This worked out well because the English doctors were already planning to head up to Chengdu as a part of their trip. We got in touch with the travel insurance company from which I'd bought a policy before I left the states, they said they would cover my flight. Rachel and Sunita helped through all of this too, doing a fair bit of the talking as I was feeling weak as another fever set in. Within about 36 hours I was in Chengdu and had been admitted into the hospital as an in-patient. The afternoon of my admission I came down with another fever; as I was in a hospital, this time they took my temperature and it turned out it was about 105.

At first they thought I had Typhoid Fever. When I learned of the symptoms of malaria I was fairly convinced that that was what I had (whereas I was pretty sure I didn't have Typhoid given its supposed symptoms), but they hadn't found any signs of malaria in my initial blood tests and so they didn't think that was it. The English doctors had told me that often it takes several tries to positively identify malaria but the Chinese doctors didn't seem to have this possibility on their minds. They started me on antibiotics for my suspected Typhoid, fed to me via an IV hung from the cieling (pictured at right)--which also provided fluids in an attempt to bring my low blood pressure back up. They also diagnosed me with a urinary tract infection that I'm pretty sure I never had. Blame on it the language barrier. . . . In keeping with my earlier pattern, 48 hours after my first post-admission fever I had another. They took some blood again, this time I was finally positively identified with malaria. I started treatment and thankfully responded well-- thus far I haven't had another fever. I had been jaundiced (meaning my skin and eyes looked yellow on account of some issue in my liver) for several days by the time they identified my malaria, and just as this started to fade, anemia (low red blood cell count) set on, and so my skin made an almost seamless transition from a sickly yellow to transluscent white . . . and I got an oxygen mask added to the medical apparatus that made my condition look more serious than it felt. Except for the two fevers, throughout all this I felt almost fine.

My white blood cell and platelette count had stayed low, so the Chinese doctors wanted to do a bone marrow biopse. I didn't want one, the English doctors were ambivalent, my parents didn't like the idea (I had been in touch with them since my admission to the hospital, as I had a phone by my bedside that could recieve calls), and a day or two before the consulate had told me a horror story about this particular hospital badly messing up the surgery of an American citizen only a few weeks before. It is supposed to be a rather painful procedure, that can cause bleeding, which seemed especially concerning given my low platelette count (platelettes help with blood clotting) and low white blood cell count (weakened immune system). This was the most stressful point during my six days in the hospital in Chengdu. The Chinese doctors wanted to give me one badly-- I had a commitee of something like six doctors with clipboards show up to encourage me to go forward with it after I initially declined. Though the one English speaker did all the talking, the effect of six doctors standing around my bed was still intimidating.

I decided to wait until I got to Bangkok, which was a transfer that had been in the works almost from the moment I got into the hospital in Chengdu. The US consulate and insurance company wanted to move me to Bangkok because the care is supposed to be much better and there were some not-insignificant communication issues between myself and the medical staff in Chengdu (English is pretty rare in China and in China the doctors don't tend to keep patients informed anyhow), but I couldn't get cleared to fly initially because they weren't completely certain that what I had wasn't contagious. That was cleared up when they diagnosed me with malaria (which isn't contagious), but then came the anemia, which made it so that the doctors couldn't clear me to fly without medical accompanyment. The visa situation for that medical accompanyment was sufficienctly complex that my transfer to Bangkok kept getting pushed back one day at a time until at last my red blood cell count recovered enough for me to get permission to fly alone.

So finally, yesterday, skin color normal, I was dismissed from Chengdu International Hospital. As they had given me very little time between removing my IV (which for some reason they had kept me on from morning to evening each day despite recovered blood pressure), I ended up running a little late for my flight. This was just the excuse I needed to turn to the driver of the ambulance assigned to drive me to the airport, tap my watch and make a siren noise as I moved my finger in little circles in the air. I didn't expect it to work, but it did: on went sirens and flashing blue lights. And off we went!! That man could drive . . .

Thanks to the speedy transport, I made my flight without trouble. I sat on a plane for a few hours, arrived at the airport in Bangkok to find the driver sent by the insurance company along with my dad, who had arranged transport to Bangkok when my condition had still been looking somewhat serious. We got driven to the hospital here. The insurance company had told me the hospital here was like a resort and I was skeptical, but it's turned out to be true. Allowing for necessary sterility (in that it's a hospital), the place is like a fancy hotel. Anyhow, medically things have been altogether anticlimactic down here in Bangkok. They're just kind of like, "Well, the treatment seems to have gone well. Keep taking that medicine!" I'm still a bit anemic, but other than that I'm all but completely fine. Mostly I've been sitting around the hospital with my dad, keeping up the pattern from the last few days of doing very little. I'll probably become an outpatient tomorrow, and if not then the next day, and be cleared to fly even long distances in the next day or two or three.

Which leads me to my current dilemma of what exactly I want to do with myself. Apparently I'll probably be fine to go about life as normal within the next week. With one exception: on account of my anemia I probably shouldn't go to high altitude, as I would be especially prone to high altitude sickness. But the reason I wanted to keep travelling prior to my sickness was to go to Tibet and the surrounding high-altitude regions where Tibetan people and culture can be found. It sounds like my red blood cells might get back up there if I give it a few weeks, or they might not. Different people regenerate them at different speeds, or at least that's how I understand it. I'm just below 10 on the scale they use, normal is 14-18. So . . . maybe I'll come home. Or maybe from here I'll head south (Malaysia? Australia? I still have some funds thanks to my having spent so much of my time in India . . . ). I'm not sure-- all this needs more thought. In any case I suppose I'll be deciding fairly soon.

This is all a little disappointing-- I was kind of thinking of Tibet as my big finale, building on my traveling thus far. But . . . shit happens. Going home sounds nice enough, if that's what happens. Maybe I'll pick up a little rafting work this spring. Travelling elsewhere sounds okay, too.

One interesting aspect to this experience has been that it has given me a glimpse into the world of medicine. Among other things I now have some idea what it feels like to be a patient, which I never really did before. On top of that I was able to snag a nice pair of Chinese hospital-pajamas.

Till next time!
--Josh

1 Comments:

Anonymous Anonymous said...

"This was just the excuse I needed to turn to the driver of the ambulance assigned to drive me to the airport, tap my watch and make a siren noise as I moved my finger in little circles in the air. I didn't expect it to work, but it did: on went sirens and flashing blue lights. And off we went!! That man could drive . . ."

amazing.

12:16 PM  

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