Sunday, June 24, 2012

The Bat Cave, or… why going to medical school ruins all your fun

The past two weekends I've gotten out of my little town to go do some of the “touristy” stuff in the region. So I could tell you about the beautiful walk I had along deserted tropical beaches last weekend or about the karst formations stretching as far as the eye can see in the Reserve de l’Ankarana this weekend, or about the lemurs I FINALLY saw jumping around in the trees, but I wont. I could also tell you about my project here, but that’s for a separate opportunity (mainly so non-medical people don’t have to slog through it). Instead, I’m going to tell you why my weekend felt like I was in a Michael Crichton novel.

So yesterday, as I am walking through the forest with the obligatory guide, Rosia, at the Ankarana Reserve, she offhandedly tells me that one of her fellow guides died last week. I say something I think appropriately sympathetic, after which she says “yeah, he was 29 and was completely healthy and then all of a sudden on Monday he felt sick, and by Thursday he was bleeding out of every orifice and died.” Oh, I say. Anyone else affected? He was the only one… doctor said it was “gastrointestinal hemorrhage.” Ok. I’m pretty sure Ebola and Marburg viruses have never been reported in Madagascar, so I’m thinking through the differential in my head, telling myself a perforated ulcer or something of that sort is much more likely, and I mostly manage to put it out of my head. We spend about 5 hours together walking through the forest, and we agree to meet again this morning at 7:30.

I show up at the appointed time and Rosia, who was totally fine yesterday, isn’t there, so someone goes to find her. He comes back and says “Rosia is very ill, she had to be taken to the hospital in [the nearest sizeable town] by ambulance. I’ll find you another guide.” People here don't go to the hospital unless something is very, very wrong, so now I’m starting to panic a little, trying to remember what I learned about the incubation periods of Marburg and Ebola, how close you need to get for transmission, etc, all the while knowing full well that the chances of this being anything other than a coincidence are infinitesimally low. And because I’m rational like that, I go on the planned walk to the Grotte des chauves-souris, or cave of bats, with my new guide, Dolphin (pronounced doll-FAN). We stop at some point on the way to look for lemurs (there were none) and of course I had been ruminating so I pull out my phone to see what my medical encyclopedia can tell me about Ebola virus. And what do I find? The animal reservoir is unknown, but it’s thought very likely that it is… bats.

Ok, but I know I’m being unreasonable so onwards I go. It’s a steep 163 stairs down to the entrance of the cave, and even as we get to about 100 feet away I can hear thousands of bats in there screaming loudly and the odor is almost suffocating. It’s one of those smells you can FEEL in the air, if you know what I mean. And at this point of course I go back in my head to all the fungal infections that people get by going into bat caves and inhaling the air and I start to wonder if those are truly found only in the southwestern United States, or if that is just the example they teach us in medical school because that’s where we live and practice.

And then there is rabies, for which bats are one of the most common carriers, which I think about constantly as the bats swoop around my head in the darkness, outlined by the light from my headlamp. Or, more mundanely, the risk of slipping on one of the wet rocks in the dark and breaking a bone, with no way out but to crawl up all of those 163 irregular stone steps on hands and knees. I tell myself to take deep breaths and try to relax, but the idea of deep breaths just makes me think of inhaling all those infectious particles that I know are hanging about in that thick, heavy air.

In the end, through sheer pride or stubbornness or whatever, I follow Dolphin into the depths of that cave in absolute darkness and don’t leave until he has said his prayers to the gods of the cave and told me we have seen everything, and a small part of me is proud not to be one of those screaming foreign women he had told me about who were afraid the bats would get caught in their hair.

Now I’m back in Anivorano, I’ve confirmed that no cases of Ebola or Marburg have ever been reported in Madagascar, and moreover they are usually spread only by contact with secretions. So I’m probably out of the woods. But if not, I’ll let you know in 2 – 21 days.

Monday, June 11, 2012

First impressions of Madagascar

Suffice it to say, life got in the way so I never finished writing about Timor or Australia. Maybe I’ll get around it to it one day, but in the meantime…

Let me start by saying that Madagascar the country, which is a rather large island off the southeastern coast of Africa, is nothing like the movie (which I’ve admittedly seen only the first half of).  There are no lions or penguins or whatever else here. However, since before the island broke off of Gondwana it was connected to both India and Africa but has since been isolated for millennia, it is home to some rather unusual wildlife, including many species of lemurs (found only in Madagascar) and 7 of the world’s 8 species of baobab tree (also see The Little Prince), 6 of which grow only here. It is likewise home to the world’s smallest chameleon and to many other species of wildlife I’ll probably tell you about if and when I see them someday.

What I have seen so far, however, is the people, who are also a bit of an unusual mix, as the highlands of the country were originally populated by Indonesia, while Arab traders mixed heavily with the people in the north, and various other ethnicities are mixed in to make a population that doesn’t really look “African” or “Asian.” In culture as well, having spent time in some of the other former French-African colonies, I guess I was expecting, well, basically an African country with some heavily-accented French speaking. On the contrary, the French spoken here – amongst educated people and those working with foreigners – is actually relatively fluent, and they use the proper “vous” instead of “tu,” which was the mode of address in all in the other African countries I’ve visited. Baguettes are ubiquitous (although horrendous and deserving of the name in appearance only) and in the capital you can’t walk more than 50 feet without seeing a display of some horrifically sugary, icing-covered pastry mimicking the French fashion.  Prices are pretty high and they are obviously used to tourists, at least on the coasts. There was even a tapas bar in the town I just came from – Diego Suarez – though I didn’t try it.

But what’s weird is that despite being #151 on the UN Development Index, which is higher than most other sub-Saharan African countries, Madgascar has the third highest rate in the world of child stunting due to malnutrition, with the current prevalence estimated at 53%, trailing only Afghanistan and Yemen. In the town where I am staying, Anivorano, I have electricity 16 hours per day and no running water. The town is situated along the main north-south road, with a few muddy paths running off of it, and stray dogs, ducks and chickens wandering around everywhere. I have to jump over running streams of trash and god knows what else to get to work in the morning, which fortunately isn’t too far away. And I’m currently fighting an invasion of mini ants, who for some reason have decided they like my water bottle, causing me to do an urgent wipe-off-the-ants jig when they crawled all over me, and now to be very thirsty.

And then there are the little things… like this morning I attempted to get a coffee, which I later learned is only drunk by “old people” here. I went to the woman who sells coffee at the market, and she began by pouring condensed milk – which was thick like raw honey – out of a can. It was full of these huge black lumps, however, and on further investigation it turned out they were bees. They were just flying around and landing in the milk and hanging out there, and she was vaguely picking some of them out and more were landing. Now, I could handle one bee or maybe even two in my coffee – I’ll pick them out, whatever – but upwards of 10 is just too much. That was more bees than milk. I paid the nice lady anyway, and decided three months without coffee isn’t the end of the world.

And then there is this weird thing where they switched over from francs to ariary as their currency several years ago, with the banks last accepting francs as legal tender in 2009, thus none are available now. However, all the prices are still quoted in francs, causing people to have to divide every price by 5 to get to a currency they can pay with, despite most people not having much education at all. This means that they pull out calculators to figure out how much they have to pay, or I presume in their head they visualize that a 1000 ariary note actually says 5000 on it. Maybe they just don’t know their numbers, and assume every number as written is actually times 5 as spoken? Anyway,  I asked the most educated and worldly person I know here about it today and he seemed to think it was totally normal and that francs were still in use, so I asked if I could actually see a franc note. “Of course,” he said, and then explored his pockets to find one, only to eventually conclude that they aren’t around anymore.

Well, I imagine I’ve lost most of you by now, so I’ll end here. I’m here for the next few months working with a medical NGO on the malnutrition problem and trying to set up and run a small clinic, and this time I actually brought my laptop and have a GSM internet modem, so you’ll be hearing from me more often. As always, please keep in touch!

Adventure map for 2009...