Wednesday, March 23, 2011

The Needle and the Damage Done

The Needle and the Damage Done

Or

There's a hole in Scotty's arm where all the vaccine goes

I don’t do well with needles.  That’s actually a vast understatement.  I have a very un-macho tendency to literally pass out at the mere sight of needles, particularly if I know they are meant for me.  I would make a terrible rock guitarist, circa 1970.  Now had I known exactly how many times I would be subject to shots and blood tests during my stint in the Peace Corps, I might have reconsidered the whole venture.  By my count I was poked in the arm and posterior no less than 17 times for vaccines, and another 10 or so for blood tests and general sadistic whims of doctors and nurses across two continents.  I’m getting just a little bit light-headed just typing this, that’s how grossed out I am by needles.  So in an attempt to expunge my irrational fears, I’m going to spend today’s post explaining all the wonderful shots I was subjected to, and their purpose.  We will spend a little time talking about disease and maladies for which there were no shots.

Ghana like many tropical countries is host to many diseases and maladies.  This is due partially to the climate, which is friendly to disease carrying pests like mosquitoes, and partially due to the somewhat unhygienic living conditions encountered there, and also partially due to the fact that countries like Ghana can not afford to spend the large amounts of money that are likely required to eradicate many diseases from their land.  I will say that progress is being made on this front, even in Ghana.  Some diseases are nearly wiped out that used to be far more prevalent.  But others are still very much a danger, both for Ghanaians and certainly for us Orbunis.

As many of you know, generally speaking life expectancy is lower in places like Ghana than it is in places like the United States.  Although, as an aside, if the United States keeps up on it’s path of current unhealthy eating habits and poor exercise routines, our lead in this category may shrink.  The primary reason for lower life expectancies in places like Ghana is disease.  And even more sadly, the bulk of the difference is made up of young children, who have not yet developed robust immune systems, succumbing to disease in their youth.  Most Ghanaians, should they survive childhood, have a solid chance of living a decent live span.  But the high infant mortality rates bring down the overall average, not to put to fine a point on it.  Incidentally this is yet another reason women tend to have more children in poor countries.  Again not to sound too detached about this, but if your very survival in old age depends on you having children to take care of you, and you are not completely convinced that your children are going to survive their tender and vulnerable years, then it stands to reason that you might consider having more children than you would otherwise.

Now I, having successfully survived my tender and vulnerable years in the United States, with only emotional damage wrought by living through the embodiment of a John Hughes movie in high school in the 1980s, was at least of sound body if not mind, and ready to withstand and endure the rigors of tropical life.  Or so I thought.  Unfortunately compared to a Ghanaian of similar age I had not grown up in Ghana and my body had not inured and acclimated itself to the various pests that are endemic to that country.  Not to say that Ghanaians are totally immune to endemic diseases once they reach a certain age, for they most certainly are not.  But they do develop some natural defenses.  And the Peace Corps was going to do the same for me, via the needle.


My first shots actually occurred before I even left the States.  All of us Peace Corps volunteers who were going to Ghana in 1993 met in Philadelphia in early July for a week of initial training and shot-taking.  One day we were all herded down to some government office in downtown Philadelphia to receive three shots, all at once:  one for Yellow Fever, one for Measles Mumps and Rubella (MMR), and a final shot for ”IPV”, which is for Polio.  I believe the last two are administered to children in the United States, or at least they were when I was young, but the Yellow Fever vaccine was altogether new and exciting to me and my body.  For you see, the yellow fever vaccine is actually a little tiny bit of yellow fever virus that is injected into your blood stream.  This is a special “attenuated” version of the virus that is very much “live” or real, but somehow supposedly harmless.  Your body recognizes that the virus has invaded, and gets to work producing natural antibodies to neutralize it.  For yellow fever vaccine, apparently your body will continue to produce antibodies for about 10 years after it is introduced to this lively little virus.  That’s how freaked out your body gets when it discovers good ol’ yeller fever parading down its blood vessels and arteries.  So I hesitate to call what they did to me a “vaccine” per se.  It seems like my body did all the heavy lifting here and all they did was give it a little nudge.  Should be called the yellow fever nudge shot.  We will see this strategy employed again.  Some volunteers did have a bit of a reaction to this or one of the other two shots and were fairly ill for a couple of days.  After I swooned from the needles I felt pretty good actually.

But I was very glad to have some protection from yellow fever, since it is a nasty disease and quite endemic to Africa.  And sadly it seems to be getting slightly more prevalent in Africa, and currently causes about 30,000 deaths per year, mostly in Africa.  Yellow Fever was a contributing factor to the failure of the French panama canal project in the 1800s.  Of course this was before the vaccine was invented (in 1937), so the French and Caribbean workers died by the thousands from this disease.  Also not helping matters was the belief at the time that yellow fever was caused by “swamp air”, so very little effort was made to control or eradicate the disease carrying mosquitoes in the area.  We’re smarter now but the disease seems to be making a comeback, which is not good.
 
But I was safe from that particular disease, provided I didn’t end up staying in Ghana for longer than 10 years.  That would not prove to be an issue.  Once we got to Ghana we were immediately subject to a barrage of needles; 12 shots in a one month period.  I may have the order mixed up, but I think we got off the plane, got our passports stamped, and got a needle stuck in our arms.  This one was for Hepatitis B.  In fact this was one of 3 Hepatitis B shots I was to receive.  The second Hepatitis B shot occurred the very next day.  The Third and final – at least for me, since I left Ghana shortly thereafter – Hepatitis B shot occurred 6 months later.  That one was probably a booster shot.  Additionally I was the proud recipient of two Gamma Globulin shots, which I think may have been related to the Hepatitis B vaccine.  The Gamma Globulin shot deserves special mention here because it was a rather large shot, administered right in the posterior.  Additionally it was a very viscous substance and left a very noticeable lump in my trunk, if you know what I mean, for quite some time, while it slowly dissolved into my bloodstream and administered its special G.G. powers throughout my body.  During that time it was not enjoyable to sit down on anything so prolonged standing or prolonged laying face down on the floor were the most common side-effects of the good old G.G.

I’ll also note that while we received 3 shots for Hepatitis B, we did not receive anything for any of the other versions of hepatitis, which were also roaming around Ghana at will.  I believe two of my fellow volunteers were stricken with another variant of Hepatitis while serving.  One of them had to go back to the States for several weeks for treatment but she came back after she was feeling better.  That is tough.

There were two other shot “series” that we received: Typhoid, and Rabies.  Well rabies we are all familiar with, what with the raccoons and dogs foaming at the mouth and what-not here in the states.  But it must be more of an issue in Ghana because we were getting the rabies vaccine, discussion closed.  Of course in the states we vaccinate our pets against vaccine, but typically not humans.  Over there I guess it was just the opposite.  Does that make us the pets?  And this vaccine works like the yellow fever vaccine.  You are administered just a pinch of fake-rabies and your body get to work building the proper antibodies to destroy it.  Not pseudo-rabies, which is an actual disease endemic to swine, and not rabies at all apparently, but a proper rabies-rabies that has been, as they say, “attenuated”.  I get the concept but it still seems a little creepy to me.

Lest we forget Typhoid Fever, caused by eating food or water that has been improperly handled, shall we say.  For example you might be subject to typhoid fever if you were to drink water out of a stream downstream from where an untreated sewer is located.  I don’t think I need to be any more clear on how one contracts this disease in polite company.  Even though we had to get three shots for this vaccine to work, I’m rather a fan of it because unlike the rabies and yellow fever vaccine, the typhoid vaccine actually cuts right to the chase and puts the antigen right into your body.  Of course therefore it’s not as affective or long-lasting, but I feel like I’m getting some sort of spider man super-power with the typhoid vaccine.

Rounding out the shots finally were a Meningitis A & C shot, and a diphtheria shot.  Meningitis has recently been making a showing in the United States, which deeply disturbs me quite frankly.  I’m pretty sure 18 years after my shot I am no longer immune to meningitis but I really don’t want to get stuck in the arm again. 

Oh I almost forgot one!  Right before I left the Peace Corps I got my first Cholera vaccine shot.  I’m not sure why they felt they needed to wait until I was in Ghana for 8 months before administering one final shot.  Could be my incessant whining and crying convinced them that one more shot too early really would cause me to run back home, so they delayed the cholera shot out of mercy.  Or perhaps the cholera shot was expensive, and they wanted to make sure you were going to stick it out in country before spending good money on you.  If that was the case the joke was on them because I left Ghana only about one week after receiving my cholera shot of pure golden deliciousness.  Or maybe the cholera vaccine had just been invented, and they wanted to test it out on unsuspecting Peace Corps volunteers first.  That theory seems most plausible of all.

But I’m saving the worst for last.  If you’ve stuck with me this far, you deserve some sort of payoff to this somewhat laborious tour through tropical diseases.  Malaria.  There is no vaccine for malaria, and it is, along with AIDS, probably the number one killer in Africa.  So it’s bad stuff.  About one half of the people I know who spent more than a month or two in Ghana got malaria.  And a good chunk of them got very very ill with it.  Malaria like yellow fever is spread by mosquitoes, and like yellow fever we used to think it was spread by bad singing.  Hence the name malaria, you know mal (“bad”) aria (“song”).  Sorry, couldn’t resist.  Bad swamp air, not singing, of course.

But unlike yellow fever we have not yet figured out how to create a proper vaccine for malaria.  And this is bad because malaria like I mentioned kills a lot of people every year.  It’s one of the main reasons why mosquito nets are so useful in Africa.  Of course one can’t go around wearing a mosquito net all day; it gets in the way of things.  So scientists have at least created a few “anti-malarial” drugs that can be taken to help prevent malaria.  The drugs don’t provide perfect protection, and they have some vary common and very disturbing side-effects.

All of us volunteers were administered and told to take regularly the anti-malarial drug known as mefloquine.  This drug has a lot of side-effects.  I’ll list them now:

Common side-effects:

Diarrhea; dizziness; drowsiness; headache; lightheadedness; loss of appetite; muscle aches; nausea; stomach pain or upset; strange dreams; tiredness; trouble sleeping; vomiting.

Severe side-effects:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bizarre behavior; chest pain; fainting; fast, slow, or irregular heartbeat; flu-like symptoms (eg, chills, fever, headache, muscle pain); loss of balance or coordination; memory problems; mental or mood changes (eg, anxiety, confusion, depression, hallucinations, mood changes, paranoia, restlessness); numbness or tingling of the hands or feet; red, swollen or blistered skin; ringing in the ears; seizures; severe or persistent cough; shortness of breath; suicidal thoughts or attempts; symptoms of liver problems (eg, dark urine, pale stools, persistent stomach pain or loss of appetite, persistent tiredness, yellowing of the skin or eyes); tremor; vision changes.

Wait, did I see “bizarre behavior” in there?

Let me tell you a quick story and then we will wrap this up. 

July 11th, 1993. 

I arrive in Ghana.

July 12th, 1993. 

I start taking mefloquine.  “You might have strange dreams”.  We didn’t hear about any of the other side-effects.

July 15th, 1993. 

We start in-country training in Koforidua, Ghana.  We are staying at a boarding school.  I’m sharing a room with M_ (name obscured), another teacher in training.

July 18th, 1993. 

M_ has a bad reaction to the mefloquine and displays some “bizarre behavior”.  Specifically, and I missed all of this because I was hanging out in the school cafeteria at the time, M_ left the school grounds in only his skivvies, and was found in the main square of Koforidua having a totally psychotic episode, running around and screaming about looking for a flashlight.  In his defense it was dark out at the time but clearly he had a pretty severe breakdown.  And it was due to the mefloquine.  M_ was bundled up and shipped back to the states the very next day; we never got to say goodbye to him or anything.  It was extremely disturbing to all of us, as you can imagine.  It was probably far more disturbing to M_, of course.  I didn’t sleep very well that night, suddenly bereft of my roommate with no explanation as to why he freaked out so badly (we found out about the mefloquine angle later) and legitimately wondering if I would be the next to go.  As a bizarre post-script, we found out much later that he ended up being ok, and wanted to come back even, but was told that he could not after having such a severe reaction to the mefloquine, because we were required to take it.

July 19th, 1993.

I stop taking mefloquine.

July 20th, 1993. 

I don’t get malaria. 

In fact I did not get malaria at all while I was in Ghana.  I was lucky, I was placed at a village that was hilly and somewhat high off the plains, so it was a bit cooler there, and the mosquitoes didn’t like it as much up in Boso.  I didn’t even sleep under a net.  Yes I was playing with fire, but on the other hand I at no time found myself running around Boso in my underwear screaming about flashlights.  Or if I did and just don’t remember it, the good people of Boso had the infinite grace and tact to not tell me about it.

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