Medical Mud on the Tracks: Finding a Nickname for a Flesh-Eating Parasite

April, 2011

By the time I got home to Oregon it was obvious that the injections I got in Bolivia were not winning the battle. I met with my travel doctor and brought the drugs I got from Bolivia: the bactrum pills I got at a pharmacy and the 4derm ointment and prescriptions for the injection from the doctor in La Paz. He described the injection as “a shotgun method anti-bacteria and anti-fungal.” He didn’t seem too concerned about the wound on my cheek and assured me he’d figure it out soon. At this time it was the size of a quarter with a crater in the middle and crusty, orange rim. My doctor simply took a swab of the viscous middle and said he’d wait a week for a sample to grow from the culture. He gave me a prescription for penicillin – which I was surprised, is still the best basic anti-biotic – and sent me home to wait. I continued visiting friends, looking for work, settling back in to life in the USA.

A week later I called my doctor but he said the culture hadn’t grown anything yet. After a few more days I called again – no culture. My doctor wasn’t too worried, certainly not animated, so I tried to play it cool as well as to stubbornly contrast Shalynn’s growing impatience and my family’s general over-concern. His best guess was that it was MRSA – a highly contagious skin bacteria that spreads on contact. It can be a nasty infection, some cases of which can only be cured by extricating the infected area.

When I called at the beginning of the next week and my doctor still had no results I urged him to take the next step and try a biopsy. Shalynn had grown more and more impatient with his apparent lack of concern and the fact that I had to call his office for each bit of news. She wanted me to see a specialist, but I was confident my doctor could figure it out if given a bit more time, but prodded him into going for the biopsy. The culture, he had said, would only reveal an organism if it was a fungus or bacteria. Since nothing grew, it must be something else, something only diagnosable under microscopic scrutiny. He was reluctant to cut into my skin but the wound was getting worse and he agreed that would be the next step.

A biopsy is a simple procedure: he rubbed around the wound with an alcohol swab, stuck in a local injection of Novocane, then sliced a 3mm chunk from the topmost and furthest back corner of the wound. My mom came for support; watching her saddened face grimace was the hardest part of the procedure. The biopsy is daunting to think about and is painful, but quick.

Wrapped in a pressure bandage to stop the bleeding, I went off with hopes of finally discovering what was causing the wound. My doctor sent off the sample of my flesh to a local lab and expected to find out within a week. In the meantime he came back to me with guesses as to what kind of infection I had.

“Did you come into a lot of contact with wool? Because I think it might be cutaneous anthrax that lives in sheep’s wool.”

“Well the scuzzy hostel I stayed in the night before the pimple popped up had alpaca blankets that felt like they hadn’t been washed in years. I might have anthrax.”

As I contemplated nicknames for the infection, another week passed and I didn’t hear a word from my doctor. Shalynn was now mad at me for not going to a specialist, and she was disgusted by my doctor. I called his office daily and didn’t get an answer for a few days, until a nurse called me to ask where I wanted to fill my prescription of Ciprofloxin.

“What do you mean? I haven’t heard anything about a new prescription. Did they get a positive identification?”

“Oh you haven’t heard? Let me read your charts here… Yeah it says here you have a staph infection.”

“Oh, ok. So the Ciprofloxin will heal the whole thing?”

“I guess so.”

At this point I was really disappointed in my doctor. I couldn’t get a hold of him that day so I left angry sentiments with his receptionist and “Staphanie” and I went to the pharmacy to get our Ciprofloxin. My doctor called me the next day, tail between his legs, defeated. He apologized for the lack of communication. I asked him about the staph infection and the timeline and how it would heal and what the scar would be like – he didn’t know if it was a staph infection.

“Adam, you should see a specialist. I’m sorry, but I don’t think I can help you anymore.”

I lost over three weeks of ground in the battle. Now the wound was crusted over like the cheesy roof of a casserole and was the size of a decent forkful. I found a dermatologist and she happened to be Argentinian. She had a French name so I completely lucked out on that random fortune; her knowledge of the region’s micro-parasites made her take my affliction much more seriously. As soon as she saw me she was deeply concerned, took another biopsy, and had the sample tested for specific, difficult-to-detect micro-organisms.

A day later I got the call: “Adam, you have a protozoal parasite called leishmaniasis. It is difficult to cure, but I’ve set you up with an appointment at the Infectious Disease Clinic for tomorrow, and they’ll be able to hopefully get you taken care of really soon.”

“Oh Leishmaniasis! Wow. Ok. Well that explains it.” It appeared that “Leishlie” and I had a long road to travel.

La Paz Again: The long low point in a long adventure.

March 8-12, 2011

After getting robbed in Carnaval, after exposing an infection on my face to booze, cold, crowds, and open air at Carnaval, after having the time of my life at Carnaval, the repercussions of our blended fortunes fell heavily upon us. We had all of our traveling gear with us in Oruro and decided that night to head back to Cochabamba to regroup. All the embassies were closed to celebrate Carnaval, so we decided to take a bus to La Paz to be there in the morning when the US Embassy opened up. I had never been to an embassy before. I was somewhat surprised, then proud, to encounter that the embassy was mostly run by Bolivians. Even though we are US citizens we were still carefully scrutinized before allowed entry. Shalynn began putting on her “distressed poor me” act to beseech for a rush order passport, and the embassy official could only encourage her that if it were a life and death situation, like any family who is sick that you have to get back to…

Thanks to her Uncle Earnest’s recent diagnosis of terminal cancer, Shay got a brand new passport the next day.

In the meantime we filled our days with dreary errands; we had to plan our route, buy some replacement items, restore our sense of adventure. More importantly, I finally resolved to find a doctor who could look at my infection. We found a public health center near our hostel and didn’t wait too long to talk with a doctor. She asked where we had been, when the wound appeared, if I’d had any contact with other people. We told her that we lived in the jungle for two months and she asked if I had heard of leishmaniasis – we both firmly negated the idea since it had been over two months now since leaving the jungle…

I understood most of what the doctor said and she ended up diagnosing me with some bacterial or fungal infection. She gave me a prescription for a cream, and then had me wait for something else. Soon another nurse took me back and had me pull down my pants. She stuck me in the flank and told me to come back two more days. All told, my first experience with foreign, free health care cost me 15 Bolivianos for the doctor’s visit and 80 Bolivianos for the medicine. Not bad treatment for $14!

After Shay got her passport the real battle began with trying to get the Bolivian customs office to give her a new visa stamp. Even through we had proof of us flying into Ecuador together and our flights leaving Santiago in 10 days, even though we showed them my passport and the date and location which it was stamped upon entering Bolivia via Lake Titicaca, and even though we had the official police report that we were together and that Shalynn Pack had her passport stolen, the customs officials said they would be unable to verify that she had entered the country legally. Despite having been in the country for over two months, their records of our presence had not yet been entered into any sort of computerized database. The only proof of our entering the country was a small stamp on our passports and a sheet of paper in a file cabinet somewhere in the one-room annex to a convenience store that serves as the Bolivian immigration office.

We returned daily for our punishments; I had a shot in the butt and then painful work of La Paz’s hilly streets, and Shay had to beg every day to get her passport back with a stamp. We wandered the streets looking at the markets, found our way to the bus stop to check on dates and the cheapest rides to Chile. We were cynical of Bolivia’s problems of corruption and a lack of infrastructure. Why couldn’t they spend ten seconds and sign a stamp on her passport? How difficult could it be? Did they want us to openly bribe them? We kept running into an Australian who overstayed his visa because he spent two months in the hospital due to a severe intestinal bacteria. He had the hospital records, letters from the doctors, letters from his employer back home, and letters from Bolivian and Australian lawyers. I translated for him. The customs official said he was unlikely able to help him.

Our will finally broke. We started arguing about whose fault it was that we were where we were. Why didn’t you wear your travel wallet? Why did you pick up his keys? We were drained from the daily errands, agitated, cold in the high altitude, disillusioned with our experience of an incredible country, and I had to get shots for an open wound on my face that had gotten worse for a month straight. At our lowest point we started drinking, then went to a crappy movie theater and watched Toy Story 3 and bragged loudly in English about how we’ve actually been to Disneyland, but then spent the rest of the night homesick for our old toys and home.

On Friday I got my second-to-last shot and we went to the Migration office. They said to come back before they closed at 5 to get her passport. We were really worried that if we couldn’t get it that day that we’d have to wait over the weekend and then would only have a week to get the 2500 miles to Santiago. We came back at 4:30 and I yelled and begged and Shay held me back and begged. We went up to the desk every 5 minutes to ask why it was so difficult. At one point they said they couldn’t find her passport. Five o’clock passed. By five-thirty they were asking us to leave, but we wouldn’t. At this point we just wanted her passport back and would maybe just bribe the official at the border.

Finally at 5:40 they read off a few names. Shay was called and they handed her the passport with its stamp. We hopped a bus the next morning after Shay gave me the last shot. She had food poisoning and had a miserable trip to Chile. I had a bandage on and hope that the injections I had gotten would finally get rid of this infection.

¡Carnaval! Party! Parasite! Purloined! The Open Wounds of Parasites and Vultures

March 5 & 6, 2011

Carnaval in Oruro is THE Place to be for the beginning of Lent in Bolivia. After we finished our volunteer projects, we went with 50 others from Sustainable Bolivia to the gem of Bolivia. Oruro is a beat up town of 240,000 people that hosts another 200,000 or so for 22 hours straight of dancing and drinking. After we past through an immigration checkpoint where we had to leave our trip organizer, Erik, behind for some BS Bolivian bullying, we all piled into an office building we rented out to sleep in. 50 people, one bathroom, CARNAVAL!

My face still bothered me, but we figured that we’d be on the move and home in no time, so I’d stick it out until we flew home on March 21st. We left Cochabamba on March 4. In three weeks, what could go wrong?

We woke up early on Saturday and found our seats. We had prime real estate in Oruro’s central square, a section of the parade known for being rowdy, loud, and very encouraging for the dancers. It´s so crowded and people started drinking before we got up. The parade starts around 8 am and the dancers dance a 4 mile track up to the church on the hill, which has an entrance to a mine shaft. A portrait of the Virgin Mary miraculously appeared in the shaft one year and so they changed the ceremony from honoring Pachamama (Quechuan “Mother Earth”) and el Tío (the demon of the mines) to honoring La Virgin del Sacavon (Mary of the Mine) and her battle with the devil.

Shay and I had an INCREDIBLE time watching the dances of Carnaval.

We had to get to our seats by going through a restaurant and crawling below the bleachers and pushing our way through the crowd. Then we joined the party. From 10am to 5:30am Shay and I danced and watched the incredible costumes. Morenadas DancersMy favorite were the Morenadas, which are dancers dressed with golden and silver masks of old men with large, multi-colored beards and rings of skirts. There is also Tinku from the jungle regions, la Diablada celebrating the angel and devil´s eternal battle, and everyone´s favorite dance Caporales, which is very high energy and has up to hundreds of men and women with bells on their legs jumping and kicking and spinning in unison. When the Caporales dancers make their run, everybody is cheering. The lead dancer blows his whistle to silence the crowd, then in a powerful charge, the hundreds of the dance troupe leap in unison.

Tinku Dancers representing traditional dance and dress of the jungleGringas from Sustainable Bolivia watch the dances, Paceña in hand.

There are also children dressed up in the same costumes, cars decorated with blankets and silver and coca leaves, fireworks all day long set off right in front of you, and smoke bombs. From the stands you can give the dancers high fives or – more commonly – pass off your beer or bottle of Singani for them to take a swig. One Caporales dancer fell several blocks behind indulging in this tradition, and as he wandered down our street, alone and stumbling, he accepted a few more offerings and then snapped into a singular charge with bells raging until he ended the dance with a leap, landing on his face, and a policeman carrying him off to the boos of the crowd.

At Carnaval everyone shares their drinks and their cheers. In the stands another tradition is to throw water balloons mercilessly. A guy in our group would have soaked a pair of old ladies across the street had they not blocked with their umbrella. Within our section bottles and bottles of foam spray met my face, shay´s face, everybody once or twice in the face at some point. Our bottle of mixer fell below the bleachers but there are children below selling cans of beer, and they´ll hand you your stuff that falls below. A group next to us was chanting for us one by one to try their beer bong. Eventually we were locked in by the restaurant and had to climb fences to get in and out. The street food was always good and always cheap, and we watched most of the 50000 dancers and 10000 musicians for 20 hours.

Then we joined the parade around 4am and followed it all towards the church at the top. We didn´t make it. Around 5 am we were sitting in another stand trying to decline glass after glass of Singani with warm milk from some bolivian guys who were hitting on both of us, and we decided to call it a night.

On the next day, Sunday, I truly reaped the consequences of my conviviality. I woke up after a couple hours of sleep, and the wound on my face seemed to have blown open. It went from being a small scab to a full open wound. It was still small (relative to how bad it would get eventually) but I could no longer deny the affliction. I resolved to get it checked out as soon as I could stay in a place for a few days. We had planned to go to Sucre, Potosí, and Tupiza on our way down to Argentina, then head across to Valparaíso to meet Shalynn’s sponsored child. We soon lost control of all our plans…

I hoped the foam didn't worsen the infection on my cheek, but still had too much fun.

We wandered around the city to where the water wars were much fiercer. Near the church on the hill every ten yards up there was another bastion of water ballooners. It looked too fun to me to miss out on, so we bought a bunch and climbed as high as we could, running the gauntlet of foam sprayers and water bombs. Right as we reached the top we were attacked by a bunch of kinds with super soakers. We made peace and threw water balloons hundreds of yards down the hill into the crowds. How glorious.

Except for it started to rain right after we got soaked. At 4000m, Oruro gets cold when you´re wet and it´s raining. We lost our will to fight, and when every little kid has a squirt gun and a bottle of spray foam CARNAVAL is a dangerous place. So we lied low until our bus for Sucre.

While a few other girls whom we were traveling with changed their tickets, a kid walked by Shay and me. We were exhausted from the partying and lack of sleep. She was slumped down next to our two big backpacks and our two small backpacks, and this kid dropped his keys right next to me. It seemed to happen in slow motion; I reached down, picked up his keys, and met his eyes as I came up. He smiled – in retrospect I can only describe it as a sly smile – and then said “gracias” and bowed. Shay woke up from the entrancing interaction before I did: “Where’s my backpack?! Shit someone stole my backpack!” She ran off looking for the culprit and I was stuck with the stuff. When she came back I ran around the station in every direction, checking the bathroom stalls, running around the loading bays, peeking into open doorways on the blocks surrounding the bus station. How could we have been so dumb?! We let down our guard at the worst time, in the most crowded tourist attraction in the country. We began to take inventory of what we lost: My laptop, camera, the engagement ring I had just given Shalynn at Machu Picchu. More problematically, we realized Shay had left her travel wallet in the bag. Bye bye passport, cash, credit cards. Suddenly our adventure would become much, much more difficult.

I left Shay in the security office of the bus station with our bags and headed into the traffic to find a Taxi. I sat in a car for a minute and quickly realized we would never make it to the Tourism Police station before they closed in 30 minutes in the gridlock of everybody leaving town after the weekend’s festivities. I got out and had to run 20 blocks to the main plaza, feeling my way by the cheers of people still watching the dancing. Here I was, totally gringoed out in my Felt hat and alpaca sweater, frantically running to the police. I fought through the parade (they stop from 6am to 8 am and then hit it hard again) and quickly explained to a Policía that I needed to get in. He took me along the parade route – I glared hard at anyone in the crowd with a can of spray foam. I submitted a police report with the BOOM BOOM BOOM of good times and flowing booze marching by through the wall. I had to cross the street through the Tinku dance to buy paper for them to print a report, and couldn’t resist dancing a little bit to get through the feathers of the costumes. I couldn’t believe our day’s fate. After the craziest party I could ever imagine, I wake up with an open wound on my face and end the day wondering how we are going to get out of Bolivia without Shay’s passport. All I could do was laugh and dance and trust that we’d figure it out.

Kisses on the Cheek

February 7 through March 4, 2011

Some how we made it back from Uyuni. It wasn’t easy – that’s for sure! Our train that was supposed to leave at 1AM didn’t leave until 10AM the next morning. Not that I’m a haughty gringo that expects everything to be on time, but we all boarded the train at midnight and expected to be woken up by the lurch of it starting up. Shay and I didn’t have a blanket, so as we froze in an open air tin can on the tracks 12,000 feet above sea level, we woke up shivering every 20 minutes and deliriously wondered what time it was and why haven’t we moved yet? Morning light solved our problem: “Hello Uyuni!” We had not moved. In fact our “train” was just a few train cars that were not even connected to the engine! There was a sign on the tracks that said “Hay Lluvia (There’s Rain)” so the train will leave at 10AM. The bathrooms were locked. I used the tiny train latrine only to realize that whatever I was doing was just landing on the tracks below me.
We stayed overnight in the train station and on the train, hoping that we'd actually go somewhere!

Later on our bus broke down for several hours…

But as I said, we made it back to Cochabamba and got into our routines as volunteers. In my travels through rural Bolivia I met many children who hadn't ever seen a white guy in person. They loved my camera and had tons of fun jumping around and hiding and then looking at their pictures.Shay began working on worksheets about Climate Change for Bolivian schools. I began producing videos for Energetica, occasionally leaving the city to film some of their work in the rural areas. Living with the other volunteers with Sustainable Bolivia was a blast! We had nightly group dinners and parties several days a week. The only problem was I met so many people. Bolivia maintains a kiss-on-the-cheek greeting, and my cheek had some unknown infection on it. I’m sure I made several bad impressions as I forcibly resisted kissing cheeks. Once I even tried to switch it up and kiss on the left cheek but along the way her lips intervened. That one was awkward.

I had to be vigilant! I did not want to be ground zero for some outbreak. Although I know I’m really lucky I didn’t actually have a contagious infection because I wasn’t as careful at first. I had monitored the sore since discovering it in Uyuni and it wasn’t going away. It wasn’t getting better either. Once I shaved and intently went over the small scab. It didn’t bleed. It didn’t hurt. I thought maybe that would open up my pores or something. Maybe.

Another week went by and the sore had redness around where the scab was. We went to a pharmacist and got an anti-bacterial cream. I was starting to feel self-conscious about the sore, especially with all my dodged “nice to meet you’s” and going for the left cheek. Seriously, try hugging somebody with your heads meeting over the left shoulder. Without warning, you can break a nose!

I usually put this cream on in private. I think that might be an obvious statement. Most people would apply their creams in private. So moving on, once I put the cream on before a party. I was getting impatient. Maybe the cream covered it up, too, I thought. I made a goofy hat out of a cereal box and clippings from “Time” magazine for the “A Very Happy Un-Birthday” Mad Hatter party. I must have really looked like a fool; I didn’t notice that the cream had caused the wound to ooze. So here I was, crossing my eyes and lisping the phrase, “Muthdard? That’th ridiculouth!” and my face was leaking. Finally a friend pulled me aside and asked if I was ok. She said she had MRSA once on her forehead and that’s what it looked like at first. I was so embarrassed. I went into the bathroom and washed away a viscous, clear-orange dewdrop.

In the couple of weeks that followed, more and more friends were worried. I brushed it off and was assuring, but grew uncomfortable. I’m a hypochondriac as any kid who grew up watching medical shows would be, thinking he knows all the diagnoses that he could possibly earn. But I was also very reluctant to pay for a dermatologist appointment since we were to leave Cochabamba soon and I wouldn’t have enough time to do any sort of treatment. I reviewed my travels and any sort of contact I’d had with my face. A friend from the Uyuni trip brought up about that scuzzy hostel where we partied with our toothless guide Roberto and I was convinced I picked up an infection from the pillow-case. Shay and I both rationed that I couldn’t have MRSA since she hadn’t caught it yet – a reasoning that still shames me in its risky passivity.

I celebrated my birthday in Cochabamba. It coincided with the pre-Carnaval celebration “Copadres,” in which all the guys hang out together and do manly things. At a meat buffet, I unwittingly tried cow udder. We went out to a bar and Shalynn and all the girls came in with a birthday cake. The band and the whole bar sang “Feliz Cumpleaños” for me. I was happily distracted.
I celebrate my the beginning of my year with Leishlie, the friendly parasite.

Traveling through the Salt Flats of Uyuni: I first noticed the parasite

February 3 through February 7, 2011

My first step on this nightmarish journey through Leishmania began in a fittingly surreal location: the Salt Flats of Uyuni. Shalynn and I left the jungles of Manu in early January to travel on through Lake Titicaca and La Paz, and on to Cochabamba, where I had set up a volunteer position working as a documentary producer for Sustainable Bolivia. After getting situated in the city and moving into one of the volunteer homes Sustainable Bolivia rents out, I made a production schedule with the Bolivian Energy NGO for whom I would produce short promotional films. Our schedule allowed Shay and me time off to go to Uyuni with some other volunteers, where I first noticed something wrong with my face.

The Salt Flats of Uyuni stretch out for over 4000 square miles and are the largest salt flats in the world. The combination of the high desert geology and the unreal reflections and perspectives of the endless flats make Uyuni the most frequented natural attraction of Bolivia. Our group spent 3 days in the region; fourteen of us were crammed into 2 jeeps on an adventure through a microcosm of Bolivia’s failed tourism infrastructure.

We negotiated with our tour company for several hours yet were still screwed into our sardine arrangement in the jeeps. We spent the next three days on bumpy mud roads in disrepair expecting to crash or blow a tire at any moment. Our driver was a complete asshole who ignored all of our questions, formalities, and even shouts of panic and anger as he drove away with one of our group left behind. Costumer service? Although I like most Bolivians and encourage everyone to go, this tour operator was about par for the course in Bolivia.

Our guide was a great character, on the other hand. He introduced himself by saying: “I have no teeth because I worked in the mines of Potosí as a kid.” He started in the silver mines at 13 years old, but eventually taught himself Spanish (being a native Quechua speaker) and English, and eventually German, Italian, Dutch and Portuguese as he found more and more work as a tour guide. Roberto shouted at us at every stop to convey each attraction’s main details. He was loud and hurried in his baggy wool sweater and toothless grin. Once we arrived in separate groups to a site and when one in our group couldn’t recall how many times Roberto claimed to have climbed the mountain before us (63 times), he yelled at him for being a fool who didn’t pay attention. He was a fun guide, to be sure, who danced with us to Madonna in the hostel and took every opportunity he could to take off his pants, explaining that the minerals of the geysers steam and the salt flats were good for the osteoporosis.

We began our tour at the train cemetery. Literally at the end of the line, these trains were abandoned when the demand for salt decreased. We continued on to see formations at The Valley of the Rocks and petrified coral left over from the ocean that covered much of South America before the Ice Age. That night we stayed in a small village. Four children came to perform for us while we ate dinner, and although their frightened expressions and dull, repetitive music left us with a strong awkward feeling, we donated to their travel fund to be able to go to high school.

The next morning we awoke to the cries of llamas flowing out of their pens into the neighboring valley. We continued driving across the high plateau to Laguna Colorada, where hundreds of flamingoes collect below snow-covered, purple mountains. I had brought a couple of cans of Potosina beer and snapped one open for our brief stop. It was terrible. Utterly terrible. As I spit the piss beer out the window, I caught my reflection in the rear view mirror; I noticed a pimple on my right cheek. It looked a little weird – hardened and dark. But no matter. We had a great day!

That night we partied with Roberto in a really run-down hostel near the Laguna Colorada. The sheets were staunch and sticky. The wool blankets dusty. The pillows smelled moldy. I slept fast and woke up early for the big day on the Salar. We had to argue with our drivers to get them up in the morning and to even head out to the Salar after the full day’s drive. They said the rains had made the roads unsafe. Roberto told us they would beat him up if he gave them any orders, and suggested that we just bag even going. Since we had come primarily to see the Salar, we were greatly disappointed, but fought for a few hours on the Salar. We blew two tires on the way but it was worth it. The Salt Flats were covered with a few inches of water and formed a perfect mirror to the heavy clouds. We began working on all of our pre-planned “warped perspective” photos with our friends. Sudden inspiration told me to streak across the salar and I never have felt more free or energetic or as easy to run. As we piled into the jeep again to head back to town to catch our train, I looked into the side view mirror again. Back-dropped by the blue, gray, and white of the clouds in the sky and reflected on the salt, the little red bump on my cheek stood out.