Aedes aegypti: the culprit
Dengue. Two weeks of hot and cold fever vision head pains, shakes and splatters. It came in three acts, climax in the third at an empty guesthouse in Kep, Cambodia: a half-ghost town seaside resort where squatters live in the charred roofless ruins of French colonial villas that are slowly being reclaimed by the tangled green of the surrounding jungle. For three days, the rain came down without respite. Waves crashed over the seawall; streets flooded. And in my bedbug-infested room, I sweated and feared. The fever came stronger. I don’t remember night number nine.
Morning of day ten: I think it’s time to see a doctor.
I pulled myself out of bed, each limb a tired heavy log. Cowering under my mildewy plastic poncho, I stumbled five hundred dizzy rainy metres to the little restaurant where a persistent waiter had tried to sell me tours when I first arrived.
“Hello friend,” the man said, seeing me emerge from the rain. He wore the same striped golf shirt as when we first met. He was young, mid-20s at the oldest, with a faint wisp of a moustache on his smooth brown face. “You come back. I remember. You want boat tour today? You want visit old temple?”
“No,” I said, “I’m sick. I need to see a doctor.”
“So, you no want tour?”
“No.”
“Oh.”
“I want to see a doctor. Is there a doctor in Kep?”
“There is doctor over there,” the waiter said, waving to the distance.
“Does he speak English?”
“Maybe.”
“Maybe?”
“Maybe.”
“Can you take me?”
The waiter frowned, looked me up and down. “You buy tour?”
“Oh man, not today. I have diarrhea. Do you understand? Di-a-rrhe-a. My head feels like it’s going to explode”—I mimed—“But when I’m better, I SWEAR I’ll only buy tours from you. I swear.”
The waiter thought this over. He hailed a guy dozing on a plastic chair, spoke to him in rapid-fire Khmer.
“This my brother,” he said. “He drive tuk tuk. He take you.”
“Does he speak English?”
“No.”
“How will the doctor know what’s wrong with me?”
The waiter sighed, shook his head. “Okay, okay,” he said. “I come. I translate. You buy tour next time.”
“I buy tour next time.”
We dashed to the tuk tuk and the driver started the engine. The little Chinese motorbike chugged to life and its gaudily-painted trailer bounced over the pothole-riddled road. We drove along the seawall—lurch, lurch, lurch—brown churned ocean, salt spray in my face, jungle-clad islands poking hills through the hazy distance, each lurch and bump a hatchet in my skull, a blow to my stomach. Sphincter puckered: I’m surprised I didn’t shit my pants.
As we drove, the waiter made idle conversation: “Where you from?” and “How long you stay Cambodia?” and “You want have tour tomorrow?”
I held my throbbing hot head in my hands. If I’m alive tomorrow…
We passed a statue of a naked woman, another of a giant crab, then an empty market and more bombed-out villas. Locals cowered in the doorways of ramshackle huts, watching the cold driving rain. No one was out in the streets.
After about fifteen minutes the tuk tuk stopped in front of a dilapidated one-room shack.
“Why are we stopping?” I said. “Where’s the doctor?”
The waiter gave me a strange look and said, “This is doctor office.”
The wood and corrugated iron shack was built on wooden stilts over an open sewer where brown frothy water and debris gushed towards the sea.
I hesitated and the waiter said, “You no worry. This is good doctor. No problem. He give me babies.”
I stepped into the rain, ran to the covered porch. The waiter followed. Rain hard on metal roof: deafening. Chinks in the floor showed me rushing filthy water. A half-unconscious man groaned topless on a rattan mat in a corner, and behind a chain-link window was the middle-aged doctor’s sour mud face.
The waiter spoke to the doctor. A piece was missing from his fat lumpy forehead. I steadied myself against the rickety wall. The squat doctor grunted, gave me a quick glance: the only time he looked at me.
“You’re telling him everything, right?” I said.
“I tell, I tell.”
“You told him about the headache and diarrhea and fever?”
The waiter added something and said, “I tell. I tell.”
The doctor started rummaging through a small glass case: his medicine chest. There were maybe twenty different types of pills in boxes and bottles. No more. The doctor picked up a little pair of scissors and started trimming away pills from larger bubble sheets. He took his sweet time, rounding all the edges before placing the pills in a little plastic bag. The doctor pushed the bag through the chain-link and coughed.
“He say take one now, then one later,” the waiter said.
I examined the contents of the bag: two big grey-black discs, four slightly different round white tablets, two gel caps filled with multicoloured pellets, and a pair of something pastel pill green.
“I only take one?”
“You take one one one now,” the waiter, “and one one one later.”
“One one one?”
“Yes, one one one.”
“You mean I take half of them now, then half of them later? And when later? Later tonight? Tomorrow?”
The waiter spoke. The doctor spat.
“Five o’clock later. One one one.”
“Okay,” I said. “Okay. How much for all this?”
The waiter asked. Another doctor grunt.
“You pay four thousand riel.”
One dollar. One one one. All right. I fished out the money and said thanks to the doctor in Khmer. He narrowed his eyes. The waiter stepped off the porch and I followed and—thwack!—slammed my head against a roof beam. I fell, narrowly missed tumbling into the sewer. Ha ha went the smiling waiter. Ha ha went the stained shirt-wearing tuk tuk driver. Ha ha went the shit-eating doctor. Ha ha went the topless guy who I thought was unconscious.
“Ha fucking ha,” I said. “Real funny. I’m glad you cocksuckers are having such a good laugh.”
Smiles and ha has were my reply. Slowly, I picked myself up and climbed into the tuk tuk. We bounced and flew beside the angry sea.
Back at the restaurant, I chased the first round of pills with water. The waiter said, “You pay my brother.”
“How much?”
They spoke.
“Three dollar,” the waiter said.
“Three dollars?!” Most Cambodians makes less than that in a day.
“Three dollar.”
Too sick to haggle, I paid. The driver smiled. Head reeling, I sat down.
“When’s the next bus to Phnom Penh?” I asked the waiter. “I think I need to go to a real hospital.”
The waiter looked at his watch. “It’s one thirty,” he said. “Last bus was ten minutes ago. You stay Kep today. You want have tour today?”
The rain eased for a few hours, and bundled in my poncho, I sat shaking on the small rocky beach, watching the waves. Khmer children splashed from inner tubes while their fully dressed mothers waded into the surf. A teenager approached me—“Hello sir. Can I practice English with you?—and we exchanged halting pleasantries until the rain came heavy again. Back in my room, I finished the pills. I still felt awful. Using the hotel’s ancient computer, I researched the medication the doctor had given me: all the pills were for urinary tract infections.
Another toss and turn night. Damp rainy bed. Cold fever sweats, hot flashes. Itching all over. Cough cough. Knives between my eyes. Aching weak body. Running to the bathroom down the hall again and again and again… Sunday morning I pack my bag and trudge to the bus stop for a bouncing rain-delayed ride back to the capital. I won’t describe the journey, but know that it was bad. When I finally collapsed in my apartment later that evening, I called a friend who’d been living in Phnom Penh for the past three years.
“Absolutely do not go to a clinic today,” he said. “Wait until Monday. The medical infrastructure in the city is bad enough as is, and the doctors they have working nights and weekends are bottom of the barrel: mail-order degrees. Hang in there man.”
Another night. Same same. It’s always worst at night. Vision shakes and death dreams. Shivering and soaking through my sheets.
In the morning, I headed to a clinic. I drove my own motorbike. Stupid fucking me. The doctors were all outside smoking when I arrived. One of them—a hollow-faced eastern European woman with a thick cigarette-husky voice—said, “Follow me.”
Examination. Blood tests. Verdict: you have dengue.
Dengue fever (also known as breakbone fever) is a mosquito-borne tropical disease endemic to Central and South America, Africa, India, and Southeast Asia. There is no vaccine and there is no cure. One to five percent of the nearly 100 million people infected each year die. Symptoms come in waves and can last for over three weeks. Dengue is transmitted primarily by the Aedes aegypti mosquito, a little black and white striped fucker that is most active during the day. Highly domesticated, Aedes aegypti makes its home in plastic containers and old tires. Aedes aegypti lives mostly in cities and preys almost exclusively on humans. Another common host is Aedes albopictus: the Asian tiger mosquito.
Treatment: a whole mountain of medication to combat my symptoms and several hours of being fed intravenously. After handing me a hefty bill, the doctor said, “Go home and rest for the next few days. There is little else you can do.”
Driving home, dizzy me. Why didn’t I take a tuk tuk? Cheap fucking bastard. Crossing an intersection, I’m clipped by a racing motorbike. I spill into the street. Traffic stops. The other motorbike keeps going. A few men loitering on the corner rush to help me up. My hands and elbows and shoulders are scraped and filled with dirt. Holes have been torn into my shirt and bag. I’m shaken, but my wounds are superficial; the bike is fine.
“Be more careful,” one of the men said in perfect English, “and look both ways before crossing the street.”
