An Uexpected Adventure

I’m sitting here on the common porch overlooking the city as the sun begins to set. There are billowy clouds in the distance across the horizon. These are the dog days of summer here and it has been particularly hot and humid this week. It hasn’t rained in awhile but it feels like it should. When we walked this morning at 6 am, the humidity was almost suffocating; I was drenched with sweat when we returned. Jim loves it but, it has become oppressive for me. However, up on the ninth floor, there is a wonderful breeze that makes being outdoors a pleasure. Below me on the street, I see the traffic stopped by the military. This means the President is about to come home to one of his numerous houses located just a few blocks away. Almost daily, at any time of the day, traffic will be stopped for his movement for lengths of time creating more congestion on the already snail paced streets of Luanda.

The latest ongoing adventure was unexpected; a medical evacuation to Pretoria, South Africa. This all began at the end of October, when I had an episode of, what I thought, was acute gastroenteritis. Most people have episodes from time to time attributing to something you ate. But this time, it continued. After 10 days or so, I reviewed my symptoms which seemed to be more consistent with a parasite. Giardia, I thought. I sent off stool samples which came back negative (not unusual). So, I decided to treat myself with the appropriate antibiotic anyway and I improved. But, not quite….so, despite more negative stool samples, I did a second round of antibiotics, which did finally seem to treat my symptoms. Yet, I continued with intermittent episodes of fatigue, malaise, nausea, some abdominal pain that would last a few days and resolve. I had no appetite, aversion to most food and drink and was losing weight. I did research on post infectious Giardia symptoms which can continue for awhile. And, after consulting with a few people, it was felt this is what I must be experiencing. Then on New Year’s Day, I couldn’t get out of bed and for the next week, pushed myself to go to work despite increasing intestinal pain, diarrhea, fatigue etc, etc. Finally, after consulting with the doctors at the Embassy in Pretoria, I was on a flight to Johannesburg with immediate admission to Kloof Hospital in Pretoria. Between the doctors at the Embassy and a local GI doctor, it was felt I had some type of inflammatory bowel process going on (my serum inflammatory markers were quite high). The prospect of having new onset ulcerative colitis or Crohn’s disease, after never having any indication in the past didn’t seem possible. I couldn’t imagine having a chronic illness. But, luckily for me, once the GI doctor did a colonoscopy, I was diagnosed with amebic colitis. So, I had a parasite, Entamoeba Histolytica, that created chaos in my colon. The doctor let me wake up during the procedure (which I wasn’t happy about) but I did get to see quite impressive images of all the abscesses present in my bowel. The biopsies confirmed the diagnosis and once I was started on a three week course of 2 different antibiotics, I recovered nicely. When I thought I had Giardia, I partially treated the Amebiasis but since I did not completely eliminate the luminal trophocytes with the second antibiotic, it just took hold again. Luckily, it seemed to be confined to my colon, but it can spread to the liver or brain if not treated.

How and where I acquired this parasite is not known. I am very, very careful of what I eat, drink, how I prepare food. etc. Many people are asymptomatic carriers but I do know that people die here of untreated amebiasis. When I think about my previous travels to third world countries, I ate food from stalls on the street, drank the water and only had one episode of gastroenteritis in 3 years of traveling overseas. So, how did I get so lucky this time? Why don’t other people in the Embassy contract it?? Maybe my age or just bad luck? Whatever the reason, it was a very sobering experience. And with all experiences, I have to learn something. This time, I learned a lot about intestinal parasites, how difficult it is to diagnose the specifics and the importance of completed treatment to eradicate them. The regional State Department doctors in the medevac center at the Embassy in Pretoria had no criticism of my treatment approach having many years of experience of similar situations. I was satisfied with the care I received in Pretoria and very appreciative to the Health Unit staff there. The upside to all this? I lost a bunch of weight and hope not to gain it back.

It was coincidental that the illness just preceded our trip to Cape Town. A few days after my hospital release, Jim traveled, as planned, to SA and we continued with our brief vacation. It was a wonderful way to recuperate without the pressure of returning to Luanda and work. We spent the next 8 days seeing the sights of the beautiful Cape, enjoying good food, orderly traffic and lovely walks. The surrounding area around Cape Town is so similar to central and northern California without all the people. Despite my fatigue, we enjoyed short hikes in the Cape Peninsula and the lovely Parks in the city. One day, we visited Robbin Island, the site of the prison where Nelson Mandela and other political prisoners were kept for 30 years. The guides on the tour were all former political prisoners, each telling their and others’ stories of time in the prison. Despite the beauty of the area and seemingly normal western type life for many, there are still shanty towns with a great deal of poverty on the periphery of the city. And, in the end, it is still Africa.

Here are some photos of our trip.



Back in Luanda for our last few months, I was recently informed that I will leave here the beginning of June. We will be ready to go. My replacement will be another new hire straight from orientation. And, although I offered to stay a few days to overlap and orient my replacement, I was told here that due to housing issues, this was not possible. I will have a few days of “consultation” in DC before month long “home leave”. We will divide our time among family members in Ohio and the west coast before onward to Ankara.

So, in the meantime, we continue with our experiences of life in Luanda, Learning to make tasty creative dishes with what we can find or afford here augmented with our last Samtrex order (an online store from South Africa that sells food to Embassy personnel in Africa. We receive a consumables allowance that we can use to ship things from the US. I sent lots of Charmin, Bounty paper towels, canned chicken and tuna, almond butter, etc. and if you have weight left over you can use it to ship your Samtrex order. After a year, your weight allowance expires.)

We have learned how to deal with mold—imagine coming back from our trip and despite having the AC on, finding two closets and one room covered with mold; clothing, shoes, purses, items hanging on the walls etc. I spent 2 days just washing clothes and now trying to keep it from taking over the closets again.

We have the opportunity of using different brands and types of appliances. (If anyone ever considered buying an all in one washer-dryer from Bosch—don’t do it!!! The clothes take forever to wash and you never get them dry. When we moved into this apartment, we had to give up our regular washer and dryer as this type was included in the apartment due to space constraints.) And, of course, dealing daily with the issues of a poorly constructed new apartment building and its mentally unstable landlady.

Jim continues to be a great CLO. In addition to teaching water aerobics, he is now teaching swimming to some of the local staff. Although they live near the water, few know how to actually swim strokes. They want to feel more comfortable in the water and they have been consistently attending his classes. Jim also has started to read books—something he has not done since I have known him. Additionally, his blood pressure has dropped 20-30 points from borderline hypertensive to fit normotensive. He didn’t realize how much stress he experienced in his daily life in Cincinnati.

I also finally joined a book club a few months ago made up of international expat ladies. Presently, we are reading, In the Footsteps of Mr. Kurtz: Living on the Brink of Disaster in Mobutu's Congo by Michela Wrong. It is a very interesting and well written book that really keeps your interest. It gives you a good idea how these wealthy African countries are raped by their leaders leaving nothing for their people.

And to continue a look at reality in the third world of Angola, go to this link from the Economist:

http://www.economist.com/blogs/baobab/2011/02/expensive_angola


and another entry from the same guy.

Expensive Angola
Hot on Dubai's heels
Feb 9th 2011, 17:29 by O.A. | LUANDA

THE Angolan government this week said it sees Luanda, the capital, as a "new Dubai" and there certainly are similarities with the emirate. Luanda has access to vast oil wealth. If only they could get visas, tourists would love the beaches and game parks. Flight routes have been improving following the opening of a modern airport; planes arrive non-stop from Europe and America, mostly carrying oil engineers. Ryanair, the low-cost carrier, has looked into the route from London.
Then there are Luanda’s new skyscrapers. Oil money has swept into local banks and quickly seeped into the construction sector (even though the country much more desperately needs farm loans to boost agriculture). Half a dozen more luxury hotels are under construction along the Marginal, the waterfront promenade, adding to the spiky shadows over the marina on the sandy Ilha peninsula where a $5.5m 110-ft Ferretti lords it over the other super-yachts.
If only that were enough. Dubai’s rise may have started with oil but it has long since run out and the emirate now relies on banking, tourism and foreign investment, sectors where Luanda, and Angola in general, do poorly. Few banks give the appearance of commercial savvy or probity. One critic refers to them as "Laundromats". The American government recently froze the accounts of the Angolan embassy in Washington over irregularities.
Suspicion runs both ways. In formerly Marxist Luanda, foreigners from capitalist countries are not warmly welcomed. It is nigh impossible to get a visa unless one has a powerful sponsor or some other in. Those who make it past the airport face additional hurdles. It takes 56 steps to set up a business if you are Angolan, and foreigners must jump through even more (even tighter) hoops.
Baobab was walking along a seafront road between the presidential palace and the national police command this week when an armed policeman approached and asked to see my passport. Two Japanese were caught in the same drag net. We explained—using primitive sign language--that we were not carrying our passports and in any case did not speak Portuguese. The copper became increasingly irate. He spoke no English except for "mani, mani" (try saying it out loud). His less-than subtle demands for a backhander eventually led him to write $10 into the sand with a stick. We continued to insist that we didn’t understand. He stammered, "Angola… policia… bandidos." We smiled broadly and repeated, "No Portuguese". The policeman shook his head—presumably at how thick the world outside Angola must be—and let us go.

We finally made a trip with friends an hour north to Shipwreck Beach—basically a tanker graveyard. There are theories about why the ships are here but the most likely is that the ships were just dumped here to get them out of the way.



I will leave this entry with the last of my reality photos of sites around Luanda when there is heavy rain. We were with a group going on another field trip a few hours north. To get out of Luanda, we had to drive through typical scenes. At one point we had to turn around and take another road. But in the end, the rain stopped and as the last photo will show, there can be a rainbow!