Gliding along an Amazon river and encounters with flesh-eating bugs
We sat on a small metal boat and glided downriver, meandering through foliage and tiny mines. Armed with weighing scales, magnifying glasses and rucksacks stuffed with cash, the Venezuelan traders stopped at countless small-scale mines along the water. “I have diamonds in my blood!” mused one as macaws patrolled the jungle canopy.
The mines' whereabouts were given away by the roar of motors that pumped in river water to churn up topsoil. At the bottom of one giant pit, the perimeter of which was easily the size of a couple of Manhattan blocks and thirty feet deep, half a dozen men squatted in waist-high water, picking through the mud in soaked and dirty rags. One miner rode a hose as if taming an anaconda. They could earn more here than in the “real” world. Standing at the edge of the pit, forty-five-year-old Venezuelan miner Jesús López told me he earned two thousand dollars in an average week with both gold and diamonds. “I make this sacrifice for my children,” he said, as we began to clamber down into the pit. Another told me he used to work as a Venezuelan soldier in pursuit of illegal miners—before joining them.
I got chatting to the miners and we bonded over music and beer. We otherwise had few things in common. I meticulously covered myself in DEET as insects flew around us on the boat, biting incessantly. I knew the hard way that prevention was far better than cure. I nudged the conversation towards tropical diseases; there I’d have an in. On my lower back, just below my waistline, on the right, I have a credit card-sized crater, around a centimeter deep; it’s a scar from a flesh-eating disease I had caught during my 2008 backpacking trip.
“Leishmaniasis!” they exclaimed when I showed them. Unlike British doctors who’d never seen the disease before, the miners diagnosed it immediately. They all knew people who had suffered it—and knew people who had died from it. Thankfully, I’d been in England when it was diagnosed, so I got proper treatment.
It started a full couple of months after getting back to England after my trip, with a small lump above my groin and a dark patch on my lower back. I saw a Manchester general doctor who told me that the lump was a swollen lymph node and nothing to worry about; the dark patch would soon disappear. A week later, I was in the emergency room. The dark patch had opened into a deep wound. Still, the doctors assured me, it was nothing to worry about, just an infected hair follicle.
For the next four months, the lesion grew and, three times a week, I saw a local nurse who would clean and dress it. It was becoming a huge, deep, open wound, clearly not an infected hair follicle. Around six months in, a second dark patch appeared to the right of the first, above my right leg. I wasn’t going to let this one grow, so I got myself to a dermatologist immediately. He was unsure what he was looking at but his junior mentioned leishmaniasis, which he’d read about recently. Had I been anywhere exotic recently?
I read up about leishmaniasis. It was caused by a protozoan that spreads via sandflies. It happens to be extremely common among the poor in the tropics, like the miners I was meeting, and not so much in the UK, where just a couple of people, often soldiers, get infected every year. I quickly got an appointment with a tropical disease specialist, Andrew Ustianowski, at a more specialised unit in Manchester. In the weeks in between consultations, I learnt a huge amount about the disease, and grew more scared.
Dr. Ustianowski sent a biopsy to London’s School of Tropical Medicine for a pathologist to confirm that it was indeed leishmaniasis, and hopefully to identify the strain. I was surprisingly adept at living with a large open wound; I even did a six-mile run to raise money for Medecins Sans Frontieres, one of the few charities which works to help diagnose and treat people with neglected tropical diseases. However, the pathologist came back with nothing. We were unable to confirm leishmaniasis, let alone the strain. Now what? I was terrified. If no one could work out what this was, what did that mean for me and my survival?
Dr. Ustianowski, one of the most calming and reassuring people I’d ever met, suggested we go forth with treatment for leishmaniasis and hope for the best. He had been reluctant to do this given that treatment was a half-century-old antimonial called sodium stibogluconate. Wealthy people didn’t get this disease, so drug manufacturers weren’t incentivized to research better treatments. I would spend twenty-one days on an intravenous drip. Were I not so young and healthy, it could have had severe effects on my cardiac rhythm and pancreas.
There was no way of knowing that I even had leishmaniasis until the treatment was over. Then, hopefully, the wound would dry up. But what if it wasn’t leishmaniasis? Then what would we do? I warily entered North Manchester General Hospital for the treatment, my home for the next three weeks. My mom came up to visit a few times, as did friends—and even curious medical students and doctors who’d only ever read about the disease in textbooks. I spent those three weeks trying not to worry too much. I read a lot. I built a website which formed the backend to one I would use for more than a decade later. I went deep into learning about how the heart works and what the electrocardiogram I had to have every day—lest the antimonial impact mycardiac rhythm—actually meant. Dr. Ustianowski enjoyed discussing these things with me. Unlike most of the patients in the infectious diseases ward, I wasn’t suffering too much at all and could even get the bus into Manchester, with a cannula still in the back of my hand or arm, and have dinner, or go to the cinema, with friends.
Towards the end of my three weeks in hospital, the wound looked like it was drying up—and a couple of months later, it dried up completely. I’d won out against a flesh-eating bug, or rather science and Dr. Ustianowski’s application of it had. I appeared on a primetime BBC program about tropical diseases, alongside one of the few scientists in the UK studying leishmaniasis.
The whole experience caused me to consider studying medicine after I’d graduated from physics. I had great respect for Dr. Ustianowski after my experience with him, and for the work of James Orbinski, a doctor working in the Rwanda who went on to run Medicins Sans Frontieres. His book, An Imperfect Offering, was one of those I read during my hospital stay. Maybe this kind of work would be a way to make a difference in the world? In the end, though, I decided that I cared more for science than I did for the practicalities of being a medical professional. As with physics, I was more interested in the theoretical than the practical.
While my sharing of the leishmaniasis scar served its purpose, bringing me closer to the miners’ real-world experience, I didn’t feel comfortable telling them the whole story. They were covering themselves with lemongrass-based citronella oil, a homemade protection that clearly wasn’t as powerful as my DEET. And, ultimately, my leishmaniasis treatment had been free and, while diagnosis took some time, once made, I was treated exceedingly well. The miners, on the other hand, knew that if a sandfly with leishmania bit them, they would likely die.
Jorge and I flew back to Santa Elena and took the same bus route I had across into Brazil and through to Lethem, the southern Guyanese border town that didn’t have any ATMs. Armed with cash this time, I met Patsy. She told me she’d been amazed when I’d wired her money from Georgetown just a day after staying with her. “I didn’t think I’d ever hear from you again,” she said with a smile.
Back in Caracas a few days later, on December 6, 2012, I began editing the piece with Andy in his office. But I felt weak and feverish. He was keen to get the story done as it was going to be the first of a new Reuters photo essay format. He asked if a word he’d changed was okay. But I felt awful. Instead of responding, I dropped my head to the desk. He tried to continue with the edit but it wasn’t happening. I was shattered and simply didn’t have any energy. It wasn’t a normal fatigue. I was freezing and could barely speak. Surely, this wasn’t another tropical disease? Félix took me home to rest. But it was worse than that. I called Sarah and she took me to Clinica Ávila, the best hospital in town. We waited for my GP, Karin, who admitted me. I lay in a hospital bed, shivering uncontrollably. She told me not to worry; it seemed I had dengue, or malaria—or both. That would have shocked me, had I not been ill with dengue or malaria—or both. I was too weak to do anything but drift in and out of sleep.
I woke up to a message from Andy: “Diamonds on Reuters global front page - awesome!!” It was a big deal, he said, before coming in to visit. He hovered over my bed, but I could barely speak to him. I was paranoid that I’d caught another tropical disease but too tired to express anything to him, friends or doctors, let alone ask questions. I fell asleep again.
When I woke up the next morning, I felt fine. Surely the doctors had misdiagnosed me, or, at the very least, I was young, healthy, and able to barrel through this. As I waited to be discharged, with an intravenous drip feeding me glucose, salt and water in my right hand, I grabbed my phone with my left hand and tapped out a quick GlobalPost article—one hundred dollars for this short—about upcoming regional elections. I persuaded doctors I was fine and Sarah took me to my apartment to rest in the comfort of my own bed.
Feeling better, I responded to a television producer from Sky TV, in the UK, to say I’d be willing to do an interview about Chávez’s health and his suggestion that Maduro could succeed him. I slept for a couple of hours. When I woke up to my alarm that evening, though, I felt as I had at Andy’s desk. I grabbed an orange and ripped off the skin, took a small bite and then threw the whole thing on the floor. I had no energy whatsoever and was freezing, despite the Caracas heat, and had no appetite, despite not having properly eaten for days.
The problem with dengue and malaria, I was learning, is that one minute you feel absolutely fine, then you collapse, and then you’re fine again. This painful sinusoid, along with hot and cold sweats, can go on for a week or more.
Minutes before the interview, I threw on a t-shirt and brown faux leather jacket, a la Marlon Brando. My hair was a spiky mess; I was unshaven. I sat myself in front of my laptop and, immediately, was in front of millions of British television screens. You can see, on air, the moment the presenter tries not to laugh when she sees me for the first time. I looked like someone they’d brought up from under Waterloo Bridge. Somehow, I was vaguely coherent, but as soon as it was over, I slid back to bed, leaving the orange remnants for another day. “You look like a member of a boyband the morning after a drug-fuelled night out!” a friend in London messaged me.
In the shower the next morning, I collapsed to the floor and curled up there, freezing despite the hot water streaming over me. I eventually got out and asked Félix, the Reuters driver, to take me to Clinica Ávila. How long would I stay this time? This was when I really started to panic. Another tropical disease, and this time in a developing, unstable country—with Dr. Ustianowski, expert pathologists, and my family many thousands of miles away. I pined to be back in England with my mom, grandparents, and friends, especially given we were just a few weeks from Christmas. I stayed in hospital for a week. Caracas friends and colleagues brought meals, drinks, and entertainment. I continued messaging editors with news of the elections and Chávez’s potentially impending death; he’d just anointed then Foreign Minister Nicolás Maduro as his successor in case he was unable to return from treatment in Cuba. “The story will be there when you recover,” William at USA Today said, advising me to take a break. Jackson hired a nurse to watch me overnight—not confident that the hospital, despite being the best in the country, was up to it; Magdalena, who supported the office by cleaning and ensuring there was always food and drink available, brought a huge bag filled with fruit. Both Sarah and Andy spoke with my mom regularly, calming her and persuading her that she didn’t need to jump on a plane.
Both empathized. Andy had two children himself and saw it from both perspectives. “Been there a few times myself, ill in faraway places with mom mega-worried,” Andy said. He even reminded me to call my mom, in case I hadn’t. “It's hard in your twenties to put yourself in a parent’s shoes (especially a single mum like ours),” he said in one message. “I now understand it far better, being a parent—the irrational worry, the feeling no one can care better than you.”
I spoke with my mom multiple times a day, but her fretting over me only made me more anxious. “Let the doctor know you have no one to look after you when you get home, so you need to stay in hospital until you are fully recovered,” she said. “Let me know if you need me to fly out to be with you?” She’d said a variation of this on every call, and I told her I would let her know if things changed and she needed to come. When I’d had leishmaniasis, I’d get frustrated with her questions to me and doctors. Her worry would spark my own. One day when I complained aloud to her, she stopped me and asked how I’d react if it were the other way around. Of course, I’d be even more annoyingly on top of things than she was.
Tests, according to doctors, showed that I had both dengue and malaria, both of which lower platelet levels in the blood. So, every day, I was given a blood test and we’d look to see if the numbers rose, a proxy for recovery. I booked a flight home, though doctors said I couldn’t fly if my platelet count was below a certain level.
Thankfully, I had global health insurance; few freelancers bothered. Would Reuters have been liable had I not? Thankfully, with Andy at the helm, I knew I would be properly taken care of, no matter what happened—but that would have been thanks to Andy, who was of the Reuters old school which looked after people. Nothing, though, was written. After all, I was a freelancer and, ultimately, no one had any liability for me. I wasn’t getting paid for my time; I wasn’t getting sick leave or covered for lost earnings; that was at least part of the reason why I’d done the GlobalPost piece and then a phone interview with CBS from the hospital bed. I had no meaningful contract with Reuters—or anyone for that matter. Still, at least I’d bought my own health insurance; that turned out to be more valuable than I had realized.
After a week in hospital, and just a few days before my flight home, my platelet count finally rose. I’d barely eaten and had lost fifteen pounds. But they released me. Andy invited me to stay at his apartment, with his wife, children and father-in-law, until my flight to London a few days later. “You'll have room, bathroom, TV to yourself, and the run of the house if/when you want company,” he said. But I wanted to go back to my own place. Still, he insisted. “That's what you did last time. Go home, freshen up, change your clothes or whatever, then up to my cocoon!” He was right; it was so much nicer to have people around—and then even nicer to get back to England, and see my mom, grandparents, and friends for Christmas.
Twenty minutes after landing in Heathrow, I was at my grandparents’ small semi-detached house in Slough, the one they’d bought for ten thousand dollars in 1967. I walked in and felt at home for the first time in months. For them, my most recent illness was another demonstration that perhaps I should reconsider my career path. My family never admonished me, but they were always concerned for my well-being, mentally as well as physically, often gently suggesting that I was lonely. My grandmother went further: she was always asking, with great endearment, if I’d met someone to marry. I was their eldest grandson. They’d built me up, over decades, to do something better than this, surely, as the huge graduation photo of me hanging in their living room attested.