Malaria!

The morning the ship arrived, I was in a rush to get onboard because I was on call for the first 3 days in port. Before our last buffet breakfast at the hotel was even over, I had received several emails about a student that needed to be taken from the ship to the hospital that day. My responsibilities as the nurse on call include carrying the pager for 24 hours and responding to all calls. I also hold morning clinic from 7-7:30 while in port, as well as liaise (if needed) with patients to on-shore physicians. All of this requires me never to be further than 1 hour from the ship.

Patient with Traci, my co-worker on the ship, in the ICU room

I didn’t know it at the time, but I was about to essentially drop off one patient and pick up another one to take back to the exact hospital that I had been at for an entire week already. It worked out well because the time needed to sort out the logistics of where and how to get there, as well as how to navigate the internal systems in the hospital (such as where the ER was, how a patient is registered, having money converted because everything must be paid in cash, how to explain to the rickashaw driver what part of the hospital I was going to, what to expect in terms of service, timeliness, etc) would have been way more for either Chris or Traci than myself. I was happy to do it. I hadn’t considered this knowledge as skills at that point, but I quickly learned how much I had subconsciously learned the week prior. It was priceless over the next week!

A student had fallen ill 3 days before arriving to India. She had progressively gotten worse, her symptoms initially mimicking fatigue >> flu. She had high spikes in fever and was not responding to antibiotics for possible pneumonia. By the time I arrived on the ship that morning, she was barely able to walk due to extreme fatigue, nauseous, abdominal pain, hypotensive, jaundice, corneal hemorrhaging and was developing a rash over her back and chest. We weren’t quite sure what was going on with her, but an ER visit was definitely needed. I was able to get her into a taxi that rushed us across town, but by the time we arrived, she was barely able to lift her head. Initially, the ER docs thought viral hepatitis.

On one of her better days, she was showing me the sign for Orcas Island, her home

It wasn’t until the next morning that I had a diagnosis: an extreme case of p. falciparium malaria. I was shocked! Most likely she was bitten by a mosquito in Ghana, but we can never know. Her levels of malaria in her blood initially were 'severe', and she was developing rapid multi-organ failure. I barely left the hospital for the next 6 days.