When you travel often enough, you become pretty savvy about detecting and treating your own illnesses. You know the line between a regimen of Immodium and a course of Cipro. You keep separate bags for “skin things” and “inside things,” both filled with pills and ointments collected over five continents and not always well-labeled. You know that an orange is golden but strawberries are fire, and that the water is fine as long as it's boiled. But that knowledge can turn into complacency after a bit, and you can start to get a little lax -- after all, you know how to self-medicate, and what's a little tap water when brushing your teeth? How can you say no, when that street meat smells (and tastes!) so damn good?
So I shouldn't have been surprised when I woke up one morning late last year with some pretty serious flank pain. But, being me, I figured it would work itself out (I’ll just drink more water!) and spent the next two months and two international trips steadfastly ignoring it while the pain steadily worsened, until it felt like two fists had casually grabbed and then squeezed and then refused to release my kidneys.
I went to see my doctor. She spent the next six weeks running test after test, narrowing down options while I developed symptoms like constant fatigue, nausea and dizziness. There were ultrasounds and x-rays, weekly blood samples and all kinds of cultures, gastrointestinal specialists and tropical disease specialists, endoscopies and colonoscopies, diet changes and days spent mostly in bed and a week in which my doctor’s best guess was pancreatic cancer. I figured I should start settling my affairs. Incidentally, I would like for my ashes to be scattered from mountaintops, whenever the event should occur.
Finally, four months after the pain first started, I went to see a tiny old man with very large eyebrows and a wall full of diplomas. The only parasitologist in all of New York, he diagnosed me with amoebiasis (caused by E. histolytica). He gave me two rounds of intense antibiotics, and within three weeks, the pain had released its grip.
E. histolytica (literally, "tissue destroyer") is a parasitic amoeba you pick up from infected food and water, and usually presents with digestive issues and fatigue rather than the flank pain I experienced. WHO estimates 40 million to 50 million cases of amoebiasis each year. As far as tropical diseases go, only malaria infects more people. The resulting diarrhea and liver abscesses lead to 100,000 deaths annually, mostly in tropical areas and developing countries.
This is to say, what I had was neither rare nor uncommon, nor particularly hard to diagnose, if you know what you’re looking for. But what it is is a disease of poverty. Amoebiasis affects the people who have no choice but to eat and drink contaminated food and water. It does not, therefore, provide the medical community with much of a profit, since its victims generally don’t have the means to pay to get rid of it. The antibiotics alone cost me $300, with insurance – the same as a month’s salary for a minimum-wage worker in Peru, where we think I picked up my hitch hikers.
Our world has a way of ignoring or under-treating the diseases that kill people in the lowest socioeconomic brackets. Diarrhea still leads to 10 percent of the world’s children dying each year – a statistic that only prevails because most of those children live in Sub-Saharan Africa and Southeast Asia. (In other words, because they are poor.) Global malaria funding consistently falls short. Tuberculosis cases are currently increasing in Sub-Saharan Africa. Ultimately, poverty is deadly not just because of lack of access to medicine, but also because current medical systems are simply not designed to help the poor.
Occasionally, people ask me where we should start – is it more practical and effective to build a school, or a clinic? My usual answer is to start with a school, but get that clinic up as soon as possible. That really, you need both. That education gives students access to higher socioeconomic tiers, which translates to more medical access. But the reason this question is so pressing is because of the sheer impossibility of really, truly choosing between schools and hospitals – because just as in education, where school systems aren’t designed to help the poorest of students to succeed, the medical system is not designed to help the poorest of people to live and to thrive.
In the end, I spent more than $3,000 -- around 10 months’ minimum wage in Peru -- to find and treat a condition contracted by 100,000 people every day. I'm proof that the medical system does, in fact, work – as long as you can pay for it.