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Cambodia: Dengue Fever in Phnom Penh


Thanks Juliane for this translation

December 2013

About being sick and well again

Of course on a long journey you get sick once in a while. The body is exposed to unfamiliar stresses and strains, different climates and extreme conditions. The immune system faces new and dangerous pathogens and bacteria and cannot always successfully repel them.

Everywhere in Asia signboards warn of the risks of mosquito bites: Here in Myanmar.

Until now I haven’t written a lot about my diseases, not about the diarrhea and fever in Bulgaria and Iran, not about the inflammation with pus in my throat in Pakistan. Not about my food poisoning in India when I got so weak I had to crawl to the toilet at night. I didn’t mention the root treatment at the dentist in India, the sharp pain in my chest which made me howl with pain in Bangladesh, desperately looking for the next hospital. Parasites, sunburn, burned bottoms of the feet, dermatophyte, pulled muscles, grazed hands and knees from falling, a broken nose, a broken toe – all of this I’m only mentioning briefly.

I haven’t written about the situations I had to master alone because there was no one willing or able to help me. And nothing about the moments where loving people nursed me back to health and did everything to make me feel better.

Even though this might sound like a lot – I’m actually healthy most of the time.

But what follows now is supposed to be about one of the „great“ tropical diseases: dengue fever.

The beginning
I’ve just arrived in Phnom Penh. The day hasn’t been particularly exhausting and I feel well. I’ve found an accommodation via warmshowers, the lodging network for cyclists, I can put up my tent on the roof terrace of an Englishwoman. At night we go out for dinner with the other roommates and have some beer together afterwards. Suddenly I feel that I’m getting a headache and a my head is getting hot as well. Within only an hour my temperature rises drastically, my head is ringing and I feel dazed. Maybe there was something wrong with the food but my stomach seems to be alright. And it can’t be because of to the couple of beers.
I lie down in my tent to sleep, maybe in the morning I’ll feel good again. But the the fever is getting higher, I feel hot and cold alternately, my head aches with every movement. I don’t sleep a lot in this night and I have weird dreams. There’s something seriously wrong with me.

Day 1
When I wake up, the first thing I reach for is a paracetamol, the second, my laptop. My hosts’ apartment is located right under the roof so I have the luxury of WIFI in my tent. I type “Dengue Fever Symptoms” into the omniscient Google. Because I sure have a suspicion, I’ve already heard many stories by other travelers and cyclists as well, also about particularly large numbers of infections this season.
“Suddenly rising temperature, pulsating headache, especially behind the eyes and a general feeling of sickness.“
Exactly my symptoms. Even though you’re not supposed to do this, my self diagnosis is: dengue fever.
Of course there’s never the right time for such a disease. But luckily I have a place where I can stay and people who can care for me. Unfortunately, today I have a few things to do I can only do personally. I force myself out of bed, I feel weak, my head is glowing and is about to explode with every movement of my eyes. It feels like having a severe flu, migraine and a hangover – all together.
A cold shower and a strong cup of coffee don’t have the effect I wished for. I better leave the bike where it is, the traffic of Phnom Penh would be clearly too much for me today. And so I’m heading for the German Embassy on foot. There, I can pick up my new passport, brand new and with 48 still empty pages. Together with my visa application and two passport photos I take it to the Embassy of Myanmar, then it’s time to go home. Everything is done for today, I only want to lie down. I decide to see a doctor the next day if I don’t feel better. There’s no special medication anyways, besides paracetamol against the fever and drinking a lot, you can’t do much.

My tent on the roof

Day 2
I feel the same as yesterday. The fever is still high, the headache still so strong that I try to avoid every movement. The paracetamol I take every four hours brings only little improvement. But two things are different:

1. Now I know for sure that it’s dengue fever.
2. I’ve accepted the disease, the first important step to recovery.

After all, I did see a doctor yesterday. One of my hosts, a young French guy, came to see me and told me that his father was a doctor and his office just round the corner. He offered me to take me there. The doctor seemed alright and after paying 30 dollars and a quick examination he sent me to the blood test to verify the suspicion of dengue he expressed as well. The blood test wasn’t done in his office but in a private clinic across town.
An envelope for the clinic in my hand I took a Tuk Tuk and went of into the crowded streets of Phnom Penh. Like every major Asian City there is a lot of traffic at everytime of the day or night.The streets are jammed, nothing works, specially at evening rush hour traffic. The people drive right into the crossroads even if the traffic light is red, try to go against the direction of traffic , the traffic police can´t cope wwith it and all the drivers honk continuosly. The best way to get forward is a motorcycle, because you are able to drive between the waiting cars and over the walkways. Over one hour took the ride, all the noise, the smelly fumes and tthe bumps on the bad roads : I wonder how seriously the doctor could expect I can endure a ride like that in my condition.

Once at the clinic, I gave the envelope to a nurse and filled out a form with my data. I was led into the “Emergency Room ” , set on a bed, blood pressure was measured and a heart rate monitor was clamped on my finger . A nurse in a white coat came and wanted to put in a intravenous cannula attached to a bottle of paracetamol solution. I said that I had come here only to give a blood sample and nothing else. A doctor came and assured me I need not to worry , all would be fine. Another nurse came with a document to sign. I would be willing to pay $ 50 medical expenses directly , as well as give the clinic the right to cash up directly with my insurance company because I was a in-patient.It seemed to me like a dream , or was it the fever? I did not sign and asked again to take the blood sample so that I would be able to leave . Once the results would be there I would then call with the French doctor, as agreed.

Finally my blood sample was taken , but the doctors insisted that I stayed for one hour to wait for the results. They wanted to keep me at the clinic if it was dengue fever. I thought it was unnecessary, because according to my knowledge dengue is only in 1-2 % of cases dangerous, namely when it comes to a fever shock or bleeding . And of these severe forms turn only 1% fatal, and these are to a large extent toddlers. So I did not see me at risk and also did not feel so bad that I would have been better off in a hospital bed than in my tent. I had the feeling that it was about money. So one night in the hospital will cost several hundred dollars , and the competition is great here . Throughout the city, there are private clinics and pharmacies of different standards .

After one hour the results showed: Dengue fever positive.

I paid $ 96 for the blood test , left the clinic and looked for a motorcyclist who brought me back home . I think I could have saved myself of all of this. Not only the $ 126 , which an average Cambodians could never spend for medical treatment , at least not for a simple blood test , and especially all the stress I had.

Although it is only the second day, it is easy for me to accept the disease. I have done everything important yesterday, and must wait at least 4 days for my visa anyway. Also if I need 10 days to recover myself I still have enough time to leave the country by bike, without taking a bus.
Also, I can use the time to work with the computer, read my book or write the next blog articles. But only if I feel better in the next days, because today I cant think about any activities. I spend the day with sleeping and snoozing on the roof.

The blood test is positive. There is not much I can do except rest and take Paracetamol against the fever

Day 3
I feel better in the morning. Not good, but better. The headache is not as strong like yesterday , instead my whole body hurts. Bonecrusher fever is another name for dengue, now I know why. The joints , the bones , the whole skeleton just hurts . I also have fever but not so high like yesterday. I decide to go out for breakfast and drive a kilometers by bike. A typical breakfast here is a serving of white rice with shredded pork and omelette with sweet sauce . Green tea for drinking. It feels good to eat something right . I ‘m going back home and realize that I´m already tired by cycling these 2 kilometers. But I have all day to rest. My hosts ask several times a day if I need anything.

Day 4
I’m doing much better. The fever is hardly noticeable anymore , no more headache and it starts to get boring on the roof top. In the morning I take again a paracetamol,  it will be the last one.
Day 5
I feel good. Still a little weak and tired, but that’s all . In the evening the two Americans who live here invite a few friends for dinner. There is a german butcher here in Phnom Penh and the two prepare sausages, sauerkraut and mashed potatoes, a feast for me.
Day 6
I organize my stuff in Phnom Penh , buy myself a new MP3 player and go to several bike shops for good brake pads and a new bottom bracket . In the evening I pack my things , tomorrow I want to continue.
Day 7
I pack my bike and leave Phnom Penh. 95 km I cycle today. In the evening I feel my muscles and bones a little bit , but I’m really fit again.

So I overcame the dengue fever quite well and fast, I’ve also heard from people who werer really sick for ten days ten and have lost a few kilos .

Now I hope that I do not get it a second time , because then it´s more likely to get a more dangerous course of the sickness.

Here a few more pictures of Phnom Penh:

Traffic can be quite chaotic.
At central market
At central market
At central market
At central market

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