by James Best
‘But you might be wrong, Dad.’
‘I might, but we’re also organising a replacement.’
‘But I might not need a replacement.’
I tried to frame it in a way that was more positive. ‘If we get a replacement, and the old one does turn up, then you’ll have two.’
Sam paused, and then smiled. ‘Yeah.’
Our hostel boasted a rare luxury: hot showers in a spacious shower recess. Sam had got out of the habit of having regular showers and had started to just wash instead. And his hair, which he’d chosen not to cut while we’d been away, was now long and hanging over his eyes. Because he wasn’t in school he didn’t have to keep his hair short about his ears and eyebrows, a De La Salle College regulation.
Unfortunately, his newly long hair was also getting very greasy. I was determined to get him to use some shampoo but this posed a sensory challenge for him and he really kicked up a stink. I pushed back. There was a lot of shouting and threatening from me—way too much actually—and a lot of screaming and yelling from Sam.
‘You are not coming out of there until you have washed your hair!’
‘No, I don’t want to wash my hair,’ he whined. ‘It gets in my eyes!’
‘I’ll help you and make sure it doesn’t get in your eyes.’
‘No! You are a hateful father!’
Eventually a compromise was reached. Sam had a (very) short shower and we shampooed his hair over a basin.
It had been a backward step for Sam and I was upset that I hadn’t controlled my temper. I couldn’t help but let Sam know my disappointment at his resistance. Then after breakfast I had to break the news to him that Red Chilli had no private rooms or dorm beds available the next night. We would have to sleep on mattresses in a tent. I braced myself for his reaction.
Straight up, he replied. ‘I don’t want to sleep in a tent.’ Memories of Etosha came flooding back.
‘Neither do I, Sam,’ I replied, ‘but there’s no other option.’
I could have moved us to another hotel, I suppose, but it would have been very difficult to organise. I pushed and in the end he acquiesced with remarkable grace.
‘You can stay in the reception area in the evening and play your DS,’ I said. He still had the smaller DS.
He thought about it for a while. ‘Hmm, oh, all right. But I will stay in the reception and play my DS.’
‘Yes, that’s it,’ I said. ‘Well done, Sam, I’m proud of you.’
Shampoo and tents; swings and roundabouts.
On a day of leaden skies and heavy air, we visited a large local mosque with two young Australian NGO workers staying at Red Chilli, Emma and Whitney. I thought the excursion would be beneficial for Sam, some hands-on religious education.
The National Mosque of Uganda is the largest mosque in sub-Saharan Africa and can hold twenty thousand faithful. Construction started under the Amin regime but the money dried up when the economy collapsed and it remained half-finished until 2004 when Colonel Gaddafi granted funding for its completion. Before we entered, Emma and Whitney had to don a headdress and long skirt over their pants; the necessary cloth wraps were provided at the entrance.
Sam watched them garb up. ‘We don’t have to wear sheets.’
‘No, Sam, it’s only ladies,’ I clarified.
‘Why?’ he asked.
‘Because it’s their culture,’ I explained.
Sam wasn’t happy. ‘I don’t want to wear a sheet.’
‘Do you understand what a culture is?’ I asked. ‘It’s what a group of people, like a country or a religion, set up as their rules.’
‘Oh.’ He pondered this and looked out the corner of his eyes. ‘I don’t want to wear a sheet. I don’t want it to be my culture.’ I presumed this was part of his aversion to long sleeves again.
We were shown around by a very nice guide, Ali, a father of three. The mosque itself was beautiful. A giant concrete arch spanned across the broad steps up to the mosque, while a towering minaret with three hundred and four steps up to its gallery stood to the side of the arch, like a sentry at a gate. The arch was a symbol of Uganda, and reflected the shape of the traditional thatched huts of the Bugandan nation. As we ascended the stairs the speakers suddenly crackled into life and the mullah’s morning prayers boomed around us.
We ventured inside the cool and delicately lit main chamber, gazing up at vast domes covered in intricate carvings of Islamic motifs. Italian-designed stained-glass windows emitted rays of light onto a vast Libyan-made carpet, a pleasure to walk across in our socks. Over the windows were arches made of Ugandan hardwoods while the arch across the pulpit was encased in small tiles of compressed copper dust, nods to the natural resources of this central African nation.
Flecks of dust hovered in light shafts, as though time itself was held in the grasp of the mosque. It was a place where you felt compelled to whisper.
Ali sat us down in a circle on the soft carpet and told us about the formation of the Ugandan nation and the story behind the mosque. In centuries past, current day Uganda was dominated by Buganda, a sophisticated nation that had its own king, parliament and ministers. The first visitors were early Arabic slave traders from the east, either trading their goods for slaves and ivory or simply stealing them. The Arabs also brought Islam. In the late nineteenth-century British explorers also began to enter eastern and then central Africa in search of the source of the Nile, adventure, fame and fortune. As part of the ‘grab for Africa’ the British established Buganda and some surrounding tribal lands as a British colony under the name Uganda.
Sam liked the carpet. As he stimmed by dragging his fingertips across the tightly woven pile and the patterns contained within, he tilted his head, looked out the corner of his eye seemingly into space and seemed to ignore what Ali was saying. I wondered how much was sinking in. I tried to reinforce the principal points to Sam as Ali continued.
Sam suddenly stood up. ‘I’m bored. I want to go.’
‘Sam! Shh!’ I hissed. I pulled him back down and explained to Ali. ‘He has special needs.’
‘Not a problem,’ Ali said, with a gentle smile. ‘He is one of God’s children.’ Ali was very good with Sam, not in the least fussed by his quirkiness. We continued our tour around the carpet and columns, under the domes, past the giant encased Koran.
Not only was it Sam’s first experience of a mosque but his first exposure to any religion other than Christianity, as far as I knew. Maybe he had been taught about other religions at school? I peered at the Koran in its glass case. ‘Sam, this is the holy book of Islam. It’s like the bible of Christianity.’
‘But you don’t have to be an Islam,’ he clarified.
‘No, Sam, you don’t have to,’ I reassured him.
Ali led us up the long corkscrewing staircase inside the minaret. Sam thought the staircase up the minaret was like the tower at Hogwarts. We emerged, puffing and sweating, onto the gallery, buffeted by the wind coming off an inky cloud front heading our way. Sweeping views of the chaotic city rippled below us. The name Kampala is Lugandan for ‘small hills with impala’. Looking at the vista stretched out before us, this made complete sense to me. There were no impala, but the city’s bustling markets, crammed roads and suburbs carpeted the undulating mounds of the landscape.
Ali revealed that his youngest child was disabled. When his son was a few months old, he had developed hydrocephalus, a condition where there is build up of cerebrospinal fluid around the brain, which Ali described as a ‘big head’.
Now aged eight, Ali’s son could not stand or walk unaided, had impaired speech and memory and didn’t go to school. A shunt to ease the pressure of the fluid in his brain had been placed just two months ago. I wondered why it had taken so long. Perhaps Uganda’s health system had improved a lot in the last eight years. Ali told me they’d tried local herbal approaches early on, but his family had run out of money.
While not privy to the details of the boy’s history, I wondered whether this
disability might have been preventable if the clinical scenario had presented in the developed world. When he discovered I was a doctor, Ali was pleased to hear my brief assessment that there may still be hope of significant improvement, given the recent placement of the shunt. It was the best I could offer. I looked at Sam after he described his son’s impairments. ‘We all have our challenges to face,’ I said to Ali.
‘Yes, Dr James.’
As we filed out of the bottom of the minaret the storm finally arrived. Large splats of rain landed here and there before raining hard as we ran helter-skelter for shelter. The deluge of fat drops made a thundering racket on the concrete. The humidity broke, it became easier to breathe. It was the first time Sam and I had seen rain in months. As the cloudburst ran its course and faded out, we hailed some boda bodas and zipped through the afternoon peak hour back to Red Chilli.
The air was charged after the rainstorm. Large marabou storks swooped low over the traffic, then through the jacarandas between the low-rise buildings, their broad dirty wingspans flashing over us. As our bike drivers ducked and weaved through a hive of bikes, minibuses and cars, I looked across to see Sam’s smiling face, hair swirling in the cool wind, as he gripped the driver’s waist and looked around his leather-clad shoulder to the road ahead. At one stage, our bikes mounted the curb to bypass a traffic snarl, the pedestrians annoyed but not surprised as they jumped out of the way.
Over the next few days at Red Chilli we focused back on schoolwork, neuroplasticity exercises and video interviews for the university. It was also a period of consolidation and rehabilitation. We tended to our bodies, our gear and our spirits in an attempt to repair and rejuvenate.
Threadbare shoelaces that were about to snap were replaced with string. Sam’s stretched and chewed t-shirts were chucked and new ones purchased. Cameras and screens and other electrical equipment were all thoroughly cleaned. I bought yet another pair of back-up reading glasses and replaced Sam’s lost pencil case.
The magnetic chess board was badly scratched but, amazingly, we had managed to hold on to thirty-one of the pieces. We were only missing a single ‘Slytherin’ bishop. Sam postulated it was Severus Snape who’d gone walkabout.
To top things off, I’d managed to lacerate my scalp on the underside of a metal window frame while climbing some stairs. It didn’t need stitching, and an Australian vet nurse conveniently staying at Red Chilli kindly irrigated the wound with some iodine antiseptic. When I was talking to Benison on Skype later that morning she was taken aback to see my hair covered in blood and iodine.
Sam’s hair looked a lot better after the shampoo, but with long curls hanging over his eyes and ears, multiplying freckles and the lanky-limbed body of a teenager, he was looking rougher and tougher. My youngest child was no longer a child; an adult body was emerging, with all of the challenges that entailed. Batten down the hatches.
CHAPTER 27
Fever!
Across in Addis Ababa, Ethiopia, only 1250 kilometres to our north-east, Barack Obama delivered a speech to the African Union, the first United States president to do so. He noted that with mobile phones and increasing access to the internet, Africans were beginning to ‘leapfrog old technologies into new prosperity’. Major progress was being made to allow Africa to finally utilise its massive resources, for the continent to become partners with other parts of the world instead of remaining merely a dependant. However, with the continent’s population set to double to two billion in the next quarter-century, with the majority of that growth among children under eighteen, it was, the president said, also a time of great challenges. Growth in training and employment needed to match the population boom, so that young people in Africa could lead a life that had dignity.
Over lunch in the Red Chilli bar, a crowd gathered around the television, hanging on every word. They applauded at the end of the speech. From an African perspective Obama had been an important president. With a Kenyan father, he was ‘proud to be the first Kenyan–American President’. The world was watching Africa, and Africa knew it.
Meanwhile, I was watching Sam, and Sam knew it. He became irritable, and so in turn did I. His maths lesson became a battle. What was going on? I put my palm to his forehead. He didn’t have a fever, and his pulse felt normal, but I started to become concerned.
‘I am sick,’ he said feebly. He lay down on the couch in the foyer and didn’t want to do anything.
Maybe he was getting sick. He was recovering from a bad cold he’d contracted a week or so earlier, but he seemed much worse than would be expected: crotchety mood, wavering concentration, a blocked nose and cough. Perhaps a new virus had piggybacked on the last?
I left him for an hour and a half to get some cash from an ATM. On my return, he was burning up. Oh, fuck, oh, fuck! Please don’t let it be malaria.
Sam was at a high risk for malaria, of that there was no doubt. His phobia of long sleeves put him at greater risk than other travellers, although less so in Uganda where it was too hot to wear long sleeves anyway. Mosquito nets were the problem. Despite my best efforts, he would inevitably end up twisted in the netting like a shark caught in a net, often with limbs poking out, exposed to the hovering buzzing mozzies. Occasionally he’d pull the whole net from the ceiling.
I whisked Sam into a cab and we headed through the traffic to a surgery recommended by the Red Chilli staff, where an expat British doctor worked. Sam lay on the back seat, listless and lethargic. In the consultation room of the smart-looking medical practice, the doctor, who had worked in Kenya and Uganda for decades, was curious about our trip and its purpose. ‘Blimey! Just the two of you, eh?’
He was very knowledgeable about tropical medicine, and not overly concerned about malaria. He was concerned about the possibility of Katayama fever, which occurs in response to a schistosomiasis infection. Schistosomes are parasitic worms that can penetrate the skin of anyone who swims in fresh water in sub-Saharan Africa and other parts of the developing world. Lake Malawi, where we had swum a month or so earlier, has been called ‘Schistosomiasis Central’.
While not life-threatening, schistosomiasis can make you weak, tired and irritable and complications can occur if it remains untreated long term. Katayama fever is an immune response to an early phase in the disease, when the schistosome eggs are first deposited into the body’s tissues. If this was what Sam was suffering from, it was better than malaria; schistosomiasis is usually easily treated.
The doctor felt further tests weren’t necessary but advised us to return if the fever continued. Still, I continued to be anxious. Sam’s temperature remained high through the night, but he didn’t look dramatically unwell. In the morning he was quiet and picked at his breakfast, happy to just lie on the couch and do nothing, but he responded appropriately enough when I spoke to him. Good—no signs of delirium.
Throughout the day, however, his fever continued. I decided I needed more reassurance and bought a malaria-testing kit from a pharmacy. I required three or four drops of Sam’s blood to do the test, which is to much to obtain from a finger prick. I attempted a venesection, which proved to be very difficult.
‘No! I don’t want this!’ Sam squawked, as I approached the vein on the cubital fossa, on the inner aspect of his elbow, with a needle.
‘Sam, we need to do the test to make sure you don’t have malaria,’ I explained.
‘I don’t want this, I don’t want malaria. Malaria sucks!’
‘Yes, malaria does suck, so we need to know if you have it. Malaria is very serious, Sam.’
As I stuck the needle in, he growled at me. ‘Malaria is more common in Malawi. They should call it Malawia.’
I eventually got the blood, despite the syringe plunger breaking halfway through. In a hostel room, with a pillowcase as the tourniquet, dodgy equipment and an uncooperative patient, all the while being filmed by the video camera on a tripod in the corner of the room, it was not my most professional venesection. But the test was negative.
I breathed
a sigh of relief and let his anxious mother know via Skype, knowing Benison would be fretting overnight in Sydney otherwise. It didn’t rule out malaria altogether, but it was a reassuring indicator.
That afternoon, Sam deteriorated again. As his temperature soared, he looked worse than ever. ‘I haven’t got malaria,’ he said, twisting and turning on the soaked sheets, his cheeks red and eyes bloodshot.
I watched him anxiously. ‘I certainly hope not.’
He looked across at me. ‘It’s all right, Dad,’ he said, ‘don’t worry.’
I couldn’t help worrying. His skin was covered in goosebumps, but he didn’t have rigors, involuntary shakes. I checked him over for unusual rashes but could find none. This was Africa, after all, and there were other worrying infectious diseases besides malaria. Should I take him to the hospital?
I decided to see what he looked like after a dose of paracetamol kicked in. An hour later, the medicine did its trick, and Sam improved. His energy returned, and he requested something to eat.
But I remained unconvinced. I sat on my bed, looking across at him as he tossed and turned under the mosquito net. The last fever had shaken my confidence. He’d been febrile for more than twenty-four hours—and high fevers too. Bugger this.
There is a principle in general practice; it’s based on a driving analogy. Most of the time in my job you’re hitting the brake, telling people not to worry, that everything’s okay and nothing needs to be done. Only very occasionally it’s the opposite, time to hit the accelerator, to do something, to investigate, to refer.
I hit the accelerator. I ordered a cab to the International Hospital Kampala. The hospital was significantly more down at heel than the private clinic we’d visited earlier, but moved efficiently enough. Our consultation was paid for in advance, cheap by Western standards but expensive by Ugandan, hence the empty waiting room. We were straight in to see the doctor. I was unnerved that the doctor didn’t examine Sam physically, but the main thing was a blood film to look for malarial parasites, along with a blood count and other basic blood tests.
