We have had a long, long day. This morning we left the sad Copacabana at Lake Titicaca, and conquered the border. Again we passed a timezone: we reach the border at 9:00, and continue into Peru at 8:15. 200 km later we encountered a violent demonstration against the fuel prices, and added another 300 km. We are tired, but glad to have reached Cuzco, and it is free of demonstrations. We have found a hotel with guarded parking and a room with a decent bed. Now we only need a meal.
We have crossed the city and saw more tourists than in the Van Gogh museum. That means we don't have to search long to find an Internet connection, a phone, an ATM and other similar things. There is a restaurant opposite our hotel. Small, recently refurbished with wooden furniture. The chairs aren't rickety, the lighting is tasteful, and they added some music. A place for the average Western people. And for us. Mirjam orders spaghetti a la carbonara; I go for a pizza with tuna. The food isn't that great, but we are too tired to really taste it. Before 10 PM we fall asleep.
But not for long: Mirjam gets sick. She throws up all night long, and suffers from diarrhea. At first we think her body simply has to pass something, and it will improve by itself. But that's false hope. At 6:00 AM I arrange for more bottled water at the night porter, and add 40 grams of sugar and a bit of salt. I fear Mirjam will dehydrate, at this rate and at this altitude. But no matter what we try, she throws up everything she drinks in half an hour. Mirjam is very ill.
At 8:00 we've had enough. I ask for a doctor at the reception. After a few attempts we get to talk to a physician on the phone (Dr. Manuel Manrique Prieto). He says he will be here in 10 minutes - it will be 20. His diagnosis is very quick: dysentery and severe dehydration. A hospital stay is necessary. The doctor directs us to the Pardo clinique, which is the best in town according to our travel guide and the hotel reception.
The hospital looks decent - I had visions of the ones I saw in Pakistan. The tubes, all needles, the fluids, everything comes out of sealed packages, and the use-by dates are far into the future. Mirjam has severe pains in her belly - she has been in a foetal position for the last few hours. She is also very nausious. Quickly the doctors prescribe a whole range of medication, with two antibiotics and something to battle the nausea. Fortunately especially the last medicine works quickly, and soon Mirjam feels somewhat better. To combat the altitude she also gets additional oxygen.
I've already read stories about travelers diseases, and I have the feeling we are dealing with salmonella here. The initial treatment for that disease is the same, so the difference is not so important for now. The results from a blood test agree with me: Mirjam has a typhusoid colon infection, probably caused by Salmonella Typhi, one of the 2300 species of Salmonella. (Dysentery almost always causes blood loss in the stools, and Mirjam doesn't have that.)
All night long nurses keep coming and going. Mirjam hardly sleeps, but the next morning (Saturday) she feels fine. She is immediately released - a sick bed of slightly more than 24 hours. The doctor and I agree on his salary, and we pay the hospital seperately by credit card. Relieved we get a transport to the hotel by ambulance, courtesy of the hospital.
While I go in search for the medications Mirjam has to take the next week, she gets worse. Mirjam fears it all starts over again, and an hour later it does. We return to the hospital. Again Mirjam has pains in her belly, but now in a different place. The physycian returns, he thinks it is an inflammated pancreas. They quickly arrange for an echography, and the doctor performing it detects inflammations on the pancreas, liver and oviduct. Apparently the bacteria has gained access to other organs.
Pancreatitis is not without danger. The pancreas produces enzymes that help digest food. When it gets damaged it won't work anymore. When the pancreas gets blocked (by the inflammation) the enzymes don't process the food, but instead damage the pancreas itself. Without pancreas there is no insuline - diabetes. Without pancreas no enzymes - a difficult and life-long diet. Dark scenarios loom, and all that because of a @#$!&!! plate of spaghetti.
Another physician detects a kidney problem as well: due to dehydration the kidneys partially stopped working. With even more medication the kidneys are sorted out again.
It is a difficult night. Mirjam is kept awake by the nurses, and I don't sleep because of the worrying in the empty hotelroom. Carnival Sunday is no party for us. Mirjam feels better, but then she gets medicins for everything that is bothering her. Short of breath? Oxygen. Pain? Pain killers. Nausea? Another bottle into the infuse. High blood pressure? A pill. Kidney problems? Diureticum. When one of the medications wears out the symptoms return. She simply gets more 'stuff', and away she goes. All Sunday they tinker with the medication.
The days are long, the nights are even longer. Monday morning, when I return to her bed side, she gets worse. It is starting all over again, now with all the medication. Mirjam gets nauseous, throws up bile which seems to be coming from her toes. Exhausted she slumps back in her bed. I start to panic. And that damned doctor, he said he would be here between 8 and 9, hasn't arrived yet, and it is 11:30. Every minute next to my sick darling seems to last an hour.
Every time I worry about something I use the same antidote: research the thing that worries you. When someone says: "take this, it is good for you", I want to know why. Yesterday afternoon I have spent a couple of hours on the Internet looking for pancreatitis, liver diseases, kidney dysfunctions and salmonella. And I have looked up all 16(!) medicins with their workings. It is a way of dealing with it, even when I run into limitations of my own knowledge. I compensate that with a large dosis of pigheadedness.
At noon, after a furious phone call to ask where he is, the physician returns. "Yes, doctor, but what PROOF do you have that Unasyn is effective against Salmonella Typhi?" I already have established a good relationship with the laboratory lady downstairs, and I know they don't have a sample. We cannot test the antibiotica on a petri dish. Still I want proof that we are battling the bacteria instead of suppressing the symptoms.
"You are from Europe - with Europeans this definitely works best. I have a lot of experience with salmonella. I would have treated a Peruan differently", he answers. "Well, I have read in a British scientifical research paper that 95% of the salmonella in England is resistant to the medication you use!", I call out almost desperately. I start to think all symptoms are professionally suppressed, and that the pancreas of Mirjam is slowly dying. "And we haven't left Europe yesterday you know!" I explain to him the journey we are making for three months now. He is surprised, but continues his blood pressure measurements, pulse readings etcetera.
When he leaves, and the laboratory lady returns for a blood sample, I have accepted the fact that I have to wait for a new echography, or for the laboratory lady to perform a test without doctor's orders.
To our amazement the nurse returns with the medication I suggested. The doctor already left, and is not available for comments. "Oh well", I think.
Five hours later Mirjam is up for another echography. Fortunately she hasn't been nauseous all afternoon, and hasn't thrown up either. The humorous, Peruan-Japanese gyneacologist who again performs the task, has good news. The inflammations are gone.
The mystery is solved that evening. The nausea is probably caused by the first antibiotic, and that's why Mirjam feels a lot better. Our Japanese joker and his good tidings have helped as well, I think. But anyway, we have our proof, and again I thank my pigheadedness.
I think of myself as a nice guy, even though I have a vindictive side. "Just break the windows, or set fire?" - the evil side of my temper thinks we should do something about the source of all this. Mirjam is rapidly improving, and I think I can safely leave her bed side for a while to let this side of me have it's way.
I turn to the police. We are in South America, there are cops everywhere doing nothing, except when you least want them to, with a radar gun for example. "Do you have a receipt?", the crew-cut officer behind a prehistoric PC asks me. "No, if I had to carry all the restaurant receipts with me...", I answer. "Of course you do have a medical statement of the doctor, which states your wife has been admitted to hospital?", he tries again. "No, of course not", I reply. "I come to tell you there is a restaurant in your city with dangerous hygienic practices. That's all. If you don't do anything about that...", I tell him, "then I set fire to the place myself", but I keep that last part to myself.
The officer keeps on dodging me. If I would be so kind as to return tonight at eight. No, I want to be with Mirjam this evening. An eavesdropping officer cuts the discussion short. They take my statement, and the police will see if I tell the truth. Right after he prints my statement he and two other officers jump in one of those giant Toyota Landcruiser - the standard police car in this country.
I briefly return to the hotel to send my daily email to the parents of Mirjam. Because I'm near the restaurant anyway, I decide to go in. The nice waitress recognizes me. She is surprised I come here for a receipt six days after our meal. The receipt we left behind was no official one. If we really wanted to, she would have given us one from a numbered book. "I can make you a receipt, but it will have to be dated today", she offers. "Let's not do that", I reply, because I know she will probably be in enough trouble with the health inspection. Actually I feel for her. She really is unaware of the problems, she is helpful, forthcoming, charming. When she fails to show the police the receipt (with the correct date and number) she will have problems with the tax people as well.
I enter the kitchen. Kitchens here are not what they are elsewhere, like anything in this country. Even houses in the middle of the city are made of sun-baked stone. Everything is a bit more grubby, less tiled, less spic and span. But I immediately see why Mirjam is in hospital. The cook, a boy of about 20 years, is busy crushing some eggs in a blender containing a bottom of creme. If the bacteria were on the outside of the eggs, they are now in the creme. And heating it sufficiently is probably out of the question, it would destroy the mixture.
I look into the restaurant, and see some unknowing tourists. I'm unsure what to do. I point out the dangers to the kid. The waitress turns pale when she hears what Mirjam went through. Her body language is clear: she is very sorry and she feels guilty. I trust she will tell the tourists their order is canceled. If the cook and the waitress are smart enough they will clean and study up this very night.
When I return to the hospital Mirjam tells me she was visited by two large officers, and that one of the nurses must report to the bureau next morning to make a statement. If you wear a hat in this country, you can get everything done by anyone. (Excluding myself.)
The sixth day in hospital (Wednesday) starts off with a cheery doctor who tells Mirjam to eat solid food. If that doesn't disagree with her she can go home at 18:00. Well, we won't go home yet. Back to the hotel to get some strength back, and then further away from home, that's our plan. That is home for us. But this is nitpicking.
Mirjam stays fine, and is only hungry: she hasn't eaten in five days. At 21:00, when the doctor has dealt with his emergency and Mirjam has been all wrapped up and ready for four hours, we again enter the ambulance to go to the hotel. This time for real.