Seeking Help in Sandakan (HKSAMH part 2)

DAY ONE OF ILLNESS. I had just gone from this…

A-OK

… to this…

Sick on Sipidan

… in no time flat. My face felt hot and my energy was drained. I was having a great time chatting with my fellow divers from around the world (Canada, U.S., Spain, Sweden, Slovakia and of course the obligatory German), until I ultimately lost the ability and/or inclination to speak, eat, or sit upright. They had a lovely lunch that I couldn’t stomach.

Lunch on Sipidan

I bowed out of the third dive, then the fourth, then I just wanted to get back to Mabul Island and lie down. Of course, that meant a half-hour roller coaster ride through choppy waves. Arriving at Mabul Island, the dive master asked if I’d like to get my luggage and go all the way back to mainland Semporna, closer to supplies and doctors. Good idea. Drat, another half-hour ride (thankfully, not as choppy).

I spent the night at the rundown hostel where my Sipidan adventures had begun. I finally managed to connect with Karen via email and then Skype, and we made plans to meet up the next day. I sprang for a private room with air-conditioning. Although the bed was as hard as a rock, sleep came quickly.

DAY TWO OF ILLNESS.

I awoke in the crummy hostel feeling crummy and hot, possibly feverish.

Scuba Junkies, emphasis on the "junky"

I asked at the dive shop for a local clinic (or in Malay, klinik). There was one just down the block. Listening to my description, the doctor suggested that it could be a viral infection, a bacterial infection, or possibly dengue fever. He didn’t think it was dengue fever because I didn’t have diarrhea, a strong indicator. He gave me Tylenol for the fever and suggested I take an antibiotic just in case. Cost for his time and two prescriptions: RM70 (US$24).

Prescription in a bag

Prescriptions here come in a cute little bag with simple instructions on the front. Very convenient for keeping track of pills, although U.S. lawyers (and well-informed patients) would balk at the lack of 17 pages of warnings and disclaimers.

I forced myself to eat lunch and took my pills. Completely drained of energy, I flopped back onto my rock-hard bed and was surprised when Karen appeared a few minutes later- oh, wait, it was actually a few hours later. My level of care certainly improved, as she bought me beverages and light foods.

She also had a thermometer and confirmed my 102 degree fever. I had chills, sweats and body aches. I would much rather have been doing a third day of scuba diving near Mabul, as planned!

All I could do was try to get some sleep and stay hydrated.

DAY THREE OF ILLNESS.

Tiny Semporna was looking like a dead end. We couldn’t take the rock-hard bed any longer, so we decided to continue as originally planned to Sandakan, where Karen had booked us five nights at a resort. It was meant to be a break from traveling where we could just relax as a couple. Sounded like a good place to recuperate.

I was starting to have diarrhea now, calling into question the doc’s diagnosis. I can go to a clinic in Sandakan for a second opinion, just gotta get there… by bus.

Our chariot awaits

A 5-hour bus ride sounded daunting to me. At least there was a bathroom on the bus, so I could continue to drink fluids. And the driver did not take hairpin turns at breakneck speed like they do in Peru, although he made some pretty daring passing maneuvers. We unexpectedly had to switch buses halfway, which delayed our arrival an hour. I just tried to hold on, hold on. Late at night, we walked into the Sabah Hotel, the most Christmassy place we’ve seen in this predominantly Muslim country.

Christmas cheer

A nice room, nice bathroom, nice pillows and blankets. Fever of 102, chills, diarrhea. I collapsed into bed for the night. Hard as a rock. Oh well.

DAY FOUR OF ILLNESS.

I woke up with a temperature of 100.2 and bad chills. I’ve always thought that was an unkind twist of nature- your body is way too hot, so you get chills and want to throw blankets over yourself. Karen also noted a slight rash on my back (she knows best what “normal” looks like back there).

Breakfast was included in the room price. Despite a lack of appetite, I forced myself to eat some potatoes, a sausage, some fruit, and of course I drank fluids.

Turns out there are kliniks all over Sandakan’s small downtown area. Through a recommendation from the hotel, we wound up at Klinik Thian. As we stepped into the roomful of locals, the power went out- the lights, fans and the overworked air-conditioning unit all fell lifeless. Activity continued: nurses scribbling notes, weighing people, etc. The Malaysian system for record-keeping is to handwrite everything on 3×5 cards and staple them together. There are hundreds of cards everywhere: on the counters, on desks, and in bags.

Malaysian medical records storage technology

In a few minutes, the power was back on and the temperature back to bearable. I was called pretty quickly- was I given preferential treatment, or were most of those locals waiting on the pharmacy at the next window? Who knows.

Ken at the Klinik

The doctor poked and prodded a bit. He suspected viral infection, dengue fever or malaria. One thing he didn’t buy into was a bacterial infection- and he posited that the antibiotic I was on was probably causing my diarrhea, D’oh! Previous medical care is now skewing my current medical care by introducing extraneous symptoms! Needless to say I stopped taking the antibiotics immediately. The doctor sent me to the Gribbles lab around the corner for a blood test.

I'd feel better if you could at least afford a nicer sign at the entrance

I paid my money and got poked. I was careful to observe the instruments the woman used to administer the test: they were all properly-wrapped, single use and sterile. That’s something I’ll need to keep an eye on here.

Proudly poked by Gribbles

The results came back negative for malaria, but my white blood cells and platelets were low, which could be dengue or a viral infection. Hydration and rest would be critical. The doctor suggested I go to the local hospital, where they could perhaps put me in a “day care” ward with an IV drip, and then send me home at night.

Arriving at the hospital

We arrived by taxi (or in Malay, teksi– I love languages you can sound out!) at the Emergency entrance of Duchess of Kent Hospital and handed over my note from the klinik. Several people gathered around and read it like a document unearthed from a pharaoh’s tomb, turning it over and asking others for help interpreting it. I explained that I needed to be admitted for rehydration. They took my passport and signed me in as Kenneth James (well, that is what it says on the first line of the first page), so that shall be my name for the duration of the coming ordeal. They charged me an RM50 (US$17) admission fee. As Karen was waiting for the receipt, they put me on a gurney and wheeled me into the hospital. Heads turned as the white guy made his grand entrance.

They slotted me in next to two other patients. Soon a nurse was asking me questions, then a doctor was asking the same questions: fever? (yes) diarrhea? (not since I stopped taking those antibiotics) abdominal pain? (no) rash? I think I have a slight rash on my back, but Karen is the one who knows what my back is supposed to look like. I asked to have my wife come back. The doctor continued as if I hadn’t said a word.

They needed to move one of the patients near me but couldn’t quite fit his bed through the gap, so one of the nurses pushed my bed aside, slamming it against the concrete wall with a jolt. Enough room now.

Several more people stop and ask me all the usual questions about my condition. When they ask about my rash, I tell each of them that my wife knows more about that and we should have her join us. My polite request is ignored as if it had never left my lips. Finally, I stop answering any questions until my wife is present, and before long Karen has appeared.

Ken gets a drip

They set me up in a ward of 6 beds, a fairly clean environment which has the only central air we’ve seen in Malaysia. As they put me on an IV drip, I remind Karen that she and I both need to pay attention to the supplies they use, making sure sterile items are unwrapped in front of us and handled properly. When I ask to use the toilet, the staff appears confused, as if this need has never appeared in a rehydrating patient. Eventually, Karen and I work out a system whereby she helps wheel my IV stand to the bathroom and stands outside while I pee. The bathroom is a wreck- the floor is wet because it’s also a shower (like on a scuba diving boat), and the toilet doesn’t flush properly. I trundle back to bed.

Ken settles in

The doctor is concerned about malaria, which doesn’t seem right to us, since we’re taking an anti-malarial pill every day. He explains that there are four types of malaria in this area; our chosen pill only protects against the most life-threatening cerebral variety (don’t get me wrong, I like being protected from that one). He runs two blood tests for malaria, and both come back negative. Dengue fever is another concern, but the test is expensive, so the hospital only runs it once a week. He does a primitive tourniquet test for dengue fever on my arm, and the results are negative. What we do know is that my platelet levels are still low.

The doctor is making noises about me staying the night. This prospect didn’t excite me. I announced that I would be leaving and spending the night at the hotel and that I’m willing to methodically hydrate to his specifications overnight. He said I should drink a total of 3 liters of water overnight. That meant drinking about 250 ml of liquid every hour (the math is so easy with the metric system- I love it).

He gave us prescriptions for more Tylenol and a rehydration powder to add electrolytes to water. They also have a carbonated isotonic drink here called 100 Plus, so we stocked up on that.

100 Plus

I had an alarm wake me every 1 to 2 hours- I would drink 250 to 500 ml, go to the bathroom, and go back to sleep. It made for a long night, but I never felt dry and I knew I was working toward getting better.

Continues in: Duchess of Kent Hospital

 

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2 Responses to Seeking Help in Sandakan (HKSAMH part 2)

  1. Bertrand says:

    oh, Ken
    What an adventure! But I can’t help smiling as I see so clearly chat you have bene through. Home you Will enjoy diving again soon. Do you have an idea of the contamination cause.

    • Ken says:

      We don’t really know, Bertrand. All the indications point to a “simple” viral infection (not dengue fever, not malaria, etc.). So someone might have coughed on me at the airport… who knows? I’m glad to be back where I belong: out enjoying Malaysia!

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