Parasitic Occupation (Post #137)
Sunday, June 18th, 2006Mike writes–
Oh, the things i`ve been through on this trip…
As Michele mentioned in Post #136, we didn’t do a lot of sightseeing in Quito. One reason is that we were dealing with the situation described below.
While we were in the Santa Cruise Island after finishing our Galapagos cruise on the Legend i noticed a zit or ingrown hair on the back of my neck just about an inch below the hairline. It seemed logical that it was an ingrown hair because just about 10 days earlier Michele had shaved the back of my neck. One night Michele attempted to squeeze the pus out of it but only got what appeared to be oil. oh well, i figured it would be gone in a week or so…
Well, by the time we were in Riobamba it was not gone. In fact, it had grown a bit and by June 9th (the same day we rode the train), it was a bulge about 2″ in diameter. “hmmm… maybe my ingrown hair is infected,” i thought. I was beginning to think going to a Dr. when we got to Quito would be a good idea. Then, when we got up on the morning of June 10th, i thought it seemed like it was shrinking a bit. “Maybe i don`t need to go to a Dr.” It is such a pain to go to a Dr. in a foreign country. I was also considering the difficulty the language barrier might pose to me in the Dr´s office.
After thinking about it some more while we were on the bus from Riobamba to Quito, i decided it would be best to just go to the Dr. After all, while i do believe i know a bit about medicine, i really didn`t know what this thing on my neck was.
After settling into our hostal in Quito, i went and asked the manager about what hospital would be best for me to go to if i was looking for English-speaking Drs. He recommended Hospital Vozandes which is a hospital the Lonely Planet guide book indicates is American owned (at least it was at the time the book was researched). I understood him to say that all of the Drs there are foreigners and they speak English. Great! The Manager called us a $3 cab to the hospital and off we went.
Upon arriving at the hospital, my hopes were immediately dashed. As i looked around in the reception area of the hospital, i didn`t see a single sign in English… Spanish, Spanish everywhere. I actually began to get a bit angry. I just had different expectations based upon what i understood the hostal manager to be telling me.
We waited in line for a few minutes and were told to walk down the hall to the right and go to the Emergency “room”. When we got there, i began to get more angry. It was totally unclear to me what i was supposed to do next. There was a nurse in what appeared to be an Emergency reception room. She seemed to be “receiving” patients but everything was being conducted in Spanish and patients seemed to be cutting in front of me. I guess i wasn`t being assertive enough. Finally i spoke to the nurse in broken Spanish about why i had come to the hospital and showed her the inflammation on my neck.
A few minutes later i was in the Dr´s office again trying to have a conversation with him about my condition. After having a look, he called another Dr. in the hospital who could act as an interpreter. She explained to me in English what was going on. Ok so, the Dr. was going to drain my abcess and send what he drained to the lab. While we were waiting for the lab results (to be ready 4 days later on Wednesday — which was also going to be our last day outside of the U.S.) they would put me on a course of antibiotics which might be changed depending on the lab results.
So next the Dr. removed whatever was underneath the skin on the back of my neck. Michele and i had already noticed that whatever it was, it felt pretty solid, not like the softer feeling one would expect from a bacterial infection. The “draining” of my abcess was, as of yet, the most painful experience i have ever had. I was obviously unable to see what he was doing but i felt him repeatedly pull my skin up, scrape around with some sort of blade, dig in the center with another instrument, and poke a needle several times into my neck. He did not use any anaesthetic.
When it was finally over, the collar of my shirt was soaked with blood, and the Dr. had taped gauze to my wound. When he told me i could sit up, i saw the tools the Dr. was using. These included a pair of surgical scissors and a syringe among others. I also noticed the “test tube” into which he had packed the sample. It was about 6″ long, the diameter of my little finger, and it was packed full of blood and something the color of pus but seemed to be solid (or colloidally suspended).
Since the the Dr. and i weren`t able to communicate directly, he called in the English-speaking Dr. to translate again. The translator explained that what i had was most likely the larva of a parasite since the thing in my neck was hard and actually quite difficult to remove. I commented that i also noticed it was hard to remove (was it ever!). So, the course of antibiotics would stand but additionally, i was to keep this gauze over the wound to prevent the larva from getting oxygen. Allegedly they would die within 24-48 hours without oxygen and, when i returned on wednesday, anything still there could be removed. When i explained we were expecting to fly to the U.S. on Thursday, i was told that was no problem.
Later that evening, we went to an internet cafe and did a google search on parasitic flys endemic to South America. The most likely candidate we came up with was the Human Botfly which you can read more about at this site http://www.vexman.com/botfly.htm . These creatures infest humans in one of a few ways. One way is that a fly catches a mosquito, lays its eggs on the mosquito and when the mosquito goes to bite a human, the human body heat causes the larva to hatch out of the eggs and burrow under the skin. They also allegedly lay eggs in clothing. When a person puts the clothing on, the eggs hatch and the larva burrow as with the mosquito bite.
Through our research online, we found that the larva use the hole they burrowed through to breath and covering this hole is the way to starve the larva of oxygen and cause them to come back to the skin`s surface in search of oxygen. They can also sometimes be removed manually but care must be taken to remove the creatures in their entirety and not leave any infection-promoting pieces behind.
At this point, we began to get concerned about whether the Dr. had done the right thing by attempting manual extraction. Furthermore, we weren`t confident the gauze was really going to suffocate these bastards. Seemed to us that air can pass through gauze. So that night and the following days we started taking the additional measure of smearing antibacterial ointment on the wound. Yes, we know antibacterial ointment isn´t going to kill a fly larva but the antibiotics of such an ointment is actually held in petroleum jelly (like vasoline). Smearing petroleum jelly on the breathing hole is one proposed way of preventing the larva from getting oxygen. We figured antibacterial ointment is just one step better because we would also be discouraging bacterial infection at the same time.
On Sat, June 10th, upon leaving the hospital i was told to come back on Monday, to get my neck cleaned, and on Wednesday, to get the lab results.
We went back to the hospital on Monday. A nurse cleaned my neck and put a fresh bandage on. About 30 minutes after leaving the hospital i started feeling bad. About 4 hours after leaving the hospital i had a high fever and chills. We decided to go back. This time 2 doctors examined my neck in the emergency room. Neither one spoke English so they got a 4th year med student to act as the translater. They gave me Tylenol to reduce my fever and after some discussion, said (via the translator) that they did not think there were any larva in my neck. After paying $15 for the emergency room visit, I was told to be sure to come back on Wednesday.
And so, this story is now coming to an end…
We went back to the hospital on Wednesday to get the lab results. The doctor we saw did not speak English but i understood about 90% of what she said. She told us the test results were negative for bacteria. This didn’t necessarily mean there were never any larva in my neck. However, she said there was no larva now and that no further action was necessary.
At this time (4 days after the last hospital visit), the thing on my neck is much smaller and seems to be diminishing. Although everything turned out o.k., i will probably never know for sure whether or not there were larva living in my neck. There was certainly something big there at one time but what that thing was will probably remain a mystery.
Michele Harmon