#6 Tropical Diseases and Parasites
You can’t call yourself a real Expat Aid Worker until you’ve suffered and lived to tell about your experience with a tropical disease or parasite that you don’t hear about much in your home country.
When drinking with newbies or home on R&R, stories of having had one of these low shock value diseases or parasites will get you a gasp and an “euw” and make you seem worldly:
- Giardia
- Amoebic Dysentery
- Ringworm
- Scabies
- Lice
- Bedbugs (note: does not work in New York City)
- Hepatitis A
Break out the medium shock value diseases and parasites to bond with Expat Aid Workers who have 3+ years of experience in a developing country:
- Malaria
- Dengue
- Cholera
- Rabies
- Tapeworms, round worms, hookworms
- Yellow Fever
- Typhoid
- Tetanus
- Hepatitis B
Save the stories of the extreme shock value diseases and parasites for one-upping crusty long timers:
- Hemorrhaging dengue
- Advanced stage malaria
- Cerebral Meningitis
- Schistosomiasis
- Anything on the list of Neglected Tropical Diseases
When speaking of these diseases, Expat Aid Workers should carefully select tone of voice and level of detail to elicit the proper reaction from the audience.
Too much detail and folks back home will tune out (they are not used to Expat Aid Workers’ penchant for describing their physical symptoms in minute and graphic detail). Inordinate complaining makes you look weak and turns off potential hook ups (whines, can’t deal, needs to be taken care of, should just go home if can’t take it). TMI can also turn off potential employers (not cautious enough, irresponsible, can’t keep things to self). Excessive “moasting” (moaning + bragging — more on “moasting” later) and you sound like that geek in high school who’s making shit up to impress. Brace yourself for the slap down from that dude who’s been shot at in a warzone or jailed in Mexico.
Keeping the above tips in mind, tropical diseases and parasites are a surefire conversation topic for any Expat Aid Worker gathering. Author’s note: As of 2020, further embellishment will be required for any tropical disease stories, as you risk being easily one-upped by a COVID-19 story from someone who has never even left the US or the UK.
Stuff Expat Aid Workers Like 
I was at a party recently where a young lady asked about 6 people, including myself, chatting what the strangest ailment they ever had. Naturally, mine was malaria and it not only became the topic of discussion but impressed the conversation starter to flirt relentlessly all night. Though unintentional, I am very guilty of this one.
I think you need a further category for sexy new diseases that others mightn’t have caught yet. For example MDR-TB is trending at the moment.
Also not sure where unclassifiable diseases with horrible symptoms fit in. Here in the Republic of Sh!thole, we have horrible diseases so neglected and obscure that they don’t even have names. Annoys me that you might get a horrible disease but not the kudos that goes with the big name diseases. We might be too poor here at Sh!thole to afford the sexy diseases, but we do have dignity.
One option might be to allow in a #stuffexpataidworkerslike category for obscure and expensive new drugs, with horrible side effects, used with the hope of killing horrible no-name diseases but the possibility of killing the patient instead.
Cheers
Even better than showing off your track record of diseases to ‘civilians’ is to show off to other expat aid workers how you have managed to survive all this time without ever getting infected with anything. A point which subsequently allows you to appear so native that even mother nature has accepted you as a local (even though locals still quite often suffer from these diseases).
“Oh what Malaria? No, never had it. I guess I’m just immune”
Tick!
THIS. I was so close this year. Three months into Afghanistan, I still hadn’t bled out of orifices one shouldn’t bleed out of. But my hubris was punished shortly thereafter. And how.
I’ve only had catergory A, repeatedly, and have to say I AM FUC**NG SICK AND TIRED OF IT!
currently based in Holland and managed to bring back some bugs with me from (somewhere) and have been suffering for over three months and they can’t seem to work out what is wrong with me. pretty sure this would have taken 10 days in a place like Kenya (both diagnosis, treatment, and feeling better)
so not cut out for this job…..
You forgot: http://en.wikipedia.org/wiki/Staphylococcus. Had a case of it a year and half ago. Nasty.
After languishing for years as a perfectly sound, healthy person, I have to confess I’ve gotten some strategic mileage recently when telling the story of how I was diagnosed with filariasis shortly after moving to my current South Asian locale. The story gets better with mis-diagnosed side effects from the filariasis drug, cleverly named Banocide.
You’re right: the telling is best when the story isn’t dropped into the conversation too often, and the right tone is key. Can’t be too graphic or enthusiastic, otherwise all credibility is lost.
I got altitude sickness on the side of an active volcano and had to be hauled down by a French Foreign Legionnaire and an armed guard, but not before the Legionnaire had to chase down the ten-year-old who was carrying my backpack up the mountain. Top that, suckas.
Dengue. Bleh. I had dengue 3 times in El Salvador… rumor had it there were 4 types of dengue, 3 non-hemorrhaging and 1 hemorrhaging, and you could only contract each kind once. So of course, you’ll notice, I was THIS CLOSE to having the hemorrhaging kind (which would have put me into the category of diseases with which to one-up crusty longtimers).
The 1st time dengue floored me for about 8 days. Miserable disease, that one. The 3rd time I came down with it was on Dec 24 and I hadn’t done any of my Christmas shopping. Had 2 small children at the time. Spent the day touring the central market in San Salvador with husband and delirious fever… but the 2nd and 3rd time were nowhere near as bad as the first.
My co-worker, who has the same birthday as I do (just pointing out the 1 degree of separation here) was slightly famous because her daughter had the first known case of hemorrhaging dengue in the country. Luckily she survived after a couple full blood transplants.
Need to clarify that the strategy of talking about not ever getting anything only works when you liberally mention all of the risky things you do.
For me, that’s eating sushi in the midst of a cholera epidemic.
But I think the ultimate is when you can tell the story of how you survived one horrible disease because the symptoms were counteracted by another horrible disease, e.g. “well, the swelling from the filariasis wasn’t so bad because of the dysentery”
Sent to five different hospitals, threat of med evac from HQ, lived on a drip and couldn’t talk or swallow for about a week. Final diagnosis? Strep throat. Such the anticlimax.
Hear hear! After 3 medical centres and 3 hospitals (half of them in Indonesia and the other half in my home country), three days in a drip in an Isolation Unit (mention This and you get extra points!) for infectious tropical diseases (oneup: I was the Only One in my home country in a Long Time), getting special attention from the head doctor of the hospital —all this because I had been bitten by a rabid rat and my symptoms were very strong for any normal disease— they found out I had a strep throat (oneup #2: a level 3 one of that, which is a Rare Form of Strep). People were mightily worried, admiringly supportive and totally freaked out by my experience. When after weeks of tests, tens of various injections to various parts of my body (including the bite wound, outch!), they found out it was no more or less than a strep.
The anticlimax!!!
You left out having an emergency operation (e.g. appendectomy) on a remote island under primitive conditions…
I had a nice bout of cyclospora in Burma/Myanmar a couple years ago, lost 10kg in 2 weeks with no annoying sick feelings (i.e. no stomach pains, no nausea, no headaches, etc), just the hassle of heading for the loo a few times each hour for a couple weeks before a correct diagnosis. Good for those looking to lose weight quickly.
Next time bust out Chikengunya. It’s like Dengue but more exotic and funny sounding. I always wanted to raise a hen and callit Gunya.
Had two level two’s (including multiple rounds of malaria) and one level three! But that’s from being a missionary kid not an aid worker. Does that count?
Score card so far:
Chikengunya: Once
Malaria fulciparum: Thrice (once medivaced from Kisangani to Entebbe). The ganga saved me.
Dengue: Twice
Giardia: With me for ever now I think. We are old friends.
Shrapnel in leg: Once.
Punched in Face: Twice (quite deservedly so both times).
Turtle bite to stomach: Once. Passing blood for 4 days.
Kidnapped/mock executed: Once
Do I get a prize?
No. No prize, though much field cred (see that post). This blog isn’t actually an instruction manual.
Damn. I thought it was. Now I’ll have to sell the dog, the motorbike and the tank.
Can I keep the cynical laid back attitude though?
From an Infectious Diseases Physician turned into EAW, just a few comments/clarifications:
– one can never survive rabies -> 100% fatal disease
– meningitis is always cerebral
We can discuss on which disease goes where (I propose moving schisto to the medium shock value range and tetanus + yellow fever to the severe shock value group).
PS And what about the topic of taking malaria prophylaxis among EAWs? Always works with the new EAWs in town…
PS2 No offence, I love your blog otherwise. Spot on. Always.
Doctor H, the internets seem to believe it is possible to survive rabies, though the internets are not always correct. WikiPedia (which we all know is completely infallible) says that: “Treatment after exposure, known as post-exposure prophylaxis (PEP), is highly successful in preventing the disease if administered promptly, generally within ten days of infection.”
I’m too lazy to figure out whether the cited reference is legit or accurately cited, but it has a believable title: Drew WL (2004). “Chapter 41: Rabies”. In Ryan KJ, Ray CG (editors). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 597–600.
I paid a very hefty sum for my pre-exposure vaccine. They did say I’d still need post-exposure too, and I think the time frame they gave was a bit less generous than 10 days, but still…