The Good Knight Nurse’s Health Report

A health report from a Knight nurse who's no Nightingale. The patient, although uncomplaining, shows signs of fatigue and exasperation. His night sweats are uncontrolled, forcing the Good Knight Nurse to seek other sleeping options. This, in a 7.2mX2.5m (18sqm) truck, poses a problem. She resorts to writing her reports.

I remind myself of these sage words: “If you think adventure is dangerous, try routine; it’s lethal” ~ Paulo Coelho. 

While he twists and turns in the sodden bedclothes coiled around his arms and legs, the Good Nurse pads around in the dark, looking for a scrap of available space to fashion a dry nest for the night. Picnic baskets, crates, camera bags and discarded shoes are shuffled and moved. She juggles cushions onto the floor and uses any available length of cloth to cover herself for a smidgen of warmth. The heat of summer has toned down in the subtropics too.

Sleep will eventually come, she knows. A twinkling star draws her attention skywards. A cool shower of air sifts down from the open hatch above her. The silky coolness touches her arms and neck. Her attention momentarily shifts from their calamities. Now focused on the night sky, she hears the Verreaux Eagle owl’s soft frog-like prrrup’s. There are always positives, even when the skies are bleak. She wishes he'd snore, like the good old days, now she has to feel his pulse or poke him in the ribs when she doesn't hear his breathing. He's so quiet.

It only takes one domino to topple to set off a chain of events. In Butch’s case, it was a Blister Beetle hiding in his underpants as long ago as February. After two courses of antibiotics, tubes of ointment and TLC, it took weeks to heal, and the purple scars have yet to fade.

We had just packed and stowed away the medicines when he complained of a bladder infection. The meagre first aid box was extricated; fortunately, there was no cure lurking in the dark corners, so off to the GP he went, where he had all his vital stats checked. His heart and lungs were fine. He returned with a second course of antibiotics and a prescription for more after his molar tooth extraction.

We agreed he’d brave the extraction site’s healing, gargle with salt water and only take the dentist’s prescribed Probiotics.

I’m a food person, not a doctor, and I rarely take medicines. This might be prescribed to my early childhood and boarding school education, where one had to be on death’s doorstep before receiving medical assistance or attention. Just as well. Today I’m an unsympathetic nurse who believes, like a former matron drummed into our heads, that “God only helps him who helps himself.” A bitter pill to swallow when you’re eight and feeling poorly.

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In pretty Pomene, we went arse over kettle when a massive wave struck us, whipping our feet from under us and smashing Butch, unsteady on his feet, into to jagged coral and a razor sharp rock face. The gash on his leg seemed to be minor and healing. The wound was fastidiously cleaned, and ointments were applied daily.

Although Butch had no discomfort a fortnight later, we noticed his swollen and discoloured ankle and calf muscle. After a good night’s sleep, the swelling would subside but reoccur, especially after a long day behind the steering wheel. The small gash showed signs of infection and weeping, and he immediately started on another course of antibiotics the dentist had prescribed.

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And then the unthinkable happened. Butch, upon returning from the ablutions on an evening, decided to cross a Macadamia drying floor by negotiating his path over these green, slippery, nutty marbles—a lethal mistake. Anton, our host, and I were startled by a god-almighty crash. Butch went down like a ton of bricks. His feet set the nuts in motion, rolling like ball bearings. With no grip, his feet were swept from under him, knocking his breath out as his head, back, bottom, and legs hit the hard clay floor. He saw stars and what followed was a cry of anguish, despair and near concussion. He’d set off a train of events, and the dominoes started tumbling.

The Easter weekend was looming, and we thought a visit to the Gorongoza National Park would be a good bet. But then he suffered a high fever, night chills and hallucinations. We both realised his condition was deteriorating.

Fortunately, we were the only campers on a farm, and the owners were very clued up about sub-tropical illnesses and suggested Butch start a course of Malarial medications. This was despite a negative Malaria test I’d done the previous day. Some days were better than others, and he kept his spirits up. The soothing ear-candling session was a hit and distraction.

Performing the Malaria test for the first time was quite daunting. Firstly, the instructions were poorly printed in such a small font that I needed to photograph and magnify the template. The contents of the packet and the instructions didn’t match, so I had to wing it and hope for the best. By that stage, Butch was beyond caring anyway.

Butch’s leg was not performing well at all. Purplish-red, hot, rock hard and inflamed but not sensitive to the touch, we consulted our GP in South Africa, who gave us additional instructions and kindly checked in every day to see how he was doing. She diagnosed a coral infection, one that takes ages to heal. The gash was clearing up and was not painful at all.

By Easter Monday, there was no marked improvement, Butch was becoming increasingly anxious, and we decided to head for Beira. By now, I’d run out of diagnosis, Butch had run out of patience, and we were both running out of good vibrations and medications.

Butch and I agreed he needed to see a physician immediately. Considering all the dire opinions about local medical care, we decided, to Butch’s relief, that he should fly to Johannesburg. His nephew agreed to do the legwork and enquired about a suitable Doctor and hospital.

Within two minutes, we received a call. Under no circumstances was it advisable for Butch to fly without first having a double Doppler Sonar to see whether he had developed a hematoma or blood clot. He could die from the pressure and altitudes associated with flying. We had no option but to consult a doctor in Beira.

Google was, by now, an excellent, intimate friend. There were two hospitals we were informed of. We’d travelled from afar and had 10 hours of driving under our belts. We were stressed, hungry and in a foul mood. I had driven the Honey Badger, which, at the best of times, is stressful as I battle the roads, traffic, sudden speed limits and my driving instructor, who, regardless of his ill health, still had much advice regarding my driving abilities.

Praise be. We made it to Beira. We gratefully accepted the offer to “camp” in a construction company’s yard. Once again, a stranger, without a second thought, was ready to assist us, ferry Butch and me to the private hospital in Beira and assured us we could stay as long as needed. He’d stay with us and act as our go-between and interpreter. Nothing was too much for this generous good Samaritan.

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The pretty, young Mozambique Doctor attending could’ve been our granddaughter. She ushered Butch into an examination room, held his heel in the palm of her hand, swivelled his foot this way, and that took a look at the two-centimetre wound, his swollen and discoloured leg and made her diagnosis. A barrage of Portuguese erupted from her as she explained his condition to two student doctors, who nodded, leaned over the leg, and delivered their opinions. We couldn’t understand a word.

Every so often, I’d try to chirp and bring her up to speed with my ministrations, but she swatted my words away, disinterested. After her preliminary examination, Butch was whisked off for an x-ray to check that he’d not broken a bone in the macadamia fall. The x-ray was clear as daylight no broken bones.

Then to the pharmacy, where a pharmacist dispensed the required medication. Another double round of new, better and stronger antibiotics with instructions to report back the following day at nine o’clock for the sonar. We were swiftly dismissed. Later we realised an injection was also prescribed to be administered by the pharmacist, which had not been done.

With the formalities quickly attended to, and our bill, an equivalent of thirty Myprodol in South Africa, was settled, we could return to our truck. Although all thoughts of flying to Johannesburg seemed to have fizzled out in the night air, we felt more optimistic. I was relieved knowing an actual Doctor had seen my patient, and she thought we were daft or ill-informed to prefer a South African medical opinion. She tut-tutted and  tsst-tsstt’ed a lot whenever we brought up the subject.

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Bombshell! The Good Knight Nurse could picture the headline “Stepmother Misdiagnoses Our Beloved Father In Mozambique.” How would I ever live it down? I set about documenting Butch’s medication, symptoms and diagnosis. Our nephew, in the meantime, had investigated flights from Beira to Johannesburg—an astronomical R21k.

In the case of a blood clot in his leg, Butch would have to undergo an Emergency Medical Evacuation, which our travel insurance would cover but had to be paid upfront in cash before take-off. I shudder to think what that would cost. A sixty-minute scenic roundtrip from the Waterfront in Cape Town costs R6000 per person without the emergency medical crew and their expensive equipment.

We were up bright and early the following day to report to the hospital for the sonar. Butch was readmitted and wheeled into an examination room where he was once more prodded and probed by a menagerie of pretty, young nurses who smiled, nodded and gave their opinions in very rapid Portuguese, which sounded like a round of bullets expelled from an old AK47.

A general surgeon had been alerted and would be at Butch’s attendance once he’d completed his ward rounds and seen his patients at the General Hospital. A very charming Dr arrived who seemingly understood a smattering of Portuguese. Our hospital interpreter informed us he was a Cuban doctor in Mozambique, and if we understood and spoke Spanish, we were welcome to do so. 

“Aqua con gas por favor Signor” is the total of my Spanish picked up in Mexico while floating on a giant pink flamingo lilo with my daughter’s in-law five years ago. “No, we do not speak Spanish. Can you translate for us, please?” Thankfully he said, “No problem, you’re welcome!”

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My mother drummed it into our heads that "cleanliness comes before Godliness".  We were never-ever to leave the house without clean underwear in case a bus drove over us, because the whole town would gossip about the dead Knight with the shabby underwear. She couldn’t live the disgrace down, she said. 

Butch assured me he had presentable underwear on before our mission to the hospital. His mother had also been dead scared of shoddy underpants and the injured child.

After a lengthy, detailed account of Butch’s injury, his treatment thus far and his wish to fly to Johannesburg to see a doctor had been recounted, the Doctor nodded sagely, wrung his hands in exasperation, and agreed to perform the sonar but could confirm that it was cellulitis of the leg. The medication prescribed the previous evening was correct and would do the job.

Butch was ordered to lie on the examination bed, and when ready, the Doctor would perform the sonar, he said while presenting Butch with a cotton sheet. Butch stripped down to his boxer shorts. As luck would have it, the Christmas boxers had a few stitches missing in the seams of the crotch area. Whether it was nerves or relief, we laughed, giggled and cried hysterically. With a sheet pulled up to his chin, he waited in state for the Doctor, who couldn’t suppress his giggle at the sight of his near-naked patient. Whether he noticed the lost stitches we'll never know. He kept a straight face.

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The Doctor thoroughly examined all his arteries and veins, showed us pictures and explained each heartbeat and pulsation in detail until Butch was satisfied. His final diagnosis confirmed cellulitis, which, left unchecked, could be very serious.

A nurse cleaned and dressed the wound, and I was instructed on the procedure going forward. It was crucial that Butch completed his course of medication, kept the injury clean as required, and kept his leg elevated and rested sufficiently. He prescribed bed rest for three days.

We made reservations to stay in a hotel in Beira. With a sea view. We'd be without our Honey Badger for three nights. A first in six months.

A fortnight later, Butch completed his course of medications; the wound had healed, and we were thrilled to announce that the leg was better. His ankles were back to normal, there was no discomfort, and the searing pains in his legs,  associated with coral fever,  were gone. He reported that he was 98% better.

Relieved, I packed the bandages and betadine ointment, discarded the empty boxes and sighed. I have no problem being the chief, cook and bottle washer, but being a nurse doesn’t suit my impatient personality. One morning he said, “Marich, we’ve been on the road for seven months, and not one day has been boring. In all this time, I’ve never considered giving it up.”

98% is not 100%. Ask any wannabe Einstein. We were out of the woods but still in the jungle. On two occasions, after a prawn dinner and copious amounts of yummy roasted, salty peanuts bought from street vendors, he suffered an upset tummy, cramps and a general feeling of malaise. Out came the first aid crate and his symptoms were treated. He accepted his lot and would, for a while, refrain from those favourite foodstuffs fearing an allergy.

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From time to time Butch dislodges the hidden scales from behind the loo and ceremoniously weighs himself. His intermittent fasting has certainly paid off, and he was nearing his “Goal Weight”, he’d remark triumphantly.

Trying not to sound too bitchy or envious, I reigned myself in for a while, but on Monday spoke my mind. I thought he was too thin, and his immunity would not have recovered. He had lost too much weight; at 93kgs, he was losing muscle, not fat. I had enough and reminded him that anorexia was an eating disorder. He agreed. But, he had to force himself to eat as he had no appetite and had become apprehensive about his dietary intake. My beloved was half the man he used to be, which worried me greatly, he didn't think it a train smash.

On Saturday, just 18 days later, after a long journey with many delays, bad roads, roadblocks and a border crossing, we arrived at our current campsite. An exhausted Butch alighted the Honey Badger and later complained of lightheadedness and fatigue.

Alas, we constantly neglect ourselves when in a rush, and there’s a clock ticking. We would pay dearly for it. Butch was very weak, dehydrated and worried.

That night he suffered a severe bout of hot and cold fevers and diarrhoea which continued the following day. He had a telephonic consultation with a local doctor, who prescribed an antibiotic and instructed him to hydrate.

The fevers continued, and the Good Knight Nurse decided to add a course of Malaria medication to the regime. That got everyone started, and in no time, Butch, much to his annoyance, reluctantly allowed us to bundle him into a waiting car to be shipped off to the clinic. Into a Woolies shopping bag, I slipped his iPad, spectacles, phone charger and phone with a promise that he’d be home shortly, but he’d have his book while he waited. With these words echoing, “I just want you to know, I’m not at all happy about this!” he was off.

Blood tests were taken at the hospital, and the Malaria test was positive. He was admitted and spent 24 hours in the clinic receiving drips and injections. The sister immediately realised he hadn’t eaten and insisted on supplying him with eight golden bananas.

He received excellent healthcare; the staff were kind, helpful and friendly. Although conditions were a far cry from what we’re accustomed to with our private healthcare system in South Africa, his fears were allayed knowing their knowledge of Malaria and its treatment is topnotch.

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Butch was discharged the next day. He still had to complete a course of antibiotics. He only suffered one bout of fevers since and reports a general improvement in his well-being. He is still weak and needs to rest but, his appetite for food and life has returned.

We’ve stocked up on Malaria meds and Bilharzia medication. We do not want to tempt fate. But, forewarned is forearmed. Today he’s feeling chipper and will slip on his flippers and strap on his goggles to go snorkelling in Lake Malawi. I’ll hold my thumbs; nothing unforeseen attacks us.

We will slowly continue our journey north into East Africa. We have pink skies at night, a traveller’s delight. The Good Knight Nurse will hang up her medical bag and resume her duties as cook, cleaner and clairvoyant (it rhymes). “If life were predictable, it would cease to be life and be without flavour.” – Anonymous.

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** Malaria requires a medical diagnosis

Symptoms are chills, fever and sweating, usually occurring a few weeks after being bitten.
People may experience:
Pain areas: in the abdomen or muscles
Whole body: chills, fatigue, fever, night sweats, shivering, or sweating
Gastrointestinal: diarrhoea, nausea, or vomiting
Also common: fast heart rate, headache, mental confusion, or pale skin