Duke Diary Dispatch: In Togo, Struck by Typhoid

Duke student Montana Lee's medicine and associated information to treat Typhoid Fever

The morning after, my friend Bella and I sheltered in the room of French professor Laura Florand, who was visiting for a week, during a strong rain; at Laura’s suggestion, I set a timer and forced myself to free-write for 10 minutes and get something down. I continued a few minutes after but still felt uninspired, and, feeling cold though the rain had stopped, announced that I was going to put on a long sleeved shirt and pants. A concerned look came onto Laura’s face: it was apparently quite hot out, far too much to feel cold by any stretch. She advised me to take my temperature, which I could thanks to Bella, whom I affectionately call the trip’s pharmacy, as she has been prepared with everything from hot pink Benadryl for my mysterious hives to nasal decongestant to now a CVS digital thermometer.

I put the thermometer under my tongue and shut my jaw in place as I waited. After a minute, it beeped urgently: 102.3°F. Laura then sternly told me to do what comes unnaturally to me and fully rest. As Isabella Helton wrote about in her Paris dispatch, the “basic human act of doing nothing” is very hard to accomplish, especially as we practice it so little in Duke's hyperactive and engaged culture.

I tried to tough out the fever on Thursday and Friday, but on Friday afternoon I felt bad enough to go to the local Centre Medico-Sociale (the medical clinic), a large and dusty courtyard with a few one-story buildings. Each door had the room’s purpose on it: Consultations, Injections, Laboratoire, Pharmacie. In the consultation room, I took a pinprick blood test manufactured by Abbott, much like the COVID rapid tests in plastic except with blood, which indicated I did not have malaria. 

Montana Lee's dinner June 15, in the throes of her illness. She drew a smiley face in her rice using soy sauce to cheer herself up.

In that case, I figured I couldn’t do much and would go home to continue to tough it out. (Somehow, when you’re feverish, it’s easy to get overly worried about what it could be but not think straight and try to find out the problem when you can actually access care.) But thankfully, the head nurse at the clinic, a local mother named Nicole, wanted to find out more. My temperature at that point was 102.9°, high enough that she wanted to inject a fever reducer and even prescribe antibiotics immediately, but ever-conservative (medically speaking), I resisted: I told her Tylenol would work on me and we could talk the following morning, after the blood and stool analyses she had ordered.

She and her male nurses seemed to be amused by my neuroticism and fear of antibiotic resistance, which wasn’t particularly helpful when feeling feverish and terrible. So she prescribed me 1000 mg of para (paracetamol, the term they use instead of acetaminophen) every 6 hours for 3 doses and told me to come back the following morning with fresh stool in the small glass bottle she had given me. The Tylenol totaled 3 grams in 24 hours: near the upper limit, which I also felt concerned about.

Reminding myself that patient-doctor trust is central to treatment, and that Nicole has likely seen thousands of cases of tropical disease over a lifetime, I did as she had told: waking up at midnight and 6 AM to take the Tylenol, coming back the next morning with what she had asked for, and doing a blood analysis. Two hours later, the results were ready. They indicated a low white blood cell count and yeast in my stool, but thankfully, no intestinal parasites. Based on those facts and my laundry list of symptoms, which I’m certain you don’t want to read about, Nicole and her colleague  diagnosed me with typhoid and prescribed me the antibiotic ciprofloxacin, which is the go-to for typhoid, as well as the antifungal fluconazole to keep the yeast in check. 

I was impressed at the sophistication of their tests and generally the level of care in this hot and dusty village clinic in rural West Africa. Though the lab hadn’t cultured the bacteria and looked for Salmonella typhi under the microscope, the diagnosis made perfect sense. I’m not sure if my village clinic had the capacity to do that, though I wouldn’t be surprised if they did based on the apparent sophistication of their blood and microscope stool analyses—but even so it would take days. I was too sick for that amount of time to pass; untreated, typhoid can cause intestinal perforation and a host of other scary consequences. 

I had gotten the Typhoid vaccine at the Duke travel clinic, so I was a little surprised at the diagnosis, but they explained that it prevented the case from being much more serious; indeed, when I checked online, the vaccine is estimated to be only 50-70% effective in preventing illness.  Still,  I’m extremely grateful I got the vaccine; I likely would have been much worse without it.   

In addition, during the malaria test I had noticed that one of the male nurses, who wore nice glasses, had an iPhone 13 in a sleek blue case– a possession entirely incongruous with his surroundings. When I came back the next morning, in a much better mood and looking to get some payback for his snickering at my feverish skepticism, I teased him about it in front of the other two young male nurses, Nicole, and the medical assistant. (That was not inappropriate in this setting and culture.) They made him take it out and show us, and everyone thought it was quite funny; the nurse in question was embarrassed and proud at the same time. It turned out that he was from the capital of Lomé and doing a stage (internship) in a rural area as a mandatory part of his training, which explained the fashionable glasses and the iPhone, but I was still amazed. An iPhone 13 would cost a huge portion of his likely annual income; but perhaps his family had money or he had a side hustle. Vouloir, pouvoir (when there’s a will, there’s a way) is not an uncommon attitude here.

Back to the present: the medicine worked like a charm, and I was feeling well enough to go on a program field trip to a UNESCO World Heritage site four days later. Though I’m almost back to normal, writer’s block is still hitting hard, even though having typhoid is such a sensational topic that one would think it’d be easy to write about. As I work on my next entry, I’ll remind myself of what they might say here, vouloir, pouvoir! 

Until next time…

In good health,