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Fingered in Mombasa

The premature crossing from Pakistan had been pretty rough, as evidenced by the chafing of my running rigging. I knew it was the wrong time of year, but after I had exchanged all the things that could be safely stored, my only thought was to leave the teenage thieves and pick the pockets of Karachi in my wake. Now the seas finally settled and became much less violent. Full sail on the old girl and she made 8 knots. Dolphins and the sea were my only company. Now I slept with one eye open for a few minutes because nothing flashed on the radar screen. Thoughts of noteworthy medical cases, foreign countries, and seafaring interwoven in my dreams.

At 87.3 nm off the coast of East Africa, I received a sat call. An old acquaintance told me in a very worried tone that he had tried to call many times and was now desperate to talk to me about a confusing medical issue. Sat phone dead… No bars… Off I went to climb the mast hoping to get a signal. 5 feet swelling up and constantly spinning me around like a rag doll. I forgot my seat belt in a hurry. Getting higher had never improved the signal before, I finally figured why should it now? A detached Direct TV satellite dish on top of my mast would improve my reception just as much. I came back down battered and bruised to ponder my friend’s dilemma.

This was all very unnatural, to say the least, coming from a man who had once helped me treat some of the strangest meals and illnesses in all of Africa. Maybe it was about him or a family member that caused him to lose perspective. No… he was always objective and very professional, hiding the tears he kept wanting to shed. I was confused. Finally at 13:27 I contacted him to set up a meeting!

While waiting for my friend to arrive from Magongo, I sat in the shade in a darkened open bar in the old town of Mombasa. The setting sun was huge as inland dust particles refracted and magnified the red-orange hues in Kilindin Harbour. The dirty ceiling fans were spinning slowly swirling dust that could be seen through the rays of light. You could feel the dampness and sand you were breathing. Everything was quiet except for the occasional clinking of a bottle, the whirring of fans, the sound of wood hitting the floor, and the music. In a candle-lit corner, an old man in a worn and tattered sarong danced to Luo Ben music with a one-legged woman who could still spin and wriggle with one crutch and peg.

My nervous colleague arrived by tuk-tuk, matatu bus to the Old Port roundabout. He looked very frustrated. We exchanged formalities and I got him on the bar stool next to me. I urged him to tell me the source of his anxiety. He became abrupt when he sat next to me and it took several Mojos to calm him down.

Apparently on the same bar stool I was now sitting on, a well-dressed man came in and started talking to him about the local poaching problems, of which there were many. The conversation continued for several hours. The man continued to reflect on various national and international topics. While drinking another beer and changing the subject to recent areas of ivory and ironwood, his little finger fell without the master noticing. My friend jumped up at this point in our conversation and pointed to the bar, saying, “Yes. Right where you’re sitting, his finger just fell off!” My friend who was sitting again said that the man walked fearlessly and now left one of his toes on the wooden floor. My friend began to draw her attention to the fact that she had not only left her finger on the bar, but had now walked away and left her toe too! However, he was far too stupid at this point to comment.

My dear, confused friend asked me what I thought about this tragic event. To calm her fears, I suggested that she (my friend) may have had an acute psychotic episode that required immediate neuroleptic medication, confinement to a nearby ward, and intensive psychiatric counseling. Of course it didn’t help!

Well… I said, “Did he have a rash?” “Actually yes, he had pale discolored spots and bumps on his hands and I also noticed it on the bottom of his legs when he crossed his legs.” “He also had trouble seeing and kept sniffing.” Confusing, I thought. I asked, “Surely he wouldn’t have mentioned the fact that he was impotent during your poaching conversation,” would he? “Well…he did, but only compared to the barren white rhinoceros.” “Did he keep dropping his glasses?” “Yeah, how did you know that?”

“From what you told me, and considering he was an African male with vision problems, impotence, and discolored rashes, he was unknowingly suffering from a bacterial infection called mycobacterium leprae.” I said. My friend pondered the statement for a while, but was finally relieved by my thoughtful leprosy diagnosis and reassurance that he was not at risk of infection or, more importantly, impotence.

Then we moved to a couple of rattan chairs at a torch-lit corner table and continued to drink tea and chat in Swahili with the locals. I have to admit that maybe she didn’t fully believe me because she was counting her fingers and toes all night.

Leprosy or Hanson’s disease

The earliest known writing about this bacterial infection was in Egypt around 1500 BC. It is also mentioned many times in the Bible. Throughout history, it has carried a certain stigma with it. Often the sick were isolated, like tuberculosis patients in the past, and this still happens in some countries. In other cultures, they were forced to wear certain colored clothes and ring bells when they came down the street so that people would avoid them. All sorts of reasons were conjectured for their condition and misery. Witchcraft, family curses, punishments for past deeds and etc… were just a few. Unfortunately, the victims of this affliction suffer enormous psychiatric and emotional damage from being judged by society.

Leprosy is an infection that primarily affects the peripheral nervous system, i.e. not the brain or spinal cord. It can cause numbness and weakness in the hands and feet, often leading to a limp in the wrist or leg. As a result of repeated trauma to these areas, fingers and toes can actually fall off, unbeknownst to the sufferers. Typically, the affected areas have either small or flat, discolored rashes, a chronic cough with mucous membranes, and sometimes loss of vision.

The usual age of onset is 20-30 years and it is most common in Africa, India, Nepal and Latin America. Cases are not unheard of in the United States, but these tend to be recent immigrants.

As far as we know now, you cannot get this infection from casual contact or touching lesions. It is usually caused by close contact with infected respiratory secretions or mucus over a period of months or even years. Other sources or carriers are believed to be infected soil, armadillos and possibly mosquitoes and bed bugs. It usually takes 1-7 years from the time of infection to the onset of symptoms.

The diagnosis is based on the presenting symptoms, type of lesions, affected areas and microscopic examination of the lesions. These bacteria cannot be diagnosed with blood tests or cultures.

Treatment mainly consists of dual therapy using a combination of Dapsone and Rifampin for long periods, if not for life. Other drug treatments are available.

So… If you’re about to sail to Mombasa to see the biggest sun you’ve ever seen… make a note of how many numbers you have beforehand and afterwards.

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