Dengue is Me

Sat Oct 21, 2006

It finally happened. I contracted dengue. Barely four months into my third trip to Cambodia. It was quite an experience going to the hospital and I have to share it with readers who are planning to come here.

My symptoms started on a Wednesday evening, with pins and needles in my hands and ankles and feet. That night I came down with fever. The next day, my temperature was 38.6 degree celcius (101 degree farenheit), then went down to 35.9. Apart from the fever and chills, I did not have any other symptoms. The next day my temperature rose to 39.2 (102.5), which convinced me to see a doctor in Cambodia.

I called up someone who has been here for 11 years, Malaysian missionary Esther Ding, who is the founder of Khmer Life, and also, she says, Villageworks, the one that is now owned by the Singapore Girls’ Brigade (interesting story for another time). Esther told me to see Dr Lily of First Central Clinic on Monivorng Boulevard, just 10min walk from my house.

Dr Lily wasn’t in (I found out later she is from China and is the manager of the centre, which is Chinese run) and I was taken to see another Chinese lady doctor. A nurse approached me with a thermometer and I recoiled. “Is it clean?” I asked, thinking I had to put it in my mouth. Another nurse said don’t worry. In Cambodia, doctors always take temperature from the armpits. The temperature and blood pressure were normal.

The doctor did not speak English and I asked for a translator. It was a Khmer man who as it turned out, spoke worse Mandarin than me! So much for that plan.

The doctor then took out a wooden tongue press from a small metal box and stuck it in my mouth. It all happened so quickly that I did not have time to ask if it was sterilised. She kept asking me to say “ahhh…” and the Khmer man was translating, “doctor ask you to say ‘ah’, say ‘ah’!”, while I was just concentrating trying to push out the press! When I succeeded I immediately went to the sink to rinse my mouth and tongue. Very rude, I know. Meanwhile the doctor had put the press back into the box which contained some other stuff…

It was all very perfunctory, her questions, she only seemed keen for me to do a blood test. That was fine because I wouldn’t have trusted her diagnosis anyway. It turned out I had very low, 1900 (normal is 4000) white blood cells count, and low platelet count, 1850 (normal range is 1500-4000), which the doctor said would only continue to drop. Then I realised the name on the card was not mine! It was some other person called Wang Fuxing. I pointed this out and the doctor insisted it was my card, they just used the previous patient’s name! Anyway, it turned out it was my card, so they said anyway. The doctor decided I would have to stay the night at the hospital for observation. When I refused, we agreed for me to go on a drip, but only after I confirmed what I was getting. She claimed the first time it was antibacterial/virus drugs (fangjun yao), but the bags I saw were sodium chloride and dextrose. Salt and sugar. There might have been some drugs injected into the bags, but I did not see any on the preparation table.

It was fine with me because I had not been eating for the past 3 days, so I could do with the food. There is no treatment for dengue. In Singapore, the doctors give you potassium salt. You just need to have plenty of rest and drink lots of water.
It was traumatic though, because the first nurse, a Khmer woman, had tried to insert the needle and did it wrongly, causing me much pain. Then a Chinese nurse, who said she was more experienced, came along and wanted a go. *I* had a go at her: I’m paying money for this, why didn’t you come the first time round, why send an inexperienced nurse? Anyway, she too failed, muttering that my veins were too fine. Finally it occurred to them to change to a child’s size needle. Despite not being able to see my veins, they had insisted on using the standard adult sized needle. I was thinking how typical this inflexibilty in customer service is—in Singapore and in Cambodia. People just don’t use their brains, but follow SOP (standard operating procedure). The doctor herself finally got the needle in. So my advice is to get the doctor to do it for you the first time round.

It was hilarious being at the hospital, whose clients consisted only of Chinese and Koreans and me. There were no white people at all. When I told my English friend Myriam, she said, get a second opinion from a proper doctor! What was funny was the way people kept streaming in and getting put on drips like it was routine. The woman on the bed next to me had an inflamed throat and was given a drip! At 9pm, these two Chinese men strolled in, chitchatting with the clinic’s administrator, then comfortably settled on the beds, reading newspapers while being hooked up. You get the sense that for these people it’s just like going to the pub. “I’m not feeling too good today, I think I’ll pop down to the clinic (pub) for a drip (beer).” Alan and I were joking about infusing them with beer which is roughly the same colour as the dextrose. One Chinese guy asked the patient in the next bed whether there were any openings in his cardbox box manufacturing factory. Another one had asked for half a pack of dextrose, but fell asleep and when the nurse woke him up, he said, let me finish it and promptly went back to sleep. I wonder if it is the aircon that they like?

I had read in a book, I think it was the one written by a British doctor who had volunteered to work here in her 50s, that Khmers are big believers in drips. Whatever they’ve got, they insist on a drip. You often see people riding pillion on a motobike holding on to their drip bags. (There is also a country where the people like injections, although I forget where.)

In Singapore, it is antibiotics. Doctors insist on prescribing it to you for whatever illness. I am not sure if it is because they think that is what the patients expect, or whether it is their way of making more out of you. I dislike seeing doctors in Singapore for that reason. Taking antibiotics regularly is not without harm. You could get immune to the drug when you really need it, and worse, most antibiotics don’t work with pinpoint accuracy, which means they destroy good bacteria as well.

Anyway, it turns out, the consultation was only USD2 (what it was worth, probably!), blood test, USD7, and the 2 drips, USD25. No wonder they were so keen for me to take the drip—it’s more than 10times the consultation fee! Still, at USD34, it was fairly cheap. Myriam’s foreign doctor charges USD40 for consultation alone, about 6 times the price in Singapore.

The good news is I felt much better after the drips and could eat a bun that night. It’s the day after and I feel well enough to type this.