The untimely crossing from Pakistan had been rather rough as the chafe on my running rigging indicated. Wrong time of year I knew, but having traded for all of the goods that could be stowed away safely, my only thought was to leave the adolescent thieves and pick pockets of karachi in my wake. Now, the seas finally settled and became much less violent. Full sail up on the old girl and she was making 8 knots. The dolphins and the sea were my only company. Now, I would sleep with one eye open for a few minutes as nothing blipped on the radar screen. Thoughts of noteworthy medical cases, foreign lands, and seamanship were intertwined in my dreams.
When 87.3nm off the eastern African coast I received a sat phone call. An old acquaintance told me in a very anxious tone of voice that he had tried to call many times and now was desperate to talk to me about a perplexing medical problem. Sat phone dead … No bars … Off I went to climb up the mast with hopes of getting a signal. The 5 foot swells and constant rolling tossing me about like a rag doll. I forgot my safety strap in the rush. Getting higher had never improved a signal before, I finally realized, why should it now? A disconnected Direct TV satellite dish on top of my mast would improve my reception just as much. I came back down battered and bruised to reflect on my friend's dilemma.
This was all very out of character, to say the least for the man who had once assisted me in treating some of the most bizarre aliments and diseases in all of Africa. Perhaps it involved him or a family member, causing him to loose perspective. No … he was always objective and very professional, hiding the tears that he constantly wanted to shed. I was perplexed. Finally, at 13:27 I made contact with him to set up a meeting!
While waiting on my friend to arrive from Magongo, I sat at a shadow darkened open bar in Old Town, Mombasa. The sitting sun was huge as the inland dust particles refracted and magnified the red-orange tones over Kilindini Harbor. The dirty ceiling fans rotated slowly circulating dust that could be seen through the rays of light. You could feel yourself breathing in the humidity and sand. All was quiet except for an occasional bottle clang, the whirl of the 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 lady still able to twirl and curtsy on her single crutch and peg.
My nervous colleague arrived in a tuk-tuk after taking the matatu bus to the Old Harbor round-about. He looked very frustrated. We exchanged formalities and I escorted him to the barstool next to mine. I urged him to tell me about the source of his anxiety. He became bug-eyed once seated beside me, and it took several Mojo's to calm him.
Apparently, on the same barstool that I was now sitting, a well dressed man came in and began talking to him about the local poaching problems, which were many. The conversation went on for several hours. The man continued to elaborate on various topics of national and international concern. While having another beer and changing subjects to the recent ivory and iron wood allotments his little finger fell off without the gentleman noticing. My friend jumped up at this point in our conversation and pointed to the bar saying, "Yes. Right there where you sit his finger just fell off!" Seated again, my friend said the man walked off undaunted now leaving one of his toes behind on the wooden floor. My friend started to call his attention to the fact that he had not only left his finger behind on the bar, but had now walked off and left his toe also! He however, was much too dumb-founded at this point to comment.
My dear, bewildered friend asked me what my opinion of this tragic event was. To calm his fears I suggested that he (my friend) may have had an acute psychotic episode requiring immediate neuroleptic medication, confinement in a nearby ward, and intensive psychiatric counseling. That did help, of course!
Well … I said, "Did he have any sort of rash?" "As a matter of fact, yes he did have pale discolored patches and bumps on his hands and I also noticed it on the bottom of his feet when he crossed his legs." "He also had difficulty seeing and kept sniffling." Puzzling, I thought. I inquired, "He certainly would not have mentioned the fact that he was impotent during your poaching conversation did he"? "Well … he did, but only in comparison to the infertile white rhino." "Did he keep dropping his glass?" "Yes, how did you know that?"
"From what you tell me and given that he was an African man with visual loss as well as digital loss, impotence, and a discolored rash, he was obliviously suffering from a bacterial, Mycobacterium leprae infection." I said. My friend pondered the statement for a while, but was eventually relieved with my thoughtful diagnosis of Leprosy, and with the assurance that he was in no danger of infection, or more importantly, impotence.
We then moved to a couple of rattan chairs at a torch lit corner table and proceeded to drink tea and talk in Swahili with the locals. I must admit that he may not have believed me entirely because he kept counting his fingers and toes the rest of the night.
Leprosy or Hanson's disease
The earliest known writing concerning this bacterial infection was in Egypt in approximately 1500 BC. It is also mentioned many times in the Bible. Throughout history it has carried a certain stigma with it. Often suffers were isolated as tuberculosis patients once were and this still occurs in some countries. In other cultures, they were made to wear certain colored clothes and ring bells as they came down the street so people could avoid them. All types of causes for their condition and misery were postulated. Sorcery, family curses, punishment for past deeds, and etc … were but a few. Most unfortunately, the victims of this affliction suffered tremendous psychiatric and emotional damage due to their denunciation by society.
Leprosy is an infection that primarily attacks the peripheral nervous system ie not the brain or spinal cord. It can cause numbness of the hands and feet as well as weakness, oftentimes resulting in a limp wrist or foot. With repeated trauma to these areas, the fingers and toes can indeed fall off, unbeknownst to the afflicted. Typically, there are either small or flat, discolored rashes in the affected areas, a chronic cough due to mucous membrane involvement, and sometimes a loss of vision.
The usual age of onset is 20-30 yo and it is most common in Africa, India, Nepal, and Latin America. Cases are not unheard of in the United States, but these are usually recent immigrants.
From what we know now you cannot get this infection by casual contact or touching the lesions. It is usually due to close contact with infected respiratory secretions or mucus over a period of months to even years. Other sources or carriers are thought to be infected soil, armadillos, and possibly mosquitoes and bedbugs. From the time of infection to the time of onset of symptoms is usually 1-7 yrs.
The diagnosis is based on symptoms present, type of lesions, areas of involvement, and a microscopic examination of the lesions. These bacteria cannot be diagnosed by blood tests or cultures.
Treatment consists primarily of the use of dual therapy with a combination of Dapsone and Rifampin over long periods of time if not a lifetime. Other pharmaceutical therapy is available.
So … If you are sailing to Mombasa soon to see the largest sun that you have ever seen … please make note of the number of digits you have beforehand and afterhand.