Feb. 11, 2014, 11:35 p.m.
One Sunday, just over a year ago, I was blissfully windsurfing in the deep blue Caribbean. By the following Wednesday, I was in intensive care, and on the Friday in a medically-induced coma, from which, according to my doctors, I was very lucky to emerge alive.
I had almost died – from malaria.
At this moment, thousands of young travellers will be setting off on their gap year adventures, often to malarial areas. Like many of them, I never took seriously the risks of this dangerous disease. As an aid worker based in Haiti since it was devastated by an earthquake in 2010, I’d been warned about the risk. I’d usually, but not always, used nets and insect repellent when working in rural areas. I’d also taken anti-malarial tablets – until they ran out. None of my colleagues ever bothered with medication, so why should I?
But in early December 2012, having flown from Haiti to visit family in the Virgin Islands, I suddenly suffered an acute headache and an ever-worsening fever. Even then I wasn’t particularly troubled – I had friends who developed malaria in Africa and had recovered with the right treatment, within a few days.
There were two facts I was unaware of at the time. First, the only strain of malaria found in Haiti, falciparum malaria, can be lethal; secondly, that without immediate treatment, the chances of death rise exponentially.
Due to fly back to Haiti the day after my symptoms appeared, I rashly assumed hospitals in that stricken country would be able to treat whatever it was I had. And twice, the plane I was due to take, suffered mechanical failure, which meant spending a night in Miami and the loss of precious time. I was finally admitted to a clinic in Port-au-Prince, the Haitian capital, some 48 hours after my first symptoms - by which time the falciparum parasite was hard at work. Pneumonia and jaundice caused by liver failure had already set in. No wonder everything had a golden glow; catching sight of myself in a mirror at one point I saw my eyes were totally yellow.
The clinic did its best, but my case was too serious for its medical facilities to deal with. Thank heavens I had bought full medical and evacuation insurance: it probably saved my life, as it meant I could be flown out to the Dominican Republic, the closest country with a decent, functioning medical system.
Being flown out by air ambulance was a relief, but the intensive care unit I was taken to was full. The friend who had come with me was handed a list of other hospitals to try: off we went on a midnight tour of the darker side of Santo Domingo, the country’s capital, until we found one.
From this point on, my memory is a blur. By now, the parasite had attacked my lungs, liver, kidney and stomach, and there was fluid on my heart. As my organs failed, my body went into septic shock. My legs swelled to twice their normal size, while my skin, eyes and urine were yellowish orange. I had numerous medications to tackle the different problems, as well as undergo blood transfusions and dialysis.
The worst part was the feeling of drowning, since my lungs were full of fluid. The last thing I remember is having an oxygen mask on my face, trying desperately to breathe. To my right was the doctor, arms crossed staring intently at a monitor of my vital signs; behind him, my friend, silent and in tears.
I am not going to die, I thought. I am close, but it is not yet my time. Strangely, I did not feel frightened. And then I slipped off into a coma, induced so that I could be put on a ventilator that would breathe for me.
Apparently, people look pretty appalling on a ventilator. The tubes have to be strapped across the face to ensure they don’t move. The body rises and falls in an artificially eerie way. Add this to the swelling and infection – I wasn’t a pretty picture.
One friend who visited was so shocked he couldn’t even approach my bedside.
Of the week I spent on the ventilator, I remember very little. The faces of family and friends who came to visit me occasionally floated across my vision and I recall voices telling me stay calm. I didn’t feel any pain because of the heavy sedation, but I felt in a very dark place. At 33, I was fighting for my life.
At some point, things turned around. My lungs were getting better, and my liver count improved. Around the same time, I had to come off the ventilator, to prevent permanent damage to my windpipe from the tubes. Doctors carried out a tracheostomy, in which a small opening is made in the neck, into the windpipe and a tube attached to a machine inserted to aid breathing. Slowly I emerged from the coma, back into the real world.
And yet intensive care is not the real world. It is an oppressive, strip-lit place of eternally beeping chaos. There are people dying and people crying. There is the 24/7 chatter of the nurses. There are no windows, no daylight, no starlight. Time stops: minutes blur into hours, into days, into weeks. Like 80 per cent of ICU patients, I was delirious, in an alternative reality full of fear and paranoia. It was like one of those nightmares that seems to go on forever.
It took the doctors a few attempts to remove the tracheostomy tube so that I could breathe on my own, but finally they managed it. The minute they wheeled me out of the ICU into a quiet room of my own, I emerged from my nightmare.
Very slowly, things started returning to normal. After a few weeks, I took my first few steps, my blurry vision started to clear and I began eating food again. It had never tasted better.
Depression set in, though, when I realised I wouldn’t be returning to my previous life in Haiti – in fact, I wouldn’t be able to do much of anything for a few months. My wonderful doctor – without whose determination I believe I would never have made it – noticed this dip in my morale and would push my wheelchair outside into the sunshine: after four weeks of windowless hell, it was blissful.
After six weeks, still fragile, I left hospital to stay in a nearby hotel. I improved steadily and, after numerous tests and surgery to close the tracheostomy, I was allowed to fly home to London. There, I had surgery twice to get rid of scar tissue in my trachea from the ventilation tubes. It took six months for me to feel anything like normal.
Being very ill has taught me a lot, not least about complacency when it comes to protecting my health. My message to would-be travellers is this: if antimalarials are recommended, be sure to take them and stock up well – they may save your life. Try to avoid getting bitten: use spray, nets and long sleeved clothing. Fever and other symptoms should be checked immediately, and in remote areas, a malarial testing and treatment kit is useful. And always make sure you have good medical insurance.
If my terrifying experience can help save just one young life, it will have been worth it.
Mandy George is fundraising for Malaria No More UK, a charity dedicated to saving lives from malaria. For details, go to justgiving.com/mandygeorge
What is malaria?
Malaria is an infection caused by the malaria parasite entering the bloodstream through the bite of an infected mosquito. There are five different strains, of which P. falciparum and P. vivax are the most dangerous.
Malaria is found in over 100 countries worldwide and causes at least 660,000 deaths annually. The disease is common in tropical and subtropical regions including much of Sub-Saharan Africa, Asia, and the Americas
Malaria usually begins with flu-like symptoms such as fever, sweats and chills, headaches, joint pain, vomiting and jaundice, and can lead to coma and death. Early, accurate diagnosis and treatment is critical.
Malaria can be prevented by taking antimalarial medication and avoiding mosquito bites with the use of insect repellents and mosquito nets.
In 2011, 1,677 travellers returning to the UK were diagnosed with malaria and eight died. Travellers should seek medical advice before travelling to a malarial area. If you develop malaria symptoms while travelling or after returning to the UK, seek medical treatment immediately.