Parasites, cholera, dengue fever, and Covid19

The other thing I keep thinking about with Covid19 is my mission in Nicaragua.I had a great mission.  It was fun, it was life changing.  I made friendships that changed my life in so many ways.  I lived in Nicaragua from 1996 to 1998. the economy was still a mess and the church was really new.  We had a short period where we had to stay home and not go out because of unrest around the elections in our area, but mostly I think about how disease impacted me personally and the economy.

I was sick most of my mission.  I had diarrhea from intestinal parasites, E. coli, Giardia,  or food poisoning pretty much the entire time. The lowest moment was when I was in Grenada about half way through and it was really hard. I was also leading the mission district, the church district and the branch. We had almost no local leaders - the district president had used all of his budget to help a family whose son committed suicide and then tried to cover for that by using all of the budget from the branches, and then tried to cover that up and made such a mess. One of branch presidents confessed to me that he had an affair and that she was pregnant. Another had invested the budget to keep it out of the district presidents hands into the local farm coop, which went bankrupt.  His daughter was also either possessed or severely mentally ill. He was probably mentally ill. His whole family had a history of violence and hechizeria. That is a long story in itself. We ended up releasing all of them and calling all new leaders and I was stuck with the job of finding those new leaders. 

The other missionaries just added to my stress. Elder Hernandez, a missionary in my district, hated me and tried his best to make me look bad and to make my life miserable. One of the missionaries that I lived with tried to kill himself and then ran away to Honduras. All of that on top of being so sick. I was losing weight. I had a cough that wouldn't go away, diarrhea, a skin rash, and a fever that simmered and kept me awake at night.  My companions during this time were pretty good, but between my health and the stress I was breaking. I wasn't sleeping and physically I was falling apart. At the worst point, I dropped to almost 110 lbs and must have looked like I was dying. The mission president's wife saw us while she was driving to Managua, pulled over, ordered us into the car and drove me straight to the hospital.  At the hospital the doctor checked my symptoms - fungal infection on my skin, in my lungs, parasites, bacterial and amoeba infections, and losing weight. Plus on top of that I had gotten this terrible, terrible haircut so I looked like Tom Hanks from the end of Philadelphia. He came to the only logical conclusion - I must have HIV.  I did not have HIV.  He checked. But, I did get medicine for all of the things, and orders to stay at the mission home until I had gained some weight and got some help dealing with all of the mess in my area.  

I did get better, but we were usually dealing with one of us being sick - sometimes with malaria, dengue fever, but mostly intestinal problems from bad water or food. We worked at hospitals as volunteers and saw a lot of really sick people. One of my areas was hit pretty hard with cholera.  The water system was a mess and so we only had running water a few hours at a time.  Many people used river water or contaminated well water. The river in Matagalpa was bad enough that all the fish died while I was there and I can remember watching them float on the top of the water from a bridge while sipping fresco de malacuya.  Dengue or malaria was a problem for us and the people in Nicaragua.  I never got either, but some of my companions did. I did have a fever once so high that I began to hallucinate - seeing ants crawling all over people and things around me. I still have health impacts from that time. I have serious liver damage, possibly started from either the diseases or treatments that I had during those years.  

What does this have to do with Covid19 and our current quarantine conditions? 

It was the first time that I lived with pretty real risk of getting sick from serious diseases.  It was also clear how overwhelmed the health care system was. For the first six months of my mission we volunteered in the hospital in Leon most mornings. All the beds were full - sometimes with two people/bed. The hospital didn't have enough supplies or medicines.  Patients had to bring their own medicines most of the time. The Russian equipment was old and not always functional. They only had one set of electrodes for the EKG machine. That we were even allowed to work as nurses, orderlies, record keepers, etc with no training really showed how desperate they were for help.  Most of the time we did intake, helped set bones, moved patients around between departments, helped with minor surgeries, cleaned up after patients and treatments, ran errands for the doctors or nurses, and whatever else was needed.

 The impact of having these diseases was a drag on the economy as well as the physical health of people.  Nicaragua's economy was the worst in the Americas with high unemployment, educational problems, system corruption, a weak and unreliable democracy, but having a pretty high rate of malaria, dengue, cholera, yellow fever, parasites, poor water, etc. made it worse.  I think another impact of disease was more subtle. Just knowing that there was this risk changes behavior of people and investments. If you know that to go to Nicaragua you are encouraged/required to get a whole list of vaccines and potentially take medicine to prevent malaria, treat all liquids consumed as potentially contaminated and that food wasn't safe to eat, you might reconsider visiting Nicaragua.  You may choose to go to Costa Rica instead. You would stay in different hotels and eat different food.  You might not do business there or send your kids to study there.  

Covid19 quarantines are obviously hurting businesses and people that have lost their jobs. So many are closed and so many people unemployed, but I think some of the other impacts to the economy are because of the psychological impacts of people being scared - of the disease, of other people, of the government, etc.  Scared people are not rational and that encourages conspiracy theories. I think that is why Facebook is flooded right now with Plandemic and other nutjob videos. It is fear that is behind the protests where people bring their guns to the capital. Rational people can have a discussion and disagree amicably.  We aren't there right now and that is scary.  Nicaragua was that way too. Everyone polarized and tons of absurd rumors spreading that encouraged people to vote for strongmen like Daniel Ortega. Scared people don't want democracy - they want someone strong and are susceptible to extremism.  

The uncertainty also hurts the economy.  I feel this in my own life.  I want to plan summer vacation and activities, but I can't because I don't know what summer will be like.  Will we have the pool open? Will church open? Will I travel for work? I don't know.  I feel this at work.  Projects that require travel or international recruiting or investment - at a standstill.  Reduced capacity for lab and field work.  Prices dropping for corn, soy, meat. Animal production reducing herds and flocks. You can't invest confidently without the ability to make a plan and expect those plans to happen.  Nicaragua was full of this.  I understand now better people's unwillingness to make plans.  You just can't when so many things are out of your control.

There are some interesting differences.  Most of the diseases that we worried about were spread by a vector that we couldn't shut ourselves away from.  Mosquitoes were everywhere and we had mosquito nets and bug repellent, but they will bite you.  You can't hide from them completely and they spread many of the diseases - Malaria, dengue, now also Zika.  The water carried E. coli, amoebas, giardia. The food carried hepatitus, parasites, and bacterial food poisoning.  This disease is really carried by us. We are the vector.  We are the host and the carrier.  Quarantine and lockdowns does prevent infection and spread, where most of our diseases in Nicaragua we worried about were not something we could shut ourselves away from.  We could avoid eating street food, but we couldn't avoid eating and drinking entirely, and after a few weeks it was clear that no food was really safe, so I ate street food indiscriminately.  As annoying and potentially detrimental global shutdowns, travel restrictions, and quarantines are they do slow or prevent the spread of this virus.  

At some point we will have to figure out how to live with this disease.  The lockdowns will have to end and my guess is that the disease will not disappear. We will have to figure out how we can better test for, treat, and live with Covid19 like we live with other diseases.  Hopefully there will be a vaccine developed that will prevent infection.  Vaccines are a miracle.  When I worked in the hospital and saw measles, mumps, rubella, tetanus, diptheria, hepatitus, etc in real life, it really cemented how amazing vaccines are.  I hope one of the long term impacts of Covid19 is the end of the antivax movement.  But, even with a vaccine, we will need to learn to live with that risk and to face those fears.  Nicaraguans lived with a lot of fear every day - the economy, disease, crime - all worse than now, but still bravely and almost everyone we met were happy and worked so hard taking care of each other.  Besides a vaccine, that I think is the solution - we can combat fear through action. I don't mean arming yourself with a stupid gun.  Action - look for people that are hurting and help them.  Chose to live bravely in face of fear.