- Diseases, Disorders & Conditions
My Week in H1N1 Limbo
Part 1: Oink....I mean ACHOOOO!!
Pariah. Outcast. Leper....just the words "Swine Flu" accompanied by a cough sends people scampering for the hills..or the nearest well ventilated area. The misnomer is the latest buzz on every one's lips, and makes most folk glance askance and take two shuffles to the side at even the most innocent sniffle. Influenza A/H1N1, as it is more correctly called, is definitely the thing to watch this summer. A full fledged Stephen King horror epic in the making - and this week I had my small walk on role in the whole drama.
Enter Sharrie, stage left. Pregnant mom who starts off with an annoying tickle in the back of her throat on Sunday which rapidly develops into a nasty cough, fever, sniffles, chills, sneezes,headaches and no appetite by Monday morning. I feel like death. No, I feel like death warmed over. By Monday night I begin to worry that this is more than just a simple flu and make the decision to get tested for H1N1 first thing the next morning. The fact that I am newly pregnant and work as a teacher are also grounds for acting responsibly and getting checked out as fast as possible. And did I mention I feel like death?
I had done lots of reading on the net, so I was not in a state of panic about the whole thing; after all H1N1 at this point for most people exhibits as a mild to moderate flu. I was actually more concerned about what I would meet in trying to get help in our health care system which is notorious for being a nightmare.
With this in mind I decided to go for the initial test at a private nursing home. In all fairness to the institutions concerned, considering the tremendous burden this pandemic has put them under, I won't be calling any names.
I made a phone call and found out that to have the test done at the nursing home it would cost $300 TT (approx. 6TT = 1 US) and the test results would be available in one hour. Not too bad I thought. So off I went with my shaking, shivering, coughing, sick and miserable self driven there by the able bodied Chris. I walked in to the lab covering my face and feeling like every eye in the room was burning a hole through my back. I was so paranoid that I made sure Chris had everything in hand - like my medical forms - so that I would not have to deal with the embarrassment of someone refusing to take something from me because I had touched it. We whispered why we were there to the receptionist and I was immediately whisked off with one other gentleman - who appeared to be in fine health - out the back door into the open space near the small external lab facilities at the back of the building. The young lab technicians scurried to secure their face masks and Mr. Gentleman and I were seated in two office chairs stationed one on either side of the lab door..well into the stream of fresh air blowing around the building.
The chairs were not as comfortable nor as new as the one above, but I guess they served the purpose. There was no tent or shade, which was not a problem at the time as it was a cool, breezy morning. Mr. Gentleman and I sat side by side attempting to make small talk while Chris stayed in the reception area filling out forms. I found out later that after 9 years he STILL has no idea what my correct birth date is!
The conversation went as follows:
Sharrie: So...you here for the H1N1 test too huh (ACHOOOOO) *nose and mouth responsibly covered*
Mr. G: Yep..thought it better to be safe than sorry (moves chair a little further to the right)
Sharrie: But you don't look sick....I feel like death...
Mr. G: Well ah had a little sore throat and thing and I was a bit worried because I was travelling recently.
Sharrie: hmmm..yep. Well boy..I think everyone will end up getting this sooner or later so nothing really to panic about.
After a couple minutes of our shooting the breeze and feeling like Gog and Magog guarding the entrance to the mysterious lab, a technician returned (suitably protected in her mask and surgical gloves) and told us that she was ready to take our samples. Out came very long cotton swabs and Mr. G. nearly fell over backwards in his chair when she told him she had to stick them up our noses.
Mr. G.: "OH Gawwwd...mam...I does have real trouble with meh sinus an ting'! Dat going to hurt??"
She explained it would indeed be a little uncomfortable, but it was nothing to worry about. After all, she said, "a six year old had the test done yesterday and she didn't give any trouble!" Poor Mr. G had to suck it in and be brave or risk being shown up by a six year old girl.
He was asked to lean back in his chair, tip his head back and the swab was then inserted as high up in the nasal cavity as it could go. Poor Mr. G gasped and aggghhhed and owwwed. I was reminded of the scene in Total Recall where Arnold gets the probe removed from his nose.
Next it was my turn, and I am pleased to say, that even though my eyes watered like all hell and I was fighting back the urge to cough, I didn't so much as utter a single 'ow'. I never knew my nose was so big though, or so closely connected to my brain.
Once that was out of the way the technician disappeared into the forbidden lab while we continued to enjoy the breeze and dab at our eyes. After about ten minutes she came back and told us that they would have results in about another five minutes, but the report would actually take an hour. We were given the option to wait or return later. Mr. G quickly scampered off - no doubt to check that his nose was still intact - while I chose to wait. At that point I was practically folding into my seat as I felt so ill, I didn't have the energy to go anywhere. So I waited, and waited...and waited....and waited while young girls in white lab coats and masks hurried back and forth between the lab and the main building. By the end of the first fifteen minutes I noticed a difference in their behaviour. They were going to great pains to walk as far away from me as they could, they'd check the wind direction, and when they crossed paths one would whisper to the other, both would glance my way and masks were affixed more securely. One techie came into the zone not wearing a mask, was promptly pulled aside and whispered to and she immediately grabbed the collar of her lab coat and pulled it right up over her face practically up to her eyebrows. "UH OH...this is not looking good" I thought. Another techie asked me in passing if I had "travelled anywhere lately". I felt myself beginning to grow horns and a tailand all manners of scaly protrusions on my body. I told her I had been to Tobago two weeks ago, but other than that all I could think of was that I had attended a wedding where there were several overseas guests the Friday before. "Hmmmmmm" she said, and I concentrated on making myself as small as possible and clamped my hanky even tighter over my face if anyone dared to pass.
After about forty-five minutes the trail of ant techies dried up and it began to rain. There I was, sick as a dog, an outcast not sure of my fate, caught out in inclement weather with no shelter. And did I mention I was feeling like death?? I peeked into the lab, but there was no one there and no one seemed to be coming to rescue me, so I wearily shuffled myself over to the nursing home back steps and tried to find some shelter from the rain. After about 5 minutes of pondering my dilemma and seeing that no help was forth coming I made the decision to walk back into the main reception area. As I walked through the door I caught sight of Chris who from a distance put up his hand and whispered "stop..you have it". I froze and sank into the nearest chair worried that I was going to be run out of town with flaming torches.
Chris on the other hand was working himself into a frenzy of indignation with the receptionist. Apparently they had told him I tested positive for the Influenza A strain of the flu virus which meant that I would have to do further testing to determine the subtype. Both the regular old seasonal flu and the H1N1 virus fall under the spectrum of Influenza A. So while there was a good chance I just had regular old flu, because I had tested positive under this particular class the subtype would have to be determined before I could be cleared. They said that the subtype test could only be done by the Ministry of Health. The problem was that they seemed unable to tell him where to go to have the test done, or to whom he should talk. In fact, they did not seem to have any sort of protocol in place for handling possible H1N1 cases. In other words, "we've taken your money, done the test, you have a positive, bye bye you're not our problem any more, take your germs elsewhere". Chris was livid. Eventually..after much heated conversation and threats that he would bring me over to sneeze on people, they did find a number for him to call. He had to use his own phone to make the call and after another vague, frustrating conversation finally got the reply that we should probably go to the nearest Public Health Facility. By this stage I was exhausted, faint from hunger and just dying to get back into my bed. Those office chairs were uncomfortable. This was not off to a good start. I have never had a problem with this place before, and would still go there first because their standard is usually excellent, but I certainly think that they need to have a little H1N1 customer service training. I think lack of information is the biggest cause of misunderstanding and fear.
Afraid to go to the main hospital in the South of our country , we decided to go to the public health facility closest to our home which is actually, in my books, one of the best run and cleanest facilities in Trinidad. I would recommend it to anyone. I have always been impressed by the level of service at this institution.
We pulled up in the car park and Chris left me in the van while he went to see what the procedure was. There was a big white tent with more office chairs set up in the yard with a sign advising H1N1 cases to assemble there to be screened, but there was no one in sight. Five minutes later he came back wearing a soft blue surgical mask with a rigid white one for me to put on. I covered my face with it and immediately felt like I was going to have an attack of claustrophobia...and it was hurting my nose!! I forced myself to breathe normally and set off into the health center..avoiding eye contact with all the other unmasked people with various bandages, crutches and ailments waiting to be attended to.
Again we were whisked past the general public and shown into a large examination/ surgical room. The nurse (suitably dressed in her mask) opened the windows wide and told us the doctor would be in in a few moments. Sure enough Dr. N bustled in, told us hello and quickly got down to the task of filling out the necessary forms and asking the necessary questions. He had a lovely island lilt - I'm thinking maybe a Jamacian accent - and a warm, professional way about him. Chris instantly recognised him (even with the mask) as having been the doc who had attended to one of his staff members and Chris himself on two separate occasions.
He explained to us about the testing - that the private labs could only determine the type but not subtype of virus, and told us that a second swab would be taken, this time a nose AND throat swab, and would be sent to the facility handling all suspected cases on the island. He also told us that the system was so over burdened that there was a back log and the 'rapid test' would take up to two days. It was Tuesday so I could optimistically expect to get results by Thursday evening.
The nurse came back in with two swabs that seemed even longer than the first and I winced. Doc warned me that it would be a bit uncomfortable. Piece of cake..I had done it before. WELLLLLL....I think Doc got even further into my brain than the techie did..in fact I think my left eye bulged out slightly. Chris took all this in with barely concealed amusement. I made a mental note of that fact. I was actually more worried about the throat swab as I am a notorious gagger and being pregnant does not help matters. Worse yet, I had not been able to keep a thing down for the last 24 hours due to excessive coughing combined with the morning sickness so I was already feeling nauseous. I prayed to Michael, Gabriel and all the good saints that I would have enough self control not to toss my invisible cookies and managed only just barely to hang on. When I put the mask back on I had to fight hard not to upchuck in it. BLECK!! The Doc then told me that he found the masks were much more comfortable if they were put on right side up, with the little metal strip at the top...he found it was very painful the way I was wearing it. I rolled my eyes and proceeded to put the mask on the right way. Surgical masks for Dummies 101. It was indeed a lot more comfortable that way...my claustrophobia eased up slightly.
Next I was handed my medication - Paracetamol, Benadryl and Tamiflu. Now anyone who knows me will tell you that I avoid medication like the plague...or more topically, like the Swine Flu. I think in my past life I must have been a witch doctor...I much prefer to use black pepper to staunch bleeding and heal wounds, aloe plant to soothe burns, a couple glasses of water to cure a headache or lime, rum and honey for a cough. If you check my medicine cabinet the only deviations you will find from this logic are a tube of Terramycin and a bottle of Auralgan, because there is nothing more icky than an eye infection, and nothing worse than an ear ache in the middle of the night. Except maybe a toothache which you can treat with oil of cloves.
But I digress. Doc explained the correct dosage and the fact that Tamiflu was most effective within the first 48 hours - the time frame I was still in, and, as I was considered in a 'high risk' group due to the pregnancy, that I would be given the drug. "Sharrie the witch doctor" who researches EVERY bit of medication and its potential side effects before it gets swallowed, of course then had a million questions. I had done some reading up on the drug and I knew that Tamiflu was a class C medication, meaning that not enough data had been compiled to ascertain its safety in pregnancy. I asked Doc if it was really necessary, as in most cases the H1N1 was quite mild. He said that the rule of thumb was "that when the risks from the disease could possibly be more harmful than the drug" you usually try to err on the side of caution. Take that however you'd choose. He said it was up to me to decide what I thought was best. At that point, feeling like death...I wasn't so sure..what if my symptoms got worse? I decided to mull it over till later that evening.
Dr. N was very good. He spent nearly an hour..maybe more, with us answering questions and giving advice. He was pleasant and helpful even though I knew he must be under a tremendous amount of pressure. The only time I saw him sigh and look weary was when he had to fill out the million and one forms and write up medical leave certificates and run off to several different stations to have them certified and stamped for myself, Chris and Stef. We would all have to be under quarantine for the next couple days until the test results came back. He promised to keep in touch with us and ushered us out the door. He bowed to us gallantly -shaking hands not allowed - and bid us farewell and assured me I would be just fine. I clutched my dubious medicine and tried even harder to ignore the now penetrating stares of the health center population. My mask felt like a beacon but at least it was slightly more comfy!
At the exit Chris asked to have one of the H1N1 leaflets like the one that was stuck to the wall. The guard apologised and explained that that WAS their only copy...they had not been provided with any extras by the MOH. I forgot to mention that my Benadryl was in a sterilized Lucozade bottle as, apparently, the medicine only comes in certain sized containers with no extra bottles for distribution to the public. I was told that I was lucky to get a bottle, as that week they had been having to ask patients to go out purchase their own bottle, wash it, scald it and bring it back so that they could receive the medication to take home. I was quite happy we got anything to begin with because many people have complained that the health services never have medication in stock...sadly many doctors whisk it off to their own private practices before it ever sees the general public. It is a sad fact. Corruption exists everywhere and in Trinidad it is almost an art form.
Part 2: The Wait....How Long Can You Limbo?
My sis e-mailed me this today..I can totally relate!
My bed! My BED! My wonderful bed!! How I missed thee!!
After spending a total of six hours in and out of medical institutions waiting and waiting and wilting and wilting it was the most glorious sight I had ever seen. I gratefully collapsed into its warm coziness while Chris went about phoning the necessary people to make arrangements for our stay at home and generally busying himself with things that had to be done. The doctor had advised me not to say anything to my school as yet, so as not to cause unnecessary panic, but I felt it was the right thing to call my Principal and put her in the picture. She is a smart, wonderful woman who handles things well, and I knew she would not panic but would appreciate the 'heads up'. I also called a couple people I had been in close contact with - like my sisters - to tell them what was happening. I let them know they probably had nothing to worry about, but that if anyone came down with flu like symptoms they should go for the test just to be safe. They were all more worried about me and the baby..God bless them.
After that was done I reluctantly took a Tamiflu and tried to get some healing sleep. Twenty minutes later my body rebelled and up came the Tamiflu. Baby Asparagus apparently wanted nothing to do with it. Good boy...takes after his mum! That decision made for me, I drifted peacefully off to sleep. Doc phoned at about 9.30 that night to check on me and to let us know that the sample had arrived at CAREC and that he would follow up on it and let us know the results as soon as he could. 9.30 p.m. at night and that man who had been up and working since before 6 a.m. was still doing his job and looking out for his patients. I was very impressed. He even gave me his cell number and told me to call any time with questions or if I had any problems. Brave, brave man! I went back to sleep with some faith in my country restored.
And so followed the night and much of the next day. I woke feeling human again and actually felt the first stirrings of an appetite in over twenty-four hours. Pumpkin soup was made and I sipped it gladly feeling the strength coming back. I debated whether to have another Tamiflu, as one should be taken morning and evening, and decided I would not risk the small morsel of food in my tummy for it. Besides, I was feeling so much brighter. I knew this for a fact because the disorder of the house and the dishes in the sink that I could not care less about a couple hours before were now starting to mightily get on my nerves! I started to clean in short bursts with long rests in between. I was glad for my trusty laptop and a few good books to help while away the time. Chris spent his time tidying the garden and Stef grumbled and complained that she was missing exams (weird child!). I was in enforced quarantine for four days, while they would be in quarantine for two or until the test results came back saying we were all free to go back to life as normal.
Wednesday passed and Thursday passed. Doc kept in touch, but much to his dismay and to ours no results were forthcoming. The lab was just too over worked. "Chin up" one of his text messages said...while I responded "Thanks Doc..but I now have cabin fever and Tamiflu does not cure that!". Michael Jackson's death (rest in peace Michael..Lord knows you never had peace here) added a bit of drama to the whole wait and a little distraction. Then Doc called to say that no results were to be had till probably today. Offices were duly informed and the wait went on.
Today is Friday. The wait STILL goes on. Ten at night and I get a text from Doc saying CAREC, for whatever reason, did NO testing today. At this rate by the time I know what I am sick with I won't be sick any more! Doc sounds even more fustrated and fed up than I am. I feel so bad for him that it is the only thing keeping me sane. Four days wait for a 'rapid test'. My only consolation is that friends over in the UK are going through the exact same ordeal I am ..and now they have been promised results on MONDAY!
So my dear friends..I guess all in all I have to be thankful that I am on the mend - even if a little crabby - and that my whole 'swine flu' experience has been quite an eye opener. We aren't prepared for a Pandemic of this magnitude..we are trying hard to do our best, but the system just can't cope. There is still a lack of basic operational procedures in place, a lack of printed matter so that all citizens can have access to information, a lack of staff to deal with the swelling tide of cases in a timely manner. What if I was not one of the more responsible people out there? What if I just chose to ignore my doctor and take myself out of quarantine? And there will be and ARE those people out there. One of them is probably rubbing shoulders with you as we speak. What about those who can't afford to take the private test to screen themselves in the first place? What about those who would take offence at the young techie pulling up her lab coat and just stomp out of there in a huff taking their H1N1 germs with them? What if this DOES eventually evolve into a Stephen King Epic like "The Stand" where the virus mutates into something not so mild and impossible to deal with? The threat is real, the questions are troubling. And nasal swabs are no fun.
This long winded tale was just my attempt to record my experience. If it educates - great...but there are better websites out there you should familiarize yourself with - like this one for example: http://www.who.int/csr/disease/swineflu/en/index.html
Knowledge is your best line of defence...educate yourself, keep abreast of what is happening in the world, in your community, so that you can make informed choices. And above all DON'T PANIC. (At least not until the FASTEN YOUR SEAT BELT sign flashes repeatedly).
I leave you with a cheerful nod (no shaking hands) and a wish that I will be released from my quarantine soon. Sigh...maybe if I had some magic "OINKment" I'd be right as rain already. H1N1 or not H1N1..that my friends is the question!
Current statistics for Trinidad & Tobago from the MOH Facebook Site for 27.06.09:
Total recovered and reintegrated
Current active confirmed cases
Population of Trinidad and Tobago: Population: 1,047,366 (July 2008 est.)
Current statistics (of which I am now one)
How do you feel about H1N1?
UPDATE 27th July 2009, 9.08 PM - Still no test results and CAREC is advising that no reports will be available till Monday now!! Somebody please send me a cake with a file in it!! (Or even just the cake!)
FINAL UPDATE 06th July 2009 - Two weeks after onset of symptoms, one week after recovery and end of quarantine, I finally have test results.
Now I could let you know what they were - but it just might spoil the drama of this hub! The main thing is that I have recovered fully and have learnt that it takes too long for testing to be done in Trinidad. I have also since learnt that is is taking almost the same length of time world wide due to the sheer volume of cases. Many countries (I am sure ours is no exception) have been deliberately NOT doing testing in order to keep their statistics low. This is particularly true of countries that rely on tourisim as their major form of income. Result being, if you are sick they tell you stay home in isolation for 7 days and treat it like you would any other flu. No tests, no swine flu right? For most people you will recover quickly and without incident. If you are in a high risk category - ie. pregnant, very old, very young or immuno compromised in any way please see your doctor and monitor your symptoms closely. Pay attention to what your body tells you..if you feel worse do not hesitate to seek medical attention.
There are good, dedicated doctors out there and people should follow their advice. If you are coughing, sneezing, have a fever, sore throat, body aches, feel exhausted (and maybe vomiting) - isolate, hydrate, rest and use paracetemol for fever. DO NOT USE ASPRIN.
Sharrie signing out....OINK! ;-)