Call Me Old-Fashioned But Immigrants Should Come Here Fingered in Mombasa

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Fingered in Mombasa

The premature crossing from Pakistan had been pretty rough, as the rubbing on my running rigging indicated. I knew it was the wrong time of year, but after bartering for all the goods that could be safely stored, my only thought was to leave the young thieves and pick pockets of Karachi in my wake. Now the seas finally calmed down and became much less violent. Full sail up on the old girl and she made 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 blew on the radar screen. Thoughts of remarkable medical cases, foreign countries, and seamanship were intertwined in my dreams.

When I was 87.3 nm off the East African coast, I received a phone call. An old acquaintance told me in a very anxious tone that he had tried to call many times and was now desperate to talk to me about a confusing medical problem. Phone dead… No bars… Off I went to climb the mast hoping to get a signal. The 5 foot swells and constantly rolling tossed me around like a rag doll. I forgot my seat belt in the rush. Getting higher had never improved a signal before, I finally realized, why should it now? A disconnected live TV dish on top of my mast would improve my reception just as much. I came back bruised and battered to reflect on my friend’s dilemma.

This was all very out of character, to say the least, for the man who had once helped me treat some of the most bizarre ailments and diseases in all of Africa. Maybe it involved him or a family member, causing him to lose perspective. No… he was always objective and very professional, hiding the tears that he kept wanting to shed. I was confused. Finally, at 13:27 I contacted him to arrange a meeting!

While I was waiting for my friend to arrive from Magongo, I sat in an open bar in the old town of Mombasa, which was darkened. The setting sun was huge as the inner dust particles broke and magnified the red-orange tones over Kilindini Harbour. 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 the occasional clink of a bottle, 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 who was still able to twirl and twirl on her only crutch and stick.

My nervous colleague arrived in a tuk-tuk after taking the matatu bus to the Old Port Roundabout. He looked very frustrated. We exchanged formalities and I escorted him to the bar stool next to mine. I encouraged him to tell me about the source of his anxiety. He went bug-eyed when he sat down next to me, and it took several Mojos to calm him down.

On the same bar stool I was sitting on now, an apparently well-dressed man came in and started talking to him about the local poaching problems, which were many. The conversation lasted several hours. The man continued to elaborate on various topics of national and international interest. While getting another beer and changing the subject to the recent ivory and ironwood colonies, his little finger fell off without the gentleman noticing. My friend jumped up at this point in our conversation and pointed to the bar and said, “Yeah. Right where you’re sitting, his finger just fell off!” Sitting down again, my friend said the man walked away undeterred, now leaving one of his toes on the wooden floor. My friend began to call his attention to the fact that not only had he left his finger on the bar, but now he had also left his toe! However, he was far too dumbfounded at this point to comment.

My dear, bewildered friend asked me what my opinion of this tragic event was. To allay his fears, I suggested that he (my friend) might have had an acute psychotic episode that required immediate neuroleptic medication, confinement to a nearby ward, and intensive psychiatric counseling. Of course it didn’t help!

Well… I said, “Did he have any kind of rash?” “Actually, yes, he had pale discolored spots and bumps on his hands, and I also noticed it on the bottoms of his feet when he crossed his legs.” “He also had difficulty seeing and kept sniffing.” Confusing, I thought. I asked, “Surely he wouldn’t have mentioned the fact that he was impotent during your poaching conversation, would he”? “Well… he did, but only in comparison to the infertile white rhinoceros.” “Did he keep dropping his glass?” “Yeah, how did you know?”

“From what you tell me, and given that he was an African male with vision loss as well as digital loss, impotence and a discolored rash, he was unknowingly suffering from a bacterial Mycobacterium leprae infection.” I said. My friend pondered the statement for a while, but was finally 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 converse in Swahili with the locals. I have to admit that maybe he didn’t quite believe me because he kept counting his fingers and toes for the rest of the night.

Leprosy or Hanson’s disease

The earliest known writing about this bacterial infection was in Egypt around 1500 BC. It is also mentioned many times in the Bible. Throughout history, it has carried a certain stigma with it. Sufferers were often 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 when they came down the street so people could avoid them. All types of reasons for their condition and misery were postulated. Sorcery, family curses, punishment for past deeds and so on… were just a few. Unfortunately, the victims of this disorder suffered enormous psychiatric and emotional damage due to their condemnation by society.

Leprosy is an infection that primarily attacks the peripheral nervous system, i.e. not the brain or spinal cord. It can cause numbness in the hands and feet as well as weakness, often resulting in a limp wrist or foot. With repeated trauma to these areas, the fingers and toes can actually fall off without injury. Typically, there are either small or flat, discolored rashes in the affected areas, a chronic cough due to mucosal involvement, and sometimes a loss of vision.

The usual age of onset is 20-30 years and it is most common in Africa, India, Nepal and Latin America. Cases are not unheard of in the US, but these are usually new immigrants.

From what we know now, you cannot get this infection by casual contact or touching the lesions. It is usually caused by close contact with infected respiratory secretions or mucus over a period of months to even years. Other sources or carriers are believed to be infected soil, armadillos and possibly mosquitoes and bed bugs. From the time of infection to the time of onset of symptoms is usually 1-7 years.

The diagnosis is based on the 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, if not for life. Other pharmaceutical therapy is available.

So… If you’re sailing to Mombasa soon to see the biggest sun you’ve ever seen… please note the number of digits you have beforehand and afterwards.

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