Ok, so maybe that's not the exact story....
It was Friday, Oct. 23. I was at work at our office in Usakos. I was preparing for MY Kids Club that day, as well as a Saturday activity of some math fun for the kids. I remember thinking that, originally, I was planning on going to Swakopmund for the weekend, but then plans changed because we had decided to have the Saturday activity this particular weekend, instead of the following one, due to a few of the children getting confirmed at church at the end of the month. Part of me was thinking this may be a boring weekend, as well as sort of wishing I could get away for a day or 2. Not because I was unhappy, but about once a month, I get away to recharge - if only for a day or 2 - and I hadn't done that in a few months.
My mom and I also exchanged a few emails that week, scheduling a time to talk on that upcoming Sunday, and both admitting that there's really no new news, or anything exciting happening. Still, we would chat anyway.
It was noon on this Friday, and Michael (the other volunteer now at my site) and I were waiting for Iwin (pronouced as Ivan), our maintenance guy and driver, to come pick us up, bring us back to the orphanage, and then go pick up the kids from school. Due to all the coffee-drinking that morning, I had to use the bathroom. I walked around our building to the bathroom. It's inside our office building, but the entrance is on the outside. There is also sand all around our office building. When I came out of the bathroom, I shut the door, and then turned to face the door, because I realized I hadn't shut it all the way. As soon as I closed the door, I felt a sharp pain in the tips of my big toe and second toe. Not life-threatening or drop-to-your-knees kind of pain. Just a sharp poke. I looked down and thought I had stubbed my toe. See, I'm pretty clumsy on my feet, and it's not uncommon for me to stub my toe. In front of me was a drain pipe, and when I looked down, part of it had been broken off. There were 2 points on this metal pipe sticking out, where a piece had broken off. I also was bleeding at the tip of my big toe and the top of the second, right below the nail. I thought "Hmm, that's strange that I'm bleeding from that. It didn't feel like I had hit my toe THAT bad." But then again, I'm clumsy, and strange things happen sometimes, here in the Peace Corps, in Namibia. So I went into the bathroom, grabbed some tissue paper to help stop the bleeding, and walked out of the bathroom again, around to the front of the building.
Iwin was there waiting for us. I said "Iwin, man, I think I stubbed my toe pretty badly! It hurts!" So we walked back to where the incident happened, and he looked around. He thought that maybe I got bit by something. He wasn't convinced it was a snake, and if it had been a scorpion, there would only be 1 wound, instead of 2. He shook the drain pipe, thinking that maybe something was in there - spiders, bees, whatever. Nothing came out. I sort of looked around, as if I knew how to look for a snake. I've seen snake tracks only 1 time before, so I am definitely NOT an expert on snakes, and so was not exactly sure what to look for, except the actual snake. We saw nothing.....
So Michael and I got in the van, and Iwin started driving us home. They were laughing at me and my pain. Now, I have a high pain tolerance, and I know what is a "normal" pain, and what isn't. I also know what it feels like to stub my toe. This pain in my big toe was not going away. It wasn't "shaking off" like a normal stub-the-toe type of pain. It didn't feel right. I am also not the type of person to run to a hospital, just because of a little pain or injury. We had almost made it to the orphanage, when I was looking at my 2 toes, and they were already swelling. (It had been about 20 minutes since the incident.) I knew something was not right. I didn't know exactly what was wrong - maybe I broke my toe?? - but I knew it was normal, or right. So I made the decision to have Iwin take me to the local hospital. Luckily, in Usakos, there is a clinic, but also a small state hospital, which is where we went. At this point, I also called our PC medical office, just to inform them I was going (this is standard procedure - they need to know if we seek medical help for anything. Efraim, our nurse, told me to call him later with an update).
Thankfully, Michael came with me. I sort of felt bad. I mean, I'm independent and can handle myself, and I don't feel like I need people near me at all times - even if I get injured. I mean, they can't do anything to fix it. And I remember telling Michael that if I had known what exactly my injury was, I would have no problem with him going back to the orphanage, and I'd call when I was ready to be picked up. But deep down, I DIDN'T know what was wrong. And I had a bad feeling it was a bad bite of some kind, and well, I guess I admitted to myself that I wanted someone to stay with me.
As we were sitting there, my foot and ankle were starting to swell, and slowly I was getting a lot of tenderness on the inside of my calf, and even the inside of my thigh. Whatever is going on, I knew it wasn't good.
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| My foot, when I finally saw the doctor |
Approximately 1.5 hours after the incident, I finally saw the doctor. I actually had Michael ask a nurse if I could go ahead of a few of the locals in line. I felt bad for doing this, but none of them looked like they had any life-threatening problem. The doctor, from Zimbabwe, was very nice, and believed that I was bitten by something. At this point, he wasn't sure what exactly bit me, but he said we would treat it as a snake bite, since this would be the worst case. He then said he was going to admit me. What??? Admit me to the hospital?? I didn't think that was necessary, but he said they would have to monitor me. So I called Efraim, to let him know. He said he would be back in touch (he had to contact our PC doctor).
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| Right before they gave me the anti-venom |
So they brought me to a bed, separated only by curtains from the other patients. Michael said he would wait a bit with me, and then go back to the orphanage and grab a few items for me to spend the night. The nurse put an IV in my arm, and immediately gave me hydrocortisone thru the IV. Then they said they would give me an anti-venom medicine. Right before she gave it to me, she let me know she'd stay with me a bit, because it's common for people to have some reactions. I asked her to explain what kind of reactions are normal. She said there could be shortness of breath and itching. After she put the anti-venom in my IV, I immediately started itching - mainly deep inside my ears - it was a very strange sensation! Then I had this urge to go to the bathroom. They got me a wheelchair to use, turned off the anti-venom drip, and as I was being rolled to the bathroom, I started having difficulty breathing. I made it to the toilet, and as soon as I pulled down my pants, I noticed that the inside of my thigh was black-and-blue and swollen. This wasn't good, I thought to myself. I made my way back to the wheelchair, and at this point, was really having a hard time breathing, and began sweating as well. I was able to open the door, and asked someone to get a nurse. The nurse came, and rolled me back to a different table. I made my way onto the table, where the other nurse and doctor were waiting. I couldn't lay back on the bed because I started having abdominal cramping, so I was sitting in a crouched postion. I was sweating even more, and could not catch my breath. I told them about my leg, and so they helped me remove my pants so they could see the swelling and discoloration in my thigh. They then put cold compresses on my neck and back, and started me on a glucose IV, since I hadn't eaten. The doctor never left my side. Eventually, I was able to slowly get my breath back, and the doctor had given me a shot for the pain in my toe, as well as one for the abdominal cramping. I remember being worried about the venom in my leg, and what if it was continuing to travel up my leg? We had to stop this! Even if they gave me a drop or 2 of the anti-venom, I felt like that was what was needed! He said that I wasn't stable yet, and that he wouldn't give me the anti-venom again, due to the reaction I had. He also eased my mind, saying that the 4-5 drops that I already got probably stopped the venom from spreading further.
At this point, they told me that Efraim, our PC nurse, was on his way from Windhoek (our PC doctor is currently the US for trainings because he recently was given this job) and they were bringing an ambulance. I would be going to Windhoek that night. What???? Ugh. This is definitely not what I had hoped for when I said the weekend might be boring, and I hadn't gotten away in a while.
Efraim came, and we waited for the ambulance. Michael and Sanas, our accountant at CEC, went back to the orphanage to get a few more things for me. Mary, my director came and they all stayed by my side until the ambulance showed up.
Finally I left for Windhoek, in the ambulance, with the IV still in me, as well as a catheter at that point (fun times lol). I remained positive the whole time, and was even joking with Efraim and the EMT. I was feeling better at this point, except that toe was really hurting! They gave me morphine, which definitely helped me enjoy the ambulance ride more :)
We reached the hospital in Windhoek around 11pm. They said I would be meeting a doctor whom the PC has worked with before. When he came in and introduced himself, he said he was a surgeon. What????? A surgeon?? What was I going to need a surgeon for?? In Usakos, they told me that the hospital in Windhoek would be able to take my blood, and figure out what kind of venom my body had come in contact with. Then they could treat it. Well, apparently, this is not true. They can't just take blood and see what kind of venom it is. So the surgeon unwrapped my toe, and we saw that the tip of my big toe was black, from the necrotic tissue, due to the venom. He said he would have to cut that tissue out, as well as make 2 incisions in my foot and 1 in my thigh, to release the venom and extra fluids. Wonderful. So, about 1:30am Friday night, I went in for surgery. An interesting bit of info - their emergency room is called "Casualty" and the operating room is called the "Theatre". I asked if there would be popcorn and 3D glasses available. There wasn't :(
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| Time to ride in an ambulance! |
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| Selfie with the EMT and Efraim, after the morphine! |
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| When I arrived in Windhoek |
I woke up Saturday morning, with a foot and leg wrapped up. Once the doctor came in he removed the bandage. I had open incisions on my toe, foot and leg! (I asked the doc if he could perform a little lyposuction on my thigh - I mean, here is a big incision on my leg - let's just remove some of that fat while we're at it! He didn't agree with me.)
Next, they wrapped up the incisions on my thigh and foot, with a sponge-sort-of thing inside them. This was connected to a machine, which, over the course of the next few days, would pull out the venom and other fluids.
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| The vacuum bandage on my thigh |
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| Vacuum bandage on my foot |
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| All hooked up... |
During this time, I was grateful to have visitors - other PCVs, one of my Namibian sisters, some Namibian friends and PC staff. Karen even brought me an adult coloring book and some games! It was a nice way to get caught up on each other's lives and have someone to talk to. When I didn't have visitors, I asked a lot of questions. The doctors and nurses got used to it, though :) There were 3 doctors helping me after the surgery - and they each had an opinion about what kind of snake had bitten me. One of the doctors was a "snake bite expert". He was pretty excited with the whole event, even taking pictures of my foot and toe! Finally, the 3 of them were in the room together, and after discussing, decided that it was a Horned Viper (Horned Adder) which bit me. This snake is smaller than a Puff Adder, and likes to bury itself in the sand. Note - due to the heat of the summer, this is also the time when snakes start coming out more, seeking cool places. The surgeon said my snake was a bit one - probably about 3 feet long, and 2 inches in diameter. Apparently, if I had been bitten by a Zebra snake (spitting cobra), I would have had pain all over by body, because it's venom attacks the neurological system. And being bit by a black mamba would have been serious life-threatening incident. My viper attacks the circulatory and lymphatic systems. So, that is why there was a lot of discoloration. As for the lymphatic system, the venom did damage mine, a bit, in my leg. This is why I still struggle with swelling in the foot and ankle.
On Wednesday, I went back into surgery, where they removed the vacuum bandages and stitched up my toe, foot and leg. The surgeon said he had to removed a small part on the big toe's bone, due to necrosis. He also had to pull the skin on the bottom of my toe, to be able to suture it together. At first, I was worried that part of the padding of my toe was gone, and if, at a later date, I had problems with not enough padding on the toe, they would have to do a little plastic surgery and add some fat padding. So far, I don't think I'll need that. But only time will tell....
So my toe is a little deformed....but at least I still have it!
Over the next few days, I began physical therapy and trying to walk. The biggest problem for me, which continued even after I left the hospital, was that every time I put my foot down - even off the side of the bed, there would be an immense amount of pain in the foot and calf, due to gravity pulling the blood and fluids down. It literally would take me about 2 minutes to finally stand up. And I couldn't stand or walk on the crutches for too long because of the pain from the swelling. I had moments when I thought this would never get better. Luckily, it has!
On Monday, November 2, I was finally released from jail (the hospital)! I have been staying at the Peace Corps flats in Windhoek. Every day, our medical team redresses the bandages. About a week later, I was able to get off the crutches. I still walked, or limped, slowly, but I was making progress. And finally, this past Friday, they took out all of the stitches on my leg and foot, and 3 of the 8 on my toe! They are really happy with the progress I've made and the way things are healing. It feels so much better without the stitches, and I feel like I can walk a bit better as well. The only reason I'm still limping is due to the swelling in my ankle, which is limiting my motion. But now, I have a compression sleeve that I can wear while traveling and if I'm going to be on my feet for a while. Thd doctor said I may have a swelling (lymphatic) problem for a long time - even possibly for the rest of my life. But as I heal more, I'm hoping that becoming active again will help in keeping the swelling out of my foot and ankle. And I may even need to get massages and lymphatic drainage on the leg, on a regular basis. And this is not a bad thing :) Also, currently, the bottom of my toe, near the tip, is still very sensitive. This is probably due to the new skin forming, as well as the fact that a little of the bone was removed. I continue to do my therapy everyday and was actually was able to go the mall yesterday, and stay on my feet for a total of about 3 hours! This is progress! (It also felt nice to be able to get up and walk around on my own without any help. When I first got out of the hospital, I had to drag another PCV with me to the supermarket, to help carry the bags, since I was on crutches.)
Pictures from last week:
So everyday I'm progressing more and more, and everyday I give the PC medical team a hard time about when they're going to let me go back to Usakos. I miss the staff. I miss the kids. I was not able to be there to help them study for their end-of-the-year exams. And I feel bad about that. So, on Friday, Efraim said, that as long as everything keeps progressing, I can go back to Usakos on Wednesday! It will have to be cleared by the regional medical team in PC South Africa, but I have a good feeling they will let me go. They are confident in my ability to bandage my toe on my own, and I even told them I'll send them pictures everyday of my toe, just to ease their mind. I will have to come back to Windhoek on the following Wednesday, for a follow up appointment with the doctor, as well as a few PC meetings and then our PC Namibia 25th Anniversary and AllVolunteer Conference (President Geingob is supposedly coming!). But at least I'll be able to see everyone back in Usakos for a week.
Here are 3 videos - the first is of the children and staff at CEC, sent to me by Michael, the second is of the 2 puppies at CEC - Ice (the white one) and Motley (the brown and black one) and the third is my video back to them....
I am so thankful to have been so lucky that I didn't lose a toe, and that things are progressing so well. The doctor said that I just have to be patient - it's as if my leg got mangled in a car accident, but without breaking any bones.
I am also so thankful to Michael and the rest of the staff at CEC! They were there for me the whole time, and even after I had gone to Windhoek. The doctor and nurses at the Usakos hospital were wonderful!! They never left my side, and they took wonderful care of me! I cannot thank them enough! (I'm bringing them fat cakes - a Namibian treat, which is fried dough - when I get back to Usakos.) Even our Country Director, Carl Swartz, was passing thru Usakos, and stopped at the hospital to thank the doctor and staff. They were so surprised! They said that people only complain; they never have anyone come back and thank them. Way to go, Carl!!! And the staff at the hospital in Windhoek, and everyone at PC Namibia has been so wonderful too! Thank you also to all my family and friends who have reached out to me! And all I think about is how I was lucky enough to have PC on my side, being able to cover all of the costs. Many local Namibians would not have been able to pay for an ambulance, surgery and a hospital stay. I asked the nurses and doctors, what happens to these Namibians? The only answers I got were that 1) Namibians learn, from an early age, to look out for snakes and to notice signs of them and 2) many will use traditional healers (I even heard that the San Bushman can capture a lizard, which is as big a snake, and take it's venom to use as an anti-venom for snake bites. I told our PC medical team that we need a Bushman on staff, or at least that lizard in an aquarium in the office!) So, needless to say, I'm a very lucky girl....
In a way, it's been good that I've been stuck here, in Windhoek, because I've had a lot of work to do and catch up on - and needed the staff. (Look for my next post about an exciting project that is finally happening!!!!) So, it helps to be able to just walk into the office and have short discussions on all of the things I'm doing.
So - what have I learned from all of this? Well, first, if you go to a country where there are many snakes, learn how to notice the signs of snakes being present. (Side note, my Namibian sister can smell them, if they're nearby!) Second, the way I handled this medical incident is how I need to start living the rest of my life - positive and patient. Because if you are having a bad day, what are you supposed to do - curl up in the corner and cry about it, thinking of all the possible bad outcomes of the situation?? No. Buck up and find a solution - and fix the problem and remain positive. One day at a time. Because you never know what tomorrow will bring.....
Love you all!
Ndapandula
