Thursday, 13 January 2011

My encounter with Strongiloides in Africa

I have been to Mozambique several times before in the past twenty years although, this time, the gap between my last visit in August 2002 to visit my ageing grand dad, and now, extended to almost 8 years, before that I used to come frequently and visit family and friends here.
I was born in a remote location about 250 miles north of the capital Maputo, in Inharrime and after finishing my primary school family moved to the nearest town where secondary education was offered, Inhambane. I still hold very strong emotional ties with the place as this is where I spent some of the best times of my childhood before the civil war and unrest in the seventies, when my parents moved to India with all of my siblings and grandparents. That’s where my secondary education and pre University years were spent until I turned 19 and decided to spread the wings and fly to Europe in the eighties. Times in India were hard as my father had decided that he had had enough of the place and decided to try his luck again back in Mozambique in the late seventies, leaving me, my siblings and my mother under the care of my grand dad (my mum’s dad).

When I finished my pre University years and my grandfather struggled to afford my University fees I decided to move to Portugal in the hope that I could perhaps find a job and manage to afford to carry on with my academic education there.
This was far from reality as things didn’t exactly turn out to be as I had hoped for. Instead, turning into an absolute nightmare situation from the moment I landed at Lisbon airport at 11 PM at night and finding out that the relatives who were supposed to be expecting me there at the arrivals simply had neglected my telex sent from Delhi when I was departing and I was left stranded there at those odd hours, a suitcase of clothes, pockets full of dreams and hope, and a meagre $50 that my grand dad had managed to give to me when leaving home.
My first bite of reality sandwich happened there and then, mid January, freezing cold, stranded at Lisbon airport and no familiar face around.
My grandfather had always been the most important part of my life throughout my childhood until adulthood. A mentor and friend of utmost importance had moulded my character to such an extent that even after he passed away eight years ago I can still feel the echo of his voice within my soul teaching me about life and its pitfalls, the world around and its beauty and how best to live and interact in a society in harmony. His educational views and philosophy in life could put him in par with some of the highest academically achieved humans I know and yet he was a man who had hardly completed his primary education. His views and knowledge had been acquired in the University of Life through hard labour and painstakingly walking through arduous paths. His experiences had marked him and moulded his character to turn him into the special man that he was. He carried scars, both physical and mental, and yet he went through life with a glee in his face without any bitterness or hatred. His life had never been easy but he rose above any obstacle or nasty experiences he had endured to raise a special daughter, my mum, and then go on to raise and educate seven of her children where I was the oldest. In life he was the wind beneath my wings under which I felt I could fly high into the sky and touch the clouds, and the memories I keep of him often has sparkled a glow of hope in me at my lowest ebb and at times when I would have just hit the lowest and felt that there was no light at the end of the tunnel remembering how special he was has always helped me come through in life.
I enjoyed special privileges under his care and affection obviously because I was the oldest of his grand children and my mum had never had any siblings. So when I was born he immediately took me in as a son emotionally. Hence a special bond that I enjoyed with him. I never saw him as a grand dad, but more like a father to me.
So here I was at Lisbon airport, stranded at odd hours of the night, when I was expecting my grandfather’s elder brother and family who lived in Lisbon for years to be there to pick me up. The arrangements had been made long before my departure even from India, and my grandfather had made sure that his elder brother was willing to accommodate me and help me through the first stages of my stay in Portugal. There had been exchanges of letters and confirmation to the point that his brother had reassured him that they would be taking me in their home and I would be well looked after. This was my first time really away from home trying to be on my own but the head on collision with the nasty reality of life’s pitfalls had not even given me chance to step out of the airport and take my first breath of the chilled Lisbon air without knocking me off with such a nasty blow.
Out of the blue I see someone whom I had seen before in India while in college but besides him just being a familiar face I had no personal acquaintance with him. His name was Vinod. I knew he was from Diu, the town where I had been living while in India with my mum. He approached me and asked if I was still waiting for someone there as all the other passengers who had arrived in that flight had already gone away. I mentioned to him that my grand uncle was supposed to be there but apparently he didn’t come so I didn’t know what the matter was and I didn’t know what to do. It was approaching midnight already and the cold chill starting to take the toll, so he suggested I go with him and he would offer me overnight stay at a place where he was staying along with some other people who were from the same town in Diu.
To make this part of the episode of my life shorter descriptively at this time, suffice to say that what was supposed to be a simple one overnight stay at my friend’s kind offer, it really turned out to be a six month stay, helped in all aspects, financially and mentally by this Samaritan friend who came out of the blue and happened to be at the airport on that day by a sheer coincidence as he mentioned later on that as he suffered from insomnia that night he decided to make a trip to the airport just to see any familiar faces landing as he knew a flight from Delhi was about to land and invariably it brought passengers from Diu.
My grand uncle’s meanness knew no bounds. I got to know that immediately the next day when Vinod took me to visit him and remind him of my arrival in Portugal. Some other time I will go deep into this and the repercussions of the situation I was stranded and the eight long years of hell lived in Portugal until my arrival in 1990 to London.
Twenty eight years on here I am, in Mozambique right now, and writing this, sitting on a bed in a clinic. In this past twenty eight years there has been joys and sorrows, more joys than sorrows in fact. I met and married one of the most beautiful girls I met, from inside out an absolute gem. It’s as if life was telling me that I had paid my dues already so it was time for me to reap the rewards. She has blessed me with two lovely children, the first one I named Amin, in memory of my late brother who died of Leukemia at a tender age of thirteen, some 25 years ago. Hence the name sprouting constantly in all my writings and I use it as my pseudonym. My brother was diagnosed with the nasty disease while I was in Portugal and I couldn’t see him anymore. He passed away in Mozambique where my father had managed to finally call the rest of the family back from India a few years after my departure from there.
The passing of my brother had left an enormous hole in me emotionally specially at a delicate time that I was going through while in Portugal. So his name has become a very strong part of my own self in everything I do, culminating in naming my first born Amin which my wife had happily agreed to.
Of course having my own initial also starting with the character A helps to dilute the confusion, and from the very beginning I use this name for many things, including usernames, email addresses, nicknames on the net etc. Have been doing that for years even before my first son was born. Obviously now my son queries and sometimes comes up with questions like “dad why do you use my name instead of yours which is Ayub”, or things like “dad stop using my name for your photography or on the net because Amin is my name and not yours”. Well, I guess one day I will have to sit down with him and explain him why, but for now my friends who have always called me Amin know now that my real name is Ayub. Well, there was also the motivation of the fact that its easier to pronounce compared to Ayub as my real name is written in Portuguese so reading it in English there is a tendency to mispronounce it, and the correct way to pronounce it would be if it had been written as Ayoob.
I am at the moment bedridden with the nasty infection in a clinic in Maputo where for the first time in seven days I felt well enough and with motivation to sit with my laptop and type in. It has been a roller coaster, from the moment it all began on the 29th of December when I was bitten by the tse-tse fly.
I arrived in Mozambique on the 14th of December, alone. My wife and kids went to Singapore for her brother’s wedding so I decided that as I hadn’t seen my parents and siblings for over eight years perhaps this was a good opportunity to come and visit them instead. I asked the wife to apologise to the family and explain that it was quite important for me to come and visit my family here as my grandmother also is reaching her eighties.
Everything was turning out to be the perfect holidays mixed with photography work I was doing in the rural areas. I arrived in Mocuba on the 26th. A lovely and peaceful place. But unfortunately plagued with same problems that I noticed all over the country specially in the rural areas. The typical problems that this country has when it comes to poverty, the gap between the super rich and the extremely poor widening alarmingly, no middle ground and the associated problems that such situation brings into a community are enormous. My cousin Tania and her husband, both doctors, took me to visit the Hospital where they work and I was absolutely shocked. This is a hospital with 250 beds and the lack of basic resources is staggering. She told me stories about lack of gauges/valves to attach to oxygen bottles hence patients do not have access to oxygen as needed. I saw the malnutrition wards and it left me sickened to death. Images that we usually see in the media I was witnessing first hand here. I had my Camera strapped but at first just couldn’t get myself to photograph such a shockingly emotional sight. We went to view other wards and she mentioned that the prevalence of HIV/AIDS is still so high around there that she decided to adapt a protocol that anyone being admitted to the hospital should be given a test for HIV/AIDS regardless. She mentioned that a huge number of health workers there in the hospital are HIV infected.
I managed to gather courage in the end and asked her to take me back to the malnutrition ward and let me take some photographs to document it. I still haven’t processed them and quite honestly do not still know what to do with them. The hospital has no conditions to provide even proper meals to patients. I looked at their kitchen and saw a few broken down fridges and freezers, and just one chest freezer where they kept some food in it. My cousin almost had an emotional breakdown for trying to come to terms with the fact that she just couldn’t help more to try to resolve the day to day crisis of the hospital. She told me that she used to call her mum, my auntie in Maputo, and literally cry saying that she sees her patients dying unnecessarily purely because they lack the most basic care and needs. An absolute waste of life, and she would literally make calls here and there, try to work out some connections up in the hierarchy so that she could get funds and equipment to provide for the hospital.
I stayed with my cousins four days and witnessed firsthand their occupational hazards. They have absolutely given all their time and effort and dedication to the community and to this hospital. Even on the day I arrived, the 26th of December the shortage of blood was so intense due to the fact that this town is located precisely on the main route from South of the country to the North so any motor accident victims first port of call is here. There had been so many emergencies that they had run out of blood, and even on his day off my cousin had arranged some sort of blood donation gathering in the local mosque. They told me that people in the region are so poor that unless they are tempted with a meal in exchange for blood donation hardly anyone would turn up. But his resourcefulness managed to get mosque and church goers to end up donating blood as he sent the mobile units right at the heart of the local mosque and church compounds and caught the people coming out straight out from prayers. As if implying that you just worshiped God and He asks you to be generous so what better way to prove your faith and trust in Him than leaving a few ounces of blood on your way out? It worked, and they managed to get some good numbers to fill the desperate need for a few days.
Our journey by car back to Capital, 1200 km, began on the 29th, and we stopped about half an hour later on a location that is famous for pineapples. Huge pineapples of the size I had never seen before were being sold by the road side. Locals call it Abacaxi in Portuguese. In between the buying and putting the fruits in the car suddenly I felt a huge sting on my right leg below the knee, as if a huge needle had been inserted through my skin. I gave a huge thump on the ground and screamed and immediately a local seller hit with his hand down where my foot was to trap a huge fly and he caught it in his hand. I looked immediately at my leg and there were two big drops of blood of the size of a penny on two spots near each other. My cousin turned to the local and asked what was that and he said it’s a tse tse fly. I immediately cleaned the spots with alcohol that they had in the car with the first kit and squeezed a bit more to release any superficial blood under the skin. Put the alcohol gel again and the blood stopped. Needless to say that this episode kept on playing on my mind for the entire journey and I was eager to get back to the capital Maputo to then run some blood tests to see if I had been infected. I have done three blood tests so far and thank God up to now everything has proved to be negative.
Malaria is another thing that I have been tested every few days and thankfully everything has been fine so far.
But last Wednesday I started feeling very ill and even after the first diagnosis of gastroenteritis and medication for it few days after I was still getting worse and my health deteriorating. Finally on Sunday the doctor admitted me and started running some more tests. I was getting weaker and weaker and symptoms really were strange. Extremely weak and lethargic in the mornings, the fatigue was so bad that breathing was getting very difficult. On Sunday the day I was admitted my blood pressure dropped to 100/60. The medication that I was under also, besides not helping, the side effects were making it worse. I was taking Metronidazol in tablet forms, two tablets of 250 mg morning, afternoon and evening. After the first day I was still going down, so on Sunday when the doctor admitted me he put me on an IV drip and started giving me Metronidazol through the drip. This took me to another roller coaster, besides not feeling any better from the original symptoms I started having extra ones. I will not even go through the descriptions here but suffice to say that when couple of days later I decided to google the side effects of this medication it was as if I had written all that myself. Good thing was that the doctor stopped the medication after one day as we had come to the conclusion that it was a viral gastroenteritis and the antibiotics didn’t seem to be doing anything. Each day my condition was becoming worse and with debilitating effects. The toll on my emotional being and the mental effect was so strong that I started panicking.
The symptoms were all very strange. Absolutely debilitated in the mornings and at night all sprouted. The only meal I was able to eat well was dinner at 7PM and then by 11PM hungry again. So strange. I am quite used to go long hours sometimes without solids regularly even while exercising heavily, but this was way too different. I was trying to consume meals to try to counteract the effect of weakness but it was just like no nutrients were going into my blood stream. I started losing weight dramatically. I do fast during the Ramadaan months and even then I am able to maintain a reasonably tight regime of cardiovascular exercise activities at nights. I would fast through the day in London, no meals or fluids daytime, then after sunset during breaking of the fast I would only drink a pint of fruit juice and half hour later go for an eight mile run, come home, shower and then have a good meal and nothing else. Early morning take a glass of milk and be ready for the fasting the next day. So I was aware in comparison with the present situation that something was wrong, drastically wrong. And the fact that in the last few days the hunger soon after the best meal I was able to consume started making me think that couldn’t just be gastroenteritis.
Tuesday evening the doctor came into my room and brought a small bottle of water and told me Ayub, drink this in small sips please for the next few hours until you fall asleep. Dr Wahid is a personal friend of mine. His story and how we got to know each other some eighteen years ago is one that demands a completely new chapter of this blog. I will eventually write it, someday, sooner rather than later. I asked him what it was and he told me that it was the holy ZamZam water. Wahid, besides being an extremely good MD is also a very deeply religious person. His faith in the Almighty knows no bounds. I am often amazed at his dedication to medicine and the faith he places in God. He has also memorized the complete Kora'n and is a man of outstanding position in the religious community here. I started sipping the water slowly and then chatted a while and then said goodbyes and he went away and I fell asleep. The next day at 4AM as it was becoming usual during this nasty episode of mine, woke up and rushed to the toilet. I had had a strange encounter. I immediately called Wahid and he requested stool samples for analysis the same morning. Next evening he walked into my room with the result of the tests and with a less worried face, tells me in a half joking way where the heck did I get this from, showing me a sample in transparent lab container. And proceeded to tell me the life cycle of these bugs, and we both concluded that this really had to be faith. I am, after all it seems, carrying this probably for years, years back. They have lived happily inside me and doing all the damage over the years for finally deciding to sprout their absolute nastiness now. Probably alongside with the gastroenteritis episode and also the mental worry I have been cooking for days now about the tsetse fly bite episode it decided to catch a lift on the back of my emotional stress and try their luck. All this Wahid said might have pushed them to become hyper active and now we know this is the culprit. So far today it has been good. Took Albendazole for it yesterday night and for the first time in all these days I managed to wake up finally feeling different compared to all those days since last Wednesday. I am, I hope, on the mend. I can’t wait to get back to London. I missed my flight, didn’t want to leave the country in this state. So now I am hoping to be on the mend soon and try to catch a flight soon Wahid tells me I can fly.
Ironically what we all thought, including the doctors, that all this must have been caused by something I ate or did while I was here in the country, turns out to be that these bugs might very well have been found their way into my system through my skin as its the typical infection route. Go figure.
For anyone wanting to have a brief insight about these Strongiloides, you can either google it or read on the following link

Monday, 6 September 2010

Cycle of life

Last week we had Dario spending friday with us.

Its amazing to see how someone who played in my arms as a child since he was just three years old has now blossomed into this fine young man, fully grown into a responsible adult. A twenty one year old college graduate, stunningly polite and educated, with manners that astound any parent, smart and good looking and now playing with my own three year old son. My heart warms with a glow when I observe him interacting with Irfaan and my older seven year old. His attitudes are refined, amazingly joyous in manners and an absolute fabulous company for my children and great social buddy for me.

Any parent will understand the full impact of the words I am about to write to exteriorise what this young man has turned into. If I ever see my own sons grow into a young man like him I will be a happy and fulfilled father.

The significance of Dario's growing up and the various stages of his life through his young days till his adulthood gains more signficance still when I look back and remember the hard days that his parents had to endure. And my life was intrinsically linked with them from the very first years of my arrival in the UK. Here I was, a young twenty odd years old struggling in an environment where I had no family and whose closest biolgically linked relatives were thousands of miles away in Africa. My quest of adventure and freedom had brought me to London from across two continents after a long stay in Portugal for eight years. Having been born and raised in a tightly knit community where everywhere I looked there was always a grandpa or uncle or auntie, a familiar and safe pair of arms, I had never experienced what it was being completely isolated in a cold environment where everything and everyone I looked was either new or a stranger. This by itself wasn't an issue that I consciously brought into my mind everyday. I spoke several languages including english so it was pretty easy to get involved in various communities and be part of it. But at the end of the day all relationships and friendships had to be forged from scratch. Each face was a new face, each situation was a strange one, and while the thrill of getting to know lots of people at a fast pace the fact remained that the true emotional links, those ones that you feel that they warm your heart and soul and you truly are part of a family was inexistent. It takes time to forge such relationships and I suppose it only comes as a byproduct of weeks and months sometimems even years of closeness and affectionate approach.

My encounter with Dario's parents happened in these circumstances. I can never forget the first time we met and the circumstances leading to this moment. I am sure they will not mind me writing about it and certainly if Dario reads about this it might add in him the respect and admiration he already has for his parents.

I remember Fatima, Dario's mum, when Dario was hardly three years old literally crying because they had no money to buy milk for the children. Dario who has a twin sister Diva would be crying for milk and Tony, the dad would have gone out looking for work and struggle to get anything, so that he could return with money to buy food and milk for the children. I remember Tony when he managed to get freelance work working outdoors on the concrete floor mending cars without any shelter and on his bare knees that after a few days his knees had got inflamed with fluid and I took him to hospital where doctors had to insert needles to drain the fluid out. All this for a meagre £30 pay for the day.
These were the times I had happened to meet them and got very close to the family. For me they were my family away from home. I shared all their moments, their ups and downs and I became part of the household. I would feel the comfort of having a family in all the aspects and would get involved in every aspect of the family issues. From the struggles to the successes of moving on the ladder economically and socially, in terms of comfort and educating the children, the lows and highs of life's pitfalls, I was always an integral part of the family. One thing I have learnt is that true effort and struggle always pays off. Tony was never shy of any hard work and he always put his family above anything else in life. I saw that man work 16 hour day shifts, struggle to make ends meet at times but then good times followed and today he has three young and beautiful children grown up to the point that he can look at them and feel proud of their achievements. Ana the elder one has grown to become a successful council worker in the children's protection department. And she is due to have a baby next January. What a beautiful ending to a most heart wrarming family story. But unfortunately faith still had to throw another blow at them. I got to know that Fatima was diagnosed with breast cancer a few months ago. She has gone to have a successful treatment and when I saw her yesterday she looked pretty good and recovering. She told me of her stressfull moments and that she worries now constantly, and that she is constantly looking over her shoulder as she has been told by her doctors that the next five years are crucial in order to see if there is any recurrence. She told me how she constantly worries and with every single niggle her mind immediately boggles and thinks that this is it, the monster is back.

I then reminded her of her days. Told her to have positive attitude and look ahead towards her brilliant future. Learn to enjoy the fruits of her labour and reminded her of those painful old days when she shed tears for not having enough to even provide her young children with milk. I had to tell her that life has bestowed her with some of the most wonderful things that a human being can aspire, have children grown up and turned into these beautiful young adults that any parent could be proud of. I know I would if I my children one day grow up to be like Dario.

I left her after taking a few photographs and promised her to send her the copies after processing them. I also promised her to delete any that wouldn't have come out making her look nice. That turned out to be a needless worry because as I sat down here to process the photos I notice how beautiful she still looks. Her looks have not suffered one single bit over the years and its just as if she hasn't aged. Apart from just a couple of pounds extra that she has put on over the last 18 years and a couple of wrinkle lines on her neck below her chin, which I told her I would photoshop it :), she is still the same beautiful lovely open smile and great hearted warm soul lady I met 18 years ago. That lovely lady who would open the door for me every single time I would come knocking and had a wide open genuine smile and the first question would be "have you had anything to eat?" and most times even at those late hours of the day I wouldn't have had much to eat and she would prepare me a quick warm meal or a sandwich for me.

Coming to think of it what else would children from such warm hearted parents and special humble soul humans turn out to be if not really this special wonderful young adult like Dario has. I see in his eyes and attitude when he plays with my own children. He carries it in his natural behaviour and soul the goodness love and affection that he always witnessed in his parents.

Dario with his dad Tony and mum Fatima

Dario with Irfaan playing

Thursday, 2 September 2010

Dew drops

Couldn't help going out looking for dew drops to photograph. The morning was nice and crisp, light soothing and warm and spent a couple of hours on my hands and knees looking for the nicer dew formations with refractions of flowers on them.
Macro photography is one of my passions amongst other ones such as wildlife and portraiture. In the past couple of days dew formation in the grass has made me go out early soon day breaks and be on my hands and knees looking for beautiful refractions in the dew drops. Its fascinating to see how nature really transpires in the tiniest things.

Here at last

I have been deliberating for quite a long while now about starting a blog, months probably years in fact, and more so since the birth of my first son.

Ever since I held him in my arms seconds after he was born and I felt him take his first breath and my soul filled with undescribable joy I knew my life had changed forever.
I was witnessing the rise of a new dawn in my life. Life's meaning took a new turn and everything else in my life that I considered important shifted one notch lower to make way to the most important thing in my life, my son.

Looking back now seven years have passed. He has started in his new school today. The joy in his face this morning when he woke up and unusually not grumpy and sleepy, all rearing to get ready to go to school and attend the new environment made me think that I do not want another seven years to pass by without me starting to leave a legacy of expressed feelings written down so that one day he could read and follow my sentiments moment by moment for the next few years of his life.

Life took another turn still three years ago when my second son Irfaan was born. That was the culmination of my joy and happiness. Having experienced the magical moment when my first son Amin was born I would have thought that the birth of Irfaan would have missed the meaning of uniqueness of the moment due to the familiarity of the feeling already had with Amin's birth. But far from it. I wept and shed tears just like the first time when Amin was born and I first felt him in my arms.

So today I have decided to dig in and start jolting down thoughts, feelings and moments that among the years I have gone through and perhaps even go deeper and dig further back and let resurface moments that might perhaps shed light on what lies beneath the reasons why what and who I am today.

But for today this will suffice. This is a joyous moment for me and I would like to share some of the images I capture though time. Some are of my special ones. Others are simply what nature provides me with and enhances my life around. I try to teach my boys to appreciate the nature and learn through it. Beauty resides amongst the smallest of things in and around us and if you take time and care to look further and deeper you will be amazed at the wonderful things that in our day to day life we pass through without noticing.