Tuesday, July 21, 2009

Amoebas / Amigas

I think the bag of cut papaya did it, though the culprit will never be known. A week later I was becoming better acquainted with my new favourite location and visiting enough baƱos to write a local guidebook. But my new co-habitants may have taught me a thing or two.

Every traveller gets sick. Well, that may not strictly be true - the official statistics for 'Traveller's Diarrhoea' are 20% - 60% [1] - but I'd hazard this pushes towards 100% in Xela at this time of year. 'Malo Mayo' (Bad May), as it is locally known, arrives with the start of the rainy season. You might assume the cleansing powers of torrential highland downpours, but you'd be precisely wrong. The water funnels down the steep, intensely cultivated valleys, collecting assorted fertilizers, pesticides, rubbish and precious topsoil and quickly fills Xela's aging sewers to overflowing, adding imaginable horrors to the sludgy mix. This flows through the narrow stone streets, mixing with dog excrement, slushing round street vendors food stalls. Next day's sunshine dries the deposited 'soil' to to a fine dust to be thrown up in clouds by every passing chicken bus. I paint a grim picture of an often beautiful city but the reality is that May to September is a boom time for doctors here and the hospitals are full.

So, in other words, I've not had a unique experience. There are hundreds of us clutching aching bellies. Xela is well prepared: while-you-wait poop test labs are two a penny here - or should that be one a pound (actually its one for Q20, £2) - and people don't think twice about collecting a 'botecito' (small tub) and returning it shortly afterwards with their sample. (The receptionist at Metropolis dresses very chic and I wonder if it helps compensate for being given shit all day). In fact stool samples seem as normal a topic of conversation for Xelatecos as potatoes or the weather were for my Irish grandparents. I had to retrieve my 'Examen De Heces' results sheet from my spanish teacher before she called yet another colleague over from the coffee counter for their penny's worth. Everyone here is an expert with their own recommended remedy: teas from local herbs; orange juice mixed with citrato de magnesia; Grapefruit Seed Extract; this or that vegetable...

Now I'm open to natural remedies and I did not want to make a hasty grab for the antibiotics. In fact the more I read about the wonders of our digestive system and the abuse of modern medicine, the more I hoped to avoid taking the 'Nuk-u-lar' option. Here are a few interesting facts: our 25 feet plus of intestines contain more beneficial microbes that we have cells in our bodies [2]; these 'flora' help to digest our food and tests on mice with sterilized intestines show that they need 30% more calories [3]; our gut is sterile in the womb but is rapidly colonised by flora in the months following birth, with some evidence suggesting the process is kick-started by trace fecal matter from the mother, a process denied to caesarian born babies who are perhaps less healthy as a result [4]. Furthermore the gut flora - or 'friendly bacteria' as the marketing genii of probiotic yogurts have dubbed them - create a 'barrier effect', occupying space and resources and so denying harmful micro-organisms the chance to move in. That's the risk of the nuclear strike: it wipes out the good with the bad. Post-antibiotic guts are weaker, more vulnerable guts. Not a scenario I wanted to embrace as I continue my travels.

Hence visiting two different doctors, both english-speaking, to get their opinion on my second poop-test results, which had indicated 'E. Nana: +'. They both confirmed it: Amoebas. It was not going to be a brief passing through (pun intended). They had moved in to stay and according to the doctors pressing the button was the only option.

Antibiotics Part I... and Part II
Strike One: Nitazoxanide; brand name Nodik 500; duration three days; one tablet every twelve hours. It seemed to work. My stomach, which had been like a clunky school plumbing system, sloshing and gurgling, returned to its normal self. Hurray! But a day later the waterworks were back, exactamente lo mismo de antes. The antibiotic Mario Brothers had failed.

'Antibiotic' means literally 'anti life' and, actually, 'anti-microbials' is a more accurate term. Since Alexander Fleming's discovery of penicillin in 1928 they have probably saved millions of lives, yet they are a blunt weapon. As mentioned, the more we learn about the complex symbiosis between gut flora and the digestive system the more risky the use of such a blunt blade appears. Many patients do not complete their course of antibiotics. They are a Prescription Only Medication in the UK but but easily available at Guatemala's liberal farmacias, which offer all sorts of potent potions over the counter. Not completing a course means some bugs may get away - the stronger ones.

This contribution to the breeding of antibiotic resistant diseases pails in comparison to the monumental folly of industrial meat production. Hats off to Europe - and on this subject I am proud to hail from the Old World - who have banned the practice [5], but US industrial meat producers feed antibiotics to their livestock on a daily basis, to prevent rather than cure infections. In the excellent Omnivore's Dilemma, Michael Pollan explains how American CAFO's ('Compact Animal Feeding Operations') create the perfect laboratory for new strains of antibiotic resistant infections. Economics - skewed by huge financial and fossil fuel subsidies - determine that corn is the cheapest 'input', so it is fed to cattle in the millions of tonnes. Never mind that their bellies have evolved over eons to digest grass and that feeding them corn leaves them, effectively, permanently ill. Hence the need to mix antibiotics in with their food. In fact 70% [6] of antibiotics consumed in the US is used in this way. 'Gripe A' anyone? We asked for Swine Flu and we keep asking for worse so long as we maintain this foolish practice. The Keep Antibiotics Working coalition in the US introduce a bill to ban the practice [7] which failed the first attempt and had been reintroduced to Congress in March this year. Will the media circus over swine flu do anything to further the next attempt? One would hope so. Media coverage of the issue is appalling and I'm amazed that 'Dirty Hospitals' can remain such a hot political potato in the UK with barely ever a mention of what is breeding the 'superbugs' in the first place.

Anyway, after visit number three to the doctor's I proceeded with the second strike: Paromomycin Sulphate; brand name Dediacol; four days long this time. Results were good. I seemed to be cured.

The whole experience had been educative. My host family had laughed at my faulty pronunciation, joking about my problems with 'amigas' (female friends) but the lessons I've learned may make the misnomer strangely accurate.

In the months leading up to the illness I had been feeling healthier than ever before, with daily yoga and boxing training thrice weekly. But my amigas put the breaks on all of that. It was quite a contrast from one week to the next: from early starts to long, broken nights; from a thousand skips to stumbling on pavements, walking step-by-methodical-step, slow, energy saving movements. My plans to start teaching yoga; on hold. Working on by boxing combinations: on hold. More Kung Fu drills learnt: on hold. So much to do in my final months in Xela and half the energy to do it with!

There was a choice: get angry or accept it. I decided to accept it. My stomach ache was as much part of life as the pleasant, post-yoga ache of stretched muscles. "What," I though "if I decide to look on this as an opportunity rather than a curse?". I was being denied what had been most important to me, so why not chose a new focus? I picked up the guitar I'd bought a few months back, languishing in the corner, and began to practice. It was just the kickstart my playing needed.

That's one way of dealing with frustrated intentions: if one door closes, try some other ones. I've sometimes pondered that if I lost sight or hearing it would make me focus on what I had left. I used to run every day at university and loved it. A year after graduation I developed some sort of chronic inflammation in my left knee, brought on by repetitive movement. Gutted. But I learned to work round it, playing Ultimate Frisbee for exercise. Perhaps I would never have started my yoga practice without the forced change.

It will pass...
There's something about patience, here, too. If patience is a willingness to let things unfold in their own time then a patient disposition means accepting when things don't go your way. Yet patience is not fatalism. Fatalism is getting to a flooded river and giving up. Patience is sitting down and enjoying the sun, pondering calmly how you could cross, or whether there's another route, and waiting a while to see if the waters subside. It is finding that balance between, on the one hand, a raw determination to get something done, and on the other the ability to meet obstructions without anger - so they don't steal the pleasure of the moment. Patience is a quiet determination, allowing flexibility for reappraisal and open to the possibility of changing course - sometimes it really is best simply to cut your losses. Other times just don't quit it!

So, I tried to be patient with my illness. A patient patient. It felt like a lead jacket: a constant bellyache that sapped energy, sapped pleasure from the moment and molested my concentration. Yet I realised that the challenge was to accept and even embrace the discomfort: "This is where I am. I accept this illness. I accept this barrier."

All well and good. The blog would have ended here, with the illness having passed in a few weeks: "Listen to the great lesson I've learned"; blog posted; "Next life-enhancing experience please". Then the stomach ache returned. My mood sank with my energy and I was well and truly pissed off. That'll learn me! So much for my zen-like acceptance. I wanted to smash something up.

A warm welcome?
So maybe there's a shallower and a deeper acceptance. One can accept pain as a temporary nuisance - 'I accept this, it will pass' - and make use of it as an opportunity, but essentially this state of mind is one of waiting. That's fine, and frequently effective, but what if it never passes? Far more difficult to accept a barrier as though it was permanent and look for value in it.

I don't yet know if I'm free of amoebas (poop test four may provide some reassurance). I sincerely hope I am, but perhaps I'll have to live with a fragile belly for months to come. It could be longer - a friend suffered with parasites for years after returning from Brazil.

The real challenge is to keep at it, again and again, accepting where I am and how well or ill I feel. To welcome the suffering as a teacher:

"Most people want to take joy without suffering. I will take both. See how far suffering takes me. When you do not resist suffering, you will make friends with other people who suffer. I suffered a lot in my own body. Now when someone tells me of his sufferings, I feel in my body what that suffering is. My personal experience provides me with great love and compassion. So I say, "My friend, let me try and do something." Pain comes to guide you. When you have known pain, you will be compassionate. Shared joys cannot teach us this." (B.K.S Iyengar)

Cultivating equanimity in the face of adversity is a lifetime's work. I'm learning a lot about it through my yoga practice. And a lot about it through others. And perhaps the amoebas/amigas have been the best teachers yet.


1. http://www.cdc.gov/ncidod/dbmd/diseaseinfo/travelersdiarrhea_g.htm
2. http://en.wikipedia.org/wiki/Gut_flora
3. Sears CL (October 2005). "A dynamic partnership: celebrating our gut flora". Anaerobe 11 (5): 247–51
4. http://en.wikipedia.org/wiki/Gut_flora
5. http://en.wikipedia.org/wiki/Antibiotic_resistance
6. Executive summary from the UCS report "Hogging It: Estimates of Antimicrobial Abuse in Livestock", January 001 and http://www.ncrlc.com/antibiotics-agri_page2.html
7. US Senate Bill S. 549: Preservation of Antibiotics for Medical Treatment Act of 2007
8. Light On Life, B.K.S Iyengar, p52.


  1. A friend emailed me this verse from the New Testament. Very appropriate for the topic:

    Phillipians 12: I know what it is to be in need, and I know what it is to have plenty. I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want. I can do everything through him who gives me strength.

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