Jim is a history professor at Colby. He had just finished a semester directing the Intercollegiate Sri Lanka Education study-abroad program. We were taking a three-week vacation in India with our children, who were then 8 and 12, and after that we were headed back to Sri Lanka for Jim's sabbatical year. I was taking a sabbatical, too. Dissatisfied with my work lobbying for business interests in Maine, I was contemplating a career change.
Jim's fever persisted in Udaipur. At the end of our first day there, I flipped through the pages of my worn copy of Where There is No Doctor. The index wasn't helpful, and the results of my research were remarkably unsatisfying. "Not every fever is malaria.... The common cold, typhoid and tuberculosis can cause mild fevers." Heat exhaustion was another possibility. I suggested Jim take a cold sponge bath. He ended up shivering for an hour afterwards and felt no better.
By the time we reached the desert city of Jodhpur four days later, Jim was unable to eat or to walk in the heat of the day. We sought out an upscale, air-conditioned tourist hotel. Jim slept for the next two days and nights while I worried. Our precautions before traveling"rounds of vaccinations, prescriptions of antibiotics, sterile syringes, a first-aid kit overflowing with salves and creams"were of no use. The fever was still low, he still felt nauseous, and he had no appetite.
We opted not to take public transport for the six-hour trip to Jaipur and paid for a taxi and driver. We chose our lodging based on the recommendations in our travel guide. Hotel Meghniwas was family-owned, located near the center of town. The innkeeper was a retired colonel in the Indian army and he recognized Jim's symptoms straight away. Hepatitis.
Colonel Singh called his personal physician, who arrived the following morning. The young doctor's bedside murmurings were reassuring. His lab assistant drew a blood sample, and the next day the physician returned. The diagnosis: Hepatitis E. Transmitted through contaminated food and water, with a four-week delay of onset. Acute symptoms peak two weeks before jaundice occurs and abate about a week after that. The treatment was simple. Bed rest, liquids, a no-fat diet, and an ayurvedic treatment of vitamin K tablets. It appeared that this was a mild case. Long-term liver damage was a possibility, but we would only know the severity as the symptoms continued to develop.
For the rest of that week, Jim slept 22 hours a day and was able to eat little and to drink only intermittently. I kept the kids occupied seeing the sites, all the while wishing and willing Jim back to health.
At the end of the week, Jim was weak and jaundiced. In our family photos at the Taj Mahal he looks exhausted. In Delhi the temperature was a sweltering 111 degrees, and we made an extended visit to the air-conditioned national museum. Back home in Sri Lanka he began a diet of king coconut juice, fruit, and bland curries. It would be six weeks before his appetite and energy level returned to normal.
In the year that followed, my understanding of the world around me fused with exploring career options. I realized that the link between poor health and poor social conditions in Sri Lanka and India were the same as at home: unemployment and poverty, income inequalities, and lack of access to health care contribute to poor health status. My liberal upbringing surfaced, and the idea of grassroots work hovered.
I now work with a community health coalition in Waterville that seeks to improve health and quality of life. We convene local agencies to review data and identify health problems annually, and then we spawn partnerships to address those problems. As a result, a prevention coalition addresses teen substance abuse through prevention programming in the schools. A diabetes care initiative combats diabetes complications by changing primary care and hospital practices. A community collaborative promotes physical activity and healthy weight. A network of doctors provides medical care on a sliding fee scale.
That experience in India"Jim's brush with illness in a strange place"is often on my mind and inspires me to make changes locally that improve health for everyone. Jim was lucky; he had the financial means and family support to find a doctor, a diagnosis, and appropriate care. But not everyone is so fortunate. And it doesn't seem right to me that sheer luck"and the kindness of strangers"should determine our health and well-being.