vagrant

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Back at the beginning of March when Ashe and I were in Panama city, scrapping around looking for boats we noticed that we had some particularly nasty looking bug bites that were forming small red welts on her legs and on my back and elbow. This was nothing new, after living in the rain forests on various islands in the Bocas del Toro archipelago we had experienced all sorts of biting beasties from swarms of chitre to hairy malarial mosquitos and possibly even the blood sucking assassin bugs which live in thatched roofed huts and come out at night to feast on your flesh and inoculate you with Chagas disease. These things have never phased me very much; when living in these places we are constantly surrounded by people who’ve been there their whole lives and survived to be more non-chalant about biting insects as I am. Sure, when the chitre were making meals of us on Shepard’s Island we used DEET ocaisionally but for the most part it was natural bug repellents like coconut oil with citronella.

After a couple of weeks with these weird little bites not healing we decided that we decided that a sketchy hostel we stayed at in Panama City probably had bed bugs and we spent an entire day at Hacienda Merida on Isla Ometepe in Nicaragua cleaning out our bags, doing all of our laundry and dissinfecting everything we owned in order to expell any hitchhiking insects and their eggs from our gear. So we thought we had the problem licked and after reading that bedbug bites could take months to heal we sat back, tried to ignore them and wait for them to heal. Over the next few weeks they just got angrier though, not much but enough to make us worried and when we got back to Boston in April we asked my sister about it who has had bedbugs before at her ghetto apartment in Allston and she looked at them and quickly said “Those thing are NOT bedbug bites…” so we popped on the internet and had our worst fears confirmed: our bites were looking more and more like Leishmaniasis.

For those unfamiliar with this fabulous parasite (basically everyone) it is an intra-cellular parasite that is transmitted by sand flies or “no see ems” in many different parts of the world including southern Central America, much of South America, the Middle East and southern central Asia. We are fortunate to have the cutaneous version of the disease which only causes large, open, weeping sores which don’t heal and leave fabulous scars rather than the visceral version which just causes organ failure and death. All things considered it still hasn’t been much fun dealing with a relatively uncommon tropical disease in Boston where nobody seems to know what to do about it. After being seen by an infectious disease clinic we were shuffled off to a dermatologist who took biopsies (which only made the buggers angrier) and confirmed within a couple of weeks that we certainly did have Leishmaniasis. Then we were in the hands of the infectious disease unit at Beth Israel who were apparently emailing back and forth with the CDC and a slew of specialists trying to figure out how to treat our crazy lesions. In the meantime our sores got worse and worse, Ashe’s legs were covered with twenty large ones which started melding together into disgusting weepy piles of scabby goo as they got bigger. All through this process we were undoubtedly doing at least as much research as the ID team and coming up with very little promising information. Considering that this is a parasite that affects two million people a year there has been very little definitive research done on treatment, especially long term efficacy of the treatments currently available. My impression is that Leishmaniasis research suffers from the same problems as Malaria research, there is no money in curing a disease which primarily affects poor people in developing countries.

Our doctors here have been pretty excited to see this stuff up close, apparently their only other exposure too it has been some five minute blurb in medical school. Only about 100 Americans a year get Leishmaniasis outside the military which has seen about 700 cases since the invasion of Iraq; soldiers there call Leish the “Bagdhad Boil”. Those lucky folks are getting Old World Leishmaniasis however which is a bit easier to treat than the New World variety which we contracted in Panama. One of the major problems according to our doctors is that some New World varieties can relapse in mucus membranes up to 20 years after the original infection has healed. I will spare you direct links to pictures of this fabulous manifestation of our parasitic friends, just google “mucotaneous leishmaniasis” if you’re brave and curious.

Before going the traditional route we tried a number of herbal remedies and of course found plenty of speculation about their use and effectiveness.  We tried Pau d’ Arco, goldenseal, neem oil, garlic extract, propolis.  None of them were effective in the least and I almost think that messing with the sores so much only made them worse.  Our research into alternative remedies was difficult not only because of the speculative and spotty information about naturopathic medicine but also, many of the studies that we were looking at with regard to treatment with natural materials were part of research work by drug companies and they didn’t disclose the actual ingredients they were using.

After trying for a number of weeks to get a new oral treatment called Miltefosine from friends and aquaintances in Latin American countries, we gave up. This drug is much safer than the other current intraveinous treatments but it’s effectiveness is still in doubt, it lacks FDA approval and is only available in the US at great cost. So on Wedenesday when our ID doctors found out that the strain we have has the possibility for relapse they recommended that we get admitted to the hospital for five days to receive daily intraveinous infusions of an anti fungal treatment that looks way too much like anti freeze dripping into our veins. This is preferable to the other treatment which is a heavy metal infusion for 28 days and causes all sorts of fun side effects including liver and heart damage. Being treated for five days and two follow ups with something less invasive is better for sure, especially since we were looking at the possibility of postponing our trip to Madagascar in June to work with the Ankizy Fund.

Plenty of people have suggested that I might want to be more cautious about where I travel in the future and having seasoned travel doctors gasp when you show them your skin certainly makes me think twice about insect exposure but not about travelling to places where these diseases are endemic. We have access to all sorts of medical care and economic support but the vast majority of people who contract these things are on their own. While we were living in Bocas del Toro we heard plenty of ex-pats talking about Leish, some who had even gotten it and been treated. In Panama you can buy a series of shots at the drug store rather than sitting in a hospital room for five days. It didn’t seem like quite such a big deal until we got back here and became the darlings of Boston travel medicine.

So, while I wait for Sunday to roll around I’m stuck here in a ward full of people who are far more sick than I am.  We are not allowed off the floor and I’m feeling more than a little lethargic, wishing they had a gym or at least an operable window.  Parades of medical students, reisdents and case managers come to our rooms to gawk at our skin and ask the same questions over and over again.  Overall I’ve been really impressed with the quality of care but I still can’t figure out how keeping people locked in an observation ward speeds their recovery.   I feel lucky though, at least I’m coherent and stretching and antsy instead of delusional and bedridden like my elderly roommate who had a stroke two months ago.  Listening to all of the family drama of having a loved one her with a serious condition is bizaare; I’m the fly on the wall behind this thin curtain separating the two of us.  When the nurses change shifts and start asking him the same questions over and over again that he lacks the faculties to respond to, I want to answer for him since I’ve heard all of them before but I can’t decide how involved I should get.   We just talked and he offered me a job and started talking about his investments.  He thinks he’s at work, shuffling papers in some office somewhere thirty years ago; every nurse is an employee, every orderly a potential customer.  We shook hands, his grip like iron, he asked if I would talk to him at night when no one was around, he tried to make eye contact but forgot what he was doing and glazed over, staring at channel six, the C.A.R.E network, still lives of nature scenes, canned music tinkles over waterfalls…

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We’re getting ready to leave Central America after a few months here mostly in Panama and Nicaragua. We’ve made some good friends, had a puppy briefly, cataloged many exciting insects new to us, befriended a toucan , pulled our hair out, planted trees, became human feasts for tiny bugs, pulled a boat out of the jungle, ate new and alien fruits, learned how to surf (?), built a cassita, stared at the stars, saw an octopus, learned how to shell a coconut and make patacones and coconut rice and cut metal with a machete and get rid of bed bugs and do more with less. We climbed a volcano, swam in the ocean, searched for a boat, made pasta, read our year’s share of books, went to a carnival, learned some Spanish, discovered a disturbing allergy to mangoes , saw two waterfalls, drank the best coffee of our lives, swam in a crater, and had long productive, frustrating, wonderful conversations about the state of everything.

Now is the right time for leaving though, I miss New England and friends and family and pine trees and shingles and wood fires with no plastic in them. It’s nice to know that we’re leaving when we are ready and a little homesick, not feeling like we’re just getting started here and having the rug pulled out from under us by obligation or perceived necessity. Returning to the states is sure to be interesting, a pile of mail waiting to root through, friends to see, the projects I want to do and be involved with are starting to pile up in my mind like stacking firewood and I’m wondering how well we will cope with the tale end of winter after wearing sandals and eating fruit from the trees for four months. Departing and arriving, they make me more introspective give me lists of resolutions which may not come to pass but at least I have the time and space to articulate them. I still want to learn how to sail, build a bike trailer, make some long bike trips and learn more about building bicycles, keep working on my cabin, learn more metal fabrication, visit more farms, renovate a teardrop trailer, start cultivating a little land around the cabin, work on some longer video projects, go contra dancing, play more music, make more sculpture and go night swimming. Obviously I’ll need to whittle this list down a little since I will only have a couple of months in New England and then we are off to Madagascar for the summer to work on projects which will hopefully be related to that vague and unruly list of short term goals.

After I gave up trying to make money a couple of years ago I find that I have much more time and space to pursue things I’m interested in, for me the process of making money for it’s own sake was destructive, depressing and counter productive. I found myself with the couple of hours of “free time” I had at the end of the day, I would stare blankly at the walls and wonder where all of my energy and ambition had gone. Of course there was a huge psychological hurdle to get over, the perceived security of a regular paycheck is seductive, it plays on our fears and not our hopes, grabs us by the neck like a belligerent Scot and punches us in the neck. Sometimes I get the same feeling when I’m involved in one of my intermittent bouts of hypochondria, this vaguely uncomfortable bubbling in the pit of my stomach usually precipitated by some conversation with another American about the necessity of health insurance and some accompanying horror story to accentuate the point: you are never safe, bad things can happen at any time. It’s an intellectual trap, fear breeds fear, we end up living our lives as if the biggest catastrophe of our lives is looming, shadowing all of our actions. It’s these moments when I think that I should probably get a steady job, a 401k, six more insurance policies, a filing cabinet, a gym membership, a guard dog, a new bike lock, some better sunscreen, and a nice reasonable low interest mortgage. Then I take a deep breath and remember the imminent collapse of the dollar, the limitations of traditional economic value, the inherent hypocrisy of the insurance industry, the price of a barrel of oil, the rapture of the nerds, the long now, the possible digital nature of the universe, new economies, true security, local currency and the taste of fresh blueberries in Maine.

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We´ve been camped out at the Hotel Acapulco in Panama City trying to find a boat and not spend any more money than necessary. We´ve been going a little crazy here, it´s hot and amazingly loud and there is nothing to do and very little to eat in the neighborhood we are staying in. Sometimes we just run around the hotel room at top speed in our underwear. Tomorrow we will be on a very long bus ride to Nicaragua in order to escape this city and find some Spanish schools. We will leave the sailing for this summer….

 

Music by Jim James of My Morning Jacket with Calexico from the “I’m Not There” soundtrack.

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We spent about a month living and working at Javier and Janet’s homestead on Islan Bastimentos, Up in the Hill. They make natural body products and tile mosaics and teach surfing and have a small shop and generally live the good life on a hill overlooking the ocean on both sides of the island. We didn’t shoot as much videa as we had hoped because we were busy building an addition to their cabin which we were staying in. That’s not entirely true, we did alot of reading and relaxing and star gazing and talking and eating also. You should go to Bastimentos and stay in their cabin and say hi for me. I miss the brownies and the waves lulling me to sleep already…

Music is a cover of “One Drop” by Gilberto Gil.

Click To Play While staying at Ulrich’s house on Isla San Cristobal we hiked into the jungle to help extract a new dugout canoe which Ricardito was having built. Around the Bocas Archipelago it still makes economic sense for people to build these canoes which are carved from a single piece of wood. For most people living in the islands they are the primary form of transportation, whole families will pile into a tiny sinking cayucu the the kids bailing while the father paddles to church. The larger ones are made to move materials around or goods to market. The biggest ones that we’ve seen approach fifty feet with about a six foot beam, all carved from one tree. The trees that are big enough to produce one of these are getting rarer and farther away from the water. People must spend weeks in the bush roughing out the boat with hand tools and chainsaws before it is pushed to the neares river or ocean. After that it’s reworked with power tools and usually painted. The one which we helped push out was about twenty feet and only took an hour and a half with about ten people. I can hardly imagine what it must be like to get one of the huge ones out of the jungle. Ulrich has one which is 43 feet and he posted a video and a write up about it.Ashe and I take equal credit for shooting and editing this one…

Click To PlayCoconuts are everywhere in the tropics.  Our friends in Bastimentos use the husks to pave their paths.  A couple of people have said that coconuts and bananas contain all of the nutrients necessary to sustain a human.  They are good for damn near everything including making candy, soap, oils, jewelry and kitchy souvenirs.  Coconut oil is addictive, mostly because it’s 90% saturated fat but I think we are going to have a hard time when we get back to New England without a ready food source falling from the sky.  A good grater is necessary to fully take advantage of coconut and make coconut milk.  We were staying on San Cristobal and our friend’s house was devoid of graters so we made one….