Why acquiring hookworm the old-fashioned way is a baaaad idea

I was asked about a month or more ago to address the topic of acquiring hookworm as I did the first time, and the dangers inherent in doing so. By which I mean going to Cameroon and walking barefoot in the latrine areas of the locals, as I described shortly after doing so here.

The person who contacted me was rightly concerned at posts he had read of people suggesting that they do just that, to save on the expense of purchasing hookworm.

As I describe in the post linked to above, before I went to Africa to get hookworm I considered the many risks associated with doing so, and I only accepted those risk because I had spent 18 months scouring the internet for sources of hookworm, or any other of the various types of helminths I considered safe.

I could not get the ova or larvae from laboratory supply companies, from universities with parasitology departments studying the organisms, nor by locating the areas in the USA where hookworm infection is still endemic because so many people in the S. Eastern US, and Appalachia in particular, still live as they did before Rockefeller’s eradication program began in the 1920s. What every health department I called, in Georgia, Mississippi, Kentucky, Tennessee, Alabama, Louisiana and I am sure a few others, all said was something like, “I know we do have cases in our State, but it is not a reportable disease, and so we have no idea where you would find people with hookworm infections”.

I contacted the various universities with parasitology program, I lied, cajoled, begged, offered to pay large sums, i tried to enrol in the programs at Nottingham (the only then active study, into allergies, was full).

I emailed or called every laboratory supply company I could find, no dice. The closest I got was a dead adult hookworm mounted on a slide for parasitology classes.

I tried everything to avoid going abroad to acquire hookworm for the following reasons:

The high risk of acquiring mosquito borne diseases like Malaria, Dengue fever, Filariasis (leading to Elephantiasis, incurable). Those borne by other insects, like trypanosomiasis (sleeping sickness), West Nile Virus (Nasty!!!), Leishmaniasis (avoid the photographs), the Plague and while most forms are treatable pneumonic can be fatal in less than a week and the mortality rate if untreated is 100%.

Obtaining medical care in Africa is not a happy prospect if you really need it. For instance when I visited the hospital in Limbé the regional capital, when I approached the building I thought the hospital must be behind it because this building was clearly intended for keeping animals. I am deadly serious.

Medicines, including clean syringes had to be supplied by the patients, which is why if you to to Africa besides your anti malaria’s, antibiotics for cholera, shots for typhoid, and cholera (not very effective and makes you feel like dog meat), shots for all the hepatitis versions, etc., you have to take a supply of various syringes so you can be sure of not having one reused on you.

After all the official rate of HIV infection in Cameroon is about 20%, and given that life expectancy there is 47 this means that probably about 50% of adults in Cameroon are HIV positive.

Yellow fever of course, but a requirement of entry to countries where it is endemic is proof of inoculation. Which is good because it destroys your liver in a trice. Then there is Typhus fever (interesting thing: “The first reliable description of the disease appears during the Spanish siege of Moorish Granada in 1489. These accounts include descriptions of fever and red spots over arms, back and chest, progressing to delirium, gangrenous sores, and the stink of rotting flesh. During the siege, the Spaniards lost 3,000 men to enemy action but an additional 17,000 died of typhus.”).

Don’t forget TB, much of which is now totally resistant to antibiotics, interesting thing it can affect your bones as well as your lungs, so your bones crumble away.

Getting bored with listing diseases, there are too many more to want to continue, so just going to list the highlights, you can look them up on Wikipedia: Leptospirosis, Lassa Fever, Ebola & Marburg Viruses (your hemorragic fevers), Schistosomiasis, Rabies, Diphtheria, etc., etc., etc.

Then there are the water borne diseases, meaning you have to stay away from fresh water, whether flowing or still. Don’t forget all the large predators, some that live in water that are above you on the food chain in Africa.

My favourite story was of a German tourist who was told not to swim in the lake by the hotel he was staying in, heedless of the advice he did just that, and was a crocodile’s dinner as a result).

Hippos eat people, too.

There are many other diseases, among which are Polio. If memory serves the eradication effort failed because a bunch of religious lunatics in Nigeria refused vaccination at the end of the global eradication program, Cameroon is next door. But I am getting tired of listing them, that last link takes you to the CDC page for travel advisories for Cameroon and I think lists most of the diseases.

Of course the greatest danger to life and limb in Cameroon does not come from disease or predators, although there are tigers on Mount Cameroon, the second highest mountain in Africa, and it’s largest active volcano. I walked up part of it and down to where it had bisected the road to Nigeria, the flow was enormous.

No, the greatest danger to life and limb in the third world comes from the citizens of the country you are visiting most of the time.

The only guide book to Cameroon warned that cars were the greatest risk, I laughed at that given what I had read about the diseases. But so it proved.

In just two weeks in the country I came upon three accidents, shortly after they had happened, involving fatalities. In one memorable case four in one car that had burned. Quite an image, plus countless others, not involving fatalities, one involving a large gravel truck, a minibus, and a motorcycle.

The minibus had been tossed down the slope next to the road and its contents and passengers distributed at random hither, thither, and yon, along with all their possessions. They seemed to be in the worst shape, the motorcyclist seemed fine, but the passengers in the minibus were all moaning and gripping various body parts, heads in particular.

I was once in a taxi that was one of four cars simultaneously overtaking another car while two cars, one overtaking, came at us in the other direction.

Exciting!

There are no driving tests, few seat belts, no visible police outside the capital, no road signs, only one paved road (from the capital to the oil refinery) that I saw outside the capital, no signs, or road markings. There are only a couple of fire stations in the capital, and I doubt even that many in the rest of the country. Both are quite near the presidential palace by some freak of chance.

As to an ambulance, forget it. If you cannot get yourself to the hospital you aren’t going to make it, and even if you do, see description of hospital in Limbé as reference, I would not rate your chances unless your wounds were very superficial.

The drivers all navigate by honking constantly, as if an audible warning, amongst 3-15 all at once is a license to do just about anything.

The taxis are interesting, I and my traveling companion who I took with me so we could take turns sleeping in dodgy situations, and glad I did, got in a taxi, paid our fair, and waited to take off. Bear in mind almost no one owns a private car in Cameroon, most cars on the road are taxis, and almost universally they are Toyota Tercel sized vehicles that are exported from Germany by the container full, after they fail their road worthiness tests and are deemed by their owners not worth fixing.

We were waiting in one such vehicle, and as the morning rush hour, almost all on foot, passed by the taxi driver slowly filled the Tercel up until there were five passengers in the back seat, and two in the front passenger seat, of which I was one. Then we set off.

When we arrived in the country, in the capital Yaoundé, at night, we got a taxi, were greeted by a woman with skirt hiked to mid thigh standing with legs apart pissing in the street immediately we left the airport.

Within five kilometres the taxi had run out of diesel, so the taxi driver took part of his fair in advance, flagged down one of his friends driving by in another taxi and disappeared into the dark to fetch some diesel. He returned with a one litre soda bottle full of diesel about a half an hour later, and off we went to the capital. All dirt roads.

Then there is the issue of wealth, Cameroon and countries like it where the money economy shows an average daily wage of about a dollar fifty US a day and where family sizes are large, means that parents frequently watch their children die for lack of medicine costing a few dollars.

Such people, when confronted by a white man, perhaps the first they have ever seen as was the case with many I met, must know that your pocket change represents one to three months wages. Ask yourself if you would hesitate to rob, or even kill, to get that money living in that situation. I know my children would come before some white asshole from a country so rich, and that cared so little for the world’s poor.

I heard many stories relating to Cameroonians returning from living in America having saved enough money to build a nice house (about $25K for a four or five bedroom mansion of you are interested) being taken for a ride on the Bay by their old friends and ending up as fish bait for the money in their pockets. I was offered almost a kilometre of beach front property outside Limbé for $10K.

Life is cheap in places like Cameroon, and if you go there you can expect to be exhausted from the constant danger, and the tension it causes.

The last night we were there we spent at a deputy chief of police’s house in Yaoundé, the capital. When we woke up, thanks to the Mosque broadcasting the morning call to prayer at dawn and all the roosters crowing their guts out, we found the power was out. We soon realised it was just the house we were in. What had happened was that someone had stolen her electricity meter, while the power was live through it, in the middle of the night.

She was not surprised, apparently it happens quite often, but not always with a successful outcome, of course. That is how poor people are.

Before I went there I reasoned that I was most likely to return without any disease, next most likely to return with the wrong disease, and would be lucky to return with hookworm.

My original plan was to work with the local pathology labs and doctors to identify infected children, collect a stool sample, culture it (easy in its natural environment) and so infect myself that way.

I quickly learned that that level of poverty makes everyone corrupt. It is not just the ruling class, everyone is on the make, and being white you are the best opportunity to come along in a long time. It took me about four, wasted, days to work out that the doctors and labs were just waiting to see how much I was willing to pay, and that there was no guarantee I would get what I paid for at all.

It was only then that I resorted to walking barefoot in latrine areas.

One can consider such a thing and believe it will be easy to do, but when the time came the only thing that made me do it was the thought of returning home to all those who had decided, clearly and often expressing naked derision, that I was a lunatic for considering infecting myself, never mind going to Africa.

The thought of having to tell them that I did not have the balls to do it was all that compelled me to do it in the end.

Then there is the cost, once you add up the price of two plane tickets, one for you and one for your wingman, all the other travel expenses (the vaccinations are a killer), etc., it is certainly far, far cheaper to buy it from one of the providers.

Plus the outcome is certain, there is no guarantee you will come back with any disease, let alone the right one.

So unless you want the adventure, and I have to admit Cameroon made me feel more alive, and more appreciative of living in the West, than anything I have ever done, I suggest you be sensible and just buy it from someone.

Our policy is that no one is turned down for therapy on the basis of the inability to pay.

If you are pissed off with the price and think it should be cheaper, you know, based on cost of the raw material, I suggest you read this post.

I did what I did only because there were no alternatives, if I could have bought it, even at double what we charge, especially given my experiences in Cameroon, I would have.

I was very lucky, I met a cousin of the Prime Minister on the plane there, and her husband who managed a French owned banana plantation. They happened to live in the darkest area of the map provided by the WHO showing the highest rates of hookworm infection in Cameroon, Limbé. They kept me prisoner once we arrived in town, I kid you not, until they had convinced me and my companion of the danger we were in traveling around the country.

To persuade us to stay with them they went so far as to lend us his car and driver for the duration of our stay. I doubt you would be so lucky, and without that I am pretty sure we would likely have been in grave danger.

They employed six or so people around the house, one of which worked from 6 am to 6pm, and another the other twelve hours. The guy who worked during the day walked around the walled grounds all day with a revolver and machete, and the night clerk slept on the bare tile floor in front of the front door with a gun and machete in his hands, all night. No pillow, no blanket, no mattress. A hard man, a serious man, a man without a sense of humour.

The windows were all barred, the doors all locked with multiple locks, and the man of the house had multiple hand guns to back up the guards.

That is the third world, and if you think visiting it is a bargain compared to buying a sterilised dose of helminths from us, go right ahead.

But don’t say I didn’t warn you, and make sure your life insurance is paid up, and that your will is up-to-date.

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