While traveling in Ghana, West Africa in March 2019, I contracted a bacterial infection on my right foot. As it turned out, it was Necrotizing Fasciitis, commonly known as flesh-eating disease.
In the early morning hours of March 8th, 2019, I was on a long-distance bus from Tamale to Accra. I woke up in the middle of the night feeling feverish. My feet had swollen. I thought it was because I was on the bus and couldn't move around for an extended period. When I arrived at the bus terminal in Accra, I had to remove my shoes and put on a pair of flip flops. I rested in the bus terminal for a couple of hours before walking to the guesthouse, which is not far from the terminal. After checking in, I rested in the air-conditioned dorm for the whole day. I did not eat lunch or dinner. I ate nuts and biscuits that were in my bag.
The next morning the guesthouse staff came to my dorm and offered to bring me breakfast because I was too weak to even get out of bed. I noticed that there was a 1" diameter blister on my right foot. One of my dormmates was an American girl who was studying medicine at the local university. She thought I had a parasite in my foot and advised me to seek medical attention soon. After managing only a sip of juice and a bite of scrambled eggs, I vomited violently. The ladies came back to get the tray. They were worried and called their manager. Within half an hour, I was carried out by two men to a taxi waiting outside the building. One of the men accompanied me to a nearby private hospital. I sat in a wheelchair in the hallway next to the Emergency Department for nine hours before being admitted to a ward. By that time, the blister had turned completely black and covered half the surface of my right foot.
There was no air-conditioning in the 6-bed ward. The other occupants kept turning off the ceiling fan which was directly above me. I was feverish and had no water to drink for the whole day. Late that night, a nurse came by with a pair of scissors and cut open the blister — without, I believe, even sterilizing them. Blood and lymphatic fluid came pouring out. The nurse eventually put a stainless steel pan underneath my foot after I exhausted the supply of absorbent pads. The wound was left open for hours before she came back to dress it. I was then given antibiotics and painkillers by IV. I was able to purchase bottled water from another nurse after midnight.
In the middle of the night, I needed to use the bathroom. I rang the bell at least five times. Nobody came. I struggled to get up, carried the IV stand, and navigated an obstacle course to the bathroom. Visitors were asleep on the floor, blocking the path. After breakfast, technicians came by to take my blood. I protested because they were supposed to take a fasting blood sample. Apparently the technician could not tell the difference between a fasting blood sample and a regular blood sample. Swelling and skin redness continued. The pain in my leg did not cease. Drainage from the wound remained heavy.
The next day, during the doctors' rounds, the chief surgeon told me that my wound was caused by diabetes and being overweight. I disagreed, stating that though I was overweight, I had never been diabetic. He then suggested it could be Cellulitis.
I also informed him that I was still feverish. He changed the prescription. I was not convinced that I was receiving proper care in this hospital, so I signed a waiver and got discharged after paying the $700 CAD bill with my credit card. I returned to the guesthouse around lunchtime. The staff told me there were no dorm beds available. I had to stay in a private room.
After washing up and having something to eat, I did a lot of research online. I also sent out frantic messages to people who might be able to help me. Nobody responded except one. My Spanish friend, who works at the WHO, recommended a doctor at the University Hospital. But that hospital is further away. Because the AC was very strong in the private room, I had a good night of sleep. The drainage from the wound was still heavy.
The next morning I went to the Outpatient Department of Ridge Hospital (Accra Regional Hospital) with a small bag of toiletries. I was counting on getting at least a new dressing. If I happened to be admitted to the hospital, I would have the essentials with me, unlike two days before. Before a nurse would change my dressing, I needed to consult with doctors for my first visit. I was seen by a team of three doctors after waiting 1.5 hours.
The more senior doctor on the team told me I should be on aggressive IV antibiotic treatment for a week. I bargained with him, stating that I had a plane ticket to return to Canada on March 24th. He warned that if I delayed treatment until returning to Canada — two weeks away — he would have no choice but to amputate my right foot before I could leave his care. From that moment, I knew something was seriously wrong with my right foot.
Unlike the private hospital, this public hospital does not accept credit cards. The cash I had on me was only sufficient for one day of antibiotics and some painkillers. When the antibiotics ran out on March 12th, I begged the ward doctor on duty to let me have a one-hour leave so I could take a taxi to the nearest ATM, just a couple of kilometers away. He would not let me go. I was put back in bed with my right leg elevated above the rest of my body.
The following day there was only Paracetamol in my IV. I was secretly taking the oral antibiotics I had gotten from the private hospital. After the second meal of the day, I was burning up and drifting in and out of consciousness. Around 10 pm, one of the two younger doctors from the Outpatient Department came by to check on me. I remember telling him I might not make it through the night. I urged him to harvest my organs as soon as possible after my demise. I wanted to give my kidneys to the young lady sleeping in the bed across the corridor. She was waiting for a dialysis session. Her brother had been scrambling to raise enough funds for even one session.
The next morning I woke up still feeling weak, but somehow the redness and swelling had stayed at the knee level on my right leg. The skin on my right calf had become shiny. Around 1 pm, the young doctor came back with a box of antibiotics, painkillers, and dressing supplies. He told me he had arranged an account with the Hospital Finance Department on my behalf, and had gone to the pharmacy to pick up the supplies after his shift. I could have kissed him, except I was too weak to even sit up.
The antibiotic treatment continued for another four days. Dr. Richard would come by to see me every day. Drainage remained heavy but the dressing was only changed every other day because very few nurses knew how to change dressings. They would come around to take body temperature and blood pressure every four hours and change the IV bags. Fortunately, the ward had central air-conditioning. I did not have to give myself sponge baths daily. Though the bed sheets were badly stained with drainage from my wound, they were only changed on the fourth day — and even then, there were no clean replacements. I was sleeping on a vinyl surface for two more days before I signed a waiver and got myself discharged from the hospital.
After the IV tubes were removed from my arm, another doctor offered to drive me to the closest ATM. I knew I would be strong enough to leave the hospital. I would be better off staying in the guesthouse as long as I kept my right foot elevated and took oral antibiotics at regular intervals. The pain was constant whether I took painkillers by IV or not. I paid the $500 CAD bill for my 6-day stay with cash, signed a waiver for early discharge, and left Ridge Hospital on March 18th. I returned to the guesthouse and a dormmate helped me install a sling for my foot. Except for one day when the guesthouse was full, I stayed there until I returned to Canada. Every other day I would go to the Outpatient Department for a new dressing. I would have bandaging from toes to knee. An infected mosquito bite wound on the side of my calf never healed and had to be covered too.
During my transit from Accra to Vancouver, my foot swelled up and the skin became very red again. After arriving at YVR, I went directly to Burnaby Hospital. After a series of tests, I was hospitalized and put on IV antibiotics again for the reinfection. I was in the emergency ward for another two days before being transferred to a ward. Despite being admitted, the nurse in charge soon insisted I leave. I went back to my friend's house. I was told to report to the Outpatient Department for dressing changes on alternate days, even though drainage was still heavy.
I was staying at a friend's house four blocks from Burnaby Hospital. A homecare nurse was supposed to come to change my dressing on alternate days. I became a training subject. Several student nurses came with their instructor to perform home care on three different occasions. That routine continued for another week or so, until one night I had a high fever and was in severe pain. I had to go back to Burnaby Hospital. I was in the emergency ward for a few days before being admitted to a ward. Nurses there did not know how to dress my wound, so again I was told to go home after a couple of days, in spite of the redness, swelling, and heavy drainage. Before the head nurse discharged me, I spoke with a social worker. My friend did not want me to stay in his house any longer. He was unhappy with the homecare teams. The social worker was unable to find me a temporary place to stay.
My "friend" wanted to charge me $1,200/month. He also asked for sexual favors. I ended up paying him $887 for the three-week stay and the airport pickup. He attempted twice to have sex with me. From then on, I would walk to the Outpatient Department for a dressing change on alternate days. I was very lucky to have two nurses who would debride my wound at each dressing change. The debridement was done without any local anesthetic. They would engage me in deep conversation during the procedure. The swelling and redness finally subsided after four debridement sessions to remove all the dead, leathery tissue.
In the last week of April, I found a place in Vancouver to stay for six months. My file was transferred to a community clinic near my place for wound care, along with weekly appointments with specialists at Vancouver General Hospital. By the time I was about to move from Burnaby to Vancouver, I had been given all kinds of antibiotics, both by IV and orally. The size of my wound had not decreased. The Burnaby Hospital dermatologist finally called the day before my move to arrange an appointment. If I had waited for the dermatologist to debride my wound, I probably would have gotten a couple more reinfections. I did send a letter of appreciation to the Administration of Burnaby Hospital praising those two nurses who performed the debridement.
I had not taken a shower since March 9th because Pseudomonas Aeruginosa had been found in my wound — a bacterium people typically contract from unsterile surgical equipment, like those scissors in Accra. I was suffering the consequences of that negligence two months later. The Infectious Diseases doctors at VGH ordered a biopsy on my wound and the infected mosquito bite on my calf. The resident doctor in the operating theatre got a little overzealous and removed too much tissue from the bite wound. He had to put seven stitches in that wound to stop the bleeding.
Because of the mishap with the biopsy, the remaining source of infection was eliminated. From then on, my wound began closing steadily. I stopped taking antibiotics near the end of May. I was still taking painkillers three to four times a day. When my file was transferred to VGH, I also became a case study for medical students from UBC, especially those considering Dermatology as their specialty. Since they had not seen the dead tissue, I gave their instructor a copy of my photo collection documenting the wound from March 10 to May 9. The senior Dermatologist recommended a skin graft. He told me it would take at least six months to completely close if I chose not to have one, but that the graft would likely reduce healing time by about 50%. I signed up for the skin graft. When a Surgery resident called me in mid-August, I cancelled the booking because I was flying out of Canada two months later.
To this day, I am still amazed that a common bacterium like Streptococcus A could create such havoc — and even prove deadly if not treated promptly. I hope that by sharing my experience, I might save someone from dying of Necrotizing Fasciitis. By the way, the mortality rate of NF is 25–35%.
