How I survived Necrotizing Fasciitis in 2019.

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%.

Art of Spuddling

 

I was delighted to learn a new word on Facebook a couple of weeks ago: spuddling. Although it sounds faintly derogatory, it describes my current lifestyle with remarkable accuracy. In fact, I sometimes think I could write a book on the subject.

After deciding to retire early in 2011, the course of my life changed irrevocably. At first, I was bored out of my mind. I went from juggling multiple jobs and studying constantly to a barely simmering existence. I did not appreciate this newfound freedom. Instead, I searched for activities that would make me appear busy to the outside world. Gradually, however, I turned inward and focused on simplifying my life and improving my health.

By the summer of 2013, my possessions had been reduced to a few suitcases of clothing, several boxes of books, and a handful of miscellaneous items. I had lost about 20 kilograms and was fitter than I had been in a decade. On the advice of a nutritionist, I cut down on processed foods and began cooking more often, despite having little natural talent for it. I quickly discovered that cooking, even when done imperfectly, is a surprisingly time-consuming activity.

In early 2015, while caring for my mother, I learned about brain plasticity and the complexities of stroke rehabilitation. Outside of caregiving, I studied theology and philosophy independently, content to learn without pursuing another degree. I taught myself philosophy with no timetable and no pressure. Around that time, I also began sewing my own clothes using my mother’s sewing machine, eventually realizing that I needed far less than I once thought to live comfortably and happily.

After returning from East Africa in April 2016, I was informed that my caregiving services were no longer required. With even more free time, I began volunteering at community events, particularly during the summer months, and adopted a regular walking routine. I briefly considered finding a companion, but my long-standing solitary habits made small talk and relationship demands difficult to sustain. I experimented with simple cooking and baking again, but none of these pursuits held my attention for long. I came to understand that my spuddling lifestyle did not blend easily with conventional socializing.

Since 2013, I have spent roughly half of each year living and traveling outside Canada. During these nomadic periods, my time is fully occupied with exploring and experiencing new environments. Documenting my travels has become my most enjoyable activity, and I have yet to grow weary of it. Although I once planned to leave social media behind in 2018—seeing it as a wasteful reminder of a competitive, dog-eat-dog society—I reactivated my Facebook account during a later journey through West Africa. I now use it intentionally, as a platform to educate and entertain, even though it brings me little personal joy.

In addition to volunteering, I have participated in research studies since 2016, sometimes receiving an honorarium, sometimes not. I choose studies that interest me and have real-world applications, avoiding long-term commitments. My only request is to be informed when the findings are published. While I am not part of academic circles, I make a conscious effort to stay informed about current research.

The COVID-19 pandemic temporarily eliminated the volunteering aspect of my spuddling lifestyle. During lockdowns, I returned to cooking and baking—this time with greater success, thanks to daily practice. I gravitated toward fusion dishes rather than traditional recipes, using food as another outlet for creativity. Around the same time, my interest in integrated solutions for climate change and renewable energy resurfaced. I repurposed and recycled discarded items from my neighborhood and learned to adapt my activities to better match my natural aptitudes.

Many of my friends continue working full-time well past the official retirement age, fearing boredom and a loss of purpose. My response to them is simple: I have been having the time of my life since retiring in 2011. I am free to satisfy my curiosity, to help others, to live mindfully, and to pursue knowledge without urgency or obligation. I even have time to write, reflect, and share my thoughts creatively. In learning how to live without rigid structure, I have mastered—at last—the art of spuddling.

Cuba in early 2022

I visited Cuba from Feb 9 to Mar 8, 2022. Even though I had visited 114 countries before setting foot in Cuba, I was taken aback by the status quo of this socialist country. It was one of the most challenging countries to travel in many aspects.

Soon after booking a hostel in Havana a week before my scheduled arrival, I received an email from the hostel, informing me that I should bring hard currencies such as EUR, CAD and USD to the country to spend. The reason was that there were black markets for these currencies which could fetch 3 to 4 times the official exchange rates. Also, it would be unwise to withdraw money from the ATM's at the airport. Armed with all the USD that I could withdraw from an ATM in Cancun, Mexico, I tried to fly into Havana on Feb 6th. After three attempts with two different airlines at the Cancun airport, I finally arrived in Havana on a scantly filled commercial flight in the early morning hours of Feb 9, 2022. The plane was, however, fully loaded with packages and cargo.

I waited at the airport for a few hours before taking an official taxi to city centre. The ride was 25 USD and I paid the driver with US cash. At the airport, I found out a few things. The state-owned exchange bureau at the airport would not change USD. The state-owned bus company, Viazul, is only operating at about 20% of its pre-pandemic schedule. Tours to various attractions were operating at about 10% of the normal schedule. I saw no more than a handful of independent tourists during my 6 hour wait at Havana Airport. Supposedly, there were TransTur buses running between the airport and city centre 3 or 4 times a day. The ride would cost 5 USD (cash only).

When I woke up from my afternoon nap, I was hungry. I asked the hostel owner if I could find a supermarket or grocery store nearby. He replied that there was no supermarket or grocery store in Cuba. He told me to change my USD with the parking attendant outside. I changed 10 USD for 900 CUP. A French couple showed me where I could get dinner at some local restaurants. I wandered around the neighbourhood for about an hour. I saw people buying and selling from the windows of unmarked houses. Restaurants served food in small portions. My 900 CUP could only get me a plate of food but no drinks. I eventually bought 2 lbs. Of croquettes for 240 CUP. When I returned to the hostel, I showed the croquettes to my host. He shook his head and gave me a plate of rice and beans, salad and salsa. He told me to save the croquettes for another day.

The next day when I visited Old Havana, I was approached by various people to change money. When I walked on a pedestrian street near Parque Centro, most stores were empty and/or locked up. Vendors sold their goods on small stands outside the buildings. By early afternoon, most stands would disappear when the goods were sold. Panderias (bread shops) only opened for a couple of hours each day. Shoppers brought their own bags and lined up outside the bread shops for hours. I also noticed that there was very little garbage on the streets.

There were two young men from Germany at the hostel in Havana eating bread with ketchup for dinner. They had very little cash on hand and would not be leaving Cuba for another week. I helped them by giving them 56 USD cash for a bus ticket they purchased for me online with their credit card. However, that amount of money was not enough for the rest of their stay in Havana. A few days later, they found an expat from France who would give them 85 CUP for every EUR they e-transferred into his French bank account. It was a whopping 20% commission!

Santiago de Cuba was where I found out that Cubans are still on the food rationing system. One day I walked by a shop (bodega) with a huge price list on the back wall. I could still see that there were four eggs left in the cardboard carton on the counter. I asked the shopkeeper if I could buy the eggs. He told me that only Cubans could buy in his shop. The eggs were priced at 2.2 CUP each. When I went back to my Airbnb place, I saw my host eating steak with rice and beans. I later found out why he could have so much food. His house was registered as a "Casa Particular" which entitled him to purchase special provisions at local prices for international visitors. He charged me 8 USD for a chicken drumstick, rice and shredded cabbage on the first day in Santiago de Cuba. From that day onward, I would only eat food that was available to locals only. I would not go to any restaurants. "Pan con Jamon" became my staple food. Within two weeks, white specks developed on my finger nails.

What kind of food was available to locals varied from city to city. The most common form was sandwiches from bread with margarine to fully loaded hamburger. I once had a fish burger at a cart on the street in Matanzas City for 50 CUP. My favourite drink had to be the freshly squeezed sugar cane juice for 5 CUP. I basically ate on the run; sometimes I would eat my personal pizza or sandwich on a park bench. I carried a water bottle, plastic bags and scrap paper in my bag because vendors would not provide any containers.

I asked several locals about drinking water from the tap. The answer varied from "Yes, definitely." to "Drink only bottled water". In my opinion, boiled or filtered water should be fine because Cuba is a fairly big island that contains several rivers. Wastewater is collected and treated before being released to the waterways. It was hard to find bottled water especially in smaller sizes. A 1.5 L bottle cost 17.50 CUP and 4 L bottle 47.50 CUP. Soft drinks were considered as luxury goods. People drank more rum than beer because rum was much cheaper.

Internet became more accessible to the public only in recent years. The state-owned telecommunications company, ETECSA, provides both mobile internet and hotspots in homes and public places. The cost of internet access was average but the transfer rates were painfully slow. Social media websites such as Facebook appeared to have no blocks but other US and UK based websites were all blocked. VPN's were functional only in Havana and Varadero. To call my bank in Canada, I either would have to buy a calling card from ETECSA or call from a cell with a local SIM with a monthly plan. A 13 minute call to Toronto cost me 26 USD when I had to pay my TD VISA using telebanking.

Prior to the Covid 19 Pandemic, tourists could only travel in Cuba in official buses, taxis or rental cars. The trains were running but at a much reduced schedule. For example, the trains between Havana and Santiago de Cuba ran only once every 4 days when I was there. Train tickets generally cost more bus tickets. I was able to ride in collectivos and local buses on several occasions without being caught and fined. City buses and ferries cost 1 - 5 CUP. Ruteros (unscheduled buses) cost 5 - 20 CUP and nobody knew when and where these buses would go. In addition, there are tricycles, horse carts, pick-ups and converted trucks to cover shorter distances. Intercity buses for locals were primarily retired tourist coaches which cost 10 - 20 CUP. I rode in an iconic classic car three times during my visit.

Though serious crimes are uncommon in Cuba, scams and petty theft happen on a daily basis. When you go to the beach, you should leave your wallet and passport in your room. I always had a hat, sunglasses and a face mask on; however, the locals could always tell that I was a tourist. One day when I got off the ferry to visit the north side of the bay opposite to Havana. A local man walked beside me and offered to take me to the hilltop via a shortcut. He tried to be my guide and told me to sit on a bench outside his farm. Then he asked me for a donation to his farm which looked no more than a vegetable patch on the hillside. When I was visiting in Vinales, there were signs all along Moncada Road. These signs would not lead you to the National Park but private properties. I went into one such farm and the farmer wanted to sell me fruits from his farm.

The biggest scam that happened to me took place in Santiago de Cuba. After purchasing a Cuban made linen dress, I thought I would buy a pair of locally made shoes to go with my dress. When a man approached me for money change, I thought what perfect timing, and agreed to change 20 USD. But he wanted to change 100 USD. I showed him that I only had 40 USD. He told me to wait in an obscure corner. He came back with a pile of 100 CUP bills and told me to count. I was supposed to get 4000 CUP but there were only 38 of the 100 CUP bills. He counted the money again and it was 38. From his pocket he pulled out another 100 CUP bill and 5 of 20 CUP bills. He returned the new pile to me and took my 40 USD. I proceeded to a nearby park and counted the new pile of money. I only received 2600 CUP and was shortchanged by 1400 CUP. I never bought the hand made shoes that I had my eyes on for days.

Cuba is one of my favourite countries in the world. I was in a time warp, in a land where there is no excess for four weeks. When I saw the endless sandy beaches in Varadero, I realized that I was living on an island with so much beauty and among some of the most resilient people on this planet.