A few weeks ago I noticed a lump/bulge that was slightly painful. I assumed it was an inguinal hernia and went to the doctor to have it confirmed, or diagnosed as something different. A physical exam and an ultrasound confirmed that it was in fact a hernia, albeit small. It was at that moment that I was faced with quite the dilemma: do I operate? And if so, where?

I had a hernia repaired (on the opposite side) back in 2009. I remember I was extremely frustrated with Peace Corps because they were making me have the operation in order to serve as a volunteer. At the time, I was in great physical shape and didn’t have any pain or notice that I had a hernia. It was only during a physical that the doctor noticed that I had one and the look on his face after he marked it on the form seemed slightly regretful because he probably knew that I was going to need to deal with a bunch of medical bullshit that might be unnecessary. Needless to say, I had the surgery (I wanted to go into Peace Corps and I didn’t want the hernia to get worse later on; I also had medical insurance at the time).  After the surgery and the following months, I went from being extremely healthy to feeling weak and unable to move.  As time passed, however, I regained my strength and I feel that it was a good decision to have the operation.

However, this time around is completely different. First off, I noticed the hernia and it was painful to touch when I found it. Although walking wasn’t an issue, I didn’t want to be out in the middle of nowhere in Madagascar for work and then all of a sudden have a problem. I needed to look into options to have it repaired.

Searching around and talking with people I decided on the Lutheran Hospital near where I’m staying. I had met the surgeon; saw the facilities and I liked the idea of the close proximity to my house.  I also wanted to get this done with quickly because I was still on Peace Corps health insurance and I might be able to be reimbursed (I think I should). Interestingly, safety and recovery aside, the cost of surgery in Madagascar is much cheaper than it would be *with insurance in the United States.  Moreover, I know for a fact that if I didn’t have any kind of health coverage and was living in the United States I probably would try to ignore my symptoms because of the crazy financial costs.  Makes you really wonder about your health. In addition, the surgeon that would do the operation spoke very good English (nice to have a clear explanation from time to time) and had 18 years experience. On June 14th I went in to have the operation.

I’ve done a lot of integration over the past three years. Not a lot surprises me or makes me feel uncomfortable in this country. I don’t know if I have a skewed sense of normal or if I just don’t care about some things that aren’t ‘appropriate’ or ‘proper’ by Western standards. It doesn’t mean that I start acting like that, but it does mean that I’m not affected or offended by it. However, I think I wouldn’t have been comfortable with getting surgery in Tana three years ago. I think I would have been more worried about everything.  I still haven’t decided if that’s good or bad that my views have changed. Just the thought of going into a hospital alone, being a complete outsider or foreigner, and then really being as vulnerable as one can be once they paralyze your legs and start cutting you open; not a lot of people really would go for that. Personally, if I didn’t feel I had to, I wouldn’t have gone for it either. However, it really seemed like the best decision. I have so many things going on and starting up here that it really didn’t make sense to put all of those things on hold or change them entirely just because I have a health issue that hundreds or thousands of Malagasy people have every year and can be repaired with minimal complications.

So, I showed up bright and early and went through the next day of intense integration, learning, and healing. First, nobody decided to tell me that I would need an enema before the operation – I was a little caught of guard. When the lady came in with the bucket of hot water and told me that I needed to take my pants off I thought, well, ok; not really sure where this is going. However, when it was time to lie down on the bed and then role over, and the tube in her hands was being unrolled, realization of what was happening set in real fast—“Oh…” I also thought it interesting that I had to keep asking the lady to shut the door as other people in the hospital might not want to see what was going on. She seemed a little put off by my request either because she wanted to be rude to me or she was upset that I was calling her out, but in between flushes if there was anything I felt I needed to say you better be damn sure I said it. It was soon after that that I realized that the privacy in a Malagasy hospital, although they are conservative culturally, is nearly non-existent, mostly because it’s not important. They see naked people all the time, what’s the big deal? It’s only in a Western hospital that we freak out about all that nakedness. So, I’m just a normal person too…just slightly more noticeable.

I had local, spinal anesthesia rather than general. I would never make that choice again in my life. I want to be put to sleep. I hated the feeling of being paralyzed and I really didn’t like being conscious during the operation, even though it didn’t last that long. I also had extremely low blood pressure during the surgery so that didn’t really add to my comfort level. After surgery, it took me about 4 hours until I could move my legs and I really didn’t like that feeling of helplessness.

Once I was out of surgery, everyone was really nice and did their job to check on me. What really amazed me was that I was able to arrange for someone to watch over me at the hospital because I didn’t have anyone to go with me. This man, who works at the administration office of the hospital agreed and just showed up after work and sat in my room. We talked, he fixed the bed, he brought me food, he woke up whenever I needed something and he slept in the chair next to my bed. It’s amazing to think of a person being that nice. I obviously gave him money to thank him for helping me out, but he wasn’t even going to ask for money. He simply was helping someone sick. I’m sure there are people like this in the United States, but I feel like they are few and far between. There’s something very admirable and humbling to see someone have such a good heart and want to help another human being just because it is morally the right thing to do.  If heaven exists, it might be safe to say that he has guaranteed his spot.

Over the course of my first night in the hospital it became apparent that I AM THE VAZAHA! Really, I thought being in Tana I might lose my allure, but no, I’m forever blessed and cursed. Everyone in the hospital soon knew about Nicolas (say it like you’re French), the vazaha at the end of the hall who had surgery and could speak Malagasy. Everyone seemed to be both curious and proud in a way. A few even wanted to practice their English skills. I don’t think there are a lot of foreigners who have a serious medical operation at a Malagasy hospital. In a way, it was a chance for a few of the medical providers to shine and show me what they were capable of, in others, they only showed me what I feared and thought might be the case. Regardless, the operation ended, with the bad and the good, and I was able to leave the hospital after the first night.

After the first day, I thought I was going to be in the clear except that I started to get a headache. As a result of the anesthesia and the needle in my spine I had a horrendous headache that wouldn’t allow for me to stand for very long. In fact, I spent about five straight days in bed only leaving to go to the bathroom, never even venturing outside. I had to lie down to eat my meals because sitting was unbearable as well. This was the worst headache I’ve ever experienced in my life, truly debilitating. Trust me, I was wondering if having the surgery was a good idea or if I had made some horrible mistake. Online it said it should last a day or so, the doctor originally told me three days, when day five hit I started wondering. However, improvements happened, though they may be slow, and I’m now able to walk around a bit. I’m still very weak, but I am getting better.

I read on the Internet that caffeine and fluids can help alleviate the headache.  I know that the hospital doesn’t do the blood patch for the spinal fluid leak and I was pretty sure they didn’t have any caffeine to shoot into my veins. So, after five days of not really getting better, I turned to caffeine for my savior. No, I still don’t drink coffee, but I chose black tea. I really made an effort to drink it down and whether it was a placebo or not, I started feeling better. Probably a combination of hydrating my body, flushing out my system as well as the caffeine intake that got everything moving in the right direction and beginning to heal. In some ways I wonder if it is because I’ve stayed away from caffeine for so long that it had such a positive effect on my body or if it is just coincidence.

In a way I do feel that my old repaired hernia area is stronger now after surgery. It took many months before all feelings of discomfort dissipated, but for the most part it feels good. I remember that three weeks after my hernia surgery in 2009 I started digging out a hillside for my brother’s carport. I’m hoping that this one will heal quickly as well and that I won’t have too many issues in the future. I think I’m going to take a little longer rest with this one just because of the location and lack of medical facilities in Madagascar. Oddly, I do like the idea that I have two scars instead of one. Although, I really hope that I don’t need to get any more stitches for a while…

I couldn’t really do much other than sleep and watch an occasional TV show while I was in bed, but I did try to make some progress on all of the CRS documents that I was given as well as study some French. The more I look into the work the more I realize that I am going to be VERY busy. But, I think that’s a good thing. I need something to pass the time and it will be good for me to have a project that I am constantly working on, but the fear of burnout or failure does exist. No need to worry to much as I haven’t even started work yet, but just getting mentally prepared. Overall, the more that I look into it the more that I think this will be a very good experience for me.

I still don’t have my new visa, which is another stress. The guy from the office called me and said he needed my old passport that had the old visa. So, of course, on the first day that I could actually stand for more than five seconds I pounded a ton of fluids and made the venture out to the other side of town. About two hours and two buses later I managed to get to the office. And he got the passport. I should have my new visa by next week. Really, now that the surgery is over this has been my biggest stress. Yeah, I could go on vacation, but I don’t really want to go on vacation just so I can get a new stamp in my passport and more time to get a visa. I don’t know the exact dates, but I should be going to Androy (deep south) next month, which I’m really excited about.

Before the surgery I managed to set-up a bank account.  Apparently, because I had to close my account with Peace Corps, Bank of Africa usually makes a person wait two months before they can re-open an account. However, I simply stated what was happening and that I really didn’t have two months to wait for money. Although what I had to say was rather simple, it took a few trips and a lot of talking, but I managed to get everything squared away. I have to say that the people who I spoke with in the bank seemed pretty competent and really did seem like they wanted to help me out.

I move into my new house next Thursday. I met all of the roommates a few weeks ago and they all seem very nice. I’m really excited to be living with all of them. It’s interesting because I’m going from having all country Malagasy friends to living in a house with eight foreigners. I think it will be a good change of pace and more than anything it will be nice to have a social group since I’ll be out of Tana a few weeks every month.

Altogether the last few weeks have really made me think about life. I remember all of the pains that I had to deal with before coming to Madagascar. It seemed endless and at many times I wondered if it was worth it, was I making the right decision? Three years after the fact I’m thrilled that I made the push to come to Madagascar. I just keep telling myself that these stresses and ailments are just other roadblocks on the way to something else that I will truly love and enjoy. I’m excited and optimistic for the future.