Article: Pneumonia. Too easy to miss.

It's not just a touch of flu!

"Infected tonsils" the doctor pronounced and instructed the hijab-clad nurse hovering nearby to prepare a penicillin injection. This was NOT how we'd envisaged our visit to the Libyan desert oasis town of Ghadames to proceed. Amber was by now too ill to show much concern, but I was freaking out...

A week before, we'd climbed aboard an overlanding truck in Tunis to begin a journey that would hopefully take us via the ancient silk trading routes all the way to Beijing. Amber had woken with a cough and fever on the day we departed and had been fighting it all the way through Tunisia. The last two rain-sodden nights of camping had seen her go rapidly downhill and this morning when we'd stopped in Nalut to check out an ancient Berber grain store and mosque, she'd been too ill to leave the truck.

We'd figured it was a recurrence of a nasty 'flu we'd both had and were hoping it would clear up soon, but our driver George reckoned it was time to quit self diagnosing and seek some medical attention. Ghadames, down in the desert where Libya meets Algeria and Tunisia, had the only medical facility in 600km. Amber was feeling a lot worse - she was becoming extremely lethargic and seemed to care little for what was happening to her. George was right. We headed for the hospital.

The hospital building itself was reassuring enough - I'd seen regional hospitals at home in Western Australia that didn't present any better. Sure, the portico and lobby were a little dusty, but not bad considering we were on the edge of the Sahara and there were sand drifts across the roads and carparks outside. Alarm bells started ringing when the doctor ordered that injection, though.

With my memory disgorging every horror story I'd ever heard about infections caught in hospitals, I watched closely to ensure that the hypodermic and syringe were coming from unbroken wrappers and that the injection was freshly prepared. I fretted about the things I couldn't be sure of. Was the water they prepped the penicillin with sterile? Was that unadulterated alcohol they were swabbing with?

My stress levels were about to get a big nudge upward. After telling Amber that she was very sick and must follow his prescription to the letter, the doctor turned to me, said "You must give her this twice a day for the next five days" and handed me a box containing everything necessary for a five day course of intramuscular injections. No way - you've GOT to be kidding...

Luckily one of our fellow travellers was a nurse who later showed me how it was done. I'm pretty sure I was more nervous than Amber when I swabbed her thigh for the first injection. I'm also pretty sure she'd tell you otherwise! Everything went surprisingly smoothly until it was time to push the plunger on the syringe. I'd overdrawn it while preparing the injection and it had jammed! Talk about a fumbling first attempt - "Nuuuuurse!" It went better the second time around, but mastering the technique of IM injections never did make me comfortable administering them. It was a huge relief when Amber was able to swap to taking tablets!

It took a while, but the antibiotics eventually nailed Amber's illness. Back home many months later a doctor - horrified to hear Amber had received an injection in a Libyan hospital - ordered blood tests. The results gave an all clear, but the doctor told us it was almost certainly pneumonia, not tonsillitus, that Amber had been suffering.

We were doubly lucky. Pneumonia is a condition which can quickly become life-threatening if left untreated and antibiotics are the appropriate treatment for the most common forms of the disease. The symptoms of pneumonia, as in Amber's case, often mimic those of a bad cold or flu, with a persistent cough, fever with sweats and chills, and chest pain that fluctuates with breathing being the most common.

Pneumonia can be caused by a wide range of pathogens. The most common types are bacterial, viral, and as a result of infection by the mycoplasma organism, which is common among children and young adults and spreads easily in crowded environments like aircraft and transport hubs. Luckily the symptoms of this type of pneumonia appear more gradually and can be quite mild. Often a person with mycoplasma pneumonia will not be sick enough to seek attention and can recover without ever being aware of having had the disease.

We were surprised to learn that even partying is a risk factor for pneumonia: The effects of alcohol can result in aspiration pneumonia if vomit is inhaled. Aspiration pneumonia can develop when just about any foreign matter (including water) enters the lungs. We had no idea that a day spent tubing the river bars and enjoying the water sports at Vang Vieng could present such potential hazards!

As we discovered, pneumonia is all too easy to develop and often difficult to diagnose. If you ever find yourself suffering persistent, inexplicable flu-like symptoms, or suddenly feel worse after getting over a cold or flu, it's worth a check up. Especially if a lasting high fever with sweats and chills is present.

Three months after our visit to the hospital in Ghadames, Amber's hair started falling out. She lost heaps and was sure she was going to wind up bald before it was over. She didn't, and the hair she lost is growing back now. The GP who ordered her blood tests told us that the hair loss was directly related to the pneumonia and that it indicated her body was stretched to the limit fighting the disease. He reiterated how lucky she was that she sought treatment when she did, but couldn't suppress another shudder at the thought of that treatment being in Libya.

We're just grateful. The folks at Ghadames were attentive and kind and wouldn't accept a cent from us for the treatment and supplies they provided. I'd like to think it was a communication rather than diagnosis error that had us believing Amber had tonsillitus, but in the end it didn't matter - she got the treatment she needed. Next time we'll think twice before assuming that fever and a nagging cough is nothing more than a flu relapse!