The unexpected crossing from Pakistan had been pretty rough as the scrape on my rigging indicated. I knew it was the wrong time of year, but having traded for all the goods that could be safely stored, my only thought was to leave Karachi’s teenage thieves and pickpockets in my wake. Now, the seas have finally settled down and become much less violent. Sailing under full sail on the old one and she was making 8 knots. The dolphins and the sea were my only company. Now, he would sleep with one eye open for a few minutes while nothing flashed on the radar screen. Thoughts of noteworthy medical cases, foreign lands, and seafaring intertwined in my dreams.

When I was 87.3 nautical miles off the east coast of Africa, I received a satellite call. An old acquaintance told me in a very anxious tone of voice that he had tried to call many times and was now desperate to tell me about a perplexing medical problem. Satellite phone dead… No bars… I went to climb the mast hoping to get a signal. All 5 feet swell and the constant rocking throws me like a rag doll. I forgot my safety strap in the rush. Uploading had never improved a signal before, I finally realized, why should I do it now? An unplugged Direct TV satellite dish on top of my mast would improve my reception just as much. I came back battered and bruised to reflect on my friend’s dilemma.

All of this was wildly out of character, to say the least, for the man who once helped me treat some of the strangest foods and diseases in all of Africa. Perhaps it involved him or a family member, causing him to lose perspective. No… he was always objective and very professional, hiding the tears that he constantly wanted to shed. He was puzzled. Finally, at 13:27 I got in touch with him to set up a meeting!

Waiting for my friend from Magongo to arrive, I sat in a dark open bar in Old Town, Mombasa. The sitting sun was huge as dust particles inland refracted and magnified the red-orange hues over Kilindini Harbour. Dirty ceiling fans turned slowly, circulating dust that could be seen through the rays of light. You could feel yourself breathing in the moisture and sand. All was silent except for the occasional clang of a bottle, the whirling of fans, the sound of wood hitting the floor, and music. In a candlelit corner, an old man in a worn and tattered pareo danced to the music of Luo Ben with a one-legged lady who could still turn and bow with her only crutch and peg.

My nervous colleague arrived in a tuk-tuk after taking the matatu bus to the Old Harbor roundabout. He seemed very frustrated. We exchanged formalities and I escorted him to the stool next to mine. I urged him to tell me about the source of his anxiety. He got googly-eyed once he sat down next to me, and it took several Mojo to calm him down.

Apparently, on the very stool he was now sitting on, a well-dressed man entered and began to talk to him about the local poaching problems, of which there were many. The conversation went on for several hours. The man continued to elaborate on various topics of national and international interest. As he drank another beer and changed the subject to the recent assignments of ivory wood and iron, his little finger fell off without the gentleman noticing. My friend jumped at this point in our conversation and pointed to the bar saying, “Yeah. Right there where you’re sitting, his finger fell off!” Sitting back down, my friend said the man walked away undaunted and now left one of his toes on the hardwood floor. My friend began to draw his attention to the fact that not only had he left his toe on the bar, but now he was gone and left his toe too! He, however, was too stunned at this point to comment.

My dear and bewildered friend asked me for my opinion on this tragic event. To allay his fears, I suggested that he (my friend) might have had an acute psychotic episode that required immediate neuroleptic medication, confinement to a nearby ward, and intensive psychiatric counseling. That didn’t help, of course!

Well… I said, “Did he have some kind of rash?” “In fact, yes, he had pale, discolored patches and bumps on his hands and I also noticed it on the bottoms of his feet when he crossed his legs.” “He also had difficulty seeing and kept sobbing.” Puzzling, I thought. I asked, “You certainly wouldn’t have brought up the fact that he was powerless during your conversation about poaching, would you?” “Well… he did, but only compared to the infertile white rhino.” “Did you keep throwing the glass?” “Yeah, how did you know that?”

“From what you tell me and given that he was an African male with visual loss and digital loss, impotence and a discolored rash, he obviously had a Mycobacterium leprae bacterial infection.” Said. My friend pondered the statement for a while, but was finally relieved by my thoughtful diagnosis of leprosy and the assurance that he was not in danger of infection or, more importantly, impotence.

We then moved to a couple of wicker chairs at a torchlit corner table and proceeded to drink tea and talk in Swahili with the locals. I must admit that he may not have believed me completely because he continued to count his fingers and toes for the rest of the night.

Leprosy or Hanson’s disease

The oldest known writing about this bacterial infection is found in Egypt in about 1500 BC. It is also mentioned many times in the Bible. Throughout history it has carried with it a certain stigma. Patients were often isolated as were tuberculosis patients and this is still the case in some countries. In other cultures, they were forced to wear certain colored clothes and ring bells when they went down the street so that people could avoid them. All kinds of causes were postulated for their condition and misery. Sorcery, family curses, punishments for past events, etc… were just a few. Unfortunately, the victims of this condition suffered tremendous psychiatric and emotional damage due to their denunciation by society.

Leprosy is an infection that primarily attacks the peripheral nervous system, that is, not the brain or spinal cord. It can cause numbness in the hands and feet, as well as weakness, often resulting in a floppy wrist or foot. With repeated trauma to these areas, fingers and toes can fall off, unbeknownst to those affected. There are usually small or flat discolored rashes on the affected areas, chronic cough due to mucous membrane involvement, and sometimes vision loss.

The usual age of onset is 20 to 30 years and it is more common in Africa, India, Nepal and Latin America. Cases are not unknown in the United States, but these are usually recent immigrants.

As far as we know now, you cannot get this infection from casual contact or by touching the lesions. It is usually due to close contact with infected respiratory secretions or mucus over a period of months or even years. Other sources or carriers are thought to be infected soil, armadillos, and possibly mosquitoes and bed bugs. From the time of infection to the time of onset of symptoms, it usually takes between 1 and 7 years.

Diagnosis is based on the symptoms present, the type of lesions, the areas of involvement, and microscopic examination of the lesions. These bacteria cannot be diagnosed by blood tests or cultures.

Treatment consists primarily of the use of dual therapy with a combination of dapsone and rifampin for long periods of time, if not lifelong. Other pharmaceutical therapy is available.

So… If you’re going to sail to Mombasa soon to see the biggest sun you’ve ever seen… please take note of the number of digits you have before and after.