An aedes aegypti mosquito carrying dengue fever, NYTimes

During my holiday in Indonesia I unfortunately got dengue fever, to be more precise the Dengue Hemorrhagic Fever (DHF). Initially, I thought it was just a disease and I was quite optimistic. I will get better in two or three days I thought… I was a bit too optimistic back then. Below I will share my experiences and tell you about the slow recovery process. Hopefully it will give people a different perspective about what dengue can actually do with your body and life. It’s more than ‘just’ another disease.

For those who don’t want or don’t have time to read any further. All I want to let you know is that dengue is a highly underestimated disease and it can take months if not years to recover from it. So please be warned and keep it in mind when traveling to mosquito-friendly countries. Dengue fever comes in many forms, some are not that severe others are simply lethal. Unfortunately, at the time of writing there is no medicine or treatment available for this disease. So again please be warned, don’t be too naive and let a mosquito ruin your holiday and the months that follow thereafter.

A little bit about me

I’ve been visiting Indonesia for several years now. My bond with Indonesia is quite strong since I have my roots there and my lovely girlfriend Maria from Indonesia. I never had problems when going to Indonesia, I could eat and enjoy the street food and just walk outside on the beautiful beaches in Karimunjawa (or any other island) or on the crowded streets of Jakarta. This year however, things turned out a bit different. I got some serious problems when I got dengue fever. Me, sick?! I could hardly believe it. I haven’t been sick for a very long time. I don’t want to brag about my health, but I thought I was living quite healthy. I went to the gym 4 times a week, had a diet with spinach smoothies, blueberries, grapefruits, nuts, seeds, yogurt, chia seeds, broccoli soups and all other healthy stuff. So yeah, I was quite surprised when I got sick.

My 7 days experience at Borromeus, an Indonesian hospital

I was on my way to Bandung to visit my girlfriend’s family. I can still remember this day, Thursday the 5th of May 2016. We were traveling with the train from Jakarta. Suddenly I felt very tired and slowly my headache became more apparent. I initially thought I had some kind of small flu or maybe I ate something wrong. When we arrived in Bandung I took some paracetamol and tried to stay awake, but I couldn’t I was too tired and decided to go to bed early. I felt quite sad, I traveled that far to see my girlfriend’s family again, but I couldn’t really enjoy the family reunion. The next morning when I woke up my head was hurting really bad, I had lots of pain behind my eyes. It surely didn’t feel like a normal headache, it was the worst headache I ever had. Besides that my head felt hot (‘panas’ as they say in Indonesia, a word I simply won’t forget after hearing it so many times), most likely I already had high fever. Also my tongue was whiter than normal. My girlfriend and her family suggested me to go to the hospital in order to find out what I had. I was still optimistic and stubborn, I told them let’s wait a few hours and see what will happen, probably I will get better. I tried to sleep, but I couldn’t. I was sweating and my headache was really horrible. My condition wasn’t getting any better, In the late afternoon I asked if someone could bring me to the hospital. When I tried to get out of bed I felt very weak, I was dizzy and my head was hurting. I had a hard time walking to the car. We were going to one of the best hospitals of Indonesia, a catholic hospital: Rumah Sakit Santo Borromeus

RS Santo Borromeus, Bandung

Day 1 – After two hours of driving we finally arrived in the evening at the hospital. Initially, I was a bit skeptical about going to a hospital, especially abroad. My girlfriend assured me it was a good hospital and I shouldn’t worry too much. When I walked inside the hospital it looked really clean and well organized. Quite similar to what we have in the Netherlands, perhaps even better than some hospitals in the Netherlands.

Inside RS Santo Borromeus, Bandung

A doctor and a nurse were examining me at the hospital. For medical diagnosis they needed some blood samples. It took about 1 hour to get the results. I was still optimistic and hoping for the best. I was pretty confident, I was healthy and I had all the necessary vaccines already. What could happen, right?! After 1 hour of waiting they told me that I had dengue fever. Huh, what?! I was a bit shocked and surprised. They told me that they wanted to monitor my condition daily and that they need to take daily blood samples. They asked me if I wanted to stay at the hospital or not. I decided to stay, because I was not quite sure if I could drive 4 hours every day back-and-forth from my girlfriend’s parents place to the hospital and in case something happened I would get immediate help. Later on I realized that this was definitely one of the best decisions I’ve ever made in my life! I can still remember my girlfriend’s mom joking about the fact that I didn’t wanted to stay at their place and that I found a better hotel room. We all could still laugh about it. I decided to take a shared room, since it was cheaper and I didn’t expect to stay that long. They gave me an infusion, apparently it was quite serious. On my first day at the hospital I didn’t get much information. Not knowing what you exactly have can be quite frustrating. So I asked my girlfriend to get my phone and look for more information about dengue. After having absorbed all the information I was a bit less worried, even though I read that some people can die from dengue. I figured out that dengue fever usually has a 7 day cycle. So all I had to do is survive those 7 days, how hard can it be, right?! I was trying to mentally prepare myself and get some rest. Note that I was lying in a bed in a shared room with about 5 other people. It was quite hard to get some sleep, since the lights were turned on all the time and there was lots of noise in the room.

Day 2  – I only slept lightly for a few hours, I felt tired, very weak and my head was pounding. I still had this severe headache. On top of that my bed was completely wet, I was laying in my own sweat. Eating, drinking, going to the toilet, washing and all other simple tasks I simply couldn’t do without help. Early in the morning around 6:00 AM my doctor appeared at my bed and told me what I had and what I should do. He told me to take lots of rest, keep eating and drinking. He also prescribed some medicines for my headache and nausiness. This was my first full day at the hospital, it was a very long day. I couldn’t do much, I was just laying there and had not much energy to do anything at all. Some now and then I woke up and tried to drink and eat, but it all tasted really weird, it had no taste at all. I tried to make a quick phone call to my parents, just to let them know I was kind of ‘fine’. I managed to say some words, but it was really tiresome for me. All I wanted to do is sleep. Since I couldn’t really sleep in this shared room, I asked for a smaller room for two people. In the evening I was transferred to a separate room. I was relieved and happy, because I knew it would help me to getting my much needed sleep and rest.

Day 3 & 4 –  Things got a bit worst, I was getting more and more tired. My joints and muscles started to hurt really bad. I felt I was lying on a concrete bed. On top of this I still had fever and severe headache. The worst part was that my thrombocytes (Platelets) in my blood were further decreasing, my platelets were around 80,000 per cubic millimeter. Thrombocytes is an important component in blood to stop you from bleeding. If those values are getting too low you will get internal bleeding and your internal organs might get damaged. My values were way below average. Healthy people normally have between 150,000 to 450,000 per cubic millimeter of Platelets. Things were not looking good. My doctor and girlfriend kept saying, that I was fine and everything was ‘stable’. I was not really sure about this… From day 3 things started to get a bit blurry for me and I didn’t have the energy anymore to process all the things that happened around me. It feels like you are slowly dying from the inside out. Although I do remember the daily rituals. First I had my doctor visiting me between 5 and 6 AM. Between 8-10 someone would collect my blood, clean my bed and bring me my breakfast. About every two hours I had temperature and blood pressure measurements. Around 9:00 AM someone would wash me in bed. Between 12:00 and 13:00 PM I would get my lunch. Since I was in a catholic hospital I also got visited by a priest, usually they come around 5:00 PM. When they enter the room they usually sound the bells and walk to your bed while holding a candle lantern. First they will ask your name and then give you some blessings. It was an unique and unforgettable experience, I’ve never experienced this before in my life. Every time when they entered the room it felt like I was back in the middle-ages, the whole setting was calming and soothing. Unfortunately I don’t have pictures of this, but to give you some impression the candle lanterns looked like this:

Their visits and blessings surely gave me hope and strength to go on. After their visit I got my dinner. Like I said before, all the food tasted really bad. Normally I enjoy eating food, but eating was surely my least favorite part of the day. My favorite activities were daydreaming, thinking about the future and getting washed and cleaned in bed.  After having my dinner there was nothing but complete boredom. I felt restless and I couldn’t do anything at all.

Day 5 & 6 – Those days were the worst. My thrombocytes were even dropping further, my platelets were around 60,000 per cubic millimeter. Every time when I tried to sleep I was falling/shaking awake in my dreams. My bed was completely soaked in sweat. I lost control and couldn’t do much at all. I felt like a turtle lying upside down in a dessert without any type of protection or control on the outcome, waiting for my time to come… I knew if I was going to stay like this then I wasn’t going to see my loved ones again. All kind of questions are going through your head. My first and biggest question was:

Is this it?

Shortly after this, other questions followed. Is it time for me to go and say goodbye? Should I let others know that I love them? How will my girlfriend react if I go, can she handle it? And what about my family? Should I give up?

Deep down there I knew it was not the time, not YET, others still need me! So I tried my best to rest and move as little as possible in order to save my small amount of energy I had left. I  prayed in my mind and I was hoping for the best, that’s all what I could do. Even though I was on the other side of the world apart from my family, I was not on the “other side” yet. I knew my parents from the other side of the world were crying and were desperate. Having this so called gap of 11000 km between a parent and their kid is horrible. It’s an awful feeling, not being able to see or talk to your family. Especially when you have no energy to talk on the phone. My family felt stressed and helpless and couldn’t do that much for me. I really wished I had developed some telepathic skills, just to tell them I love them and that they don’t have to worry.

Day 7 – When I woke up I was feeling a bit better, I was feeling more alive. I knew my thrombocytes had increased a little. I felt relieved and very happy when the doctor told me in the early morning that I can finally leave hospital. I still had high temperatures and didn’t felt that great, but still I felt much better then the past days. Not knowing I had a long way to go for recovery… When I got out of bed and tried to walk I felt like an old grandpa. My stamina drastically decreased and my muscles were weak. The parents of my girlfriend were arranging the paper work at the hospital administration. I decided to sit down in my room and wait. After about 15 minutes I felt like I was fainting. So I decided to lie down again and sleep a bit more first. I simply didn’t have the energy anymore, my body was broken, although my mind was still pretty much intact. I was thinking about what to do next, about how to recover, about my flight back, etc., I had to move on… Early in the afternoon I was ready to go and say goodbye to my bed:

My hospital bed

When got out the hospital I was so relieved and happy, I DID IT, I MADE IT! I felt the warm sun shining on my face, saw the traffic and people walking on the crowded streets of Bandung. Life didn’t stop, it just moved on as if nothing happened. I was crying on the inside, but I knew I had to do the same, I had to move on!

What to do when you have dengue fever?

My days at the hospital were horrible. Unfortunately there is no medicine or commercial vaccine yet for dengue fever. So here are some tips on how to get through this:

• Drink (much) more than usual. At the hospital I had two ‘power’ drinks. I had guava juice and Pocari sweat (Japanese sport drink). Both drinks will make sure you stay hydrated and have stable thrombocyte levels. I’m pretty sure if I didn’t had those two drinks I probably had some more serious problems and wouldn’t be here.
• Get some straws, it’s easier to drink and saves you some energy.
• Use mouthwash, try not to brush too often in order to prevent bleeding.
• Try to keep eating, even if you feel full and haven’t had a dump for several days (like I did).
• When you eat, don’t eat spicy stuff, just eat plain things. I was on a rice diet, because it was easily digestible.
• Eat papaya fruit to help with your digestion.
• Put a bucket next to your bed for peeing or for when you need to vomit. You don’t want to walk to the toilet every time, you need to be careful with your energy, especially for the last couple of days.
• Take paracetamol, between 6×500 mg to 8×500 mg to lower your temperature and relieve your headache.
• Make sure you have someone around who can take care of you like your partner, friend or family member. You will have a hard time feeding and drinking all by yourself. Luckily, during my trip I was not alone. I had my girlfriend and her family taking care of me. They were there for me, they helped me with translation, administration, phone calls, eating and drinking. I’m really grateful and thankful for what they did. Honestly I don’t think I would have made it if they were not there…

Dengue fever symptoms

Here is a short overview of my symptoms I got during my hospital treatment:

• High temperatures between 38.5 and 40 degrees.
• Severe headache, lots of pain behind your eyes.
• Feeling dizzy.
• Constipation, can take several days.
• Some skin rash, especially on my hands and arms.
• Joint and muscle pain. Simply lying or leaning against something hurts really bad.
• Being tired all the time.
• Heavy night sweating. After waking up my bed was soaked.
• Easy bleeding, simply don’t scratch.
• Easy bruising, prevent hitting something accidentally.
• Skin on your hands and feet will easily start to fell off.

The recovery: my after-hospital-life

After I left hospital I stayed at my girlfriend’s parents place in Bandung, which was kind of close to the hospital. My doctor told me that I can further recover at home and need to come back after several days. I was not yet allowed to fly back to the Netherlands, since my doctor first needs to give me a fit-to-fly approval for that.

Week 1 – During the first few days when I was recovering I noticed that I had lost lots of hair and I had some bruises. I also noticed that my strength and stamina was completely gone. Getting up out of bed, walking, walking stairs, holding a phone to talk to your parents, texting, reading were all just too much for me. Although I noticed I was slowly recovering again. I simply needed some rest and had to make sure I was fit enough to fly and go back on my own to the Netherlands.

Later that week I had my trip back home. After a long trip of 15 hours I finally safely arrived in the Netherlands. Finally I could see and hold my family in my arms. It was a great feeling to be back again! I was quite tired of the trip and I had some jet lag. I simply needed more rest. Other than that, I felt okay. Just to be sure I made an appointment for next week with the AMC hospital in Amsterdam to do a check to make sure I was indeed okay.

Week 2 – I went to the hospital and went to the department of tropical diseases. Since I got treated abroad the doctors couldn’t tell yet if I had the contagious MRSA virus with me. They had to do more research to figure out. So they were quite precautions and were completely covered. It was quite weird to meet your doctors like that, I felt like I was some kind of zombie. They did some diagnosis and saw that I still had fever and that dengue fever was still active in my blood. Their advice was to get more rest, keep drinking and take paracetamol. Later this week I again got headache, but less severe than I had before. I have to say the pain was quite different. When I touched my skin or hair on my head it was hurting a lot! My skin on my head was burning. It lasted for a few days. After this, the pain on and inside my head gradually disappeared. The burning sensation I had before now moved to my hands and arms. My skin was very sensitive, it felt like I had open wounds and blisters everywhere. Later this week the burning pain moved to my chest and shoulders. During the weekend I felt some weird pressure on my chest and had several stings in my heart region. On top of this I had breathing problems. A small activity like walking, getting up, walking stairs caused me pain in my heart area. Normally I would have this kind of pain when I’m cycling for hours at maximum capacity with a hear rate of above 170 bpm. I tried to take it easy and rest some more, but I simply couldn’t sleep that weekend, I was quite worried.

Week 3 – I didn’t like how things were going… I was expecting some improvements, but things got worse instead. I still had fever, headache and felt very tired. My breathing problems and heart problems were still there. I went to the hospital to do more research. Multiple blood tests were done, had an echocardiogram (ECG), had ultrasound scan of my internal organs like liver, kidneys, bladder, CT scan of my lungs. The doctors couldn’t find anything! They told me I should rest some more.

Week 4 – Gradually things got better, my temperatures decreased (no more fever), breathing and heart problems disappeared and my headache was very light. Unfortunately, on Tuesday I started to have some problems with my right leg, to be more specific my ankle and knee. It started with a burning and tinkling sensation again and it felt like something was squeezing my legs. Some hours later I couldn’t really walk on my right leg, every movement I made was hurting.This pain lasted for a few days.

Now I finally start to feel better, less pain and less headache, hopefully I won’t have any other downfalls. We will see, I’m still trying to stay positive and optimistic after all what happened to me. It’s an horrible disease, I really hope that you won’t get it. Hopefully there will be proper medicines and vaccines for it soon!

What to do during recovery?

During the recovery it’s recommended to rest as much as possible. Also know that when you have dengue fever your immune system gets a big blow. Basically your system won’t work as good as before. You have to try your best to eat healthy and stay healthy or you will be sick again. So here are some tips to help you with your recovery:

• Drink lots of water and other healthy juices like guava juice, orange juice, pure coconut water
• Eat lots of vegetables, fruits and easy digestible food.
• Eat daily steamy bowl of oatmeal, it’s good for your heart and immune system
• Take vitamin pills
• Magnesium supplements to increase your energy, calm your nerves, improve your digestion and your heart’s health.
• Stay active and try to push your body little by little, don’t give in and sleep and rest all the time.
• Take daily paracetamol 3 times a day 2×500 mg to lower your temperatures and reduce your headache.
• When you get back to your country. Consult a specialist and do additional research, just to be sure you have no other diseases and if your internal organs are fine. Also check for the contagious hospital MRSA virus.
• Don’t panic, get stressed or get desperate. The recovery process is really slow. Here are some facts that are apparently quite common according to other people who have experienced dengue fever:
  • You will have fever or high temperatures for several weeks.
  • Itchy feeling on your skin for several days/weeks.
  • For several months you will feel tired.
  • Your hair will grow back, but this will take between 6 – 9 months.

Dengue fever symptoms during and after recovery

Here is a short overview of the complications and symptoms I got after the 7 day cycle of dengue fever:

• Significant Hair loss.
• Constant fever and high temperatures.
• Breathing problems.
• Feeling pain and stings in your heart area for several days.
• Headache.
• Feeling depressed.
• Burning skin sensation, like you have some open wounds or blisters.
• Very sensitive skin.
• Sore muscles and some pain.
• Joint pain.
• Some bruises.
• Feeling tired all the time, simple things like walking stairs are too exhausting.
• Heavy night sweating.
• Skin starts to fall off, especially my hands and feet.

Dengue disease prevention

When you are traveling to mosquito-friendly countries please make sure your are prepared and prevent from being bitten. In the map below you can see in which regions you have an increased risk of getting dengue:

Dengue, countries at risk, 2011

For convenience and in order to get a more complete picture I want to share the following map:

Global map of the predicted distribution of Aedes albopictus (tiger mosquitoes) where the color red indicates that the presence of tiger mosquitoes, 2015, (Wikipedia)

This map shows the predicted presence of tiger mosquitoes in red and absence in blue. Luckily not all tiger mosquitoes carry dengue fever or other diseases, but still it makes you a bit worried.

When traveling to those mosquito-friendly countries you can do the following in order to prevent from being bitten:

• Buy some DEET (50%) insect repellent, you can get higher percentage, but be careful with your skin, it’s quite toxic. All I can say is that it helps a bit. I still get mosquito bites after using it.
• Thick and long clothes (I know it will mean lots of sweating, but it’s still better then using DEET chemicals on your skin).
• Outdoor anti-mosquito hat.
• A portable mosquito net for sleeping.
• Some people claim that taking a daily dose of vitamin B1 also helps and prevents you from being bitten.
• Chemical insect repellent against insects (usually available in hotel rooms). Before going to bed you simply spray under your bed and other places where you might expect mosquitoes.
• Definitely don’t go during rainy season, this is asking for some serious trouble since the mosquito’s are the most active during this season.

Final words

As you can see dengue fever can be quite severe, unfortunately for some it’s lethal. It really depends on your body, you as a person and the type of dengue fever you have. At the moment dengue fever is classified as a mild disease to humans, it’s categorized under biohazard level 2. To put things in perspective, malaria is categorized under level 3 and Ebola under level 4. So please be careful next time when you are traveling to mosquito friendly countries, please don’t be too naive. I hope by now you understand what dengue fever can be like and what it can do to your body. If you ever get or have dengue fever, all I can say is the following: Please don’t give up, stay strong and positive, no matter how hopeless the situation will be, keep having faith!