Three months after I arrived in Delhi for a semester-long study abroad program, I was lying in a hospital bed with a fever of 103.6°F (or so I was told once I was discharged), too dehydrated for nurses to find a vein in which to stick an IV. I somehow managed to provide a stool sample, into a cup and everything, and the next day, after I had come out of a feverish haze, the doctor told me I definitely had a bacterial infection.
His exact words were, "There is lots of bacteria in your stools. Lots of bacteria.” Much to my and my parents’ chagrin, I had contracted typhoid fever, and was about to get really friendly with the Indian healthcare system and lots of salmonella.
As an undergraduate, I majored in global health, and wanted to go abroad to a country where there were public health problems to be studied. France or Spain, although charming, have fully functioning health systems. And at the time, I was feeling a little lost about school. I wanted to see how what I had been reading about for three years translated to the real world, and India seemed like the perfect place to do that.
Although I was excited for this opportunity, I was also incredibly nervous about getting sick in a country with what I empirically knew was a weak healthcare system, especially since everyone I told about my impending trip -- from the nurse who gave me a pre-travel check-up to my uncle who had visited Mumbai once in the 1980s -- warned me that getting sick wasn’t a matter of “if,” but “when” and “with what pathogen.”
Waterborne illnesses are common in India; diarrhea, a primary symptom of these infections, kills 1,600 people daily. I was told to only drink bottled or filtered water, and to avoid raw fruits and vegetables in order to decrease my risk of getting sick. As they say, “Boil it, cook it, peel it, or forget it.”
But somehow, I made it through most of the semester with minimal intestinal distress, barring a bout of bacterial dysentery that was cured after a week’s course of antibiotics and dozens of tasteless Oregon Trail jokes. I therefore became cocky about my gut’s ability to ward off infectious diseases. I already battled dysentery, so nothing else could bring me down. Except for mangoes.
There was only so long I could last avoiding fresh fruit, and my willpower gave out as mango season began. I was also tired of eating Indian food all the time, so when the opportunity arose for me to live in my own apartment for the last month of the program, I did. I was excited to cook for myself, and the kitchen was good-sized with a water filter above the sink, which I used to wash all fruits and veggies before eating.
Turns out that water may not have been the cleanest or that filter may not have been working or I may have just picked up a bug by brushing my teeth with tap water instead of bottled water. All I can tell you is that I got sick. Really sick. I went to see Housefull 2 at a nearby movie theatre on a Friday night, and I had to leave during intermission because I felt like an alien was trying to pop out of my stomach.
That night, I tossed and turned, hobbled to the bathroom every hour, each time shocked by the amount of fluid that was somehow still coming out of my body. My forehead was burning, and I was sweating through my sheets. I had never been so sick, and soon realized this wasn’t going to be something I could wait out. On Saturday morning, I threw my laptop and a change of underwear into a bag, stumbled into the street, hailed a taxi-wallah, and checked myself into a private hospital.
After checking into the hospital and an hour of being repeatedly poked in the hand, the nurses found a vein, and let me fall sleep. I vaguely remember being given a sponge bath to help break my fever. The next day, I was finally visited by the doctor, an elderly Sikh man with a fantastic white beard, and his posse of students. At least, I presumed they were students. Once a day, the doctor would enter my room, accompanied by this group of six or seven men, without any consent from me that it would be cool for him to let these strangers watch him examine me.
The doctor’s instructions were always cryptic, stemming from the fact that Hindi, and Indian English by extension, is an oblique language. You never say something is “bad” in Hindi; you say it’s just “not great.” On my third day, when I asked if I could be released, the doctor started with a long sigh before explaining, "You can leave whenever you want. No one is stopping you. But you don't want to leave before you're sure you're well because if you do, you'll just be right back here tomorrow…” I took that as a no.
Except for the doctor’s daily visit and the nurses coming in to change my IV and serve me chai and, eventually, bland Western food (mashed potatoes and what I think were frozen peas) that would be gentle on my stomach, I spent most of my time alone, watching American TV and movies. But even in my isolation, it was hard to forget I was in India, starting with the fact that everything I watched was heavily censored. There’s no kissing in Bollywood movies, and that standard is retroactively applied to all American films. Homosexuality is also definitely not discussed, so imagine my surprise when I flipped to "Black Swan" one afternoon. I was curious to see how the censors would handle the whole Natalie Portman and Mila Kunis sex scene. (Spoiler: They didn’t. It was totally cut, and showed Natalie Portman’s character smothering the camera with a pillow.)
After two days of rolling around in bed and trying not to accidentally rip out my IV, my fever broke and I felt strong enough to walk further than the bathroom, wheeling around the IV pole. By the fourth day, the doctor deemed me well enough to be discharged, but even that message was never directly relayed to me. It wasn’t until the nurse came in and told me to get dressed that I realized I was leaving.
The final shock was the bill at the end of my stay: a little over 40,000 Indian Rupees, or $800 American dollars. I thought of this as a great deal, especially compared to American prices; $800 is less than half than the average cost of one night at an American hospital. $800, however, is about half of the average Indian per capita annual income, and way too expensive for the average citizen to afford.
As I handed over my credit card to pay that bill, I became painfully cognizant of the fact that I had the resources to treat this illness, while thousands of others did not. Waterborne illnesses like typhoid can be fatal if left untreated. Not only is typhoid potentially dangerous, it’s also entirely preventable by ensuring access to clean water. The burden of disease is huge, and could be avoided all together with better urban infrastructure, not just instructions on how to avoid risky foods.
When I traveled to India to study public health, I never imagined I would be on the receiving end of the system. But this experience, as unpleasant as it was at the time, solidified my interest in global health generally, and good urban planning and infrastructure more specifically. Public health isn’t just about vaccinations and doctors and healthcare systems. It’s also about where we live, and I became fascinated by figuring out ways to create safe and healthy cities. It just took a few thousand bacteria invading my gastrointestinal tract to figure out what I wanted to do with my life.