I'm crying. I just finished reading a message titled "Preterm", written by our friends James and Sarah Appel, missionaries in Chad, and I'm sobbing as the tears stream down my face. I just can't believe they have suffered this terrible loss, the loss of their first baby, at only 21 weeks of pregnancy. I'm crying, in part, because there's a lot of emotion that I've kept inside for the last few days. I'm crying because it was only a few days ago that I was also treating someone for malaria, and also wondering what would happen next.

It had only been 6 days since our arrival back in Nigeria, and we were finally starting to get out of the dreaded jet-lag. We woke up close to the normal time, and sat at the breakfast table for our usual oatmeal with milk, bananas, bread and peanut butter. Michaela, not surprisingly, chatted the whole meal about how she would like to visit the snow again some day and how she loved the sleds and how cold and soft and hard snow can be, depending on whether you're playing with it or landing on it. My mind wandered from her conversation to my own thoughts about the time we spent in the States during our leave, when I noticed that Joshua had left the table after taking only a few bites of his favorite breakfast, very unlike his usual hearty appetite. 

"What's wrong?" I asked. "Are you not going to finish your food?"

"My tummy is full, Mommy. I don't want to finish it." He replied, and I instantly knew something was wrong. I felt his forehead and he didn't have a fever, but halfway through the morning he went down for a very unusual nap, and I knew we were in for some sort of illness. Lacking any other signs or symptoms, I wondered if he was coming down with the cold I had been battling with for the last 10 days. Too soon for malaria, I thought, though the incubation period can be 5-7 days, and we had gotten some mosquito bites at the airport while waiting for our ride. And come to think of it, we did forget to take our prophylaxis a week before leaving for Nigeria...I ignored the thought and prayed this was only the usual upper respiratory virus...

Much to my disappointment, by 6 pm he had developed a very high fever, his little body shivering despite the stuffy, humid, 86 degree weather. After a dose of Tylenol, I carried him down to the lab for the necessary malaria smear. I was shocked to find out the test read 2+ malaria parasite in his blood, higher than he has ever had. I mean, he has had malaria twice since we have been here, but both times the test has been weakly positive. Since it is a bit of a subjective test which varies depending on the expertise of the lab worker, we often wonder if they are true positives (some lab technicians will NEVER report it as negative!), but we never ignore even the weakly positive. But 2+ left no doubts in our minds, and we started combination therapy with artemether and camoquine immediately.

The fever didn't break all through the night. It would reduce with the Tylenol, and re-spike within 2 hours. We gave him alternate Ibuprofen and Tylenol at the max dose, along with tepid sponge baths all through the night and throughout the next 48 hours, with no improvement of symptoms. Could this be resistant malaria? Is it going to become severe, going to his brain, or his liver? Is this what we have been dreading for the past 4 and 1/2 years of service in Nigeria? So many thoughts went through my mind. I prayed over him almost constantly during 3 sleepless nights that were sure to throw me back into severe jet lag. He slept almost constantly, though he managed to wake up enough to ask for water or go to the bathroom. We added a third anti-malarial medicine just to be sure, and then started to reconsider our diagnosis.

By the third day, he was looking thinner than ever. His little hot body felt light as a feather, and he asked to be carried to places even as close as the next room. And then, a bit to our relief, he finally had a symptom. "My throat hurts," he told Daddy. An exam of his throat revealed a couple of scattered pustules, and we started empiric treatment for Strep. Within 24 hours of antibiotic treatment, he finally broke the fever. After a day or so, he started to harass his sister, a sure sign that his health was improving. It has been a few days since his last fever, and he is eating ravenously every two or three hours, trying to make up for lost time.  He's back to his silly, playful self, running all over the house, and complaining every time he has to take yet another pill. We are grateful to God for His healing and mercy.

But as I read the message James sent about their baby, I just could not control the tears. It just hit so close to home, not only because of the recent illness Joshua had, but also because of the little guy that I feel kicking inside me even as I type this message.  Our prayers go out for James and Sarah, that God may hold them close during this difficult time, and bring to their hearts the peace that only comes from above.

Belen