Wednesday, April 16, 2014

A Visit to Nurse Rooke*

*A psuedonymn 

I needed booster shots—for Hepatitis A, DtaP/Tdap, and typhoid, to be exact—before I returned to Nepal for my MA fieldwork. So I called my university’s health center for an appointment. “You’re traveling abroad?” the operator asked. I confirmed. “Oh, well then, you’ll need to make an appointment to see the travel nurse. Its forty dollars per appointment.”

I was annoyed at her insistence that I see the travel nurse for my shots; couldn’t another nurse give me the immunizations? Why did I have to pay an extra forty dollars? I reluctantly agreed to an appointment.

Nurse Rooke seemed friendly enough. “Hello, Tori, what can I do for you today?” she asked as I walked in. I told her the same thing I had told the operator, and handed her my vaccination record. She commented that I had “quite a laundry list” of vaccinations—fourteen different vaccinations, to be exact, each with multiple injection dates. She put it aside, and asked me where I was traveling to? Nepal, I replied. Had I been there before? I told her that I grew up there. I answered her follow-up questions as she proceeded to pull down a large book that listed all diseases found in each country of the world: I had been seven, my brother had been four, when we moved there; we had lived there a total of eight years; my dad is a pediatrician and had worked as a volunteer at a government hospital all that time; we had returned to the States every two or three years for four to six months for furlough. She found the page on Nepal. “What were your parents thinking, taking a four-year-old and a seven-year-old to a disease infested country like Nepal?!?!” was her unfiltered reaction.

I felt the adrenaline pumping through my arms, and I had the sudden urge to punch something nearby, if only to release the surge of power that suddenly, uncomfortably, coursed through my muscles.

Malaria was one of the diseases listed. She immediately gave me options as to malaria medication. I told her that I did not need malaria medication. I was going to Kathmandu, so while mosquitos were present and I would be in Nepal during the monsoon season when the disease was at its peak, Kathmandu’s elevation was too high for malaria. She insisted that I could not risk malaria. While the medication was uncomfortable—one risked yeast infections, one produced nightmares bordering on hallucinations—it was better than getting the disease itself. I admitted that malaria was present in Nepal, but it was only found in the Tarai, along the Nepal/India border—and I would not be going there during the monsoon.

She put her disease book aside and began to ask me questions. How did I get clean drinking water? How did I clean vegetables? Did I eat street food? What did I do about food poisoning? Diarrhea? Pickpockets? Safety on public transportation? Did I speak the local language? I answered her questions as best I knew how, slightly confused as to why she was asking these questions in the first place. After each question, she paused, staring at me, like she was checking me out. I uncomfortably shifted positions, wondering when she would give me my vaccinations.

Nurse Rooke then pulled out an REI catalog and showed me traveler’s pouches that allowed me to put my passport and cash close to my body under my clothes. She pointed out a bag that was advertised as pickpocket proof. She handed me a pamphlet that advertised strong mosquito repellents, going as far as circling one or two that she though particularly effective. She brought up malaria medication again. I told her sternly, in all my time living in Nepal, I never had to take malaria medication; I did not need it now. What about medication for diarrhea? She recommended one that would clean me out within a few hours, killing whatever bacteria had gotten in my gut. I told her no thank you.

I felt my ears and cheeks begin to burn, and I hoped that my face wasn’t visibly turning red.

Nurse Rooke turned back to my vaccination record. She commented that the typhoid was best taken orally—she could give me the pills to take at home—and looking at this record, I had one polio booster remaining. She could give me the hep A and polio today, then I could come back later for the DtaP/Tdap. I agreed to all the above. As she prepped the vaccinations, she commented that I could get malaria medication real cheap at Costco; I thanked her for her concern and reiterated that I did not need it. We scheduled an appointment for my DtaP/Tdap vaccination, and I went to the counter to be discharged, and pay for the vaccinations and my session with her.

As I walked out of her office, I had an epiphany—most of the students who were sent to Nurse Rooke were undergraduates going abroad for the first time. They were clueless as to how to manage themselves in another country. I was the anomaly here. But I remained angry—why was I still required to pay forty dollars for being grilled and humiliated about growing up abroad? Why had she not conceded that I was an expert—especially concerning malaria? I walked out of the health center with my face now completely hot and the adrenaline still coursing through my arms. I had never felt so angry in my life. 

A year later, I needed another booster before returning to Nepal, this time to conduct eight months of volunteer work and pilot research. When the operator said she would make an appointment with the travel nurse for me, I begged otherwise—I did not need a travel counseling session; I regularly traveled abroad and I just needed a shot. She said it was standard procedure, and I needed to see the nurse.

When Nurse Rooke turned around a saw me walk into her office, she blandly commented, “Oh—you again.” She courteously asked me how my previous time in Nepal went; I answered briefly that it had gone well. What could she do for me today? I told her which vaccination I needed. Did I want any malaria medication as well? I told her no thank you. She gave me the vaccination and I left. The assistant at the cashier’s desk had me wait a moment, because that forty-dollar fee wasn’t showing up on my account. She called the travel nurse’s station; Nurse Rooke told her that I hadn’t come for an advice session, just to receive a shot. The assistant was visibly perturbed. I felt triumphant.

I think Nurse Rooke was disappointed that I didn’t contract malaria.

Two years after that, I was due for a TB skin test before returning to Nepal to commence dissertation research. When I walked into her office, Nurse Rooke met me with a smile. “Off to Nepal again?” she asked, and I replied affirmative. She pulled down her book of diseases, and I felt my muscles tense. She asked me where in Nepal I would be going? I admitted that this time, I was going to the Tarai; however, I would not be going during the monsoon, and sleeping under mosquito nets and using repellant would be enough protection. She showed me the page on Nepal in her disease book—according to the map, mosquitos honored Nepal’s sovereignty from India and did not cross the national border from Uttar Pradesh. I laughed, and said that most likely wasn’t the case. Nurse Rooke commented that it was up to me whether I should take malaria medication or not. I decided I didn’t need it, and she didn’t put up a fuss. She took my skin test and told me when to come back for the results. Had I ever had tuberculosis? She asked. I told her I had never had TB.

I thought back to when my family had all had TB skin tests done upon our return to the States in 2001. I was fifteen at the time. When we came back into the office to have our arms looked at, the nurses had a hissy fit when my Dad’s read positive. Dad had prepped them before—he told them he had worked in Nepal and been exposed to TB numerous times; it was likely that he would come up positive, but that did not mean he had contracted the disease. That didn’t matter. It took some time to convince them, and the doctor, that we were all ok.

Thankfully, my TB test came back clean this time as well, much to Nurse Rooke’s satisfaction.