The joys of field research

I had returned from a year off study in which I’d bummed around Zimbabwe and Europe spending what little money I had and some of what I didn’t have. I’d largely recovered from major surgery and had as close a handle on my diabetic blood sugar control as was possible in the early 1980s. The treatment was one daily injection, and no blood test kits. This needed to be fortified by a stable lifestyle free of changes in mood, mental exertion and physical activity. I also lived several hundred kilometres from my diabetic specialist.  

But I was young and healthy and had started doing field research involving unpredictable levels of both physical and mental exertion. And a fair share of interesting events was usual when living alone in a game reserve; enough to cause blood sugars to behave randomly. 

The reserve showing the forest in the middle of the picture.

Copyright Adrian Armstrong. 

One such event happened when I was walking in a forest on a narrow path flanked by tall bracken. I was probably tired and inattentive but a slight movement caught my eye.  A black mamba reared up directly in front of me. Within striking distance. (Generally, I regard black mambas as within striking distance if they are closer than about 10 meters). But this one was, without question, definitely within real striking distance. I'd nearly trodden on it. 

I am unashamed to admit that I am terrified of black mambas. Highly venomous and aggressive they grow up to 2.5 metres. Surviving a bite is unlikely. More to the point, my perception of these killers, ready to sink their fangs into any human was instilled by experts. Herpetologist experts told me this when I needed to weigh live snakes and went to the local snake park for help. 

Behind the scenes in any snake park are many snakes that are not on display to the public. It was these animals that were weighed. A number of herpetologists crowded the lab going about their snakey work. My herpetologist selected a reptile, using tongs or by hand (dependent on the aggressiveness and toxicity), and carried it to the scale in a bag where I recorded its weight. The snake was returned to its cage. We worked for a few hours.

The last species to weigh were black mambas. Suddenly the procedure changed. "Ok, listen up everyone!" exclaimed my herpetologist loudly. "We are going to be carrying mambas to the scale. Stop what you are doing and step back. We don't want any mishaps!" We'd carried maybe 30 or 40 snakes that morning including puff adders and cobras but none had evoked a warning. My irrational fear of these animals was now officially rational - backed up by expert opinion.

Snake park where mambas were weighed. 

Somehow I'd ended up doing research in a reserve full of black mambas.  When I first arrived in the reserve, the ranger told me what to do if I got bitten. Do not exert yourself. Lie down in the shade. Get comfy. Loosen all tight clothing. Look up at the sky. And enjoy your last few moments! I lived in terror. 

Black mamba. Note the size. Copyright SANBI.

The mamba swayed slightly from side to side. Its head about waist high. Clearly annoyed at my intrusion. I recalled the snake park warning. Somehow my brain went into survival mode. I was unlikely to move quicker than the mamba could strike. So flight was out of the question and I had no intention of fighting this thing! I stayed still. Deathly still. 

It seemed were we there for hours. Eyeball to eyeball. Its tongue flicked (the damn thing is tasting me I thought!). My legs trembled. After an age, the snake moved slightly. It lowered its head a tad. Its head was now closer to me, to my bare, trembling thighs. Still I stood. Very gradually, it lowered the top of its body to the ground and disappeared into the bracken. I was left with one thought in my head; Where the hell is it? Then I turned and ran. 

But this experience was not over yet. I'd been checking some traps and just beyond where I'd seen the snake were traps that I could not leave unchecked. I'd have to retrace my steps past where I'd seen the snake. Nervously, I dragged myself back along that terrifying path. Visibility was restricted to the narrow, dusty path, the bracken preventing me from seeing anything on either side. I imagined reptilian eyes on my legs. Where is it?  

The fact I'm writing this means that I didn't encounter that snake again that day. And fortunately the traps were empty.  I hurried back to camp and made a pot of tea, spilling much of it as I slowly counted my blessings. I have no idea how my blood sugar reacted. Terror took priority that day!  

Ant's snakey motto: It's better to see a snake before it sees you.

 Ant's blog: diabetes and travel. 

After six years at university the need to travel again raised it's head (actually, the travel head had been lifting for a few years)! In early 1983 my mate and I decided to hitch around the world. Plans were planned, sleeping bags and rucksacks bought, all funded by selling everything that we couldn't squeeze into a rucksack. 

The Smoke that Thunders, Victoria Falls

The original idea was to hitch through Africa to London and then, who knew? For various reasons, the Africa trip was cancelled and replaced with a tour of Zimbabwe (then Rhodesia) about a year after a horrific guerrilla war ended. The game reserves were empty of tourists and the rangers were more than happy to invite us on their patrols. We spent two months touring Victoria Falls, Matusadona, Rhodes Matopas, Gona-Re-Zhou, Hwange, Chimanimani, and Rhodes Matopas Game Reserves, often on patrol with rangers.

Matusadona Reserve, view from Lake Kariba.

That trip was followed by the trip to Europe. My mate would fly from Zimbabwe to London a week ahead of me travelling from Johannesburg. 

My Dad asked how I was going to manage diabetes care during the trip. That needed some thought. So I bought a small flask (remember insulin needed to be kept in a fridge and in the 80s there was no rucksack-sized fridges). I also went for a diabetes check up with my doctor, just to make sure. But it would be a formality, I felt fine, strong in fact. I was a wildlife biologist with an award-winning MSc about to embark on the trip of a life time. 

The next day I was in hospital. They found blood in my urine and that my urine drainage system was partly blocked. Quick biology lesson: you have two kidneys which filter blood and pass waste material (urine) down a pair of ureters into the bladder. The bladder stores urine until it is voided from the body via a tube, the urethra. My left ureter was blocked! Urine was backing up into the left kidney. A catastrophic situation and not ideal for hitch-hiking around Europe. In fact the doctors felt that it was not ideal for anywhere except the operating theatre which is where I found myself 12 hours later.

Urinary tract. Copyright US govt Terese Winslow.

Why? What? We didn't use WTF in those days but that would have been appropriate indeed. It transpired that as I had spent a lot of time outdoors, I had been in several rivers and pools where there is a parasitic disease called bilharzia. Like all parasites it goes through a number of development stages (think butterfly: egg to caterpillar to chrysalis to adult). In bilharzia the stages occur first in aquatic snails and then mammals. At each stage the number of individuals increases dramatically and a single egg leads to the final stage called cercaria which produces hundreds of thousands of eggs. This is a common parasitic strategy to ensure infection of unsuspecting hosts (like wildlife biologists). It only needs one cercarium to enter the body through a tiny nick in the skin. Apparently I had one of these cercaria together with a welcoming nick and the bugger found its way to my left ureter, where, as all good parasites are wont to do, attached itself and started producing large numbers of eggs. The blood in the urine was indicative of a ureter blocked with thousands of tiny eggs. 

I awoke in intensive care after four hours of surgery feeling warm, content and full of a cocktail of drugs. I'd been an experiment. My diseased ureter had been totally removed, my bladder opened and a sliver of bladder tissue converted to a new designer ureter. The bladder was stitched up, the sliver tubified and stitched up and the end attached to the gaping hole in the kidney. The surgeons gained access to all this plumbing via an incision across my lower abdomen through several layers of muscle. There was talk of over 1,000 stitches. Never before had this operation been tried and certainly not on a diabetic, prone to infection. To put it mildly, there was a hint of risk!

I was in hospital for three weeks accompanied by drains into my gut cavity, catheters, drips,  and a host of bloody bags attached to a stand which I painfully staggered around with. I was on bilharzia treatment, antibiotics, all fuelled by soup. The pain was incredible.

Talking of pain, the nurses were great and kept me going with their jokes and comradery. I was really looking forward to the time when the catheter drain from my bladder was to be removed. One dryly said "It will feel like peeing razor blades! We'll listen for the screams and give you extra pain killers". What a bunch!

After three weeks all the drains, catheters, plugs and drips were removed and I was discharged on 13 April. Blood sugars all over the place and very difficult to control using one daily morning injection only. Temporarily, I used an additional single dose of 4 units of Actrapid to bring the high sugars down.

Looking smug. The last day in hospital!

I went to airport on 28 May to start trip to Europe. Very excited! At last! At the departure lounge, with rucksack on my back, I suffered a major hypo (low blood sugar causing confusion) and went into a coma. I awoke in a hospital thinking I was in Europe and a bit more than a tad confused. The effects of the surgery had only just started impacting my blood sugar control. 

I discharged myself from the hospital the next day (I had Europe visit) and went straight to organise another ticket. Two days later I was in London with my mates from university. I could not believe I was finally there! 

I'd never been on a hovercraft and crossed the channel on this one

I spent eight months travelling through Europe with a devil may care attitude. Get on the road, get a lift, if it dropped us at a place we liked, stay there until we wanted to move on. When I ran out of insulin I bought it locally. Unfortunately, in Europe insulin strength was 40 units per ml and I was using 80 units. With this concentration my daily dose exceeded the volume of the glass syringe and I needed two injections. But needles were limited so I had to reuse  needles with very basic sterilisation (small vial of alcohol!). Sterilisation in its broadest meaning. 

The small flask filled with water that I used to keep the insulin cool, worked well enough to keep my blood sugars vaguely under control. I know they were vaguely in target because I had bought an early prototype glucometer that used a finger prick of blood to measure blood sugar. This was about the size of a small shoe box and the reagent strips were largely unobtainable in Europe so I had to eke them out - about one test every four or five days perhaps. When they ran out the damn thing became a burden in an increasingly heavy rucksack. 

The trip was amazing. It restored my faith in people who were kind and generous. Except one lot of lads who picked us up. They were stoned out of their minds and screamed at us to put our rucksacks against the car doors so that we couldn't escape! We managed to make a break at a traffic light when they appeared to forget we were in the car. 

 St Marie aux Manes, Alsace, France

On another occasion we got a lift on an autobahn. Usually hitch-hiking is slow. What with waiting for a lift and then taking several lifts to get to your destination. Not this time. We were picked up by a guy driving a Mercedes who took us straight to Munich, at 220km/h! We weren't sure if he was a component driver or an idiot but we arrived several hours ahead of our schedule in one piece!  These are the chances you take when hitch-hiking. 

Portofino, Italy. No cars allowed. We got there by train.

Beautiful paintings on houses in Austria

I arrived back in South Africa intact, full of amazing experiences and having suffered only two comas requiring stays in hospital early in the trip. My flask type fridge worked as did conversion to lower strength insulin, irregular blood sugar checks and irregular food. By the end of the trip I had largely got my blood sugars under control and was looking forward to my next adventure; several years of doing research in the bush on my own. And yes, comas once again raised their annoying head as did more stitches and a few face to face encounters with Africa's most deadly snake, the black mamba. 

Diabetes 101 Type 1

 As I approach 50 years of being a type 1 diabetic I thought I'd share some of my experiences of living with this disease. This is not meant to advise on how you manage diabetes or your life but to show how diabetes, or any other ailment, does not need to hold you back.

Way back in 1975 in Johannesburg, South Africa, I was a normal active teenager. I spent a lot of time outdoors, hiking, camping and travelling. In July 1975, I hitch-hiked with friends to the Makadikadi Desert and Okavango Swamps in Botswana and back home via the Namib Desert in the then-called South West Africa, now Namibia (that trip is another story). A few days during six weeks of hitch-hiking I felt ill but put that down to running out of food and/or hangovers.

By September 1975, after short time in hospital, armed with a vial of insulin, a glass syringe and some needles (huge, long and painful) and scant knowledge, I was giving myself daily injections. I remember thinking "what just happened?" Very few teenagers had even heard of diabetes, I certainly hadn't. It was nearly 10 years before I knew of someone with diabetes. 

Treatment was primitive then. Inject in the morning, test for blood sugars using a colour-coded strip dipped in urine, eat the same each day, use the same amount of energy each day and DO NOT EAT ANYTHING SUGARY. Keep the insulin in a fridge. Emotions were simply not mentioned and I was unaware that these things impacted blood sugar control.

Ok, I can do this, I thought and three months later I left home and started university nearly 1,000km away, armed with my scant knowledge. What my parents went through I have no idea. But I was happy to be starting my career as a wildlife biologist. Perhaps that comforted them?

There were very few diabetes-related events that I remember from university. I knuckled down and worked harder than I had ever worked in my life; lectures and practicals all day, study in the evenings mixed with rugby practice and girlfriends. I gave up drinking alcohol - at least for a while!

I do remember the hassles of keeping insulin a fridge. I was in a university residence and the warden kindly let me to use his family's fridge. I recall the embarrassment every morning knocking on the door of a family preparing for work and school, to get my insulin. Then taking it upstairs to my room and having to go through the whole process again to return the vial to the fridge. No wonder I stopped doing the urine checks!

Another recollection was a period about two years after being diagnosed. I suffered a few days of constant hypos - really bad ones (for non-diabetics a hypo is low blood sugar and causes severe confusion). I still knew nothing of diabetes and barely had spoken to a medical person about diabetic treatment. I wasn't prepared for the total confusion and lack of understanding of what was happening, feeling lost and alone, unable to speak. These severe hypos made me think that I was cured and I stopped my injections! That soon changed when I experienced a day or two of very high blood sugars!

I remained at university for six years all the while under the same treatment as I was first given in 1975. I had great fun and had moved into digs which was always home to strays, be they musicians, mates or dogs. But I was keen to travel and a hitch-hiking trip through Europe beckoned. I had a year to do it. 

My next blog explains how I managed diabetes, major surgery, comas, attacks by weirdos, speeding on autobahns all while having a wonderful time.