Retch-22: Laos in the time of cholera

The official analysis was “diarrhea, with vomiting.” Right.

By Rolf Potts

Ray, a bearded New Yorker who had recently dropped out of college to travel the world, was convinced that southern Laos was turning into a horrific cesspool of death and disease.

“I’m telling you,” he said to me as we stood outside the small ice-cream stand near the Phonsavanh Hotel in Pakse. “Cholera is completely out of control down here. A French guy I talked to in Savannakhet said the Pakse hospital was full of dead bodies.”

“Did the French guy see the dead bodies?” I asked.

“No, but he talked to a guy who saw the dead bodies.”

“And you’re sure he didn’t just talk to a guy who talked to another guy who saw the dead bodies?”

Ray looked at me with irritation. “Look, I have a sense for this kind of thing. I could tell he was serious.”

I decided to drop the big question. “So if you’re sure he was telling the truth about dead bodies in the Pakse hospital, what are you doing in Pakse right now?”

“Fuck it, man,” Ray said enthusiastically. “This is where the action is.”

By this point, I had been in Pakse for 24 hours and I was at my wits’ end. I’d been hearing the cholera rumors since coming overland from Vietnam, but I couldn’t get any hard facts. Nearly every traveler I’d met had heard there was a cholera epidemic on the Mekong flood plain south of Pakse, but not a single person had gotten this information from an official source. Many travelers were aborting their Laos travel plans and moving on, but others — like Ray — were embracing the cholera rumors with vicarious zeal. For these people, the very notion of the epidemic was enough to turn an otherwise normal trip into an adventure.

On the other hand, all the Laotian government offices and agencies in Pakse were categorically denying the existence of cholera. I visited two different government travel agencies in Pakse, and both insisted there was no problem with traveling south along the Mekong. The woman at the local health office laughed at the idea. “There are some people who have diarrhea,” she said, “but there is no cholera.” Even the officials I phoned at the U.S. Embassy in Vientiane knew nothing of the cholera rumor.

Since there was no hard evidence of an epidemic — and knowing how travelers tend to exaggerate — I continued with my plans to head downriver. As I hiked down to the river pier on the morning of my second day in Pakse, I met a Lao man named Kumsing who was working on a rural electrification project in the area. He was uncommonly friendly, and he spoke great English.

“Where are you headed?” he asked me.

“South,” I said. “I’m going to visit the 4000 Islands on the Mekong.”

Kumsing clicked his tongue. “That’s a nice area, but you have to be careful these days. I was there last week, and many of my workers got sick.”

“Was it cholera?”

“Yes, cholera. You won’t catch it if you’re careful. Not all of my workers got sick, just the careless ones.”

“How many workers were careless?”

Kumsing did some quick math. “Sixteen. But none of them died.”

“But everyone else stayed healthy — no cholera?”

“Yes, the other two are fine.”

“Other two?”

“Yes. Plus I didn’t get sick, either!”

On paper, my trip to the 4000 Islands of Laos should have been the easiest journey I’d taken all year. Not only was I returning to familiar territory (I’d traveled the Laotian Mekong in my own boat a few months previously), but I’d also come to write a story on the area for a well-paying glossy print magazine. Instead of randomly vagabonding my way down the Mekong, I would be visiting pre-selected places and interviewing people I already knew. Since southern Laos is a peaceful, enchanting region, my magazine assignment promised no hardships beyond the simple process of collecting story information.

With the objectives so clear-cut, my return to the 4000 Islands was supposed to be — as the pilots in “Catch-22″ said when referring to easy missions — a “milk run.”

In reality, it had been quite the opposite of a milk run. Before I’d ever heard rumors of cholera, the mere process of traveling overland to Laos from Vietnam had been a headache in itself. On a map it looked easy to cross into the south of Laos from the Vietnamese Central Highlands — but there were no legal customs stations along this border. So to get to Laos from the Central Highlands, I first had to take a day-long trip out of the highlands and up the coast to Danang, then wait for the next available bus to Laos via Lao Bao.

Since this road to Laos follows a treacherous route over the Annamite Mountains, I opted to take the smaller, safer, air-conditioned bus offered by a travel office in Danang. Unfortunately, the air-con bus existed only in the travel office photograph; after purchasing my ticket, I was unceremoniously dumped off at the local transit station and ushered into a huge, decrepit old DeSoto bus.

I spent 22 hours on the DeSoto, including a three-hour delay in rural Laos when the drivers stopped to unload a cache of smuggled items into two separate Nissan pickups. I arrived in Savannakhet just in time to eat, sleep and board a morning bus to Pakse, which (including a four-hour stop when the drivers dropped the transmission onto the road and had to reassemble it) took 11 hours.

I arrived in Pakse exhausted, and spent the next couple days trying to confirm the cholera rumors. When I heard Kumsing’s tale, I postponed my boat trip and went back to check with the health department.

“I just met a man from the electric company who says that 16 people got cholera last week,” I said to the woman in the office.

“That wasn’t cholera,” she told me. “Those men just had diarrhea.”

“All 16 men just happened to get diarrhea at the same time?”

“Yes,” she said. “Maybe it was food poisoning. There is no cholera in Laos.”

This sounded a tad suspicious to me, but I felt I had come too far to abandon my journey to the 4000 Islands. Grimly resolved, I returned to the pier and boarded a mid-morning freight boat bound for the island of Don Khong. Granted, I was no longer on my idealized milk-run vacation, but — whatever the facts were about cholera — I figured I’d be safe if I kept myself religiously clean and avoided the local food.

Furthermore, I was personally convinced — after six months on the road in Southeast Asia — that cholera couldn’t touch me. As with Yossarian in “Catch-22,” avoiding doom seemed a mere matter of will power, milk run or not.

Cholera couldn’t touch me, I reasoned, because I had a pure body and was as strong as an ox. Cholera couldn’t touch me because I was Tarzan, Mandrake, Flash Gordon. I was Bill Shakespeare. I was Cain, Ulysses, the Flying Dutchman; I was Lot in Sodom, Deirdre of Sorrows, Sweeny in the nightingales among trees.

I, like Yossarian in “Catch-22,” was miracle ingredient Z-247.

My journey to the 4000 Islands of Laos started splendidly. After spending the first night on Don Khong, I continued downriver to Khone island on the Cambodian border — where freshwater dolphins haunt deep pools and the Mekong suddenly crashes down into the largest complex of waterfalls in Asia. As I hiked around collecting information for my article, I sustained myself on bottled water, peeled fruit and an enormous bag of roasted peanuts. After a couple of peaceful, slow-paced days in the 4000 Islands, the notion of cholera had ceased to be a concern for me.

I probably would have forgotten about cholera entirely had I not suddenly vomited onto my shoes the morning after returning to Don Khong. I had come back to the island to tie up a few loose ends of my story, and at first it didn’t occur to me what was happening. When I vomited again a few minutes later, the gravity of the situation began to dawn on me. After I threw up for the third time, I took out my phrase book and started asking directions to the hospital.

I remember the next part only in bits and pieces. I know I kept asking people where the hospital was, and people kept pointing me up the road — but the hospital never materialized. It had rained the day before, and the humidity made the air quiver in the sunlight. As I walked, my brain rattled inside my skull like a sodden lump of clay; psychedelic fireworks burst behind my eyelids every time I doubled over with stomach cramps.

Though I didn’t know it at the time, the Don Khong hospital was nearly two kilometers outside of Khong Village. By the time a Lao motorcyclist found me squatting beneath a tree on the side of the road, I was still 200 meters away from my goal. The motorcyclist helped me to the concrete-floored hospital reception room, and I sat on a wooden bench while the staff debated what to do with me.

The hospital was constructed entirely of cinderblocks and had no window panes. Since there was no electricity on Don Khong during daylight hours, I sat in the half-light and waited. A nurse gave me a plastic bag so I wouldn’t have to run outside to vomit. Each time I retched, a few more patients wandered in from adjoining rooms to watch me. Before long, about 20 people had gathered to watch me expectorate a clear, stringy gelatin from the bottom of my stomach. As I sat there clutching my plastic bag, I half-expected one of them to ask me for my autograph.

Finally, a young Swedish doctor named Michael arrived. Michael was not really named Michael, and he wasn’t actually Swedish. But, since he was technically not supposed to be treating cholera cases in southern Laos, Michael will be Michael for the sake of this narrative.

“I see you’ve been vomiting,” Michael said, gesturing to my plastic bag. “Do you also have diarrhea?”

“Yeah, it’s killing me,” I said. “Does the hospital have anything that can stop it?”

“This hospital doesn’t have much by Western standards. Nor does this country, for that matter. Your ideal health option would be to get out of Laos as soon as possible.”

“Can the cholera kill me?”

“Technically, we can’t prove it’s cholera without doing a culture test, first. Whatever it is, it won’t kill you.”

“But we know it’s cholera,” I said. “There’s an epidemic going around, right?”

“I think the best thing for you to do right now is get out of this hospital. First we’ll find you a comfortable guest house, and there you can take oral rehydration salts until you get your strength back.”

“Has anyone died from the cholera this year? There’s lots of stories going around Pakse.”

Michael gave me a nervous look. “Like I said, we can’t call it cholera without a culture test. I know of 16 deaths so far. But those are mostly the very young and the very old. This is not something you should worry about.”

Michael got me some oral rehydration salts from the hospital storeroom and had an orderly motor me back to my room at the guest house. I stayed there and drank salt water for two days while the cholera bugs had their way with my intestines.

Though I could describe in colorful detail what cholera does to the inner workings of the human body, such exposition would be neither necessary nor tasteful. In a euphemistic nutshell, cholera renders everything that enters your body — water, bread, strawberry Pop-Tarts, etc. — into pond water. Furthermore, this pond water creation/expulsion process happens at such a terrifyingly rapid speed that I suspect Einstein himself must have suffered from cholera around the time he came up with his relativity theory. I went for hours at a time without leaving the bathroom.

When I wasn’t in the bathroom performing glorious acts of gastrointestinal alchemy, I spent my time stretched out on my bed, staring at the ceiling, which was mint green. The mint-green ceiling featured a brown metal ceiling fan — which didn’t move in the heat of the day, since the electricity didn’t come on until sunset. My bedspread was orange.

I pondered these things continuously for 48 hours.

Michael came to check on me each morning and evening. After two days, he concluded that I was strong enough to leave, and he arranged a ride to take me back to Pakse. I can’t recall ever having been so happy to see a Toyota Landcruiser.

Since my late-afternoon arrival in Pakse didn’t leave me enough time to make it to the Thai border station, I checked in to a hotel and set off to inform the local health department of my demise.

“I just caught cholera in the 4000 Islands,” I told the lady in the office. “Maybe you should warn people about going there.”

“It’s probably not cholera,” she said. “If you’re sick, maybe you should go to the hospital.”

“I’ve been to the hospital. I’ve been vomiting and I’ve had diarrhea for two days now. Trust me: I have cholera.”

“I don’t think you have cholera. Did the doctor do a culture test?”

“Look,” I cried, exasperated, “if what I have isn’t cholera, then what the hell is it?”

“Well,” she said diplomatically, “it’s probably just diarrhea, with some vomiting.”

Retreating from the health office in defeat, I walked to the Sedone restaurant and drowned my frustrations in a glass of lemonade. Keeping in mind my condition, I got a seat near the toilet. After a while, I got up and introduced myself to a guy named Doug, whom I’d overheard warning a table full of travelers about the epidemic. Doug, a Canadian on vacation from his job as an aid worker in Thailand, seemed almost pleased when I told him that I had cholera.

“I knew it would happen!” he said. “You’re the first tourist to catch it, but there’ll be more.”

“Why aren’t there official warnings?” I asked. “I tried to get some solid information before I left for the 4000 Islands, but all the government agencies were denying that cholera existed. They’re still denying it, for that matter.”

Doug smirked. “Of course they’re denying it. I have friends doing volunteer work in this part of Laos — cholera passed the culture tests a month ago. The government is keeping it quiet because this is Visit Laos Year. They don’t want to rain on the tourist parade.”

“This is the first time I’ve ever heard of a communist government lying to promote independent tourism.”

“In a way, it’s hard to blame the government for doing it. The West has encouraged Laos to go capitalist — and one of the principles of capitalism is supply and demand. In a poor country like Laos, tourism may very well be the number-one source of hard currency. Back when the epidemic started, some paper-pusher in Vientiane took one look at tourist revenues and decided right then and there that cholera did not and would not exist. Now people like you are getting exposed to cholera because the Laotian government is afraid to discourage you from coming to Laos.”

“Catch-22,” I said.

“Right. The same thing happened with AIDS in Thailand in the late 1980s. And just like in Thailand, the people who live here will bear the brunt of the problem. It’s the people living in the 4000 Islands — not you — who are going to suffer the most when doctors aren’t allowed to go down and treat them properly.”

“Sure,” I said. “I don’t need to worry about the quality of local health care when I can just go home.”

Doug grinned. “Well, technically, you can’t go home. Under international law, you aren’t allowed to cross the Thai border if you have cholera.”

“But technically,” I said, “cholera doesn’t exist in Laos.”

“Catch-22″ had finally done me a favor.

I crossed into Thailand at Chong Mek the following day. Continuing to Ubon Ratachani, I caught a night train to Bangkok. There, I checked into the modern confines of a medical clinic and began my slow recovery.

This essay originally appeared in Salon on August 24, 1999.