Parasites and Plot Twists

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Terms To Know Before Reading

• PCMO: Peace Corps Medical Office. These are our doctors.

• Med sep: Medical separation is when PC sends you back to the USA for treatment. Many people never return, so PCVs fear this.

• Headquarters: In this blog, this refers to PC's main medical office based in Washington, D.C.

• "Posh Corps:" A nickname used to describe countries with conditions and amenities such as running water, electricity, heating/AC, wifi, and efficient transportation. This term doesn't often hold water because different sites throughout a country can vary significantly. Everything is on a spectrum, no matter the country.

One of the reasons that PC Albania is often labeled "Posh Corps" is because we have low rates of parasitic infections. Aside from the occasional food poisoning, PCVs in Albania don't usually have major GI issues. Therefore, when I first made this blog, I did not anticipate discussing the maladies experienced throughout my service. However, I have found them to be an unfortunate and persistent part of my expat life here.

Seven weeks ago, my GI system began unusual behavior. My GI communications with PCMO fell through the cracks, but strep sent me to Tirana for an antibiotic. While there, I requested a stool sample. I had amoebic dysentery! Unfortunately, I received this news on a Saturday at site. My medicine - Metronidazole - didn't arrive until noon on Monday. I'd had the parasite for weeks, and I was barely keeping it together. Then - the plot thickens - the antibiotic for strep caused an allergic reaction. Hives broke out everywhere, and breathing became difficult. Tuesday morning at 3:00, I awoke in a panic and informed PCMO that I needed to come to Tirana. It felt like I was headed towards anaphylaxis or pneumonia (again). They picked me up and kept me until Friday afternoon. Thank god for that, because things got worse until Thursday morning. I spent most of my time in Tirana being shepherded to doctors appointments, sitting the hospital for IV fluids and blood draws, and sleeping. Overall, the amoeba caused weight loss, bloody diarrhea, abdominal pain, constant fever, nausea, and vomiting. Everything improved once the medicine began working.

Per doctor's orders, I finished 10 days of the amoeba medication, waited 5 days, and then tested the stool again. Lo and behold, my amoeba was dead! That was happy news, and I couldn't be prouder of Metronidazole. Then, the doctor dropped a bomb.

I tested positive for Giardia, another parasite. All the doctors were lamenting and apologizing, but I can't help but laugh. Talk about bad luck. My first thought was "Plot twist! This is going to make great material for my blog." PCMO gave me Giardia medicine but told me not to take it yet. Metronidazole is hard on the stomach, so it's not ideal to begin the Giardia medication so soon afterwards. Thankfully, the Giardia symptoms haven't slammed me yet. I contracted it sometime within the past 16 days, though, so we're in a waiting game with Giardia.

All that being said, I think am single-handedly carrying PC Albania's 2026 parasitic infection statistics, and I will throw down with anyone who calls Albania "Posh Corps" for GI reasons. I narrowly avoided a med sep, but I'm not off the hook until everything returns to normal. Given these experiences, here are some notes about both being sick in Albania and the parasites.

First, I'm sick so much of the time that it's easy to wonder if it's all mental. Between working with kids, living with kids, and being in a foreign country, illnesses add up. It starts to look bad to miss work or always say "I don't feel good," but that's the honest truth. Therefore, it's easy to feel like you lack the motivation and qualities of a successful PCV. I eventually realized that it actually takes a lot of motivation to function "normally" (or at least try to). Also, to some degree, the parasites have been great for making connections in my community! Nothing launches conversation like "I have a parasite!" in response to "how are you?" One guy at my site even had a parasite before and described it to me in detail.

The concept of being sick in Albania differs from ours. In the USA, we specify illnesses, and they have a hierarchy. For example, the stomach flu is a specific type of flu, and a flu is worse than a cold. In Albania, most everything is called "grip" (pronounced "greep"). You have a cold? Grip. Flu? Grip. Sinus infection? Grip. Allergies? Grip. Pneumonia? Grip. It is often challenging to explain medical issues to Albanians at my site - especially to the older generations. Additionally, Albania as a whole doesn't have the best medical infrastructure, so DIY medicine can be as good as it gets. My host grandfather meant well, but he was especially persistent with telling me what to do when I had the amoeba. His DIY medicine was drink tea, eat honey, eat loads of food, and don't shower (if you do shower, you must sit in a warm room until your hair dries). There's value in doing most of those things, but it's not going to kill a parasite, eliminate strep, or cure pneumonia. Illness can be very isolating because our cultures just don't compute illness the same way.

My first parasite - Entamoeba histolytica - is spread when fecal matter contaminates water or food. This surprised both PC Albania and Headquarters because this parasite is not common in Albania. They were very interested in knowing if I'd traveled to Africa or Asia. The answer is "no." This parasite is Albania borne. Giardia, on the other hand, is more frequently found in Albania.

Most people who have Entamoeba histolytica are asymptomatic (https://www.ncbi.nlm.nih.gov/books/NBK557718/), so they'll never know that they have it, and it never causes problems. I eat the same food as my host family, so there is a significantly non-zero chance that they have it too. Imagine having an immune system of steel.

Update on June 5: The waiting game is over. The Giardia symptoms have struck!

Update on July 18: PCMO gave me 8 Giardia pills. Apparently, you have to take all 8 at the same time. I did not intuit that. PCMO was not pleased. They brought me back to Tirana and watched me take all 8 pills in their office. My brain sounded an alarm the entire time: "this isn't right, slow down, this is too many pills, what are you doing?!?"