I'm sitting here with a pack of ice on my knee, the cold numbing my leg while drops of condensation run across my skin. A moment ago a hot pack was sitting in the exact same spot. I've got leishmaniasis, or papilamoya as it's known locally. I've had it for over a year now, one spot on my arm that we treated with injections which we thought had worked, but it came back in almost the same spot and two more places beside. I was using a silver cream which was keeping them more or less steady, but not making any improvement. Then I tried gavilana, known in Panama as tres puntas, and known in local English as jackass bitters. It seemed to work brilliantly and within two days the holes in my arms had gone. And the three on my knee, or so I thought. We went off to Panama and returned without putting anything on my knee. It began to look infected, the dogs and flies were showing interest, so I thought I had staph and we went to the clinic. The doctor seemed to delight in telling me that it was leishmaniasis and went on to explain how painful the injections were, how I would forget things, how I would taste metal as long as the injections lasted. I left the office horrified.
Leishmaniasis comes in various forms, the form here in Costa Rica is subcutaneous, which is a lot better than the other kinds. It's a protozoa which is introduced to the body via the bite of a sandflea or mosquito. I spend very little time on the beach, but I do live in the forest: sloths are carriers. No doubt some mosquito fed on a sloth before biting me. Now while I would normally find that a cute idea - sloths have thick fur, the only place a mosquito can bite is directly on the nose - in this case I'm not so enthralled.
The protozoa multiplies and gradually eats away a hole in the skin and then the flesh. It makes an ugly crater like wound with the surrounding skin raised and hard and red, falling away into a smooth or jagged edged hole with a thick whitish fluid at the center. Looks like a volcano. It isn't painful unless the area is touched directly, but it can itch. It seems that everybody who lives here gets it at some point. And there are as many cures are they are sufferers.
Hot banana peel, roasted lime juice, gavilana, hombre grande, silver, coralillo, tiger's paw, milk thistle, green clay, hot and cold - are a few of the recommendations I've heard. Each person has something that works well for them and will work repeatedly, it seems to be a case of finding the right thing. The other 'medical' option is to have a series of injections. If the papilamoya is small the injections can be given directly into the surrounding area. However if it is more serious the injections are given daily into the glutes. We have friends who have received up to 90 such injections day after day until the hole closes. The main active ingredient is antimony, a heavy metal. The treatment really thumps one's liver, as well as one's glutes. I REALLY don't want to go there.
The hot - cold seems to be working. I've been at it for 8 days now and the sides of the holes are lower and less angry. I was using tiger's paw too which is a beautifully shaggy philodendron, but the sap stung like crazy and hasn't made so much of a difference except to make my knee extremely sensitive to touch. Plus I wasn't keen on keeping the wound so wet all the time. I've been letting it air and dry out for the last two days and it seems so much better.
The thing about leishmaniasis is that it will eventually go away by itself, but the hole will be much bigger which brings greater risk of secondary infections, and larger scars. The scars I'm not so worried about, but the secondary infections I am. In this hot humid climate, living on the farm there's potential for all sorts of nastiness creeping in. Ah the rainforest. Alright, time to change to the hot pack.