Note: not a metaphor.
Kampong Speu reeked of staph and all of the kids in our village seemed to get it. They had milky, irregular scars all over their arms and legs. You hardly see anyone outside Cambodia with that many scars.
Some of the Western people got it too. Like me. I'd get infected cuts in my feet just from the friction from my sandal straps. They made invisible cuts in my skin that let in the bacteria.
I couldn't believe how easily our cuts got infected. It happened almost like a ritual: get a cut, clean it out, get infected anyway. Was staph in the soil? The water that I showered in? The noxious Kampong Speu air? I still haven't found a good explanation.
In the US children wake up every day to take their Adderall before going to school. In our Kampong Speu village children woke up every day to take their antiretrovirals (ARVs) before going to school. All but one of them had HIV.
In the best case ARVs give an HIV-positive kid a functionally normal life. But some kids have adverse reactions to the drugs. They grow fragile or ill, or have bizarre and debilitating complications. HIV lurks behind them like an invisible second shadow.
Because we never knew what stroke of bad luck might end up with someone dying, the village had one firm rule: treat everything. Even for routine infections the village doctor often took the nuclear option of using maximum-strength antibiotics like vancomycin. So at noon, after having taken their ARVs, a second wave of kids with infected hands and feet would meet the village doctor at the clinic. He'd greet all their little open palms with tiny little gift boxes of antibiotics.
We didn't consider any side effects that such overprescription might have. For one, rampant infection combined with abundant prescription of antibiotics creates the ideal breeding ground for new resistant strains of staph. Instead we only thought about how antibiotics kept us on the safe side, however precarious it may be, lest a wound fail to heal or, worse, begin to spread.
And yet none of this interested me that much until one of my infections failed to heal and started spreading.
On the first night it felt like a bug wanted to eat through my foot. I remember tossing and turning, sticking out my leg hither and thither to escape the scorching brush of the sheets against my skin. When I checked in the morning I saw a tiny little bump just above my heel with two tiny white dots at the top. "Spider bite," I said to myself, and covered it with a Band-Aid.
Over the next two days the supposed spider bite grew and grew. It got puffy, it swelled, spread and deepened until it felt like it reached my bone. The swelling consumed first my ankle, then my foot, and then finally reached up to my calf.
By the time I limped over to the clinic to see Kathy I had the shank of a man three times my size. I explained to her the situation, showing her my cartoon leg. I asked her to cancel my PE classes unless she wanted me to teach the pogo.
"You need antibiotics," Kathy said, "It's cellulitis, I know 'cause I've had it myself. Could lose your foot you know." She carried herself with the authority of a woman who believes she's the mother of every child on earth.
"I'll take them as soon as I need them," I said, "My body can handle infections. That's what my immune system is for." My immune system cringed.
"I'm serious," she said, pulling a purple box from the glass cabinets, "take the antibiotics. Start with the strongest ones." She tried to give me the purple box.
"Um, shouldn't we start with the weaker ones? Then move on to the stronger ones?"
"Listen," she frowned, "I've had my own kids die in my arms." Parry and riposte.
The purple box said vancomycin. I took it and headed out the clinic doors. As I limped towards my house, she watched me, imagining me dying in her arms.
When I got home I put the sealed box of antibiotics on my countertop.
Americans like Kathy don't know a lot about medicine. Still, Cambodians know a lot less. Most of the educated people got killed by Pol Pot in the 1980s leaving a knowledge vacuum that never got filled. Due to a dismal health care system which puts western medicine in the hands of folk doctors, their life expectancy still hasn't cracked the 70-year mark.
I saw Cambodians cruising on motorbikes with IVs sticking out of their right arms, fluid bags and poles in their left. It harks back to a folk treatment — something they apparently did during the Khmer Rouge — where people treated anything and everything with a coconut IV. I prefer to drink my coconut water through my mouth. Call me old-fashioned.
I had read in the newspapers about hundreds of Cambodian doctors who had failed their doctoral exams and never got their medical licenses. They petitioned the Cambodian PM who relented and granted them their licenses anyway. After all, they did pay for the exams.
One newspaper reported that Cambodian doctors who passed their exams still misdiagnosed common diseases four out of five times.
You also have the folk doctors who bike from village to village peddling Western medicines that they knew little about. They have sacks full of pills and injectables that they prescribe to their regular clients. These folk doctors never went to school at all.
Lying on my floor I thought to myself. "You're a problem solver. The information is out there. Put two and two together. If you go to one of these witch doctors they'll just make it worse."
A voice popped into my conscious mind.
"Arrogant of you to assume you know better than the doctor," it said. "Also, Alec, how predictable."
"Well, maybe knowing absolutely nothing is better than knowing whatever this guy knows," I told the voice.
"Could be. Hope you don't regret this," it said, just before it disappeared.
I did the math. I had the antibiotics, and I had at least a few days of cellulitis before I'd lose my leg. Plenty of time to take an emergency flight to Bangkok. Maybe.
With the deftness of a blind ape I cracked open my MacBook Air and started punching the keys: P-U-B-M-E-D. I-N-F-E-C-T-E-D-W-O-U-N-D. H-O-W-T-O-T-R-E-A-T-S-T-A-P-H. Et cetera. I was squinting, concentrated, my fingers a blur. Firefox clenched its digital sphincter in preparation for a surge of open tabs.
PubMed taught me that I ought to clean the wound more often since a clean wound heals faster. I gathered my supplies: some gauze, a water bottle, tweezers, a flame, disinfectant. I sterilized my own water, created a pressurized squirt bottle, tweezed out the dead skin and regularly soaked the wound in iodine. This helped somewhat. More importantly, it gave me a tremendous sense of agency. "I'm a doctor now!" I thought to myself, "I'm practicing medicine! On me!"
Then I read something, and I sincerely don't remember how I discovered it and I wish I did. It was about doctors using table sugar to treat all kinds of infections. Chronic infections. MRSA. Diabetic ulcers. Shotgun blasts to the chest.
I thought to myself, "this is just the kind of thing Alec would do."
"And if it's not true," emerged the voice from my subconscious, "about the sugar in your infected wound?"
"I'll trust the science," I told the voice, cracking back open the MacBook and opening PubMed.
It couldn't be so big a risk, I learned. PubMed told me that Zimbabweans used sugar as a wound dressing for centuries. The dissolved sugar causes the bacteria to pump water out of their insides, basically making them shrink and dry out. According to some news articles (including one from the BBC) sugar worked about as well as anything else that I could find, including triple antibiotic ointment, when it came to surface wounds like mine.
I had gotten all the information I needed. I took the bag of sugar in my cabinet — leftover from when we tried to make tiramisu — and from that day forward I packed table sugar into my wound whenever I got the chance. Sometimes three times a day, sometimes four, and sometimes even more. I'd change the bandage every few hours. The sugaring made the wound weep ceaselessly.
Meanwhile, I walked around the village with my leg taped up. Kathy would ask me if I was taking the antibiotics. "As needed," I would say, technically truthful.
At least the wound had stopped getting worse. But the sugar didn't work a miracle, although that would have made for a neater story. Funnily enough I actually find myself in the office of the village doctor asking for him to take a second look. In his good judgment he tweezed out a chunk of necrotized skin.
In its place I saw a void about a cubic centimeter in volume. "That's gonna take a lot of sugar," I thought.
Over the next few weeks, with my foot elevated and marinating in that sweet saccharine nectar, I had time to think about why sugar wasn't more commonly used to treat cuts and wounds. How could we not know about a solution that's so cheap, effective, and widely available? The answer: probably because there's no money in a solution that's so cheap, effective, and widely available.
Out of sheer curiosity I called a clinic in Greenville, Mississippi: I had read that they'd been treating wound patients with sugar for forty years. I wondered how they saw the issue. Were they as excited about sugar as me?
A nurse picked up the phone. I said I'd like to know more about the sugar program. She asked if I was from a newspaper. "Oh, I'm just a student," I said, "just interested in hearing about what you guys are doing. Writing a little article."
"Um, no comment," she said, and hung up.
To this I wish I could tell her that she had nothing to hide, nothing to be shameful of. I'll never know what she thought however because that clinic never returned my follow-up.
As my wound healed I tried to explain the sugar methods to the village: the simplicity, the cost. No one cared. People liked to do things their own way. Instead they told me about their ointments. Tiger balm, iodine, Neosporin.
I nevertheless dreamed about children entering that little village clinic with their palms open, and instead of pills, little sugar cubes would fall into their hands. No more resistant bacteria, no more disrupted gut-brain axes, and no more pharma-industrial complex. But a dream it shall forever remain.
Still, I'll always remember my infected wounds in Cambodia, and how much they taught me about thinking for myself.
Kampong Speu being what it is, it couldn't resist sending me away with a little parting gift. I took to Greece an abscess in my pinky toe which I eventually had to get drained at a walk-in hospital.
That was the last infection I had. And now I have my scars, too.
This essay was originally written as a scientific explanation of why sugar accelerates wound healing, but that's just not as interesting as my personal experience in Cambodia. I wanted to weave the two ideas together to say something more compelling. I took some liberties with the storytelling but the main details are true. Especially the science. Sugar actually does help heal infected wounds, and it should be near the top of anyone's list of home remedies.