How to tell if your health care clinic might be dangerous...

As a biologist, I tend to be enamored with strange, tropical diseases that have no cure and few treatments.  This is evolution at work!  Yellow fever is an excellent example of a well-evolved viral pathogen, so named for the yellow eyes caused by jaundice symptomatic of the disease.  Now when I say I’m fascinated by these diseases, I mean from the safety of my lab in Vero Beach I feel totally comfortable researching such pathogens, you know, in books and via “the google.”  I don’t actually want to get up close and personal with the Flavivirus that causes yellow fever.
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If you read my post about my trip to the county health department (yeah, you should go read that before continuing), then you already know I wasn’t able to get a Yellow Fever Vaccine because according to the nurse, “there is a national shortage” and it’s “not required to enter Senegal.” 

But I was pretty determined after learning 50% of people who contract yellow fever DIE, and that the virus is endemic to Senegal, that I should probably get this immunization.  I mean, who wants to have yellow eyes and bleed out your eyes, nose and mouth while vomiting – this just doesn’t seem like a fun way to explore Africa and would definitely hinder my ability to share food from a single bowl with my Senegalese hosts.  I’m confident that bleeding from the eyes is an etiquette faux pas at dinner.
 
First let’s clarify something about what travel vaccinations you should get, the USA does not require you to get ANY immunizations to enter another country.  Some countries do require you to have certain vaccinations and proof thereof to enter.  The USA via the Centers for Disease Control does offer recommendations for immunizations depending on your destination country.  These recommendations are based on the risk and probability of contracting particular diseases, in other words, if the CDC recommends a vaccine, it means the risk for contraction is high in that country and the health impacts serious and possibly life-threatening.  For travel to Senegal, the CDC recommends Hep A, Typhoid, Yellow Fever, anti-malarial medications and all routine vaccinations (MMR, diptheria, tetanus, pertussis, polio, chicken pox and flu).  Remember, the public health department told me last week I didn’t need yellow fever because Senegal was “low risk.”
 
Let’s take a look at this little map I borrowed from the World Health Organization (see above left).  Follow along with me, find the west side of Africa, look for Senegal, oh looky there it’s yellow.  I wonder what yellow on this map means…I’m stumped, yellow yellow yellow, hmmmm, oh my gosh could it be yellow fever?!
 
I made a few calls today and found this shady urgent care center that also does “travel medicine.”  They said they had one dose of the vaccine and that they could take me at 7pm.  Right there I should have been suspicious, what kind of health care facility other than the ER is open at 7pm?!  But ok, I’m game, I mean, there’s not really a better way to spend a Monday night that hanging out in a cootie-covered clinic so someone can shoot live virus under your skin.  I waited an hour and fifteen minutes before the medical assistant called me back.  She proceeded to tell me it wasn’t required for me to get the Yellow Fever Vaccine to go to Senegal, seriously, my teacher friends, we are utterly failing at teaching reading comprehension, please see paragraph above on required vaccinations.
 
So fast forward, we’re ready to go, she picks up the syringe, flicks it, and then says, “oh darn, this is an 18 gauge needle, this won’t work.”  My dear readers, do you know what 18 gauge needles are for?  Drawing blood.  Oh my god, she almost stuck that in my arm!  She returns with a new needle and switches it out.  I cannot make up what happened next, she pinched my skin (it’s a subq shot) and MISSES!  Yes, misses, and shoots that dose of yellow fever vaccine all over the exam room.  Nooooooooooo that is the last dose of vaccine my brain shouts.  Now she’s all flustered and I’m trying to remain calm as she apologizes repeatedly.  She tells me not to worry, there’s enough left in the vial to mix another dose (really, can I confirm this??).  Yep, she mixed me another dose,  and managed to actually get in it in my arm the second time – but whether it was actual vaccine or just sterile water I’ll never know.  Well I might know, in a few weeks, when I’m bitten by a mosquito carrying Flavivirus and enter the acute stage of yellow fever, at that point we will all know what was actually in that vaccine.
 
 It's going to be great - everything is going to be great.  Or everything will be tinted yellow.  One or the other.