“It is only when a mosquito lands on your testicles that you realise there is always a way to solve problems without using violence…” Confucius – Chinese Proverb

In early 2024, both the UK and US consular services issued health warnings for travellers heading to the Dutch ABC islands in the southern Caribbean, more so for the island of Curacao. There were over two-thousand documented cases of dengue fever reported over a six-week period before local authorities were able to successfully contain the outbreak…

There is a centuries-old protocol for ocean-going vessels arriving in foreign ports. Back in the old days it was common for ships to carry rats, plague and a veritable number of other deadly diseases onboard. Therefore, all new arriving vessels, to this day, still fly the yellow quarantine ‘Q’ flag on the port-side mast spreaders when first entering port. This signifies to the local harbour authorities that a new vessel has arrived – and that its crew & passengers need to be processed for immigration, customs and, back in those sad times of deadly plagues, examined for disease and pestilence. If found to be infested, the vessel would have been told to undergo segregation and quarantine. It is still a legal requirement under international maritime law for vessels to be cleared by port health officials before all crew and passengers are allowed ashore. For ourselves, flying the ‘Q’ flag has always been a protocol thing, we take the flag down once we have cleared customs and immigration – only on few occasions have we been asked to visit the port medical authorities to complete a somewhat meaningless paperwork exercise to signify that our vessel is plague free. But, as ever, we learned the hard way never to take these old-fashioned protocol things for granted…

We arrived back in Curacao in mid-January much later than we anticipated. Our plan was to sail into Puerto Rico at some point soon and, with Puerto Rico being US territory, we needed to renew our expired US B1/B2 entry visas which are a legal requisite for crews on private vessels turning up in US territory. A normal ESTA tourist visa is not valid unless arriving by commercial airline or registered cruise ships. We had previously cancelled our late-December visa application to the US embassy in London, having then to rearrange our mandatory interview date for early-January… normally we would be back onboard Sänna by this time. In the event, we got back to the Curacao boatyard amid what appeared to be a growing health crisis… there was covid rippling through vessels and crews arriving from parts of the eastern Caribbean. But, you know, covid didn’t worry us anymore, we were both fully inoculated, we had each suffered covid twice in the past. What could possibly go wrong?

We didn’t give much thought to any local health crisis. Our main priority was to wait for the lull in the easterly trade winds – consistent winds that blow relentlessly year-round through the Caribbean. We had little chance of making our way further eastwards against these winds, we would be pummelled in the attempt and it would be a dubious venture. Venezuela was not far to the south of Curacao but a complete safety no-go for sailboats, while heading back west to Colombia was of no interest – it had already taken huge amounts of effort to make it this far to the Dutch ABC islands from Colombia. This had been a full on extremely wet passage… we had no wish to relinquish the hard work we’d completed to get this far east. No, our only real option was to first head to the Dominican Republic, north across the trade winds, a starboard beam reach for near on 450 nautical miles… a fast and yet another wet ride. What we didn’t appreciate at the time was the severity of the hidden threat lurking in the Curacao Marine boatyard…

Curacao north to the Dominican Republic
The day previous we had watched a team of boatyard guys dressed in protective clothing, they were busy fogging the whole area around the low lying mangroves surrounding the yard which also included areas of standing stagnant water. This wasn’t anything new, this procedure is a regular occurrence throughout many areas of the tropics, the sprayed fog contains chemicals that keep down mosquito swarms. Sänna’s hatches too are protected with insect screens, we try to keep both mosquitoes and those other irritating insects we despise, the irritating ‘no-see-ums’ out of the boat – Ceratopogonidae are tiny biting flies that are small enough to get through the fine mesh of an insect screen but have the bite of a lioness on heat. Painful, itchy but not particularly dangerous. Ceratopogonidae don’t carry diseases – their danger is spelt out in the name.

The mosquito, however, is a completely different kettle of fish. These little bastards bite, they bite hard, they prepare your flesh by first injecting your skin with an anesthetiser so you don’t feel the prick of their feeding probe that then searches for your blood beneath the surface layer of your body. They then suck your blood before flying a short distance to lick satisfied lips, their hunger satiated until the time of their next feed. You know when they’ve fed, you itch and scratch the bite on your lower leg or some other body part you can’t easily reach, the red blob that is your body’s immune system reacting to the anaesthetic the mosquito injected in to you before gorging itself silly. If you swat a mosquito dead and it’s full of blood, it’s too late, there is a good chance the blood is yours… or, more bothersome for you, the blood of whoever is snoozing beside you at the time. Worse is when, in the morning, your clean white bed sheets are blood stained and ruined – you’ve suffered a deadly attrition during the night without you even knowing.

Seeing the fogging team covering the boatyard in a misty haze, we began to ask around other boat crews in the yard. Was there a problem? Did we need to worry? The yard office said it was just a precautionary move, something they always did from time to time to keep mosquito eggs from hatching into larvae. Was there covid in the yard? Yes, they confirmed, some vessels that had arrived from Trinidad, Grenada and the Grenadines were being asked to quarantine. This surprised us, covid had been largely under control for over two years now with most social restrictions lifted. In the event, a wind weather window began to open up a few days ahead, we could leave providing we stayed clear of this covid.

The forecasted winds looked variable and tricky. Previously, I had received promotion marketing material from Predict Wind, an online weather forecasting website also offering passage route planning – an hour by hour course advisory prediction based upon how they forecasted the winds to blow over the next four day period. You get courses to steer – the objective being that a few hours or a day later you are in the best geographical position to take advantage of the next wind shift. This method of crossing large stretches of water is becoming increasingly popular with long-distance sailors, more so in this age of constant communication, internet access and powerful computer modelling. We have before, well over ten years ago, used the routing services of Bob McDavitt down in New Zealand, back in those days McDavitt did not use computer forecasts, he was a vastly experienced weather forecaster, a living legend with hardcore southern ocean mariners and red-neck New Zealander fishermen. McDavitt routed us from New Zealand to Tahiti in French Polynesia, a fraught twenty-two day passage during which his weather routing instructions were largely spot on. I activated an account with Predict Wind, I downloaded their passage plan then studied it with some interest.

We finally left the Curacau Marine boatyard, first heading the twenty miles or so north to drop anchor in Spanish Waters, a large enclosed bay and the only real worthy anchorage in Curacao. There we could fuel up then take the bus into Willemstad to clear customs and immigration. We planned to leave Curacao for the three to four day passage north to the Dominican Republic, we planned to leave the next morning the last day of January. Everything, so far, was looking good.

A few hours out, we were tracking the west coast of Curacao still under the lee shoreline of the trade winds. We had relatively flat seas plus a nice offshore breeze driving us along at around six knots. We knew that as soon as we cleared Noordpunt, the northern tip of the island, we would be in the full fury of the trade winds and the rolling seas that go with it. We were prepared, our mainsail half-reefed with our staysail ready to unfurl should the winds blast their way across our beam – in the event it wasn’t too bad once we cleared the headland, we settled into a nice reach making well over seven knots.

Our first overnighter began well enough, reasonable force three to four winds from starboard abaft the beam, we eased along at a steady seven plus knots. When we changed watch, with Marie taking over the midnight to 3am slot, I noticed that she seemed not to look well. I asked if she was OK, she replied by saying she was absolutely fine. I was worried, Marie does this, it takes a head-on hit by a freight train to knock Marie down. My dear wife, a vastly experienced hardcore sailor, is never ill, nor does she complain. I left her to it, there wasn’t much happening, everything was going ok, a reasonably straightforward overnight sail.

While trying to sleep I myself began to feel whoozy. Nothing much to begin with but as the hours moved on it seemed like the beginning of cold-like symptoms, that yucky bit when you’re not feeling at the top of your game but can’t really complain too much. You men out there know what I mean, you need sympathy at this stage, you need those around you to acknowledge you are not feeling great – that period between something you can’t pin down and that dire, desperate illness that women mockingly refer to as ‘Man Flu’. Many years ago, I visited a local pharmacy feeling rotten, I asked the woman behind the counter what she had for Man Flu, what would she recommend. A shotgun, she replied without any deliberation – and from the expression on her face she wasn’t joking. Around 3am I surfaced up in the cockpit, expecting to tell Marie all about my moody deterioration in wellness – and was shocked.

Marie had deteriorated a lot more than myself. She felt nauseous and unsteady. I advised her to take some seasickness medication with paracetamol so that she could get some sleep. I also mentioned how I wasn’t feeling too great – she never said anything, she never mocked me or took the piss which meant she wasn’t well. I began to worry, these were all the symptoms of covid – we’d both suffered covid twice, it had knocked us both down in a bad way and, four years previously, I myself had been rushed to A&E back in Nottingham with breathing difficulties and a lung infection. I’d been ok… but the thought of both of us being not well at the same time was a significant problem – the Predict Wind forecast showed a deteriorating weather situation come daylight. Marie retired below, I considered our options – to turn around back to Curacao meant sailing full into a close haul, we would need a fully functioning crew to do this safely even if only the two of us. Our best option, I figured, was to wait for first daylight to assess our situation then. Things could easily change for the better if we both improved.

Well, this wasn’t to be. The winds increased through the night as we pretty much expected. Our destination in the Dominican Republic was the port of Barahona, this gave us the best chance of taking advantage of the variable winds which were predicted from every direction during the course of our four day passage. I was feeling uneasy with our Predict Wind forecast, the course changes we were expected to be making didn’t fit with our own expectation. Normally, we would have just dealt with it but, by the next morning, it was obvious that neither of us felt well enough to be attempting the forthcoming tough passage. By this time our starboard reach was turning to a close haul as the winds backed from southeast to a north easterly – more worrying was the wind increase to 25 to 30 knots. This was not how the forecast predicted, my own gut feeling was that we were not where we should be at the right time should we still wish to make landfall in Barahona.

It soon became obvious that we needed to reef our sails, we were now close hauled hard on the wind almost sailing out of control too healed over. Under normal conditions we would have simply gone out on deck, reefed the main before furling in the headsail jib to its maximum reefing point. We might even have wound the head full in before unfurling our inner staysail – Sänna loves sailing on a reefed main and staysail, it becomes a smooth and controlled ride. I took one look at Marie, I straightaway decided she was in no state to assist though, as I clipped on my harness lines to go up to the mast to reef in the mainsail, she made a feeble attempt to help by clipping herself on ready. I didn’t need to suggest she stayed safely in the cockpit, she at once sat down and made no further efforts. This was gonna be me alone, I felt rough but not nearly as bad as Marie looked. Marie never gives up like this. Never. More worrying, both of us appeared to be showing an ominous red rash, me around my lower legs, Marie across her abdomen.

By this time we were clearly in some trouble. The wind was backing further across our bows, we could either change course to go with it or tack the sails through the wind. We decided to tack, another huge effort because by this time I was more or less sailing single handed. Marie was sick, she had a high temperature, she had taken herself below, my wife had no choice. My opinion by this time was that it was almost certainly covid, we had got the virus back in Curacao Marine, there was no other logical explanation. Our every effort now was to decide what to do. With the winds backing to the north it would be simple for us to turnaround to sail downwind back to Curacao, we were only a day and half out whereas to make Barahona would still be a further three days. The problem I had in trying to make the best decision was the Predict Wind forecast, this showed the winds veering to our starboard beam onto a reach – not good winds to be heading back to Curacao. But the wind forecast had not proven to be that accurate so far.

I decided to follow my instincts and experience. Our own backup forecast I’d downloaded from Windy, another marvellous piece of online software regularly used by many sailors. I’d had the foresight to get a Windy forecast which I’d then saved as broken down PDF files on my iPad, this showed a slightly different sequence of Winds, which didn’t differ greatly from the wind predictions by Predict Wind – the difference being the courses to steer that the passage plan provided by Predict Wind gave us. I was beginning to lose faith in this predicted passage plan. In a normal situation we would have stuck with the plan and just worked our way through it, reserving our judgement until we’d completed our passage to Barahona, but right now we were not in a good place to take this risk. I decided to disregard the passage plan, I was effectively sailing solo while not being in the best health myself. Furthermore, I would not risk the winds turning against us having reversed our course back to Curacao – we would press on, we would continue to make for Barahona knowing we could vary our course more eastwards if need be, to make landfall in the handful of official ports of entry further east along the southern coast of the Dominican Republic. In hindsight, this proved to be the right decision.

Dengue Fever
I had suffered dengue fever once previous while we were back in El Salvador. Marie was home in the UK at the time, I was readying to leave Sänna for a few weeks in Bahia Del Sol on the Pacific side of El Salvador. With just myself and the ships cat, we were making arrangements to transport our cat Nellie back to the UK. I came down ill, a flue-like illness well before the world had heard of covid. Fortunately, there were two US boats in close vicinity manned by husband & wife crews, both wives, it turned out, being medical nurses – and both diagnosed my same red rash covering my legs as almost certainly dengue fever – confirmed by a local medical practitioner who took one look and confirmed dengue. I was ill, I was bad for two whole weeks which was way worse than anything I eventually suffered with covid. But after being laid up feeling miserable and wishing I could put that shotgun to my head, I’d gotten better, the whole experience being more like a bad dose of that dreaded man flu.

At first, I thought best not to confirm my suspicions to Marie. We were, after nearly three days at sea, on course for Barahona. Once through customs and immigration I could find a local doctor – though I knew from experience that dengue, like covid, is not treatable. It was simply a case of suffering for about fourteen days, taking paracetamol and somehow getting through bouts of extensive sickness and loose bowels. I had got away with it through the excellent care of my two American nurses, who cared for both me and the cat – the cat made things much worse by her uncontrollable nightly disappearances to hunt cockroaches. Yes, I had a fine time! This now, in the middle of the Caribbean Sea, in my unprofessional diagnosis, was dengue fever.

Barahona is the main westernmost commercial port on the Dominican Republic southern coast. Sailing yachts do occasionally call there, in the main to complete customs & immigration… other than this there is little reason to go there. Our original plan was to take best advantage of the trade winds to reach the Dominican Republic from Curacao then make our way eastwards inshore along the southern coast, out of the full force of the trades. There were plenty of available anchorages along the way, we could then make our way across the infamous Mona Passage to the west coast of Puerto Rico. From there it was a more straightforward passage through the US Virgin Islands, into UK Virgin Island before turning southeast to follow the Caribbean islands chain down to Granada or perhaps Trinidad & Tobago – and back out of the dangers of the hurricane zone. This plan was now in tatters and we both knew this. Our main goal now was to find somewhere safe to rest out until this thing, dengue, covid or whatever it was, had passed through us. First, we had to undergo the port-of-entry procedures, which, on this occasion, would mean obligatory vessel and crew health inspection. Our first priority was to actually get to the Dominican Republic.

We got ourselves through it. We both had a terrible time, the boat heaved and rolled in the rough seas and high winds, I was constantly on deck reefing and tacking the boat while feeling thoroughly like death. I vomited over the side several times, my head hurt like thunder and I wished I had that shotgun to put me out of my misery. Marie was even worse, she rarely surfaced, never ate and spent most of her time in our bunk seemingly unconscious. She suffered a raging temperature, fever and never much noticed the rolling and pitching of the boat. Several times I considered making a Pan Pan emergency medical call on the VHF radio but I reasoned that wouldn’t make things any better. What would the rescue authorities do? Airlift a medical team to take care of us? Would they evacuate us off the boat? What would happen to Sänna then? When I began to reason things like this we had no real options, perhaps we would be simply overwhelmed by the sea and the wind, maybe just disappear forever – the missing British couple who would eventually be forgotten. I could radio our position, explain our situation so that at least we could be tracked, someone would know that we were suffering. In the end I did nothing, even with Marie out of the game we were, in our own way, managing our dire situation. We were making good progress towards Barahona, the winds became more consistent, with the auto helm taking over we had the ability and experience to make landfall. Once ashore we could assess our position and get medical help. By the end of day three I myself was feeling much sharper. As we neared the cape of Cabo Beata the seas began to ease, the wind dropped to a steady twelve to fifteen knots – day three ended with a magnificent sunset. Morning sunrise was grey and miserable with a little rain, it was day four, we were fast approaching the outreaches of the port, the seas shallowed and we took the first red navigation buoy to our starboard side. Marie slept through all of it, she had overdosed on seasickness pills and paracetamol with ibuprofen mixed in between. Once I slowed the boat Marie’s own instincts kicked in, she roused herself knowing the sound of the engine being switched on meant we were nearing the end.

Our first issue was accessing the actual port. We anchored with little difficulty in the small designated area reserved for incoming sailing vessels. We were surprised to see that customs & immigration officials were actually waiting for us on the dockside outside of the small decrepit sailing club, they proceeded to commandeer a local fishing skiff by instructing the fisherman to bring them to our vessel. By this time I was feeling much better though nowhere near my best. Marie, however, had made no improvement. As soon as we were boarded, Marie tried her utmost to present herself as normal but straightaway the customs official saw that Marie was far from well. He point-blank asked what her illness was. I explained our situation – he looked worried, saying that during the past three weeks a number of other vessels had arrived from Aruba and Curacao, the Dutch ABC islands, with either dengue fever or covid onboard. He processed our customs and security procedures then explained that we needed to take our dinghy across the harbour to the harbourmaster’s office for immigration and health inspection. I was a little confused, thinking the other official now alongside the customs officer was for immigration, but it turned out he was from the Armada (navy) office – we needed the Armada’s permission whenever we changed anchorages. But this was fine, these people were polite, they were nice, they were sincere and helpful.

Taking the dinghy the mile or so across the commercial harbour was difficult. Even more difficult was tying the dinghy to the high harbour wall then attempting the difficult climb upwards using only the remnants of an old twisted rope. I struggled, for Marie it was a near impossible task. In the end I hauled her upwards with the dinghy painter line tied around her waist… we both flopped to the hard ground without realising we had little strength to even walk. I left Marie sitting upon a huge ship’s mooring bollard while I went to find the immigration office, which I found just outside the main harbour gates. I fetched Marie, we got processed by a happy smiling immigration official who spoke no English, the guy then happily pointed out the port health office. We went in, here would be the point of no return, if we got told to quarantine ourselves onboard then I seriously feared for how we would get by. The health official asked no questions, nothing, she simply stamped the four copies of paperwork provided by customs, the Armada and immigration. We breathed a sigh of relief then left, next and last of all was the harbourmaster, who gave us the necessary anchoring permit and explained that, when we departed Barahona, we would need a permit from the Armada allowing us to move to our next approved anchorage. Fine, but what I needed most of all was a doctor.

At this point Marie made a horrendous discovery. Marie is alarmingly organised whenever it comes to insurances, renewals, utility billing and all that kind of stuff. Her annual multi-trip travel insurance had renewed religiously every year but, this year, just prior to us leaving the UK, her insurance hadn’t automatically renewed. Nowadays, I myself never purchase travel insurance, it’s hard to find at reasonable rates given the lifestyle we lead and twice, when I have had the need to make a claim, my policy has not paid out. The one time it did pay out during our time in Alaska, my insurance company did not at first pay the dentist who removed my tooth – when I returned to Sänna from the UK a few weeks later, the dentist was banging veraciously on our hull demanding his payment. He carried a gun. I hurriedly called my insurance company who apologised profusely before explaining to the dentist over my phone that payment would soon be forthcoming.

New UK government and Financial Services Authority (FCA) regulations had recently been introduced to prevent large conglomerate companies auto-renewing any form of annual payment without giving prior customer notice – therefore, insurers, prime culprits of this way of doing business, now have to suitably pre-notify existing customers of impending renewals and also offer the same renewal rates as those for new customers. For many years it was common practice for insurance providers to gain new business at discounted rates then hike the price in subsequent years under their auto-renewal schemes. This was now outlawed. Marie checked her emails – yes, she had been prior notified but had not responded correctly by accepting their new renewal offer. A mistake born out of habit – one that was now to have serious consequences. Neither of us had any form of medical cover, mine was self-inflicted whereas Marie had made a genuine and uncharacteristic mistake.

First, until we clarified Marie’s insurance position, we would hold back from finding a doctor – after all, though I still felt weak, I myself was improving by the hour. Marie figured that, using the same reasonable argument, she too would be feeling fine once the virus, whatever it was, had subsided… we guessed fourteen days or so from the outset of the virus at the very worse, we were around a five or six days into this thing so, given our calculations, in a few days we would both be happily on our way. We also reasoned that both covid and dengue were not treatable by normal medication, easy-to-get off-the-shelf medication was advised to relieve symptoms and we always carried plenty onboard. Unbeknown to ourselves, fifteen other vessels were by now officially quarantined back in Curacao Marine with over seventeen cases of mosquito-driven dengue fever confirmed. The UK and US embassies back in the Dutch ABC islands had issued travel advisory warnings to travellers, citing the seriousness of the confirmed dengue fever outbreak. Covid wasn’t mentioned. The seriousness of the situation is that, if the female of the mosquito species bites and takes the blood of an already infected body, then that mosquito itself carries the dengue virus and infects the next body it bites. This is the way that dengue, malaria, the zika virus and other mosquitos-borne viruses like yellow fever are transmitted. Worldwide, every year, 6.5 million are struck down by dengue with an average of a 25% fatality rate. In the year 2024 this figure doubled, experts claiming that global warming is driving a rapid increase in mosquito swarms. Clearly, we were in a serious situation, though right now we weren’t even sure it was dengue fever. Marie still held out for covid, something we had both survived relatively easily.

When I then received a WhatsApp message from a Swiss boat back in Curacao, explaining the seriousness of the dengue virus situation there, I confirmed back that we ourselves were not well, they advised that we notify the UK embassy here in the Dominican Republic to request help. Marie still refused to be panicked, saying it was a short term situation that would soon pass. It was hard work here in Barahona, surely we would be best finding a more easy anchorage where we could simply rest, recuperate and recover. This, for whatever the right or wrong reason, is what we decided to do. The next morning I took the dinghy over to the Armada office, the captain there was exceedingly friendly and helpful. He advised that we make our way to Las Salinas, a good anchorage around eighteen miles to the east. He also said he would notify the Armada naval officer there in advance of our arrival, in this way we would have no problems once we had dropped anchor. He made a point of asking how Marie was, he said to be careful, dengue is dangerous. He gave me the necessary clearance permit and we arranged to leave Barahona the next morning.

Las Salinas was a relatively easy crossing over the often wild Bahia De Ocoa, we made our way in light winds under engine power – neither of us felt inclined to get the sails out, even though we would have experienced a nice gentle sail in good conditions. We rounded the entrance to the large bay of Las Salinas to anchor off the Las Salinas Hotel, the owners had conveniently constructed their own landing slips suitable for small vessels and dinghies. They had done this to facilitate easy access to the hotel, their own restaurant and to the small town straddling the wide scenic bay. It was a delightful spot, sheltered, flat water – perfect to sit things out. There was a convenient pharmacy, numerous small convenience stores and a few cheap restaurants to choose from. The hotel itself provided decent food – this was a nice place until our situation improved, soon we would be able and well enough to move on. Except that, in no way were things gonna get better, in fact, our situation was about to get much worse.

After one week sitting things out in Las Salinas we were well into February, we were approaching Marie’s birthday. By now, I myself was well recovered. Marie, on the other hand most definitely was not. The sickness, her feverish high temperature was unchanged, Marie was hardly eating and couldn’t keep anything down, she was losing weight and the red-raw rashness on her abdomen was worsening. More worryingly, she was developing abdominal pains which prevented her even sitting upright. I constantly replenished our stocks of super-strength ibuprofen and paracetamol from the local pharmacy. Our attempts to take the short dinghy ride to the hotel restaurant to celebrate Marie’s birthday ended in failure, Marie sicked up over the side when only halfway across. We turned around, making our way back to Sänna to cheer her up the best I could. Marie endured a sorrowful birthday.

Anchored not too far away was the one other boat in the anchorage, I’d spoken to the French singlehanded sailor once or twice when I asked him for any information he had on local pharmacies and doctors. He knew the island and the northern Caribbean well, directing me to the one good local pharmacy owned by a helpful medical practitioner who confirmed the nearest doctors being around fifty kilometres north – maybe two hours by bus. I knew Marie could not make that sort of journey on local transport which was often noisy, overcrowded and unreliable. The pharmacist offered to drive us there and this seemed a good solution, however, when I took the dinghy over to the French boat to tell him our plan, to ask if he could keep his eye on Sänna while we were absent for an unknown period, we had already dragged our anchor twice when big blows came through. The Frenchman was quite blunt. Look, he said, your wife is ill, you will not get good health care here in the Dominican Republic, you must get yourselves to Puerto Rico. I was shocked, he repeated himself by saying Puerto Rico is US territory, there they had good health care, quality doctors and hospitals to high US standards. This advice made some sense – but straightaway I reasoned that US standard health care meant US standard healthcare costs. Extortionate. Way out of our range.

Without doubt we needed a plan. We could make efforts to seek medical assistance here in the Dominican Republic or we could use our best efforts to get ourselves across the Mona Passage to Puerto Rico. Marie also came up the idea of making a video of her abdominal rash then send it to her GP doctor back in the UK – she had previously been under NHS consultancy care for other health issues, there was the distinct possibility her present health problem may be linked to a recent laparoscopy investigation that had been done through the region of her belly-button, this smack bang in the middle of her worsening rash. Conceivably, this laparoscopy could have caused the infection. In the meantime, I created a passage plan to get us further east along the southern Dominican shoreline to reach the Mona Passage. These infamous eighty or so nautical mile straits joins the Atlantic with the Caribbean Sea, it would pose a real challenge, we would need the right winds and sea conditions to cross – but right now I was thinking little of that. We made a joint decision to leave Las Salinas at first light.

Las Salinas, Dominican Republic to Salinas, Puerto Rico
Leaving Las Salinas required that we get the necessary departure permit from the Armada Naval, this being an irritating and somewhat time-consuming procedure that’s required each time you wish to leave an anchorage or port in the Dominican Republic. The Armada explain that this is a maritime safety issue though it every time causes delays in departures. There is also a requirement for each crew member to present themselves to ensure that no ‘unregistered passengers’ are being ferried or transported illegally – there are major problems with irregular immigration from the dire political mess that is Haiti, the Dominican Republic shares a long border with Haiti with its violent upheavals and social unrest. So before leaving Las Salinas we both made our way in a mile long dinghy ride to the Armada base at Punta Calderas near the entrance to the anchorage. We found a sleepy guard who authorised entry to see an equally sleepy navy clerk who made out a hand-written permit to a destination in the Dominican Republic I made up. Of course, we had no idea where our next port of call or anchorage would be. I was effectively going to be sailing solo while Marie rested up, I too needed overnight sleep at least for the second night. Upon leaving the bay I made the decision to first head for Puerto de Hania, a tight anchorage around fifty nautical miles distance. We could just about make Puerto de Hania while daylight lasted.

In the event, the usual trade winds from the east turned into a nice southerly onshore breeze across our starboard beam – we made good progress making between seven and eight knots. The currents were tricky around Punta Palenqua but we soon got back into a steady sail that needed hardly any effort from either of us while using the auto-pilot. Just before sunset we entered the tight river anchorage of Puerto Hania to drop anchor off the small local harbour there who promptly sent out a small skiff to inform us that anchoring was not allowed off the fishing harbour entrance and immediate approaches. I apologised, I told them we would up anchor and move but we never did, a French sailboat then came to anchor close beside us – if the winds veered and shifted then we would undoubtedly swing and collide. I didn’t care and neither did the French vessel – at first light we would be gone. I didn’t bother with any more Armada permits nor did I inform them over the VHF radio that we were there in Puerto Hania. At 0630 hours I hauled our anchor to head out, no one bothered us.

By this time Marie was experiencing bouts of more intense abdominal pain and nausea which we could only control by her overdosing on pain killers well over the prescribed limits. Her feverish temperature was exceptionally high. She was laid out flat on her back drifting in and out of sleep. Another full-on day of onshore breezes meant that we could make the near sixty miles to Casa de Campo and the large marina there. When making the approach I radioed in on the VHF asking if they had a free berth and also access to a doctor. Yes – they had a berth available but the nearest doctor was in La Romana about an hours’ distance. We came in to a stern-too berth with pickup lines, the marina operatives kindly assisting by taking our lines to tie up. In the marina office, I explained our situation and they offered to call the doctor on our behalf – they never did. Marie’s main problem now was continued abdominal pains compounded by severe constipation, we both figured her pains might possibly be caused by bowel constrictions having not been to the lavatory for nigh on ten days. Through the marina, I spoke to the doctor by phone who advised that we visit the local marina pharmacy to buy a laxative, he felt sure that Marie’s pains and abdominal rash were the result of bowel constipation and advised Milk of Magnesia. I purchased two large bottles plus a mountain of vitamin supplements from the pharmacy, by this time Marie was only consuming liquids. Two days of Milk of Magnesia caused the proverbial volcano to erupt, which at least meant that we could, for now, discount any ongoing risk of bowel infection. I again spoke to the marina manager, an American, who advised the same as the French sailor back in Las Salinas – get Marie to Puerto Rico.

Our next anchor stop was the incredibly beautiful island of Isla Soana, a day-tripper ravaged location by day but we were totally alone overnight. From here I could begin our plan to cross the Mona Passage – and the wind direction would be key. The eighty mile straits could, in the right conditions, be split by anchoring behind tiny Isla Mona – around forty miles and halfway across. In the situation we were in, we needed winds blowing down from the north through the Mona Passage, hopefully from port side abaft the beam. We were in luck, after one single night anchored behind Isla Soana, we left. We had cleared customs and immigration in Casa de Campo, they conveniently had office premises within the marina complex so this was relatively straightforward and, by this time, Marie was beginning to feel better. Her improvement was a godsend – we began to believe that a simple blue bottle of Milk of Magnesia had done the trick.

The Mona Passage was quite straightforward. We got the downwind sail we hoped for but our single night anchored behind Isla Mona was a nightmare. It was a deep anchorage with twenty-five metres under our keel – we had to deploy most of our anchor chain in waters that heaved and rolled throughout the night. Neither of us slept a wink. The next morning Marie was able to assist, she got the anchor up without any problems before we left to make the forty miles or so to Bahia De Boqueron, a wonderful anchorage and a port of entry into Puerto Rico. However, in Boqueron we learned that US Customs & Border Security was now located at the main airport fifty miles away north near San Antonio – a one-hundred dollar taxi ride. Although where we were in Boqueron was an official port of entry, the customs and immigration offices there had been closed. At least we had our newly issued B1/B2 US visas in our passports. Before we left by taxi, Marie received a reply from her consultant GP back in the UK – he declined to make a concise diagnosis without a physical examination. He advised that we see a local doctor, also saying there could well be a link to her recent laparoscopy scan which had been done through keyhole surgery in her abdominal wall where the rash was located – the rash which was now ominously larger, heated and even more painful. He said, from the photos, the rash was likely an infection.

Boqueron is a delightful small coastal town with easy access by dinghy, we could get provisions, beers and pizzas. We took ourselves for a much deserved evening out though it quickly became apparent that Marie was too unwell. She had ceased eating solids again, was feeling weak and could not walk far. We were also running low on ibuprofen and high-dosage paracetamol. Luckily, not too far out of town, there was a pharmacy around fifteen minutes walk away. Once there I asked for the highest strength of both medications, the pharmacist was concerned and called a woman out from the corner office. This woman, in a reassuring white coat, explained that she was herself a doctor and owned the pharmacy, I showed her the photos of Marie’s rash, she then interrogated me about each of Marie’s symptoms. She looked closer, took a little time studying each of the photos close up, then turned to me to say that Marie must get to a hospital as quickly as she could. The doctor said Marie’s issue was likely to be a severe abnormal infection which could only be confirmed by a CT scan. I explained our situation, that we were on a sailing vessel anchored out in the bay, had no medical insurance and that Marie would be unable to walk this distance to the pharmacy. The doctor advised that we get the boat to the small port of Salinas, around sixty miles eastwards, there was an excellent cottage hospital there with easy access from the shoreline.

Of course, with that recommendation, at first light the next day, we pulled anchor and left. By late evening we dropped anchor off Salinas (not to be confused with Las Salinas in the Dominican Republic). I got Marie ashore through the dinghy dock in the marina, having prearranged a rental car through a sailing website and WhatsApp. The car was a wreck, the owner of the car was even more of a wreck, a squat Danny DeVito lookalike who said he would only deal in cash. I said I needed the car for perhaps three to four days. No problem, he said, but the vehicle would not be insured though, he went on to say, it ran well. I didn’t care. As soon as I had the keys I bundled Marie in and quickly found the local hospital. What happened next is an experience that will last long in my memory…

The hospital was quite small, we explained Marie’s situation to the receptionist using Google translate. Everything was in Spanish. The woman behind the counter asked for Marie’s health insurance details, Marie confirmed she had no health cover. No problem, said the receptionist, she asked for Marie’s credit card details which Marie gave. She asked us to take a seat in the waiting room – given our experiences back in the UK with our free NHS Accident & Emergency service, this was likely to be a long wait. But, no sooner had we taken a seat, Marie’s name was called by the receptionist. We were both given access through a secure pass door to a small room with two nurses. They sat Marie down, took blood samples, temperature, blood pressure and gave a quick examination of Marie’s abdomen, asking on a scale of 1-10 at which number level was Marie’s pain. Marie did what she always does, she played it down with a seven though, to me, she had always said eight or nine. I calculated that Marie had been professionally triaged in less than twenty minutes of arriving at the hospital.

We were asked to again take seat in the waiting room, Marie needed to wait to get an X-Ray. A young nurse arrived to say that we needed to pay in advance upfront for the X-Ray; this was the bit I was dreading – we have all heard horror stories about the cost of US health care. The cost was gonna be thirteen bucks and I needed to pay with my credit card. I thought the nurse had said thirteen hundred dollars, my mind went blank. When I saw the card machine showing the amount of thirteen bucks, I guessed the nurse had processed the wrong amount. No, she said, it was correct, and now that payment was completed could Marie come with her for the X-Ray. Ten minutes later and Marie was back, X-Ray completed, we had been in the hospital for less than forty-five minutes. Marie was told the X-Ray results would take around fifteen minutes, the initial blood test results around the same – Marie would then see the doctor. Both Marie and I were on a high, it couldn’t get better than this – soon we would know what Marie’s health problem was.

Well, the doctor examined Marie then said she would need an intravenous saline drip inserted, then an antibiotic drip with a low-dosage morphine painkiller drip to boot. Within ten minutes Marie was taken to the emergency room then bedridden. The same doctor came by to say her X-Ray was already through and showed abdominal infection, the blood test showed high levels of infection in her bloodstream but needed to be further examined in more detail, he was concerned but did not say over what. Two hours later the drips were completed, the same doctor then said he would prescribe a further seven days’ oral antibiotics which should take care of Marie’s infection. We were both hugely relieved, we felt that, finally, following nearly three weeks of hectic sailing, harbour hopping and passage making, we had finally taken care of Marie’s health – though we still did not know the cause. Marie’s blood samples had been sent away to the US for further analysis, the final results would take about one week. I tell you, I was dreading the costs. At reception, on the way out, the receptionist presented us with the total bill of a hundred and forty-six bucks… excluding the thirteen bucks X-Ray. We were both staggered – I had expected a couple of thousand dollars.

We were told Marie could leave, to rest and recuperate back onboard Sänna, we should return to the hospital in around seven days following the course of oral antibiotics. We still had Danny DeVito’s rental car, so it was an easy ride back to the marina where we had left the dinghy – we then had around a fifteen minute dinghy ride back to where we had left Sänna on anchor. Four days later, on the 13th March, it was Marie’s son Henry’s birthday, at this time Marie’s health took a sudden turn for the worse.

While on the phone talking to Henry, Marie’s abdomen suddenly burst open, oozing foul smelling puss all over herself and Sänna’s rear cockpit seating – not unlike the scene in the movie Alien when the alien hatchling bursts out of officer Kane’s stomach. The stench was nauseating, the foul green puss kept erupting out of the wound that had suddenly opened out of nowhere. Marie had still been in pain with the by now mandatory high temperature which, she said, had been subsiding as each day taking her antibiotics went by. It was late evening, just getting dark. Marie, being far more reactive to emergency situations than I am, instructed me what to get from our onboard medical cabinet – swabs, alcoholic pads, tape and bandage pads. I was completely panicked and useless – and Marie knew it. I tried my best to assist, but Marie had taken over, this was Marie at her best in a crisis. I decided that I needed to launch the dinghy to get Marie back to the hospital as quickly as I could – I had already returned the rental car to Danny DeVito, so I had no way of transporting Marie once we had landed the dinghy at the marina dock.

Nighttime had descended, it was pitch-black dark. With my head torch and Marie curled up on the floor of the dinghy, I headed down the inlet towards Salinas town. I could see Marie deteriorating, she was in excruciating pain with the green stinking puss seeping out of the bandage pad she had applied herself, her dress was covered and stank. The dinghy dock itself was dark and oppressive, the marina office was closed. With Marie bent nearly double we got to the gate with the security guard, I asked if he could get us a taxi to the hospital. He took one look at Marie, then called on his phone at the same time telling me a taxi would take too long. Five minutes later a slick black car pulled up, windows blacked out – inside were two young guys adorned in gold earrings, silver bracelets and gold thick-linked neck chains. Get in, they said, they drove at speed – not on the road but straight over a large area of wasteland. It would be quicker, they said. The driver told us to hang tight.

Fifteen minutes later we were back outside the same hospital as before, I offered the driver and his friend fifty bucks in leu of the taxi fare – they wouldn’t take it. I grabbed a wheelchair parked outside of the main doors, I didn’t check to see if it actually belonged to anyone. I stuffed Marie in to the chair and sped her inside – the same receptionist, the same procedure – this time the same internal door opened, we didn’t wait, we were ushered inside. In the emergency room, Marie was triaged with incredible efficiency and speed – blood tests, temperature, blood pressure and all that. The trauma nurse removed Marie’s abdominal dressing, the wound burst open once more with the same odorous puss pouring out. The nurse expertly cleaned the wound and dressed it, the same doctor burst through the door. The doctor took one look, then poked his fingers inside Marie’s wound feeling around with his finger – Marie screamed in agonising pain. The doctor apologised, then ordered the nurses to get Marie onto the emergency ward. Same intravenous drips – this time a stronger level of morphine, no antibiotics but a large saline drip too. He arranged for more X-Rays, same procedure, same thirteen bucks price.

Marie lay nearly unconscious on her emergency bed. The doctor asked to see me, he was worried, Marie would need to be transferred by ambulance to a specialist surgical hospital two hours away in Guaymas. He had already arranged for her emergency admission, also for the important CT scan. The transfer ambulance had by now arrived outside – but the driver and paramedic wanted paying in cash, they knew we had no health insurance. I was horrified, I guessed an emergency ambulance would cost at least a thousand bucks. No, the doctor said, a hundred and fifty bucks but he had negotiated them down to one hundred. I already had this amount of cash in my wallet. They wheeled Marie out of the hospital doors on a trolley, lifted her into the ambulance, they asked me to join her. I refused, explaining that I had the left our boat and dinghy which I needed to make secure – I would follow as quickly as I could. I was in open tears when the ambulance sped off to god-knows-where with Marie inside.

But, I was stranded, I had no transport. I panicked, then called Danny DeVito on WhatsApp. I explained what had happened. Wait there, he said, I’ll be there in ten minutes. Fifteen minutes later he screeched to a halt in the car park, same car – no charge, it was free, he said, keep it as long as you need it – but it’s not insured. I almost cried again. Suddenly, I realised I had no idea where they had taken Marie. I went back inside the hospital doors to ask the receptionist to where had Marie been taken, she just said the doctor wished to see me. I sat horrified with the doctor, every word he told me was like a burning dagger through my heart. The doctor explained, that if the highly infectious puss had burst inside Marie’s abdominal wall, which he warned me that he thought it had, then in the Guaymas surgical hospital there would be emergency procedures and surgery for Marie’s life survival. Her internal organs would quickly fail if the infectious puss got to them. Sepsis, he said. I was, of course, silent. I composed myself the best I could, I asked what had happened – what was the cause of Marie’s illness. The doctor then told me the first blood test results from a few days ago were now back – in the white blood cells there were antibody markers confirming hemorrhagic dengue fever, the most dangerous form of dengue there is. This type of dengue is a serious complication of the normal virus, with a sometimes 75% fatality rate. This manifestation of the virus causes high fever, vomiting and predominantly attacks the abdominal wall. Everything, all of it, suddenly fell into place…

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