Few things are quite as unwholesome as getting sick in a foreign country. For one, you are far from the comfortable trappings of home and loved ones who will care for you and dote on you.

The cognitive toll of sickness requires the familiar, and nothing is quite as familiar as the maternal. Hence, the yearning for soup just the way mother made it or an indulgence in every home remedy dismissed whence younger as crackpot theories with no scientific basis.

But getting sick on strange shores is much more than an inconvenience. Living alone as a student means having to make your soup despite a 101 degree fever. You change your own sheets, make your own tea and do your own groceries.

Then there’s the intractability of communication, especially if you don’t speak the native language very well. Sickness is hard enough to describe in your mother tongue, let alone in a foreign one. You resort to saying ‘pain’ while pointing to the offending organ.

Every city begets its own sickness and I don’t mean that simply as metaphor. Take, for instance, the Delhi Belly and what I have started to refer to increasingly as the Kathmandu Kough.

In Brussels, plagued by the incessant rain, it is the common cold. Similarly, in Copenhagen, with its lack of sunlight, it is seasonal affective disorder, or SAD. Now, in Madrid, it seems to be strep throat.

Since I first arrived in Madrid exactly a month ago, at least four of my classmates have fallen victim, one-by-one, to ailments of the throat. I had managed to avoid this grim spectre, but it has finally come for me, just like the masque of red death came for prince Prospero.

Sickness takes as much of a mental toll as a physical one but at least the former is lessened in Madrid due to the warm and plentiful sunlight. The first few days, I bathed for an hour or so in the sun, feeling rejuvenated at least for a while.

Unfortunately, the last three days have been overcast and rainy, robbing me of even that little bit of sanity. So instead, I lie in bed and reflect on the city while sick and reflect on what sickness says about the city.

In Illness as Metaphor, Susan Sontag cautions against using illness purely as a metaphor and that the most truthful way to speak of illness would be to release it from the trappings of language.

But for those who suffer, illness, or sickness, seen as metaphor can often be strangely liberating. Metaphor implies a shared malady. It helps you feel less alone, especially when in a strange foreign land.

Madrid is an informal city. Coming from rigidly planned urban spaces like Vienna and Copenhagen, Madrid is almost familiar. Two weeks after I’d arrived in Madrid, there was a blackout in my building for one whole day and a week later, a blackout on my entire street for a couple of hours. Any Nepali would’ve felt right at home.

Even this Madrid malady of the throat feels familiar. Kathmandu’s sickness once used to be gastritis but with rising incomes and some semblance of political stability, people are eating regularly and on time and healthier, making gastritis not as common as it used to be a decade ago.

Now, another ailment has risen to the top—the Kathmandu Kough. With the earthquake, constant (re) construction, Melamchi pipe-laying, and all the rest of the myriad reasons for digging up Kathmandu streets, coupled with the ever increasing number of bikes and cars, there is constant dirt, dust and particulate matter in the air.

Kathmandu now has one of the worst air qualities in the world, on that list with Beijing and New Delhi. All of this has meant that respiratory and diseases of the nose, throat and lungs have become much more common. It seems that both Madrid and Kathmandu get you by the throat. 

Long ago in the West, cities bred sickness. Most housing in the cities was akin to slums; sewers and drainage were open; streets were teeming with refuse; and health and sanitation were the province of the elite. Even at the beginning of the twentieth century, most city dwellers lived lives that were poor, nasty, brutish and short.

The West’s fortunes have changed. First-world cities are now cleaner, greener and healthier than they ever were. Diseases associated with the environment like tuberculosis and cholera are long gone, replaced with lifestyle diseases like diabetes and heart disease.

Cities in the Global South have much catching up to do. Even as lifestyle diseases rise, there has been no abating of environmental ones, such as tuberculosis and respiratory ailments. That Kathmandu is afflicted with breathing diseases is no surprise; it is an inevitable consequence of its pursuit of development at any and all costs. Environmental concerns fall to the axe of progress. 

In cities, the paranoia of living in close proximity with so many others who might be carrying so many diseases and illnesses becomes acutely real.

It is a wonder we get sick more often, given how often we hold onto bars in buses and trains that have been held onto by thousands of others and how we share small compartments in a bus, a car, a train, with complete strangers in close quarters.

Cities like Kathmandu are increasingly populated with the masked. Although it is not an aesthetic that any city should cultivate, it is a health concern—you protect yourself from others and the environment and you protect others from yourself. 

In Kathmandu, when ill, I lay in bed and avoided the outdoors, for there was only disease and the diseased out there. The dust never helped and neither did all the pollution and exhaust.

The mental anguish of navigating Kathmandu alone was enough to give anyone an ulcer. But if there is one thing that has kept me going throughout this illness of mine in the city of Madrid, it is the sun.

For all of February, the sun has been just right, ensconcingly warm, like being wrapped in a blanket of UV rays. Down by Sol and Plaza Mayor, where the all tourists and the performers who cater to the tourists are, the sun is plentiful and in the mornings, bathes the entire space in a summery golden glow, all pleasant and resplendent. 

But the weather forecast predicts rain for the next three weeks. An Spanish anomaly if anything. It really does seem like nothing gold can stay.