Monday, February 05, 2007

Infectious Diseases 101

We are coming towards the end of our 6 week placement here at Ishaka Adventist Hospital and are feeling sad at the prospect of moving on. We have been made very welcome, have a comfortable home with a view to die for and have learnt lots of practical medicine. For the first time in 20 year medical careers we have looked after people with malnutrition, measles, malaria, TB, HIV, typhoid and rheumatic fever.
Most are rewarding conditions to treat. We have now had 3 small children unconscious and fitting with cerebral malaria for more than 48 hours who wake up, start eating and 2 days later are smiling, well, and soon on their way home. The wailing, miserable, scrawny malnourished babies usually take at least a week to make their first smile but they do. Except one baby which died this weekend. Even conditions like TB and HIV respond to treatment and patients become active and well again – though drug side effects of the regimes we use here are still an issue.
There remains much stigma and ignorance around HIV and so late presentations with full blown AIDS are an everyday occurrence. Cryptococcal meningitis, strange neurological syndromes and severe TB make the prognosis poor.
We’ve seen a few older people with GI cancers we can do little for. Probably the condition we are most shocked and surprised by is rheumatic heart disease. A benign streptococcal sore throat or skin infection damages the heart valves of young children who then present several years later with heart failure. Everyday in clinic we see children as young as 9 in heart failure, though most are teenagers or older. We can control their rapid heart rate with digoxin, their failure with frusemide (and have even chucked around some captopril and atenolol,) but they need new heart valves. You can have this done as a medical tourist in India for $4000 or in South Africa for $6000, not much help when 50% of the population live on less than $1 per day. It is a classic disease of poverty, worsened by overcrowding and poor nutrition. It is unheard of in the post-war generation in the UK. Interestingly enough after my last blog (moaning about the tendency to over-prescribe) the incidence of rheumatic fever fell dramatically after the zealous prescribing of penicillin to all children with purulent pharyngitis in Costa Rica.

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