Ask The Doctor

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Ask The Doctor

WRITING FROM MALAWI

The power is out and the generator overheated. We are out of many medications and lack a heart monitor and a vaporizer for asthma treatments.
But we still can make a lot of people better.
Many patients have HIV and the average patient coming in to the clinic doesn’t hesitate to tell us their HIV test results. Many in the US are untested and very naïve about this. Of course US gays are very aware and many are getting tested annually to make sure they catch it early enough to ensure a long life and postpone diseases.

With the electricity out sometimes there so I am without Wi-Fi so this is not a coverage of the medical news this time.
I am substituting for the chief physician at a Loma Linda hospital in central/east Africa. It is one of the poorest countries in Africa, not having a port to an ocean. HIV is very prevalent here and most of the hospitalized patients have HIV. The antiviral program is excellent here and they have a great guidebook. I brought many discarded bottles of antivirals and they could use most of them. If it is one of the newer medications, they can’t use it since they will not know it well. They also fear a lawsuit should something happen when they deviate from the guidelines.
The newspaper headline recently was an HIV physician was sued after leaking an HIV status.
There were heavy rains on and off for 5 months, which prolonged the malaria season 3 extra months and dried and flooded the corn crop, their main staple. They make a paste of the ground corn, like grits only finer and eat it with veges or meat if they can afford it. Many chew on sugar cane; this and corn are empty calories—offering no fiber, minerals, vitamins. The people are thin and most children admitted to the hospital are much worse off from their malaria, etc., since they don’t have a healthy body to fight it. A 3 year old died yesterday of malaria as the transfusion was starting, too late. His malaria took him over very fast.

FAKE SEIZURES
There is a condition called pseudo seizures. We have two girls and a boy who thrash in the bed making all think they have seizures. When their heads are held still they stop. The type of muscle movement is not seizures but conscious movement of the child. Usually anxiety is the cause. These can be faked or the anxiety of the patient causes them to have these movements and they can’t control them without counseling and possibly anxiety medication.

MAIN KILLERS
In the US, the main killer is heart disease and cancer but the main killer in Malawi is trauma, especially traffic crashes. Sometimes the minivan drivers are drunk and pack 5 instead of 3 to a seat (having only 3 seatbelts available, which are rarely worn); these are against the law.

LACK OF RESOURCES
Without important resources we have trouble diagnosing and therefore we treat with more guessing than we would in the US. After a week we have shown that this patient did not have malaria, typhoid fever, or pneumocystis on top of his HIV and now we think it is disseminated TB. We have treated him for all these things and are waiting for the TB treatment to take effect. It is not in the lungs and he has no cough so we can’t check sputum. Then he has a fungal infection of the tip of his penis and foreskin and of the mouth and esophagus. He couldn’t swallow. Then he suddenly deteriorated and died. Looking back, he didn’t get his HIV checked early to prevent such deficiency of his immune system. Please get tested regularly if you are at risk and be safe.

VIOLENCE
The chief of the church ladies’ group also confirmed that they were pushing no violence towards women in all the Adventist churches and that some areas have the abuses of forcing wives to have sex, raping other women, and beating them if they don’t comply.
They are also campaigning to not kill the Albinos for their body parts imputed to have healing and economic powers and not have sex with an albino to “cure” HIV. The president and congress have outlawed discrimination, kidnapping and murder of Albinos and all witch doctor activity. One man is in prison for life for his actions; the perpetrators are identified as Christians and Muslims. I remember in South Africa and Zambia that rape and violence against women was routine. Gays are terrified to come out and probably pretend to be straight here.
I see the private patients in the outpatient and inpatient wards and see the more difficult patients in the general medical wards with the PAs. The employees of the Tea Estates and the hospital and schools/university here have insurance. One of the men with an eye injury came back and I noticed his T shirt under his other, open shirt had large holes in it. As with others they wear the clothes till they can’t be worn. A few go without shoes.

The rains this winter were hard and intermittent instead of steady, saturating the soil so more puddles happened, so mosquitoes and malaria were more active. Usually the malaria season lasts from Late December to February, but this time it extended to May. That is a lot of suffering. We remind parents (who develop a partial immunity to Malaria so that the episodes are milder as a rule) to keep their kids from sleeping while touching the nets so that some skin is available to the mosquito. I hope today’s rain is not enough to cause puddles etc.
The corn and other crops were damaged by the repeated flooding and corn prices are double this year.

The longest day of the year for California and the shortest day of the year for Malawi happened earlier this week; the solstice is fun to think about but not to endure when it is so hot in California.
I am emailing my friend at the LLU VA for advice on what antibiotics to use for certain kinds of pneumonias since we are out of quite a bit here and dip into the older, cheaper bottles.
Children and adults come to the hospital late since it is expensive even when it is free since they can’t do childcare or earn money while ill and have to drag a relative to help them at the bedside and cook and clean for them.

An RPR test shows a person had or now has syphilis. We don’t have the titers so we don’t know if they have it again. The standard is not to treat again. This may miss many syphilis cases resulting in chronic infection, transmission, and complications.
The tenofovir renal failure patient died. He had small scratches dug into his chest and abdomen where the family puts herbs, a folk remedy.

Be happy if you have some medical insurance!
Be Safe! Wear protection. Keep those questions coming.

Daniel Pearce, D.O., FACOI
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine
Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine
HIV Specialist, Assistant TB Physician, Riverside County Public Health Department
Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside
Researcher, Inland Empire Liver Foundation and Clinical & Translational Research Center

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