I am working in Malawi, Africa at a Loma Linda Hospital to substitute for the general physicians who are on vacation. Here are a few of the medical problems I found in late June and early July:
There is a lady in her 60s who had trouble swallowing and was vomiting undigested food. This could mean that the food was not reaching the stomach. We tried treating her for ulcers but that did not work; So we then consulted the surgeons who did an Upper GI test which showed much narrowing of the esophagus. They put a scope in and biopsied a tumor and are waiting for the pathology, but it is probably cancer. She had a feeding tube placed through her abdominal wall to get her nutrition since she had lost about 40 lbs in about 6 months. Instead of the cans of feeding like Ensure, we are giving her a solution made from finely ground oat flakes and peanut powder and milk powder. This has been a great and inexpensive way to feed patients through these tubes or through a tube in their nose going to their stomach. This is a palliative care (comfort care) procedure.
The risks for esophageal cancer are smoke and alcohol. Perhaps the cooking fires in a small space made her more at risk. Eating burned or smoked meat or food is also a risk.
I am seeing a lot of patients who do not take their hypertension meds daily and end up in the hospital with strokes. A few recover but most are weak and/or cannot talk. Their family transports them home for them to take care of them instead of placing them in a nursing home.
COST OF UNTREATED HYPERTENSION
Besides strokes and heart attacks, the heart tires out when high blood pressure is not treated adequately. Just like carrying a heavy load in your car (or on your body, as in obesity) for years will eventually wear down the joints, so the heart pumping against increased pressure will cause the heart to tire out earlier. This is called heart failure. Medication can treat it some, but it is best to prevent it. End stage heart failure causes shortness of breath, the need for oxygen, swelling of the legs, poor blood flow to the kidneys, liver, intestines.
There is a similar problem with not taking their antivirals. If they take them on and off, then resistance develops and the medications do not keep the viral load down. When the viral load rises, then the immunity lowers, letting in opportunistic infections. I am noticing that many Malawians are very disciplined about their medications.
We have a man in his 40s who has a bumpy liver. Most likely this is cancer from long-standing, untreated Hepatitis B. We are thinking of biopsying him in order to confirm the diagnosis. These patients need life-long Hepatitis B treatment but that is not available even though it is available as an HIV med. He would have to contract HIV to get the medication. The antivirals I brought from my Inland Empire patients may not last his lifetime. I bring discarded medications to Malawi that my patient is intolerant to or are not working, or are replaced by superior medications.
ALCOHOLIC CIRRHOSIS AND SWELLING
When the liver fails, stage 4, the abdomen fills with fluid and the legs too. We do give a medication to help them urinate more, but that doesn’t help the liver. Eventually they will get confused, sleepy and then die. They might bleed through some varices in their esophagus that will quickly cause death if they are not rescued in time.
MENINGITIS IN A 6-WEEK-OLD BABY
I saw this child in the ward with a complaint of swelling of her forehead. The soft spot was even with the skull but I could feel the bone plates of the skull hadn’t fused together yet. The space between them could be felt. The space between the two forehead bones had fluid leaking under the skin so that an extra bulge was present on the forehead. Not being a specialist in newborns, I called the pediatrician and we got it sorted out. The baby had meningitis and received antibiotics and improved. She was less sleepy and was nursing from the mother well at discharge.
It is winter in Malawi, the opposite of weather in the North so I don’t expect mosquitoes to spread malaria at this time. But we see mosquitoes and malaria daily here. Adults usually experience the less severe forms of the disease since their bodies have had it so many times. Babies and children get quite ill and some have died while I was here in the past. The parents use nets at bedtime to prevent it, but still the children get bit. If they take medications early, then the disease is less severe. Fevers, general body pains, abdominal pain, vomiting, severe headache and many more symptoms are common with malaria. Those visiting for a short period, like me, take medications to prevent it; and they usually work.
Daniel Pearce, D.O., FACOI, AAHIVMS
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, Borrego Health (Riverside, San Bernardino, San Jacinto)
Member, HIV Aging Research Project, Palm Springs