Tropical illnesses!

09/03/07

This week has been a good reminder of how the spectrum of disease here in Equatorial Africa differs from familiar UK practice. The hospital has a monthly “Grand Round” to which all hospital staff and students are invited, which is basically a 90 minute presentation on a clinical topic. Last month it was on “Tetanus” – a disease which is unfortunately not as rare here as it should be (the hospital had more than a dozen cases last year), and which often affects newborn babies due to the local tradition of putting dung onto the umbilical cord stump soon after birth. Not many people are vaccinated here either – the disease is very rare in the UK, in large part due to our vaccination programme.

However, this month’s Grand Round was on two diseases that have been hot topics here in Uganda over the last couple of weeks – Meningococcal Meningitis and Bubonic Plague! Apparently meningococcal meningitis is relatively common across a band of Africa from West to East taking in northern Uganda/Kenya and southern Sudan/Ethiopia. In the last few years in Uganda there have been sporadic outbreaks affecting 50-300 people each year, and there has been one such outbreak in the North recently which was thought to have reached as far South as Masindi – only about 3hrs drive from Kiwoko! If that wasn’t scary enough, it was then reported that 19 people in Masindi didn’t have meningitis but in fact had Bubonic Plague. You may recall this as Europe’s “Black Death” from the 14th century – from where we get the nursery rhyme “Ring a ring of roses”, and recorded in Samuel Pepys diaries along with the Great Fire of London….

But enough of history. Before you get concerned I am vaccinated against all likely strains of Meningococcus, and Plague is rarely transmitted very far. Plus the hospital groundstaff have been out killing rats this month…. although only this evening I have caught one trying to crawl over the roof of my house! As an aside, the scientific name for the rat is Rattus rattus – which made me laugh! The meeting was very interesting though, and has raised the suspicion level for these two diseases among differential diagnosis lists.

One of our Ugandan doctors, Dr Dan, is very funny whenever we discuss common UK conditions such as heart disease, stroke, lung cancers, etc. Because most of these are rare in Uganda, he describes them as “trendy white-people diseases”! I was able to get him back earlier in the week – one of my patients came back for review and results of a biopsy I had taken a couple of weeks ago, and turned out to have TB which was unexpected, even though that was what I was looking for. I had to go and find out what the local appropriate management was – I’ve never actually treated TB before, so I told Dan that it was a trendy black people’s disease. He and Dr John, our other Ugandan junior doctor both thought this was hilarious.

Actually it brings up an interesting point about Ugandan culture – political correctness simply doesn’t exist here. White skinned people are Muzungus, fat people are called fat, short people short… always to their face, and purely descriptive with no offence intended, or indeed taken. Some might say that I will fit in well, with my own particularly politically incorrect outlook on life!

The latest exotic disease that crossed my path arrived yesterday afternoon. It was a public holiday for National Women’s Day (don’t get me started….) and I was on-call for the hospital. I admitted a man with classical symptoms and signs of Leprosy – another condition I’ve never seen before (perhaps I should get out of the UK more often…). My colleagues today agreed with my diagnosis, and we will await to see the results of investigations. A fascinating week of non-surgical illness!

I’m still keeping busy with many surgical patients to look after. I’m splitting the workload with Dr Peter at the moment which is keeping things controllable. The one disappointing thing this week was that my six-month old baby who I operated on a month ago failed to return for the second part of his operative treatment. I think money may be the issue – even though I had ensured the mother knew that I would take care of the bill if needed. It will be very sad if this child gets neglected and dies, especially after my efforts to save it’s life a few weeks ago…. I’ll keep you updated on any progress – perhaps I’ll try to find the village it lives in on my next cycling excursion, and kidnap the baby back for further treatment… (However, somehow I don’t think that would be culturally acceptable!).

The main exciting news of the week is that our new satellite broadband internet connection is up and running. So far it’s a single socket, but tomorrow I’m heading into Kampala to help buy the components necessary to set up a hospital network, which will include an access point in my house. That will be fantastic (even if it is dependent on power-supply), and will allow me to connect with the outside world when I’m unable to leave the hospital. The monthly cost to us Muzungus will probably be similar to the cost of broadband in the UK, but it’ll certainly be worth it, even if I don’t often have the time to access it.

So, many greetings again from Kiwoko – do keep me up to date with the chat from the UK, and please pray for the patients and staff here at the hospital.

Steve