Tropical paradise

31 07 2010

My second full day in Tanzania, I got a text message from my housemate saying that her husband (my other housemate), was at the clinic with malaria. She would be there with him all evening, not sure when she’d be home. Husband hadn’t been feeling well for 2 or 3 days (I jokingly admitted to them just yesterday that my first impression of him was that he was sweaty! I mean it was 8am, its not THAT hot out yet, and he was sweaty and sort of distraught.) Husband had done a Rapid Diagnostic Test (RDT) which he randomly had at home (generally, you would need to go to a clinic for these) the second day, which turned out negative—however, RDTs do have a pretty high rate of false negatives. As it turns out, husband spent three full days in the clinic, with doctors shocked at the medical anomaly that he was: despite an incredibly high malaria parasite count, Husband had actually drove himself to the clinic and walked right in, almost cheerfully telling the staff he wasn’t feeling the best and thought he might have malaria. Of course the symptoms did hit harder over the course of the next few hours and days, reaching a severity that was expected based on the high parasite count, and leaving husband and wife wondering if they were seriously going to need to medi-vac out to Nairobi, to a better equipped hospital, like the clinic staff was hinting at. The day that Husband was released from the clinic, parasite count deemed under control and manageable from home with the medication and directions they were given, Wife started feeling sick. Immediately she went to the clinic herself, and tests quickly confirmed she too had malaria. Caught early, her parasite count was orders of magnitude lower. She spent a few hours in the clinic, was given medication and directions for care, and spent the next 2 or 3 days at home in bed–feeling miserable, but recovering. For me, my housemates’ situation was an appropriate yet undesired introduction to my summer living in “tropical paradise”, studying malaria.

Seven weeks later…I got up and got ready for work fairly quickly. About 10 minutes into my bike ride, I started feeling not the best. Though I was only riding my bike, I had motion sickness! Nauseous, dizzy, weak, feverish and clammy. A little dizzy, vision off. I kept peddling, though quickly started feeling worse. It took me over an hour and a half to bike the normally 45-minute route to work; I stopped 8 times to get off my bike and sit down on the side of the road (where I was viciously attacked by mosquitoes and ants…oops). Eventually I made it to work, stopping at the cafeteria to grab a glass of juice which I thought might help settle my stomach before sitting down at my desk. When I opened my email account, a chat message popped up from Husband. The conversation we had went something like this:
Husband: We saw you biking, drove past you on our way to work
Me: oh no, I bet I looked awful!! That was the worst bike ride, I’ve ever had, took me twice as long to get to work as normal
Husband: Seriously, why?
Me: I feel really sick. I got motion sickness from my bike!!!
Husband: Uh oh. How do you feel now????
Me: eh, ok. Sort of nauseous, feverish.
Husband: That sounds like malaria. Don’t bike home! I can come pick you up if you need. Seriously that could be really dangerous if you bike home, with malaria your vision goes.
Me: thanks, yea I know, well I think I’ll be find I’m feeling a little better already
Husband: I have some RDTs at home. I need to test myself again anyway tonight, we can do it together. Seriously that sounds like malaria. Don’t bike home.

A message pops up from Wife: You don’t feel well?!? Do you think it’s malaria?!

Why the panic? Why the quick conclusions that my slightly-off feelings must be malaria? I started feeling better almost immediately after settling into work and drinking my juice and some water, and by noon felt perfectly fine. But later last night we did indeed take RDTs (“might as well have the experience before you leave” joked Wife). Mine turned out negative for malaria, as I expected (though still wonder at the odd motion sickness from my bike. Seriously felt the same as I did on the ferry ride home from Zanzibar!) Husband’s, however, turned out positive. Seven weeks after Husband first became sick, he is testing positive still, and feeling it as well, despite being on medications (several types) the entire summer. Malaria is simply difficult to get treat, difficult to clear from your body especially when it is allowed to first reach the drastic level of Husband’s case. He already relapsed once and is potentially coming to a relapse again. Honestly, he could be relapsing for years. He claims his concentration abilities at work have been affected, he’s just sort of been in a slightly off, can’t process things state, and we joke at home that the malaria has made him grumpy 🙂 Wife, however, has been fine, presumably parasite-free since two weeks after the initial incident. Husband didn’t catch and begin to treat his malaria until 3 days after he first felt symptoms. Wife caught it at the first sign, treated immediately, and is doing fine. Lesson learned: if you feel nauseous, it could be malaria. You have a headache? Malaria. Your body feels tired this morning? Malaria. Absolutely any less-than-perfect feeling? Malaria. Better test yourself and find out. Oh the RDT was negative? Eh well those things don’t work anyway you could still have malaria. Go to the clinic for microscopy.

This lesson, referred to more scientifically in the public health, malaria-control field as “prompt and effective treatment”, has been mentioned many times in my interviews this summer. Interviewees have stressed the importance of educating people on seeking prompt diagnosis at the first sign of malaria, working with the health care systems to provide easy and quick access to diagnostics and ensuring availability of medications. Prompt and effective treatment can significantly reduce the level of morbidity and mortality associated with malaria, and decrease the socioeconomic burden that results from a person having a long, slow, drawn out recovery.

While the concept seems simple and logical, though, it’s easier said than done. Husband knew all about malaria, before he became sick—he works in public health, and earlier this year worked on a malaria project. He knows more about malaria than I do, even though I’m the one working with it this summer. Husband also lives in a well-equipped city, and has the money for treatment. Why didn’t he seek out medical diagnostic and treatment, at the very first sign of malaria?

Well for one, the first signs are so nondescript. Mild fatigue. Mild headache or muscle ache. Slight nausea, slight fever. Symptoms that can result from things as simple as the common cold, a meal that didn’t sit well in your stomach, or accidentally swallowing too much of the water here while brushing your teeth. Too much to drink over the weekend, not drinking enough water that day to deal with the heat….or even rushing out the door on your bike early in the morning, too soon after waking up! You can’t blame Husband for not realizing right away…in fact, I’d actually give him credit for realizing when he did, with symptoms still mild he did an RDT, and then then next day decided to go to the clinic anyway, getting himself there right before his symptoms really broke loose.

It leaves me wondering, however, if this concept of prompt and effective treatment will ever take hold, and I give a lot of credit to the people and organizations that are working towards improving this aspect of malaria control. Husband, who is so well educated on malaria and has the access to and money for the clinics and treatment still ends up so unpromptly and uneffectively treated that he has been in an under-the-weather state for seven weeks, the end not quite in sight. I can only shake my head at the magnitude of the problem we face in trying to get prompt and effective treatment to all of Tanzania—or all of sub-Saharan Africa.

– Kristen Pfau

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2 responses

31 07 2010
Julie

A great product for nausea and motion sickness which might help you is DizzyStop. It’s all natural and non-drowsy.

1 08 2010
Andrei

It’s unlikely the high count was due to delay in seeking treatment. In fact, the timeline made sense – not feeling well one night, getting RTD test (negative), feeling bad the next night again, getting a lab test. The diagnosis and treatment were indeed prompt and effective, bearing in mind that the disease can be infamously stubborn and complex. What’s more “interesting” here, is that had I not had access to reliable diagnosis and treatment, as well as the ability to pay for quality care and drugs, I would have most likely died – with the count that high, at over 3,500, my kidneys or liver or both would have most likely failed. This is the tragic reality for healthy adult Tanzanians, and people in many other parts of the world. A muzungu getting malaria is terrible, but I get to live.

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