Thursday, 6 October 2011

Dr No-love or ‘How I learnt to stop worrying and live with malaria’.

Up until this point, I’ve been writing about my fun adventures in PNG but this time, I felt like I wanted to share what I’ve learnt from my little run in with malaria. From my experience, I now have more faith in the medical support offered here in Kokopo, and a lot of respect for what they have to deal with day to day (some of you know that last month I witnessed a hit and run and with Robert our driver (who is an angel), helped take a young boy (who was hit but is now OK) and his father to hospital. Ask me about that when I’m home if you’re interested in a hard to believe story, I don’t think it’s one for the blog. What is also hard to believe is what the hospitals here have to deal with with such low numbers of staff and limited equipment. Two weeks ago was the first time in my life I have YEARNED for a doctors clinic in Melbourne, where I can bitch about the tardiness of the doctors while I flip through a trashy magazine, glance up at day time telly and sip chilled water in temperature controlled comfort. And there’s a toilet! Not that I’m suggesting people in wealthy countries should feel guilty about having access to decent medical facilities, not at all. I just wish more people around the world could share in our level of discomfort.

‘Mal’aria’ means bad air. Seems so obvious once you know! The Romans once believed that the illness was caused by bad air rising from swamps. Malaria is actually a disease that pre-dates humanity. The ancient Egyptians suffered from falciparum malaria (one of the strains I had) and supposedly, Egyptian Pharaohs slept under bed nets. Amazing to think we are still using the same prevention tactics they did.

Today, according to the WHO -
Half of the world's population is at risk of malaria. Every year, there are nearly one million deaths. Every 30 seconds a child dies from malaria. Malaria is the leading cause of death in PNG.

Shocking stuff so I’ll stop depressing you now.

The British colonialists drank tonic water (which has quinine in it – a malaria treatment) whilst they ponced around India. The tonic water tasted really bitter (oh the poor little lambs) so they added gin and lime and tadah!- a tasty malaria treatment was born. Despite my enthusiasm for the traditional medicine of my forefathers, these days, there is so little quinine in tonic water that it seems you’d need 67 litres of G & T to ward off infection – which makes malaria the least of your worries (thanks Dan though for the suggestion!).

Through lack of a commitment to hard liquor and tonic, a couple of weeks ago I felt like crap and was subsequently diagnosed with malaria, a strain called falciparum. (I later found out I also had vivax.) Falciparum is the nasty one that can turn cerebral.

The medical people I am required to deal with in Australia (If I’m vague about who these people are it’s deliberate) displayed incredibly stereo typically ‘western medicine is infallible’ style logic to my diagnosis. Basically, they didn’t believe it. I had a blood slide done at a lab recommended by the health staff I work with and then got a rapid test done from a pharmacy (I’m told by an MSF doctor working in another part of PNG that these are quite reliable) and this confirmed the diagnosis. The Aus medical people responded to the two different methods of diagnosis from two different sources with – ‘but how sure are you that you have malaria?’

Hmmmm, are you asking the medical opinion of a high school teacher of Japanese? Perhaps I should get in touch with that rogue mozzie who I had a intimate encounter with some time back and ask it straight up if it cheated on me with an infected partner? I mean seriously. I have the symptoms, two diagnoses, I live in malaria central. Of course, the possibility exists that I don't have malaria, but how can I be SURE either way?

The basis for their disbelief you ask? – I’ve been taking a new and very expensive drug, Malarone, as an anti malarial. No one (apparently) gets sick with malaria whilst on malarone. Silly me, I should have explained to the parasite carrying mozzy that someone paid a lot of money for me to be malaria free and wouldn’t they mind moving on to a cheaper host? Oh, and it was also pointed out to me that I was ‘too chipper’ to possibly have malaria (opinion obtained through skype). Yep, thanks for that very scientific approach. Next time I will endeavour to report my symptoms in my best imitation of Don Coleone right before he collapses into the tomato plants.

They then tell me that even though I probably don’t have malaria, to take the treatment anyway. So I do, and I start feeling better. It’s almost like I had malaria and the drugs have worked!

Then, after about a week, I’m sick again. I feel really really not chipper. Back to the hospital (this time a different hospital, one recommended by the Aus medical people). They do a slide and say, you have falciparum. I tell the Aus med team. They say, no way, not possible. You DON'T have Malaria. They tell me to have a full blood test done because I must have something else. I have two full blood tests done at different places. The blood tests suggest that the falciparum malaria is on the way out (so the drugs are working). One expat doctor says that falciparum is present but she thinks it’s under control, but that I also have vivax (another strain) in small amounts. She is also very surprised I don’t have flu like symptoms (I developed those later it turned out) as my bacterial count was very high. She said sometimes people get things like pneumonia after malaria while their immune system is down. Great.

The other blood test comes back (from the hospital) and the lab tech says to me, look, I know what your Australian doctors think but you have got malaria. We can see the malaria and we see vacuoles in the blood (they appear like holes apparently and indicate that the blood has been fighting a foreign something – like malaria). So I take treatment for the vivax, and treatment for the bacterial infection and bang, start feeling better in several days. The Aus medical people still doubt that I had malaria and prefer to believe that I had something magical which produced malaria symptoms and then responded to malaria treatment.

Sorry, do I sound a little sarcastic? It’s just that I would understand if they were being sceptical because they don’t trust the medical help in PNG. My feelings on the medical help available in PNG can accurately be described as ‘iffy’. But on one hand, they don't trust AT ALL the diagnosis of the doctors here, but every time I asked them their opinion on the treatment I’d been prescribed they waved me away with – I’m sure whatever the doctor has prescribed you is fine. Yeah thanks for that. Let’s take the drugs prescribed by people you think are WRONG in their medical judgement.

Turns out, some doctors here do prescribe things which are less than ideal but that’s not because they are incompetent – it’s because they spend all day everyday prescribing drugs for malaria for local people and they sensibly prescribe based on what drugs people can actually access. Which, as it happens, ain’t very much. I was prescribed quinine (sadly not to be taken with gin) by one hospital and then went to their pharmacy and they had NONE! Luckily for me, I’m an expat with money and the means to search for good info. Geoff and I are able to pay for better treatments at the private pharmacies. We were able to find out what we should be taking but no thanks to the supposed ‘medical team’ in Aus. I mean, at every point of the way, they were kind and interested and I felt confident that if I got worse they wouldn’t have hesitated to medivac me out of here, but it was so frustrating to have to deal with their conflicting attitude to the medical opinions of the doctors here.

Much more concerning than my own petty frustrations was that when I went to the hospital, I couldn’t see a doctor because a young man had been attacked by his uncle with a bush knife and the doctors were trying to hold him together. Several small and very still babies were also lying around with drips in, looking so vulnerable, their tired young mothers sitting by them. So, we all were waiting, in vain, lots of sick people in a hot room on broken hospital beds. A big wake up call. Again, having money meant I could go to a clinic run by expats from the Philippines and be seen there. It’s so tough for local people here. And these are the people who can physically get to town and afford the fees at the hospital. Put in this context, my complaints about not getting good support seem pretty pathetic I think you’ll agree. 
And why is there no medicine in the hospital pharmacy? I can’t speak specifically about the hospital I went to, but I do know that there is a problem with people stealing drugs and selling them illegally. I just happened to be at the local government building one day (for work) when a ute full or confiscated medicine came in. It’s another long story (kind of like The Wire, PNG style) which may be a bit sensitive to write here, but basically medicine destined for the clinics is sometimes instead available, for a higher price, on the black market.

So, the end of my story is….. I’m healthy. I was treated and looked after and by dint of my privileged Australianess am never likely to be one of those people who die from this disease every year. I know some of my loved ones are ever more scared to visit here now after what they’ve heard from us. Truth is, I’ve been sicker with a head cold. My preliminary research suggests that a few gin and tonics can have positive effects for patients learning not to worry about malaria. If you’re interested in taking part in this research please leave a comment below. 

Thanks for the facebook love when I was sick and moaning through my updates. Much love,

1 comment:

  1. whoa dude, crazy stuff. glad you're feeling better. i love how they said you were too "chipper." tha's my girl! even malaria can't take the spunky outta ya.

    man, did you actually take the quinine? i had water parasites from thailand which america weirdly diagnosed as malaria (before the simple stool sample which told all) and because maine is so far removed from malaria land as you can get, had to take older medicine, quinine. it was effed up. i only took it for 3 days but i lost my hearing. white noise. that's all i could see. i got dizzy and threw up a lot. hell. worse than the water parasite. after the stool sample was sorted finally got antibiotics to knock the sucks out. trouble is body was down from the parasites and quinine and so i got the side effects from the antibiotics, uncontrollable hand spasms and hand clenching and my legs turned tomato red. finally got correct medicine and felt better :) enjoyed your post as always. yah to health~!

    xoxo danielle