I spent the summer of 1995 in the Greater Toronto Area on an internship for a corporate comprehensive health organization project. I rode the subway, went to the Skydome and visited Stratford for King Lear. But the highlight of my summer was visiting Wahoo, Nebraska. I drove the Trans Canada there and decided to go home via Denver to sight see a bit.
Wahoo you say? Or Wahoo you knew! I am 43. I grew up thinking a certain late night host was amusing for his acerbic wit. He’s grown old, I have grown old and the schtick got tired. But in 1995 the home office for Late Night with David Letterman was in a small Midwestern town in the USA so I detoured off I-80 to visit. As the joke with his home office went… there was nothing except a road sign and a slice of middle Americana. The home office was a figment of imagination, just a place name to drop every Monday to Friday night at 2355 hours or so right before the TOP 10 list (the comedy gold for the night – better than his monologue for sure).
So from the home office in Nalerigu, Ghana, tonight’s Top 10. The category tonight is top 10 Medical Facts Jim Learned While at Baptist Medical Centre….
#10. Malaria isn’t funny. Don’t get me wrong, I didn’t laugh about Malaria before but I have had a crash course in a boat load of outpatient and inpatient cases. One of the few lab tests we have at our disposal here is a blood film where the lab tech looks at red blood cells to try to identify malaria parasites in the red cells. But if the clinical story fits, you treat for malaria whether the test is positive or not. Sometimes a repeat test helps but regardless, malaria or the secondary infections that coexist with it can be lethal especially to kids less than five.
#9. Pott’s TB isn’t funny either. OK, OK I promise not to have ten items that go ‘X isn’t funny’ . But TB spread to your lower thoracic spine and then possibly forming a big abscess nearby is an ugly way to be sick.
#8. If you’re an old man and your prostate is big you might have problems passing your urine. Actually not a big surprise cause I see that in Canada too, except we have more options in Canada for treatment. Here people often wait until they are retaining urine and obstructed and then need a suprapubic catheter through their abdominal wall.
#7. If you are a young man and you have problems passing your urine it ain’t your prostate – it’s schistosomiasis. Google away people – its a bug found in water and crosses your skin barrier and winds around until it blocks your bladder from the inside. Fortunately, treatable with Praziquantel, a medicine.
#6. Typhoid fever in a youngster often leads to intestinal perforations requiring surgery. What else can I say? Don’t ignore typhoid fever…don’t drink untreated water and the tummy pain might not just be cramps.
#5. We in Canada take for granted our diagnostic options on hand at home. I saw two cases today that would be simple to diagnose precisely and fix if I had availability of certain lab tests. We will treat on clinical ‘best guess’ grounds and it should work out but we are blessed in British Columbia. Of course, people could travel to Tamale and Accra for the same availability but lack of $ limits and that kind of travel is beyond the reach of most.
#4. There is nothing like seeing and doing instead of reading. Reading about cases matters but you get wise and comfortable treating and diagnosing by seeing lots. I appreciate the opportunities here to help and do.
#3. Infant and toddler mortality is high. Sad. Many are saved, all are not. Convulsions and neurological troubles often result from cerebral malaria. Each week there are deaths from this. Probably 90% are fixed but when 10-20 kids a day get that diagnosis…..you do the math.
#2. In the outpatient clinic the most common presentation is “generalized body pain, headache, dry cough and nausea with fever”. Malaria until proven otherwise.
#1. Cerebral malaria isn’t funny.