Brandi and Scott arrived last week. Brandi Vasquez is, as far as I know, THE first, official Global Health Resident in Obstetrics and Gynecology…..EVER. Thanks are due to the Department of Obstetrics and Gynecology, the Hubert Yeargan Center for Global Health, the Duke Global Health Institute, the Blue Jean Ball Committee (and BJB donors!) and Covidien HealthCare for making our presence and work here possible. They have accepted the challenge to support global women’s health on a level previously uncommon if not unheard of at other institutions. Special thanks also goes out to Stryker Surgical and Cardinal Health for their very generous donations to our work here.
Women’s health has languished in the corner of the Global Health house for too long. The Safe Motherhood Initiative has been labeled an “orphan initiative”. Women’s health care has largely taken a back seat to other pressing issues such as HIV. Very little improvements in maternal healthcare have been realized in sub-Saharan Africa in the last 15 years and we are far from on track to reach Millenium Development Goal number 5 of a 75% reduction in maternal mortality by 2015.
“No Woman Should Die Giving Life”.
A nice little saying that warms the heart, but has done nothing to save the lives of millions of the poorest and most under-represented women on earth.
“Since the human race began, women have delivered for society. It is time now for the world to deliver for women.”
Another little feel-good dittie that has gone nowhere. When will this “time” be that mothers are valued enough to prevent their untimely death at the moment when life seems most precious?
Thanks to the generous donations of many of you, we are planning to hold the first combined Advanced Life Support in Obstetrics and Neonatal Resuscitation Courses in a referral hospital in Tanzania on November 3-12. Improvement in emergency obstetric care is the third of three core health-sector strategies designed to reduce maternal morbidity and mortality. We are all excited about the prospects for disseminating this information and technology locally and regionally. Thanks to all who have seen us through to this point and who continue to support us.
Thursday, October 23, 2008
Sunday, October 12, 2008
The question of Malaria
I am pleased to report that Barney survived his experience at the Vets and returned home to us as good as new. The total bill was 250,000 Tanzania Shillings which is about $210 USD. This was for blood work, three electrical stimulation treatments (still not sure what those were for) and 2.5 weeks lodging with food. A good deal, all in all, especially when compared with the $250 my brother-in-law just spent on one visit to the Vets in the states for a check-up and a few shots for his new puppy. This also happens to be the full cost to surgically repair a patient with vesicovaginal fistula in many sub-saharan African countries (see www.endfistula.org and more on this topic later).
We were in Bukoba two weeks ago helping to teach the first ALSO (Advanced Life Support in Obstetrics) Course in Tanzania. The flight across lake Victoria from Mwanza was truly spectacular and surprisingly uneventful given that we were flying in a plane that was older than I am with pilots who were half my age. The course was a success. We trained over 40 people in caring for obstetric emergencies and hopefully generated some interest in the widespread dissemination of this teaching throughout Tanzania. The maternal mortality ratio (number of maternal deaths/100,000 live births) in Tanzania remains high at 500 - 900 depending on who's counting. This compares to about 12 in the US.
Towards the end of our week there, I began to feel sick. Chills, Sweats, a pounding headache, muscle aches and fatigue. I nearly passed out giving a lecture on post-partum hemorrhage. Our kind hosts insisted that I go to the hospital in Bukoba to get evaluated. There was no question in anyone's mind, except for mine, that I had malaria. I had been living in Moshi (where the rate of malaria is felt to be quite low) and had been taking Mefloquine for prophylaxis. That said, there is a widespread propensity to make the diagnosis of malaria for anyone with concerning symptoms. I have seen the same in Niger and suspect that this practice is widespread wherever malaria has been common in the past. I had some blood tests done at the hospital. They showed moderate anemia and possibly an atypical infection, viral or......MALARIA! The smear for malaria was negative. I took the pills for malaria, of course, and over the next few days, slowly began to feel better: A scene that has played itself out countless times in Africa and elsewhere: Treatment for malaria when the diagnosis was almost certainly something else. I returned home to Moshi and, feeling a bit weak still, I had the lab tests repeated at the Duke lab and they were normal. Significantly abnormal labs at the Bukoba hospital were likely wrong, leading to assumptions that were also likely wrong. Laboratory issues that people here deal with all the time. No anemia, no abnormal white blood cell counts.... Probably a viral illness. Something my immune system had never encountered outside of East Africa.
The reasons for overdiagnosis and treatment of malaria are many and complex. People are dedicating their careers to figuring this out. Most providers here have seen dozens if not hundreds of people die from malaria. To be wrong about the diagnosis and withhold treatment leads to disaster. To diagnose and treat malaria when it is actually something else that will resolve on it own is somewhat of a self fulfilling prophecy. Treat for malaria...patient gets better...must have been malaria. It reinforces the practice of treating liberally in the absence of data or with data that is suspect. Fortunately the treatment is fairly benign and most people get better. I have spoken to a number of people here who say that they get malaria many times a year and keep the medications on hand and self treat at the first signs of fever or malaise. Have to wonder what this all is doing to the efficacy of the drugs.
We were in Bukoba two weeks ago helping to teach the first ALSO (Advanced Life Support in Obstetrics) Course in Tanzania. The flight across lake Victoria from Mwanza was truly spectacular and surprisingly uneventful given that we were flying in a plane that was older than I am with pilots who were half my age. The course was a success. We trained over 40 people in caring for obstetric emergencies and hopefully generated some interest in the widespread dissemination of this teaching throughout Tanzania. The maternal mortality ratio (number of maternal deaths/100,000 live births) in Tanzania remains high at 500 - 900 depending on who's counting. This compares to about 12 in the US.
Towards the end of our week there, I began to feel sick. Chills, Sweats, a pounding headache, muscle aches and fatigue. I nearly passed out giving a lecture on post-partum hemorrhage. Our kind hosts insisted that I go to the hospital in Bukoba to get evaluated. There was no question in anyone's mind, except for mine, that I had malaria. I had been living in Moshi (where the rate of malaria is felt to be quite low) and had been taking Mefloquine for prophylaxis. That said, there is a widespread propensity to make the diagnosis of malaria for anyone with concerning symptoms. I have seen the same in Niger and suspect that this practice is widespread wherever malaria has been common in the past. I had some blood tests done at the hospital. They showed moderate anemia and possibly an atypical infection, viral or......MALARIA! The smear for malaria was negative. I took the pills for malaria, of course, and over the next few days, slowly began to feel better: A scene that has played itself out countless times in Africa and elsewhere: Treatment for malaria when the diagnosis was almost certainly something else. I returned home to Moshi and, feeling a bit weak still, I had the lab tests repeated at the Duke lab and they were normal. Significantly abnormal labs at the Bukoba hospital were likely wrong, leading to assumptions that were also likely wrong. Laboratory issues that people here deal with all the time. No anemia, no abnormal white blood cell counts.... Probably a viral illness. Something my immune system had never encountered outside of East Africa.
The reasons for overdiagnosis and treatment of malaria are many and complex. People are dedicating their careers to figuring this out. Most providers here have seen dozens if not hundreds of people die from malaria. To be wrong about the diagnosis and withhold treatment leads to disaster. To diagnose and treat malaria when it is actually something else that will resolve on it own is somewhat of a self fulfilling prophecy. Treat for malaria...patient gets better...must have been malaria. It reinforces the practice of treating liberally in the absence of data or with data that is suspect. Fortunately the treatment is fairly benign and most people get better. I have spoken to a number of people here who say that they get malaria many times a year and keep the medications on hand and self treat at the first signs of fever or malaise. Have to wonder what this all is doing to the efficacy of the drugs.
Subscribe to:
Posts (Atom)