Common Medical Problems Seen in the Cross Emergency Medical Clinic
June 28, 2015
by Dr. Gregory Bartha
Malaria is the most common problem I see in the Cross Emergency Medical Clinic. It strikes mainly babies and young children, presenting with high fever, diarrhea, vomiting and occasional seizures. The text books advise anti-malaria treatment for any child under age three who has high fever and lives in the area. First, we usually do blood examinations on these children. There are characteristic markings in the red blood cells which indicate malaria. The greater the number of these abnormalities present, the more severe the condition.
It’s usually best to keep very young children and anyone with disabling symptoms in the clinic for a day or two and treat them with intravenous quinine or an artemisinin-type drug. The artemisinin drugs are derived from an herb and were developed in China. They are the most effective drugs for the type of severe malaria found in Africa. If the malaria parasites were to become resistant to them, mortality from malaria would increase substantially.
Children usually recover rapidly, though diarrhea may persist longer. Some cases can be very serious. One 15 year old boy developed jaundice and an enlarged liver and spleen. He also had blood in his urine and bowels. This can happen when the malaria parasites destroy a large number of red blood cells. We transferred this boy to a regional hospital. It took him about 10 days to recover and he required a blood transfusion.
A three old girl was also brought into the clinic and was unresponsive. She was cold and clammy with a variable heart rate. She had been completely well earlier in the day. This can be the presentation of severe malaria in children. Fortunately, the nurses were able to get an intravenous line (IV) into her. She was given fluids, quinine and medicine to reduce the fever. She did gradually recover, but when she arrived at the clinic, I thought she was going to die. It was a very scary situation. Thankfully, the nurses are very skilled in placing intravenous lines in babies and children. This task can be extremely difficult because the veins are small and difficult to find.
A common complaint of older people is chest, back and neck pain. Frequently, nothing abnormal can be found. I think this complaint results from the continuous stress these people are under. The stress is caused by demanding physical work, nutritional deficiency and worry about family and financial problems. Anemia, chronic infections and recurrent malaria can also contribute to the pain. Resources for investigation into these problems are limited. A physician just has to use his best medical judgment and pray that the patient will respond to the prescribed treatment.
Eye problems are fairly common. I see patients with cataracts, eye irritation and allergy and decreased near vision. Cataract surgery is available, but the expense is beyond the means of most people. Skin wounds are also common. Many are infected, deep and heal very slowly. Some require surgery. Typhoid fever, brucellosis and syphilis also occur frequently.
It has been a steep learning curve for me to familiarize myself with these diseases and symptom complexes. I’m thankful for the assistance of Oboot Luke, the doctor stationed here at the clinic. He has been an enormous help to me and has become a great friend.