Malaria

As I've mentioned before, the most common condition on the paediatric ward is malaria. Almost every child who comes in is tested for it and most are treated for it, even if they also have other problems as it often goes hand in hand with infections such as pneumonia or malnutrition. The sickest children are unconscious, fitting and often severely anaemic and 2 children have died of it during my time here. Both came in very late and died of anaemia before the blood arrived. The lowest haemoglobin level I've seen is 1.6. To put that into context the normal is about 12 or so, in the UK we give transfusions below 8 and in Uganda we transfuse below 5 or 6. Before I came here I didn't realise it was possible to have such a low count and still be alive!

We test for malaria using an RDT and a blood film. The RDT (rapid diagnostic test) takes about 2 minutes and is a bit like a pregnancy test but using blood instead of urine. 1 line is negative, 2 is positive. They are pretty sensitive but occassionally you get false negatives. They are also pretty specific but with really sick children you don't know if they are sick because of the malaria or whether they have malaria but also have meningitis or something else (as malaria is so common here) so we usually treat for both. We then send a slide of blood to the lab where they look for parasites. The highest I've seen was over 5000 prasites for every 100 white blood cells- that's a lot of malaria!

Luckily malaria is very treatable. We use quinine here for most cases or co-artem in the less severe cases. Quinine is quite a dangerous drug and in the UK it's almost always given in Intensive Care with the patient on a heart monitor but here it's just given slowly and in a bag with sugar so it doesn't lower the patient's blood sugar too much. Apparently it makes you feel rubbish but it definitely works! So many times I've started a child on it in the afternoon who looks awful- unconscious, fitting etc and worries overnight about them and then turned up the next morning and not been able to find them. I always worry they've died but usually they are just so much better they are unrecognisable! It's one of the best things about paeds here.

So one day a week and a half ago I woke up and really couldn't face getting up. Eventually I did but I skipped chapel and it took ages to get ready as my arms were feeling very weak and I felt a bit rubbish. I went down and started the ward round and my lovely medical student Tom carried a stool around so I could sit down with every patient as I didn't feel like standing up. I saw about 6 patients and then Dr Mary, the consultant turned up and I decided to go and have a rest in the staff room. A tiny little voice in my head said that I was feeling similar to last time I had malaria in Ghana but it's so hard when you first feel ill to know if it's real or you're just tired, and it was a Friday and the end of a long week. I went to speak to Dr Mary and she said I had to do an RDT and it was positive! Luckily my blood film showed no parasites, which suggests that the doxycycine I'm taking as prophylaxis had worked a bit but the RDT is enough to show it was malaria. I begged not to be admitted so she gave me some coartem and I spent the next few days in bed. For the next couple of days I got more achy and my arms really hurt but then I started feeling better and was just really weak. Emma was a star and looked after me, cooking all my meals and even offering to wash my hair. Dr Mary and one of the nurses came to check up on me a couple of times which was sweet. After 5 days I was able to get up and go for a little walk and the day after I went to the ward for an hour and a half (and then slept for the rest of the day!). The day after (last friday) Mary was away so I did a full 4 hour ward round which I was very proud of. And last Sunday, 9 days after the malaria I trekked to see gorillas, but that's for another blog.

This experience had taught me lots. Firstly, no antimalarial is 100% effective but now I've had malaria whilst talking doxy twice I've decided to give up on it! I'm going to try to buy another one in Kigali and if so will swap over. Secondly, I've now had it twice and both times at first dismissed it as feeling tired and maybe early flu. Thanks to Dr Mary I was diagnosed and treated really fast and I think that's why it ended up being so mild. So basically I urge anyone who is in Africa, or another malaria area to assume that any fever, or feeling weak and achy is malaria and get tested. Emma and I are going to carry RDT packets and coartem around with us for the rest of our trip just in case!