Shanksteps #30
Fever
When you think of fever, what usually enters your
mind? For me it means that someone’s whole body is
warm to the touch, often feels cold, is usually sick
(often here with malaria, typhoid or other sickness),
and often can be treated with Tylenol or Ibuprofen.
Recently, I found that fever does not mean the same
thing to all people. I realized this when I asked a
man from Nigeria (in English) how long he had had
fever. He answered 8 years; every day; all day long.
Then I asked if when his wife or family touches him if
he is hot to the touch. Oh no, never that. So, what
do they mean by fever? To this man it means hurting
all over. To others it means sickness or warmth in a
certain area (ie. He has fever in his mouth…). One
woman had fever of the feet – she believed she had
fever because her feet were sweating.
History and Physical
For those of you medical types, learning to take a
good History and Physical is one of the earliest and
most important things you learn in medical school.
You use these skills throughout the rest of your
career. However, when you move to a new culture, you
must adapt these skills to the new environment. I’d
like to give you an example of the type of H & P we
have to do here. Remember, everything is translated
at least once, sometimes up to three times.
I walk into the ER to learn that there is a 1 ∠year
old male with fever, headache (I’m not sure how the
parents know this, but EVERY child comes with
headache), body pain, abdominal pain, and vomiting.
How long has he had these symptoms?
*1 day (even the kids about to die, that have
obviously been sick for a long time).
I see that he was seen a week ago for similar
symptoms, has he been sick for several weeks?
* Yes, it started 1 day before we went to the
dispensary. He isn’t better yet.
Has he taken any other medications than the ones given
at the dispensary?
* No, and since he wasn’t better after one day, we
stopped giving those meds
Have you been to a traditional healer?
*No.
Have you given him any traditional medicines or roots?
* No.
Have you had his uvula cut?
* Yes, 2 days ago.
For what reason?
* He was coughing.
Where did you have it done?
* I don’t know the man’s name, but he cuts our
neighbor’s hair.
On Physical Exam, I find a severely anemic child,
breathing horribly and very fast, very hot to the
touch, with a distended belly and a very large spleen.
When I look in his mouth I find what look like burns
around his lips, and back of his mouth. Similar burns
are around the anus. Across the chest are numerous
cut marks that look to be 2-3 days old.
Again I ask:
Where did he get all of those cuts on his chest.
* The traditional healer.
For what reason?
* His heart was beating fast. It releases the
sickness.
Did you give him any roots or traditional medication
in his mouth. Some roots are more potent at this time
of year and can burn.
* Yes, we gave him roots to help dissolve his uvula.
But we gave the same to his brother last year and he
didn’t have any problems.
Has anyone massaged his belly recently.
* Yes, the traditional healer did because he was
having pain, and his belly was getting bigger.
So, this is how I put together the story. He got sick
with malaria and became anemic from the malaria; had
his chest cut due to the fast heartbeat from anemia;
was coughing from malaria and therefore had his uvula
cut; was having respiratory difficulty after cutting
the uvula and was given roots to burn the rest away;
inhaled and swallowed some of the root and therefore
burned his esophagus and trachea causing further
respiratory and now swallowing problems, and probably
contributed to the vomiting; had a large spleen from
malaria untreated and therefore had it massaged by the
healer. (Normally you have to be very careful with a
large spleen for fear of rupture – and I have seen
kids die of ruptured spleens after having them
massaged by the traditional healer.)
So, now a simple malaria has turned into a nightmare
and probably death for the child. He needs treatment
for malaria; transfusion of blood for anemia;
antibiotics for the infection in his throat and mouth
from cutting the uvula and chemical burns; tetanus
shot and serum antitetanus after having the uvula cut
with the same razor as is used in the community to cut
hair; HIV testing in 6 months; Neosporin on his chest
wounds; oxygen; and LOTS AND LOTS OF PRAYER!!!
Although this story is a mixture of several patients,
it is all true and happens here on a regular basis.
Some of these kids die, many have long expensive
hospital stays. There is NO preventive medicine here
and very little education. Even when I try to educate
parents, usually they trust tradition much more than
the white doctor. It’s very sad, so much is
preventable.
Please continue to pray for our patience, and
patients! Some days are very frustrating, and many
are medically challenging. Pray for our patients to
understand what we are trying to do and teach. Pray
for continued miracles here. Thank you for your
prayers, encouragement and love.
In His Awesome Service,
The Shanks