Jane Wilson-Howarth

Blog

 
 

Scattergun prescribing

Wednesday, 22 November 2017
Last week I had the privilege of visiting some clinics in a remote part of Gorkha district in Nepal and that trip got me reflecting on different styles of medical practise. I've posted some photos on Instagram @wilson.howarth and I shall write about my recent experience soon but meanwhile here are some notes about the mission to Nigeria I went on in the summer.
 
Early July, a message with the title ‘Mad idea’ arrived in my inbox. Intrigued, I opened it immediately. It was an invitation to go to Nigeria for three weeks ‘as soon as possible’. Then over the next several days I discovered that this voluntary assignment was to investigate a malaria outbreak. I said I was interested, but then had my usual doubts about my competence. Yes, as a doctor with an interest in tropical medicine, I knew a bit about malaria but I’d never personally diagnosed a case – except in bats. I knew a lot about Anopheles mosquitoes but that wasn’t likely to be relevant in understanding what seemed to be a new outbreak. I’d run health sessions for this NGO’s volunteers over many years but I didn’t know Africa. I’d never been to West Africa and I had absolutely no experience of treating malaria. What use would I be then?
My link person within the NGO had more confidence in my abilities and joked that my one key qualification was ‘understanding the demographic’. I was to be investigating volunteers aged 18 – 25 and I had one of those at home. I have more letters after my name than in it but she knew that I understood how likely it was that the volunteers would follow advice, take their malaria pills and protect themselves from bites.
I’ve already written a little about the trip and my homestay in previous blogs (the first is Short trip to Nigeria then Nigerian Swallow) and thought I’d now detail my unusual mission to Nigeria. The volunteers were based in a small town where electricity was at best intermittent and facilities were basic. They slept under insecticide-impregnated mosquito nets and seemed to understand and comply with malaria avoidance strategies. Why then had eight of them been treated for malaria 12 times in the previous six weeks? Could this be a new malignant strain of malaria that was resistant to antimalarial pills? Was it another infection altogether?
For some of the British volunteers this was their first experience of living in a low-income setting and several were understandably spooked when they became unwell – especially as I’d hammered home my message at the pre-departure health briefings that malaria is a killer. They may also have been aware that Lassa Fever was taking lives not many miles away. Local doctors also reported treating lots of people for typhoid, which is another dangerous disease.
I spent lots of time talking to the volunteers. They were well supported by their NGO and could readily pitch up at the local private hospital if they felt unwell. I took a retrospective clinical history about how each volunteer had felt in the days leading up to each malaria diagnosis, and strangely only one told a tale that suggested she’d had the high fever typical of malaria, and she’d clearly had suffered an attack of bacilliary dysentery.
I questioned various local staff and doctors. I visited the medical laboratories where malaria is diagnosed. I tested the volunteers using two different kinds of Rapid Diagnostic Kits.
None of them had had malaria.
This was a welcome surprise but what was going on?
Doctors in different countries practise different styles of medicine. The local tendency was a scattergun approach – prescribing a range of medicines that would cure all the nastiest diseases, including typhoid, dysentery and malaria. In regions where patients may not return to the doctor if their symptoms don’t improve, this strategy probably saves lives.
The local doctors were over-prescribing but had done no harm. I could reassure the volunteers. My final challenge though was to explain that although none of the volunteers had suffered malaria, they could still have confidence in their doctors and accept that taking five or six or even nine prescriptions was acceptable even where one would have been enough.
Thus I could leave Nigeria confident that the volunteers were not all about to be wiped out by an invincible mutant parasite.
 
Two brands of Rapid Diagnostic blood-Testing kits for malaria

There's more about my Nigeria trip here too: Nigerian serenadeFake news? and Priorities
Posted: 22/11/2017 09:24:45 by Global Administrator | with 0 comments



    Pontifications
    Travel
    Wildlife
    Writing
    October 2020(1)
    August 2020(2)
    July 2020(1)
    June 2020(1)
    May 2020(1)
    April 2020(4)
    March 2020(4)
    January 2020(1)
    October 2019(2)
    June 2019(2)
    April 2019(2)
    March 2019(9)
    January 2019(2)
    October 2018(3)
    August 2018(3)
    June 2018(4)
    May 2018(5)
    April 2018(3)
    March 2018(1)
    January 2018(4)
    October 2017(4)
    August 2017(3)
    July 2017(2)
    June 2017(2)
    May 2017(1)
    April 2017(1)
    March 2017(4)
    January 2017(1)
    October 2016(7)
    August 2016(2)
    July 2016(1)
    June 2016(1)
    January 2016(3)
    October 2015(1)
    August 2015(1)
    July 2015(1)
    May 2015(2)
    April 2015(2)
    March 2015(2)
    January 2015(3)
    October 2014(4)
    July 2014(1)
    June 2014(4)
    May 2014(1)
    April 2014(1)
    January 2014(4)
    October 2013(1)
#righttobreathe / 100 word story / 100-word story / 50 Camels / 50 Camels and She's Yours / A Glimpse of Eternal Snows / A Wide Woman on a Narrow Boat / Aberdeen / Abuja / Active Fairness System / Adam Reta / adventure stories / advertising / affairs / age concern / air pollution / air quality / Akwanga / alcoholism / Alicia Ostriker / Americanisms / Amharic / animal reservoirs / ANM / Annapurna / antelope / anthology / Asad / audacity / audible / audio musical project / audiobook / author / Author from Hull / author interview / author reading / author-to-author / Auxiliary Nurse Midwife / Baglung / Bagmati / Bajaj / Bajaj Pulsar / Bajura / banknotes / BBC Radio Cambridgeshire / bear precautions / Benjamin Langley / Bertrand Russell / Bethlehem Attfield / Bhotang / bicycle / bike trip / birdlife / birds / black bear / black kites / black pine forest / Blitz / Bloodshot Books / Blue sheep / book launch / border guards / Boreal Wildlife Centre / Bradt / Bradt Travel Guides / Brahmin / breakfast / bridge / brown bear / buckwheat / buckwheat bird / buffalo cart / bulbul / camaraderie / Cambridge / Cambridge writers / Cambridgeshire / camping hazards / canals / carcinogens / caste / catastrophe / cave diving / celtic / chaite-dhan / Chandragiri / Chele / childbirth / children's books / Chirang / Chisapaani / Chisapani / Chobhar / Chobhar Hill / Chough / city cycling / civet / climate change / clinics / cold desert / colourful hat / comfort / coronavirus / Covid / Covid-19 / cows / creating characters / cycling / cyclist / daisy chain / dal bhat / dangerous wildlife / dawn / dawn chorus / Dead Branches / demonstration / Department of Roads / desert / development / development work / Devon / Dhading / Dhading besi / Dhangadhi airport / Dhaulagiri / Dhee / dhulomandu / doctor memoir / Dolpa / Dolpo / domestic violence / Dr. Katrina Butterworth / dragon / dragons / Drakmar / droppings / Dunai / dust / early marriage / earthquake / earthquake alarm / earthquake damage / earthquake today / East Anglia / eco-resort / eco-tourism / Edinburgh / elbow sneezing / embankments / emergency / England / English journey / English language / environmental crisis / Eräkeskus / eternal snows / Ethiopia / ethnic cleansing / evacuation / evocative smells / Ewell / expat / exploitation / Fagu Purnima / Falgun / feelgood read / Fens / festival / festival of colour / festivals in March / fiction / Finland / fire-tailed sunbird / fishing / fishtail / flash fiction / flash literature / flash prose / flood protection / floods / 'folk / football / footbridge / footpath / for / forest / forest fires / friends / Gai Tihar / gaming / Ganesh himal / Gangetic Plain / garden / garment / Ghami / Ghemi / ghoral / giant crab spider / giving birth / global warming / goodread / goral / gorge / Gorkha / gossip / GP writer / grandad / Greece / grey-headed canary-flycatcher / haiku / handwashing / hangry / happiness / happyness / hare / Hatibhan / health assistant / Heffers / Heffers bookshop / Hell's Grannies / Henningham Family Press / himal / Himalaya / Himalayan Black Bear / Himalayan Goral / Himalayan griffon vulture / Himalayan Hostages / Himalayan Kidnap / Himalayan serow / Himalayan Sunrise / Himalayan woolly hare / Himalayas / himals / Hindu festival / Hindu kingdom / Holi / Holi Purnima / holocaust / home delivery / honey buzzard / hoopoe / horror / hot springs / Hotel Deep of Worldtop / Hotel Peace Palace / house crows / how long to write a book? / human kind / human spirit / idyllic childhood / Indonesia / Indra Jatra / infidelity / inspiration / inspiring fiction for children / Ireland / irrigation / Is She Dead in Your Dreams? / jackal / Janajibika Hotel / Jane Wilson-Howarth / Jews / Joe Wilson / Jomosom / Jomsom / joy / jungle / Jungle book / Juphal / Kaag Beni / Kag Beni / Kali Gandaki / Kali Gandaki gorge / Kalopani / Kalunki / Karnali River / Kashigaon / Kashigoan / Kathmandu / Kathmandu Valley / Katrina Butterworth / kestrel / khana / Khartoum / kickstart / kidnap / kindness / Kipling / Kipling's jungle / kites / Kolkata / Krishna / Kumari / Kurds / Kurentar / Kusma / labour / ladoos / lama / Lamjung himal / lammergeier / lammergeyer / landscape / landslide / landslides / Large Indian civet / largest tribuary of the Ganges / Laxmi Puja / leave no one behind / leave no-one behind / letter-writing / life lessons / living goddess / lockdown / lockdown project / LoMantang / Lombok / London pigeon / loneliness / Lord Ganesh / Lord Krishna / loss and recovery / love / Lukhu river / Machhapuchare / Makwanpur / Manbu / mani wall / married life / Martinselkosen / Mary Kingsley / masala tea / maskmandu / masks / maternal mortality / Maya and the Dragon / medical emergency / medical evacuation / medical memoir / medical Students / Melamchi / memoir / memoirist / memory / Michael Rosenberg / microfiction / middle grade readers / Middle Hills / mineral water bottles / Monsoon / morning mist / Moth Snowstorm / motorbike / motorbike trip / motorbikes / motorcycle / mountain medicine / mountains / mouse hare / mouse-hare / Muktinath / Mukwanpur / mulberries / Mustang / nag puja / narrator / narrow boat / nature / Naubisi / neighbours / Nepal / Nepal Communitere / Nepal road trip / Nepal roadtrip / Nepal Valley / Nepal wildlife / Nepali / Nepali food / Nepali tea / Nepali Times / Nepali topi / Nepali wildlife / Nigeria / Nigiri himal / nilgai / Nilgiri / Nilgiri South / non-fiction / Nonsuch Palace / Nonsuch Park / Northumberland / novel / nuthatch / Nuwakot / obstetrics / onions / orb spider / ox-cart / pangolin / parenting / Passer montanus / passing places / passive pleasure / Patan / Patan Durbar / Patan Durbar Square / payer / People in Need charity / percussion / PHASE / PHASE Nepal / PHASENepal / Phewa Tal / Philippines / Phoksundo / phonetics / photoktm2016 / pigeons / pika / pike / pilgrims / plastic waste / pleasure / PM 2.5 / poem / poetry / Pokhara / Police My Friend / pollution / polytunnel / pony trekking / post earthquake recovery / Potatoes / powder / pregnancy / Pridhamsleigh Cavern / puja / Pul Chowk / Pulsar / Pungmo / Purnima programme / Pyncnonotus cafer / rabies / Rajapur / Rajapur bazaar / Rajapur Island / Rajapur market / Rajapur town / rat snake / reading / reading aloud / Real Fairness for Real men / reconstructed dialogue / recording / Red Dawn Rising / red-vented bulbul / refugees / relief work / Remover of obstacles / Requiem / rhododendron / rice / ricefields / Richard Mabey / Ringmo / risk takers / river crossing / river island / river-crossing / road trip / roadtrip / Rock Doves / rock shelters / Roe Deer / Royal Enfield Riders Club / Royle's pika / rubbish / Rufus-breasted Niltava / rupees / Russian border / rustling / rustlings / Sally Haiselden / samosa / Sarengkot / sarus cranes / scorpion / screening / Second World War / Seeta Siriwardena / self-harm / senses / serow / Shangri La / Shangri-la / Shanti bazaar / Shey-Phoksundo National Park / Shivapuri / Shivapuri Nagajung National Park / Shivapuri National Park / Shivapuri Village / Shivapuri Village Resort / short fiction / short story / shrikes / silk / Simon Howarth / Sindhupalchowk / Sinhala / Sinhalese / Six degrees of Separation / skipper butterflies / skippers / snow leopard / Snowfed Waters / social isolation / solid waste / solid waste disposal / Soti / South Sudan / sparrows / Speaking Tiger / species leap / spider venom / Spiny babblers / spotted owlet / squirrel / Sri Lanka / Sri Lankan author / Stephanie Green / stink bug / stolpersteine / street art / street dogs / Subsistence agriculture / Sudan / Suli Gad Khola / Suli Gad river / Summit Air / sunbird / sunrise / Surrey / suspended bridge / Sussex / Suttee / Tahr / tales / tar tattoo / tato pani / Tatopani / TBS Kathmandu / tea / tea shop / teacher / teashop / Teku / Teku Hospital / Teku infectious diseases hospital / terai / Thamel / Thankot / Tharu / Tharu people / The Book Warren / The British School Kathmandu / The Lonely Cat / Thessaloniki / time / To be blessed / totobobo / traffic / traffic jam / traffic rules / traffic uncles / transHimalaya / transHimalayan / translation / travel anthology / travel narrative / travel writing / traveling with children / travelling with children / tree sparrows / trekking / trust / Tsirang / Twin Otter / Uganda / unplanned pregnancy / Upper Mustang / urban cycling / urban life / urban pollution / urban water supply / Valley / vampires / vegetarian / velvet-fronted nuthatch / Viiksimontie / Village dogs / village life / volunteering / vulture / Wai / Wanderlust / water supplies / water tankers / West Sussex / western Nepal / white lies / WHO / widower / wild goat / wild places / wildlife / wildlife stories / William Matthews / winter madness / winter Wheat / women of a certain age / Women Travellers / words / wordsmith / World Book Day / World Book Day 2020 / World Cup 1990 / World Environment Day / world's deepest gorge / writer / writers group / writer's life / writing / writing about writing / writing characters / writing exercise / writing for children / writing group / writing habits / writing prompts / xenophobia / year fives / yeti / young mother / young motherhood / Your Child Abroad / zoonoses