Page 16 - October - December 2022 Edition

3) So, after death and violent crime, what about you will soon realise no one takes prophylaxis in
common health problems? The commonest the city, I didn't and no one in my family had
cause of going home early is "tired all the time". malaria since 1983: but if you go out of town
Fatigue is worldwide the commonest reason for everyone with common sense takes an antima-
seeing a doctor and Uganda is no different. larial. Don't listen to rumours, don't ask a doctor
There are many reasons for fatigue but rule no 3 who has never seen malaria, don't mess with a
is "if you are tired go to bed" Sounds rather killer disease. You can read the whole article on
pathetically simple but if applied would greatly the website, but the best summary is Rapid
reduce the number of people who quit, get Diagnostic tests are essential and trustworthy,
medevac'd or stay but have a miserable time. buy a few and always have one with you.
Innumerable causes include constant minor
infections such as the common cold. Post 6) There is another tropical disease that is a lot
infection chronic fatigue syndrome is real. Many commoner than most people used to think.
parasites cause fatigue. Add to that unfulfilled Bilharzia. Some fresh water in Uganda is possibly
expectations and disappointment. Come in and "bilharzia free": some of the soda lakes, maybe
see us but still common sense says when you Lake Bunyoni but as a general rule all fresh water
have a cold, feel rotten, don't be a hero, go to potentially has bilharzia. Those advertised as
bed. "bilharzia free" almost all are high risk. Some
travel advisers say "never go in fresh water in
4) The commonest real disease we see is Africa". But ignoring medical advise and
diarrhea. Literally see it, as regular patients bring smoking, drinking and eating hamburgers is
it in small pots for us to examine. Most visitors will common: so not surprising people also go white
get an attack of travellers diarrhea in the first 2 or water rafting, water skiing and sailing on Lake
3 weeks, or even days. Door handles and bank Victoria. So, what is the risk? Yes, it is very
notes are more likely sources of infection then common. Yes, it can be very serious causing
food, but again sheer common sense should paralysis, epilepsy, infertility and prostatitis.
warn you against eating something you buy on However, it is also easily treated.
the side of the road. The fact is you can wash
your hands like lady Macbeth and you are still The answer is sheer common sense. Go white
going to get a dose of travellers diarrhea eventu- water rafting, sailing, or have wild midnight skinny
ally. The best option is always have a dose of dipping parties. Water sports are good exercise
treatment with you. If you see a doctor up in the open air and it is difficult to smoke a
country they will probably say you have malaria. cigarette when you are water skiing. But be very
Common sense suggests that if you have fever aware of the risk of Bilharzia.
and watery diarrhea it is likely to be a stomach Our advice is to choose one of the options on
infection. So, rule number 4 is if you get sudden the website. Best summary is the quick test is
onset watery diarrhea take the medicine. We accurate, the treatment is cheap and effective,
use azithromycin 500mg as a single once only and Bilharzias a potentially serious disease that in
dose. Double if you are rather more traditionally most people has very vague symptoms. It's
built. 95% are better in 24 hours. An alternative is difficult to prove you have it and impossible to
aminosidine. If you do nothing most people will prove you haven't. So, we have a low threshold
be better in 5 days, but most of us have better for treatment. Any possible exposure and any
things to do than sit on the toilet for 5 days so suggestion of infection we treat it. So, rule
take the medicine. Get it from us and keep it number 6. Enjoy healthy outdoor water sports
next to the bed. There are a number of parasites but take Bilharzia seriously. Get tested or treated.
that give rather vague chronic diarrhea. 30% of
visitors go home with amoeba or Giardia. So, if it 7) Rule number 7 is "don't even think about it".
goes on for more than a few days bring in a The risk of HIV in Uganda is probably 1 to -2,000
sample. times higher than in UK. The country average
might be 5% but there are 2 fairly clear and
5) There are some tropical diseases that we see separate populations. Most Ugandans do not
in visitors. Malaria is a very severe killer disease of have HIV. They are either celibate or live in stable
non-immunes. There is more nonsense talked monogamous relationships and they are not
about malaria than any other disease. Rule interested in you. Their risk is close to zero.
number 5 is common sense: Take your antima- Another community is not celibate or monoga-
larial! In Kampala malaria is seldom seen and mous and they have a very much higher risk of

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