Mostly It Goes

The door opens and in walks another mother with a sick child. Fever on and off for a week. I ask if she's ever had malaria. She bursts out laughing. An error in translation perhaps? It turns out that in Uganda, you get malaria like you get a cold. A mere inconvenience that leaves you feeling rather lousey for a couple of days. Occasionally, though, it kills you and therefore any child with a fever tends to be generously dosed up with anti-malarials. With time, this breeds resistance.

Of course there are WHO guidelines to manage this but, like most UN publications, they tend to be enthusiastically ignored.

After my partially successful attempt to prevent any meaningful surgery occurring at Kiwoko, I had moved to the outpatients clinic. Armed with my trusty Oxford Handbook of Tropical Medicine I sit in an office in the outpatients department speaking with a steady stream of patients through an interpreter. There's the usual plethora. Chronic pain. Infertility. Skin infections. And of course the young child with a fever.

This case has an additional caveat. Both mother and son are HIV positive.

A cough plus fever in New Zealand generally means either pharyngitis, bronchitis, or pneumonia, each caused by only a handful of bacteria. In Uganda, there is this standard kiwi cocktail plus Tb and a whole host of bizarre parasites and creatures great and small that God saw fit to bless the tropics with. Then you add HIV infection and the list of possibilities becomes exponential.

For any phsycial symptom, HIV widens your list of possible causes. The virus is fussy. It infects a single type of cell. Not brain cells or liver cells or heart cells but a poorly known set of immune cells that don't kill bugs directly. These helper cells are the communicators of the immune system. Giving orders as to what should be attacked and when. With these cells removed by HIV the immune system is thrown into disarray.

All sorts of weird infections emerge. Most of which are virtually never seen in New Zealand where the HIV is low. 0.1% in contrast to Uganda's 29%.

Sitting in my clinic room in the outpatients department, my knowledge of this immune suppression and the consequent tropical infection comes and goes.

Mostly it goes.