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Medical practice is whole lot disparate in the tropics; few days ago, I interacted with a physician who was in Nigeria on holiday from eastern Europe. For few years now, he has decided to render his own humanitarian services for the Russians. So I used the opportunity to confirm the popular fact that malaria is very uncommon in Europe and America. Having just being in the country for 3days, he smiled and said to me that he even needed to run a test for malaria, he has been feeling somehow since he came back to the country. Teasingly, I replied my friend by telling him that this one o, he brought it from Russia.
He smiled again and said,
‘Docki, I haven’t even seen a case of malaria in 2years. If you are unlucky to have malaria over there, you’d be immediately isolated.’
The word isolation really got me into deep thought, when it’s not meningitis or tuberculosis? Ordinary malaria that everyone has and everyone treats o…
Then I could no longer help but lose my defence mechanism; in these nascent years of my medical practice, I have tried to involuntarily, or better still unwittingly, repress certain conflict I fight within. Here is my internal conflict with general practice: every outpatient that stares at you with complaint (s) must be treated with drug…, whether drugs alone or along with adjunct treatments/therapies, but by standards of medical practice, not all patients require drug as treatment! Now what would I do when all patients want to take home drug as evidence of visiting a doctor or as justification for the expensive health bill they incur?
Oh dear judges, thou shall not judge my doings, I have given a ‘handful’ of outpatients a drug or two, either as placebo, prophylaxis or at times when I even thought they necessarily didn’t need one—and the culprit here is the ever ubiquitous anti-malarial drugs!
A source from Wikipedia reveals that malaria was once common in most of Europe and North America, where it is now for all purposes non-existent. These days, malaria is widespread in tropical and subtropical regions, including parts of the Americas, Asia, and Africa. The source maintained that each year, there are approximately 350–500 million cases of malaria. That is the real pandemic!
By implication, we are all exposed to this baleful plasmodium species-causing disease, perhaps because we all get beaten by those hungry-looking, blood-thirsty tropical mosquitoes at all times. Hence, a general practitioner sees everything right in managing most of his patients for malaria if not all, at least prophylactically. However, with frequent practice of this nature, we face the danger of what I call ‘Lazy Assessment Syndrome’; our diagnostic priorities become questionable—patients tend to come back for similar complaint(s) without resolution—we tend to handily diagnose and re-diagnose ‘resistant malaria’—eventually, we make the correct diagnosis after an avalanche of time has been bought and blown off on erroneous malaria diagnosis. In some acute cases, the patient may not be too lucky to survive all these trial phases.
TREATING MOST PATIENTS LIVING IN OUR MALARIA-ENDEMIC ENVIRONMENT WITH ANTI-MALARIAL MEDICATIONS IS NOT ABHORRENT, BUT THE OCCULT DANGER IS OVERLOOKING OTHER LIFE-THREATENING DIAGNOSES AT THE EXPENSE OF FOCUSING ON MANAGING MALARIA ALONE.
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Times without number, patients would complain that they have malaria. My response would continue to be, nine out of ten,
‘how sure are you? There are a hundred and one illnesses that could present with fever, headache, loss of appetite, body pain just as in malaria fever.’
And I’d also keep insisting they tell me their symptoms so we may order for appropriate tests. Then, not many patients understand this as most would have tried one or two types of anti-malarial medications before coming to see the physician, still contributing to the danger of resistance.
If a patient keeps coming to me with too frequent symptoms of malaria and I keep treating for malaria without thoroughly evaluating for other conditions that may be causing similar symptoms, malarial resistance aside, I’m at risk of always missing uncommon life-threatening cases. I’m at risk of carelessly losing my patient!
What if malaria test comes out positive? the acceptable guideline is to give appropriate antimalarial treatment according to standard, but not overlook the possibility of patient having other conditions.
WHAT DOES W.H.O SAY ABOUT DIAGNOSING AND TREATING MALARIA?
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According to World Health Organization, ‘Patients with suspected malaria should have parasitological confirmation of diagnosis with either microscopy or rapid diagnostic test (RDT) before antimalarial treatment is started. Treatment based on clinical grounds should only be given if diagnostic testing is not immediately accessible within 2 hours of patients presenting for treatment. Prompt treatment – within 24 hours of fever onset – with an effective and safe antimalarial is necessary to prevent life-threatening complications.’
Everyone is aware of the implication of Mosquito bites; well, malaria comes malaria goes, and on few occasions if not well managed, it could result to fatality… notwithstanding, the best way to avoid overlooking other life-threatening dangers that may don the malarial skin colour is to ensure one takes a detailed history and thorough examination of the patient, but then, how long can I spend with a single patient in that private hospital where time is valued as money?
Thanks for reading this.