Antenatal Consultation/Midwifery Services at The Surgery

We are now offering Antenatal Consultation/Midwifery Services at The Surgery on Monday, Wednesday and Friday afternoons from 13.30 – 16.30. To book please call: 031 225 6001/2/3 or email: midwifeatthesurgery@gmail.com

 

 

Antenatal poster 19_01

New Phone Numbers for The Surgery

Please note that we have new telephone numbers:

Reception: +256 (0) 31 225 6001/2/3

ER Reception: +256 (0) 31 225 6008

Pharmacy: +256 (0) 31 225 6005

Accounts: +256 (0) 31 225 6004

 

Happy New Year

The staff at The Surgery wishes you all a Happy New Year!

 

Leaving Uganda?

Come and see us at The Surgery for a Departure Medical. Leave your bugs with us! No need to make an appointment. Basic consultation with our nurses is 46.000 ugx.

Uganda is a very healthy place to live.

Anyone new to the country will read that and think where is this author coming from? How can it be a healthy place to live? Isn’t it in the tropics? Aren’t there lots of tropical diseases? Doesn’t nature sting, bite and smear mucous on you? Don’t we need to have at least a dozen new vaccinations and get an injection every time the child is sick?

Actually no!

Expats living in Uganda are less likely to die from disease then matched controls in Europe. The commonest cause of death of expats is road accidents.  With less obesity, a healthier diet, more exercise, cleaner air and more freedom Uganda really is a healthy place to bring up children!

So how can we make the best of a good situation and make sure our children are as healthy as possible?

1)      Enjoy the freedom.

Get out of the house! Play in the dirt! Do more sport, go swimming the whole year round in the open air, run, ride your bike and do something new. Health body, healthy mind. Get off the computer, get your face out of face book, play touch Rugby not touch screen.

2)      Healthier diet.

What a variety! Apparently many European children can’t even name 5 different fruits never mind eat one of each a day. Here I have 5 different fruits for breakfast and they could all grow in my garden. Experiment! Try new fruits and vegetables! Ban the burger, refuse the rolex, eat something that came out of the ground not out of a packet, or fell out of a tree not out of a factory. I know someone who says she is on a diet where she avoids anything beginning with ch. So we came up with chips, chapatti, chili, chinese, chocolate and children (especially Charlie). I go along with it except for the chocolate. It’s a fruit and a regular part of my 5 a day.

3)       Common sense

There is no box in Entebbe that says “welcome to Uganda. Please leave your brain here and pick it up on the way out”

Malaria madness.  Do not follow the madness and self medicate for malaria every time you are sick. If your child has a sore throat a fever and a cough he probably has a virus. If he has fever vomiting and diarrhea it is probably a stomach infection. It is most unlikely to be malaria, or indeed typhoid, pneumonia or an unspecified “bacterial infection” diagnosed by an automated cell counter. You can give him plenty to drink, some ibuprofen and wait and see.

In many areas of Kampala there really is very little malaria. Some studies showed it is common near the bottom of some hills but almost never seen once you are more than 400 metres from the bottom of the hill. Don’t go out with a long tape measure, relax. Our local anophylene bites from about 10.00pm to about 4, and stops when the mosque starts. So unless the children are sitting on the veranda having a beer after 10.00pm they are very unlikely to be bitten by an anophylene. The little black and white patterned ones that bite your ankles in the afternoon are Aedes and do not carry malaria. Malaria if you do get it increases abruptly by 10 times every 48 hours. So no rush in the first 12 hours of fever. Wait until the morning, go to a proper facility and get a rapid test done. Sorry I do not trust microscopes as much as rapid tests. Too many scratched  slides, unfiltered old stains and unserviced microscopes. Rapid tests are 98% accurate the first day of fever and 100% if a negative is repeated after 24 hours.  If you do not believe it go on a WHO or CDC website.

So our advice is take prophylaxis when you first arrive, relax, you will not get malaria and if you are told it is they are probably wrong.  After a few months you can take prophylaxis only if you go out of Kampala. The risk in a weekend visit to a game park or even just a weekend away in Jinja is huge. Take prophylaxis.

 

4)      Antibiotic madness

Don’t join in the frenzy. Why on earth would anyone believe you need antibiotics more often in Uganda than in Europe? We are out doors, windows open, living in the fresh air. Even in Europe it is estimated that 80% of antibiotics given for coughs for example are given for no good reason, so why more?  Antibiotics are harmful. Don’t self prescribe: and that includes going to the doctor you know gives antibiotics and avoiding the one you know will not! Coughs do not require antibiotics. Pneumonia is very rare. Strep throat is visible. Use your common sense and do not give in to the “this is the tropics you need antibiotics” fashion. It is so last year dahling!

Ugandan elephants5)      Dire Rear.

OK gastroenteritis is very common, almost inevitable in new arrivals. In children most are probably viruses. Acute salmonella or shigella diarhoea is also common, and will get better without medication after 5 days on average. However the right antibiotic will get you better in 12 to 24 hours with a single dose. Most of us have better things to do then sit on the toilet for 5 days so we take the treatment.

If you are offered 5 or 7 day courses of antibiotics or injections: er… what did I say about common sense?

Uganda is a very healthy place to live. There are probably expat children in your school whose parents were born here and grew up here. They grew up in the open air, eating a great diet, seeing the doctor mostly just for immunization, playing sport and enjoying life. They still do. Why not ask them?

Fatigue

‘Tired all the time’ is one of the commonest reasons for consulting a doctor anywhere in the
world. The feeling of being constantly tired may be interpreted as “weak” or even “fever”. It may
be accompanied by a variety of vague symptoms such as abdominal pain or chest pain. It is often
a diagnostic challenge and common sense may be a better diagnostic tool then extensive
laboratory work.
There are a few diseases that make us tired anywhere in the world. There are some that are
commoner in the tropics. However in many cases the problem is Life not disease.

Medical Problems

All sorts of medical problems can make someone tired. Aneamia, thyroid disease, other rare
hormonal diseases, diabetes, chronic infection etc. Most tired people do not have such diseases
and there is no need to do loads of blood test and other investigations looking for problems that
are not there. A sensible history and examination should reveal most medical conditions.
Some drugs can cause fatigue. Overuse of medications is still very common, and it is easy for the
vulnerable to be persuaded to take an unnecessary drug for a disease that is not there.
Thankfully in Europe there is a growing awareness of the dangers of excessive use of medicines,
especially antibiotics and sleeping pills.
“Common things occur commonly” and in Uganda there are 3 chronic infections notorious for
making us tired.

Bilharzia

When you first get infected with Bilharzia you may get fever, rash, cough, diarrhoea or other
symptoms of acute illness. Thereafter you just feel tired. Most regular sailors and fishermen
realize when the Bilharzia Blues sets in and take the Dawa. The response can be quite dramatic;
you wake up 3 or 4 days later feeling Wow! Energy!
Children can become moody, difficult or fall behind in class. If they have ever been in the lake
think Bilharzia.
Giardia.
Classically Giardia causes eggy burps and greasy smelly floating-in-the-pan diarrhoea. It can also
just make you tired. As it is often missed in the stool because the cysts come in showers every 3
or 4 days, it makes sense if you are tired and gassy to try the treatment anyway.
Intestinal Yeast.
Also causes vague watery or gassy diarrhoea, but can often just make you tired without any
intestinal symptoms. A few yeast of different species are normal inhabitants of the healthy bowel.
Otherwise we wouldn’t rot when we are dead! But we often find candida in the stool in enormous
numbers. Does yeast make us tired or do tired people get yeast? Or both? Why do we often see
yeast in short termers yet not long term residents? Is it an antigenitically different strain that we
have to develop immunity to? There’s a Ph.D. there somewhere!
Whatever, the good news is that treatment is usually very easy, effective and safe and a lot of
people feel dramatically better when their candida is treated. We also sometimes find amoebic cysts in the stools of tired people. Do non-pathogenic amoebas
cause tiredness or indeed any symptoms at all? Another Ph.D. for any young bored biologist out
there!
Chronic fatigue syndrome
Once called ME for myalgic encephalitis, or yuppie flu, now usually referred to as the “post
infection chronic fatigue syndrome” to distinguish this group from other stress related fatigue
syndromes. Surf the web and you will find “executive stress syndrome” or “executive burn out” or
any other combination of terms that the author uses to describe a non-specific tired-all-the-time
condition that does not follow an obvious infection. All pretty irrelevant anyway, as the “treatment”
is the same.
The theory is that following an infection, especially viruses, the body continues to produce
antibodies and fights the infection long after the disease has disappeared. You feel tired as if you
had flu, but the specific symptoms have long gone.
Often antibodies are found to such weirdoes as cytomegalovirus, Epstein Barr, or the latest flu. It
can follow an ordinary cold, and I’ve seen it after bilharzia, shigella, undiagnosed viruses, and
after no obvious infection. Although it can affect anybody it most often hits young professionals.
Instead of resting during and after a mild infection, you keep on pushing yourself and becoming
more and more tired. This makes you struggle even harder to keep up.
In its most extreme form people with CFS are so tired they sleep 16 to 20 hours a day and even
going to the loo requires 2 hours rest to recover from the effort. One young woman I visited at
home every week or so could just about make me a cup of coffee while she reported her progress
then slept for the rest of the afternoon to recover from my visit. After one month she could just
make it out to a hammock in the garden and after 3 months she was fit enough to make it to
Entebbe. Back in the UK she continued very slow improvement and was off work altogether for 1
year. This could have been prevented if she had simply taken 3 days off and gone to bed during
and after the original illness.
Most people are not as seriously affected as that, and can get better with only 2 or 3 weeks of
strict bed rest, and 20 hours sleep a day. Probably all cases could be prevented by getting lots of
sleep as soon as the problem starts. If you are tired, go to bed. Sleep 50% more than you think
you need, and do 50% less than you think you can.
Be warned! Chronic fatigue syndrome is real and could put you off work for months. Next time
you have a cold and feel tired, GO TO BED!
Depression
CFS, culture shock, stress, depression, chronic illness, they all overlap and feed each other.
Often it is very difficult to know where a genuine disease ends and lifestyle problems begin. When
does feeling low and tired become a mental disease?
We hardly ever see the real psychiatric cases with suicidal depression. We do see a lot of people
where stress and problems at home or at work are causing tiredness that borders on a
depressive illness. Analysis in the UK has shown that 60% of visits to a doctor are partly for
psychological reasons.
It is more surprising to learn that in clinics in refugee camps and famine feeding centres, where
you would think there would be more physical disease, the same number of consultations are for psychological problems. The big missionary societies and volunteer organisations all report that
the commonest reason for terminating a contract and for medivac is psychological problems, and
again the oft reported figure is 60%.
Mildly depressed people almost always feel tired and have trouble sleeping. They often say they
would feel better if only they could get a good night’s sleep, and I am sure they are right.
Classically they go to sleep ok, then wake up around 2 or 3.00am and lie awake thinking about
things for an hour or two. Sometimes they fall asleep at dawn, get up to go to work, and then feel
tired all day.
This disruption of the sleep/wake cycle is apparently due to low levels of the chemical responsible
for mood. Low doses of one of the older antidepressants are usually very effective and nonaddictive. They give a good night’s sleep and you wake up feeling alive. They do take a long time
to work, but the good effect is often permanent.
Many people with tiredness due to mild depression simply need to cut their workload and go to
bed early! Others drink too much, a very common cause of depression. Sometimes a patient will
tell me they are depressed, yet I find none of the classic symptoms. Often the situation they are in
is genuinely depressing! Feeling depressed may be the appropriate response in some
circumstances. In these cases drug treatment is definitely not indicated.
Stress
Most people who are tired all the time do not have anything really wrong, and they are simply
stressed. Stress is however seldom simple, seldom due to one thing and the affected person is
the last to realize. He may even feel great, as adrenaline is quite euphoric.
I have said many times that here in Uganda we don’t see much tropical disease. What we do see
is a lot of niggling little infections, coughs colds and flu, upset stomachs weird viruses, especially
in the first 2 or 3 years while our immune system gets used to everything that’s going. Nothing
very important but each one knocks us down for a few days or a week and makes us tired.
Instead of resting we struggle heroically on and get more and more tired. A few slide into the full
CFS picture. Most of us get better, but a month later another virus hits us and down we go again.
We could cope with all these nuisance infections if we were working 9 to 5 and going home with
the Evening Standard on the commuter train. Instead we fight through the traffic at 7.15, work
from 8 to 6 and then battle matatus all the way home. There we catch up with paper work, or go
to an official function and drink too much. Just as all the hard work pays off and you are on top of
your in-tray, your secretary takes a week off with family problems, the e-mail brakes down and
there’s a 3 day power cut at home just as the baby cuts a new tooth and is up all night.
The result? Stress. It may manifest itself as fatigue, abdominal pain, headaches etc and you may
be convinced you have malaria, blood pressure, or ulcers, but what you really need is a couple of
days off, a week of early nights and a change in lifestyle.
This is not a popular prescription, and many patients want lots of investigations, referral to a
specialist and often finish up going to Nairobi or South Africa. This enforced break often cures the
complaint: – if you are lucky without spending a fortune, or picking up a non-existing diagnostic
label!
Sometimes it is the children who are ill with vague symptoms, as children are the “barometer of
the family”. Culture shock
This is another cause of fatigue and again often manifests itself as physical illness. Particularly
prone are single people working up country, or married men separated from their family on short
term assignments. I feel particularly sympathetic with the young volunteers working up country. I
am appalled at how poor the orientation and preparation is for some of these organizations! They
are given some information about malaria and some other tropical diseases, and if they are lucky
some figures about AIDS. But sometimes nothing at all about the difficulties of living in an
environment that is totally different from their background. I remember it was hard enough for me
going from Cornwall to London as a student, especially as the students from Durham and
Newcastle seemed to be speaking a different language!
On first arrival, everything is wonderful, the people are friendly and the world is exiting and
stimulating. You are determined to work hard, be friendly and learn about this strange new
culture, and certainly immersing yourself in a different culture can be very rewarding and a real
eye opener. Unfortunately after 3 months some of you think you are an expert, and it may be 2
years before reality sinks in. By then most of you have left, often disillusioned, and often ill.
Fact. You are what you are: Danish, British, American, whatever. You will never be an Acholi or a
Muganda. Your immune system is totally different. It takes years before you can eat anything and
everything without risking diarrhoea. Your skin takes years to acclimatize; you cannot wander
around in the sun without getting problems. You sweat more and need to drink more. Physically
you have no hope of matching the endurance of people who have worked in the heat all their
lives. You have no immunity to malaria and if you live up country you either take prophylaxis, are
very careful about nets etc, or you are going to be very ill every month.
Psychological health is no different. You are what you are: age, background, culture. We lived in
Teso for 3 years and Kotido for 9. Been there done that got the T-shirt.
Last of all. Remember the stressed person is the last to realize they are stressed. Listen to your
friends. If they are concerned, take a holiday, a few days off, relax, have fun.
Summary
Fatigue is very common and may come with a variety of other symptoms. Most medical
conditions can be suspected or ruled out by a simple examination and basic tests.
Chronic fatigue syndrome can be the end result of tiredness following any simple infection and
the only treatment is lots of sleep. Prevention is better than cure: if you are tired, go to bed.
In many cases the problem is stress related. Stress can usually be prevented by a varied social
life, sensible time off and getting plenty of sleep when you are ill.
If you feel you are living in a goldfish bowl, get out, take time off, have fun.