No. Such a policy would be unethical, poor medical practice and dangerous.
Diagnosis of fever in the tropics is one of the most challenging tasks in medicine. The symptoms of “malaria”, fever, headache, body pains, vomiting, are common in many other febrile illnesses, some relatively benign (viral diseases, gastroenteritis), some more dangerous and potentially lethal (meningitis, hepatitis, leptospirosis…). So, diagnosis of malaria can be missed, or another disease can be misdiagnosed as malaria, with potentially dangerous consequences.
The most important step in finding the right diagnosis is history and examination. A malaria test is not the only important investigation that needs to be done when there is a fever and it is better if your doctor decides which tests are necessary. Besides that, malaria is not the commonest cause of fever anywhere, and in some parts of Kampala malaria is extremely rare. Simply testing for malaria would be negligent as many other common and dangerous diseases would be missed. The only ethical, legal and sensible policy is that anyone sick with a fever has a proper diagnostic work up by a properly trained doctor.
If you are in Kampala or nearby, come for a proper medical assessment, which will include a malaria test but also a thorough history and examination to assess for other possible causes. At the Surgery we use a double tool for diagnosing malaria, both rapid diagnostic tests (currently recommended by WHO) and a blood slide (the gold standard). Our rapid tests not only test for the more common Falciparum malaria, but also for the other species.
If you are upcountry, we generally recommend both prophylaxis (see next FAQ about malaria prophylaxis), and self testing kits: the same rapid diagnostic kits we use at The Surgery can be bought and you can be properly trained in their use and interpretation. We advise purchasing them carefully because not all brands are the same quality.
We are also available for consultation by phone/email any time of day and night in case of emergency; don’t hesitate to call us or send us an email.
If I come to Uganda for 1-6-12-24 months… should I take malaria prophylaxis? And if I stay long term?
This is a complicated question. It depends on who you are, where you live, and how long you are staying. Ideally, you should discuss it with a doctor who has experience in handling malaria in this country, which is considered at high risk of malaria in all areas by the Center of Disease Control and Prevention (CDC). The doctor can develop an individualized plan for malaria prevention and management. If you have questions about what would be the best in your situation, please make an appointment to come and discuss it with us.
Most of central Kampala is very low risk; most people don’t take precautions other than a mosquito net and do not get malaria. Kololo, Nakasero, Muyenga, Makindye, Naguru, can be considered very low risk. Once you get as far out as Munyonyo, Lubowa, Kisasi, the outer side of Namirembe, the risk is high. One research showed that if you live more than 400 metres from the bottom of the hill the risk is very small, less than 200 metres from the bottom of the hill the risk is high. Most of our patients live on hills further than 200 metres from the bottom, so that is why we hardly ever see any malaria in those living in Kampala.
Out of Kampala anywhere is high risk. Night flights out of Entebbe are high risk, so our advice is to always take prophylaxis if you leave Kampala, intend to live out of central Kampala, and if you leave on a night flight.
There are different options for malaria prophylaxis, each with different pros and cons. Some information can be found at the following link http://www.cdc.gov/malaria/travelers/drugs.html
The prophylaxis for “long term travelers” is not very standardized, people are often worried about possible side effects of drugs and compliance decreases with time. The CDC Yellow book states “A traveler who will be residing in an area of continuous malaria transmission should continue to use malaria chemoprophylaxis for his or her entire stay. It is important to reassure the traveler that the drugs are safe and effective.” http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-8-advising-travelers-with-specific-needs/long-term-travelers-and-expatriates
The CDC does not put a time limit of antimalarials use, considering that the risk of acquiring (and dying) of malaria always seems to be higher that any possible side effects. It also states that “Misconceptions regarding malaria are pervasive in malaria-endemic countries among expatriates and local residents, and long-term travelers should trust health advice only from reputable and respected sources”.http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-8-advising-travelers-with-specific-needs/perspectives-malaria-in-long-term-travelers-and-expatriates#4403
In our experience, some people living outside of Kampala do not take prophylaxis as they are here “long term”. When we say long term we mean over 5 years. We consider 1 year a “visitor” and 2 years as “very short term”. So short term residents, i.e. those here less than 5 years living up country are taking a risk not to take prophylaxis. People who give other advice do not have to take responsibility for their advice and have probably never seen a genuine case of malaria. Many of course think they have had malaria, but 19 out of 20 people diagnosed as “malaria” have not had malaria. Most non immunes who have had real malaria were very ill indeed and those who stay tend to be strongly in favour of prophylaxis!
After 5 years, when you have screening on the windows, know how to use Rapid Diagnostic Tests, have experience with self-treatment, are used to the roads, and are relaxed with the inconsistencies of the phone and internet providers, then you can consider joining the residents of Kampala and take nothing.
The lack of availability of appropriate diagnostic and treating facilities have also to be taken into consideration. Severe malaria in non immune people (that is, most travelers, even long term) may require blood transfusion, renal dialysis and assisted ventilation in an intensive care unit: as you may easily guess, these services are not readily available upcountry!
Bilharzia is common in many rivers and lakes in Uganda. Many of the places advertised as “Bilharzia free” are actually among the highest risk. There is no effective prevention, so if you enter any rivers or lakes anywhere in East Africa it is wise to presume you have got infected.
Unfortunately, there is no test that is of any value in the first 4 weeks after infection and no one test that is close to 100% sensitive or specific. To make it even more complicated treatment is only effective against the mature Bilharzia flukes and the length of time to mature is variable, from 4 to 8 weeks or longer after exposure.
The good news is that it is treatable and repeated exposure and treatment builds up useful immunity.
The best advice is to see a doctor with experience in management of Bilharzia if you have any symptoms within 4-8 weeks of exposure and routine testing at about 8 weeks regardless. If you are leaving the country before 8 weeks after exposure then discuss the options with our doctors.
“Blind” treatment at 8 weeks and 4 weeks later (with the last dose at least 12 weeks after the last exposure) is a good option.
After an extensive review of the literature on the topic, we agreed that in case of any doubt (that is, in case of any possible exposure) the best option is to treat: the drugs are well tolerated and safe, the course of treatment is brief (1 day) and complications from Bilharzia can be serious and arise even several years later. This is one of the situations where we apply the principle of “Better safe than sorry”.
Testing and treatment of Bilharzia is complicated and requires a detailed knowledge of the disease, immunity and management options. There are many simplistic practices that are valuable up to a point and perhaps work for some people some of the time. The best option is see one of the real experts in The Surgery and discuss a realistic plan that works for you.
The Surgery is a general practice with general practitioners (GPs) with different areas of interest and specialization. All general practitioners can handle basic gynaecological and obstetric issues. One of our doctors (Dr Tazim) has a specific qualification in reproductive health and is able to handle most of the common gynaecological and obstetric issues. Very complex cases can be referred according to need.
The Surgery is a general practice with general practitioners with different areas of interest and specialization. All general practitioners can handle general paediatrics. Some of our GPs are specialized in paediatrics so patients may directly see them or be referred in case of need.
The Surgery is a general practice with general practitioners with different areas of interest and specialization. All general practitioners are trained in every area of medicine and expected to be able to manage all common conditions in all areas of medicine. The Surgery doctors commonly confer among themselves since they have different areas of special interest and expertise. In rare situations that require a special opinion the general practitioner will consult an external specialist.
Yes, of course. The best way to have a general check up is to talk with a doctor, who can assess your history, risk factors, lifestyle, and eventual problems, and advise the appropriate screening and diagnostic tests. We follow current evidence based guidelines regarding “check-ups” and screening tests (for example the recommendations of the US task force of preventive services and of the British National Institute of Clinical Excellency). If you expect total body scans and “all lab tests including for cancer” you may have chosen the wrong place.
Come in preferably within 24 hours but absolutely within 72 hours: come in, every time, without discussion.
Post exposure prophylaxis is extremely effective for some infections if given within 72 hours, but the earlier the better: it is best given as soon as possible.
Routine post exposure prophylaxis can prevent HIV, Hepatitis B, syphilis, gonorrhoea, chlamydia, LGV, chancroid and Donavan’s bacillus. And of course post coital contraception for pregnancy within the first 24 hours. You can come in any time day or night and see any of the doctors or the nurses.
If you are late, over 72 hours, some treatments are still appropriate but best see one of the doctors to discuss the options.
Yes. You can follow your home country schedule of vaccination if you wish to, adding the ones recommended for tropical countries. Specialized nurses handle immunization during office hours. Emergency immunization for tetanus and rabies is available at any time. Very occasional out of stocks for specific vaccines happens (worldwide) but we usually keep high level of stocks to minimize inconveniences.
Not directly. Our pharmacy serves the patients seen at the facility. If you are on chronic medications prescribed elsewhere, you can see one of our doctors and eventually get a renewable prescription from here (for example, for 6 months), and then you can go directly to the pharmacy with your file to collect the medications. We feel very responsible for any medication issued from here and we try to avoid any possible risk or inconvenience for anyone.
Not really. Come when you have symptoms – we always advise to come when you are unwell in any way.
However come for a test even if asymptomatic before you leave the country (for ever or even for a brief time): if you develop symptoms of amoeba or giardia in another country, you may not have easy access to appropriate testing and treating facilities.
We are a facility with 24-hour-service, however during the night the emphasis is on emergency care. This means you enter at the Emergency Room entrance and you will find nurses, a doctor and the lab technician. Ambulance services are always available. We always have a senior doctor and radiology technician on call.