Malaria and HIV

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As my time at Rushere draws to a close I feel it might be interesting to let you all know what the main health problems here in Uganda are. By far the most common thing i've seen in the hospital is malaria, at the minute we are in the dry season, or as it is alternatively known, the malaria season.
For those of you who haven't heard much about malaria, it is a parasite transmitted to people through the bite of a mosquito. The parasite goes to your liver and reproduces, also doing the same in your blood. It's a rather nasty thing to pick up and is the number one killer disease in Africa by some distance, HIV kills less in 15 years than malaria does in one. Rushere could almost be described as a centre of excellence for malaria treatment, in fact if anything they over treat it, basically you come in with a high fever they'll investigate you for malaria and then if the tests come back negative they'll still treat you for it (which is a smart move as the tests aren't done by computers but rather by the lab staff, we've seen some 'funny' results from tests whilst we've been here). The great thing is though that I can't actually remember seeing a patient die from malaria whilst at the hospital, so the treatment (quinine directly into the veins for severe cases) given at the hospital is pretty top draw.
As they old saying goes though 'prevention is better than cure' and I was curious as to what the government is doing to reduce the incidence of malaria. Selling mosquito nets to pregnant women at the reduced price was one initiative, however given the patriarchal nature of society over here the men would buy the nets on behalf of their wives and then use them for themselves! I also heard on the radio last week some nets earmarked for pregnant women were being used in the distillation process for the local spirit Waragi. The thing is though malaria hasn't always been the massive problem that it is today, in 1972, pressure from the international community (acting on pressure from the environmentalist movement) caused a global ban on a chemical known as DDT. The reasons they gave for this was that it was carcinogenic (cancer causing) and mutanogenic, ironically this was later disproved. Before the DDT ban malaria death toll globally was at 50,000, now its 3 million with one hundred times that number getting infected. The governments of Africa are loathe to reintroduce its use under threat of withdrawl of foreign aid...something else for the environmentalist movement to be proud of!
HIV is well known world wide, a few facts most people know... it's transmitted in three ways, unprotected intercourse, mother to baby (birth and breast feeding) and mixing of bloods (see trainspotting). It can't actually be cured at minute or vaccinated against. It eventually leads to AIDS. I've been told that the levels of HIV in the population here vary from place to place, but they are between 5 and 10% of the population. The government is tackling this increasing problem with it's ABC campaign. A is for abstinence, B is for be faithful and C (apparently a last resort) is for use a condom. Uganda is a highly religious country and if they strictly follow the bibles teaching as much as they claim then AB should be fine, however would it really kill the church all that much to endorse condom use? See quite a large number of people over here will point at the teachings that say 'man shaln't not spill his seed onto a rock' as justification for not using a condom, but the part where it says thou shalt not commit adultury gets skipped over.
The treatment offered to HIV patients is restrained by cost, but I can't help but feel the government is really shooting itself in the foot with it's current policy. HIV affects your immune system, one cell in particular known as the CD4 cell, it hijacks this cell (a key cell for your body to recognise an infection to fight) and reproduces millions of itself inside the cell. So if you looked in the blood of a patient, as the disease progress CD4 levels would go down and the viral load would go up. When CD4 levels drop below a certain threshold then you become at risk of opportunistic infections and it is at this point we give you a diagnosis of AIDS. A normal CD4 count ranges from 500-1500 cells per mm cubed of blood. In the UK as soon as someone is diagnosed with HIV we start treatment with drugs to block viral replication, regardless of the CD4 level. In Uganda they wait for the level to drop below 200 before starting treatment. The problem with this is that as I mentioned above, as CD4 drops the viral count increases, and the higher your viral load the more infectious you are. If someone has a high CD4 count and low viral load there is a much decreased risk of them transfering the virus on to someone else. So though the government is withholding treatment for HIV until the person has progressed quite far with the disease, this policy will no doubt be leading to higher transmission rates thereby increasing the problem further......so at Rushere they make patient education a key priority, if they understand their disease the theory is they are less likely to transmit it on.

Well a bit of a science based one there, hope it didn't make too hard a read. Feel free to comment!

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