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The Danger Of Playing Doctors

Back in March 2014 I caught malaria.

My host organization took me to a clinic for a test but it was closed so we went straight to the pharmacy and bought malaria treatment. From my previous 9 months experience in Africa I had found that most people self-diagnose malaria. I allowed myself to be self-diagnosed too.

I thought, “Well they certainly know more about malaria than me”.

The symptoms were pretty much like a flu, feeling unwell, vomiting, diarrhoea, but nothing too extreme. It lasted a week.

But now I know it wasn’t malaria. It was the acute infection, seroconversion or primary HIV infection phase which usually appears between the 2nd-4th weeks after the person has been infected with HIV.

One of the MDGs is about combating HIV/AIDS, malaria and other diseases. Some of the WHO recommended strategies for this MDG include diagnostics and treatment with quality-assured antimalarial medicines, tracking every malaria case in a surveillance system.

If people can get malaria treatment in the pharmacy without a test that confirms you actually have malaria, some real cases of malaria aren’t being reported properly. Treatment efficacy can also be reduced as a result of drug resistance.

After my experience of an erroneous malaria self-diagnosis finding out that I could get malaria treatment from the pharmacy just by saying, ‘hey, I am not feeling well, they think I have malaria,’ a few question comes to my mind:

  • Why did I follow self-diagnosis and self-treatment in Africa knowing the high prevalence of these diseases if I would never do it even with just the flu back home?
  • Is self-treating with anti-malarials as prevalent as taking, for example, an ibuprofen for a headache?
  • What are the regulations to sell medicines without medical prescription in Africa?
  • Are the drugs sold without prescription actually quality drugs?
  • Do they sell malaria medicine so easily because people can’t afford the cost of transport to a health facility or the tests once they’re there?*
  • Do they practice free malaria tests?
  • Are there any program focused in training pharmacist to advise about the importance of testing?

Until I was diagnosed with HIV I didn’t know about the acute infection. I think it should be an important concept when giving information about HIV as people in general could realize two things:

  1. Feeling unwell doesn’t always mean you have malaria.
  2. Infections have phases and symptoms, and so has HIV/AIDS. From a prevention phase with sexual education, used of condoms and pre-exposure prophylaxis (PrEP), to the different stages of the HIV infection.

Stages of HIV infection

stages-of-hiv-1LINKS: Post Exposure ProphylaxisAcute infection

stages-of-hiv-2

LINKS: Window periodELISAWestern Blot

stages-of-hiv-3LINKS: CD4Viral loadOpportunistic infections

After my time in Africa, and not because I thought I had contracted any disease, just as I always do after long periods abroad, I went for a general check-up.

Although I was feeling great and active, It didn’t surprise me to find that I had a deficiency in iron and vitamin B12, but then my doctor called me in to hear the other result:

“You have tested positive for HIV”

I still remember the scary feeling when I understood the meaning of my 274 CD4. Without specific antiretroviral treatment, people will progress from HIV to AIDS in a span of 8-12 years, but mine in 6 months were almost as little as 200.

18 days after I was diagnosed HIV positive, with CD4 of 274 and a viral load of 94.200 copies, I started my antiretroviral treatment. I take 3 tablets each morning at the same time (Prestiza Norvir, Kivexa). After 2 months under treatment my CD4 were 542 and my viral load 516 copies. In the doctor appointment after 4 months under treatment, my CD4 continued to increase, to 581, and I have undetectable levels of virus (<20 copies). My HIV specialist is aware of my plans to continue my aid career and has given me advice and recommendations and has approved for me to move back to Africa.

In 2015 HIV is a chronic disease for all who can access care and treatment. Going back to Africa will open a window to all of us interested in the real similarities and differences between being HIV positive in a developed country and in a developing one.

___

* I went to the doctor/hospital on another occasion and whilst I mentioned that I had had unprotected sex, HIV was never mentioned nor a test recommended by the doctor. The costs of consultation, blood tests, surgery, anaesthesia, etc… would not have been affordable with my local salary. Luckily, medical travel insurance took care of it.
Standard

One thought on “The Danger Of Playing Doctors

  1. Pingback: HIV: A heavyweight in my suitcase | Development Intern

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