Written by Dr. Gregory Bartha
A good Ugandan friend of mine – Bari Stephen AKA Destiny – is a gospel musician. He is married with 2 children. The family had been suffering with frequent bouts of malaria. This is unusual because most African families experience malaria no more than once or twice in two or three years. I visited his home, a grass roofed hut fairly close to a large swamp, but not right next to it. There were several small holes in the walls, the mosquito nets were intact, and there was no heavy vegetation near the house. So it was a bit puzzling why the two children – Ebeneezer age two and Eunice age seven – had malaria frequently.
In late February 2020 Eunice fell ill with malaria. She received several doses of Artesunate, which is the best available medicine for malaria, but she was very weak and not eating. I advised Destiny to take her immediately to the regional referral hospital in Mbale. The children’s ward for ages three to eleven is one room with about thirty to forty children crowded into it, thankfully, one to a bed. This was the time when the lockdown started because of Covid, and travel was difficult.
When she arrived at the referral hospital, her urine was blackish, and her hemoglobin level was only five. The normal level is twelve to fifteen, and problems develop when it is below ten. The malaria parasites were destroying the red cells, and hemoglobin was released into the bloodstream and then excreted into the urine making it look dark. Over about seven days she received five blood transfusions. Her blood type was A positive which is fairly common in Uganda. There was a shortage of this type blood, and she was given O positive which worked reasonably well. Finally her urine cleared and her hemoglobin rose to eight. When she was discharged, I advised Destiny to give her chloroquine tablets once weekly which is somewhat effective in preventing malaria. She was also given iron syrup to build up her blood to a more normal level. The child has been healthy and malaria free up to this time.
Greg
We had malaria in Nam but not to the severity you described. As an Internist, at one time in my career, I can relate to your story. This clinic will be discussed with my new friends at Odessa College since your are sitting on a teaching mecca. Other universities would also be interested for residents and fellows in IM. Let’s talk and get you some help. John
You are doing great work Doctor!
Greg, your stories are always so interesting and informative!