Written by Dr. Gregory Bartha

If you travel to Uganda you will see free roaming dogs everywhere. And with dogs come bites and with bites comes rabies. About 500 cases of rabies are reported each year in Uganda. Not only dogs but also raccoons, skunks, jackals, hyenas, even cows and goats have been known to transmit the disease. Not all animals with rabies are violent. Some are withdrawn and appear to be ill. The virus remains in the muscles near the bite wound for a short time then travels up the nerves eventually reaching the brain or spinal cord. Symptoms may occur days or months after the exposure and include abnormal behavior, hallucinations, and hydrophobia. There is progression to coma and death.

The person who is bitten should wash the wound vigorously with soap and water. The animal should be confined and observed for at least ten days. If the animal cannot be isolated or escapes, the bite victim must be treated. A vaccine is available and should be administered on the day of the bite, then 3, 7, and 14 days later.Best practice is to give rabies immune globulin together with the first dose of vaccine.

The vaccine was developed by Louis Pasteur in the 19th century. He infected rabbits with the virus by injecting nerve tissue from rabid dogs close to the spinal cord or lower part of the brain in the rabbits. When a rabbit developed signs of rabies, he took a small piece of nerve tissue from the animal and placed it in a flask in which most of the air had been removed. The longer the tissue remained in the flask the less virulent or weaker it became.

He then gave a dog a series of injections with the tissue beginning with the least virulent specimen, the which had been in a flask the longest. In each successive injection he used pieces of tissue closer to the time they were harvested. Finally he gave the dog an injection with the most virulent tissue, the one closest to the time of the harvest. The dog did not get rabies after this last injection because its immune system had been primed to recognize and destroy the virus.

One day when Pasteur was finishing with these experiments, a 9 year old boy was brought to him. The boy had been severely bitten by a rabid dog and had multiple bite wounds. Over the next 2 weeks he was given a series of injections with nerve tissue from a rabbit infected with rabies, starting with the least virulent specimen and ending with the most virulent.

The boy was examined closely for months. He never showed any sign of rabies and was pronounced free of the disease. This event was widely proclaimed as a great scientific advance and made Pasteur world famous.

Today bats are becoming more frequently implicated in cases of rabies. Again the best way to manage an animal bite is to clean the bite wound carefully, isolate and observe the animal, and begin vaccination if appropriate.

By Dr. Gregory Bartha

When Albert Schweitzer opened his medical clinic in West Africa, he saw many patients suffering from sleeping sickness. They would present with severe headache, fever, joint pain, and enlarged lymph nodes. Often they would become confused and agitated and suffer with daytime sleepiness and nighttime insomnia. There was gradual progression into coma and death. The disease was very prevalent in tropical Africa. It was the cause of death in a high percentage of the Ugandan population.

The disease is caused by the trypanosome parasite which infects cattle and wild animals. The tsetse fly which is commonly found in the area bites the animal and ingests the parasites. They multiply and migrate to the salivary glands. When the fly bites a human or another animal, it injects the parasites into the bloodstream. They again multiply and invade the lymph nodes and eventually the brain and meninges. The disease can be diagnosed by identifying the parasites in the blood, lymph nodes, or spinal fluid. Several hours may be required to find the parasites. Dr. Schweitzer spent many hours at this work.

Eventually the disease was controlled by treating all infected individuals and reducing the cattle and tsetse fly populations, Pentamidine and Suramin are among the most effective medicines to treat the illness. Patients can relapse and must be followed carefully for up to 2 years after treatment. 

To prevent this disease travelers should use insect repellent and wear long sleeved shirts and long pants with neutral colors. The tsetse flies are attracted to bright and dark colors. In 2020 only 700 cases were reported to the World Health Organization. Most were hunters or people hiking through dense vegetation.

Written by Dr. Gregory Bartha

Malaria is by far the most common disease seen at the Cross Clinic. It is caused by the bite of the Anopheles mosquito. The falciparum variety is the most common type in Uganda and other tropical African countries. The mosquito transmits the parasites into the human body during a blood meal. The parasites are carried to the liver where they rapidly multiply. The liver cells eventually burst and release large numbers of the parasites into the bloodstream. They then invade the red blood cells and multiply again and are released and invade other red cells. Some of the parasites develop into sexual forms which can be ingested by other mosquitoes which bite the infected person. These can develop into other parasites, and the cycle continues. The proteins on the red cell surfaces are altered so that the cells are more sticky and adhere to the small blood vessels and block blood flow to vital organs such as the brain and kidneys.

The symptoms caused by malaria infection are high fever, headache, body aches, and nausea and vomiting. Children between the ages of 6 months to 3 years tend to have the most serious form of the disease. They can develop seizures, severe anemia, and low blood sugar.

Quinine was the drug most frequently used to treat malaria and still can be effective. Many parasites are now resistant to it. Artesunate is now the drug of choice. It is derived from a Chinese plant. The story goes that during the Vietnam War many North Vietnamese soldiers were falling ill and dying with malaria. The Viet Cong started a crash program to find a plant chemical which would be an effective treatment. They were aided in this effort by Chairman Mao in China. Several compounds found in the Artemisia tree tree in China were effective in killing the malaria parasite. A Chinese chemist isolated and purified Artemisinin from which Artesunate is made. In 2015 Tu Youyou was awarded the Nobel Prize in Medicine/Physiology for her work in this discovery. The drug has saved thousands if not millions of lives.

Artesunate is given intravenously for three doses then in an oral form together with another antimalarial drug for three more days. The results are most often excellent. Some people who have had a serious case of malaria develop severe anemia and need blood transfusion. Some develop a greatly enlarged liver and spleen, ans some suffer from brain damage.

Malaria was present in the U.S. until the 1930’s when DDT eradicated all the mosquito types which could cause the disease. It now occurs mainly in travelers returning from tropical areas. The risk of acquiring malaria can be reduced by taking Malarone or doxycycline when traveling to countries where malaria is prevalent.  Also sleeping under insecticide treated nets and avoiding outdoor activity at night or dusk and using insect repellent are all helpful in prevention. A malaria vaccine is now available. It is 60 to 70 percent effective and is given in four doses over time. Work is continuing to find a simpler and more effective vaccine.

Written by Dr. Gregory Bartha

Eriakim Mulekwa is currently the program director of the Ugandan ministry I am assisting. He was born and raised in a small village fairly near the Cross Clinic. He attended government schools which were reasonably good at the time when he was a student. The teachers were dedicated and interested in the students which is not the case at the present.

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Pastor Mubbi Simon Peter is the director of the projects I have been developing and supporting in Uganda. In addition to the Cross Clinic this work includes a secondary school, 3 primary schools, a vocational training school, an orphanage, and a scholarship program.

Simon Peter was raised by his grandmother from age one and one half by his grandmother. His father brought another woman into the home, and his mother left. This was a very dangerous time in Uganda when the Lord’s Resistance Army was engaged in violent and disruptive activities in Northern Uganda. Simon Peter and his grandmother had to keep moving around to find safe places to stay. Simon Peter  got as far as the tenth grade in school when he had to drop out because of lack of funds, He worked for about two years as a gardener in a nearby town for a family who treated him roughly. Finally the abuse became too much for him. He packed up his belongings and started to walk back to his grandmother’s home.

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Written by Dr. Gregory Bartha

In times past Ugandan children did not want to go to school, and their parents preferred to keep them at home. The picture has totally changed. Now the children love to attend classes, and their parents are supportive. The realize that education is the best way to rise out of poverty.

In Uganda there are many government primary and secondary schools which charge little or no tuition. The problem is that the quality of instruction is generally poor. Teachers are not well supervised, and teaching supplies are inadequate. Some of the better performing government schools do charge tuition. Families are often asked to pay for supplies. Most students and parents prefer private schools. Tuition at these schools, while low by U.S. standards, is not affordable by most village families. And there is very little help for students wishing to study at the university level.

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Written by Dr. Gregory Bartha

Conditions have significantly deteriorated in Uganda in the past 2 years largely because of the COVID  pandemic. No one knows how many people have died as a result of the disease since testing is very  limited, and very sick people usually die at home. There is no easy access to high level hospital care. Most of the deaths are in the elderly and in the chronically ill

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Written by Dr. Gregory Bartha

“Dogs are a waste of time.” I heard this comment several times in Uganda. Dogs are ever present in rural Uganda. The are all hounds and look pretty much the same – medium size, short haired, and thin – probably all descended from a common ancestor. Most people do not keep dogs as pets but may use them as guards for the homes. They are usually fed scraps and receive little care or attention.

Several years ago a young dog appeared at the clinic. She began to spend most of her days and nights there and became quite friendly. We named her Sunny because she was always so bright and alert, and everyone at the clinic were very fond of her. About a year later she gave birth to two pups. The pregnancy was very hard on her. She lost quite a bit of weight and was weak. We called on the vet to check on her and the pups. The vet gave Sunny an antibiotic shot and some medicine for parasites. The pups were also given shots. Sunny improved, but the pups were soon found dead. They seemed to be active and healthy, and their death was puzzling.

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