How many times have we in the developed “western world” heard about how good we have it and how primitive the “third world” is. Hmmm……let me tell you a story, a true story that is ongoing as I write:

When we were in Kenya in February, my wife, Marg, contracted malaria despite taking Malarone, a drug that is supposed to prevent this (although it’s not 100% sure). She began to feel unwell in the afternoon and became nauseous; as well, throughout the night she suffered from a very high fever. The next morning I took her to a simple country clinic that handles everything under the sun. A blood test involving a pin prick of the finger to get blood with the ensuing smear put under a microscope showed that Marg had malaria. Her treatment was simple: start taking 4 pills of Malarone for 3 days and then go back to one a day for the rest of the trip – fortunately we had them with us. (If we hadn’t, we could have bought them there easily….and cheaply.) So, in 1 hour she was tested, diagnosed, and treated. She showed an immediate positive response to the new medication regimen – her fever dropped. Although tired the next day there was no fever or nausea and by the second day she felt fine….as she did for the rest of the time in Kenya.

Now a problem with malaria is that you don’t totally get rid of it and it can recur.

Last Tuesday afternoon Marg began to feel ill. She remarked that it felt just like the malaria she had in Kenya. That night she had a high fever with diarrhoea . So next morning, Wednesday, she went into the “travel doctor” – I’ll call him Dr. D.

[Just a little note on travel doctors: if you’re travelling abroad, especially to tropical countries, you are channelled to a doctor who has knowledge of tropical diseases and can prescribe the medications you might need or give you the vaccinations you will require. For some reason your GP is reluctant to do this….]

Now Marg had reported to him that she had contracted malaria in Kenya when she got back, so she was more than a little taken aback when he asked why she was at his office given that he had told her that he wanted to see her if the symptoms returned. He went on to say that since she had been taking Malarone in Kenya he was sure she didn’t have malaria; in fact, she’d never had malaria. What she had in Kenya must have been something else!! Even though she responded to the prescribed treatment for it at the time immediately. [The doctor at the Kenyan clinic was a volunteer from Canada that we know; she is an excellent GP and has become proficient at dealing with tropical medical cases due to her many years of volunteering for weeks at a time at hospitals and clinics in Africa. We contacted her and she contacted the clinic directly and asked the technician to take a look again at the smear – yes! It definitely was malaria.]

Dr. D ordered blood and stool tests. He did not prescribe Malarone. His office staff gave Marg specimen jars for the stool sample and a lab request to do the tests. She began to feel even worse and went right to bed – high fever, diarrhoea, general malaise.

Thursday she had to be driven to the hospital for the blood work to be done. She also had to get new stool specimen jars as the jars she had been given by Dr. D’s receptionist already contained someone else’s specimens! (She had phoned Dr. D’s office to let them know this. Their advice was that she should just empty them out, rinse them and then use them!? That afternoon she was feeling even worse with joint pains added to the mix.

Now, fortunately, we had some Malarone left over from our trip, just enough to take the required treatment dose (4 pills for 3 days). THANK GOODNESS!

Friday Marg was responding well to the Malarone – which would suggest that the illness was indeed malaria. In the morning she phoned Dr. D’s office but there were no results. She asked for a prescription renewal and the receptionist said she’d fax it over to the pharmacy. When Marg drove in to the pharmacy in the afternoon to pick up the meds she couldn’t pick them up as Dr. D had scratched out the Rx repeat and wrote on it that he refused to renew until the blood test results were known!

So she tried our family GP to get a Rx but he had left early after working nights. His receptionist felt bad for Marg’s situation but couldn’t do anything. Next she went to the local pharmacist, who is a great guy. He had medication but couldn’t give it out until there was a prescription. Next she went to the walk-in clinic in town where the nurse-practitioner was “not comfortable” giving her the prescription and suggested that Marg drive into Hamilton to see someone else. She just went home.

Saturday she was feeling almost back to normal – thank goodness we had those extra pills!!

Nothing seems to go on in the medical world on weekends – Marg would have to wait until Monday for the results….that’s today. She phoned Dr. D’s office only to be told that the blood (3 vials of it!) had been sent on to Toronto because it was a malaria test and the results wouldn’t be back for another 7-10 days!!!!

Untreated malaria is, at best, a terribly debilitating illness; at worst, it can kill you. If we had not had medication on hand Marg would have been in dire straits. By the time the results come in – the results that are being claimed to be necessary for a prescription – 2 weeks will have gone by.

What would be wrong, knowing that our system isn’t geared up (evidently) to diagnose and treat malaria, with prescribing the necessary medication anyway. The doctor that did the initial treatment in Kenya has seen many cases of it, has had it herself, and has talked to her patients about it. She’s very clear: “You know when you have it”. So even if it isn’t malaria what would be the harm in taking the medication? NONE. What would be the harm in delaying the treatment for 2 weeks? It could be catastrophic.

The actions taken by the local medical community around this case are simply unconscionable….and potentially life-threatening. So don’t talk to me about how primitive Third World medicine is….. Third World countries may be limited in what they can do, but what they are able to do they do efficiently and in the best interests of the patient.

Ironically, just after I had written this I saw this quote in the local paper attributed to Dr. Eric Hoskins, Ontario Minister of Health and Long Term Care:

“Our goal is to ensure that patients get the care they need no matter who they are, and that the local health-care system is there for them no matter where they live, as we continue to improve one of the best systems in the world – one that truly puts patients first.”

Does anyone know what system he’s talking about?