No flip-flops, shorts or vests; white coats are compulsory. Those were the rules explained to me before my 1st ward round on the Malaria ward. A short walk in the shade of some palm trees takes us from the OUCRU (Oxford University Clinical Research Unit) to the ward. The last 25 metres are not sheltered from the sun, and it makes us pick up the pace. The shade of the malaria ward is most welcome, but the heat is still there. There's a small oasis of cool in the air-conditionned doctors' office, where we wait for everyone to assemble. To get there, we have to single-file past two beds which lie in the corridor, each one carrying a very tired-looking patient.
The ward's name is misleading: the vast majority of the patients on this ward (13 in total today) don't have malaria. The name is historical, as this was once the ward where all malaria cases were treated. There was a time when malaria was a great burden for Vietnam, as it still is in much of South-East Asia. In 1991, there were nearly 2 million cases and more than 4,500 deaths from malaria in this country. Since then, thanks to a massive commitment from the Vietnamese Government, and significant financial assistance from the World Bank, Vietnam has succeeded in almost eradicating the disease. By 2003, cases were down to 37,416 and there were only 50 deaths.
Based on this morning's round, a more suitable name would be the Meningitis ward. Bacterial, TB, viral; even eosinophilic, a new one for me. The Vietnamese doctors summarise the case in English, for the benefit of the 2 or 3 members of the round who don't speak Vietnamese. I listen carefully, trying to block out the noise of the large fans on the ceiling. Ceftriaxone, vancomycin, ampicillin - some rebel patients still refuse to get better. It's difficult when a CT scan implies a drive through the city in an ambulance; in a city like Saigon, the drive itself could prove more dangerous than the meningitis....
Having seen a single case of malaria, we leave the ward and enter the ICU. In a side-room, a young man lies spread-eagle on a bed, the haemofiltration machine doing its best to rid his blood of the parasites within it. "This patient spent many years in a malaria-endemic region of Vietnam", we are told. Those tend to be the more rural and forested parts of the country. "His parasitaemia level is nearly 10%". That's very high; I try to remember what the management for severe malaria is. "We think he has brain death".
And there it is, malaria's latest victim. Perhaps the name of the ward serves as a useful reminder.
Barat, LM. "Four malaria success stories: how malaria burden was successfully reduced in Brazil, Eritrea, India, and Vietnam." Am J Trop Med Hyg (2006); 74(1):12-6.
The ward's name is misleading: the vast majority of the patients on this ward (13 in total today) don't have malaria. The name is historical, as this was once the ward where all malaria cases were treated. There was a time when malaria was a great burden for Vietnam, as it still is in much of South-East Asia. In 1991, there were nearly 2 million cases and more than 4,500 deaths from malaria in this country. Since then, thanks to a massive commitment from the Vietnamese Government, and significant financial assistance from the World Bank, Vietnam has succeeded in almost eradicating the disease. By 2003, cases were down to 37,416 and there were only 50 deaths.
Based on this morning's round, a more suitable name would be the Meningitis ward. Bacterial, TB, viral; even eosinophilic, a new one for me. The Vietnamese doctors summarise the case in English, for the benefit of the 2 or 3 members of the round who don't speak Vietnamese. I listen carefully, trying to block out the noise of the large fans on the ceiling. Ceftriaxone, vancomycin, ampicillin - some rebel patients still refuse to get better. It's difficult when a CT scan implies a drive through the city in an ambulance; in a city like Saigon, the drive itself could prove more dangerous than the meningitis....
Having seen a single case of malaria, we leave the ward and enter the ICU. In a side-room, a young man lies spread-eagle on a bed, the haemofiltration machine doing its best to rid his blood of the parasites within it. "This patient spent many years in a malaria-endemic region of Vietnam", we are told. Those tend to be the more rural and forested parts of the country. "His parasitaemia level is nearly 10%". That's very high; I try to remember what the management for severe malaria is. "We think he has brain death".
And there it is, malaria's latest victim. Perhaps the name of the ward serves as a useful reminder.
Barat, LM. "Four malaria success stories: how malaria burden was successfully reduced in Brazil, Eritrea, India, and Vietnam." Am J Trop Med Hyg (2006); 74(1):12-6.
This comment has been removed by a blog administrator.
ReplyDeleteThis comment has been removed by a blog administrator.
ReplyDelete