Medical Bytes with Dr. K
The world really has become a small place through advances in technology and transport. Air travel is also more affordable these days and who doesn’t look forward to holidays, especially since international travel brings with it the chance to explore a different country? According to the United States Centers for Disease Prevention and Control, worldwide more than 1 billion people travel by commercial aircraft every year and this number is expected to double in the next 20 years. Air travel has been implicated in the spread of many infectious diseases such as influenza because people sit in a confined space for an extended period of time. Air travel, like other forms of travel may also increase the speed at which infections travel around the world. On the matter of travel health, it’s the responsibility of every traveller to make sure that they are well prior to travel. It’s important to visit your General Practitioner for travel advice as well as the appropriate travel vaccines for a safe and disease free journey to a foreign land. It’s a great idea to have a travel kit which contains basic items such as paracetamol for fever, oral rehydration salts for diarrhea, bandages for cuts, antacid, antihistamine and insect repellant And don’t forget to take your regular prescribed medications. It wouldn’t hurt either (no pun intended) to get a flu vaccine prior to travel and prior to the flu season. Those most at risk include pregnant women, children, elderly people and those with chronic diseases such as asthma, chronic lung disease and diabetes. World TB day on 24 March has the theme ‘Unite to end TB’. It commemorates the day in 1882 when Dr. Robert Koch announced his discovery of the cause of tuberculosis- the TB bacillus. According to WHO, tuberculosis today remains an epidemic in much of the world, causing the death of nearly 1 million people each year (in the top 10 causes of death worldwide) - mostly in developing countries. Tuberculosis is an infection caused by the bacteria mycobacterium tuberculosis. In 2015, more than 10 million people fell ill with TB. Over 95% of TB deaths occur in low and middle -income countries. TB is still a major threat to the population of Fiji. It affects people who are living in poor housing conditions, densely populated areas and of low socioeconomic background. Fiji is considered to have a high incidence of tuberculosis with an estimated rate of 51 per 100,000 population and 450 new cases in 2015 (WHO, 2017). In comparison in 2014, Fiji had an estimated rate of 67 per 100,000 population with 590 new cases. So we could say that there may be a slight decrease in the number of cases of TB. Many of the Pacific Island countries also belong in the high incidence group including Vanuatu, Tuvalu, Palau, Nauru, Marshall Islands, Kiribati, Solomon Islands and Federated States of Micronesia. TB commonly affects the lungs however it can also cause infection in the spine, the brain, the lymph glands and other sites. It is curable and preventable. TB is spread from person to person through the air. When a person with TB coughs, sneezes or spits, the TB germs get propelled into the air. By inhaling just a few of these germs a person can become infected. About a third of the world’s population has latent TB, which means that they are infected with the bacteria but are not yet ill and cannot spread the disease. Overall without treatment, about 5-10% of infected persons will develop TB disease at some time in their lives. People with a compromised immune system such as those with HIV, diabetes, malnutrition and smokers have a much higher chance of falling ill. When a person develops active TB, the symptoms may be mild for many months. This can lead to delay in seeking help. The common symptoms are a cough that lasts for more than 3 weeks. Sometimes there may be blood when coughing. Fever, night sweats and weight-loss are the other symptoms. People with active TB may infect up to 15 people over the course of the year. Close contacts are most often affected
“TB is still a major threat to the population of Fiji.”
and this includes young children. Without treatment two thirds of people with TB will die. We can see that TB is still an issue in Fiji and many parts of the world. If you are concerned that you may have TB, please visit your GP. They will organise tests for you, which includes a chest x-ray and sputum testing (done through TB hospitals in Suva, Lautoka and Labasa). Once a diagnosis is made, effective treatment can be started with a standard six month course of four antibiotics that are provided with information, supervision and support by a trained health worker. The household contacts may also need medication to prevent disease as they are at high risk due to close contact with the infected person. To eliminate TB people need to avoid spitting in public places and using good personal hygiene by coughing and sneezing in a tissue and appropriate hand washing. Individuals need to understand the symptoms and signs of TB and go early to a doctor. Parents need to make sure their children are vaccinated with BCG vaccine at birth. As a country, to eliminate TB requires a sufficient supply of medication to treat it. In addition, it is important that Directly Observed Therapy (DOTS) is used to reduce the number of people not appropriately taking antibiotics. We need to reduce overcrowding in households. Our doctors need to be vigilant so that patients are diagnosed early and treated. We need to reduce the prevalence of smoking, as this is a risk factor. Basically it needs all sectors of society to work together, united to end TB! Wise words by mother Teresa “I alone cannot change the world, but I can cast a stone across the waters to create many ripples”. Till we meet next month, breathe, live, laugh well and enjoy the little things in life.
DR. KRUPALI RATHOD TAPPOO is an Australian qualified General Practitioner, a Fellow of the Royal Australian College of General Practitioners and the Medical Coordinator for Fiji-based NGO Sai Prema Foundation. Dr. Krupali is based at Mitchells Clinic in Tappoocity Suva and has a special interest in women and children’s health.