Med­i­cal Bytes with Dr. K

mailife - - Contents - 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.

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