Shrink's Views

ramblings of an unknown psychiatrist

Battle with Malaria: a personal sickness story

Posted by Dheeraj Kattula on July 23, 2009

Background

Towards the end of June 2009 I went to Kandamaal district, an interior hilly area in Orissa endemic for Malaria. This was as a part of a medical team conducting medical camps in different parts of the district. I was there for five days. My experiences there deserve to be a separate post in my blog. I would write that later.

On my way back, in the train it felt a bit cold. I got up from my upper berth to switch of all the fans, thinking I was helping others in a cold night. A couple of hours later I found the fans switched on! Only then I realized that probably it was MY problem and not for others. I also had a bad migraine. I reasoned it to be due to sleep deprivation and physical exhaustion. But as soon as I landed back in home/hospital, I got my blood tested. It was positive for Malaria parasite Plasmodium falciparum. Out of 1000 red blood cells about 3 were infested with the bugs. Probably, during the time spent in Kandamaal, I was bitten by one of the female Anopheles fluviatilis mosquitos carrying the Malaria bug Plasmodium falciparum.

Treatment:

I started taking medicines immediately. I respect Falciparum bug. It could do ANYTHING. I also had a board meeting to attend. I took Tab Sulphadiazine + Pyrimethamine, Chloroquine and also Artesenuate. It was surely an over-kill but I wanted to be safe.

Three days passed. Fever did not come down. I also began to vomit and could not hold anything in my tummy. I was admitted in the hospital and was given intravenous fluids. A physician friend visiting us started me on intravenous antibiotics, ‘just to be safe’. I complied in good faith. This was carpet bombing in my system. Tab Artesenuate became Injection Artesenuate.

dheeraj on sickbed

on sickbed

7 days passed. My last dose of Artesenuate was given. I still had fever. As fate would have it, I became deeply jaundiced. It was not the typical hemolytic jaundice seen in Malaria but was deeper one seen in Liver injury. I stopped all injections and i.v fluids as I began to tolerate oral foods. I started Cap Doxycyline the fourth antimalarial. Fever came down after 2 more days. Jaundice was persisting. We knew we cannot do anything about it. Malaria Hepatopathy was the diagnosis. I was supposed to have some dietary restrictions and that is all. My staff insisted that I took some liver tonic. They forced me to buy some ayurvedic stuff Syp. Amlicure DS. I take it, to please them.

Milestones:

It was the first time that I got admitted in a hospital, first time got an IV canula, first time received ‘saline’, first time IV antibiotics etc. Of course I was living in my own room but my room was made into a special ward with IV stand coming in etc!

It was the first time I did not shout ‘mummy’ when I was getting pricked with needles. I could stomach the fact that situation is grave and that killed the fear of needles and pricks.

Reflection:

It was not easy for my friend Siva to take care of me. We had physicians, gastroenterologists, malaria experts as our friends but did not have facilities to do few of the tests that could be easily done elsewhere.

Siva had to allay anxiety of my parents, who called regularly to enquire about my status. He had to balance the risks of keeping me here and risk of transporting me in a very weak state.

He and I, both of us learnt to be cool when we knew we have to wait and watch, as we do not know what was happening. I learnt that in desperation people don’t look at evidence but act in faith. Eg: my friend giving Injection Ceftriaxone and me taking Ayurvedic medicines!

My staffs were like a family. They took care of me just I would have been cared at home by my family. They made fruit juices of different kinds apple, lime, mousambi, grape, dalimbo ( a local fruit), mango, pomegranate etc and supplied at periodic intervals. They tried to give injections as painlessly as they could. They kept a watch as needed. Of course they were always praying for my recovery.

My family stood strong. They felt bad that they could not come to take care of me. I tell them that their trouble was not needed. They had faith that nothing bad will happen.

I lost 2 inches of my waist and 6.5 kgs of weight in a week’s time. I loved it. At last the ‘all round development’ that I hated has come down. Many of my old clothes have got a new lease of life. Few days ago, I comfortably fit into a pant that I had last fit into more than a year ago. I hope I do not put on weight as my appetite is slowing improving. I watched a couple of Bruce Lee movies day before yesterday. I am now waiting to get out and exercise. I started to walk today with a little extra jump in my gait.

My jaundice is not yet gone. I look as yellow as I looked a week ago. I started feeling much better though. At one point I took four breaks to send a 5 sentence email, today I could sit in the OPD and see patients. In fact I had a 1 hour psych session with a patient today.

Jaundiced eyes

Jaundiced eyes:for clarity compare the eye colour with the colour of the teeth 🙂

Thank God, I am not entering into ‘half pay leave’ zone.

Ops I almost forgot to mention…I had never purchased ‘Real- fruit juice’ till now. Rs 75/- for food products never enters my budget, but this time I bought myself many liters of such juice lichee, pineapple, apple, orange, mixed fruit etc. I also bought oats and chocos for the first time. Sickness had made me enter new markets!

I have probably treated more than 1000 patients with malaria last year. Whenever someone came with side effects, I used to tell them without even listening fully, “I know…You will feel….etc. Don’t worry. Just do…”. I do not think I would be the same now. I might listen more and then say “I understand…Why don’t you try…You might not like to do it, but it is good for you to…If you are unable, do come back. We will help you.”

I feel I have matured through the sickness experience. Felt like this after many milestone experiences, but I am not sure if I really did mature !

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4 Responses to “Battle with Malaria: a personal sickness story”

  1. Navdeep said

    Went for a camp in malaria endemic area without prophylaxis…toooooooooooooo bad

    @Navdeep.
    Behen, thanks for that advice.
    Baripada is endemic for malaria too.But only when I went there I realized that malaria in Kandamaal was far more vicious than here. Everybody whose blood we tested or saw the report of was invariably positive for Faliciparum.It is incredible.Really…

  2. RPR said

    Hey there chief!

    Terribly sorry to hear about what happened, and I thank God you’re all right now. Take care, and be careful!

    @RPR
    Thanks buddy.I ll be careful now.Using mosquito repellents now 🙂

  3. Dr Maulesh Patel said

    Ge well soon Dheeraj

    One question/query from your sickness story

    was that infection really from Kandamaal district ?
    because as per my knowledge of epidemiology of malaria incubation period (after mosquito bite to apperance of clinical sign) is 9 to 14 days in case of P.F

    But u stated that u aere there for 5 days and you got symptoms on 5th day returning to home

    Was the infection really from the area u visited or from ur home only

    Just a thought—-

    Dr Maulesh Patel
    Surat

    @Maulesh
    Thanks Maulesh bhai.
    I am on the road to recovery.
    Thanks for your thought provoking question.You are absolutely right that incubation period of malaria is 9-14 days.

    I was in Kandamaal for 5 days and my return journey was a bit delayed due to a marriage that I had to attend on my way back.
    As far as the incubation period is concerned it can be as low as 5 days.
    “The median shortest incubation period was five days (range 0-18).”
    Ref- Eurosurveillance, Volume 13, Issue 51, 18 December 2008
    European cluster of imported falciparum malaria from Gambia

    Thanks for making me scratch my head for a while 🙂
    Good that you think critically and challenge assumptions.You should have become a scientist 🙂

  4. ARUN said

    Dear Dheeraj,

    May be I was late to join your blog. But MALARIA as you know made me go there to your blog.(Assured I didn’t go there for any other).
    Regarding treatment of Malaria, first thing to do is to refer the resistant areas which are given in our website. You can also access to the latest (09) drug policy on Malaria at http://www.nvbdcp.gov.in.
    Hope you are back to work by now.:-)

    @ Dr Arun
    Thanks yaar. I will check out your website.I have joined back for work after about 2 weeks of rest.I am doing well now.

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