Tuesday, July 28, 2009

In Sickness And In Health

This entry is going to be about personal and public health issues. Why? Because conveniently enough I was sick yesterday and today the Wat/San group went through water related diseases and health issues. There will also be a special section at the end devoted to flies, who have become my second arch enemy... after mayonnaise.

Item #1: Personal Health
I'd like to start this section with a disclaimer... if you don't want to read about my health issues, simply fast forward to the next section. Don't read this, then become disgusted and scold me.

Yesterday I had my first true Mr. D (diarrhea) experience. I say "true" because it wasn't even on the same order of magnitude as what we associate diarrhea with in the US. In the States you might feel ill and get the "runs" once or twice and then it's over. Right?

I had 19, yes, nineteen visits to the negen yesterday... in 16 hours. Mr. D said "no" to Immodium. He said "no" to Pepto. I decided to say "no" to food of any kind and yet he still kept me company for some time. The strangest part was that I really didn't feel sick... I just needed to stay close to a negen all day. As evening came around I started to feel tired because I'd been up since 3 a.m. and hadn't eaten all day, but other than that it wasn't so terrible... aside from the obvious terribleness of the situation that is. The good news is today i feel fine. It's like nothing ever happened. However, I will be checking in with the medical officer over the next few days.

Item #2: Major Health Issues in Mali
Obviously a big focus of the Wat/San group is getting people clean water and getting rid of dirty water. An important starting point for this is to understand the different health concerns associated with contaminated water and other public health concerns that arise from the presence or lack of water.

Diseases related to water in Mali can be broken up into four basic categories: 
  • Water-Borne (consumption) 
  • Water-Washed (contact) 
  • Water Related (proximity) 
  • Water Scarcity (hygiene)

Water-borne diseases are anything that a person contracts from consuming water. This includes: cholera, diarrhea, dysentery, typhoid fever, hepatitis A, polio, guinea worm, etc.

Water-washed diseases are anything that a person contracts from contact with water. The main one in Mali is schistosomiasis.

Water related diseases are anything that come from water but do not result from direct consumption or contact. These diseases are transmitted through vectors, typically mosquitos or flies. Diseases spread by mosquitos include malaria, dengue/hemmoragic fever, yellow fever, and elephantitis. Diseases spread by flies include river blindness and sleeping sickness.

Water scarcity diseases come from a lack of personal hygiene, which is usually caused from lack of water. The major disease here is trachoma.

Here's an explanation of a few of the major diseases in case you don't know what they are.

Cholera
A bacterial infection that causes severe diarrhea and vomiting. If not treated immediately a person will die due to dehydration and a collapse of blood vessels. An untreated person will die from cholera in under 24 hours, and there have been cases where some people die in as little as two hours.

Schistosomiasis
This disease is caused by a parasite that can reside in the intestines or urinary tract. The urinary version brings with it pain in urination, restrictions in the bladder, and possibly death from potential inability to expel urine (only severe cases). The intestinal version behaves like dysentery, which is characterized by diarrhea and blood in the stool.

Malaria
This disease is typically caused from being bitten by female mosquitos who carry the parasite. When infected the parasite moves to a persons liver where it incubates and then disperses through the blood. Malaria is characterized by a high, spiking fever, aching, vomiting, diarrhea in children, swelling of the liver, jaundice, and in the advanced stage convulsions and death.

Trachoma
This disease is actually in the family that houses pink eye (conjunctivitis). It results mainly from people rubbing their eyes with contaminated hands, but can also come from flies landing on the face near the eyes. A bacteria gets underneath the eyelid and causes inflammation that then causes the eyelid to curl in towards the cornea. Eyelashes then scratch the cornea with blinking, which causes corneal scarring over time. The final result, if not treated, is permanent blindness.

Item #3: Flies
As stated above, flies are a vector for some water related diseases. Oddly enough, they are also a vector for a lot of non-water related diseases as well. The big problem with flies is they like to land on things like poo... and then the come land on you, or your food, or your toothbrush... And they're everywhere! Honestly, I would not complain if flies were completely eradicated from the world. Yes, ecosystems everywhere would most likely be completely destroyed, but that's a risk I'm willing to take. I think the single biggest complaint from all 67 trainees at this point are the flies. They are clearly agents of the fun-police and are bent on disrupting all instances of enjoyment or periods requiring concentration.

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