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Malaria in Bristol

You hear of people dying of malaria in Britain, weeks after they return from the tropics. Sometimes the patients don't help the medical staff by warning them of where they have been travelling. At other times the incubation period can be so lengthy that the symptoms aren't thought to be related to that distant tropical holiday. 

Doctors will normally send off some blood for analysis if they are told about your travels, but not always unless you pressure them to do so. Also in the early stages malaria imitates flu or other fevers, and the patient can delay getting to a doctor. But malaria debilitates you really fast, and serious complications come within days.

Anyway, here's a tale of a malarial recurrence in the UK, where some medical staff were particularly incompetent!



I’ve had a lot of malaria, so I can usually recognize a fresh attack is coming. There’s the obvious fever and high temperature, but also tenderness in the midriff as the liver and spleen become affected, and darkening urine.

But I’m reluctant to rush round to the doctor and cry that I have a dangerous tropical disease until I’m sure it’s not the ‘flu, so I wait until my temperature begins to spike at 104 degrees and then I seek medical help. By that time I’ve left it a bit late.

In London I’d go round to the Hospital for Tropical Diseases where they know me well, but in 1988 as I’d just moved down to Bristol I went round to the casualty department at the Bristol Royal Infirmary. I was feeling pretty ill by this point, and although it was early July, I arrived with an overcoat and blanket around my shoulders, and lay on the benches, teeth chattering, making a bit of a spectacle of myself.

‘I’ve got malaria,’ I mumbled to a junior doctor through a little chink in the blanket that seemed to be letting in a blast of arctic air.

He laughed. ‘I don’t think that’s likely.’

‘Yes. I’ve had it before so I can recognise the symptoms.’

‘When were you last in the tropics?’

’18 months ago.’

‘There you see. It can’t be, as the incubation period is 2 months at the most.’

‘I get recurrences. Why don’t you phone the London hospital?’

‘We’ll do some blood tests and find out what’s wrong.’

‘I know what’s bloody wrong! It’s malaria!’

‘Please don’t raise your voice at me. Return to the waiting area and I’ll send this blood down to the labs.’

So I lay down on the bench for another miserable couple of hours until another doctor arrived and told me in a sort of awed voice that I had malaria.

‘We don’t get a lot of that here!’

They took me in an ambulance to a hospital on the other side of the Avon Gorge, which I learnt later was an isolation unit where they treated AIDS cases, TB, and probably plague, Ebola, victims of germ warfare and anything else. I didn’t care; I was just grateful to be put to bed and get wired up to a saline drip, because by then I’d left the Arctic phase and was now in the Hot Zone.  This is a delirious nightmare of muscle cramps, crushing headaches and vomiting, when I could hear myself babbling and moaning as I thrashed on the saturated sheets.

Before dawn I slipped into an exhausted sleep, and was woken by a doctor when she did her ward rounds at 9 o’clock.

‘Good morning Mr Harrison. I’m afraid you’ve got Vivax malaria.’

‘Mmm…’ I grunted, and tried to nod, which was a mistake as it made my temples throb and dancing specks float across my vision. The diagnosis was a slight relief. I sometimes got the more deadly Falciparum, and while the two strains felt pretty much the same to the patient, Falciparum, the so- called cerebral malaria, causes red blood cells to die in such numbers that they clog up small blood vessels in the brain, and frequently causes renal failure too.

‘So I’ll put you on a course of quinine and mefloquine and you’ll start to fell better in a few days.’

‘Thanks, but…..’ she was gone and my brain was still too scrambled to work out what seemed wrong with what she’d just said. Maybe later…….I dozed off again.

That evening as the nurse handed me my tablets I realized what had been bothering me. Every time I’d had Vivax malaria in the past, in Brazil, or London, I’d been given chloroquine. Only with Falciparum malaria had I been given quinine and mefloquine.

I swallowed the tablets anyway, but when the doctor saw me the next day, I mentioned my concerns.

A flash of anger blazed behind her spectacles, and I saw that she was very young, and having her judgement challenged was a new and unwelcome development.

She made a show of examining my notes. ‘Let me see,’ she said through clenched teeth. ‘Oh yes it says Mr Harrison here, not Dr Harrison. So you’re not medically trained are you? Unless you’re a surgeon of course?’

I was still too groggy to respond with much passion.

‘Obviously not, but I’ve had malaria 16 times, so I’m familiar with what drugs I’ve been given.  If you phone the Hospital for Tropical Diseases in London, they have my records.’

‘I don’t think that will be necessary,’ and off she went.

I didn’t want to challenge her again so I took the medicine she prescribed and hoped that it would do the job. Certainly the fevers abated.

But the next afternoon when my wife Heather was visiting I became aware of an excruciating pain in a shoulder tip.

‘I must have pulled a muscle when I sat up in bed earlier,’ I said, but when I was still in pain a few hours later Heather told a doctor and asked for strong painkillers.

Then something bizarre happened. A nurse arrived with a dress-maker’s tape measure which she threaded round my midriff, and noted a figure down in my notes.

‘Measuring me for my shroud?’ I asked.

‘Don’t be silly Mr Harrison. We need to keep an eye on your spleen, to see if it’s swelling.’

‘How can a tape measure monitor an organ that’s buried in my guts and that’s about 10 centimeters long and weighs less than 200 grams?’

‘Why don’t you let the medical team decide what’s best,’ she said testily and walked away.

Heather and I giggled. ‘Oh boy. They’re a bit sensitive here, aren’t they? You could almost say that she vented her spleen on me! ‘

If I hadn’t looked it up on Wikipedia only just now, I could have continued ‘Do you know that Shakespeare used the spleen to describe Cassius’s irritable nature in Julius Caesar?

‘Must I observe you? Must I stand and crouch under your testy humour? By the gods you shall digest the venom of your spleen, though it do split you…’

But I’d made enough enemies without pissing my wife off too by being a smart-arse, and she gave me a kiss and departed for the night.

Early next morning a new doctor did his rounds, and I asked him about my shoulder pain.

‘It’s called ‘referred pain’. It sounds strange, but pain in the tips of the shoulder is often a sign of trouble in the abdomen, the spleen or gall-bladder usually.’

‘I don’t want to lose my spleen.’

‘No, I’m sure you don’t, but many people have it removed every year with no ill-effects. Usually after car crashes or fights, but sometimes for other reasons.’

I drew in a deep breath.

‘I’m a bit reluctant to question my treatment, but when I’ve had Vivax malaria in the past, I’ve been given chloroquine and primaquine…. I was in the London Hospital for Tropical Diseases before.’ I thought I’d toss in the name of that world-renowned institution again to impress these rural hicks. ‘Could the wrong medication be contributing to my spleen playing up do you think?’

I expected another withering put-down, but he said he’d look into it, and maybe he did call London, because I noticed that I was put on chloroquine an hour later.

Within a day I was feeling strong enough to get out of bed and get cleaned up. So I grabbed some washing things, left my room, and headed shakily down the corridor for a shower, as the enticing alternatives that I’d got in other hospitals didn’t seem on the menu here……

 

‘Are you feeling strong enough to walk down the corridor to the shower Mr Harrison?’

‘Er. Maybe.’

‘Or shall I wash you from head to toe with a warm, soapy sponge?’

‘Actually nurse I don’t feel quite strong enough to walk that far.’

 

Anyway, I was half way down the corridor when I heard a panicky call from behind me. The head nurse had popped out of her office.

‘Mr Harrison! You must return to your room immediately!’

‘What? Why?’

‘Because you’re in isolation!  Go back right now!’

‘No, I won’t. ’

‘What do you mean?’

‘I don’t think this hospital has the slightest clue about malaria. I nearly lost my spleen after you gave me the wrong drugs, and you don’t even know enough about the disease to realize that I can’t be contagious in any way.’

‘Just do as I say, and stop being difficult.’

‘Go and look it up. You’re being ridiculous.’

She glared at me, and two more nurses had appeared at her side.

‘Tell you what. While I’m in the shower you find me an anopheles mosquito. They are the only ones that can spread malaria by biting me and then biting someone else, but they don’t live anywhere in Europe. It’s got to be a female, by the way, as only they suck blood – the males live on nectar and fruit. Good luck with the hunt!’

 

I thought I’d reached a low point in my dealings with the hospital, but that afternoon when I had decided to discharge myself, they asked me if I could delay my departure by an hour or two to help them with some student training.

‘Sure,’ I agreed, and soon a young guy entered my room and told me that he would do an initial examination, before the consultant and the rest of the students arrived.

He clumsily palpated my abdomen to find the swollen liver and spleen.

‘Do you have any other medical conditions?’

‘Just mild psoriasis that is only visible in this one patch on my elbow.’

‘Okay. Thanks for your help. The others will be here in a moment.’

And so they were. Twenty students crowded round my bed and a consultant swept in, dressed in a snappy suit, and with an air of almost laughable self-importance. He took up a position a yard from my bed, but never even looked at me, or introduced himself, let alone thanked me for agreeing to help in the training programme.

Without a word he pulled back my bedding so I was lying there in my underpants.

The malaria had left me feeling chilled and goose-pimply, and I suffered 20 clumsy attempts to find my tender internal organs, that made them tenderer with every prod, and all the time the consultant talked over me and discussed my medical notes as if I were already a corpse.

The final straw came when he was told that I had an area of psoriasis.

‘Where?’

‘On his right elbow.’

Without a by-your-leave he grabbed my arm and twisted it so that the group could get a look, while he talked about diseases of the skin for five minutes.

Finally he was finished. He dropped my arm, and started to lead the students from the room, without a word of thanks or acknowledgement.

‘Excuse me.’ I said.

They all paused, and the consultant turned and looked at me for the first time. He must have been surprised that I even had a voice.

‘Yes?’

‘May I say something?’

He nodded.

I looked at the students.

‘I wish you lots of luck with your training, and your future careers as doctors, but please promise me one thing.’

They looked at me expectantly.

‘Try and develop a good bedside manner, and treat your patients with respect, and try not to end up like this prick.’ I pointed at the consultant, and saw most of the students smother a smile before I yanked up my blankets and turned away.

 

 

 

 

On another occasion I was staying with my mother 20 miles from London when I felt another attack developing. Once again I left it a bit late while I made sure, so ended up shake, rattle and rolling around her sitting room floor, trying to lie as close as I could to the electric fire.

She managed to take my temperature without my chattering teeth reducing the thermometer to glass fragments.

‘Goodness me! It’s 105 degrees! I’ve never seen a temperature that high.’

As she’d been a nurse for almost forty years I felt a ridiculous pride.

‘I’d better call a doctor,’ she said.

‘Honestly Mum, they wouldn’t know what to do. If I’m not better this afternoon I’ll phone the hospital in London and see if they’ll take me in.’

‘I think you should do that now.’

‘Oh, all right. ‘

They were very nice, and when the person on the phone dug out my medical history they found I’d been a patient there four times in the past.

‘I think you should recognize malaria by now!’ she laughed. ‘We’ll get a bed ready for you.’

It was a Sunday, and Mum wanted to go to church, so I encouraged her to go. She wanted to drive me up to London, but I preferred to make my own way there, because like all mothers she’d worry and fuss too much. Bless her, but I didn’t want that. Ungrateful boy.

So while she was in church I got in my car and drove up the motorway to the city. The chills and ague had gone now, but I felt wretched: hot, extremely sweaty, semi-delirious and nauseous. 

It was December and the car’s dashboard told me the outside temperature was 4 degrees, but I opened every window to the rushing wind, but still couldn’t stop the sweat that dripped into my eyes. I also vomited into my lap that must have caused a little lane indiscipline to my motorway driving.

The M4 motorway enters London on the raised Chiswick flyover and then it is about another half an hour of clogged traffic to reach the hospital that is tucked behind Euston station.  By now I was gritting my teeth and struggling to keep going. I was obviously in no state to be driving at all, but gripped the steering wheel tightly, cursing feebly at every traffic light, praying aloud that the queues could move a bit faster.

I was almost there, crawling up the two-lane Westway, able to see the fine gothic façade of St Pancras station ahead.

‘Nearly there. Nearly there!’ I muttered as I waited for yet another light to turn green.  A sharp stabbing pain in my temples made me bring both hands up to my head and groan.

‘You all right mate?’

I couldn’t work out where the voice had come from, and stared stupidly ahead.

‘Hey! Are you OK?’

Then I turned my head to my right and saw that the four occupants of the car a yard to my right had wound down their windows and were gawping at me.

‘What?’ I muttered.

‘Are you okay?’

I can see their point now. The pavements were full of shoppers swathed in overcoats, gloves and scarves, but my hair was plastered to my scalp, and sweat was rolling down my face and dropping on to my pale blue shirt that didn’t have a dry patch on it. I could have just stepped fully clothed out of a shower, except for the puke all down my front. They’d seen me talking desperately to myself, feebly thumping the steering wheel and clutching my head.

 

My eyes were rolling around trying to focus on their concerned faces, and a sudden stab of pain made me wince again.

But I gave a grimaced attempt at a smile.

‘I’m fine thanks.’

‘Are you sure……?’

Then the lights mercifully turned green and I could accelerate away from their scrutiny and my embarrassment.

 

 

 

 

 

 

 

 

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