Amoxicillin i no Malaria Marasin

The outpatient clinic of St. Margarets Hospital is literally outside of the hospital, on the front lawn. Believe it or not, it’s quite a strategic location as it gives a good view on the incoming patients which have to hike up the hill to get to the hospital! 

One day I was working at a “See and Treat” station and had a little boy come through with his father. First thing I do is to look through the health book, because I found that patients don’t tell you their full history… and often they’ll come just hoping that white “doctors” can do more than PNG health workers. YES “doctors” because it’s happened too many times when we introduced ourselves and said that we were nurses and community health workers from around the world, that the interpreter would translate as “6 doctors from America!” 

Anyways! Turns out this little boy is a re-attendance… he was at the clinic 4 days ago! I had to breathe for a second and try to have a neutral opinion on the whole situation. He had been diagnosed with “Mild Pneumonia” but the notes in his chart also said “Could not listen to the lungs well, because child cried too much” Rx Amoxicillin. Ahhh! How can you diagnose Pneumonia without listening to the chest!!?? This is PNG, it’s not like an X-Ray had been done either! “Ok fine, people do that all the time…Still not ok! But I’ll see him properly. I’ll listen to the lungs, and there better be something in there!” NOTHING, Clear breath sounds all around. I couldn’t hear anything wrong… had he had pneumonia, it would have improved with Amoxil, but the child still feels horrible.

I then thought about looking to see if they had done an RDT (Rapid Diagnostic Test fro Malaria). They hadn’t, so I did one… and sure enough, it was positive! My first positive malaria test; such a relief to find what was wrong with the child but also quite frustrating to realize that this simple and life saving test hadn’t been done the first time the child me a few days ago! Malaria, mixed infection, prescription: MALA-1 BID x3/7 and Primaquine QD x2/52.

But this story is not as bad as the patient in Eiwo’s story… the health worker had done an RDT, and it was positive. Having heard that we were coming in three days, he gave his patient Amoxicillin TID until he saw us to get a prescription of Mala-1 (new medicine for Malaria)! If you don’t have a medical background, it might be worth noting that amoxicillin is an antibiotic and will only cure bacterial infections. Malaria is a protozoan parasite and there’s nothing an antibiotic can ever do to the parasite, Malaria affected patients can only be helped by an anti-parasite medication like Mala-1 (a mixture of Artemether and Lumefantrine)

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