Interesting medical tidbits with an African twist

Back at PCH I worked with kiddos that had cancer - varying kinds including cancers of the blood or tumors of the central nervous system just to name a few. Here in Africa, there seems to be an unusually high amount of Burkitt's Lymphoma, which is a malignant cancer of the lymphatic system. I read somewhere that Burkitt’s accounts for almost 75% of African childhood malignancies but back in the US I saw just a handful of kids with Burkitt’s. I was talking about this with one of the physicians here and she shared this interesting fact with me:

Yep, Burkitt’s is the most common childhood cancer in equatorial Africa. Here in Africa they call it "endemic" Burkitt's which has a different etiology as compared to the "sporadic" Burkitt's at home in the states. With endemic Burkitt's there seems to be a connection between other common viruses that play a role in increasing risk for Burkitt’s. Epstein-Barr virus, which commonly causes mono, is one of these. B-lymphocytes in these children have been infected with EBV. Unfortunately EBV coupled with chronic malaria (which so many Africans have) causes a reduced resistance to the virus. This allows the virus to change the infected B-lymphocytes into cancerous cells, leading to the development of lymphoma. Interestingly though, in areas where malaria had been eradicated, Burkitt’s Lymphoma has declined dramatically. Who knew Malaria prevention might help eliminate cancer in Africa?

Back at PCH I also was part of a comprehensive clinic for kids with Sickle Cell Disease. Interesting fact #2: Those with Sickle Cell trait have a genetic advantage for malaria prevention.

Sickle Cell Disease is a blood disorder in which red blood cells are sickle shaped due to a hemoglobin gene mutation. The sickled cells get stuck in small blood vessels during periods of high activity, resulting in pain, fever, swelling and tissue damage – often called a vaso-occlusive crisis. In order to have full Sickle Cell Anemia you must have two copies of the mutant gene, one given by each parent. So those with just one mutant gene and one healthy gene have something called sickle cell trait. Kids with sickle cell trait don’t experience nearly the physical effect of the disease as those with sickle cell anemia.

The beauty of sickle cell trait is that it provides a reduced susceptibility to certain types of malaria. Since the gene is recessive, carriers can produce a few sickled red blood cells (too few to cause symptoms but just enough to provide resistance against malaria). The malaria plasmodium can’t infest itself fully in red blood cells that are sickled, so the cells rupture making the plasmodium unable to reproduce itself. In some African regions, up to 40 percent of the population carries at least one mutant hemoglobin gene, keeping Malaria away in these folks. It’s kind of crazy how genetics works out sometimes!

Why I Wear Shoes In Africa

A concrete ledge about two feet wide sits along one side of our dock. It protects us from falling into the ocean below. When you sit on the ledge you look out to this:
It’s become a new favorite spot of mine when I just want to get off the ship and get away from folks. The breeze is cool and it’s refreshing to take in this wide expanse that has no visible end. It reminds me of Malibu (minus the ever-present ocean debris and the constant smell of garbage).

So this weekend, as Jamie and I were doing some Beth Moore on this ledge and enjoying the peaceful scenery, I glanced behind me onto the dock to see an African woman, about fifty years old, legs spread and squatting with her colorful African dress hiked up. Yep that’s right folks - she was peeing on the concrete next to my new favorite spot. It was only a matter of seconds before the smell of her urine made its way over to us sitting so contently. Small bladders are quite the trend here let me tell you. It's the little things like this that remind me that I am in Africa. This happens all the time and it shouldn't surprise me anymore. But it still does. I’m not quite sure how long it will take before I'm used to this.

Blood Donation Done A Little Differently

Here on the Africa Mercy we each have the opportunity to be blood donors. At any given moment, your name could be called over the PA system to go to the lab to give your blood to someone in need right then and there. Last Thursday afternoon, my day came as I was sitting in my weekly work meeting and heard my name being called. Due to my travel history I haven’t been able to give blood for years in the states. However, here in Africa the need to protect the patients from Malaria isn’t nearly as relevant, so donating blood African style isn’t really an issue.

As the lab tech was drawing my blood, I really appreciated the nurse who came in and said “dang it, I’m so sad I missed the needle stick. I never see needles this big! We don’t use these in peds!” Very comforting. Five hundred mls lighter, I sat drinking my coke as my still-warm whole blood was transported directly to the OR for the patient in surgery.

The best part about blood donation on the Africa Mercy is that we have the opportunity to meet and hang out with the recipients of our donation after their surgeries. My blood went to a lady named Iyabo. She had a huge benign tumor removed from the side of her head and then had some skin grafted from her thigh. Here on the ward, the concept of HIPPA somewhat goes out the window as everyone shares a communal room, not to mention constant interaction with all those in your five foot radius. So what was intended as a get to know you visit with Iyabo soon turned into a Jenga-fest on the B ward as the ladies in the neighboring beds laughed as we played game after game of Jenga. Whether it be sharing in a game of Jenga or sharing some blood, life here on the Africa Mercy never ceases to amaze me.