Monday, May 31, 2010

Jungle Medicine

People always ask us how the Belize medical system compares to that in the Unites States. We’ve found that it compares very favorably, and while there may be fewer high-tech diagnostic options, the level of care and the competence are as high, or sometimes higher, than in the US. In our experience, doctors have always been more than willing to spend whatever time is necessary with us, and we’ve never felt that we’re just another insurance card number. And, we’ve always found the costs of medical care to be reasonable, probably not more than we would have paid in copayments in the US system, and definitely less when you figure that we’re not paying the $500US per month premiums that we paid in the US – although we do still maintain catastrophic care coverage in the US just in case one of us has some major problem and needs to return to the US for treatment.

Over the past couple of months, we’ve had a more advanced lesson about medical care in Belize, and learned that sometimes taking matters into your own hands is a little easier to do here than we found it in the US. Way back in the winter, I had what I thought was a bite on my shoulder. It didn’t go away, and there was a little hole at the center, so I asked Tom if he thought it was a botfly. He didn’t know, and said to wait a week or so to see if it was a botfly, which we now recognize pretty readily from having the horses and dogs get them. It didn’t turn into a botfly, but over the next few weeks the hole gradually got bigger. It didn’t hurt, so I waited a few more weeks, and went to the clinic at La Loma Luz to have a doctor look at it. The doctor looked at, said he suspected leishmaniasis, but he didn’t want to treat it without a scraping sent to the lab because of the side effects of the leishmaniasis treatment. They did the scraping (which made me pass out, ‘possum that I am), sent that off to the lab, and gave me 10 days worth of antibiotics. The scraping came back negative, and the doctor told me to come back and see him if the sore didn’t get better after the 10 days of antibiotics. I finished the antibiotics and waited another week or so, and when the sore seemed to be getting bigger again, I went back to the clinic. The doctor said he wanted me to see a specialist, so he gave me the name of a dermatologist in Belize City.

Since the sore wasn’t growing that quickly, and it didn’t hurt at all, I didn’t do anything about it for a few more weeks. Finally, since we had to pass through Belize City on our way home from Caye Caulker a couple of weeks ago, I decided to make an appointment to see the dermatologist on the way through. She agreed to see me the next day, and looked at the sore, photographed and magnified it on her computer, and took a chunk out of my shoulder to send off for a more complete biopsy than the scraping they did at La Loma Luz. And charged us $850BZ. Yes, eight hundred and fifty Belize dollars. After three years of experience dealing with the medical system in Belize, Tom and I were shocked. We paid the bill, and made an appointment to come back to have the stitch from the biopsy removed and to get the results.

In the meantime, we decided that for $850 we could do a little research on our own. We started to talking to all sorts of people around here – licensed medical professionals, bush doctors, and people who have had sores like the one on my shoulder – and they all agreed that despite the fact that the scraping came back negative and the biopsy was “inconclusive,” it’s leishmaniasis, also known around here as chiclera or bay sore. We found plenty of people to talk to around here who have had it, since it’s spread by the bite of an insect commonly found in the bush around here, and it seems that most people who spend any time at all outside in the bush – which I do – seem to get it eventually.

So, we started asking people how to get rid of it. A few gave us the common bush remedies, but admitted that they don’t always work so well. No thanks. A few said to pour boiling water on the lesion. No thanks. A couple of people told us to make a visit to either BATSUB or the BDF, the British or Belizean military, and have their medics treat it, although they heard that the military treatment involves 40 injections. 40 injections??? No thanks! The majority of people advised taking a trip across the border into Guatemala and buying a medicine called Glucantime, and having somebody here administer it for me, which involves small injections around the site of the sore and then the bulk of the medication as an IM injection in my butt. Most people, including the Guatemalan pharmacist where we purchased it, said somewhere between five and ten injections should do the trick, so we purchased five vials, along with five little needles for the injections around the sore and five big needles for the posterior injections, and started doing more research.

I googled Glucantime, and found that it has some adverse side effects, and that because of these side effects it’s not approved by the FDA and can’t be used in the US or Canada – hence the reason we had to go to Guatemala to buy it, since Belize tends to mirror US standards. However, it is the worldwide treatment of choice, and while other treatments are available, this is the most effective and relatively the safest (there are some less effective treatments that are safer, but they’re less effective). Worried about the side effects since some of the warnings definitely apply to me, I shot an email off to my brother Matt, who is a Physician’s Assistant and was a medic in the Army in Iraq for a year, and thus had some exposure to leishmaniasis. He very quickly emailed back with the precautions I should take, and his recommendation for dosage and length of treatment. I then took the results of this research and went to a local nurse and asked her if she’d be willing to treat me. She said yes, and her dosage and administration jibed pretty closely with what Matt had recommended, so I felt comfortable enough to get the first injections yesterday. The only thing that differed between her advice and Matt’s was that she thinks because the sore is relatively small, I might be able to get away with having it treated with five to eight injections, one each day for the next week or so. And, if she thinks it’s okay to stop the treatment after five or seven days, and then it comes back, I’ll just start the treatments again and get more shots – ugh, but as far as I’m concerned worth the risk of trying a shorter run this time, especially since I trust the nurse’s experience since she’s treated so many people in the village.

A couple of people have asked if this is the type of thing that I might have considered going to the US for treatment. My answer is NO. I don’t think most medical professionals in the US would have any idea how to treat it since it’s rarely seen there, and the worldwide treatment of choice isn’t available there. The doctors here don’t even seem to really know how to treat it, except to advise you to go to another country, get the medication, and have somebody administer the injections. And the people who offered and who most people recommended to do that are local pharmacists and nurses who do it for their families, friends, and villagers because the doctors don’t want to deal with it, so they have more experience than doctors either here or in the US. I think if I got it again, or saw anybody with something that looked like this, I would advise them to avoid the doctors, and just talk to some medical friends or acquaintances who have actually dealt with it. I’ll check back in after a week or so and let you know if this is still how I feel – so keep your fingers crossed for me!


Anonymous said...

Hi Marge,

Your the second blogger that my wife and I follow that has had Leshmaniasis as a topic recently ( May 14, 2010 entry.

Don't know how much info you have been able to dig up on this, since it is not common in the US, as you note. I suggest for a starter, and this leads to additional information about the disease. The main issue about the lesion is that it can lead to secondary infections, which is not a good thing in a jungle.

I would be interested in knowing if the "non-approved" therapy is successful.

I went to a dermatologist once, due to facial lesions from shaving. They charged only $35US (in 1980, but still not equivalent to BZ$850!!) and said it was contact dermatitis, which did not go away until I applied an antibiotic that can be absorbed through the skin. Harrummph. This was in Athens, GA, which I recall you also have an association with (Go Dawgs!).

Keep us updated on your progress.

I have found your posts on the less thought of aspects of living in Belize helpful, such as the funeral arrangements entry. Can you elaborate on the catastrophic health insurance issue, since my wife and I have to consider this in the next 18 months prior to relocating to Monkey River.



sandy a. said...

keeping fingers crossed! You will proly be just fine after treatment.
We doctor ourselves here pretty much whenever we need it (fortunately not too often) with animal meds or herbal rememdies. Usually the animal meds are the same stuff as people meds. I don't believe in doctors too much.

Marge & Tom Gallagher said...

Sandy - We took plenty of horse meds in the US. The funny thing here is that the pharmacies are the same for animals and people, so we never know if we're giving the animals people meds, or the people animal meds! And we also go the natural route whenever possible...but sometimes something from a pharmaceutical company is just that much more efficient.

Dennis - Thanks for the info. The blog link was very interesting, especially since some of the bush remedies were the same, and some were very different. I'll update the blog when I know if this worked.

And re our catestrophic coverage insurance, it's just BC/BS with the lowest possible premium (slightly less than $200US/month for the two of us) that has a $5000 deductible and none of the extra coverages. We shopped around, and that was about the best we found.

Feel free to email us direct if you have other questions.