Friday 23 January 2015

It’s not how you tell ‘em, it’s how you ask them.

Poor young França has been poorly these last couple of weeks.  The local sawbones hadn’t a clue what it might be and suggested that someone was upset with him and had ‘hexed’ him.  The only cure would be to weight him (the quack, not França) with silver.  Marcia took the boy to the private clinic in Luanda.  I know that such a course amounts to the same thing but at least they rob you in (slightly) more hygienic surroundings. 

They decided he had tuberculosis.  A remarkable diagnosis, I thought, considering they had arrived at such a conclusion armed only with a stethoscope.  Naturally, he was given a prescription for a week’s supply of anti-biotics. 
At school one of our classmates was diagnosed with TB .  He was sent to Torquay.  We all wanted TB as well; until we heard he’d died, then none of us wanted to go to Devon anymore.  What little I know of TB suggests that it is infectious, deadly if not treated correctly and requires a long course of the increasingly scarce anti-biotics to which the disease has not developed a resistance.  If França really did have TB, then once again African doctors were doing their bit for drug resistant bacteria.  Odd as it sounds, I actively discouraged Marcia from taking Alex to the doctor every time he sniffled.  I did this for the sake of his future health.  Loading him up with ABs every time he coughed or had a runny nose would degrade his own natural defences and here, natural defences are one’s best form of survival.  Alex was diagnosed as an asthmatic allergic.  I suggested that Marcia stopped burning mosquito coils in the house.

The doctors cited the lack of meat on França’s frame as evidence of the debilitating effect of chronic TB.  I know that when it comes to França, I have seen more meat on a butcher’s pencil, but he has always been painfully thin, even after a couple of years of feeding at my table.  I have never seen it but have it on good authority, he has to run around in the shower to get wet.  Some people are naturally this tall and thin and usually go on to become basketball players or successful cat burglars.  Still, even though I reckoned all he had was a chesty cough, I have heard of people living and wasting away for years with undiagnosed TB so it was better to have the possibility ruled out.  To do this, I knew, required chest x-rays, sputum and blood tests.
There are good arguments for just treating for the symptoms rather than waste time on a positive diagnosis but, in my humble opinion, they apply only when rapid death would result through want of treatment, cerebral malaria is a good example, but in the case of TB, a positive diagnosis would be awfully useful, especially for those who have been living in close proximity to the lad, so I was rather unsympathetic with an attitude of ‘Why bother, we know what it is so we’ll just treat him.’  And would that mean my family, and half the rest of the village also undergoing this treatment?  I wanted to know because if França did have TB, I was going to hit every alarm button and activate every medical emergency procedure I know.

‘Look, Marcia,’ I said, ‘if the lad has TB, he’d be hawking up bloody great docker’s oysters, França’s cough is dry.’
It was agreed, therefore, that we would pay for all x-rays and tests (why wouldn’t we?) but they were upset at the suggestion that since I was paying for the tests, the results would be mine to send to Europe for a second opinion.  I do not trust these fuckers, they would rather a patient died than they be proven wrong, or in this case, initiate a full scale TB panic in the Hippo household when all the boy had was a cough.

Well, he didn’t have TB.  But they couldn’t say what was causing the cough.  Fair enough, I am sure identifying every ailment presented to them is bloody hard even for the best GP.  Even professors, leaders in their field couldn’t identify the bug that dissolved my leg.
Having enjoyed the time off I reluctantly granted the slacker, França came back to work this morning.  Still skinny as ever but fit as a fiddle.  Last night I had made myself a proper stew.  A bloody great cast iron cauldron full.  I put everything into it, loads of meat of course, carrots, onions, celery, sweet potatoes, sweet peppers, habanero peppers, red wine, rich homemade meat stock, and let it simmer all evening right up ‘til bedtime.  Today I sat França at the table and ladled a huge bowl full of the stodge for him.

‘Get that down yer neck, son,’ I told him handing him a chunk of bread and a glass of milk.
‘So they never found out what it was then?’ I asked him.

‘No,’ he said.
‘Anyone else have this cough in your house?’ I was thinking of his siblings.

‘Yes, but not as bad,’ he said.
‘Do you still use the mosquito nets we gave you?’

‘No, they’re all torn’
‘So what do you do about the mosquitoes?’

‘Marcia gives us Dragões to burn.’

Dragão is Pork & Cheese for Dragon, the colloquial name for mosquito coils.
I should have used my diagnostic question technique earlier, I could have saved myself all the fees for x-rays and tests and just bought them new mosquito nets.

Put hairs on yer chest that will my lad


  1. Argh! I've learnt to ask the most obvious questions. Himself is often embarrassed when I do so, and although i'm sure any number of people think i'm a dolt, it has saved our bacon and pennies often enough that i'm not going to abandon it.

  2. I am betting the cough and the skinny bit are separate issues. If he is eating well the skinny bit is likely due to some deeper glandular congenital issue and it could be serious or could be nothing. Full blood lab workup will be needed to define that. And for that you need a real lab likely not available in Angola. Looking a chicken intestines to determine the cause as is likely the habit in Luanda just won't do this time. Like you said, if the cough was due TB you'd all be up shits creek. And you would have a noted progression of worsening symptoms (fever?) and there would be more cases around in the community. One weeks course of cheap Chinese watered down antibiotics will do nothing but help Darwin shift in to high gear. But what would the Cuban trained curandero in Angola know. Did the kid have the flu recently? is there mould in his house?

  3. Pork and cheese? Hahahahaha. Obvious cockney slang for Portuguese. (I am easily amused....)

  4. The more I hear about Angolan health care the more I want to kiss the feet of Nye Bevan!

    1. You'd only end up catching some 'orrible lip lurgy or athlete's tongue...

  5. I understand the men who enlisted WWI were identical in frame. Ditto WWII. Food has become a god since them.

  6. How right you are regarding asking a few simple questions. However, in doing so, you are stopping all those poor doctors, medical and witch, from earning an honest living and a portion of your dosh. Shame on you. :)

  7. marcia is goddamn dangerous! forget out for the mosquito coils!

  8. Truth is a slippery devil. I hope that Franca is soon back in top gear as a vital member of the Gowans hippy commune.

  9. Am sending the tale to Kay as part of her training! Glad to see Franca tucking into a hearty broth and hope he (and your finances) are soon on the mend.

  10. I once stayed in an Hotel in Italy where the room was filled with Mosquitoes. I mentioned it to the manager, and he sent someone to spray. What was in that spray I can't imagine, it gave me asthma instantly and I was forced to sleep on the beach. The obvious can often be far too obvious.

  11. TB is quite prevalent here and I know two people who have had it, (and they live in normal healthy environments), and have fully recovered after taking the long course of antibiotics. Like you, however, I am very reluctant to use antibiotics unless absolutely necessary, so you were right to have a good analysis, even if your's was the most effective.

  12. Parasites. If he was under my grandma's care, she would blame it on parasites, and give you spoonful of something ... i dont know what it was, but it was...something.

    Even to this day when im giving wormer meds to the animals around here, Im tempted to include myself...But here in the states, as with the same with antibiotics, a lot of livestock parasites are becoming immune to worming meds...

  13. i heartily approve of your anti-antibiotic stance. i have a hard time convincing anyone that it's a good strategy and they keep complaining about being eternally sick

  14. Hippo, I saw this online and thought it might be something people in your area could use:

  15. Makes me realise how lucky we are to have our health service. After my christmas flirtation with Flu just over two weeks ago after getting to my office and initially feeling fine within an hour my stomach developed the feeling it was about to explode, well an ambulance ride later I spent two weeks in hospital enjoying the effects of pancreasitis, Although not said exactly it appears my love of red wine may be to blame. Why is it that its always the things you enjoy that the doctors blame for your illnesses. Anyway back at work now and grateful to our health service.......


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