WHERE THERE IS NO DOCTOR SERIOUS ILLNESSES THAT NEED SPECIAL MEDICAL ATTENTION
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“MMUMrr HEALTH CSU
Banwaf.re . 5<t 0f1.
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a'
CHAPTER
Serious Illnesses That Need
Special Medical Attention
This is a reprint from
\\Zhere 'There Is No Doctor
(Indian adaptation)
published by the
Voluntary Health Association of India
C-14 Community Centre
Safdarjung Development Area
New Delhi 110016
-.9
CHAPTER
Serious Illnesses That Need
Special Medical Attention
The diseases covered in this chapter are often difficult or impossible to cure
without medical help. Many need special medicines that are difficult to get in
rural areas. Home remedies will not cure them. If a person has one of these
illnesses, THE SOONER HE GETS MEDICAL HELP, THE BETTER HIS
CHANCE OF GETTING WELL.
CAUTION: Many of the illnesses covered in other chapters may also be serious
and require medical assistance. See the Signs of dangerous illness, p. 52.
TUBERCULOSIS (TB, CONSUMPTION)
Tuberculosis of the lungs is a chronic (longlasting), contagious (easily spread) disease that any
one can get. But it most often strikes persons
who are weak, are poorly, nourished, or live with
someone who has the disease.
Tuberculosis is curable. Yet lakhs die
needlessly from this disease every year. Both for
prevention and cure, it is very important to treat
tuberculosis early. Therefore, you should know
the signs of tuberculosis and be on the lookout
for them.
Most frequent signs of TB:
•
•
•
•
Chronic weight loss and increasing weakness.
Chronic cough, especially just after waking up.
Mild fever in the afternoon and sweating at night.
There may be pain in the chest or upper back
In serious or advanced cases:
• Coughing up blood (usually a little, but in some cases a lot).
• Pale, waxy skin.
• Voice grows hoarse (very serious).
Signs of TB in children:
Children with TB often do not cough or have a mild fever in the afternoon
The most important sign in children is loss of weight even if they are
220
eating well.They may also have difficulty in breathing. If a child who
eats well does not gain weight for two successive (one after the other) months,
always suspect TB. In a small child. TB is very dangerous and can quickly
kill the child.
Tuberculosis is usually only in thelungs. But it can affect any part of the body.
In young children it may cause meningitis (see p.225). For skin.problems from
TB, see p.253.
If you think you might have tuberculosis:
Seek medical help. At the first sign of tuberculosis, go to a health center where
the workers can give you a skin test, take an X-ray, and examine the stuff you
cough up (phlegm or sputum} to see if you have TB or not. You can get medicines
forTB:free from the Primary Health Centre.iYou will probably be given 2 or 3 O'1
the following:
■ Streptomycin injections (p. 403)
■ Thiacetazone (p.404)
" Isoniazid (I.N.H.) pills (p. 404)
■ P.A.S. (aminosalicylic acid) pills (p. 404)
It is very important to take the medicines as directed. At least 2 must be taken
at the same time. (For the risks and precautions in the use of these medicines, see
p. 402to 404)
TB germs do not die easily. They will be killed only with continued treatment for a
long time.
Continue taking the medicines until the health worker tells you that you are
cured. Do not stop taking the medicines just because you feel better. To cure
tuberculosis completely usually takes from 1 to 2 years.
Eat as well as possible: plenty of foods rich in proteins and
vitamins, as well as energy foods (p. 128 to 130).
Rest is important. If possible, stop doing heavy
and tiring work and take it easy until you begin to get
better. From then on try not to work so hard that you
become tired or breathe with difficulty. Try to get
enough rest and sleep.
Tuberculosis in any other part of the body is treated the
same as TB of the lungs. For children with severe tuberculosis of
the backbone, surgery may be needed to prevent paralysis.
TBof
the backbone
Tuberculosis is very contagious. Persons who live in the same house with
someone who has TB, especially children, run a great risk of catching the disease.
3»O
221
If someone in the house has TB: (see pages. 1 63-165)
♦ If possible, see that the whole family is tested for TB.
• Have the children vaccinated against TB.
♦ Everyone, especially the children, should eat plenty of nutritious food (see
p.128).
♦ The person who has TB should eat and sleep separately from the children, if
possible in a different room, as long as he has any cough at all.
* The person with TB should eat from dishes kept separately for him. No
one else should use these dishes.
♦ A person with TB should be careful to cover his mouth when coughing and
should never spit on the floor. He should spit into a covered container.and
burn the phlegm at night.
♦ Take a child to a health center at the first suspicion of TB or if he gets a
cough that lasts more than 2 weeks or if he starts losing weight suddenly.
or if he has difficulty in breathing.
♦ Treat TB at once. A person who no longer has TB will not spread it.
Early and full treatment is a key part of prevention.
RABIES
Rabies comes from the bite
of a rabid or 'mad' animal,
usually a rabid dog, cat, fox,
wolf, skunk, or jackal. Bats
and other animals may also
spread rabies:
Signs of rabies:
In the animal:
• Acts strangely—sometimes sad, restless, or irritable.
• Foaming at the mouth, cannot eat or drink.
• Sometimes the animal goes wild (mad) and may bite anyone or anything
nearby.
• The animal dies within 10 days.
Signs in people:
•
•
•
•
Pain and tingling in the area of the bite.
Pain and difficulty swallowing. A lot of thick, sticky saliva.
Fits of anger between periods of calm.
As death nears, fits (convulsions) and paralysis.
222
If you have any reason to believe an animal that has bitten someone has rabies:
♦ Tie or cage the animal for 1 o days
♦ Clean the bite well with soap, water, and hydrogen peroxide. Do not close the
wound; leave it open.
♦ If the animal dies before the week is up (or if it was killed or cannot be
caught), take the bitten person at once to a health center where he can be
given a series of anti-rabies injections.
The first symptoms of rabies appear from 10 days up to 2 years after the bite
(usually within 3 to 7 weeks). Treatment must begin before the first signs of the
sickness appear. Once the sickness begins, no treatment known to medical science
can save the person's life.
Prevention:
Kill and bury (or cage for. 10 days) any animal, suspected of having
rabies.
* If possible, kill all stray dogs.
Cooperate with programs to vaccinate pet dogs.
Keep children far away from any animal that seems sick or acts
strangely.
Take great care in handling any animal that seems sick or acts strangely.
Even if it does not bite anyone, its saliva can cause rabies
if it gets into a cut or scratch.
TETANUS(LOCKJAW)
Tetanus results when a germ that lives in the feces of animals or people enters
the body through a wound. Deep or dirty wounds are especially dangerous.
Wounds very likely to cause tetanus:
animal bites, especially
those of dogs and pigs
gunshot and
knife wounds
holes made
with dirty needles
223
puncture wounds from
thorns, splinters,
injuries caused
by barbed wire
or nails or a piece of glass
putting cowdung on vaccination or wounds
'Causes of tetanus in the newborn child:
Tetanus germs enter through the
tumbilical cord of a newborn baby
Bbecause of lack of cleanliness or
tfailure to take other simple precautions.
“The chance of tetanus is greater. . .
WHEN THE CORD IS CUT WITH A
SICKLE OR KNIFE THAT IS NOT
STERILIZED (COMPLETELY FREE
FROM GERMS) THE CHANCE OF
TETANUS IS GREATER.
■ when the cord has been cut with
an instrument that has not been
boiled and kept completely
clean or
■ when the newly cut cord is
tightly covered or is not kept dry.
■ when the cord is smeared with cowdung or ash.
Sligns of tetanus:
• An infected wound (sometimes no wound can be found).
• Discomfort and difficulty in swallowing.
• The jaw gets stiff (lockjaw), then the muscles of the neck and other parts of
the body.
224
Painful convulsions (sudden tightening) of the jaw and finally of the whole
body. Moving or touching the person may trigger sudden spasms like this:
Sudden noise or bright light may also bring on these spasms.
In the newborn, the first signs of tetanus generally appear 3 to 10 days after
birth. The child begins to cry continuously and is unable to suck. Often the
umbilical area is dirty or infected. After several hours or days, lockjaw and the
other signs of tetanus begin.
It is very important to start treating tetanus at the first sign. If you suspect
tetanus (or if a newborn child cries continuously or stops nursing), make this test.
TEST OF KNEE REFLEXES
With the leg hanging freely, tap the knee
with a knuckle just below the kneecap.
If the leg jumps just
a little bit, the
reaction is normal.
If the leg jumps high, this indicates a
serious illness like tetanus (or perhaps
meningitis or poisoning with certain
medicines or rat poison).
This test is especially useful when you suspect tetanus in a newborn baby.
What to do when there are signs of tetanus:
Tetanus is a deadly disease. Seek medical help at the first sign. If there is any
delay in getting help, do the following things:
♦ Examine the whole body for infected wounds or sores. Often the wound will
contain pus. Open the wound and wash it with soap and boiled water;
225
completely remove all dirt, pus, thorns, splinters, etc.; flood the wound with
hydrogen peroxide.if you have any.
♦ Inject 10 lakh units of procaine penicillin (P-399 ) at once and repeat
levery 1 2 hours (For newborn babies crystalline penicillin is better.) If there is
I no penicillin, use another antibiotic like tetracycline.
♦ it you can get it, inject 40,000 to 50,000 units of Tetanus Antitoxin or
5,000 units of Human Immune Globulin. Be sure to follow aH the precautions
(see p.83). Human Immune Globulin has less risk of severe allergic reaction, but
is very expensive and harder to obtain.
♦ As long as the person can swallow, give nutritious liquids in frequent, small
sips.
» To control convulsions, inject phenobarbital (for the dose, see p 422) or
diazepam (Valium, p.423), adults: 10 to 20 mg. to start with, and more as
necessary.
• Touch and move the person as little as possible. Avoid noise and bright light.
♦ If necessary, use a catheter (rubber tube) connected to a syringe to suck the
mucus from the nose and throat. This helps clear the airway.
How to prevent tetanus:
Even in the best hospitals, half of the people with tetanus die. It is much easier
to prevent tetanus than to treat it.
♦ Vaccination: This is the surest protection against tetanus. Both children and
adults should be vaccinated. Vaccinate your whole family at the nearest health
center (see p. 175). Vaccinating pregnant women against tetanus will prevent
tetanus in newborn infants (see p.296).
♦ When you have a wound, especially a dirty or deep wound, clean and take
care of it in the manner described on page 102
♦ If the wound is very big, deep, or dirty, seek medical help. If you have not
been vaccinated against tetanus, take penicillin. Also consider getting an injection
of tetanus antitoxin.
♦ In newborn babies, cleanliness is very important to prevent tetanus. The
instrument used to cut the umbilical cord should be sterilized (see p.308); the
cord should be cut short, and the umbilical area kept clean and dry.
THIS BABY'S CORD WAS
KEPT DRY. AND LEFT' ;
HE STAYED HEALTHY.
THIS BABY'S CORD WAS COVERED
WITH COWDUNG. KEPT TIGHTLY
COVERED AND NOT KEPT DRY.
HE DIED OF TETANUS.
MENINGITIS
This is a very serious infection of the brain, more common in children. It may
begin as a complication of another illness, such as measles, mumps, whooping
226
cough, or an ear infection. Children of mothers who have tuberculosis sometimes
get tubercular meningitis in the first few months of life.
Signs:
• Fever.
• Severe headache.
• Stiff neck. The child looks
very ill, and lies with his
head and neck bent back,
I i k e t h i s.----------------------------
• The back is too stiff to put
the head between the knees
• In babies under a year old: the fontanel (soft spot on top of the head) bulges
upward.
• Vomiting is common.
•
The child is very sleepy, or may be irritable.
•
The child refuses to eat.
• Sometimes there are fits (convulsions) or strange movements.
• The child often gets worse and worse untii he loses consciousness.
• Tubercular meningitis develops slowly, over days or weeks. Other forms of
meningitis come on more quickly, in hours or days.
Treatment:
Get medical help fast—every minute counts! If possible take the person to a
hosp.ital. Meanwhile:
♦
Inject ampicillin (see p 399)- or crystalline penicillin (see p398)
♦ If there is high fever (more than 40°), lower it with wet cloths and aspirin or
acetaminophen (seep.414)
♦ If the mother has tuberculosis or if you have any other reason to suspect
that the child has tubercular meningitis, inject him with 0.2 ml. of streptomycin
for each 5 kilos he weighs and get medical help at once. Also, use ampicillin or
penicillin in case the meningitis is not from TB.
Prevention:
For prevention of tubercular meningitis, newborn babies of mothers with
tuberculosis should be vaccinated with B.C.G. at birth. For other suggestions on
prevention of TB, see pages 219to 220
227
MALARIA
Malaria is an infection of the blood that causes chills and high fever. Malaria is
spread by mosquitos. The mosquito sucks up the malaria parasites in the blood of
an infected person and injects them into the next person it bites (see p. 166).
Signs of malaria:
• The typical attack strikes every 2 or 3 days and lasts several hours. It has 3
stages:
1. It begins with chills—
and often headache. The
person shivers or shakes
for 15 minutes to an hour.
2. Chills are followed by fever,
often 40’or more. The person is
weak, flushed (red skin), and at
times delirious (not in his right
mind). The fever lasts several
hours.
3. Finally the person begins
to sweat, and his temperature
goes down. After an attack,
the person feels weak, but
more or less OK.
• Usually malaria causes fevers every 2 or 3 days (depending on the kind of
malaria), but in the beginning it may cause fever daily. Also, in small children and
persons who have had malaria before, the fever pattern may not be regular or
typical. For this reason anyone who suffers from unexplained fevers especially in
the rainy season, should have his blood tested for malaria.
• Chronic malaria often causes a large spleen and anemia.
Analysis and treatment:
♦ If you suspect malaria or suffer from repeated fev ,s, go to a health center
for a blood test.
♦ If there is no health center nearby, take chloroquine or whatever medicine
is known to work best in your area. Using chloroquine tablets with 150 mg. of
base, adults should take 4 tablets once a day for 3 days. For the children's dosage,
see p. 406.
♦ If you get better with chloroquine, but after several days the fevers start
again, you may need a different medicine, like primaquine. Get advice from the
nearest health center.
♦ If a person who possibly has malaria begins to have fits or other signs of
meningitis (p. 225) he may have cerebral malaria. Seek medical help at once.
This is dangerous.
228
HOW TO AVOID MALARIA:
Malaria is a problem in many of the hot or tropical parts of the world. If every
one cooperates, it can be controlled. All these control measures should be
practiced at once.
1.
Avoid mosquitos. Sleep where there are no
mosquitos or underneath a sheet.
Cover the baby's cradle with a mosquito
netting or a thin cloth.
2.
Apply mustard oil on your body to prevent
mosquito bites.
3.
Cooperate with the malaria control workers
when they come to your village. Tell them if
anyone in the family has had fevers and let
them take blood for testing. aiso get your house
sprayed so that mosquitoes are killed.(When
spraying keep all food and water covered. >
4. If you suspect malaria, get treatment
quickly. After you have been treated,
mosquitos that bite you will not pass
malaria on to others.
5 Destroy mosquitos and their
larvae (young). Mosquitos breed in
standing water. Clear the
neighborhood of ponds, pits, old
cans, or broken pots that collect
water. Drain or put a little oil on
pools or marshes where mosquitos
breed. Organize children to fill the
cut off tops of bamboo poles (of
fences, etc.) with sand.
6. Malaria can also be prevented, or its effects greatly reduced, by taking different
doses of anti-malaria medicines on a regular schedule. For more information
about this, see pages 405 to 407
229
ELEPHANTIASIS
This infection is caused by a kind of worm that affects the
lymphatic system of the body. It is spread by a certain type of
mosquito. The mosquito sucks the worms along with the blood of
.an infected person and injects them into the next person it bites.
Signs:
*
*
’
■
Fever with chills and rigor.
Raised painful areas on the skin, especially on the arms and legs
Swelling of the lower limbs
Enlargement of the lymph nodes: lymphs vessels become swollen
twisted and painful
" Permanent enlargement of the affected parts like legs, scrotum.
penis.
'J, eatment:
" Tablet Hetrazan (see p 413 for dosage)
" Aspirin tablets help relieve pain and fever.
” Tie elastic bandages on the legs to decrease the swelling. This
will also help prevent permanent swelling of the legs. Be sure
to take off the bandage at night
^Prevention:
Take all the precautions-against mosquitoe bite as for malaria (p. 228)
TYPHOID FEVER
Typhoid is an infection of the gut that affects the whole body. It is spread
from feces-to-mouth by contaminated food and water and often comes as an
epidemic (many people sick at once).
Of the different infections sometimes called 'the fever' (see p.32), typhoid is
one of the most dangerous.
Signs:
First week:
® 11 begins like a cold or flu.
• Headache and sore throat.
• The fever rises a little more each day
until it reaches 40° or more.
• Pulse is often relatively slow for the
amount of fever present. Take the pulse
and temperature every half hour. If the
pulse gets slower when the fever goes
up, the person probably has typhoid
(see p.32).
• Sometimes there is vomiting, diarrhea,
or constipation.
1st day
37%’ C
2nd day
38°
3rd day
38'6°
4th day
39°
5th day
39/i’
6th day
40’
230
Second week:
•
•
•
•
•
High fever, pulse relatively slow.
A few pink spots may appear on the body.
Trembling.
Delirium (person does not think clearly or make sense):
Weakness, weight loss, dehydration.
Third week:
• If there are no complications, the fever and other symptoms slowly go away.
Treatment:
♦ Seek medical help.
♦ Give chloramphenicol (see p.400), If there is no chloramphenicol, use
ampicillin. If there is no ampicillin either, use tnmethaprim
♦ Lower the fever with cool wet cloths (see p.88).
♦ Give plenty of liquids: soups, juices, and Rehydration Drink to avoid
dehydration (see p. 182).
♦ Give nutritious foods, in liquid form if necessary.
♦ The person should stay in bed until the fever is completely gone.
♦ If the person shits blood or develops signs of peritonitis (p.108)or
pneumonia (p.208)
seek medical help at once.
Prevention of typhoid:
♦ To prevent typhoid, care must be taken to avoid contamination of water and
food by human feces. Follow the guidelines of personal and public hygiene in
Chapter 12. Make and use latrines. Be sure latrines are a safe distance from where
people get drinking water.
♦ Cases of typhoid often appear after a flood or other disaster, and special
care must be taken with cleanliness at these times. Be sure drinking water is clean.
If there are cases of typhoid in your village, boil all drinking water.
Look for the cause of contaminated water or food.
♦ To avoid the spread of typhoid, a person who has the disease should stay in
a separate room. No one else should eat or drink from the dishes he uses. His
stools should be burned or buried in deep holes. Persons who care for him should
wash their hands right afterwards.
’ After recovering from typhoid, some persons still carry the germs of the disease
and can spread it to others. For this reason anyone who has had typhoid should be
extra careful with personal cleanliness and should not work in restaurants or where
food is handled. Sometimes ampicillin is effective in treating typhoid carriers.
• Take vaccination against typhoid once in 6 months, especially during summer (see
P-175)
231
CHOLERA
This is a very infectious and dangerous disease, and often comes as an epidemic.
especially after a big fair or festival where uncovered food is sold. It is spread from
feces-to-mouth mainly by flies (p 1 56)
Signs.
’ The patient continuously passes watery stools, which look like rice water (p.189)
The grains in the stools are bits of the inner intestinal wall.
• This results in dehydration and the patient may die.
' He may also have a' slight fever
Treatment:
Cholera is highly dangerous The patient may die without medical help.
Deaths in cholera are due to dehydration. To prevent dehydration, and
treat the disease.
• give him tetracycline (see p 400)
• give him Rehydration Drink ( P-18 2) many times a day.
• give him nutritious foods, may be in liquid form
* Make him a cholera bed to lie on
Make a hole in a charpoy or bed just at the place where his
buttocks lie Keep a bucket under this hole and fit. a wide rubber tube
into the hole. The tube should also fit the bucket. The patient
passes his stools directly into the bucket
Dig a pit far from the house, or source of drinking water. When the
bucket gets full, empty it into this pit. Pour any water used to wash the
bucket into the pit. Then immediately cover the pit before any flies
can sit on it.
Seek medical help.
Prevention:
Cholera spreads very easily (p. 1 58) Great .care must be taken not
to eat or drink contaminated food and water. Follow the guidelines
for personal and public hygiene given in Chapter 12.
If there is a case of cholera in your house, your village or
community, inform the health authorities at once so that they
can check its spread.
Get your family, your village or your community vaccinated
against cholera once in 6 months, especially if there is an epidemic. TM
COMMUNITY HEALTH CELL
232
Isolate the cholera patient in a room where there are no flies.
Wash hands thoroughly after caring for the patient, or carrying
the bucket.
Keep the dishes, utensils used by the sick person separate. Do
not let any one else use them.
Boil all drinking water, especially if there is a case of cholera in
your village.
Keep all food and drinking water covered so that flies do not sit on it.
Take care not to eat food that is sold openly on the roadsides
and in the shops. These foods are not usually covered, and can
cause cholera.
LEPROSY (HANSEN'S DISEASE)
This chronic disease develops very slowly, often over many years. It is not
easily spread from one person to another, but persons who have lived for a long
time in close contact with those who have leprosy sometimes get the disease.
Signs:
The signs differ greatly according to
the person's natural resistance to the
disease.
• Often the main sign is loss of
feeling, usually first in the hands and
feet. Persons with leprosy sometimes/
burn themselves without knowing it.
• Skin signs vary greatly. They
include: pale spots or big ringworm-like
marks that have loss of feeling in the
center, swollen nerves that form thick
cords or lumps under the skin; and large,
chronic sores that do not hurt or itch. In
one form of leprosy the skin of the face
becomes thick and lumpy or the earlobes
may become thick, short, and square.
The eyebrows are often lost, first the
outer part and then completely.
• In advanced cases, the hands and
feet may become partly paralyzed and
claw-like. Fingers and toes, or entire
hands and feet, may gradually get
shorter and become stumps.
Treatment of leprosy:
[burns and
eyebrows
thick square
earlobes
thick nerves
marks
or rings
without
feeling
deformities
of hands
and feel
POSSIBLE SIGNS OF LEPROSY
Leprosy is usually curable, but medicine must be taken for years. The best
medicines are the sulfones. For the dose, see page4O5 If a "lepra reaction" (fever,
a rash, pain and perhaps swelling of hands and feet, or eye damage) occurs or gets
worse while taking the medicine, keep taking it but get medical help.
After getting better start the medicine again.
233
Prevention of damage to hands and feet:
The large open sores and gradual loss of hands and feet so often seen in persons
with leprosy are not caused by the disease itself and can be prevented. They result
because, when feeling has been lost, a person no longer protects himself against
injury.
For example, if a person with normal feeling
walks a long way and begins to get blisters on his
feet, these hurt, so he stops walking or limps. This
protects his feet from further damage. But a person
with leprosy, who feels no pain, will keep on
walking, and the blister turns into an open sore.
This becomes infected, and"Because it still does ndt
hurt, the person does not protect it or give it a
chance to heal. So the infection slowly spreads into
the bones and begins to destroy them. Typical
deformities result. But with care they can be prevented
1.
Protect hands and feet from things that can cut,
bruise, blister, or burn them:
Do not go barefoot, especially not where there are
sharp stones or thorns. "Wear shoes or sandals. Put
soft padding inside shoes and under straps that-----
When you are working with your hands, or
cooking meals, wear gloves. Never pick up a
pan or other object that might be hot without
first protecting your hand with a thick glove or
folded cloth. If possible, avoid work that
involves handling sharp or hot objects. Do not
smoke. When you are cooking sit far from the
fire.
2.
At the end of each day (or more often if you work hard or walk far) examine
your hands and feet very carefully—or have someone else examine them. Look for
cuts, bruises, or thorns. Also look for spots or areas on the hands and feet that are
red, hot, swollen or show the beginnings of blisters. If you find any of these, rest
the hands or feet until the skin is completely normal again. In this way the skin
will become calloused and stronger, instead of blistered and raw. Sores can be
prevented.
3.
If you already have an open sore, or one forms, keep the part with the sore
very clean and at rest until it has completely healed. Then take great care not to
injure the area again.
If you do these things and begin treatment early'
most deformities with leprosy can be prevented.
The book Where There Is No Doctor Is available
at Rs 29/- plus postage. Multiple copies of reprints
of various chapters are also available.
Please write to:
Publications Officer
Voluntary Health Association of India
C-14 Community Centre
Safdarjung Development Area
New Delhi 110016
Rs. 1.50
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