|Too Young to Die (Zambia Educational Publishing House, 1992, 56 p.)|
The six D's of AIDS are: disbelief (why me?), denial (not me), desperation (maybe it's not true), despair (it must be true), despondency and finally dismal death. These are some of the stages an AIDS patient passes through. Of course there are also the well-known feelings of fear, guilt and shame. Such a patient and his relatives are bound to try anything to prolong his life or 'cure' him. The rule of medical supply and demand says that the more the number of patients and the less the number of doctors, the more the number of quacks. There is a critical shortage of doctors at the moment in many African countries, with a disease with no apparent cure. So if there is 100% mortality why not try anything at all? So these patients will try any new nostrum they can lay hands on. Another medical rule says that an incurable disease has more treatments than a curable one. As a result, the herbalists are having a field day at the moment and the quacks have come out of the woodwork. Some of their treatments are more dangerous than the disease and I know of no one so far who has been 'cured' of AIDS.
Take Samuel, a driver with a trucking firm. I found him admitted to the wards after taking my first leave in 8 years. He was a very sick man and had been getting progressively confused to the extent that at times he failed to recognise his own children. His temperature was always in the 40's with no discernible cause. He had received several courses of antibiotics but with no improvement at all. He also had stigma of the dreaded disease and even without the confirmatory tests, we knew that he had an HIV-related disease. An HIV test had been sent but the result was not in at that time. In Samuel's case, we would have disregarded a negative result because in a very advanced disease, the test can become negative because the body fails to make antibodies, which are detected by the test we were using.
Samuel's wife had clearly stated that she did not want to know the results of the test and so when it came back as positive, we did not tell her. I ordered a few more investigations and when I went to see him two days later, he had clearly taken a turn for the worse. He was confused and he had forgotten that I had seen him before. As I was about to leave his bedside he called me. 'Doctor,' he said with a tremor, 'I would be very grateful if you would save my life.' Everyone in the room was looking at me, the nurses, the junior doctors and the relatives. It was as though everyone was waiting for me to pull a rabbit out of a bedpan and work out some kind of magic. But I knew that everyone else in the room except the patient realised that it was only a matter of time before the grim reaper appeared.
'Samuel,' I said with all the confidence that I could muster, 'we are going to do our very best.'
'Thank you, doctor,' he said. I made eye contact with his elder brother who seemed to be always by his side. I knew that he realised that saving his brother's life was beyond me.
Two days after that incident Samuel's condition deteriorated further and he suddenly stopped passing urine completely, a condition known as acute kidney failure. There seemed to be no reasonable explanation for this and I was quite puzzled. One of the junior doctors however thought that it might be due to herbal toxicity. He had overheard some relatives talking about bringing him some traditional medicines because he was rapidly going down-hill. We quizzed all the family members but understandably no one admitted the fact, for fear I suspect, of being branded a killer if Samuel died, which seemed very likely with or without herbs. The evidence pointed to the kidney malfunction having been caused by a toxin, and probably given as a herb by one of the relatives. We instituted some measure to counter the kidney failure and some days later his kidneys started working again but by then he was critically ill and he died soon after. I don't think Samuel died because of his kidney failure, which had gotten better anyway but I know there must be several people out there dying from herbal medication and more are going to die.
I am not saying all herbal medication is toxic or bad, far from it. In fact in many developed countries alternative medicine is not being sneered at any more, as it has been realised that a pill for every ill is not the only form of treatment. In many African countries, the number of second-rate herbalists however must be astronomical by now and these are the ones likely to prepare dangerous potions. Herbal toxicity can also result in liver failure or shock, both of which can kill. Traditional medications are part of our country's culture and heritage and there is no way that can change overnight, nor indeed would it be desirable or wise to outlaw it, though in my opinion some form of legislation which would make herbalists more accountable is needed. The sobering fact however is that a drowning man will clutch at a straw and it would not be humane to remove that straw unless you replace it with a life jacket. But when will that life jacket for AIDS patients come?