Myiasis

is not a topic that was taught in my medical education prior to this course. I'm sure about this, as it is the kind of thing that I would certainly remember. Here in Liverpool, we spent a whole precious day on myiasis. Medical Entomology for Students is on my bedside table.

Myiasis refers to the invasion of mammalian tissue by fly larvae (more commonly known as maggots). There are many species of fly larvae that cause myiasis, some of which burrow deep into healthy tissue and some of which infect already necrotic tissue.

I will not post any gross pathology pics of maggots in human tissues, as I know that it's not the kind of thing that everybody likes to study as much as I do. At left is a light microscopy image of an ear infected by Dermatobia hominis (human bot fly) larvae, which is endemic to Central and South America. [The larvae are the three yellowish cone-shaped structures buried in the pink ear tissue.] The botflies have evolved an ingenious way to infect their hosts. They lay sticky eggs which glue onto the bodies of biting insects (e.g mosquitoes). The eggs drop off onto the tissue of human hosts when the carrier takes a blood meal.

Apparently there has been a recent upsurge in interest in "maggot therapy" in developed countries. This therapy uses sterile (lab-grown) larvae of Callifora and Lucilia species (bluebottle and greenbottle blowflies) as a means to debride chronic wounds. Again, I will spare you pics. For additional reading: Parnes, A et al "Larval therapy in wound management: a review." Int J Clin Pract, 61, 488-93.

Identification of Parasites in the Lab

The teaching lab at LSTM is massive. On the first day, they issued each of us a lab bench, microscope, and lab coat. Every day we prepare blood smears and/or stool smears from unknown samples on our lab bench. At the end of the session, the faculty tell us the pathogens in the unknown samples. Below, a pic of the students at my bench.


The CDC has a fantastic reference website for parasitic disease diagnostics. They have lifecycle diagrams of every important organism, as well as an image library to help with diagnositic microscopy.

Genius Doctors

Two doctors I admire won MacArthur Foundation grants today. Wafaa El-Sadr (right) is an Epidemiologist and Infectious Disease doctor at Columbia University and Harlem Hospital in NYC. She has probably done as much or more for expanding HIV and TB treatment worldwide than any other single person. She is the PI for some of the largest HIV treatment studies. She also advocates for access to treatment in the poorest and most vulnerable people worldwide. She is the first person who taught me that HIV and TB are "evil stepsisters," who often travel hand-in-hand.

Diane Meier (left) is a geriatrician who works at Mount Sinai hospital in New York. She specializes in palliative care, which means care directed at comfort, rather than cure, at the end of life. The MacAuthur website says:

She recognized that modern medicine’s focus on curing disease and prolonging life failed to treat the physical and psychological distress of patients in both early and advanced stages of serious illness. Her studies found that a high percentage of seriously ill patients in hospitals were experiencing limited communication between patients and clinicians, poor management of pain, and insufficient support and social services for family caregivers. To fill these voids, Meier established the Hertzberg Palliative Care Institute at Mount Sinai, a model program that assists patients and families in navigating the complexities of illness and devises strategies for managing pain and other symptoms, such as anxiety, depression, sleeplessness, and loss of appetite.

While many doctors recognize these challenges, Dr. Meier does more to resolve them than most. I have heard many talks about palliative care, but I have never heard anybody speak with such wisdom and empathy as Dr. Meier. Her work will both save money for the American health care system, which spends an inordinate amount on the last two weeks of life, and spare patients and families pain that comes with useless tests and treatments at the end of the end.

University of Liverpool

I am a student at the University of Liverpool School of Tropical Medicine for the next three months. My course has exceeded my expectations so far. There are about 90 doctors from more than 25 different countries enrolled in the course. Half of the students are from UK and half from other parts of Europe, Asia, Middle East, Africa, or North America. I've found the other students like-minded. Almost everybody plans to work in the developing world or works there already. The curriculum is focused on what we need to know in order to practice in low-resource countries in the tropics. Many of the sessions emphasize exchange of information among the students who have practiced in different countries, so we can learn more about the nuts and bolts of practice in various settings.

I love the old school crest (at left above). They replaced this logo with a hideous new one, but the old school building (at right above) still has stained glass windows with the historic crest.

MSF nurse dies in Nigeria

This is terrible. The MSF website reports that a nurse died last week in Nigeria on the first day of his first mission. He was electrocuted while in the shower.

My Last Weekend in Kenya

This was over a month ago, but I've re-discovered these pics and want to post them here. In mid-August I spent my last weekend in Kenya at the family homestead of our housekeeper Margaret, near Nanyuki in the Great Rift Valley. Margaret and I took a mini-bus 3 hours from Nairobi to get there. Margaret's mother Ruth lives in this house, along with several of her 14 children, and a few great-grandchildren. Margaret is shown in the fabulous red and pink dress below.

I was priviledged to stay as Mama Ruth's guest for the weekend. The family welcomed me. In fact, Mama Ruth insisted that I sleep in her room. Although I offered to go to a nearby hotel, my hostess would not hear of it. She slept in the house's main room along with eight other people. Nevertheless, she seemed delighted with my visit. She and the rest of the family would burst into Kikuyu prayer every hour or so. Of course I couldn't understand what they were saying, but "Nelly" was mentioned several times per session, so I assumed they were happy I was there. Pic of Mama Ruth in Blue at right.