Stun guns and Snake Bites

Medical Mythbusting Situation #2

Snake bites - there are a lot of nasty snakes here in Africa - just a few are: black cobras, both green and black mambas, boomslang, gaboon viper, and African rock python.  The availability of anti-venom is all but non-existent.  And these aren't "nice" snakes - so I really really really wanted this to be true...let's see what I found out...

1.      Question:  Will a stun-gun or other means of electrical current be effective as an anti-venom treatment?

P – Patient Information:  35 year old snake-bite victim

I – Intervention: stun-gun

C – Comparison:  anti-venom vaccine

O – Outcome:  effective anti-venom properties

Because anti-venom is difficult if not impossible to come-by in many third world countries, the concept of using some sort of electrical current by means of a car battery or stun-gun is a widely-accepted method in the prevention of death due to a snake bite.  Here is what my research found:

“Articles have been written in many outdoor magazines and other literature stating that stun guns can be utilized to treat venomous bites and stings.  This method is still considered to be an option by some medical practitioners and enthusiasts of the outdoors.  A Medline search was done using the search of venomous bites, venomous stings, snake bites, spider bites, electrical, stun gun, high voltage electricity, low amperage electricity, direct current, and shock therapy.  Some of the articles selected included laboratory-based isolated venom studies, animal studies, and case report where humans were involved in which a stun gun or other source of high voltage, low amperage direct current electric shocks were used to treat actual or simulated venomous bites or stings.  The conclusion that was found in these studies indicated that the use of stun guns or other sources of high voltage, low amperage direct current electric shock to treat venomous bites and stings is NOT supported by the literature.”  

 I really wanted this one to be true – but as it is not supported by the literature, I couldn’t, in good conscious, use it as a go-to for medical treatment.  So there you have it - if you get bit - don't shock yourself, go seek aid immediately.  Or in our case, pray a lot, and look to be evacuated to another country for assistance.

Welch, B., Gales BJ; (2001).  Use of Stun Guns for Venomous Bites and Stings:  A Review.; Wilderness Environ Med. 12(2): 111-7

Additional references:

“… continued use of HVDC shock therapy for treatment of snakebites is another instance in which favorable results of anecdotal reports have not been reproduced in controlled studies.” (Gold, 1993).

Gold, BS. (1993). Electric shock: a potentially hazardous approach to treating venomous snakebites. Md Med J, 42, pp. 244–245

Johnson, EK, Kardong, KV, Mackessy, SP. (1987). Electric shocks are ineffective in treatment of lethal effects of rattlesnake envenomation in mice. Toxicon, 25, pp. 1347–1349

The "doctor" is in...

Living here I have found that I have a whole lot of house visits from people who are sick.  In Honduras, we lived fairly far away from the villages we worked in, but here, we live as every other Equatorial Guinean lives.  We live in a house just like theirs, in a community where they live - we live much closer to how the average person lives then we ever did in Honduras.  In Honduras we lived in the "upper class" neighborhood, so no one every visited us.  Here, we live like the rest of the country does.  Because of that we are much more accessible to the average Guinean.  What that looks like is I have people coming to my door 2 - 3 times a week looking for medical help.  Today that looked like a 2 year old that had vomiting since last night.  No other symptoms  - no fever, no diarrhea, no nothing.  The rest of the assessment was totally benign.  So, I gave him some Oral Rehydration Solution formula, and some parasite meds and sent him on his way.  I admit, I feel totally out of my depth, I don't have labs to help figure out what is wrong, I don't have a medical degree to perhaps get a better understanding of what he may have - I only have my wits, my nursing degree, and a lot of hands-on experience to pull me through.  This is more than most people here have, and I have to take comfort that I have given more than they are able to find at a local hospital, but I still have a feeling of complete inadequacy, a feeling of I'm "just" a nurse, and I know the limitations that I am...but I am praying that maybe oral rehydration  solution, and some parasite meds will put him right...because that's all I can offer...I pray it is enough. The reality is -I have NO idea what is wrong with this child - with my limited resources, and my limited knowledge I can only make an educated guess.  And in the grand scheme of things - I hope that that is enough...#feelinginadequate #justanurse

Papaya leaves and Malaria

Medical Myth #1

Having been on the mission field for almost 10 years, and mostly in the capacity of a medical provider, I have found some very interesting “natural remedies” along the way.  Not being one to discount anything that isn’t “standard care” – I wanted to give them the benefit of the doubt.  A lot of incredible medicine and care has come from “natural remedies.”  However, in my desire to educate people and give them accurate information, I wanted to do the research to determine if these “cures” actually worked or not.  Using a technique I’ve learned from my Public Health Masters class – here is what I have found:

1.      Question:  Do papaya leaves have anti-malaria properties?

P - Patient information:  A 25-year old, national (Equatorial Guinean) otherwise healthy man came to my clinic and wanted to know if chewing/eating papaya leaves will prevent malaria in a chloroquine resistant strain (primarily falciparum) strain of malaria.   

I - Intervention – eating papaya leaves to prevent malaria

C - Comparison – to conventional treatment of chloroquine resistant malaria using mefloquine, doxycycline, or malarone.

O - Outcome – no evidence of malaria in one year

I searched on PubMed using the key words “papaya leaves” and “malaria”.  The results brought up only two studies related to this issue.  This concept is used as a “natural” preventative and is believed in this area, and many other parts of the world. I was therefore a bit surprised at the limited amount of information I was able to find.  As there was limited information, I further looked for a correlation specifically to the alkaloid that is found in papaya leaves – carpaine – and did an additional search for “carpaine” AND “malaria” and came up with the same two articles.  If I attempted to limit the search to RCT (Randomized Control Trial – the gold standard), then no articles appeared.  Their conclusion on both articles was that there is a potential association with the alkaloid compound of carpaine that is found in papaya leaves and it’s ability to prevent malaria, however they had no definitive conclusion, stating that further studies needed to be done.  In addition, there was found to be a varying percentage of carpaine in each leaf from 0.02% - 0.31%.  This further leads to a difficulty in how to “prescribe” papaya leaves to a patient.  Based on this information, I would advise my patient that the best form of malaria prevention was the standard treatment of care, using one of the prescribed treatments for chloroquine resistant malaria. 

Ourif, M., Julianti, T., Hamburger, M. (2014).  Quantification of the antiplasmodial alkaloid carpaine in papaya (Carica papya) leaves.  Planta Med, 80 (13): 1128-42.

Julianti, T., De Mieri, M., Zimmermann, S., Ebrahimi, SN., Kaiser, M., Neuburger, M., Raith, M., Brun, R., Hamburger, M. (2014). HPLC-based activity profiling for antiplasmodial compounds in the traditional Indonesian medicinal plant Carica papaya L. Journal of Ethnopharmacology, 155(1): 426-34.

2000 kids reached

These are all empty bottles.  What does that translate to?  In the 1 year I've been here, 2,000 children have received anti-parasite medication, and over 500 children 5 years old and under have received life-changing Vitamin A.  

Vitamin A distribution

Why Vitamin A?  I receive Vitamin A from the an organization called Vitamin Angels.  And from their web site they state, "Our bodies use vitamin A for many purposes. If this essential nutrient is lacking while children are still developing, they can get sick, go blind and even die. While the symptoms are not always visible, vitamin A deficiency puts the health and survival of children at risk every day."

Vitamin A's top sources are from Beef liver, carrots, sweet potatoes, kale, spinach, apricots, broccoli, butter, eggs, and winter squash.  All but eggs and butter (although most people here eat margarine as butter is much more expensive) are not available here.  So, everyone in the country is chronically deficient in Vitamin A.  

Waiting for their parasite meds

Why are parasites a problem?  Contamination comes from contaminated food, water, contamination from someone else infected, and in the soil -  and can be completely asymptomatic until there are serious problems.  The results of parasites in someone include anemia, weight loss, malnutrition, and tiredness.  In an extreme case, the parasites can clump in the bowels and cause a bowel obstruction, and surgery becomes the only option.  As less than 50% of the country has access to potable water - parasite infestations are an assumption in almost everyone.

My goal is to go to as many schools as I am allowed to and distribute medication to every child I can get my hands on - these simple medications can change a child's life.

Doing what I love

Health Education – “charlas”

My love for being a nurse is for many reasons, and one of the primary reasons is the ability to give health education to my patients.  I feel this is so important, and allows a patient to have personal investment in their own health.  It gives patients power over their own illnesses (for some illnesses), and puts the ball back in their court – they are the ones that can make a difference in their own lives.

I’ve learned this first hand.  I’ve had to put to my own personal use many of the health education classes I’ve been teaching over the last 10 years of my missionary/nurse career.

To start my clinic today, I thought I would start it a little differently, for many reasons.  I wanted to start it with a health education (or charla) to all my waiting patients.  The first reason is for wanting to speed things up, but not diminish my health education to my patients.  Instead of giving the same health education to each of my patients with high blood pressure, I can give a one-time class to everyone – so not only those who have high blood pressure, but those who have family members living with them that I may not know about all receive the same information.  This will help significantly decrease my individual education time with each patient and therefore gives me more time overall to see more patients.  In 6 hours I will see 25 patients – it allows me about 15 minutes per patient (no break time), and typically I’m “done” by the end of that 6 hours. 

Once a patient came to see me, and I saw that they had high blood pressure, I asked them what they learned in the health education class.  Basically, I want a return demonstration of precautions and ways of changing their lifestyle and diet that they learned in the class, to ensure they had good understanding.  Without exception, all my patients who came to see me were able to repeat what I had told them – one man even brought his wife into the room (who prepares the food in the house) to ensure she didn’t have any questions.

 

I realize that this seems like such a SMALL thing – but in my little world, where health education is all but non-existent, it’s a huge milestone and personally encouraging to me.

So – this is just the beginning.  I’m going to be training the nursing staff that work with me (I have anywhere from 2-4 Guinean nurse volunteers) to continue with the teaching so in the future I’ll have Guineans teaching Guineans, and I’ll be doing more classes.  So those who are there and waiting – they are a captive audience J  The next one will be on HIV/AIDS – I have the seminary class I teach, so all the research and writing in Spanish has been done – I just now need to consolidate just the health education portion to a 30-minute health education class.

Potable water, typhoid prevention (or at least a reduction in cases), and breastfeeding are just a few of the other health education classes I want to offer to my waiting patients.  I’m excited for this process and look forward to see what will come of it.   

Update

After a month in Belgium, and all the amenities of a 1st world country, then another 2 weeks in the U.S. where I was able to spend time with Madison, spoke at Houston Lake Presbyterian Church, and got in some doctor visits at the same time, I am preparing to head back to Africa.

In the time I've been in 1st world countries, has given me time to think about where I am and what I am doing.  I truly have come to understand and appreciate all that 1st world countries have to offer, and has given me an even greater appreciation for living in an extreme 3rd world, and living with those whom I have come to serve.  In Honduras we lived in a house in the "nicer" side of town.  However where we are now, we live just as the Nationals do.  It gives us a closer feel to those whom we have come to serve.  We gather water just as they do, we suffer power outages as they do, but it also brought to focus even closer the disparities of the health care services that are available.

While in the U.S. I had the ability to see specialists, get procedures unavailable in my host country, have labs taken that don't exist, and go to pharmacies filled with any type of medication I needed.  Seeing the severe disparities in medical care only helps solidify what I'm trying to accomplish there.

Please pray for me as I begin to re-acclimate to my life in Africa.  How quickly I have already become accustomed to consistent electricity, potable water, air conditioning, awesome internet, a fully stocked grocery store, and the conveniences of stuff 24/7.  I will miss my kid, and it makes it hard knowing I won't see her until November - I'll miss her 21st birthday.  But God has called us to be where we are for now, so we endeavor to do what He has called us to do.

Belgium

So here we are in Belgium...and many have asked why.

In the year prior to us departing for Honduras, our mission agency, Mission to the World, had us attend a 1 month intensive training in New York where we learned working cross-culturally, took classes on everything from Team Conflict, to Evangelism, and language acquisition.  In the afternoons we worked with a church and did ministry with them, and on the weekend we worked with the same church in Sunday School.

Why is this important?  Working (potentially) WAY outside of your comfort zone is what missions looks like.  Most of the time you are leaving your home country and headed to a different country, a different culture, and a different language.  This training is a way to get a taste of what that will look like, and equip you with lots of tools to help you succeed.

We have been asked here to act as coaches for new missionaries headed to fields all around the world.  We meet weekly with our group, and individually with the couples, and we also participate in the training.  I will be teaching a module on Mentors and Thriving on the Field.  It is great to have coaches from the MTW office with experience on the mission field, but it's also great to have people who are currently on the mission field - us - to give another perspective and to be a resource.

talking about how speaking the local language can have a huge impact 

I have always loved teaching and being a mentor to new nurses when I was in the hospital, and to new missionaries in my role as a missionary.  Having had people who have spoken into my life has been an invaluable asset to me and has helped me grow as a missionary, a Christian, a mom, and a wife.  Being able to do this for others just brings me great joy.  In addition, it's kind of nice having "modern" 1st world features like running water, potable water, flushing toilets, fast internet, consistent electricity, lots of ethic foods, and laundromats has just been a nice added bonus.

Mike heads back to Africa soon, and after this training I will be headed to the U.S. for a few church visits, see Madison for a few days, and then back to Africa.

I love how invested Mission to the World is in equipping, preparing, training and vetting their missionaries - this training is just a small example of what they do to set their missionaries up for success on the mission field.