Uche, Our Typhoid Mary

By Ikenga Chronicles June 25, 2018

Uche, Our Typhoid Mary

–Uche Anyanwagu

It took her a while before she made her way to my clinic again. In place of the usual verve with which she always traditionally storms my clinic, Uche walked in with reluctance.

She looked like someone who has lost the battle she was ever poised to win.

“Have a seat” I said to her as she ignored the smile with which I greeted her.

She pulled the chair and sat down, looking at me with a stare ripped of all adornment of affection.

“Did you take some rest as I advised within this one week sick leave?” I asked. She simply nodded.

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“Errhmm, did you drink loads of fluid as well?” She nodded again like an agama lizard which had a good fall off a tree.

“Abeg, this one you keep forming deaf and dumb, I no understand again oh!” I gave up further questions to allow her let her cats out of her usual big bag.

“Biko,” she finally said, “I am just here to know why you called the test result I gave you last week useless.”

“So insensitive of you to have even ignored all the things I complained to you, including how this typhoid has been eating me bit-by-bit like a piece of sponge cake.”

This was exactly what I expected from my “troublesome” Uche.

She was clearly upset I neither paid attention to a litany of her symptoms, nor heed to the cries of the one-over-three-twenties that dotted every bit of the useless piece of paper she gave me.

Typhoid Mary

“Uche, please can you tell me what typhoid fever is?”

“How am I supposed to know?” She queried instantly.

“Our Typhoid Mary.” I responded, laughing at her stern look.

“How come you have never bothered to know, yet you have treated typhoid 10 times in less than 4 months?

“Don’t worry, get a piece of paper, and let us learn.”

I offered her a piece of paper and insisted that she notes certain salient points as we converse so that she can also pass same to the very many “Typhoid Marys” thronging our different spaces.

Now, typhoid fever is also called enteric fever. It is caused by a bacterium called Salmonella typhi.This can be gotten in contaminated food or water like Typhoid Mary did to all the households she served in New York. It can occasionally be gotten through direct contact with someone who is infected.

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Typhoid fever has been mainly associated with poor hygiene which is more prevalent in low socio-economic settings where safe water and good sewage disposal are lacking. It is a serious infectious disease threat globally. More than we ever think.

She looked at me with blighted hope. I winked and continued.

“This is why I believe you have no typhoid.

“The symptoms usually develop 1 or 2 weeks after infection. You will have a very high fever, headache, body aches and pain, cough, etc. Just very similar to malaria.

“Now you can understand that marriage certificate ‘Typhoid and Malaria’ the lab will always give you.”

For the first time, we both laughed.

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“As it progresses, the main markers begin to emerge – poor appetite, abdominal ache, nausea, diarrhoea and constipation, lethargy, intestinal bleeding or perforation (usually, 2-3 weeks of the illness if untreated).

“Now Uche, do you still think have typhoid last week you came here?”

She smiled and rose to take a cold glass of water from the dispenser.

“Water and rest may have been all you needed,” I chipped in.

“Go jare, yeye doctor wey no sabi treat common typhoid.” Both of us erupted in volcanic laughter.

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“On a serious note, Uche, of greater concern to me is that the way antibiotics is wasted and abused on the false treatment of this disease will drive rapid emergence of multiple antibiotic resistance among the real Salmonella species.”

“So, how will I know that I have it then or not?”

“Cute question, Uche! Now you are talking. The diagnosis of typhoid fever based on Widal test (serology) alone is grossly inaccurate.This is because, there is a very high probability of the reports being false. We call this false-positives and it is even worse in places where typhoid fever is endemic and among those who have had typhoid fever previously.

“The standard way (what we call gold standard in Medicine) for diagnosing of typhoid fever is by isolating Salmonella Typhi from a patient’s bone marrow and/or blood culture -– usually best within the first week for blood cultures

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“I understand the bone marrow stuff could be too traumatic and the facilities/skilled manpower lacking in more than 90% places. Blood culture, rather, is faster and the initial results can be out in a day and treatment commenced.

“Uche, at a stage in my career, I repented of all the typhoid fever I had treated -– even to the point of going for confession.

“I understand it is more prevalent in the North. Nonetheless, proper diagnosis must precede.

“Simple hygienic practices like washing hands after using the toilets, peeing, and touching anything will help.So will avoidance of oral/anal sex with a carrier of the bacterium, avoiding or washing thoroughly fruits and vegetables fertilised with human waste and others.

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“The sad thing is that about 1 out of every 20 people who survive typhoid will go on to become carriers like Typhoid Mary.For them, they have no typhoid but have the bacterium living in them, and can spread it via their faeces or urine.

“So, with the powers bestowed on me, I now baptise you Our Typhoid Mary.”

“Back to sender,” she thundered as she quickly removed my hand from her head.

“That is NEVER my portion”

Startled, I asked: “I thought you had typhoid fever last week?”

  • My name is Uche Anyanwagu. Are you a Typhoid Mary?

This is the 29th in a series of short stories on “Medical Myths – Tales by Doctors” One more to go!

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