“Be sure to remind him to boil his milk and not to blow into the cow’s vagina.”
It is morning rounds. I am squatting on the floor in the overflow tent, shuffling through a tattered water stained chart. The patient is a young man recovering from Brucellosis. He has already been here for two weeks receiving gentamycin injections and oral doxycycline. He will receive four more weeks of doxycycline to complete his treatment. Today he is being discharged to finish his treatment at home.
Brucellosis is primarily a disease of animals. In southern Sudan it is transmitted to people by the ingestion of unboiled cow’s milk. A less common mode of transmission though, is the practice of “cow blowing”, forceful blowing into the cow’s vagina in order to increase milk production.
Brucellosis has a worldwide distribution but is most common among rural people who live in close contact with animals. It typically presents with a swinging fever, hip and/or back pain, and difficulty walking. A young person with a walking stick is an easy give away. MSF uses an antibody test to confirm clinically suspected cases and treats most cases with Gentamycin and doxycycline; children and pregnant or lactating women receive trimethoprim-sulfamethoxazole instead of doxycycline.
The paramedic/translator is sharing a giggle with the patient.
“Ask him if he understands,” I say.
“He understands ,” returns the paramedic.
I don’t ask.