Canadian and American clinicians rely more and more on sophisticated, expensive, diagnostic tests. Here in resource poor areas like southern Sudan, diagnosis depends heavily on the basic tools of history and physical exam. In Lankien, we are lucky to have a lab that does a number of choice tests for the most common diseases that occur here. The tests available to us are: hemoglobin and white blood cell count, stool and urine analysis, blood tests for Kala Azar, brucellosis and syphilis, rapid tests and blood smears for malaria, sputum tests for tuberculosis, blood tests for hepatitis B and C and HIV. There is no diagnostic imaging such as X-ray or ultrasound.
In addition to the clinical assessment and lab tests, we also rely on the science of epidemiology. Epidemiology simply tells us what to expect, where, when and in whom. For example, tropical disease often has a focal geographic distribution. You will not find African Sleeping Sickness in this part of southern Sudan, either the acute or the chronic form, but cases of sleeping sickness do occur in great numbers in Bahr El Ghazal, one of the western provinces. Another example is the group of parasitic diseases known as the helminthes (worms!) The only worms of any real significance here are shistosomiasis and pinworm. Other worm infections such as ascaris, hookworm and whipworm are not generally present, though they occur in other parts of Sudan such as Western Equatoria and Bahr El Ghazal. The likelihood of a particular disease also varies with the season. For example Malaria is endemic here; it occurs all year long in both the wet and the dry season but it is much more likely in the wet season. A child with a fever in August is much more likely to have malaria than a similar child in March.
Sammy Kipngetich is our most excellent and experienced lab supervisor.
Below: Sammy at work in the lab
Below: Parachecks (Rapid Diagnostic Test for Malaria) The number of Paracheks done each month increases dramatically in the wet season.