Simon Stanley comes face to face with one of Southeast Asia’s most prevalent parasites. Photos by Vinh Dao.
“I think it’s time to go to the doctors,” said my girlfriend as I staggered out of the bathroom for the third time that morning. After four days of soaring temperatures, painful joints, a screaming headache and cold sweats, not to mention the diarrhoea, she had a point.
Within two hours of making the call to Family Medical Practice, I had been sampled, tested, diagnosed and discharged, and handed no less than 240 pills to see me through a thirty day programme of antibiotic treatment for the amoebic infection known as amebiasis.
According to The American Journal of Tropical Medicine and Hygiene, the intestinal parasite which causes this endemic disease, entamoeba histolytica, affects an estimated 50 million people across the world each year, with death rates as high as 100,000. Commonly found in tropical areas with poor sanitary conditions or low food-hygiene standards, Vietnam is understandably a hotbed for such cases.
“Amebiasis is one of the most common forms of traveller’s diarrhoea in Vietnam,” says Dr Okuda, Gastroenterology Specialist at HCMC’s Family Medical Practice. “I see it on a daily basis here.
“Viral or bacterial infections normally go away within several days or a week. You don’t necessarily need a treatment, but if you feel sick, you should come and see a doctor.”
It is when a patient simultaneously experiences stomach cramps, fever, headaches or nausea, alongside the diarrhoea, that medical attention may be considered necessary. Symptoms alone cannot indicate the presence of amebiasis so it’s important to get tested. However, as Dr Okuda is keen to point out, if a patient has been suffering with prolonged diarrhoea for two weeks or more, even if they are feeling well otherwise, it’s also time to get help.
How the bacteria gets inside of you is rather a grim tale.
“It is a faecal-oral infection,” says Dr Okuda. Grim indeed. Contamination commonly occurs via unwashed hands and surfaces, entering the body through food, eating utensils, drinking vessels or cookware. In areas where human faeces is used as a fertiliser, the parasite can even pop up in the water supply. “Anything which goes into your mouth can be contaminated,” says the doctor. Left unchecked, it can spread from the intestines to the liver and beyond, littering vital organs with abscesses – serious stuff.
As with all cases of diarrhoea, staying hydrated is your number one priority. Isotonic drinks or powdered electrolyte solutions are ideal for replacing the essentials salts and sugars lost. Water alone may not be enough.
Being an aggressive parasite, the antibiotics – or anti-parasitics to be precise – are equally as tough. But should we heed the warnings regarding the overuse of antibiotics and the resultant increase in bacterial resistance? Is it really worth hesitating before mindlessly popping pills?
“For me,” says Dr Okuda, “whenever you need an antibiotic, you can take it. If you had an antibiotic treatment last week, and this week you have pneumonia and you almost die, would you say ‘I don’t want to take it’?” He has a point. In the case of amebiasis, the treatment is highly specific to the disease.
Washing your hands properly before eating and after using the bathroom is your best bet in preventing the spread of this or any other intestinal infection. Secondly, you should never drink the tap water. There is a common misconception among visitors that this also means avoiding ice outright. In most cases, the ice in your coffee or beer will have been produced in a factory using purified drinking water – a legacy of French colonial rule. Look for pure, transparent ice with a hole through the centre to be certain.
That said, Dr Okuda warns that this does not make it completely safe. “The way they keep ice here can also be a source of infection,” he says. “Restaurants and bars will sometimes scoop the ice with a serving mug which may have been kept on a table or a shelf. By scooping ice with that mug, the bottom of which has touched the table, the entire container is contaminated.”
Many foreigners also choose to avoid street food altogether. In today’s health conscious world, however, if you read every official warning out there, you might never leave the house. Accordingly, Dr Okuda suggests a more pragmatic approach.
“It is part of the risk in your life,” he says. “It depends on how much you agree to take.” For him, when you start drawing firm lines it can be hard to know where to stop. “If I say ‘avoid street food’, then [I might have to] say ‘avoid local restaurants’, [and then] do you not lose a piece of fun in your life? As my passion is eating, I hate limiting patients’ food.”
As for me, the outlook is good. Within several days of starting the treatment, my symptoms cleared up – although only the full course of drugs will ensure the complete eviction of my amoebic friends. As for when and how I picked them up, Dr Okuda says it’s not worth considering. “You may have had street food the night before,” he says, “but actually it may have come from an established place you ate at a week ago. You can never tell.”
For more information on Family Medical Practice Vietnam visit www.VietnamMedicalPractice.com