The Disease of Poverty - Part 1

Written by Dr Okeme Arome Romey

Raymond is not your typical urban kid surrounded by the glitz and glamour of city life. He's never being in houses with reflective shiny surfaces adorned with polished woods and exquisite furniture. Hell he may never ever be! The closest to civilization he has come across, is quite sadly, a doctor's office and probably, a sickbed in the ward. He is from a village far off from the rural clinic where Arthur and Esther Bradley stands out as the only piece of modern building densely surrounded by mud houses with rusted roofs.  

He had obstinately, out of frustration, absconded from his father's house to his Aunt's, as his condition worsens and help appeared to be ebb. Probably fond of him, his aunt, having heard of the only biggest hospital in terms of land mass in Gidan Waya, brought him in. She must have had an ounce of worries taken off her shoulder when she entered the out patient department by the portrait of the welcoming overlooking smile and warm embrace of the Bradley's.  
 
Raymony's heart valves (the mitral and tricuspid) have been affected by what we term rheumatic valvular heart disease. Antibodies to a certain bacterial protein mounted by the body have recognized similar protein on the valves and attacked them inadvertently. Now they are compromised.  ​In the end, the diagnosis was that of rheumatic valvular heart disease, 'the disease of poverty' some coin.  ​​

According to PubMed.gov a major determinants of rheumatic fever and rheumatic heart disease are poverty, malnutrition, overcrowding, poor housing, and a shortage of health care resource. 

Day 1 - Saw us admit him, ran some baseline investigations, nursed in sitting position(90°) and commenced diuretics and antibiotics.  
 
Day 2 - Well, not so much of an improvement but he was still alive. We had faith just as he did too.  
 
Day 4 and 5 were remarkable. He could lie with very little discomfort at a tilting of the bed at about 30°. His leg swelling had resolved remarkably.  
 
Day 6 - He was itching to be discharged. His legs were normal again, breathing pattern much more better, pulse rate reduced significantly but the murmurs, unexpectedly, remained. But he was great once more.  
​

He could barely breathe, but managed a smile. His feet up to the thighs were massively swollen that my fingers dug deep into them leaving behind their prints. His nostrils flared. When I listened to the heart it was wrapped in a blanket of murmurs. The lung fields, especially the lower parts, were like fine waves from the silent gushes of waters from the sea reaching for the shores in a cool calm thick night. He was drowning in his own fluid.  
 
Truth is, Raymond will be our regular patient with almost similar or even worse symptoms unless a reparative surgery is carried out on him. As long as he lives(which is not such a long time medically), he would be on some diuretics and antibiotics to increase his prognosis. (I was musing while looking at him and his indigent parents).