‘Zambia has been hit by a terrible drought and most people are now going for days without food’.  Clinical Officer, Zambia November 2019.

 THE CASE

 A 41-year old lady was brought in to Simwatachela clinic in Zimba District, Southern Zambia. She was very unwell on arrival and was unable to give any history. She had signs of significant dehydration with a low blood pressure and a fast pulse. She was drowsy and unresponsive to those around her.

The Clinical Officer recognized that she required urgent treatment and she was given intravenous fluids and glucose whilst he continued his assessment.

She appeared emaciated and had sores on her arms. She was known to have HIV infection and was prescribed regular medication for this. The Clinical Officer was worried that her disease was not well controlled and that she was susceptible to other additional infections. His concerns were confirmed when results showed poor immunity and a high level of the HIV virus in her blood. He commenced antibiotics immediately to treat any concurrent bacterial infection.

Once the patient had been stabilized he contacted our team for further advice regarding her overall management. 

The Clinical Officer told us that she is a widow with a 6-year old child.  He went on to say that ‘Zambia has been hit by a terrible drought and most people are now going for days without food’. This explains why our patient had become so unwell: she and her daughter had been struggling in what was already a fragile social situation and she had not eaten for days prior to admission.

It sounded as though the patient had responded well to simple rehydration and glucose. The Volunteer explained that this made it more likely that the patient’s poor nutritional status and dehydration had played a major role in her presentation.  Nevertheless, the Volunteer advised that indolent brain infection should be excluded by checking the patient for any ongoing signs of confusion or headache. Patients with poorly controlled HIV are at risk of such problems and it is always worth thinking about.  If HIV is not treated adequately then an individual remains at risk of numerous infections and complications, including death. The Volunteer is a Specialist in Infectious Diseases and was able to give expert advice about the patient’s ongoing HIV treatment. On this occasion they recommended that the regimen was changed because there were real concerns about drug resistance or treatment failure. We hope that this intervention will be successful and have a major impact on the patient’s future well-being.

The Clinical Officer had been concerned about the sores on the lady’s arms. The Doctor recommended further examination including checking inside her mouth; mouth ulcers, for example, may indicate a worrying systemic disorder. The Volunteer described a number of micronutrient deficiencies (vitamin and mineral shortages) that can cause skin conditions in someone who is malnourished. They recommended treating the patient with multivitamins as well as continuing the antibiotic therapy and keeping the skin clean. It was suggested that if the sores did not heal with this intervention that further photos were taken and sent to the Virtual Doctors; we can involve other specialists (like Dermatologists) from our team if required.

DROUGHT

 In 2018 and 2019 there have been prolonged dry spells in Zambia, leading to drought.  Most rural households rely entirely on rain-fed crop production for food and income.  The drought has had a profound effect. In some areas corn crops have failed completely this year. There is acute food insecurity and a shortage of clean safe drinking water.  Information from the World Food Programme suggests that an estimated 2.3 million people in Zambia are in need of emergency humanitarian assistance.

 The crisis has been reported in the UK press in recent weeks but our Clinical officer’s words were powerful in their simplicity. They paint a stark picture of the challenges faced by the local communities and the Clinics which care for them.

 Many of the Clinics we support do not have piped running water but rely on boreholes.  During a drought, boreholes may dry up and new open wells are dug; these pose a greater risk of water-borne diseases. In addition, patients may present with conditions related to lack of clean water for washing (such as scabies or impetigo) as well as dust-related breathing conditions as the ground dries out. The Clinicians may well start to see an increasing number of malnourished patients, especially children. These are just some of the conditions that may become more prevalent; let alone the effects that food insecurity will have on mental health and well-being.

FOLLOW UP

 We know that during her stay at the clinic the patient’s clinical condition improved dramatically. Once she was a little better, the Clinic was able to provide her with some basic foods including kapenta and soya beans as well as the staple mealie meal.  Following discharge, she was due to come back for review but we suspect that she may find it difficult to return to the clinic as the journey was long. We can only hope that both she and her child are safe and doing well. Our Clinical Officer probably saved her life this time, but we know that they face many hardships over the coming months.

References and links to information about the current situation in Zambia:

Country Brief

Food Insecurity Information Bulletin