Skip to main content

Bleeding gums


“So how long have you had the headache?” I ask. I am at one of our most remote clinics. Two hours drive from the hospital, the last 30 mins bumping along dirt road.

“Just today,” she replies. The patient is a teacher in her thirties with excellent English.

“Any other problems?” She shakes her head, and then stops, looking thoughtful.

“I did cough up a little blood this morning.” She opens her mouth wide, and sure enough there is a little fresh blood on her tongue. There is no torch so I angle her head towards the window through which the still hot winter sunlight is streaming in. I pull up her lip and see a small area of the gum is bleeding. And there, on her palate at the back of her mouth are numerous small red spots, petechiae. The rest of her examination is completely normal.

Guiltily I move from “coasting” to “thinking” mode. It is a terrible thing to confess but we see so many people with non-specific “aches and pains” that it is all to easy to adopt the “take paracetamol and come back in 2 weeks if it doesn’t get better” approach. What we as hospital physicians, safely insulated from the public frontline. used to self-righteously joke about as the “GP-way”.

“Have you any rashes on your skin?” She shakes her head. “Any bruising? Fever?” No. “And you have been completely well over the last few months?” Yes. “Have you ever had an HIV test?” Last year and it was negative. I scratch my head. If I had seen this lady at the hospital I would have been able to do various tests there and then. Out here I am a bit stuck.

“Do you have a cellphone?” Yes, she does. I turn to Sister. “Could you take a blood count?” She nods. “Ok – so take the blood count, and I will take it to the hospital tonight. Then I will phone you to let you know the result and what we must do.”

There are a few classic causes of a rash like that in an individual who otherwise looks well – and none of them are great news.

Comments

Post a Comment

Popular posts from this blog

Otherwordly isolation

I lean across the reception desk and catch the attendant’s eye. “Sawubona,” I say, dusting off my rusty Zulu. I see you. “Sawubona, ninjani?” she replies. I see you, are you well? “Ngiyapela.” I’m fine. She grins at me. “You must be a doctor.” “I am! How did you know?” “It is only the doctors around here who use Zulu. Even if it is only the greetings.” She arches an eyebrow. “I used to work here, at Hlabisa hospital up the road. I have a few other Zulu words, you know like ‘Does it hurt?’ and ‘Take a deep breath’.” She laughs. And then launches into an excellent impression of an elderly Zulu lady rattling off a series of complaints, waddling across the reception area clutching her back in mock agony. She gets it exactly right. I have come up to KwaZulu-Natal for a few days. Tonight I am staying in the Hluhluwhe-iMfolozi game park, 20 minutes or so from where I used to work. Awarded my entry ticket, I drive into the park. The sun is low in the sky, the kills bathed in amber light. I ta...
3 comments
Read more

10 years on

The door flies open. Lele peers in. "You must come out here and see. They are doing a play!" I finish up my case file annotation and come to the doorway. The waiting area is in chaos. A gang of school children are manhandling a couple of marimba's to the space in front of the consulting rooms, a team of nurses and counsellors are creating a stage area. Patients look on mutely. Some with interest, others - presumably feeling proportionately less well - without. "What is going on?" I ask. "It is 10 years since the clinic started. 10 years since MSF first started the HIV treatment programme and proved that it could be done in Africa. So the staff are celebrating. They are doing a show or something." The sister in charge of the clinic has moved to the front of the crowd of patients. She calls for silence and then gives a short introduction. Lele translates for me. "She is saying that this is a very important day. 10 years ago people were dying. And 10...
3 comments
Read more
The next patient is in her mid-20s. She sits gracefully on the edge of the chair and looks at me. "How can I help you today?" I ask. "It is this," she says, hands clasping her belly, "I look like I am 4 months pregnant!" "And are you? Have you checked?" "Oooh! Yes. MANY times - and always negative. I have been talking to my friends and they say it could be the HIV treatment." "Yes - that is true. You are on one of the older drugs, the one called Stavudine. That can make fat appear in different places on your body, and sometimes disappear from other places. Some people find that it makes their face thin." I suck my cheeks in briefly. She laughs. "I used to have a VERY round face, now it is thin!" "I suggest that we change that drug then. We have more drugs available in the public clinics than we did when you started and the one I will use has less side effects. Is that what you would like?" She nods enthusia...
1 comment
Read more