AT least 30% to 40% of people with AIDS in the world also have tuberculosis, the most common opportunistic disease also to infect people whose immunise system has been compromised or destroyed by AIDS.  AIDS opens the door and TB walks through.South Africa and Swaziland have the world’s highest TB prevalence rate, and for this reason alone people here should become more aware of the disease.  unlike HIV infection, which for the most part is contracted only through unprotected sex, TB is only a sneeze away.  When someone who is sick with TB coughs or sneezes, they can infect others.When people suffering from active pulmonary TB cough, sneeze, speak, sing or spit, they expel infectious (and so small as to be invisible to the naked eye) aerosol droplets. a single sneeze can release up to 40 000 droplets.  each one of these droplets may transmit the disease, since the infectious dose of tuberculosis is very low and inhaling fewer than ten bacteria may cause an infection.TreatedAIDS has no cure.  TB can be treated.  But the best plan is to avoid TB entirely.  This would require more thorough TB testing of the population, and putting TB patients on treatment immediately.  TB patients would have to do their part to prevent the spread of the disease by covering their mouths when they cough or sneeze as well as avoid close contact with people while their TB is active.  TB travels through the air on droplets projected when a TB person speaks, sneezes or coughs, so common sense regarding these activities (yes, even singing can spread TB!) should be practised.TB patients are sometimes isolated from the rest of the population to reduce the risk of the disease’s spread.  This was one reason why Swaziland’s new TB hospital was considered essential in a country with such a high TB prevalence rate.TB usually attacks the lungs of infected people, but can also infect other parts of the body.  Most times a person newly infected with TB will not know it, because the disease at first is “latent,” without any symptoms.  However, if TB is not identified, it will become an active disease which, if left untreated, kills more than half of the people it “attacks.”those symptoms, as reported in last week’s column, resemble those of a very severe flu: heavy and persistent (chronic) cough, sometimes producing blood in the sputum, fever, night sweats and weight loss.as said before, treatment is available.  But it is long because TB treatment requires long-term consumption of several types of antibiotics.  Of course, newer strains of multiple drug resistant TB are making conventional treatment difficult. This is bad news, because already an astonishing one-third of the world’s population is believed to be infected by TB, with a new infection striking every second.  it is important to note that the world’s infection rate is stable – a certain percentage of people (as said before over a third of the world’s population) is infected, and this is not rising.  However, the world’s population is rising, so there are actually more people with TB.TB is more prevalent in developing countries like South Africa and Swaziland than in the developed world, where TB cases are usually associated with people living with AIDS.  while TB is the most prevalent disease infected Swazis living with HIV and AIDS, it is also infecting HIV-negative people amongst the general population to such a degree that even if there was no AIDS in the country TB would remain the top public health threat.80% of the populations of Asia and Africa test positive for TB.  in the United States, 5% to 10% of the population tests positive for TB, although that number is alarming to U.S. health officials.in the U.S., TB mostly infects older adults.  in Africa, however, TB mostly infects children in their teens (adolescents) and young adults.one important fact we must remember in Swaziland is that people who are in frequent contact with TB patients are more at risk of acquiring the disease.  People who have intense or intimate contact with TB patients are at risk.  People who have frequent contact with TB patients are at risk.  These factors account for the spread of the disease in Swaziland, even amongst the HIV-negative population.Poverty is an underlying contributor to the spread of TB.  Living quarters in Swaziland are often intimate as people share rooms, even beds, and often rooms are not well ventilated.  Unaware that a sneeze or cough from a TB patient is not the same as a sneeze or cough from someone with a simple head cold (although any sneeze or cough should be avoided by others and suppressed by the person sneezing or coughing), some people do not take simple precautions.  one study found that people with prolonged, frequent or intense contact with TB patients are at particularly high risk of becoming infected, and amongst this group it is estimated that more than one in five (22%) become infected with TB. Caretakers of people living with HIV and AIDS who suffer from TB as well are at risk, and should take precautions and be tested for TB.Health care workers in general, particularly in Swaziland, are also at risk.HIV-positive people are at risk, and should be tested for TB at the first sign of symptoms, or even as a precaution.ContributesSmoking also contributes to TB infection.  Smoking 20 or more cigarettes a day makes the smoker two to four times more likely to become infected with TB.  Smoking destroys lung tissues, and makes the organ more susceptible to diseases like TB and cancer.  Finally, a person in jail is more likely to become infected with TB than someone in another environment.  one study found: “Prisoners, especially in poor countries, are particularly vulnerable to infectious diseases such as HIV/AIDS and TB.  Prisons provide conditions that allow TB to spread rapidly, due to overcrowding, poor nutrition and a lack of health services.  Since the early 1990s, TB outbreaks have been reported in prisons in many countries in Eastern Europe.  the prevalence of TB in prisons is much higher than among the general population – in some countries as much as 40 times higher.” 

Internally displaced Somali women carry their children as they stand outside their makeshift shelter in the capital Mogadishu

It caught me by surprise, a feeling tugging from the back of my throat. It was completely unexpected. my chest felt constricted. my breathing became shallow and then, I couldn’t see – blinded by my tears.

I was, at a temporary clinic set up by SA charity Gift of the Givers near an overcrowded refugee camp in Mogadishu, Somalia. for the past five days I’d been reporting for South Africa’s eNews Channel on starving babies, sick babies, babies with measles.

I’d witnessed a litany of medical conditions; TB, gastro, cholera, leprosy, pneumonia – they all jostle for space here. I had looked mothers in the eye as I asked them about the treacherous journeys they’d undertaken for weeks, barefoot and dehydrated.

They told me how they’d buried their children in strange lands along the roads. I felt pity for them, yes, but I didn’t cry. I had stories to file for 13:00 and 19:00 deadlines. I needed to write, edit, do live shots, work with my cameraman, all the while staying alert and alive as sporadic gunfire clamoured just down the street, as common to Mogadishu as a dog’s bark is in suburban Johannesburg.

Then, I met Baby Salamo. She wasn’t nearly as sick as the other babies we had reported on. Her mother wasn’t as shabbily dressed and had a smiling, hopeful face as she watched the Gift of the Givers paediatricians insert an intravenous drip into her daughter’s tiny hand. the baby whimpered, her petite lips circled into a tiny, emaciated yell, and she stretched out her free hand. I reached toward her outstretched hand with my index finger and she gripped it tightly, looking me right in the eye and screaming bloody murder. I was overwhelmed. It all went blurry after that.

The paediatrician continued with his work unperturbed by the weeping wannabe war correspondent. Salamo and I cried together. Her mother looked at me, a concerned look on her face, and rubbed my shoulder affectionately. this kind gesture from a person who had nothing forced another torrent of tears.

Baby Salamo was undergoing the first step to recovery. the doctors rejoiced when the mother, with a panicked look on her face, lifted up her baby to reveal a big wet spot. When a child gives an almighty wail and real tears pop out of her eyes, it’s an achievement because dehydrated babies don’t cry tears. some are so listless they don’t have the energy to do anything other than whimper.

Looking back now, I’m not sure if it was the kindness of the doctors, dieticians, paramedics, and nurses that pushed me over the edge that day. Everyone was so tired and emotionally exhausted I assumed they had gone (like me) into robotic mode.

Then, I noticed Ismail Vawda fussing over Baby Salamo, chatting patiently via translator to her concerned mother, finding out if she was still breastfeeding and what the baby’s symptoms were. the young doctor looked so concerned and so sincere. then it dawned on me. this man, dressed in his Islamic “topee” hat, scrubs and beard, who looked more like a kindly Papa Smurf than a paediatrician in a warzone, really did care about this baby. They all do.

The tender way they assess these patients, you soon realise is not a mechanical act learned from some textbook. the joy they feel when a tiny patient starts to respond and begins to perk as the IV fluid runs into its veins, is all real. I struggled to believe the reality of it – here are people who are giving everything, asking for nothing and seeing genuine pleasure in their patients’ recovery. these medical practitioners are all volunteers, taking either special leave or vacation leave to make the trip.

It is one thing to pray, but it is another to help and then pray. to have unwavering faith. – this is an abridged version. Free African Media

I haven’t written in awhile but I wanted to update you all on how I’m doing on the SCD!

So, I have just past the 8 month mark on SCD! I am so happy and proud of myself that I have made it this far. the journey to where I am now hasn’t been fun or easy, but I am happy to report that for the past 3 months I have NO symptoms. I experienced a pretty bad flare when I got back from South Africa in November. it lasted about 3 weeks. during those 3 weeks, I was pretty depressed, I just wanted to get better. I must note that the flare wasn’t as bad as it was pre-SCD. I went back to SCD basics (easy to digest foods and soup) and in 3 weeks I was back to normal! during that flare I also started acupunture twice a week. I really feel that this helped me as well.

I went to Jamaica at the end of December after the flare was over. it was pretty easy staying on the diet while I was there, I ate alot of FRUITS AND VEGGIES! I didn’t drink at all which was the most difficult thing for me. but I still managed to have a great time and feel great as well!

Its been 3 months since have seen blood and mucus! I am pretty regular going about 2-3 times a day mostly all solid! I couldn’t be happier. thoughts of UC no longer control my life. I feel free and in control.

With regards to missing food, obviously its hard sometimes when you crave something that you cant have. but I always remind myself that no food is worth the pain in the ass (literally) of Ulcerative Colitis.

Yesterday I was sooo happy. my mom made me butternut squash fries and chicken wings. I actually felt normal and enjoyed every bite of my dinner!

I know alot of you out there are struggling with UC. I read the stories all the time and feel sad because I know how bad it can be. I wish everyone found success using the SCD but I know that’s not the case.

Currently I am still on Salofalk tablets. I also take a SCD probiotic everyday and go to acupuncture once a week. I have a followup appointment with my GI next week. I am curious to see what he will say about my improvement.

I am a lil worried that I will see the 9 month flare that Elaine talks about in BTVC. now that I look back on it, I did have a mini flare at 3 months and another one at 5-6 months like she predicts. I am hoping that I skip the 9 month one!

I also think alot about the future and how long I will stay on SCD. since it has worked so well with me I sometimes feel that I want to stay on it forever! I am only 25, so that is a LONG time! I know for sure that I will not go back to the way I was eating before!

I wish everyone happiness and health. This support group has really helped me get through the good times and the bad times. it reminds me that although UC sucks, it doesn’t have to be the end of a happy life for us. it could be the beginning of a new and improved life like it has for me

Jessica’s story is now entered into the 2011 Ulcerative Colitis Writing Contest!!! You Can Join too, click here for details

For more information on the SCD and ideas on how to give it a try, visit the Diet Page

Rabies Traveller’s Guide  

Article by Sue Jonesie

What is rabies and how serious can it be?

Rabies is a dangerous, infectious disease caused by a virus that gets into your body usually from an animal bite, scratch, or when an animal licks you on broken skin or mucous membranes, such as your nose or mouth. this is most often a dog, but bats, cats, or any other warm blooded animal can also carry rabies. Person-to-person spread of rabies has only been reported in exceptional circumstances. Children are at particular risk of rabies. Rabies is a very serious infection because, once symptoms appear, it is nearly always fatal, causing between 40,000 to 70,000 deaths worldwide each year. a fatal case of rabies contracted in a wildlife centre, South Africa

In 2009, a young woman from Northern Ireland died from rabies. it is thought that the woman acquired the disease after being bitten by a dog whilst she was working at an animal sanctuary in South Africa three years previously. Rabies symptoms?

If you are bitten, scratched or licked (where the skin is broken) by a dog or other warm blooded animal, always seek urgent medical attention. Rabies is preventable if wound cleansing and vaccination are given soon after the bite or scratch. Early symptoms can be non-specific. the disease then progresses to paralysis, followed by coma and death. Without intensive care, death occurs during the first seven days of illness. Early symptoms may include: Itching and tingling at the wound site Fever Headache Muscle ache Excessive tiredness the onset of rabies is unpredictable. very rarely symptoms can start as soon as four days after the bite or scratch. usually people with rabies start to notice the early symptoms about 3-12 weeks after being bitten or scratched. However, symptoms may be delayed by many years giving a false illusion that the danger has passed.

What to do if you are bitten or scratched

1) Immediately clean the wound, ideally by flushing under a running tap for a few minutes and washing with soap and water. Encourage limited bleeding. 2) if possible apply antiseptic or 40-50% alcohol (whisky or other spirit can be used). 3) Regardless of whether you have completed a rabies vaccination course, you should always seek urgent medical advice. if possible avoid having the wound stitched (sutured) straight away. 4) a healthcare professional should assess your level of risk and may recommend further preventative vaccinations (called post-exposure prophylaxis). apart from the obvious health protection it is really worth being vaccinated against rabies before you travel because you will only need two further vaccinations, given over two days after a bite or scratch. People who haven’t had the rabies vaccine usually need five post-exposure vaccines given over a month and possibly rabies immunoglobulin for quick protection. Rabies immunoglobulin is in short supply worldwide and is very difficult to get hold of. the course of five vaccines can be very disruptive to travel plans, as the person and possibly their travel companions) needs to remain near to a clinic. 5) Contact the local British Embassy or Consulate for advice if you are having difficulties finding a clinic with the vaccines. See the back page of this leaflet for contact details. in the heat of the moment, it may not be possible to find out the animal’s owner’s name and address, but if you remember, leave your own contact details and ask them to get in touch if the animal gets sick or dies within 2 weeks. ask if the animal has a rabies certificate. Following travel health nurse advice

If a travel health nurse has told you that rabies vaccination is recommended for you, there is no doubt that your travel plans put you at-risk from rabies. if they say you should consider rabies vaccination you need to weigh-up the cost of the vaccine against the potential risk. many people prefer to take no chances with their health. travel health nurse advice is based on: Up-to-date information on whether rabies is a problem in the place you are travelling to your chance of coming into contact with infected animals the medical facilities available if you were to come into contact with a potentially rabid animal the duration of your stay All travel vaccination recommendations can change because of disease outbreaks and seasonal variations but travel health nurses have access to daily updates and are specialists in travel health services.

Arrange your vaccinations at least a month before you travel

Optimum rabies vaccination requires a course of three injections, which should be given over 21-28 days. if you have made your travel plans late and have less than 21 days before you travel, contact your Travel Clinic immediately. they may be able to recommend an alternative based on the time available. Rabies protection: summary of action to be taken

Arrange your vaccinations at least a month before you travel

Optimum rabies vaccination requires a course of three injections, which should be given over 21-28 days

If you have less than 21 days before you travel, contact your Travel Clinic for alternative advice

Try to get the full vaccine course

Travel Health Clinics offer convenient opening times and our staff will do all they can to fit in with your schedule so you get the protection you need

Know what to do if you are bitten or scratched by an animal

Clean the wound. Seek urgent medical help, even if you have been vaccinated – prompt action could save your life

about the Author

MASTA provide expert travel health advice and have a large network of travel clinics.

If you would like to find out more about Rabies, or travel vaccinations, then please visit our website.

Share and enjoy:

• Malaria Traveller’s Guide  
• International Travel and Health: Vaccination Requirements and Health Advice, 1998 (Vaccination Certificate Requirements for International Travel & Health Advice to Travellers)