One of the notes before going to Malawi was that everyone would need testing for bilharzia on their return to the UK. What is it though? I'd not heard of it before, and most people I've spoken to haven't either. Not even my GP had heard of it. The 'proper' medical name for this is schistosomiasis - and is a parasitic flatworm that lives in water, and are carried by snails. One such infected place is Lake Malawi, and is the reason I wouldn't go swimming in it whilst there. I did however get my feet wet on the shores of the lake whilst running the marathon as I got too close to the tide.
Symptoms of this start with an itch or rash at the point of entry, and later include fever, aching, a cough, and diarrhea. The flatworms will lay eggs which can cause chronic damage to organs such as the liver and intestines. In a recent program about explorer Ranulph Fiennes, it was mentioned that people who contract Bilharzia normally last no more than ten years.
It's hard to say whether I had any of the symptoms or not - the tops of my feet were itchy a day or two after exposure to the water - but then that could be explained away by the heat and new socks. A few weeks after I'd also got muscle ache in one shoulder on the occasional day; but again - I'm a runner so that can be explained away as well.
Long term implications include damage to the liver and other organs. In cases where an individual has been infected for sometime it can become chronic and also cause the sort of stomach swelling that has become associated with parts of Africa. So to me it makes sense to go ahead with the advice on being tested for this, even though the others in the group didn't seem to want to.
To start with I called the local GP - the receptionist hadn't heard of it and advised it was likely I'd need to speak to a tropical diseases expert but would call me back once they had more information. A day later they called back and told me that it's not a test they'd do and I'd have to go private. Not knowing how to go about that I decided to call another local practice, and they were more helpful - they did tell me they don't do the test either; but gave me the number to a switchboard that would get me through to Leicester's Infectious Disease Unit (IDU). Wow, that makes it sound like some sort of outbreak.
They hadn't heard of it either; but that's probably because I referred to it as bilharzia rather than schistosomiasis - I didn't know at the time that was the proper name. They took my details and let me know they'd get back in touch once she'd spoken to the on-call Doctor. Perhaps this time I'd have more luck.
When IDU got back in touch they advised that although the recommended time period is after six weeks, they wouldn't test for it until after three months - so an extra six weeks. Though I then struggled to contact the GP during office hours due to them closing during my lunch break, and before I knew it - it was November. When I called the GP again, the receptionist said it was probably too late. Could this delay have been a massive mistake? Should I have tried harder? Only time would tell now.
They called me back the following morning, and wasn't confident they'd bother with the test without existing symptoms. They did however get my GP to give me a call, and he wondered why I'd left it so long to contact them… obviously ignoring that I had contacted them previously. They did however get back in touch with the IDU and said they'd get back in touch. A couple of weeks later I finally received a letter with a referral number so I could book an appointment.
When I got the confirmation letter it was for a different day and time to what I'd booked. A few days later I received a letter through the post to say my appointment had been cancelled, and that I'd need to contact my GP to find out why. How is it possible for a blood test to take seven months to book, and then be cancelled?! Even though I was supposed to call the GP to find out why, they said to call the hospital to find out why instead.
GP: You need to contact who referred you
Me: But that was you?
GP: No, your referrer
Me: That's you! It even says it on the paperwork!
GP: No, we didn't refer you - it'd be the hospital
And so it went on - I was going around in circles. I told them I gave up, thanked them, and put the phone down.
As it was now Christmas I'd have to wait until I got back from Switzerland before trying again. Eventually though the hospital sent me a letter to say I'd missed my appointment - the one which had been cancelled. They weren't able to explain it to me, but they did say the GP's reception had lied to me, or in their words had "told porkies". Then, whilst I was in New Zealand, they sorted another appointment out for the end of March - 10 months after my visit to Malawi.
It had been an annoying experience, and one which made me doubt wanting to ever go back to Malawi in future. Not because of the country in question, but because of the UK. However, once at the hospital things changed.
The NHS seems to get a lot of bad publicity, but my experience was incredible efficiency and attention to detail. I was seen twenty-five minutes earlier than scheduled, weighed (currently at 66kg!), and then after waiting less than five minutes I was seen by the specialist.
He asked me a few questions such as my exposure to infected in Malawi, and other recent travel history. I think realing off a list of six additional countries since Malawi came as a surprise. I was then told more about the testing, and symptoms and was then briefly examined. This was enough to convince him that a blood test, or any other sort of schistosomiasis test, was not required. Now I had a choice - I was told I could get the blood test anyway; but this would take a couple of weeks whilst bloods are sent to a lab in London. The other option was to just take Praziquantel anyway as it would be harmless if I hadn't been infected, and if I had been then it'd cure it. I figured that skipping the blood test, which surprised the Doctor I'd agreed to (as most people like to at least know if they'd had it), I would not only be saving the NHS a little bit of money; but also avoiding the risk of affecting my performance at the Greater Manchester Marathon ten days later.
They're not the sort of tablets you can get from just any pharmacy though - the one in the Leicester Royal Infirmary is different as it has a tropical diseases department and just happened to have them in stock ready. I'd leave taking them until after the marathon though due to potential side effects affecting marathon performance.
So, I was prescribed the tablets and told to take them twice daily, for just one day. That was all there was to it. Ten months after visiting Malawi I'd finally got the tablets which had been recommended. Whether I'd been infected or not, I was now "guaranteed" to be okay. What a kerfuffle.
At least it was now over, and with this knowledge I'd know what to do if I was to ever return.