Bilharzia

A good friend of mine spent a year or so in Rhodesia (now known as Zimbabwe) in the late '70s. He still keeps in touch with some of his friends from those days, and he recently received an e-mail from one of them. That man now lives in Australia, and over the last few years he's had some health problems which proved puzzling to Australian doctors. They've finally figured out what the problem is: Bilharzia, or Schistosomiasis, a disease caused by tropical parasites.

As a sort of public-service announcement, to aid others who may be baffling their non-tropical doctors with this tropical disease, here's the original e-mail:

G'day everyone,

A few of you are already aware that over the past few years I have had some health issues which have had an impact upon my employment (and as a consequence, my finances!).

Well, yesterday I finally had a proper diagnosis. As I can trace the origin of this problem back thirty years to my service in the RLI, I thought I'd share that diagnosis in order to raise awareness of the issue, particularly with those who now live outside of Africa.

As many of you will be aware, Bilharzia, or Schistosomiasis to use the medical name that's preferred nowadays, is a disease native to Africa as well as Asia and South America. My recollection is that the Army was supposed to test us every six months or so, but I certainly was never tested for it during my service.

The disease is caused by being infected by the parasites or schistosoma when swimming or wading through rivers etc. It has three phases:

Initial phase: Apparently this causes an itch when the parasites burrows through the skin and may not be noticed at the time. There was plenty in the bush to give us an itch at one time or another!

Acute phase: This occurs several weeks or even months after being infected. It can show as a high fever which apparently is often misdiagnosed as Malaria or other high fever illness! Did you have "tick-bite fever"? Was it diagnosed with blood tests etc?

Chronic phase: This can manifest itself decades later with some or all of the following symptoms.
Abdominal pain
Cough
Diarrhoea (this can be 'disguised' by a mild paralysis of the bowels)
Paralegia
Fatigue

Complications: "Progression of liver, kidney, or other dysfunction may occur for many years after transmission is interrupted"

In March 1976, I signed out on a long leave and in the week before I flew to England, I hitch-hiked out to the farm of John and Lorna, some friends near Umvukwes. The day after I arrived I came down with a raging fever and lost 2 stone (over 12 kg) over the next four days! Lorna consulted her family Doctor by 'phone. Their diagnosis was malaria and as John had previously had malaria, there was medication available on the farm, with which I was treated. There was no Doctor's visit, let alone blood tests etc for this diagnosis. Until this week I've always believed that I had had malaria, but with hindsight I now believe this was Katayama Fever as the acute phase is also called.

Given the timing of March 1976 for the acute phase, I think the initial infection may have occurred when 2 Commando was based up at Bumi Hills on Lake Kariba. We were there for three weeks or so and from memory took over from 1 Commando. Naturally, there were occasions when we swam in the lake.

The literature I have recently read on Bilharzia on the internet from a variety of sources includes statements such as "In general, patients with chronic schistosomiasis tend to present in developed countries with lethargy, colicky abdominal pain, mucoid/bloody diarrhoea" etc, and this can be decades later!

Now I know what the problem is, I can get a course of treatment that'll clear the schistosoma from my system and stop the progression of the disease. Unfortunately, the literature also informs me that the harm that's already occurred is irreversible.

Many of us are now living in Britain, North America or Australia where the disease is not present. As a consequence, it is extremely unlikely to be on the horizon of our GPs. This has certainly had an impact upon the length of time it's taken for me get my diagnosis. So I hope by my telling this, that it may of benefit to someone who may be having similar problems.

D---- A--------
2 Cdo, 1974-77