11
Oct
08

Yemen, Typhoid Mary and Robin Cook

We are all creatures of habit, some habits are due to familiarity; others we can’t even explain. One of mine is reading and finding seemly incongruous connections in the readings to what goes on around me.

Because I work in the Health Care field, some of the books on my reading list whether technical, fictional, or historical tend towards medicine. My latest train ride book (can’t stand sitting for an hour staring into space, and not a good thing to do in American urban trains anyway) is Robin Cook’s Critical.

So there I am at 6:30 in the morning, at the far corner of the train bunk reading into the evolving story of three seemingly unrelated medical events when I come across the term Typhoid Mary. A term some have heard when dealing with contagious disease, human carriers. Out comes the Blackberry and there I am googling the term to remember what is it about it that snags in my brain.

Mary Mallon in the early 1900’s was a Typhoid healthy carrier and because of her “chosen” public endeavor of cook she infected some 47 people of which three are said died of Typhoid. I keep reading, the woman was put in isolation twice and the last time she was “quarantined” until death. Hmm…”People catch typhoid fever after ingesting water or food which has been contaminated during handling by a human carrier. The human carrier is usually a healthy person who has survived a previous episode of typhoid fever but in whom the typhoid bacteria have been able to survive without causing further symptoms. Carriers continue to excrete the bacteria in their excrement and urine. It takes vigorous scrubbing and sanitation to remove the bacteria from the hands. Though Mary washed her hands every time she used the bathroom, she still infected people.” BINGO! It takes vigorous scrubbing and sanitation to remove the bacteria from the hands….

That immediately reminded me of what I hear in Yemen. When family members are sick, or other people are referenced as sick, I’m invariably always told that the doctor said they have Typhoid. At first I was incredulous, how can so many people have Typhoid. And then why is it that doctors always say its Typhoid, and I get a melodramatic soundbite in my mind’s eye of House during one of his differential diagnostic sessions saying “that’s preposterous” to one of his team member’s offers for a diagnosis. But this statement made me revisit what I have heard so much about in the past years…

Could Yemen have hundreds of Typhoid Marys living about within their families, cooking for them continuous doses of this disease? Knowing how hygiene is not at a premium in Yemen, and the lack of sanitary know-how at ground level that people suffer; I am wondering if they are blithely giving each other the disease? Where soap and water is not enough to kill the bacteria, and where soap and water are not used with faithfulness, and where the eating habits of communal plates with hands as eating utensils is the norm, and where “hamam” practices are not things to write home about- this gave me pause for a moment.

But the doctors, are they telling people how to make sure they don’t contaminate their families once one of their members becomes sick? Are they telling them the risks of seeing the disease appear almost in “telephone message” style among the rest of the family? Does anyone realize that if the infected person is the cook of the house and is not properly informed and doesn’t take stringent precautions they could very well be passing the disease to their families and to unrelated people that come to eat in their homes?

I once sat overseas listening on the phone as my own in-laws each got sick one right after the other once my sister-in-law, the cook of the house, got sick and was “diagnosed” with Typhoid. I listened as they told me that a few weeks before at the house of one of their extended family members a few others had gotten sick, one of which frequently comes over to our compound for extended visits with her daughter… And I was, at that point, getting fed up with the Typhoid craze. Didn’t the doctors know any other diagnosis other than Typhoid, didn’t they do enough blood work-up to come up with other leads? I should have listened more closely; because all these family households are interlocked…the whole mountain region is related…

So now I wonder…I made a call…my sister in law is again sick…”but what is it, what did the doctors say?” Its Typhoid they say…oy! A relapse?… Here we go again!?

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