BY DR SANDRA HIROWATARI, CHAIR, AMA COUNCIL OF RURAL DOCTORS
It’s just water. H2O. It is a molecule that creates life, births memories, emotions, causes disease and death.
For many rural doctors, the season of ‘The Wet’ has begun.
There is a sense of de ja vu - the smells, the sounds, the fears, the wonders of this season, the sense of rebirth. Sweet green tree frogs, horrid cane toads, the galahs leave, and meliodosis returns.
Meliodosis is a result of Burkholderia pseudomallei, a bacterium particular to the tropical wet zones. Transmitted through dirt either on the skin or inhaled, thankfully unlike ebola, person to person transmission is not suspected. Serology studies reveal that 80 per cent of children in an endemic region have antibodies against B psedomallei. For most then, it is obviously not fatal, subclinical. However, of those infected with clinical manifestations, the numbers are horrifying. Without antibiotic treatment the mortality rate is 90 per cent. Even with antibiotic treatment the mortality rate is 10 per cent for uncomplicated cases, but for those unlucky to be diagnosed with fulminant disease death rates are as high as 80.
Meliodosis can be a great deceiver. It often acts like tuberculosis. Serology tests are deceiving, with false negatives and positives. Culture is the mainstay of diagnosis. The time to disease onset is not known but there have been cases where it has been many years after exposure. It can cause osteomyelitis, cellulitis, and only in Australia, it can cause encephalomyelitis. Strangely, also only in Australia, infected men may get a melioid prostatic abscess, not seen elsewhere in the world.
Here is my Wet season mnemonic: Mud, meliodosis, meropenum, multiple presentations, murderous, mangoes, Merry Christmas. Make it a gut reaction. You need to think of it in sick patients in the wet season.
Medicine is a seasonal profession. Whether it’s the flu in Winter for city doctors or Meliodosis in the Wet for Top End doctors, we have to be prepared.
The Wet causes a shift of perspective in the Top End. Aboriginal Elders have a spark in their eyes, there is a gearing up of tools, getting the water crafts ready, a careful teaching of the young’uns about reading clouds and listening to the berries on the trees. Us White fella Kartiyas are stocking up supplies so we can survive the potential flood – diesel, bread, batteries, candles and water.
When the rain finally comes it fills the ears, soaks the skin, and transforms our communities. Overnight roads can flood, horses can swim over their fences, brown becomes green, flowers begin to sprout, crocs have a bigger territory to roam. The next morning, we find holes in the roof that we didn’t know existed. But we are prepared. And we are prepared for Meiodosis cases when they inevitably arrive.
Out in the community, spirits change, I hear more laughter, there is a ubiquitous feeling of relief. Smells change. Eucalypts smell more gummy. The earth smells musky. Colours change, with the rainbows comes a whole spectrum of colours not seen in the Winter.
And then we all wait. Because ‘The Dry” is about to happen, sometime after Australia Day. We look forward to the cooler winter months. The cycle continues.
Published: 06 Dec 2018