Ah a Mosquito!

Zika, Dengue, Yellow Fever, Malaria, Chikungunya...

Back in August when we were planning this trip with our school, one of their major concerns was the recent outbreak of the Zika virus. The news made a spectacle of all the people bit by the mosquito and the unfortunate effects it had on babies. When asked if Karilyn and I still wanted to participate in the trip despite this outbreak, I was originally hesitant to come.

For those infected with Zika who are not pregnant, the mosquito causes a viral-like illness and you are left with a mild fever, chills, headache, and generalized weakness, nothing too unfamiliar than your common flu symptoms. Only those who are pregnant see the devastating effects of the Zika virus--microcephaly. My concern came not from the immediate effects, but those far into the future. No research has been done on the long term effects of being bit by the Zika mosquito. It made me nervous to think that while I was having fun in Belize now, this trip could have serious consequences later in my future.

I ended up deciding that I can play the "what if" game a million times over and the questions I had still could not be answered. At the time of our decision, Zika had already spread into the US and I decided that if the mosquito is coming into my territory, I am going to travel into theirs. While the long term effects are not known, I did not want this fear to deter me from an opportunity of a lifetime.

Since I have been in Belize and at the clinic, I have seen many people come in due to some mosquito-borne illness, and NONE of them have been due to Zika! I asked the doctor, after we had told a patient she was newly pregnant, about the local effects of this outbreak and the number of Zika babies and cases at the clinic. He stated that to date, there have been zero Zika babies born to patients of the clinic and that he has seen very few cases nation-wide.

I decided to do some research into the current number of cases. According to the Pan-American Health Organizations report from December 6, 2016, over the last 47 weeks there have been 66 confirmed cases and 715 suspected cases of Zika in a total country population of 368,437 people. During those same 47 weeks, there has been 1 case of a pregnant woman affected, 0 cases of babies born with congenital malformations, and 0 deaths as a result of this disease. It's shocking how the news can persuade a person to believe the worse. When you look at the facts, I'm very happy I chose to stick to my gut and travel because the data shows that the risk is lower than previously suspected.

In comparison to Zika, however, we diagnosed 2 patients today with Dengue Fever, another mosquito-borne illness. Most people recognize this illness as "breakbone fever" due to the sudden onset of severe bone and muscle pain following flu-like symptoms. While not all types of Dengue fever present in this manner, it is quite common for patients, like the one the Doctor and I saw today, to come in saying they have a 4-5 day history of fever, chills, nausea, and drowsiness and for them to think they have a cold. In the clinic, those symptoms always warrant a workup for all the mosquito borne illnesses including testing for yellow fever, malaria, and chikungunya.

I'll have to be more careful the next time I walk to the grocery store and be sure to lather up on bug spray! 

On my American primary care rotation during the months of October to November, it seemed everyone came in with a similar case of fever, chills, nausea.... etc. Back home, we would tell the patient they have a viral illness and they do not need anything other than a few days rest and lots of water. Here in Belize, I have to train my mind to think outside of the box to include tropical medicine. It is so common for people to have these diseases here that I need to always consider this diagnosis as an option for their symptoms.

When I get back to the States, I am going to pay more attention to the question every patient should be asked, which is "have you traveled outside of the US in the past month?" Some patients will never tell you anything unless you directly ask them and I'll admit I often forget to ask this question since I am usually more focused on the patient's current symptoms. It is easy to become trapped in what you are used to and I love using the clinic as a challenge to think of different diagnoses and local issues that are affecting the patients I see everyday.

Helping and teaching all the patients to be their healthiest self! 

This weekend as Karilyn and I travel to the South of Belize, out of the city center and into the mountain regions, we will be sure to lather up in bug spray. We sure don't want to spend the remainder of our time here stuck in bed sick!