Our most prevalent medical problem was parasites, although the actual morbidity from these was lower than we would ordinarily expect. Nearly every patient had roundworms (Ascaris lumbricoides) and hookworms (Anclystoma duodenale).
While the roundworm is perhaps more of an embarrassment or inconvenience, hookworm is a primary cause of anemia, and anemias secondary to hookworm, combined with iron deficiency, tended to make our low normal hemoglobin about seven to eight grams. Our general principle was that we would use no one as a blood donor if the hemoglobin was less than about nine grams.
While the roundworm is perhaps more of an embarrassment or inconvenience, hookworm is a primary cause of anemia, and anemias secondary to hookworm, combined with iron deficiency, tended to make our low normal hemoglobin about seven to eight grams. Our general principle was that we would use no one as a blood donor if the hemoglobin was less than about nine grams.
Roundworms, on the other hand, caused intestinal discomfort with only a fair degree of frequency and a degree of malnutrition, but were not necessarily regarded as a serious pathological entity. Patients frequently requested medication "for the worms", and we usually gave it upon request. They had a curious habit of counting the worms in the stool, and they would come the next day after vermifuge with a report. The largest number that I can recall was 111 from a single dose. The size of these worms was the same as we have become accustomed to hear, about the diameter and length of the wooden lead pencil. The vermifuge was always given with the realization that most patients would be recolonized again within a few weeks, and there was always the fear that intestinal obstruction might occur – at least that was the medical floor that circulated among us then.
Malaria was commonly found on peripheral smear, but probably responsible for fewer problems than generally assumed. It was an inevitable result of living in such an area, unless one were to take some such drunk as Aralen regularly. (All of the staff took a single pill at noon with Thursday's lunch.). Because of its inevitability in our endemic area, we did not always treat malaria except when it became the assumed cause of shaking chills and fever. In many tropical countries, anyone who comes to a hospital in dice of other then some obvious cause becomes a malaria statistic.
Schistosomiasis was another almost inevitablefinding in any routine work up. Why most experienced doctors in our area felt that there was little necessity of treating it (because of the secondary dangers of treatment, the inevitability of recurrence, and the seeming lack of symptomatic disease attributed to it), at Lambarene we felt that it might well be responsible for the high incidence of liver disease and the high incidence of primary liver carcinoma there.