Left over Case from Uganda: Peptic Ulcer Disease

Grace is an orphan from Burundi living as a refugee in Kampala. She attends the life care women's group and since she has no family, another Burudian couple treats her as their own.

We got a call that Grace was in the hospital. She had suffered from ulcers and GERD in the past. Ellen tried to keep her supplied with proton pump inhibitors, but for Africans it's not an easy concept to take medicine even when you don't feel bad, so it had been a while since she'd taken the medicine. She was low on money, so she wasn't eating. This exacerbated the ulcers, and she ended up in the hospital. When I visited they had done tests to rule out malaria, typhoid, and HIV--common causes in Africa for general malaise and vomiting. She was recieving a PPI, Cipro, and worm treatment. Her nail beds were extremely pale, so I asked about her getting iron. They said, "It's not so bad," as they pointed to her hemoglobin result of eight. She was in extreme pain, but it seemed to be somatic. Perietal signs were negative with no guarding or tenderness to palpation. Psoas and obturator signs were negative.

The ultrasound showed a normal liver, spleen, and bladder, but they had reported fibroids in the uterus. She seemed to be having an extreme exacerbation of her peptic ulcers most likely with blood loss that caused her anemia and fatigue. However, all that was reported to her was this foreign word: fibroids. We got to explain to her that they were very common in women (even more so in black women) and they were not the cause of her pain. She is 27 and still wants to have children so it was a relief to her that she would not have to have a hysterectomy to cure this epigastic pain she was experiencing. Now Ellen is seeing that she stays well supplied on PPIs and Iron.

I included this entry for several reasons. First, to show an example of lack of resources as a cause of health problems. We can educate about eating right, but some don't have the money to do so. Second, I want to have an example of how patient education is lacking. Because they did not explain fibroids, Grace was under the impression she needed a surgery to remove her uterus. She figured that fibroids were causing her pain. She was at the mercy of the doctors but without being educated herself to realize her fibroids are a benign finding. I feel that health education is a major goal to keep the people empowered over their own health. It was a good lesson that anywhere people deserve to know about their bodies, their test results, and prevention.