Laura McArthur – General Practitioner
Laura is a GP and Emergency Medicine Doctor, who has worked across the world in tropical locations. She has the Diploma in Tropical Medicine and Hygiene and studied ‘Health in Humanitarian Emergencies’ in Liverpool, the first tropical institution in the world.
Tropical medicine may seem daunting to those not familiar with treating diseases in tropical environments. However, with the right approach, clinicians can safely diagnose and manage patients even with limited resources.
In this beginner’s guide, we’ll walk through the key steps for approaching tropical medicine cases.
Start with the Basics
When faced with a sick patient in the tropics, first consider the common diagnoses you would evaluate at home. Could this be a routine infection like a UTI or pneumonia? Or are there red flags making you worried about a more serious illness like sepsis or diabetic ketoacidosis? Then consider the conditions specific to the tropics in your differential.
Manage these “normal” conditions aggressively as they can deteriorate rapidly in tropical settings. Also recognise that tropical diseases can mimic routine illnesses, so maintain a high index of suspicion.
Know Your Geography
Certain diseases are more prevalent in specific tropical regions. For instance, malaria is a huge concern in sub-Saharan Africa while Chagas disease is rare outside rural South America.
Create a mental map highlighting endemic diseases in the areas where you work. Consider making a table or quick reference guide you can consult. This geographic framework helps narrow down the possibilities.
Conduct a Risk Assessment
Take time before, during, and after trips to tropical regions to assess risk factors for individuals and groups:
- Pre-Trip: Recommend vaccinations, malaria prophylaxis, trip insurance, etc. Educate on bite and wound prevention. Consider living conditions, and trip activities, for example, are you going to risky locations such as caves with bats in? Are you going to be in stagnant water where leptospirosis and other water-related diseases are prevalent? Have there been any known outbreaks of disease such as Dengue? Read up on these conditions before you go.
- During: Monitor for insect bites, fevers and diarrhoea. Emphasise hydration and wound care. Check water sources and living quarters. Encourage good public health and prevention practices.
- Post-Trip: Advise travellers to seek care for any new or persisting symptoms. Stress the importance of sharing their travel history.
Focus the Differential
When faced with a patient in the tropics,, break down the possibilities into:
- Normal: Appendicitis, pneumonia, UTI
- Big Sick: Sepsis, DKA, severe dehydration
- Tropical: Malaria, typhoid, amoebiasis
Use the geographic framework to highlight relevant tropical diseases. Also factor in timing – an acute fever is very different from one persisting for months and can give you clues as to the potential cause.
Learning the life cycles of tropical bugs like schistosomiasis helps you logically link symptoms and exposures. If a patient swam in contaminated waterway known for schistosomiasis, a subsequent rash, cough, and GI distress would make sense.
When in Doubt, Refer Out
You don’t have to diagnose every tropical disease definitively. The priority is identifying red flags and conditions requiring higher-level care. Initiate emergency referrals when appropriate and ensure thorough follow up for any lingering or unexplained symptoms.
A common pitfall is to assume someone’s symptoms are not related to travel because months or years have passed. This is not always the case and you may need to advocate for the patient if their symptoms persist.
The key is breaking tropical medicine down into systematic steps. With the right knowledge and approach, you can provide safe care even in low-resource settings far from home.
Let us know if you have any other tips for novice clinicians practising medicine in the tropics!
More Learning opportunities:
- Webinar: Learn more from Laura as she shares more essential medical tips for working in tropical climates in our “Thriving in Extreme Tropical Conditions”
- Blog: Everything you need to know about Jungle Medicine