The poison in your ‘harmless’ insecticide

The study of medicine is fairly standard the world over.

The basic principles of biomedical sciences, pathology and clinical medicine are taught to all doctors, irrespective of country, race or economic background.

However, many training programmes across the world may incorporate other treatment options in their curriculum, based on their background.

For instance in China, herbal medicine may make up an integral part of the curriculum, while in the US Doctors of Osteopathy will have further training on osteopathic manipulative medicine.

Christian-based medical schools will incorporate biblical studies as examinable courses, while the Islamic-based schools do the same with the study of Islam.

EPIDEMIOLOGY

However, despite the content of clinical medicine in theory being the same, exposure to disease will vary depending on physical location.

This brings out the importance of understanding epidemiology, the branch of medicine that addresses the incidence, distribution, and possible control of diseases.

This explains why in Africa we become comfortable treating malaria, tuberculosis and leishmaniasis, but not necessarily Alzheimer’s disease.

Despite being one country, the location of the medical school within Kenya offers its own unique experiences.

With the great variability in our geography, culture and economic activities, as a people, we each have a unique epidemiological background.

It is with this in mind that I remember one night when the calm paediatric and medical wards turned suddenly chaotic.

DOOMED FAMILY

An entire family, consisting of a father, mother and three children aged between four and 10, was admitted through the emergency department with organophosphate poisoning.

As year four students, we were at the bottom of the food chain when it came to expertise, hence we were allocated manual responsibilities such as taking blood samples to the laboratory and monitoring the various infusions set up by the nurses on the prescription of the doctors.

The team fought to stabilise the family and while the parents stabilised, the battle was getting tougher for the little ones.

At about three o’clock in the night, in the background of a wild storm raging outside, we lost the little one.

We did not have an intensive care unit in the hospital and the nearest one was over 300km away in the capital. I took my broken heart and frozen toes to bed.

LIVESTOCK

The morning came with even gloomier news. We had lost the 10-year-old boy. It was depressing to imagine the parents, who were fighting for their own lives in the next ward, having to bear such painful news in such a helpless state.

The population served by our hospital were cattle keepers. They kept the extremely expensive Freshian that were zero-grazed and slept on a cow mattress and produced gallons of milk at a time.

They kept the hardier crossbred cows that roamed the plains with a dedicated herdsboy in tow, occasionally crossing the highway on the way to the cattle dips.

They also kept the all-season traditional Zebu cows that freely roamed the suburban areas and somehow found their way home at night.

Because of the constant presence of cattle in their lives, the presence of organophosphate insecticide was ubiquitous in the homes.

It was the chief acaricide used in farms for spraying animals and in community cattle dips dotting the countryside.

NERVOUS BREAKDOWN

Due to its availability and low cost, organophosphate was easily accessible, leading to its abuse and accidental contact.

A majority of the victims were attempting suicide, but for a few, like in the case of this family, it was intentional poisoning by their nanny.

The poison acts on the body by inhibiting special enzymes necessary for the function of the parasympathetic nervous system.

This system controls the function of the gastrointestinal tract; the size of the eye pupil; the secretion from sweat glands, salivary glands and even intestinal glands; the heart rate and blood pressure; respiration, memory and emotions among others.

With such a wide range of function affected, one can only imagine the upheaval caused by the poisoning. The heart rate shoots up, accompanied by a rise in blood pressure.

The pupils become contracted to pinpoint size while the body muscles involuntarily tremble and become weak.

Then there is the excessive sweating, salivation and the nonstop diarrhoea and vomiting. Death is almost always occasioned by respiratory failure.

POISONING

The damning poison is so volatile, it can enter the body through swallowing, through the skin and even by inhalation.

This can be very confusing, as in the case of Collins*, who was brought in with diarrhoea and everyone thought he had food poisoning.

Yet, there was no one else who was affected and he had not eaten away from home. In fact, he was immobilised at home because he had broken his leg and it was bound up by a plaster cast.

All his tests turned negative for food poisoning and as we were trying to figure out the cause of his discomfort, a sharp-nosed colleague walked in and picked out the faint whiff of organophosphate poison and the puzzle was solved.

Collins’ industrious brother had poured some of the insecticide into his plaster to control a lice infestation. Collins had absorbed the poison through the skin.

ANTIDOTE

An immediate removal of the cast, followed by a thorough wash of his leg was done and along with the already running fluids, the doctor prescribed atropine, the ultimate antidote for the poison.

The atropine is injected intravenously every five minutes until the symptoms settle.

Accidental poisoning is extremely easy and awareness is key. So the next time you are planning to take the babies to visit their grandparents in the village, keep in mind that Grandpa’s storage may require lock and key for the duration of the visit.