Schistosomiasis Presentation

As GPs we are required to manage a diverse range of presentations. As our suburban populations change with gentrification by generation X and the housing of refugee families we have travellers and former residents exposed to endemic disease causing blood flukes like schistosomiasis haematobiurn.

We all have access to several sources of information on this from MASTA and Sullivan and Nicolaides publications as well as MIMS and our colleagues in Uni of Qld and infectious disease specialists based at PAH and TM-VC.

A working party of local expertise was convened on 9/9/99 inviting representatives of the Somali community who had been singled out by the Channel 7 broadcast of an interview with Dr. Andrew Pluta as well as the Australian Doctor publication of an article by his partner Dr. Pam Rosengren in which the size of the Somali population in Brisbane was over estimated as 2,000 and their education levels under estimated.

So it was little surprise to have the community leaders upset at the stigmatisation they have borne the brunt of in the subsequent weeks of "public hysteria fostered by unprofessional statements" their words 1 quote. They also reported on their own experience of and again I quote, "feeling dirty and humiliated by the public discussion of a health problem identified as theirs alone".

Uni of Qld expert Dr. Adrian Sleigh and the Somali representatives revealed that Bilharzia is common and routinely treated with an inexpensive medication in endemic areas where an active public health program is in place. The war that displaced so many people often left in exile for 5-7 years in non-endemic areas of Africa before immigrating to Australia may have weakened local health measures. Resulting disease is often unrecognised or asymptomatic and health checks rudimentary or information not shared. A refugee program piloted by BISDIV and now funded by Qld Health and coordinated by the Red Cross, QPASTT, and DIN4A has offered all refugees in our suburbs the opportunity of readily accessing our health care system.

Whilst it is true that some refugees place the acquisition of English lessons before health matters eventually we as GPs are involved in their lives. A model of support for GPs by community nurses, QPASTT and the Red Cross exists as promoted in our newsletter, with up-skilling events such as tonight available to GPs.

The outcomes of the schistosomiasis working party convened by Dr Brad McCafl has been threefold. Firstly we have afforded a professional apology to the Somali Community Representatives. Secondly there is now improved access for patients to the Infectious Disease Outpatients at P.A.H. Thirdly we have produced a diagnostic and management algorithm to assist G.P’s in their patient care. This is presently in draft form with two treatment options noted. The recommended remains that espoused by "S & S&N which use the least costly tds dosing of 20 mg / kg eg 1200 mg tds for a 60 kg person. with the drug supplied as packs of 8x600 mg .