Nairah Mayanja Nabukenya
Malaria
Uganda

“Experience is the best teacher” loosely translated suggests that true learning comes from experience. Unfortunately, in matters of health, learning through experience is not the ideal situation as the stakes are far too high. No one wants to “learn” through pain, confusion or a misdiagnosis.

Yet in my story, I could not help but wonder, if I had faced something similar before, I might have been able to maybe, recognize what it was or what it was not and perhaps even guide my doctor towards the right diagnosis.

My symptoms started off with a mild headache, weakness and fatigue. I thought I would contain the headaches by taking painkillers but later realised I needed to seek medical attention. Together with my dad and sister, we made our way to a nearby hospital.

I did see a doctor who suspected it could be Typhoid and recommended that a Typhoid test be taken when I described my symptoms. He added that there had been several cases of Typhoid that had been reported in the past few weeks.

Instinct is an interesting thing because when my blood sample was drawn, there was a lot of blood spill, maybe not a lot but enough to feel unsettling and appearing even more alarming against the pristine white tiles of the hospital.

I remember feeling uneasy. To be fair, this had never happened to me in all history of my blood sample being drawn and I couldn’t help but wonder if a nurse could get something so routine wrong. While part of me rationalized it as a simple mistake, I couldn’t shake the bad feeling I had about the situation noticing how fidgety my nurse got as this happened.

Much to my surprise, the test came out positive for Typhoid and I was prescribed a myriad of medications and injections. I received one injection just before leaving the hospital. While hospitals are rarely pleasant, if ever, there is always a relief that comes with finally putting a name to the cruelty that the body has been enduring and will be right on its way to recovery.

The night was rough. The following day was even more difficult and apart of me was looking forward to my next injection in the hopes that it would offer some relief. Thinking perhaps this second one might trigger some improvement.

Though with each dose I took, I felt worse with my symptoms only intensifying. Severe nausea. Loss of appetite. Diarrhoea. And now vomiting.

My dad got anxious and did not understand why I was not getting any better. Without a direct line to the hospital or doctor, I waited for my next visit to inform the doctor about how I was feeling. He assured us that I would feel better once I completed the dose and the side effects were a common reaction to the prescribed medicine.

We believed that being sent home meant I was expected to recover and would be fine.

By day 3, I was terrified of taking any more medicine and yet did not want to stop out of fear of not being able to reach the point where I was supposed to start feeling better. It felt like an insult to be asking any further questions about my symptoms, so I continued with the medicine and waited to get better.

At the time, my mum was out of the country, but she returned on the third day of my illness. Motivated by her passion for healthcare, patient safety and the many stories she had come across about misdiagnosis made her unwilling to overlook my deteriorating condition. She insisted we seek a second opinion upon her return.

At this point, I could not walk unassisted and could barely speak. I was feeling extremely weak. I wanted nothing more than to lie down and wishing we could delay the trip until the following morning.

We got to our family doctor and mum went over the ordeal from the past three days. At triage, the nurse checked my pulse, and my mum noticed a flash of alarm in her expression as she reached for another stethoscope as if to confirm the reading she was getting. She explained that she was unable to detect a pulse and needed to double check using a different one.

Our doctor quickly ordered that I be put on drip and that a malaria test is taken. Malaria? Why? I remember thinking because this felt far worse than any malaria I had experienced before and yet I knew how brutal malaria could be. The thought of facing another round of medication that was not likely to work was terrifying.

The results of my blood sample came back – Malaria +++.

The doctor, once assured I was out of danger, lightened the mood by joking that I had been “slowly dying.”

He further explained that malaria now often presents itself in different ways, leading to missed diagnoses.

It made sense. Fever was not even one of my symptoms. My temperature seemed stable which is normally a symptom we all seem to know as synonymous with malaria.

I walked out of the hospital better than I had come in. This is the feeling we want to have after seeing the doctor. Maybe not immediate relief but hopes of getting better. We rely on our health care professionals to guide with precision or at least, that’s what we hope for.

Unfortunately, my story is a reminder that while we trust in the system to point us in the right direction, sometimes, even the best intentions can fall short.

My case had me wondering, how many other people had gone into that hospital and been misdiagnosed with typhoid and had to go through the same experience? Was something overlooked in the doctor’s judgment, or did I fail to communicate a crucial aspect of my symptoms? Why didn’t my first doctor consider performing other checks especially after I reported no improvement? His focus on typhoid seemed to dismiss the need for further investigation.

As someone with a background in risk and compliance, the lessons I’ve learned resonate with this year’s World Patient Safety Day theme: Diagnostic errors.

I’ve come to realize that these errors aren’t just clinical failures; they stem from deeper issues such as breakdowns in communication, insufficient oversight within healthcare systems, and lack of robust systems for patient follow ups. Feedback may be provided, but without implementing effective follow-up systems to track the patient’s progress, it often falls short of driving real improvement in care and patient safety.

From where I come from, patients often lack the knowledge to fully interpret their symptoms, while some doctors may sometimes rely heavily on common illness patterns, which can unintentionally overlook individual differences.

In my case, the symptoms I presented closely resembled typhoid and with the numerous cases reported at the hospital that month, the doctor, despite my feedback on how I was feeling, concluded it was likely a reaction to the medication.

Unfortunately, this conclusion was reached without further investigation or exploring other possibilities, and the assumption that my case fit the prevailing pattern led to a missed opportunity for a more accurate diagnosis.