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The Purge

The Purge
July 19
18:22 2019

By: Dr. Abigail Joseph

I grew up in a family house on Sibun Street in Belmopan. Times were different. Our parents and grandparents would put their chairs outside and watch us play red light green light, mother may I and hopscotch in the street. Very few people had vehicles back then; there wasn’t this congestion we see today where there is a 4 vehicle ratio to a house. So for us playing on our street was not a big deal. Life was bliss, simple and very carefree. The ONLY thing that ever disrupted our happy play was when summer came and school was closed. My grandma Rosa would line us all up. There would be a tall glass of water and some sugar nearby and we would all automatically know what she was up to. Besides, it was routine. Grandma purged us out every year and if our neighbors were frequent playmates they would get it too! Everyone would look at each other, with their faces all wrinkled, and my younger cousin would automatically start making gag sounds to upset the others while they attempted to drink theirs while holding their noses. It truly is an art you know? I remember the awful smell of the Senna. At times she gave us serosi that she claimed “cleaned our blood;” other times there was a de-wormer she would make with condensed milk as a paste so as to mask the bitterness. I didn’t know what all was in the glass we drank. We just knew it was a purge and that soon enough our tummies would ache and we would have diarrhea. Now that I’m an adult, I realize – well duh, senna is a laxative!

Belizeans are accustomed to purging. It is somewhat of a tradition. Even to this day there are adults who would pass a fence covered in serosi and ask if they can take some to boil and drink because,” their blood is dirty.” As a Belizean I totally get where they are coming from when I hear such a phrase, but as a doctor my mind tries to reason the “dirt” in the blood. We consider blood tainted when there is “poison” in the blood, when bacteremia, or septicemia occurs which is a process where bacteria, fungus or a virus gets in the bloodstream and affects multiple organs.

But literally dirt in the blood? No! It’s figurative. Symptoms of having “dirty blood” according to the Belizean concept: your skin has blemishes, horrible acne, pimples, hair keeps falling out, reduced appetite, irregular period and the list of things that would deem your blood dirty is endless. When it comes to children we are more concerned about intestinal parasites and often time they would treat them with senna. Laxatives accelerate the process of food passing through the body. If a child has intestinal parasites having diarrhea may cause some of the worms to expel with the faeces. However, using senna as the sole purge for children when trying to rid them of intestinal parasites is not very effective and can cause harm. The use of laxatives such as senna in children has side effects such as abdominal cramps and the acceleration process can produce an electrolyte imbalance and in some cases severe dehydration. It can also cause damage to the intestinal wall if diarrhea persists, where the tiny celiacs that are responsible for absorption of nutrients get worn. At the end of the day, the child can still have parasites. I understand that maybe that was the way we did things in the past but science has found new ways to rid the body of parasites without the pain and without the other unwanted side effects. In fact the Ministry of Health’s Maternal and Child Health program has a deworming program where they go to schools and ensure that children get the right amount of treatment.

Intestinal parasites can affect anyone at any age. The Ministry of Health focuses on children because they have the highest risk of contracting diseases and infections. The Ova of many of these parasites are found in the dirt: transmission fecal-oral. Kids may transport these with ease as they are often the ones who are found playing in the dirt or constantly in need of a reminder to wash their hands properly. The incidence and the prevalence of the infection would vary from district to district as the hygiene and culture in each district is different. For example, in the southernmost part of our country we would observe children who are barefoot – they interact with pigs, horses, cows, they swim in the rivers, live in houses with dirt floors, use latrines and many still go down to the river to collect water. The contact with parasites is higher in these areas due to the lifestyle, culture and environment.

There are many types of parasites out there and we tend to generalize the manifestation of their presence as having “dirty blood.” I am in no way trying to discredit years of culture, tradition or superstition. But allow me to explain one thing. I like to explain to my patients that parasitic infections are mainly caused by three groups: protozoa, helminths and ectoparasites. Understanding each of them or at least what they are, allows us to better prepare for the mode of treatment, and understanding why certain treatments wouldn’t work based to the type of parasite we have. Protozoa are single celled organisms that are capable of producing infections. It is generally acquired from drinking contaminated water. Helminths are also known as worms, and these include: tapeworms, round worms, and flat worms. The ectoparasites are those that feed on your skin, such as ticks, fleas, mites and mosquitos. Sometimes an external manifestation such as bad skin can be as a result of irritation from a bite from an ecto-parasite rather than a parasite within the body; of which laxative such as senna would be ineffective. See my point?

We come in contact with parasites daily. This is why it is imperative that we practice proper hygiene and teach our children the same. We all have parasites. It’s inevitable. At some point we might drink a little pool water, fail to wash our hands after doing yard work, forget to wash the veggies or eat meat at a restaurant that wasn’t thoroughly cooked, especially when we pretend to be “of class” and order “medium rare.” This is to say that children are not the only ones in need of a purge. As adults we should take the idea into consideration. Some parasites travel from the intestine to lay eggs in our lungs. This can give flu like symptoms or lead you to think you have a cough, when in reality all you have are worms. I remember one time in Cuba a mother brought her son with a cough for three days, and the little boy coughed up worms on the table! It happens and it can happen to anyone.

How can you know? Visit your nearest health care provider and get tested. Many times when you ask your doctor about worms they automatically prescribe Albendazole; GET TESTED, no short cuts – do the blood test or stool test…..see what specific worm or protozoa you have and get treated accordingly.

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