Trustworthy Diagnosis?

Apparently, according to the results form below, Joel has malaria:

This is the result from a blood slide test that was carried out on Saturday at the local clinic in town. I took Joel there to be checked after he had an awful week of vomiting, from early Monday morning up until early Friday morning.
This is Joel's registration card card from the clinic where he was tested:

We had already done a home rapid-result malaria test, which was negative. Apart from the vomiting, Joel was showing none of the more obvious signs of malaria- in particular, he had no fever. But as a precaution, local clinics always recommend malaria tests, so I went along with their advice on Saturday when I took Joel to the Aga Khan health centre in central Dodoma to see the doctor and have him properly checked over.  The visiting doctor that I saw, from Kampala, was very good. He reassured me by doing a proper examination of Joel's stomach and his hydration levels; but he still sent Joel for the standard malaria test.

Before collecting the results of the test, I was warned that Aga Khan nearly always issue postive malaria results, so I was a little cautious when I came back to the clinic to collect the outcome of Joel's test.

When I saw the paper above, my heart sank- a positive result! BUT could I believe it? Joel was improving by the hour and seemed so much better than he had in the previous days. He certainly was not acting like someone who had malaria!

I decided to double-check with a retired Italian pediatrician who now runs a coffee shop in town. I took Joel and the results paper and drove over to the coffee shop, where I ordered a bottle of water and then asked the Italian doctor to check the results written on the above paper. It is not every day that people go to a coffee shop for medical advice- but this is Dodoma!

"Dr Massimo, what does this mean?" I asked, as I showed him the results.

He took the paper from my hands, squinted at it, looked at Joel who was standing next to me drinking from his bottle of water, looked back at the paper and then exclaimed,

"NOTHING!!! This, it means nothing!! This child, he does not have malaria- he could not stand here if he did- this is rubbish! These blood slides are never accurate- you should do a rapid-result test to check malaria, not an Aga Khan test- and I tell you, don't go back to that clinic again!"

He then muttered something incomprehensible (in Italian??) under his breath and gave back the paper. I felt very relieved that he was so outspoken is dismissing the results, as I did not feel they were correct.

When Andrew came home from flying on Saturday evening, we made the decision to do another home-kit rapid-result malaria test- which was negative. It seemed Joel did NOT have malaria after all.

Knowing what and who to trust on a medical level are part and parcel of the challenge of living in Dodoma with small children. Making decisions on where to go with the sick child, who to see and who to believe can be as emotionally and physically draining as the effort required to spend all day in and out of the clinic: waiting for the doctor, waiting to go to the lab to do the required tests, waiting for the lab results, waiting to see the doctor again to get a run-down of the lab results. A 4-part process that necessitates a LOT of waiting!

Saturday's medical outing for Joel required much patience, as we started the day at a different clinic where we took a delightful (!!) poo sample from Joel to be analysed: 

After depositing Joel's foul-smelling offering at the MacKay House laboratories at around 10:45am,  I returned home with the 3 children to drop Esther and Ben off with kind MAF neighbours. They had called me and volunteered to take care of  Esther and Ben until I was free of medical visits. What a HUGE help this was. What fun for Esther and Ben to spend the day with their good friend Aleah and her family, rather than trailing miserably around Dodoma's medical institutions!

 Joel I returned to town to pick up his stool-sample results at 11:30am.
"No worms", the lab technician told me, but no other information was available about possible causes of his upset stomach and vomiting, as they only do full-screen tests on Mondays- Fridays!
Then Joel and I went for a quick visit to my usual food shopping venue, the "2 Sister's" shop in town, where the shop-keepers were concerned to hear about Joel's health. They very kindly set up an appointment  for me at Aga Khan, where they have a lot of influence. I was very grateful for their help.
But things take time in Dodoma. By the time I'd seen the helpful Ugandan doctor, done the malaria test and had the results, it was almost 4pm!

The day had gone; the results were uncertain. Thankfully, here we are on Wednesday and Joel is fine. All's well that's ends well! With hindsight, I'm glad I didn't believe everything I'd been told!