Cholera.... or Malaria???

I am hiding in a little internet cafe in Lilongwe, Malawi.

Not so long ago we were camped at Chitimba beach which is right on the lake. Another awesome little spot. But we found out after we got there that there was a cholera outbreak in the village not far from the camp. There had been 2 deaths in the last 2 weeks. As long as people are good with their hand hygiene, and eat well cooked food we decide it shouldn't really be a big issue.

The next day 3 people are sick with diarrhea - usually I wouldn't be too concerned because people get diarrhea here in Africa all the time, it's part of Africa, it's part of the deal with excessively tiring out your body through excessive amounts of cycling. Because of the cholera outbreak though I decide that they probably should be taken to a medical facility to a doctor that hopefully knows a little more about cholera than I do. A cholera outbreak at camp would be enough to shut down the tour for a couple of weeks. Another 3 people come along aswell who have also not been feeling too well recently either.

The doctor is not concerned about cholera. Apparently a cholera bowel motion looks like a flakey rice water and it doesn't stop coming (if you were interested... sorry I'm aware that not everyone reading this works in the medical field so perhaps many of you are not that interested).

He's more concerned that we need to rule out malaria. So he does a full blood count and a blood film and... 3 cyclists get diagnosed with malaria.

Anyhow, I have only seen malaria once before. But the Indaba staff and some of the other guys I've met who make it a habit of doing lots of tour guiding through malarious areas have all never seen 3 such healthy cases of malaria, and question the diagnosis.

The two options would be
a) to treat it as malaria with some Coartem
b) to go and find another medical facility and repeat the test
We can't ignore a diagnosis like this, and I would like to think that the doctor knows more about Malaria than we do. Time is poor, it's too late for a repeat test tonight, the tour waits for no one. So I choose option a) and if they don't actually have malaria then it's not going to kill them if they have the treatment.

My impression is that because they were taking prophylactic tablets for malaria that they will not get anywhere near as sick as someone who doesn't take any prophylaxis so the doctors diagnosis is quite possible.

For all you families out there that read everyones blogs please do not be at all alarmed. All three of these people are perfectly fine, and have now recovered, and never even got off their bicycles because we got onto the diagnosis early and they were never really that sick in the first place.