Yesterday I was mentoring these Chinese family medicine resident physicians. During my presentation I suddenly sensed a shaking chill. The weather is extremely cold here in Shenyang, far NE China – about -10 degrees. So I attributed my chill to the walk outside. But then I was struck once more by that bone-rattling sensation, followed by extreme fatigue. Not wanting to miss this teachable moment before I departed, I quizzed the residents about causes of acute fever in China. These are similar to the US: upper respiratory viral infection, strep throat, influenza. But China also has some unique causes: dengue, Japanese encephalitis, epidemic meningitis – uncommon but everyone here is vaccinated, except me.
What would you teach these healthcare people about evaluation of people with acute fever? I emphasized to them, as I do to all INMED International Medicine & Public Health students, the prime importance of first considering the local fever etiologies wherever you may be serving. I related how last July I suffered a similar febrile illness with identical chills and fatigue. But at that time I was working in Angola, southern Africa. Observe the map above. Malaria is rare in China, and very common in central and southern Africa. My malaria test was indeed positive. I was treated and recovered quickly. Tonight in Shenyang I’m nurturing my fever, confident that at the very least my residents benefited from a very teachable moment.