Meet a Specialist -Dr Miguel Madariaga
What attracted you to go into medicine?
When I was about 8 years old, I developed intense chest pain. After unsuccessfully trying some homemade remedies, my mother took me to the local family practitioner, a venerated older man, known to solve difficult cases. The waiting room was very austere but had a painting of a young physician saving a woman from Death (represented as a threatening skeleton). The image, although retrospectively melodramatic, was very impactful for my young mind. After a long wait, the doctor let us in. He listened patiently to my complaints and my mother’s worries. He examined my chest meticulously and put me under an old-fashioned radioscopy machine (where I could see my own bones!).
He concluded I had nothing worrisome and said with certainty that it was an injury caused by blunt impact. I denied any trauma. He insisted … then, I remembered … a few days ago I had fallen from my bike and hit my chest with a huge rock. Fortunately, my friends were not watching when the accident happened and I rapidly regained my composure, apparently subconsciously forgetting the incident, as well. When we came out of the office, I expressed my amazement to my mother. How could somebody find what’s wrong just by asking questions? What did it take to be able to play with the radioscopy machine? Why did I feel “cured” after he examined me? My mom explained that a good clinician was like a detective, able to find clues by asking detailed questions and examining the patient. And yes, good doctors are healers, they make you feel well by connecting with you and explaining things in plain terms. Finally, one day I could play with a radioscopy machine but it would take many years of studying. I was completely sold!
What branch of medicine are you in?
I am an infectious diseases physician. I am interested in emerging infectious diseases (such as COVID-19 or Zika) and in atypical mycobacteria infection in the lungs (this is a disease similar to tuberculosis, but not transmissible between persons and very common in South Florida, where I reside).
Why did you get involved with the Trust?
I was born and received my education in Peru, a country with a severe deficit of medical specialists. Although I currently live in the United States, I wanted to give back my expertise to patients who otherwise will not have access to my services.
Why do you think the Trust is important?
The field of medicine has evolved so much that no physician is able to keep abreast of details pertinent to other specialties. The need for expert advice is more prominent in developing countries. Swinfen Telemedicine provides the connection between specialists and vulnerable population and provides reassurance to practitioners in remote areas.
Any interesting cases you can share?
One of the most interesting cases I ever had was one of my first consultations via Swinfen Telemedicine.
In 2009, a 5-year-old girl from Nigeria, developed a big belly. She did not have any fever or other symptoms, only her abdomen was growing bigger by the day. An ultrasound showed very thick fluid described as having “wavy strands”. The fluid was drained and had a dark brown colour. The local doctors believed this was peritoneal tuberculosis, that is tuberculosis affecting the sac that surrounds and protects all the organs in the abdomen. This would be a common diagnosis in Nigeria. Tuberculosis usually affects the lungs but can go to other organs. When it affects the peritoneum, it causes accumulation of fluid (but patients usually look ill and have a fever). The girl was started on treatment with drugs for tuberculosis (that is more than 10 pills a day). After two months of treatment the belly was as big as before. I was consulted then. I started by listing all the causes of ascites (fluid in the peritoneal sac). Many of them are infectious but none of them made sense because the girl didn’t look sick and none of them causes brown fluid. I had to conclude this was not fluid in the peritoneum but something else. I speculated this was a large omental cyst. The omentum is a fat layer that connects the bowels. If a large cyst (a ball full of fluid) grows in the omentum and is large enough to occupy all the belly it can be confused with fluid in the peritoneal sac. I suggested the medication for tuberculosis be stopped, discussed the case with a local missionary surgeon, who operated on the girl and was able to fix the problem.
The girl after two months treatment for tuberculosis
Fluid being drained from the girl’s belly
Large omental cyst removed during surgery
Your most rewarding case?
Medicine gives rewards on many fronts: intellectual when able to resolve a difficult case; professional when noticing improvement in a patient after adequate treatment; spiritual when helping somebody accept the reality of the end of life. I see rewarding cases every day.
How would you like people to help the Trust?
Specialists can donate their time, philanthropists can donate money, everybody can spread the word!
(Images supplied by Dr Miguel Madariaga)