Cross-cultural communication （10）　

18）It wasn't traveler's diarrhea
　 An American woman in her early 20s came to my office complaining of diarrhea. She had come to Japan a week ago and said that she had been suffering from diarrhea ever since. She had come to Japan to work as an English teacher, so she should have already started work by now, but because she was still suffering from diarrhea, she was still taking time off from work. She was also worried about not being able to start work. When I asked her about it, she said that she had come straight from the west coast of America without stopping off in places like Southeast Asia, so I thought it was probably due to traveler's diarrhea caused by psychological factors, differences in food and water, etc., and I prescribed her some intestinal medicine and anti-diarrhea medicine.

When I saw her again a week later, she said that the diarrhea was still continuing. As it happened, she had a bowel movement immediately after the consultation, and when I saw the diarrhea, it was a reddish-brown color, and the examination revealed that it was bloody. So I asked her again about the diarrhea, and it turned out that she had contracted amoebic dysentery three years ago while traveling in Mexico. By coincidence, a few months earlier, I had experienced a case of amoebic dysentery in a French patient who had contracted it in Sri Lanka several years previously, and who had not completely recovered from it and was suffering occasional relapses. I referred this French patient to Dr. S of the Infectious Diseases Department at the Osaka City General Hospital (OCGH), and he was successfully brought under control. So, when I contacted the same Dr. S, he said that it was almost certain that it was a recurrence of amoebic dysentery, so he asked me to prescribe metronidazole immediately and tell her to come to OCGH.

I concluded that the problem was heading towards a solution, but she didn't look very happy, and left with a somewhat depressed expression on her face. The next day, she called me and said that she had become unwell and couldn't take the metronidazole. If the special medicine can't be taken, there's nothing that can be done. I thought that I had no choice but to rely on Dr. S. Unfortunately, it was a Friday and it was late in the afternoon. As it was not an emergency, I would have to wait until the beginning of the week to visit OCGH. When I explained this to her, she said that it was fine. She also sounded low-spirited and spoke in a low voice on the phone.

After finishing the morning consultation on Monday, I called her apartment in the afternoon, but it seemed that she was not there. I called the apartment manager, who told me that she had already moved out. At the time, I didn't know what had happened, but there was nothing I could do as I had no way of contacting her. A few days later, I received an e-mail from her. She had returned to the US the day after she had called to say she couldn't take the last dose of metronidazole.

It is certain that she had been unwell with diarrhea since she came to Japan. She was also in a strange environment for the first time, so it is also certain that she was not only physically but also mentally exhausted and depressed. So, when she was unable to take the last remaining medicine, metronidazole, I think the last thread of her heart snapped. It is a case that still pains me to think that there was no way to prevent this from happening.

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