October Story of the Month

By Mark Nelson, MD

Understanding a patient's cultural background is often essential in making a correct medical diagnosis. This is especially true here in eastern Ecuador where patients come from a variety of ethnic backgrounds and speak any of several different languages. One patient in particular reminded me of that recently.

Marco was a 6 year-old Shuar boy who was brought to us after a week of unrelieved vomiting at home. He was weak and severely dehydrated. We immediately began intravenous fluids and worked to correct his electrolyte imbalance. After two days of intravenous fluids, Marco was re-hydrated and should have been ready to go home. But he was continuing to vomit. He still could not tolerate anything by mouth - liquids or solids. "What could be wrong?" I wondered.

Complicating matters was the fact that Marco could only speak Shuar. His family was unable to be with him in the hospital, and we had to rely on a translator to communicate with him. As much as he continued to throw up whatever we fed him, he cried from loneliness even more.

As we began to investigate why Marco wasn't getting better, it became apparent that he had an obstruction in his colon. We tried any number of different ways to clear this up. Finally after three days the obstruction was successfully relieved. And what came out? Ants!

Prior to getting sick Marco had eaten a whole feast of ants - an important source of protein and a real treat in many jungle communities. Unable to process all this fiber at one time, the ants had simply obstructed his bowels, and caused nearly two weeks of vomiting. I, an American-trained physician, had never thought to ask him about this part of his diet.

Editor's note: I was very careful to eat only nine or ten ants yesterday when offered a plateful of them. I was remembering the above situation and also another in which the surgeon, following surgery, actually counted the ants that had been blocking the colon of a certain patient - there were 66!