Punishment by process

Ian Kunkler

consultant and senior lecturer in clinical oncology, Western General Hospital, Edinburgh I.Kunkler@ed.ac.uk

Channel 4, 21 March at 8 pm

Rating: ****

Most of us know someone who has returned from the tropics with an exotic infection. This Channel 4 documentary really captured the spirit of adventure mixed with fear, naivety, or bravado of Britons travelling in tropical countries. The programme featured the tales of a number of travellers, mainly in their “gap” year. Exotic diseases ranged from one man who had discovered that he had tapeworms—�It was like spaghetti coming out of my bottom, except that I had not been eating spaghetti” [my paraphrase]—to a young woman who woke up on the jungle floor in Thailand with an itchy rash on her arm from an eight hour drunken stupor after a rave (a case of cutaneous larva migrans).

If the NHS needed some positive press for clinical excellence, this programme provided it. Much of the clinical footage was provided by Dr Bertie Squire, consultant and senior lecturer at the Liverpool School of Tropical Medicine. His explanation of the risks that travellers faced in the tropics was clear and informative, without in any way being judgmental.

The programme provided an insight into the differing attitudes of individual travellers to risk. The more seasoned and older expedition leaders regarded contracting a variety of tropical diseases as par for the course. The young man who had contracted tick-borne leishmaniasis on his nose regretted dispensing with the head net that might have protected him from being bitten. None the less, despite continuing to require lengthy drug therapy and the uncertainty about late and potentially disfiguring relapse, he would not have missed the experience.

What was striking was how many of the travellers had amateur video footage of their adventures. We saw them splashing around in waters blissfully unaware of their infestation with bilharzia or close up shots of tropical sores. This made for good television. One traveller showed us an infected deep ulcer on his foot contracted from swimming in a lake in Australia. He made a full recovery. Other contributors were less fortunate in the local medical treatments that they had received. The young man with cutaneous leishmaniasis had had part of his nose excised in South America.

This documentary should be essential viewing for the gap year student planning a trip to the tropics. He or she would be well advised to seek specialist advice before departure. The NHS continues to provide a haven of refuge and medical expertise for those who make it back to the United Kingdom.