The External Eye Disease clinic is one of the more exciting rotations during our residency in the Department of Ophthalmology in PGH. Our mentor there was a brilliant researcher and teacher who was widely respected for his knowledge and experience. We all looked forward to being mentored by him because we get to see and learn about an enormous number of common and even rare cases just from the sheer number of patients that come to PGH everyday.
It was here that I saw the case of a girl, barely 2 years old who was brought in by her mother because the child's eyes were covered in pus. The lashes were stuck together and the child was clearly agitated. With one look, Dr. Valenton, our consultant, sadly shook his head, “it’s gonorrhea”.
“How is this possible?” I thought. Gonorrhea is a sexually transmitted disease. Was the girl a victim of abuse? No, the mother insisted. Then she claimed that her baby probably just had “sore eyes” or “piskat” because many people in the densely populated urban-poor community where they lived also had “sore eyes”. Piskat is a highly contagious viral infection of the eyes that is transmitted by touching contaminated surfaces or body parts. It is easily passed on among persons who live very close together. And a baby is particularly vulnerable because people love to kiss them. It is not unusual for neighbors and friends to ask to hold the baby or playfully kiss it. Someone with mild sore eyes might have kissed this baby and that's why she also got it. Luckily most cases of “sore eyes” will eventually get better after about a week, even with no treatment. Maybe this child simply had piskat?
“Did you drop urine on your baby’s eyes?” Dr. Valenton casually asked the mother. Yes, yes she did, the mother answered. Treating sore eyes with urine is a common practice in many poor communities because it really does seem to be effective. Personal testimonials of people who got well after putting urine were all the proof needed to make the rather gross practice become widely accepted as a cheap form of folk remedy, instead of the expensive eye drops an eye doctor might prescribe.
The use of urine and many other folk remedies result from a wrong conclusion about many self- limited viral diseases because they will eventually get "cured" if given enough time. Very often the treatment claimed to be the reason for the “cure” actually had nothing to do with it. It was just the natural course of the condition. Most of the time, these folk remedies are not dangerous. For example people also believe that mother’s breast milk is effective in "sore eyes", but luckily there’s little harm from using that. And for many people, urine is much easier to obtain than mother’s milk, so they use that instead. Again, other than it being rather gross, this is not necessarily wrong - if the urine is “clean”. The danger is if the person who "donated" the the urine happens to have gonorrhea. Then this simple folk remedy becomes dangerous. This is what happened to this child.
It was very clear that this baby did not just have “sore eyes”. It looked so much worse. Her lids were swollen, red and fresh pus mixed with the tears coming out of her eyes while she cried. We collected a little bit of her tears and stained it on a glass slide. A quick look under the microscope confirmed Dr. Valenton’s suspicion. The baby had gonorrheal conjunctivitis.
Gonorrheal conjunctivitis or GC is a severe bacterial eye infection which, unlike a viral infection, is usually very treatable with antibiotics, although a few strains have developed resistance to the more common ones. This baby was lucky. Her infection responded to the antibiotics and she quickly got well soon after.
Like “sore eyes” COVID-19 is a viral infection that easily spreads in densely populated communities; and just like most viral infections, almost everyone who gets it will eventually get well, often with mild or no symptoms. But the very fact that most patients get well even without treatment is also why it is so easy for some people to jump to the wrong conclusion and easily believe that the folk remedy they tried is very effective. More and more people try it and those who get well then become the strongest evangelists and proponents of the remedy.
This is why many well-meaning and educated people will swear that “tuob cured them.” They are certain that after doing "tuob", their symptoms disappeared and they got well not realizing that they would have gotten well even if they just rested in bed, stayed hydrated and took some pills for the fever.
"Tuob" or the practice of inhaling steam unfortunately may actually make matters worse for the few who will eventually get severely ill; and because they waited too long before getting serious help, they could die. Also, by sharing the communal "tuob", the chances of spreading the infection becomes more likely among the vulnerable members of the family. And even if they don’t actually have the infection, the danger of burns and accidents from using boiling water just can not be ignored.
Testimonials and stories are what doctors call “anecdotal evidence”. Time and again this has been shown to be the weakest form of evidence in proving the efficacy of any remedy. It often unknowingly causes more harm than good.
The very dangerous pronouncements made by people in government who do not seem to accept that they may be very very wrong about something they are encouraging their constituents to do is the reason why doctors are now raising the alarm about such popular practices.
We can not just sit back and let this kind of thinking go unchallenged. I’ve been in practice for 30 years and until now I still don’t understand why people would choose to believe a neighbor, friend, relative or worse, a politician, instead of practically the whole community of doctors.
It’s uncanny how a baseless superstition can spread as quickly as a viral infection. It makes many doctors want to give up, or for some to lose control and say things they maybe should not have said out of sheer frustration at the seeming futility of it all. But this does not mean that what they’re saying is wrong.
Dr. TK Gonzales
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