For the past week, we have been spending a great deal of
time at the Consultorio
Central, which serves urban patients residing in the central part of Santo
Domingo. It seems that around 30-40% of the patients we have seen are
presenting with Salmonella typhi. Salmonella typhi is a bacterium that is
transmitted via the fecal-oral route and causes Typhoid Fever. Signs and
symptoms of Typhoid fever include sustained high fever, stomach pain, headaches
and weakness. A stool or blood test is used for diagnosis. Typical antibiotic
treatment includes ampicillin, SMX-TMP or ciprofloxacin. A vaccination is
available – however, the vaccine is not completely effective.
There are many street vendors in Santo Domingo, which sell a
large variety of food – raw fruits and vegetables, warm bread and muffins,
fish, cooked chicken, rice, fruit juices and smoothies. The vendors wheel out their carts, some very
elaborate with grills and blenders, every morning on our walk to the bus stop. An
example of a street vendor:
Often the food looks and smells very appetizing. However,
there is very little ability to account for sanitary practices. Thus, many
people contract Salmonella typhi by
eating food sold from street vendors. After witnessing multiple patient
consults involving Salmonella typhi,
we have concluded gastrointestinal infections simply seem to be a way of life
here. An alternate source of contamination is the water supply. It is extremely
important to only use bottled water in Santo Domingo – even to bush teeth!
In the United States,
the FDA closely regulates the safety and quality of food. Even hot dog vendors
must meet certain health standards. Outbreaks of illness due to food
contamination are taken very seriously by the CDC, as one might recall various
recalls on peanut butter, tomatoes and Jimmy John’s sprouts over the past few
years. I have never truly appreciated food safety and the absence of concern
over whether or not my food is contaminated in the US – I sure do now!
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