Ma fi musari

Two kids with hepatitis A. Their liver tests are through the roof; their eyes are yellow. One is about a year old, the other two and a half.

Hep A is viral, there is no treatment except symptomatic management. So we tell the parents to feed them sweet things. Here what is sweet is not fatty, and since the liver produces the enzymes that help digest fat, this helps give the liver a rest until the body can fight off the virus. I tell the mom to feed her daughters sweet things. "Ma fi musari," she says.

"Can you give me something to keep the fever down?" the mother asks. We only have panadol syrup, a tylenol-like medication, which is contraindicated in hepatitis because it can hurt the liver even more. Medications are free at the health center, but we didn't have anything that would help, and that a two year old could swallow.

These two kids also have a genetic disorder called G6PD, called "fowol" in Arabic. A derivation of the word "fool," which means beans generally and usually fava beans in particular. Fava beans cause a hemolytic reaction in these patients, so do some antibiotics. The mother tells me they were given antibiotics a couple days ago and don't remember the name, but now the child's urine is extremely dark.

I'm worried she may have had a hemolytic reaction, meaning that it has caused many of her red blood cells to burst. I tell the mother to make sure she is well hydrated with water or juice.

"Ma fi musari," she says. There is no money.