Dealing with AF in a developing country

I found this site after I became aware yesterday that I had experienced an episode of AF and i have to say that the tenor of support and compassion of the people who post, made me want to join the site, which is something i seldom do.

I am working on an aid project in Cambodia, where first world medical care seems almost unreachable when things strike. On Thursday I got up after a terrible night of high fever topping 40deg C and decided to head to the clinic before work. I imagined that it was an upper UTI from a difficult kidney stone that had been stuck at the entry to my bladder for almost 4 months and so I had all the tests and the doctor brought me the results. I still had the kidney stone, I did have an UTI from the blockage but i also had dengue fever.

So they treated the UTI with antibiotics and dengue with only paracetamol as nothing can stop it and you just have to bear with it and wait it out. Yesterday morning i got up and felt some fluttering in my chest, I had experienced it twice before, once in Bangkok where they put a halter on me and tested for all the things that can be serious and did a echo cardiogram which was normal and nothing showed up on the halter results. So yesterday I though it was just another bout until i felt this kind of shuddering feeling in my chest and my heart began to take off like a runaway train. My home blood pressure kit showed readings as high as 154bpm and so i took my 7 year old off to school (I am a single dad and i have raised him by myself since he was one month old) and got myself to the clinic.

The doctor on duty was from South America and is competent and he hooked me up to the monitors and my heart rate started to hit the high 180bpm and he had an approach that i had not read about since whereby he packed ice packs directly against my neck as he said that there were sensors there that the body used to determine heart rhythm. he also gave me one tablet of metoprolol and after about an hour of anxious looking faces and an ECG that showed AF, my heart stabilised and i headed back to the observation room to continue with the antibioics. i went home and the AF struck again in the afternoon and i did something stupid that I remembered from my police training in Australia in the 1970s, the pre-cardial 'thump' and gave myself one moderate tarzan beat on my chest and the AF stopped immediately.

So now i am hoping to be assessed in Bangkok when the dengue is over with but you can imagine my panic and fear of leaving my 7 year old fatherless... well it was a bad day. Reading this site has given me a much calmer and more re-assured attitude to the illness and to all posters I wish to say thank you. I have lived and worked in developing countries for 18 years and the isolation and lack of access to proper medical care has often been a concern but this is the first time that i was really scared.

Oh, I confessed to the Tarzan thump to the doctor and nurse and they scolded me so I have decided to retire that remedy, however, I did read that someone else had had good success with three hearty coughs, so next time it strikes I plan to make that my reserve strategy.

Thank you for the great site.


18 Replies

  • Well we are all here if you need us all varying in our experience of AF have you read through AF info on the site helps with planning what questions to ask. Information is key to gaining some answers to what happening welcome

  • When my kids were young one of their favourite books was 'Did I ever tell you how lucky you are?' - Dr Seuss, and your story reads to me like an extract in that we may have trials as a result of AF but very few like yours.

    I hope your bad episode was brought on by the illnesses you were suffering and there won't be a repeat so scary. I hope you have some backup in the care of your son?

    I am sure you'll receive a flood of help and support here should you ask. Best wishes.

  • Welcome to the site. You should be an inspiration to those who think AF is the worst thing that can a happen to them and are living in a comfortable western country with excellent medical care.

    My only advice is to look up AF Association website as there is so much information there that can help you. Please do ask any specific question and we will try to help you.


  • Welcome John, and not a little jealousy from me as I love Cambodia and don't have the guts like you to down tools and go and work there.

    I think everything you have said seems to point to paroxysmal AF and if I were you the first thing I would do is try and get that confirmed, not sure that the "South American" doctor did that or did he?

    I would then take a CHADVASC2 test online initially to check my stroke risk, and given where you are, if it's high enough personally I would take a NOAC to avoid the blood tests, given your location.

    You are right of course you are not going to leave your 7 year old fatherless, at least not through AF may I say, not very likely.

    What would I do next? apart from reading things like the AF website from cover to cover for the knowledge and thereby power, is probably ask for an echocardiogram when next in Bangkok, to check the heart and make sure there are no other problems. I would also keep a diary of symptoms, especially trying to link it to things that are happening around you, I am not medically trained but we know the body is more susceptible to AF when low, and dengue fever must be taking it out of you big time.

    If you are very lucky the two might be linked, and you might not suffer again as the fever retreatsk, if not you need to understand the condition as much as you can.

    I wish you well, and "mean sokhpheap" or "មានសុខភាពល្អ"


  • Our daughter is also a volunteer worker in a third world country and had Dengue last year. The high fever and dehydration would certainly be a factor in setting off AF.

  • Interesting bit John on the ice on the neck, probably connected to the Vagus Nerve (links stomach,heart,brain). I think my PAF is Vagally mediated. Evidently, cold water/drink/other things via that nerve can set AF off and can also put it 'back in the box'. I have a list of things to try if I go into AF to work out what's best.

    On the coughs, a paramedic told me that can work because when we cough it sends an electrical charge to the heart - often wondered why doctors asked you to cough when using their stethoscope.

    Good Luck!

  • I was also interested in the detail about an ice pack on the neck. This is something I have not heard about. I have , however, recommended several times on this site about how easy it is to take your pulse half way down your neck to the side of your oesophagus. It's called the carotid pulse. I can find it in a second whereas my wrist pulse is impossible to find.

    Very best wishes.

  • When I had SVT's I would drink ice water to try and bring my heart back to sinus rhythm also laughter can help, Please get this checked out for your peace of mind.

  • I can understand a little of what you are going through, as I was diagnosed with AF and DCM whilst working for VSO in northern Namibia. I travelled to Windhoek to see a Cardiologist visiting from South Africa and he told me that I would have about 5 years to live (I was 56). Subsequently I found out that his thinking was way out of date but the shock of the diagnosis combined with the isolation really frightened me. I was in Bangkok recently and had to have emergency blood tests. I was impressed with their professionalism and speed of response. I think that you will receive excellent care. Good luck and let us all know how you got on.

  • Hi Barb when were you in Namibia? We are planning a 6 week trip to Namibia and Botswana next year with some friends. Shipping our Land Rovers to Cape Town. I was going to ask about medical facilities nearer the time but your experience doesn't sound good!

  • I was there 2008-9. The GP who diagnosed me (unofficially) was brilliant and all my tests were done quickly and efficiently in Oshikati.

    But facilities and training lag behind the West. I could speak to you more about your planned holiday nearer the time but I would suggest if the AF continues, kitting yourself out with BP monitor, INR self checker( if on Warfarin) and spare batteries for your mobile phone as well as adequate medical insurance that could air lift if needed. If you are aware of the risks and prepare for that then there is no reason to let a diagnosis hold you back.

  • Thanks Barb - Id certainly appreciate talking to you nearer the time - thanks. We arent going until May / June 2016. Heather

  • No probs

  • What an interesting life you live! Something I would have loved to have done. Good advice from everyone, but I just wanted to say hello and welcome to this great site.


  • Hmmm, I used to try the thump method too, pre-ablation, when in paroxysmal afib. Never worked, though. Guess I'm more Jane than Tarzan. Can't help wondering why that's not a good method vs. cough (which never helped either)? Good luck with that dear boy. What an adventure of a life for him!

  • Hi and welcome to the forum. My first episode of AF was whilst sailing in the Atlantic so no medical attention available so I just had to cope, but then I didn't have dengue fever and a kidney stone/infection!

    AF feels very nasty but as long as you are sensible, and sounds like you know when to seek help, you adapt.

    I agree about this forum, the best support and advice I ever experienced.

    Very best wishes Susi

  • Wow John that was an interesting read,nothing more I can add,great info above,just wanted to say welcome.😁

  • hello John,

    First of all much admiration for the work you're doing in Cambodia, such a needy lovely country. My firsthand experience is limited to some months travel in SE Asia 2 years ago at the age of 71 with persistent AF among other things. I investigated hospitals before I went if only to get INR checked and most sources tell you to go to Bangkok for everything. However I was checked adequately by the Vietnam Family Medical Centres in Hanoi and HCMC and a clinic in Phnom Penh, less well in Kampot unsurprisingly. However, the hospital I was told to avoid at all costs in Luang Prabang dealt with unexpected pneumonia brilliantly whilst the Hanoi clinic failed to see a broken wrist on X Ray... If I were you I would do as Beancounter suggests and make sure of your diagnosis in Bangkok. Discuss management with the guys there and do your own research on this site. A NOAC would be easier in terms of the difficulty of INR checks, but has implications for your kidneys and the greater difficulty (than Warfarin) in reversing bleeding in case of injury. On the other hand you can self check your INR, carry your warfarin and check dosage by email with a trusted clinician. Please don't put all your faith in the three cough idea! If it is AF, it can be handled, never fear and you have years and years of the ups and downs of parenthood ahead!

    Hope the dengue is receding

    Lots of luck


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