Tuberculosis

Tuberculosis.  A term we are all familiar with in the US but more from a historical viewpoint.  

It is alive and thriving well here.  One of the interesting statistics I read was that patients with HIV have a 15% chance per year of developing active TB.  We see it here everyday.  While most of it is Pulmonary TB it also presents in the neck, pericardium, abdomen, brain, spine, and kidney.  

Terry pointed out to me at Church on Sunday how many people were coughing.  I could not help but wonder how many of those coughs were spreading TB about.  

The government pays for TB treatment which is a good thing to enhance treatment compliance.  This x-ray shows a great cavity in the lung caused by TB.  

One of the millennium goals is to reduce the incidence of TB as it is still responsible for many deaths in developing countries and the economic toll is costly.

Market Day

View from the Hospital

Some things are no different than at home.  The number of women in the hospital had dropped and I was happy to be able to do rounds in an hour.  It took only a few days and a few very sick new patients to expand the time it took to do rounds.  I like to do rounds to start the day but the outpatients begin lining up first thing in the morning so frequently I see outpatients for 2-3 hours before starting rounds.  

One of my new additions is a lady with HIV and TB requiring a chest tube to drain fluid from her lung.  She is stoic taking a few Tylenol for her pain.  

Today was Market day so fewer people came to OPD.  Terry and I were able to get to the market and experience the chaos.

Without Complaint

There are 2 women on the Ward who have been there since my arrival.  Being in the hospital anywhere for a month is not a good sign.  One of the ladies in her 50's is being treated for HIV and TB.  She has been extremely weak and yesterday her Hemoglobin had dropped to 2.5, the lowest number I have ever seen.  It is a side effect of one of her HIV meds so hopefully with several blood transfusions and a medication change she will be better.  The family has to arrange for donors so it may take some time as she doesn't have many family members.

Today I saw a new patient who fractured his lower leg in a traffic accident 4 years ago.  He  had a plate inserted but "the wound has healed slowly".  I did not need a x-ray to see the plate, it was visible thru the multiple open draining areas over the plate.  I am sure the bone is infected(osteomyelitis).  He was very happy that he has continued to walk well, "it surprises many people" he boasted.  He chose to go home and work for another 2 weeks before coming into the hospital for surgery.  

It amazes me daily what people here endure and usually without complaint.

Tomorrow the Sun will Rise

I started seeing patients on my own the last 3 days in the OPD(clinic) and it has gone very well.  You just have to start seeing the medical problems first hand and reorient yourself to the tropics.  I also did rounds by myself alone today and was feeling good.  The nurse did not seem to expect that I would ask her opinion on assessment and treatment.  She remarked it is was very enjoyable.  

As I was finishing this afternoon a 6 month old twin was admitted in respiratory distress and pneumonia with a oxygen saturation of 72%.  IV steroids, antibiotics and oxygen started.  I returned this afternoon to check on the child, and sadly learned that she died an hour after I left.  I do not think anyone ever gets used to the death, especially in children.  

Tomorrow the sun will rise and we will try to help those we can.