Tuberculosis, again.

When I finished yesterday's blog on TB I really was not sure why I had chosen that topic.  I suppose it was because I had seen a couple of new TB cases yesterday.  

One of those was a 24 year old lady referred from an outlying health clinic.  She looked healthy but was recently diagnosed with HIV and had been coughing for 2 months.  I obtained a chest x-ray which was suspicious for TB.  We obtain 3 sputum samples over 24 hours looking for the TB bacteria.  She submitted her first sample yesterday and was to bring in 2 more this morning.  

While doing rounds this morning the nurse informed me she apparently started coughing up blood during the night and was brought back to the hospital this morning dead.  TB and HIV are deadly and we are reminded of that on a regular basis.

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.

Called During the Night

Joe and I were called to the hospital during the night to see our 1 year old with the chest tube.  She had been doing great and we were contemplating removing her tube in the next couple of days.  She developed sudden breathing difficulties during the night and had developed a major air leak from her lung.  We ascertained her tube was functioning properly.  There was no one available to take an x-ray until this morning and she passed away as the x-ray was being obtained.  

It was difficult for us wondering what we could have done differently to change the outcome but nothing compared to what mom and grandma have to endure.  

Our prayers are with the family today. 

Junior

Here are some photos of Junior, from the story I shared yesterday. 

Joe and Junior

Dr. Joe Llewellyn, a general surgeon from Alaska arrived here Sunday.  He helped evaluate a 1 year old child admitted over the weekend with pneumonia.  She developed a pneumothorax and Joe showed me how to place a chest tube.  To our surprise she also had a significant empyema (pus between the lung and chest wall).  This tough little girl hardly fussed with the tube insertion and is looking much more comfortable this evening.

I am not trying to dwell on all the terrible cases but feel the stories of these people people should be shared.  

This morning I saw a nearly 4 year old named Junior.  He looked half his age and was wearing a school uniform and backpack.  He politely walked up and shook my hand.  He was accompanied by his grandfather who he came to live with a month ago.  Grandpa was worried about Junior's small size plus a persistent cough and rash.  Junior's mother is a prostitute and could not care for him any longer.  He sadly tested HIV positive.  The plus is that he is now in a safe environment and will be able to get the medical and social care he deserves.  

There have not been many 3 year old children that impressed me as much as Junior did today.

Courage and Dignity

This week there was a young man in the hospital with HIV and ascites.  The ascitic fluid looked like milk which is rare but almost always caused from Lymphoma(cancer).  I informed him that he likely had cancer and the closest place he could get treatment was in Yaoundé, a 6 hour drive  from here.  He asked if it would be expensive.  When I told him yes he quickly reasoned that his family could not afford it and he would just go home.  He showed no visible distress and thanked us for what we did for him.  

A difficult situation for all of us.  I admired his courage the dignity he displayed.  

Let us pray for him and his family and that the opportunities for treatment will be the same for all people in this world someday.

Monday

As usual it was a very busy Monday in the Out Patient Department.  

I had 6 new HIV cases today and 3 new TB cases, quite a change from back at home.  

The sad case was seeing a 7 year old come in for a 2 week follow up after being started on HIV medications.  She was accompanied by her 12 year old sister who was her guardian since their mother had died.  

It was sad thinking of the family situation but I had to admire the strength of the big sister as she walked out of the room with her hand on her sister's shoulder, guiding her.  

Pray for their family and their future.