TB: Common and Unfortunate, but Conclusive and Treatable

In lieu of a pic of TB

January 30, 2015
Spent about an hour at the Health Post with patient…frustrated and annoyed.

One of my patients has been coming in for finger/joint pain. She has also mentioned an enlarged lymph node she’s had for a few months (but everyone says their chief complaint began 3-4 months, or 3-4 years ago… so who knows how long she has had it). Previous practitioners have asked her to get a TB test, but it wasn’t until a few days ago after persistent urging, did she finally get tested.

I wrote her a referral to get a TB skin test at either the health post or the hospital. Her son took her to the Hitawda Hospital, and they measured her skin reaction at 20mm (only need 5mm to be positive), and the doctor sent her back to us, with no communication, diagnosis, or recommendations for her (frustration #1).

Ok, well, we will walk you to the Health Post, just next door, to get you enrolled into the “DOTS” program for TB treatment. Should be simple, but no, ended up turning into a headache. Person in charge said either he wanted patient to get a biopsy of the lymph node – by the way, it’s only available in Kathmandu ~3-4 hrs away – or test positive with the TB sputum test. Ugh, fine. Take the sputum test. Patient walks away with a small container to collect her sputum. 20min later…she comes back. Container is empty. What’s wrong? “I have no sputum.”

AND to make matters worse, if she doesn’t provide the sputum today, the tech/lab guy is going out of town, and wont be able to run the test until next week!

Shit – our clinic is only here for 4 more weeks, and there is no Camp until September. The DOTS program is about 6 months of treatment, and TB medication is similar to chemotherapy – not fun. We are her support to finish the treatment course, to help curb some side effects.

You’d think, in a country, where TB is pretty common, the system would be more seamless. Nope. My colleague here, Bex, also had a headache case of possible spinal TB. The poor patient, of only 22 years, has been to doctor to doctor, traumatized by the hospitals with test after test, nothing of which were cohesive or conclusive. They seemed to be looking to diagnosis an autoimmune disease - yes, possible differential diagnoses, but apparently TB was too simple of a diagnosis – not interesting enough….

The bright side…both these patients were a bit oblivious to our frustration. They were both actually quite thankful for the many people around them caring for their health. They felt resolution and grateful for a clear pathway they must now take for better health.