Mother delays child's treatment...

A couple of weeks ago a mom came to the clinic with her 7 month old son. Happy but breathing at 84 breaths per minute. Too fast! He was treated elsewhere 2 months earlier and recovered fully according to mom. I continued to prod for info - to no avail. Because there were no beds at the NGO referral center I had to make a decision. Send him to Children’s Hospital with the risk that they won’t go (due to expenses, reputation of poor care) or treat him as an outpatient with follow-up and the risk that he gets worse at home. I chose the latter, seeing as he was quite content; even though his chest sounds were terrible and he was recessing! After giving him an initial intramuscular injection of a strong antibiotic and a bottle of an antibiotic syrup I sent him on his way. I just waved off a child that you would have admitted at home in a heartbeat. You have to push your boundaries a bit here…

The next day he showed up bright and early. Same condition: happy, recessing and breathing fast. I gave the same injection and the same instructions: “if he gets worse go to x place, if he’s the same or better, come back tomorrow”. We did that for 4 consecutive days with no improvement. Time for a chest x-ray. Too make a long story short, the place I sent him for an x-ray charged more than usual, so they came back empty handed. I managed to arrange for a free x-ray at the referral center. It was then that the full story came out. The child had been referred to the TB center 2 months ago, but didn’t go. And his father has been on TB treatment since November too. His x-ray was typical for TB so my next decision was an easy one- refer to the TB center, after explaining that anti-TB drugs alone are going to help her child.

So again a child’s treatment was delayed. First of all the child should have gone to the TB center two months ago. Second of all, the mom should have told me the truth on day 1. But she didn’t. I am not sure why. Many reasons probably. And this isn’t the only time it’s happened. What to do? Continue to treat the child to the best of my ability…with the information and resources I have! I haven’t heard from the child since sending him to the TB center, so unfortunately I am not sure how this story ends…