Thursday, July 15, 2010

A case of Tuberculosis...

On Tuesday I passed through Emergency and saw a very sick boy sitting on the exam table.
He was extremely short of breath and very wasted.
I later found out he is 12 years old and suffering from Tuberculosis.
In this post I will call him Abubakar.

On Wednesday afternoon just as we were leaving the hospital a father asked me a question.
“My child is very sick, can you please help?”
Since I was on my way out and not in a clinical role at the hospital I suggested he find the ward nurse.
“Go tell the nurse, and if your child is worse, ask her to call the doctor.”

At that same time I decided to show my colleague the isolation room I had ‘discovered’ just next to our office a few days earlier.
Little did I know that that was where the man’s son was admitted.
As I peeked around the corner I saw Abubakar sitting upright, struggling to breathe.
I couldn’t leave now.

I quickly found the doctor who had treated Abubakar earlier and discussed with her.
The priority in this case was Oxygen; an available but limited resource in our hospital.
The fact that Abubakar could infect other patients with TB was a concern.
Should he be brought down to the emergency room and risk infecting the other patients?

I remembered seeing an oxygen concentrator in the Measles ward and knew the machine was not used often.
So, after obtaining permission from the specialist-in-charge I hurried up to the Measles ward in the next building.
Within minutes I was rolling the concentrator down the ramp to the other building and up to ward 3.
Unfortunately at that same time, national power cut out and the concentrator could not be switched on.

With an oxygen saturation of 81% it was clear that Abubakar could not be left without oxygen.
So, the decision was made to transfer him to the E.R. where oxygen is continuously available thanks to a back-up generator.
Poor Abubakar had not slept in 3 days and was literally fighting to stay alive.
We knew he was afraid because the only thing he managed to say to us was: “Please do not go, stay with me.”

Our hearts were moved and it was difficult to leave his side.
He was obviously very sick with severe tuberculosis and signs of heart failure.
Only time would tell the outcome.
Having put him on oxygen and handing the case over to the doctor-on-call we decided to go.

We learned that evening that Abubakar had been seen at another hospital a month earlier.
Not running a TB program, they referred him to the Children’s Hospital for Tuberculosis treatment.
Unfortunately, Abubakar’s mother took him upcountry to a good hospital, but one that was also not running a TB program.
So, in the end there was a month’s delay before reaching the Children’s hospital and Abubakar was now in a very late stage of disease.

When we entered the Emergency Room the following morning, we saw a wrapped up body on the cot next to the door.
The size of the corpse looked like that of a 12-year -old boy.
In our hearts we already knew what had happened to Abubakar.
This was confirmed when we sat down and talked with the doctor who was on call.

Abubakar died at 6am that morning in the presence of his father.
He died due to tuberculosis and heart failure.
Had he come to the hospital a month earlier, he likely would have gotten better.
The hardest thing for me was that Abubakar had been so afraid the previous evening.
He must have known the end was near.

Tuberculosis is one of the world’s deadliest diseases.
One third of the world’s population is infected with TB.
Each year, over 9 million people become sick with TB.
And each year, there are almost 2 million TB-related deaths worldwide.
Let’s continue to work on early diagnosis and proper treatment of this terrible disease.

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