Wednesday, March 28
Today was a day full of coughing. Of our ward of about 20 patients, I suspect a fourth or more of them have active tuberculosis. One out of three people in the world are infected with TB, the vast majority of them (us) have silent infection that won't go on to full blown disease. But a significant number of people do, especially those with HIV, malnutrition, diabetes, and those who smoke. In one day, we diagnosed a man with likely cavitary pulmonary TB but with a nearly normal sounding chest on exam, a man with miliary TB (see less than ideal pic), and a man with possible extra-pulmonary TB of the lining of the lung. There are a few more cases of suspected disease on the ward, probably at least one at all times.
It's a bad disease. TB kills more people infected with HIV than any other condition. It's been with us for millennia, yet we still don't have very quick ways to adequately diagnose it or treat it. The patients wear the masks that I have put on them for about 5 - 10 minutes, and the staff allows them to keep them off. I wore a mask today, but none of the other staff do. Since TB and HIV often go hand in hand, I try to make sure all TB suspects are tested for HIV. There is one counselor available to test patients for the whole hospital, and he rarely does his job on the wards. We need to work on that. We also need to work on diagnosis and infection control. Lots of things to address. But these systems-wide changes can make a huge difference, especially if supported by the administration.
I'm off to bed now. And don't forget to cover your mouth when you cough. Thank you. This has been a public health announcement from Juba, South Sudan.