Happy TB Day

Very randomly i recently bumped into a couple of old mates from medical school who are here in SA working at Edendale hospital where by chance i myself work and teach at once a month ... Sanj is there as a paediatrician and Sam as an anaethestist ... obviously as befitted the occasion we shared many memories over many many drinks ... but also - for the first time since arriving in SA - i was able to openly share the experience of whats its actually like being here in the eye of the HIV storm ....

Edendale is a district hospital in Kwa Zulu Natal .... chronically understaffed and under-resourced ... the patients are all poor and black .... and an average medical take brings in over 100 new patients a day ... the casualty department is awash with blood and bullets (sam's first case on her first day here was solo-anaethetising a patient with an axe in his heart) .... and tragically over 80% of the medical in-patients are HIV positive ....

I don't think i can ever really explain the reality of what such figures mean .... percentages just don't convey what you feel when so many people seem to be dying around you .... and you just feel overwhelmed by your inability to do anything at all of any real use .... its as though you are sticking little pink plasters (band-aids in american) of aid, help or arvs on huge stab-wounds on society and watching helplessly as the blood gushes through .... you know that whatever you've done is merely pissing in the wind and you just have to hope that somehow miraculously things are going to get better ... before then having to focus on the next horrific case .... humiliating and utterly apathy-inducing ...

The worst place of all however are the paediatric wards .... i can't even bring myself to go there anymore .... i don't know how the doctors and nurses there face everyday rows of stick thin kids often two to a bed .... most lying listlessly waiting to die (since often they arrive far too late to be able to do anything for them) usually of some complications of their HIV ... its heartbreaking and totally demoralising ....

Edendale truly is at the eye of the HIV storm even in south african terms .... however the tragedy is it is now also at the epicentre of the twin epidemic of TB .... and especially XDR TB ....

Most of you will have seen the articles about XDR TB ... its had lots of very factual media coverage .... but on the coal face - XDR TB means any normal TB drug you have is frankly useless .... and so you put the patient in a side room and usually just watch them die (90% die here) over an agonising few days to weeks .... and then you have the dilemma that you have to isolate them away since so many of the general population are HIV infected that you'd be exposing them to almost-certain death as well ...

And the other kick to our collective balls is that we can't even diagnose XDR TB at the moment essentially until the patient fails treatment for normal TB .... we simply don't have any good testing for it .... so the patient basically has several weeks or months in which to spread the infection around the community before being locked up in the hospital to wait to die ....

Its World TB day today ... and unsuprisingly here at Edendale we're not celebrating ....

TB is one of the oldest diseases known to man (HIV is a merely new kid on the block comparatively .... although a rather uppity ambitious one at that) .... and is the second leading cause of infectious deaths worldwide (about 2 million deaths a year ... second only to HIV inevitably) .... one person is infected every second ..... and about three quarters of all people with HIV here in Africa are co-infected with TB ... its the ultimate double whammy sick joke ....

And although we know how to treat it and treat it well (ie cure it) .... we still don't manage to ... and like HIV it is ravaging through populations both here and in the West ... taking evil advantage of inequitable health systems, poverty and apathy ... and is now totally outwitting our rather feeble attempts to bring it to heel ....

And the scary thing is ... this disease knows how to fly ....