Fieldset
First contact with a patient

Whether the 10 year old child has Multi-Drug Resistant TB or not is not always an easy question to ask. I read the WHO and MSF guidelines on the subject, hoping that the experts of the world can give me some insight into the disease.

Whether the 10 year old child has Multi-Drug Resistant TB or not is not always an easy question to ask. I read the WHO and MSF guidelines on the subject, hoping that the experts of the world can give me some insight into the disease. Theory can never substitute for experience and at the moment I feel lost without seeing the world of the child that I might be involved with.

The child presented to the doctor about one month ago with a long standing cough. The results of his sputum suggests that he may have MDR-TB. The child has already been discussed but there are a few questions left unanswered and given that treatment may require 18 months or more, I feel it justifies at least one visit before we start him on treatment. He is at home and I decide to see the family for myself.

This is my first case that I will see with my time with MSF. The journey to his house across the dusted planes is fairly unremarkable, most notable being the lines of lorries, half built concrete buildings and old women carrying their children on their side. We arrive at the brick house with the two blue entrances, one for the adult and the window for the playing child. I am with my translator but I feel nervous at what reception I, a foreigner with his file in his hand, will get. Whenever one enters a place where TB is being incubated, you have to wear a white fitted mask, transforming you into the alien, a barrier between disease and you. It is a horrible way of introducing yourself, and at the door we are ready to wear the masks if we are allowed to enter the premises. I stand back, as non-threatening as I can be, respecting my position in this unknown world.

A tall man, unshaven with grey eyes and a large belly walks out to meet us. My translator and local doctor explain who we are and, as it is hot, it would be better to talk to the family outside, which delights me as it saves me putting my white barrier over my mouth. The boy’s eyes appear lifted from the sides, giving him the appearance of a chinese boy and he hides discretely behind his mother and sister. The father looks terrifying with big build against my ever weakening body, but his body masks his husky but rather gentle roar and we go through the history again. The boy’s grandfather died 3 years ago from TB, even though he was apparently treated for TB. No one else is sick in the family and the boy is apparently well, without any symptoms that he has tuberculosis. I wonder if the results actually belong to this boy and ask him whether he coughed into a pot (sputum pot). He nods and demonstrates his technique. It seems convincing enough.

When I ask him to lift his Thiery Henry football top off, he looks well with no signs that he has tuberculosis, and his father says he has put on weight by taking a regular portion of palm oil every day. When children look well, it may not always be evident to the naked eye that they have tuberculosis. But given that he has been on contact with someone with TB and that his sputum results show MDR-TB, he is likely to have MDR-TB. We talk about how we want him to remain well and that he will need to take medicine for 20-24 months so that he can continue to play football; a discussion that is riddled with my own doubts. His family agree that if he needs treatment, he should get it. This huge man is thankful for our help, and the boy runs back through the blue window into the house.

Of course these decisions are not taken lightly and each case is discussed with experts, but when the case is unclear, one worries that you may be doing more harm than good, a cause of concern that I suspect that is likely to remain during this year. I hope he can continue to play football and go to school and I ask the local doctor to keep a close eye on him.