I worked in Canada for 20 years and only saw two cases of active TB. Since coming to southern Sudan four days ago, I have seen two new cases of spinal TB, a new case of pulmonary TB and several suspected pediatric cases. This is in addition to the fifty patients in the TB village where people live for 6-8 months while completing their treatment. In Canada, TB disproportionately affects new Canadians, First Nations and the Inuit, and those with impaired immunity such as people living with HIV/AIDS. In southern Sudan the lines are drawn somewhat differently, poverty, malnutrition, and lack of health care are the more important common denominators.
Mycobacterium tuberculosis is the organism that causes TB in all its myriad forms. Spinal TB is particularly cruel. It eats away at the bones of the spine until they collapse forming a bump, or gibbus, over the spine. Paralysis usually comes gradually as bone, pus and other infectious debris compress the spinal cord.
The patient is 11 years old. She has had a gibbus for six months. Until last week she was managing to walk with two sticks; now she no longer has the strength to stand up. She is quite lovely, shy and slim. She reminds of my niece, Julia. Ironically she is one of the lucky ones because with treatment she will be able to walk and even run again.
TB is an ancient disease; researchers have even found evidence in 4000-year-old Egyptian mummies! It killed Emily Bronte, Kafka and the poet Keats. Although there has been treatment for more than 50 years, it still kills more people than any other infectious disease, but it kills mostly poor people so it gets less attention than it deserves. I will leave this subject for another day.