Back to Lankien today and back to work. I am looking through the medical library. I find myself hoping that the textbooks will be old editions, written by clinicians who remember treating TB in the first half of the 1900's. The irony of this does not escape me. At home a textbook is deemed to be out of date in a few years. New textbooks are full of the latest diagnostic tests and treatments, but they grow thin on the clinical signs and symptoms.
The natural history, the experience of advanced TB, has been lost in developed countries because it is so rarely seen. I want to know, for example: How long does it take, on average, for a tuberculous lymph node to form a fistula with the skin and start to drain pus? Are there early subtle changes in the configuration of the chest before a gibbus appears over the spine? What does abdominal TB really feel like on examination?
Today there is a merciful breeze. A few people wear toques on their heads.
"It is very cold today, doctor."
"Yes, very cold."
It is probably somewhere in the mid-thirty's Centigrade. I feel better than I have felt in days. I hope it stays 'cold'. But I know it won't. It is coming up to the end of dry season and the month of March will be even hotter than February. The thermometer in Lankien is broken, probably better not to know.
I had my mosquito net washed, no longer will a rain of dust descend on my head when I unwind it at night, at least for a few days anyway.