Marie (not her real name), age 45 weighing 35 kg, is from Rumonge and came to VHW on March 23rd for consultation. She had been experiencing cough, weight loss and dyspnea (shortness of breath) for several months. Dr. Melino suspecting TB (igituntu in Kirundi), referred her to Rumonge Hospital for a chest x-ray and some lab work since VHW does not have these facilities yet.
Today she returned with the x-ray and the lab results. The x-ray is impressive…revealing TB with disseminated “opacities” in all lobes. Miliary TB is apparent in the upper left lobe with pleural effusion. We still await results of sputum tests. She was admitted today, registered in the TB program and began the rifampicin, isoniazid and pyrazinamide treatment regimen.
Seven months ago when her cough became persistent Marie went to the traditional healer in Gatete who specializes in the “uvula disease”. He cut her uvula and epiglottis at that time. Her cough did not subside and now she has to constantly clear her throat since she does not have her epiglottis. She went to the local health center twice where she was told she had malaria both times. After treatment she continued to feel terrible and came to VHW. When asked how she heard of VHW, she replied,” This clinic is known everywhere and many people told me to come.”
Yesterday she walked from Rumonge to Mugara (14 km), spent the night and walked this morning from Mugara to Kigutu (6kms. uphill). Despite it being a Burundian public holiday and arriving at 0900, she was # 57 in the patient queue. After triage assessments she was first in to see Dr. Melino.
Her husband died around 2000 in a war related incident. She has had four children, two who have died at age 6 and age 3. Right now she is concerned because she has left her 12 year old daughter and 10 year old son at home to fend for themselves. She is also worried because her two room mud house (one room for sleeping and one for cooking) just has a grass roof and it will be very vulnerable during these heavy rains. She wants to get her children to VHW as she states her daughter is coughing and has “untreated shoe disease”. Marie realises that taking her to the traditional healer might not be the best choice.
She has “no fear” about being at VHW. Meanwhile we will try to track down her children for screening and assessment. There must also be communication with the traditional healer regarding the dangers of untreated TB.
Helen
Marie with TB
TB lung x-ray
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