TB or not TB, that is the question. Although this may be a clever play on words from Hamlet’s famous manifesto, it is a question that health care providers across the globe ponder all too often. For Hamlet, these words were birthed out of his existential crisis of whether or not anything but the present is true; suggesting the past and future are illusive and unknowable. For those with tuberculosis, not only is the present a real and imminent danger, it is a reflection of their past and has tremendous ramifications on their future.
A recent report from the World Health Organization detailed the increasing number of cases of TB worldwide. A growing number are multi-drug resistant, and give rise to many more deaths annually (1.8 million deaths per year) than Ebola ever claimed. Common among TB patients from high, middle and low income countries is that this is a disease of poverty. Crowded living conditions, malnutrition and chronically uncontrolled comorbid conditions place men, women and children at risk for acquisition or reactivation of this aggressive infection. Therefore, an individual’s past and present situation can have an exponential effect on his or her future.
During rounds in our rural, under-resourced hospital, we are faced daily with this question...Is it TB or not? Anyone who knows anything about TB knows it’s not only a question of whether or not they’ve had productive cough and fever. TB is the new “great masquerader” and can present similarly to a myriad of diseases and disorders. In the short time that I have been here, we have diagnosed cases of pulmonary TB, as well as meningitis, pericarditis, endocarditis, arthritis and peritonitis due to TB. All of these were in individuals who were HIV negative, and considered immunocompetent. Now imagine how our patients with HIV or full blown AIDS present. Needless to say it has been a daily exercise in humility and further education.
To combat one of the other collateral effects of this horrid disease, domestic and foreign governments have worked to offer TB medications at no cost to our patients here in Kenya. This allows them to gain access to the medications, while not diverting their household income from other essentials items like food, transportation or school fees. However, this is not without its own complications as the incidence of multi-drug resistance is increasing globally, at times rendering us completely helpless.
While Hamlet remained anguished and paralyzed by his current suffering, we likewise should be anguished about the suffering of our marginalized brothers and sisters around the world. Though being anguished, let us not be paralyzed. Let us move forward in love and deed to those across the street and across the globe who are suffering because we have One who knows our suffering and has suffered for us.