Awaken

If George Orwell had been writing in the year 1984, rather than post war 1948, he wouldn’t have died of the chronic pulmonary tuberculosis that was already destroying his lungs. It was the start of the age of antibiotics and Orwell did get to try the new wonder drug, streptomycin. He initially responded to treatment but then relapsed due to drug resistance and died in 1950. A generation later, in 1984 when I was first seeing patients, TB was no longer the feared killer that it had been in the UK. It was by then unusual to see a case on the chest unit in Leeds. Multi drug therapy (4 antibiotics for 2 months and 2 antibiotics for 6 months) had evolved from the early trials including Orwell, and led to cures for millions of people. The special TB hospitals and sanatoria, had all been closed down.

That’s enough history form the UK, now let’s look at Chad, in the present. I met Adam on my first day back from holiday, a 6 year old boy, lying in bed unconscious and fitting,. He had been a bit unwell at home in Guinebor 1 over the past 6 months. No one had thought much about it, he had a hard lump in the middle of his back, it caused a bit of pain but he had continued walking around and coughed a bit. About a week before his admission he had become drowsy with a fever, he first stopped walking, then talking, and after a couple of days was bought to the hospital unconscious. On admission he was put on antibiotics for meningitis, given drugs to control his fits and his unrelated Potts disease (TB of the bones of the spine) was noted.

Three days later on the Monday morning, I met him, he was no better and as I examined him he was breathing poorly with deep snores, still had a high fever and was completely unrousable. Reviewing the story I realised that the classical TB of his spine was also likely to be the cause of his meningitis rather than a second incidental disease. It seemed to me that the disease which had been localised in his spine for months had burst out showering germs everywhere, lungs, liver, and brain causing his sudden deteriortion. (It’s probably the same sequence of events that killed my maternal grandmother in the 1930’s when my mother was a small child).

Unlike pre-war Britain when it was incurable, it was possible to save Adam but time was short and he needed specific anti TB drugs if we were to recover him from his coma. We are not part of the National TB program and it wouldn’t have been wise to transfer him to another hospital which has the tablets. He couldn’t have swallowed them anyway. So his father was sent to buy some Kanamycin (a drug very similar to the streptomycin given to Orwell), a once daily injection. I was amazed at the price 1000CFA a dose, a mere £1.20! He also needed very high doses of injectable steroids for brain swelling. After a couple of days he was breathing better, but was still unconscious, and  a feeding tube was put in so that he could have milk and sugar.

Slowly he improved, he had no more fits, the fever went away and little by little he began to awaken. After a week he was just about rousable and would sometimes take hold of an object placed in his hand. One TB drug could improve him but it would not be enough to cure him and so he was taken by ambulance to the local government hospital where he was given the necessary tablets for a month and returned to us. The tablets were crushed and put down the feeding tube. After another 3 days he began to speak and drink small amounts. Earlier this week he took his first steps and today after 4 weeks of treatment he is walking around the ward by himself, he’s even starting to smile (sometimes but not for the camera).

He will need to complete 2 months daily supervised treatment, but he will soon be well enough to do that as an outpatient, living in the small ‘village’ we have built just outside the hospital, followed by another 6 months of home care.

Why do we not have our own TB service? After all the lung disease is very common here. The District medical officer is very keen for us to join the National Program which would give us free drugs. I have the experience to run it after my time in Guinea at the TB /Leprosy referral hospital at Macenta, but we don’t yet have sufficient medical staff to run it properly. It needs careful supervision to do well. There would no doubt be many cases requiring a separate clinic room and nurse plus some isolation rooms for hospitalised infective cases. So for the time being we continue to refer the cases we find but continue to the sickest treat by special arrangement.

We will continue to explore the possibility of young doctors from a Cameroonian mission and recently trained Chadian government doctors so that we can improve our services and capacity. We look to a future, thankfully not an Orwellian dystopia, but a time when wondrous stories are told of what God has done here, and that includes treating TB.

PS: Adams mother is very happy for his story and pictures to be shared and  when asked  said  'Yes ,we like the hospital very much, anything we can do to help'