As the day was ending at the clinic I noticed Daniel and Richard, the other ex-pat doctor, walking into an office with their last patient. Seeing as I had just finished up with my work I thought I would sit in. The young man looked pretty healthy but as it turns out he had TB. This is a pretty common illness here, one which is treated with two months of daily medications given at the clinic followed by six months of medication taken at home. The key to treating TB effectively is that the patient cannot miss a dose of their medication and if he or she does the infection can become drug resistant which is really bad-- therefore we initially require patients to stay in town and come to the clinic each morning to take their meds. If you have read Tracy Kidder’s book about Paul Farmer, Mountains Beyond Mountains (which I highly recommend) this probably rings a bell.
Anyway, the patient was about 17 years old and from a village very far away. When it was explained to him that he had TB and what the treatment protocol involved, he got a very sad look on his face. While you might guess this was due to the new information about having TB, the truth was that he was more stressed about how much it would cost for him to be able to stay in town to be treated. He explained to us that last year his family and he had been moved from another area of the country and resettled to our zone because of the limited amount of land where he is from. We sat there listening to him as he told the story of his family’s finances, they used to have more money but now are quite poor, and how he now only has 50 birr to his name (about $4). He quickly calculated how much it would cost him to rent a room for the two months and to buy food, less then $15 a month, and immediately his head sunk. This was too large an amount, impossible for him to come up with. Could he go home and borrow money from family and friends we asked? He did not seem too optimistic about this. Could he start treatment today he wondered? He clearly understood the danger of TB and wanted to start medication as soon as possible.
Normally we require a 75 birr deposit, but all he had was 30 birr. Lalmba does have a special fund for people who truly cannot afford their treatment, but I had a feeling he might not qualify. This may sound crazy but since he had shoes and new(ish) pants and a shirt I had a feeling the committee that decides these cases wouldn’t believe him. Now whether he can come up with the money or if the committee will find him needy enough to pay for both his treatment and living costs, I don’t know. I don’t think Lalmba would ever let a person go without being treated, especially for something as serious as TB, but the situation still pains me just to think about it. If that were me or probably any one of you reading this blog this would never be our reality. TB is almost nonexistent in the US in the general public largely due to our higher standards of living and better health care, when we need to get from point A to point B it usually doesn’t involve walking for hours or days, most teenagers wouldn’t have to travel and be on their own when seeking health care in a different city, and most obvious--- if we were facing a potentially deadly illness that would cost less than $50 to treat, it would not cause us an unbelievable amount of stress.
Daniel and the other doc, Richard, sent him home to collect his stuff and bring back as much money as he can come up with. TIme will tell what the outcome will be for him as he said he could be back by Thursday (it’s about a day’s walk from Chiri to his town).
Everyday we see patients like this and the same thoughts run through my head. Whether it’s a child who is so severely malnourished they look as if they just left a concentration camp, or a woman who was burned after having an epileptic seizure and fell into the fire they use for cooking, it all just seems so unfair. So much of the illness and injury we see is completely avoidable it really makes you wonder if life is playing a mean joke on so many billions of people whose reality is like this patient.
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