Bread and Butter

About a week ago, I admitted a 52 year old man who'd lost 25 lbs over about six months, and was coughing.  He was gaunt,  tired, and complained of "buk bheta, badikay - teen mash" or 3 months of left-sided chest pain.  Fevers, well everyone says they have fevers here.

In the States, my bread and butter diagnosis might be pneumonia, or perhaps coronary disease, but here it is tuberculosis.  TB is so common in Bangladesh that a pleural effusion (fluid around the lung) is TB until proven otherwise.  This Xray shows fluid around the left lung, extensive left lung damage and, if you look very carefully, cavities even (they look like white donuts in the lung field).  Cavities or holes in the lung are the hallmark of TB.

It's such a massive problem (11 million cases worldwide) that here in Bangladesh, the 4 different antibiotics used to treat it are rolled into a single pill, provided free-of-charge by the government.  Each person who is treated is personally seen every day for 6 months and observed taking their pill, just to make certain they take it - also free-of-charge.  This is "Directly Observed Therapy - DOT".

I would venture to guess that we diagnose a new case of TB, here at LAMB, about every 2 hours.  It's a near certainty I have been exposed so upon return I fully expect to take the 9 months of antibioticsthat will prevent active disease.  Thankfully, it is very unlikely that my family has been exposed.

I think I heard the IRS was offering to Directly Observe my Wallet  - also free-of-charge.  :-)