Biology Reference
In-Depth Information
Old Shongwe Hospital
At the time of my youth, Shongwe Hospital had three hospital communal dormitories for
medical patients, TB patients, and a mixture of surgical and maternity wards. Even then, before
the HIV epidemic, TB was a huge problem and required about a year and a half of treatment in
hospital. Even now TB is a worldwide problem with some 9 million people affected - 2.3 of
those in India. About 1.8 million die a year and in India there are now even completely drug
resistant varieties occur that could have huge ramifications on cost of treatment, control, using
isolation hospitals again, and potential spread around the world. At the Nelspruit Hospital
laboratory that serves the area, 350 positive TB specimens are found every day based on glass
slide smears. These are not necessarily all new diagnoses since some patients are being
monitored, but it shows the amount of active TB in the local population. In a recent study by
Douglas Wilson at Edendale Hospital in KwaZulu - Natal, 50% of people who died had TB,
17% had multidrug resistant TB, and only 58% had been diagnosed. In one region 50% of
patients had drug resistant TB and 40% died within 30 days far higher than the WHO estimate
of world TB resistance of 3.7%. Furthermore, 96% were HIV positive. Because of the
growing problem of multi-drug resistant TB, old TB hospitals and wards have been reopened
again to deal with the growing number of patients. Part of the problem is diagnosis of TB and
also whether the TB is drug resistant. Recently in the New England Journal of Medicine there
was a report of a new PCR test called Xpert MTB/ RIF (GeneXpert) tested in patients
including in Durban, South Africa and Mumbai, India. Although expensive, the major
advantage is it is 98% sensitive and also detects in 98% of patients whether they are resistant
to rifampicin, one of the frontline medications. I recall one of the frustrated TB patients
decided to slip home AMA (against medical advice) at sunset and tried to cross the Lomati
river just above a spot where we had been charged by the hippo in our fourteen foot boat.
He jumped from rock to rock but unfortunately the last rock he ever jumped onto was the
back of a hippo that killed him.
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