'I have now seen many desperately thin children who have not responded to therapeutic feeding suddenly turn around under the benefit of TB treatment. The kids begin to put on weight, then they begin with tentative smiles as if learning for the first time.'
Today is World Tuberculosis (TB) Day. TB is one of the most deadly infectious diseases in the world. Each year, TB kills 1.6 million people, and nine million are diagnosed with the disease, mainly in developing countries. Dr. Lanice Jones is a physician from Canmore, Alberta, who is currently working with Médecins Sans Frontières/Doctors Without Borders (MSF) in Yida, South Sudan. Below she tells the story of a young patient suffering from an old illness.
By Dr. Lanice Jones
“How are you?” Ajak* smiled shyly, reaching to shake my hand. Ajak was seven years old and proud of his English.
“I am fine,” I answered, as we entered the tent reserved for children with tuberculosis (TB) and malnutrition.
Ajak had arrived to this Médecins Sans Frontières/Doctors Without Borders (MSF) facility in Yida, South Sudan, just over a month ago — in pain, and with his spine deformed with healed wounds from previous abscesses. He could hardly walk, but had done his best to stand tall when introduced. His grandmother had brought him from a village about 40 minutes away by local transport.
Over the first month of intensive TB therapy, Ajak blossomed. With our excellent nutrition support based on Ready to Use Therapeutic Food (RUTF), he began to gain back the weight that had been decimated by the ancient illness known as consumption. While his spine will remain with a forward bend of the upper back, he is no longer in pain and he has managed to avoid the risk of paralysis.
A disease with a long history
In 1779, Sir Percivall Pott published a monograph describing the association between curvature of the spine and a spastic or stiff paralysis of the legs.
In 1948, in a lecture delivered to the Royal College of Surgeons in Britain, G.R. Girdlestone outlined the treatment options for Pott’s Paraplegia, or loss of function of the legs caused by an infected curvature of the spine. He advocated fresh outdoor air, nutritious food and spinal immobilization for prolonged periods of time for children.
The first anti-tubercular medication, streptomycin, became available for clinical use in 1947. This ushered in the modern era of TB treatment, and it remains an important medication for use today. By 1965, our standard first-line treatment medications — isoniazid, rifampicin, ethambutol and pyrazinamide — became available.
While every medical student learns about Pott’s Disease, it is taught mostly as a quaint and historical problem. The first time I saw Ajak, I recognized the unique kyphotic bend in the spine and the scars from previous draining abscesses, but still I wondered aloud: “Is this is actually Pott’s Disease?”
Life-saving treatment and medication
In Yida, we don’t have the benefit of X-ray, and we can only test lung TB with sputum stained and examined under a microscope, so all other forms of TB are diagnosed by taking a careful history and examination. It seems crude compared to all of the diagnostic tests available in Canada, but it works. I have now seen many desperately thin children who have not responded to therapeutic feeding suddenly turn around under the benefit of TB treatment. The kids begin to put on weight, then they begin with tentative smiles as if learning for the first time. Next comes energy for gentle play, songs and laughter, until there is finally running, crawling and mischief. These are the product of fresh air and nutrition — cures that were used three hundred years ago — as well as life-saving medication.
Ajak is one of many children in our TB program. He will soon return home with his grandmother, but will continue to be seen as an outpatient until he completes a full year of treatment. While he arrived too late to avoid the curvature of his spine, he loves to play outside and he is actively learning to read and write in Dinka and English with the help of our Dinka translator, Gabriel.
Pott’s Disease is not an illness of only historical interest. Tuberculosis of the spine, the lungs and the organs is alive and thriving wherever poverty, poor housing and poor nutrition create pockets of vulnerable populations.
World TB Day isn’t a quaint event either. Much work remains to be done to avoid drug resistance, and to battle the twin infections of TB and HIV. In Yida, we are opening up a new TB area, with more space between tents, an area sheltered by trees, an area with room for a garden and for the kids to play — which is something to really to celebrate!
*All patient names have been changed for this story.